CHAPTER ONE

INTRODUCTION

1.1  Background

Malaria is a major public health problem in ninety-one countries world-wide with sub-Sahara Africa bearing 80% of the disease burden (WHO, 2018). Malaria remains endemic in Nigeria where the parasitic disease disproportionately affects children aged under 5 years and pregnant women compared to the rest of the population groups (NMEP et al., 2016). In pregnancy, malaria increases the risk of maternal anaemia, spontaneous abortions, stillbirths, premature deliveries, intra-uterine growth retardation and low birth weight babies, and these are all important causes of infant mortality (WHO, 2017). Also, more than 70% of all malaria deaths occur in children aged under 5 years (Farid B, 2016; WHO, 2018). The scope of malaria control is changing worldwide with more emphasis on community and individual participation. Health education can improve participation in malaria control, when such education is designed to address gaps in the knowledge, attitudes and practice of individuals in the communities ( Akaba et al., 2018). Evidence from malaria knowledge, attitudes, and practices (KAP) studies reported that misconceptions on malaria transmission and risk factors still exist with adverse impact on malaria control programmes (Obol et al ., 2011). Findings from a study conducted by Singh et al. in rural areas of Northern Nigeria revealed that although knowledge about malaria prevention measures was high (90%), it was poorly reflected in their practices (16%) ( Singh R et al., 2014). Another study by Adebayo et al. assessed the knowledge of malaria prevention among mothers of children aged under 5 years and pregnant women in a rural community in Southwest Nigeria. This latter study also found poor knowledge and utilization of malaria prevention measures among majority of the caregivers in the rural study area , considering the vulnerability of both children aged under 5 years and pregnant women to malaria ( Adebayo et al., 2015; FMoH & NMEP; Kimbi et al., 2014)..

1.2     Problem Statement

Malaria during pregnancy is a major public health problem; it increases the risk of low birth weight (LBW) (< 2500 g), infant mortality and morbidity during the first year of life by inducing intra-uterine growth retardation, prematurity, and infant anemia. In malaria-endemic countries, placental malaria is associated with a 2-fold higher risk of stillbirth and is responsible for up to 35% of preventable LBW, Malaria is ancient but, it still remains a major public health problem in Cameroon and the major cause of death worldwide (Fru-Cho et al., 2013). Despite being preventable and treatable, malaria continues to have a devastating impact on people´s health and livelihood around the world (WHO, 2015). Globally, approximately about 216 millions of cases of malaria occur annually. Approximately 445,000 deaths were attributed to malaria in 2016 with 91% of deaths recorded in sub-Saharan Africa (WHO, 2017). In Cameroon, about 2 millions of cases were registered by the national surveillance system with up to 4000 deaths attributed to malaria yearly (Kinsai NS, 2017). In malarious endemic area, pregnant women are at high risk of contracting the disease with severe outcomes compared to their non-pregnant peers (van Eijk et al., 2015). Malaria is a major cause of death in newborns and infants under 5 years, pregnant women, immuno-suppressed individuals, travelers and migrants from malaria non-endemic zones. The severity of malaria in newborn is due to the fact that, acquired immunity from mother against the pathogen is waning (kimbi HK et al., 2014). Malaria in pregnant women is more complicated and can lead to severe outcomes such as anemia, abortion, anemia, low birth weight, neonatal death. Preventing malaria is of great importance in ameliorating the quality of life, reducing the morbidity and mortality in a country (WHO, 2017). The above mentioned problem prompted the study on Assessing Knowledge and practice of pregnant women on the Prevention and management of malaria in pregnancy in the Molyko health area.

1.3 Rationale

 This study sought to fill this gap and provide new insights on the depth of knowledge gaps. The findings will help to improve implementation of integrated malaria control strategies. It will also be essential in establishing epidemiological and behavioural baseline indicators to evaluate and improve progress by malaria control programmes.

1.4 Research Questions

• Are pregnant women within the MOLYKO health area knowledgeable about malaria prevention and Management?
• What are the practices of pregnant women in the Molyko health area on the management and prevention of Malaria?
• What are the challenges faced by pregnant women in the Molyko health area on the management and prevention of malaria?

1.5 Objective

1.5.1 General objective

To assess mothers’ knowledge and practices on prevention and management of Malaria in pregnancy in the Molyko community.

1.5.2 Specific Objectives

• To assess the knowledge of pregnant women in the Molyko health area on Malaria in Pregnancy in the Molyko health area.
• To assess practices of prevention and management of malaria in pregnancy in the Molyko health area.
• To assess the challenges of Malaria in pregnancy in the Molyko health area.