Full Project – The attitude of pregnant women towards the utilization of insecticide treated mosquito nets

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CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria is a major public health problem in tropical and subtropical regions of the world (Greenwood et al., 1987). South Sahara Africa harbours 80‑90% of the world malaria burden (Isah and Nwobodo, 2006; Kutiet al., 2006), about 19-24 million women are at risk of malaria during pregnancy (Isah and Nwobodo, 2006). The effects of malaria in pregnancy are enormous and include maternal anaemia, intrauterine growth restriction, low birth weight, and premature deliveries among others (Steketee et al., 2005). It contributes up to 11% of maternal mortality in the region (FMOH, 2005).

The disease often results from infection with Plasmodium falciparum which accounts for over 80% of the world malaria burden (Breman et al., 2004). The impact of the other three human species (Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae) is less well understood.  Pregnant women and children under five years are more susceptible than the general population (FMOH, 2005). Among the pregnant women, the primigravidae are the most

Susceptible (Nwaghaet al., 1996). The primigravidae are susceptible to placental infection because of the novel receptor chondroitin sulphate A (CSA), which binds a subpopulation of the plasmodium parasites, (Fried and Duffy, 1996) found that women become relatively resistant to P. falciparum malaria over successive pregnancies as they acquire antibodies against this CSA binding placental parasite forms. Also in Nigeria, the burden of malaria in pregnancy has over the years prompted the search for ways of reducing its effects to the barest minimum. The strategies adopted were packaged in the Abuja Declaration of African Summit on Roll Back Malaria in April 2000 in which African regional leaders expressed commitment to ensuring that 60% of pregnant women in malaria endemic areas accessed effective malaria preventive services by the year 2005 (TerKulle et al., 2003). These strategies included the use of insecticide treated nets (ITNs) amongst others (FMOH, 2005). The use of ITNs is very effective in the control of malaria in pregnancy (Yusif et al., 2008).  And it is estimated to be twice as effective as the untreated nets (Yusif et al., 2008). Some researchers have noted that women who used ITNs had significantly fewer preterm deliveries, and babies with higher mean birth weight than women who did not use ITNs (Kabanywani et al., 2008).  Nevertheless, the use of ITNs is still limited mainly because of its unavailability and cost, and partly because of the discomfort associated with the nets and the women’s fear of possible effects of the impregnated chemicals on them and their unborn babies (Mbonye and Neema, 2006).  Prevention of malaria during pregnancy via the use of  ITNs is no doubt one of the major interventions aimed at reducing maternal and infant morbidity and mortality rates, and thus achieving the fourth, fifth and sixth Millennium Development Goals (MGDs). This study therefore aimed at determining the use of this evidence‑based malaria preventive strategy (ITNs) and the socio‑demographic factors associated with its use among pregnant women in an area hyper‑endemic for malaria.

1.2 Statement of the Problem

Malaria infection has become endemic in the most of tropical countries in the world and Nigeria is among the country with high incidence of malaria in the children and pregnant women. It causes a lot of morbidity every year and also leading to the high incidence of death. The environmental conditions are favorable for the breeding and growing of the mosquitoes, which make easily to complete their life cycle. The mosquito is the vector of the malaria, which transmits the parasite of the Plasmodiumspp to human through biting and transmits it to human. The symptoms of the malaria includes: headache, fever, vomiting, chills, dizziness, body ache, fever and anaemia, it is one of the leading causes of miscarriage and death especially among the pregnant women. Several measures have been taken to eradicate both mosquitoes, which carry the parasites, but all proved abortive. In addition, the method of using Insecticide Treatment Net (ITN), to avoid the mosquito from coming in contact with human, which one of the best measure to avoid the mosquito to have contact with pregnant women, most especially at the night that is the best time for their activities, at that time the susceptible host is at sleep (Kabanyawanietal., 2008).

1.3 Justification

Insecticide treated bed nets were introduced in Nigeria as an effective means of preventing mosquito bites and malaria transmission following the meeting of African Heads of States in Abuja, Nigeria in the year 2000 (RBM, 2010). Pregnant women and children aged 0 -5 years were the main target population being the people mostly affected by the malaria scorge (Richard etal., 2001;Okwa, 2004). Following this giant stride in preventive medicine studies (Gamble et al., 2006; Adeyemietal., 2007) have shown that ITN used among the pregnant women reduced the incidence of malaria in pregnancy and hence the incidence of malaria infection and related complications such as premature deliveries, low birth weight babies, maternal anaemia and intra uterine fortal death.

1.4 Scope of the Study

The study will be carried out in Gwale Local Government area of Kano State. It will find out the attitude of pregnant women towards the utilization of insecticide treated mosquito nets (ITN_S).

1.5 Aim and Objectives of the Study

The main of the study is to find out the attitude of pregnant women towards the utilization of insecticide treated mosquito net in Gwale Local Government Area of Kano State. The specific objectives of the study include the following:

(i). To determine the socio – demographic characteristics of pregnant women using the ITN_S.

(ii). To determine the attitude of the pregnant women toward using ITN_S in the area.

(iii).To determine the maternal outcomes among the pregnant women that used ITN_S and those that did not use ITN_S.

(iv). To determine the foeto – neonatal outcomes among the pregnant women that used ITN_S and those that did not use ITN_S.

1.6 Research Questions

The following questions will be formulated for the study:

• What is the attitude of pregnant women towards malaria prevention?
• Do pregnant women have knowledge of preventing malaria?
• How do pregnant women of Gwale local government utilize insecticide treated mosquito net?
• Do pregnant women knows the importance of insecticide treated mosquito net?

1.5 Scope of the Study

The study will be carried out in Gwale local government area of Kano state. It will find out the attitude of pregnant women toward utilization of insecticide treated mosquito nets (ITN_S).

1.6 Significance of the Study

The outcomes of this study would be significant in the following ways:

1. The finding of this study would help pregnant mothers to take appropriate decision on utilizing insecticide treated mosquito net.
2. The findings of this study would also help pregnant women to take appropriate decision on prevention of malaria for healthful living and safe delivary.

• The findings of this study would go a long way in helping government in improving provision of insecticide treated mosquito net in various health facilities.

1. The findings of this study would also serve as reference material for the future researchers wishing to conduct similar research in the area, through increasing the literatures in the field of community health and related courses.

1.7 Operational Definition of Terms

Attitude: it is an evaluation of an object, ranging from extremely negative to extremely positive.

Pregnant women: are female adults carrying developing embryos in the womb.

Utilization: the action of making practical and effective use of something.

Insecticide: chemical substance that can be used in killing insects.

Mosquito: is a small insect that flies having slender segmented body, one pair of wings, one pair of halteres, three pairs of long hair-like legs and elongated mouthparts.

Nets: piece of open-meshed materials made of twine, cord or something similar, used typically for catching insects and other animals.

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Full Project – The attitude of pregnant women towards the utilization of insecticide treated mosquito nets