CHAPTER ONE

INTRODUCTION

1.1 Background

In sub-Saharan Africa, infectious diseases remain the primary public health threat (Marotta et al., 2018). Malaria is one of the commonest infections, disproportionately affecting children and pregnant women (Adino et al., 2021). The parasites that causes malaria are transmitted to humans through the bite of the female Anopheles mosquito and it takes about 10–15 days to develop symptoms of the disease after being infected (Perkins et al., 2011). There  are five Plasmodium species that  infect  humans:  Plasmodium vivax, Plasmodium ovale, Plasmodium malariae,  Plasmodium falciparum and Plasmodium  Knowlesi  (identified  in long-tailed macaques in 1931 and   in humans in 1965  ( Lee  et  al., 2011). In 2019, an estimated 409,000 people died of malaria, most (274,000) were young children, and 94% of the infections and deaths occurred in Africa (CDC, 2019; WHO, 2020).

In 2018, Plasmodium falciparum accounted for 99.7% of estimated malaria cases in the African Region, 50% in the South-East Asia Region, 71% in the Eastern Mediterranean, and 65% in the Western Pacific. P. vivax is the predominant parasite in the WHO Region of the Americas, representing 75% of malaria cases (WHO, 2020). Signs and symptoms of malaria in young children (such as fever, poor feeding, respiratory insufficiency, jaundice and diarrhoea) are similar to those of other systemic infections (Poespoprodjo et al., 2009). The prevalence of malaria parasitaemia has been reported to be between 18% and 83% among children in different settings in endemic regions of Sub-Saharan African countries (Nankabirwa et al., 2014).

Children under five years are one of the most vulnerable groups affected by malaria. Severe anemia, hypoglycemia and cerebral malaria are features of severe malaria more commonly seen in children than in adults (WHO, 2019). The global prevalence of malaria among under-five children was 16% (WHO, 2016). A study conducted in Bambili-Tubah Sub Division, North West Region of Cameroon revealed the highest (13.33%) of malaria infection in the Nibie III health zone while Ngophana had the least (4.55%) prevalence of malaria infection (Payne et al., 2020). Though malaria has lost its crown as the number one cause of mortality in Cameroon (WHO, 2015), it is still a major cause of morbidity and mortality especially in children. Overall, Cameroon is among the 15 highest burden malaria countries, with 2.9% of all global malaria deaths in 2020 which represents the third highest number of malaria cases in Central Africa (WHO, 2021). Suspected malaria cases caused 30% of all medical consultation and 21% of visits to health facilities resulted in a diagnosis of laboratory confirmed malaria (WHO, 2021) The presence of stagnant water in the compound where these children live is one the of the risk factor that is associated with malaria in children (Adino et al., 2021).

Direct microscopic observation of blood to detect malaria parasite remains the gold standard for malaria diagnosis which involves the examination of a stained thick blood film to determine the presence or absence of malaria parasite, parasitaemia quantification whereas microscopic examination of a stained thin blood film allows Plasmodium species identification (Mbakilwa et al., 2012). Artemisinin combination therapies (ACT) are recommended as first-line treatment of uncomplicated malaria in children in malaria endemic regions.( Ashwin and Delane, 2022). From the foregoing, avoiding mosquito bites is a logical primary method of preventing malaria, infection. However, the use of mosquitoe repellent creams, bed nets, window nets and outlet door nets prevent mosquito bites to a reasonable extent and also have the potential to reduce the prevalence of mosquito-borne illnesses, such as malaria (Khater et al., 2019). Household aerosolized insecticide spraying has also been observed to reduce malaria prevalence (Pryce et al., 2018).

1.2 Statement of problem

Malaria is a life threatening disease in many tropical and Sub-tropical areas. Those at greatest risk of the disease are children who have immunities that are not well developed and happen to be more susceptible to malaria. Despite the enormous efforts by the government of Cameroon through the Ministry of Public Health such as the free distribution of long lasting insecticide treated mosquitoe nets at times during the mother and child health and nutrition action week. The prevalence of malaria is still high in Cameroon. In the South West, Mohamed et al., (2020) reported a prevalence of 13.04% among children and 13.33% in the North West Region, thus the need to carry out this study.

1.3 Research Questions

1. What is the prevalence of malaria in children ?
2. What is the prevalence of malaria with respect to age and sex in children?
3. 3. What are the factors associated with malaria infection among children?

1.4 Research Objectives

1.4.1 General Objectives

The main objective was to determine parents knowledge on the risks factors and complications of malaria in children below the ages of five in the mile 16 community.

1.4.2 Specific Objectives

• To determine the prevalence of malaria parasite in children
• To determine the prevalence of malaria parasite with respect to age and sex in children?
• To identify the factors associated with malaria infection among children