Full Project – Factors influencing choice of malaria preventive measures utilized by women of reproductive age attending antenatal clinics

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CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

There is a growing concern about increasing prevalence of malaria, most especially as the world continually experience increasing warming every year. By implication, global warming enhance growth of malaria-causing organism. Malaria is caused by one-cell parasite called plasmodium. This organism is transmitted into human blood when an infected female anopheles’ mosquito bites, since it requires blood to nurture her eggs. Five species of plasmodium transmits malaria in humans; they are p. falciparum, p.vivax, p. malariae, p.ovale and p. knowlesiwhere infections with p. falciparum are most deadly (Boudova, 2014). The adverse effect of malaria can be devastating, especially among vulnerable populations and those in a delicate state such as pregnant women.

Malaria in pregnancy endangers both the mother and the fetus, premature delivery, intrauterine growth retardation, and delivery of low birth weight infants at less than 2.5kg. The fact that in most African countries, over 70% of pregnant women make multiple antenatal clinical visits which provides a significant opportunity for the prevention of malaria, along with other priority disease affecting pregnant women (Akaba&Onafwokan, 2013). Malaria in pregnant women remains a public health challenge in Africa. The global malaria burden is currently estimated at over 200 million cases and over half a million deaths (Sonko, 2014). Sub-Saharan Africa bears the heaviest burn with 90% of all deaths (Lin, Xu &Guoet al., 2015).

Malaria infection is common in about 100 countries of the world, and half of these counties are in Sub-Saharan Africa, among women attending antenatal visit it is revealed that 29.5% were infected in East and Southern Africa, while 35.1% infected in West and Central Africa (Takem&Dallessandro, 2013). In malaria endemic areas of Africa, over 19-20 million women become pregnant annually and are at risk of malaria during pregnancy. Malaria infection could have a devastating effect on pregnant women, their developing fetus and infants. Low birth weight, infant mortality, anaemia, prematurity and placental infections are the effects of malaria during pregnancy. This supports the importance of malaria prevention as a tool for improving maternal and child health in Africa. Women are increasingly becoming aware of malaria prevention strategies due to enlightenment campaigns by government and non- governmental organizations. More women are of reproductive age, and hence the need to sustain and scale-up current malaria prevention interventions among pregnant women as well as periodic assessment among pregnant women is valuable to determine the impact of these intervention (Enato, Okhamafe&Okperee, 2001).

A periodic assessment of pregnant women regarding malaria prevention is beneficial in identifying gaps and for planning of more effective and efficient preventive strategies. Use of insecticide- treated nets is an effective and cheap method of preventing malaria. A systematic review showed that the use of insecticide- treated nets throughout pregnancy have a beneficial impact on pregnancy outcome (Tegegne, et al 2019). Between 2006 and 2016, malaria- related illnesses in more than one million pregnant women were prevented through the malaria preventive measures in the whole of Africa.  A study conducted in Kenya reported that, although the use of insecticide treated nets (ITN) are widely accepted, most individuals are ignorant of how it is maintained and used, Musoke (2015) asserted that most women had low knowledge of malaria prevention in Uganda and that the use of insecticide-treated nets was poor.

In a study which identify malaria preventive measures in South Western Nigeria, Ayodeji, and Adebola (2015) posited that knowledge of malaria prevention strategies was satisfactory because most women reported that malaria could be prevented using insecticide-treated nets in Southern Nigeria. They further asserted that, unavailability of nets, the high cost of nets, and ignorant were factors that negatively affected the use of insecticide-treated nets. Therefore, understanding the prevailing factors associated with increased malaria cases, most especially among pregnant women would provide based line information that can be useful in planning and designing future preventive intervention (Lin, 2015). This study would examinefactors influencing choice of malaria preventive measures utilised by women of reproductive age attending antenatal clinic in Ede South Local Government.

1.1  PROBLEM STATEMENT

Malaria during pregnancy is a serious public health challenge in most developing countries. According to WHO (2020), globally, there were an estimated 229 million malaria cases in 2019 in 87 malaria endemic countries, declining from 238 million in year 2000 across 108 countries that were malaria endemic in 2000, from 2015, there were 218 million estimated malaria cases. In sub-Saharan Africa, it is estimated that, each year approximately 25 million pregnant women in sub-Saharan Africa live at risk of P. falciparum malaria infection (Gontieet al., 2020). The prevalence of malaria in pregnancy in Lagos (Southern-Nigeria) was 7.7% in 2009 (Agomo et al., 2009), while a recent prevalence of malaria in Osun state study was 16.2% (Egbewale, et al., 2018). Therefore, it is in the light that this study seeks to identify the factors influencing choice malaria preventive measures utilised by women of reproductive age attending antenatal clinic in Ede South Local Government.

1.2  JUSTIFICATION OF THE STUDY

This study aims to identify the factors influencing choice of malaria preventive measures utilized by women of reproductive age attending antenatal clinics at PHCs in Ede South Local Government Area, Osun state.Based on our literature review, there is a dearth in knowledge concerning the factors influencing the choice of malaria preventive measures utilized by women of reproductive age in this location hence, this study will help to add to the body of knowledge.  This study is beneficial to younger colleagues who are interested in   conducting similar studies in this environment by providing necessary information and better understanding on the malaria preventive measures utilized by women of reproductive age in Ede South Local Government Area. It will also benefit the community by addressing the issues/factors influencing the utilization of malaria preventive measure and making recommendations where necessary.

1.4 RESEARCH QUESTIONS

1. Are women of reproductive age attending antenatal clinics in Ede South Local Government knowledgeable about malaria and its preventive measures?
2. What attitudes do women of reproductive age attending antenatal clinics in Ede South Local Government have towards malaria preventive measures?
3. What factors influence choice of malaria preventive measures used by women of reproductive age attending antenatal clinics in Ede South LGA?
4. Which malaria preventive measure do women of reproductive age who attend antenatal clinics in Ede South LGA prefer?
5. Is there any statistical association between knowledge and utilization of malaria preventive measures based on preference in Ede South LGA?
6. Is any statistical association between attitude and utilization of malaria preventive measures based on preference in Ede South LGA?

1.5 OBJECTIVE OF THE STUDY

General Objective

To identify the factors influencing choice of malaria preventive measures utilized by women of reproductive age  attending antenatal clinics in Ede South Local Government Area, Osun State.
Specific objectives

1. To assess the knowledge of women of reproductive age in Ede South Local Government Area on malaria preventive measures.
2. To assess the attitudes of women of reproductive age in Ede South Local Government Area towards malaria preventive measures.
3. To identify the factors influencing choices of malaria preventive measures among women of reproductive age in Ede South Local Government Area
4. To identify the malaria preventive measures used on basis of preference among women of reproductive age in Ede South Local Government Area.
5. To examine associations between continuous variables under investigation among women of reproductive age in Ede South Local Government Area. 

1.6 HYPOTHESES

Hypothesis 1

Ho1: there is no statistical association between knowledge and the utilization of malaria preventive measures based on preference.

HA1:there is statistical association between knowledge and the utilization of malaria preventive measures based on preference.

Hypothesis 2

Ho2there is no statistical association between attitude and malaria preventive measures uptake based on preference.

HA2:there is no statistical association between attitude and malaria preventive measures uptake based on preference.

1.7 DEFINITION OF TERMS

• Malaria: Malaria is a disease cause by a plasmodium parasite, transmitted by the bite of infected female anopheles Mosquito.
• Long Lasting Insecticidal Nets (LLINs): Insecticides are substances used to kill insects. LLINs can prevent around 50 percent of malaria cases and can reduce child death by an average 18 percent.
• Utilisation: Utilisation is the quantification or description of the use of service by persons for the purpose of preventing and curing health problems, promoting maintenance of health and well-being, or obtaining information about one’s health status and prognosis.
• SulfadoxinePyrimethamine: SulfadoxinePyrimethamine is a combination medication used to treat malaria. It contains sulfadoxine and pyrimethamine. For the treatment of malaria, it is typically used along with other antimalarial medication such as artesunate.

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Full Project – Factors influencing choice of malaria preventive measures utilized by women of reproductive age attending antenatal clinics