ABSTRACT

Malaria claims the life of an African child every 30minutes (Walle et al, 2020). In Cameroon, malaria continues to be endemic and the first major cause of morbidity and mortality among the most vulnerable groups—children under 5 years of age, pregnant women, people living with HIV/AIDS and the poor. ). Globally according to WHO’s latest World malaria report 241 million malaria cases and 627,000 malaria deaths were recorded in 2021(WHO, 2022). In Endemic areas, pregnant women, children under five years old, and immune-suppressed individuals are the most vulnerable (Danwang et al, 2021). This accounts for 67% of malaria deaths in the whole world. In Sub-Saharan Africa, the malaria burden is incredibly high.  . Compared to the past decade, malaria incident has fallen by at least 50% in one – third of the countries where the disease is endemic. The present study was aimed at accessing the effective use of long lasting insecticide nets in the prevention of malaria among pregnant women in the Muea Sub-Divisional Hospital over a period of 5months (December 2022 to April 2023).A convenient sampling technique method was used to select 140 participants to take part in the study at the Muea Sub-Divisional Hospital. Data was collected through the use of a questionnaire and it was analysed using Microsoft excel 2013. The results of the study showed that of the 75 details about mosquito nets   were explained to 47(37.33%) of the 75 respondents of which 8(10.00%) said they received this details from neighbors   and 30(32.33%) said they received from health personals and 5(10.67%) said they received the details from friends .All the 75(100%) of the participants received the nets for free. A greater majority of the respondents said they other use of the nets is to protect my farm from birds which was advanced by 69(89.67%) of the study. Following the results obtained, it can be concluded that   pregnant women at the Muea Sub-Divisional Hospital have adequate knowledge with regards to long lasting treated mosquito nets but several factors hinder them using them effectively with most of the participants saying that heat, smell and difficulties hanging them are the major hinder range. Again the participants had all the necessary strategies to effectively use mosquito nets.

CHAPTER ONE

INTRODUCTION

1.1 Background

According to the German international broadcasting service Deutchawalle, 2019, malaria claims the life of an African child every 30minutes.   Malaria is a mosquito – borne infectious disease that affects humans, caused by protozoan parasites belonging to the genus Plasmodium. It is one of the most prevalent mosquito-borne parasitic diseases throughout tropical and subtropical regions of the world (Sharlot et al., 2022);. It is transmitted to humans through the bite of infected female Anopheles mosquitoes. Five Plasmodium species are involved in malaria transmission: P. vivax, P. malariae, P. ovale, P. knowlesi and particularly P.Falciparum which is the main malaria species in Cameroon (Craig et al., 1999). Globally according to WHO’s latest World malaria report 241 million malaria cases and 627,000 malaria deaths were recorded in 2021(WHO, 2022). In Endemic areas, pregnant women, children under five years old, and immune-suppressed individuals are the most vulnerable (Danwang et al., 2021). This accounts for 67% of malaria deaths in the whole world. In Sub-Saharan Africa, the malaria burden is incredibly high.  . Compared to the past decade, malaria incident has fallen by at least 50% in one – third of the countries where the disease is endemic. These gains have been made through a combination of interventions, including timely diagnosis and treatment using reliable tests and anti-malaria drugs, indoor spraying with safe insecticides and the use of insecticides treated nets to protect people from mosquito bites especially in the night. Insecticide treated mosquito nets (ITNs) are the simplest way of preventing malaria. Insecticide treated bed nets are a type of personal protection that has been proven to minimize malaria infection, severe disease and death. The WHO Roll Back Malaria (RBM) project which began in 1998, intended to prevent and control malaria during pregnancy via the use of ITNS and other measures. It was discovered that long lasting insecticide treated mosquito nets (LLINs) are critical in avoiding malaria in pregnancy. Also, miscarriages and still births were reduced by approximate 33% when LLINs are used throughout pregnancy. Malaria contributes very significantly to maternal anemia and fetal mortality. Pregnant women are three times more likely to suffer from severe malaria compared to non- pregnant women. Pregnant women infected with malaria usually have more severe symptoms and outcomes, with higher rates of miscarriage, premature delivery, low birth weight, and neonatal death.

In Cameroon, more than 90% of the population is in danger of malaria infection. Annually about 41% of the population had an encounter with malaria at least once. In addition, malaria is the root explanation for 50% – 56% of morbidity and 40% of annual mortality among children (Mbenda et al., 2014). Malaria inflicts an economic burden on both the government and individuals, with an estimated cost of about US $12 billion each year (National Malaria Control Programme in Cameroon, 2008) in the whole world. The government of Cameroon has put in various intervention strategies. Among these include; free distribution of treated mosquito nets, free malaria treatment for uncomplicated malaria for youngsters from zero to five years, and indoor residual spraying. In addition, the reduction of cost of diagnosis and treatment of simple malaria in health care facilities to five thousand francs CFA (Coldiron et al., 2017). This has enabled the habitants to be treated for malaria. The mass distributed campaign (MDC) of ITNs  in Cameroon was implemented in July 2011 with about 8654731 LLIN’s distributed throughout the country ( Boussougou et al., 2015), the second mass distribution befell in 2015 and in February 2019 the 3rd mass distribution campaign was launch in and is very likely to take the country to a near universal coverage (WHO; 2020). The objective of the Ministry of Public Health was to have at least 80% of the population sleeping under the LLINs. Cameroon has characteristic typical African desert with both tropical and equatorial climates which favour the breeding of mosquitoes (Mbenda et al., 2014). Transmission is endemic throughout the country, and this is mostly due to the increasing resistance of the parasite which in the greater majority is Plasmodium falciparum (Tatem et al., 2004). This study is therefore geared towards assessing the effectiveness in the use of mosquito nets in the prevention of malaria among pregnant women visiting the Muea Sub-Divisional Hospital

1.2 Problem Statement

Malaria remains one of the greatest killer diseases in Africa, a big threat to public health and economic burden despite all control strategies put in force by the National Malaria Control Program, Global Fund for Health, Roll Back Malaria (RBM), and the World Health Organization (WHO). Mosquito net ownership rates remains low in many malarious regions or among particular groups in malarious regions. Mosquito net ownership is not synonymous with its utilization since as some people get access to the insecticide treated net but don’t make use of them. Also, ownership is not the only obstacle to achieving the reduction in malaria morbidity and mortality associated with insecticide treated bed nets use. Individuals who own ( or have available).Significant challenges stand in the way of making use of ITNs, they include weak distribution systems, lack of reliable monitoring and data collection mechanism, knowledge barriers, lack of accessibility, fear of side effects of using ITNs, poor attitude of providers. Three categories of mosquito net non- use are recognized;

1. i) Living in households with no mosquito nets present,
2. ii) Living in households owning but not hanging a mosquito net and

iii) Living in households that have a mosquito net hanging but who are not sleeping under the mosquito net

      To improve the use of mosquito nets, measures have to be focused on improving mosquito net availability, encouraging the hanging of the mosquito nets and encouraging individuals who have the mosquito nets to put them down when sleeping. This study was motivated by the fact that during our many hospital and community internships it was noticed that many families and households had mosquito nets but were not using them.

1.3 Rationale

The purpose of this study is to investigate pregnant women’s knowledge on the effective use of long lasting mosquito nets in the prevention of malaria in pregnancy. The rate of morbidity and mortality of women and children associated with malaria present major global and local health problems in Africa. This study will also examine the knowledge, perception and management of malaria among health care providers in the Muea Sub-Divisional Hospital so as to make proposals to close any identified gaps.

1.4 Research Questions

1) What level of knowledge do pregnant women have on the effective use of mosquito nets

2) What factors affect the effective use of mosquito nets by pregnant women attending the Muea Sub-Divisional Hospita

3) What should be done to encourage the use of mosquito nets

1.5 Objectives

1.5.1 General Objectives

To assess the effective use of mosquito nets in the prevention of malaria among pregnant women attending the Muea Sub-Divisional Hospital

1.5.2 Specific Objectives

1) To determine the knowledge on the effective use of mosquito nets by pregnant women attending the antenatal care at the Muea Sub-Divisional Hospital

2) To determine the factors that affects the effective use of mosquito nets

3) To find out the strategies to put in place to ensure the effective use of mosquito nets