This Research Project Material is Based on MALARIA CONTROL AND MANAGEMENT STRATEGIES IN ACHI RURAL COMMUNITY OJI RIVER LOCAL GOVERNMENT AREA OF ENUGU STATE

 

ABSTRACT

Background: One of the key interventions proposed under the Roll back malaria initiative is improvement of case management of malaria at the home and community levels to reduce malaria burden.

Objective: The objective of the study is to ascertain Malaria Control And Management Strategies In Achi Rural Community Oji River Local Government Area Of Enugu State. Mother‘s knowledge and practice regarding home management of malaria fever in under five children in the study area formed the sub objective of the study.

Methods: This was a descriptive cross sectional study conducted in 2011. A systematic sampling method was used to select the 350 respondents. A respondent who had at least one living child under 5years old was included in the study. Data was collected using interviewer administered questionnaires and analyzed with SPSS version 20.0.  Result: Majority of the respondents were between the age of 18-40yrs. Less than One fifth (17.1%) of the respondents have correct knowledge of the causation of malaria and 71% have correct knowledge of the prevention of malaria. Forty two percent of the respondents used one or more of the five treatment modalities. The commonest treatment practice by respondents for their young children with malaria was taking them to health centers (39.8%) followed by home treatment with antimalarial drugs (17.1%). Only 31.4% of the children were treated with artemisinin combine therapy.

Conclusion: The findings of this study have shown that knowledge of mothers on treatment of malaria as well as practices of preventive measures is low. Artemisinin combine therapy is not widely used as the treatment for perceived malaria at home.

 

CHAPTER ONE

INTRODUCTION

1.1       BACKGROUND INFORMATION

According to WHO report in 2008, Malaria remains a disease of public health concern in Nigeria and other parts of the world. Globally, malaria posses a threat to approximately 3.3 billion of the world’s population with around 250 million clinical cases annually and more than 1 million deaths mostly in children under 5yrs of age.  In Africa, malaria is the leading cause of under five mortality (20%) and constitute 10% of the continent’s overall disease burden accounting for 40%  public health expenditure, 30-50% of inpatient admission and up to 50% of outpatient visit in areas with high malaria transmission.

Reducing the burden of malaria is a major public health challenge and a priority for the Roll back malaria partnership and this can be achieved with good control and management practices.  Except for South Africa, many countries in the continent do not have successful malaria control programmes due to among others, the magnitude of the problem compounded by lack of adequate health infrastructure as well as financial and human resources .  Malaria control practices have been examined in some rural population in Nigeria and result revealed non use of insecticide impregnated net which is the current international effort at malaria control.

Malaria control activities in Nigeria are planned and implemented through the primary health care system (FMOH 2005).  However, the use of health centers as the first resort for malaria management has been shown to be low in Nigeria.  A review of malaria treatment seeking behavior in rural Southwestern Nigerian by Ajayi (2006) revealed that more than 80% malaria episode perceived treatment outside the existing government health care system.  Brieger (2004) stated that these shortcomings encourage treatment of malaria at home with drugs bought from shops and herbal preparation and the treatment are usually incorrect or suboptimal.  This practice increase morbidity and mortality in addition to contributing to possible emergence of drug resistance.

Yet prompt and effective treatment of malaria remains a crucial element for malaria control programmes.  People who become ill with the disease need prompt and effective treatment to prevent the development of severe manifestation and death (WHO 2003).

In view of the negative economic and health impact of malaria, there is a need for the development of good preventive and control measures adoptable to the
communities hence this study is aimed at investigating the malaria control and management strategy that exist in Achi community.

The vast majority of malaria deaths occur in Africa, south of the Sahara, where malaria also presents major obstacles to social and economic development. Malaria has been estimated to cost Africa more than US$ 12 billion every year in lost GDP, even though it

could be controlled for a fraction of that sum.¹

There are at least 300 million acute cases of malaria each year globally resulting in more than a million deaths. Around 90% of these deaths occur in Africa, mostly in young children.² Malaria is Africa’s leading cause of under-five mortality (20%) and constitutes 10% of the continent’s overall disease burden. It accounts for 40% of public health expenditure, 30-50% of in-patient admissions, and up to 50% of outpatient visits in areas with high malaria transmission.¹ Malaria accounts for over 60% of outpatient visit in Nigeria and other sub-Saharan African countries.³ Prompt access to effective antimalarial treatment is one of the major strategies for reducing the burden of malaria. Prompt access means having treatment available as near to home as possible so that it is given within 24hrs of onset of symptoms.

1.2        MAGNITUDE OF THE PROBLEM

Malaria is a complex problem for which there is no “magic bullet” particularly in Nigeria where approximately 80-85% cases of death in the world due to malaria occur. Patterns of transmission and environmental and cultural factors all very so greatly that differences in prevalence and incidence occur even between neighboring villages. The virulence of vector has thwarted some control efforts and emerging multi drug resistance strain appear to be inducing an increasing toll with a resulting impact on already over burdened health services and on productivity.

In Africa where the mortality burden from malaria is greatest, the majority of children die before they reach health facilities. Factors such as distance from home, poverty, the demands of domestic life, perceived low quality of services, drug stock outs, attitude of health workers has led to the by-passing of public health care facilities in favor of health care from private or informal sector with  inadequate or poor quality of  drugs.⁴

Nigeria is among African countries that have committed it self to ensure that at least 60% of those suffering from malaria have prompt access to affordable and appropriate treatment within 24hrs of onset of symptoms (Roll Back Malaria strategy).¹ This challenge could only be attained through scaling up of home-based management of malaria.

Experience and lesson learnt in scaling up home management of malaria (HMM) in Burkina Faso, Ghana, Kenya, Nigeria, Uganda and Zambia was shown to be both feasible and effective in ensuring prompt access to appropriate treatment in the African region.¹

It was generally agreed that it was time to scale up HMM in endemic countries to cover the majority of their populations. This will in turn help the populations to access quality drugs at appropriate dosages within 24 hrs of onset of symptoms especially in remotest areas of Africa.²

It has been recognized that, in endemic countries, most malaria episodes are treated outside public health facilities, mainly at home.¹ Health facility-based treatment do not reach majority of the population. As a result, the provision of improved home – based management of uncomplicated malaria has become a key strategy for meeting Roll Back malaria (RBM) country targets.²

Many childhood febrile illnesses are treated at home prior to presentation. This is a very common practice among mothers in Nigeria and other malaria endemic countries in sub-

Sahara Africa.⁵

In Nigeria between 60 and 80% of children would have been treated at home prior

to reporting at health facilities.⁵

Going by the large population of children in Nigeria and a small proportion of functional health facilities available to cater for them, there is need to involve mothers in the management of minor disease conditions  presenting with fever. Such conditions include malaria and respiratory tract infections; the two common causes of fever in Nigerian children.

Enugu state has high transmission rate for malaria with incidence rate of 15% (MOH 2005) and Achi is a community in Enugu State. Good control and Management strategies is necessary in order to curtail this incidence thus the study is to determine the measures being used

This study therefore intends to examine Malaria Control And Management Strategies In Achi Rural Community Oji River Local Government Area Of Enugu State.

1.3       JUSTIFICATION OF THE STUDY

It is now widely acknowledged that access to appropriate and effective treatment for malaria should be provided within 24 hours of onset of symptoms. A strategy to provide such access should take into account poor rural populations in malaria-endemic countries who are particularly inadequately served by the health system. This is the access gap that the HMM strategy addresses, enabling the home to be the first ―hospital‖.⁸

Evidence from Nigeria shows that most episodes of fever are initially self-treated and over 70% of cases rely exclusively on it.⁹ However of this proportion only 15% of the actions taken were adjudged as appropriate. This pattern has been consistent across the Country as documented in several other reports.⁸ A study of health seeking behavior for childhood illnesses in 3 rural Nigerian communities showed that the most common form of first line treatment was drugs from a patent medicine vendor (49.6%), while only 3.6% did nothing.¹⁰ In a study conducted at Igbo Etiti and Ibarapa North in Nigeria on 105 preschool children, Brieger et al found that 74% of parents took treatment action under 8 hours of onset of illness, while nearly 96% acted within 24 hours. Unfortunately only

14.3% of these actions were judged to have been appropriate.⁴ Studies have shown the feasibility of home management and its positive impact on the burden of malaria.⁴

1.4       AIM AND OBJECTIVES

1.4.1     Goal

To ascertain Malaria Control And Management Strategies In Achi Rural Community Oji River Local Government Area Of Enugu State.

1.4.2     Specific objectives

1. To document the proportion of mothers who are able to recognize and respond appropriately to malaria at home.
2. To document the knowledge of mothers on prevention of malaria.
3. To determine the mothers‘ treatment practices in cases of episodes of malaria.

MALARIA CONTROL AND MANAGEMENT STRATEGIES IN ACHI RURAL COMMUNITY OJI RIVER LOCAL GOVERNMENT AREA OF ENUGU STATE. GET MORE NURSING PROJECT TOPICS AND MATERIALS

 

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