CHAPTER ONE

1.0 INTRODUCTION AND STATEMENT OF PROBLEM

1.1 INTRODUCTION

Malaria remains the main trait to public health despite decades of control effects made. It is a devastating disease that threatens productivity an economic of endemic countries (Lengeler Eg Bushe c. 2015). There were over 214 million new cases malaria worldwidein 2015 and approximately 438 thousand malaria dead which consist of 10% African overall disease burden accounting for 40% public health expenditure (WHO. 2015). Over the last century, efforts have been made to control malaria. Among which the new advances in the control of malaria is the use of insecticide treated net (ITNs), now mostly long lasting insecticide treated nets (LLIN).

ITNs are known to kill mosquitoes and have proven repellants properties that reduces the number of mosquitoes that enters the house ( Eg Buche et al, 2015) they are estimated to be twice effective as untreated nets ( WHO. 2014) and offers 70% protection compare with no nets ( Bachou H, 2013). In the past decades malaria incidence has fallen at least 50% in 1/3 the countries where the disease is endemic. This gains have been made through a combination of intervention including timely diagnosis and treatment using antimalarial drugs, indoors spraying with save insecticide and the use of LLINs to protect people from mosquito bites at night.

Mosquito nets ownership is far from universal use despite the aforementioned gain ownership rate remain low in many malarious regions or among particular groups in malarious regions. Furthermore, mosquito nets ownership in itself is synonymous with utilization rather individuals who own mosquito nets most use them in order for the potential health Impact to be fully realized ( pulford et al 2011).

In Cameroon the main strategies of malaria prevention are: intermittent preventive treatment IPT for pregnant women and the use ITN especially for pregnant women and children under 5 years (keating J et al 2012) ITN distribution free of charge have been in existence in household in Cameroon since 2003 following the Abija declaration in 2000 challenges to increase ownership of ITN may diminishes as a result of expansion of large scale distribution efforts. ITN Impacts on transmission will be diminished if they are not properly and consistently used especially among pregnant women

1.2 PROPLEM STATEMENT

A mosquito net is a curtain made of very tiny linen which is hung around the bed in other to keep mosquitoes and other insects away from a person while they are asleep (Houghton Milfflin, 2010). People who inhale the fumes of the insecticide mixture may develop tingling sensation on the skin but not harmful. For many decades insecticide treated net (ITN) have been used to protect people against malaria due to their effectiveness. The use of ITN have increased substantially across the Africa Region. WHO recommends that all people at risk of malaria sleep under ITN particularly long lasting insecticide nets(LLINs) every night (WHO, 2020). All insecticidetreated nets contains pyrethroid which is save to humans and have the ability to kill mosquitoes at low doses on contact. Use of LLINs among pregnant women is held below national and international target. The median use of an insecticide treated net among pregnant women across 37 countries from (2009-2011) was 35%. Routine antenatal care self-constitute an important delivery channel that ensures pregnant women who attend ANC clinic atleast once are covered with long lasting insecticide treated nets from their first ANC visit in each pregnancy.

Majority of LLINs delivered from 2010 to 2012 in sub-Saharan Africa were through mass campaign as countries stop to reach the 80%coverage target. Some of the LLINs used in this campaign were reallocated from ANC delivery (Van Egypt AMUG 2013).Despite the large scale distribution of mosquito nets malaria still remain prevalence in pregnant women (WHO, 2011). In Cameroon the Ministry of public health reported that malaria cause 30- 35% overall mortality and 67% annual childhood mortality (WHO, 2011).

The investigator happen to have been pregnant and have also received LLINs from the free large scale distribution of mosquito nets and believed that with this free gift pregnant women are free from malaria infection; but was still surprise to witness other of her mates who attend ANC infected by the malaria parasite. In some occasion especially in her quarter Mokindi she tried to investigate to know whether or not they received or have purchase LLINs whose answers are always obvious that, they had. Again the investigator live in the neighborhood of the Mokindi village where she witness many pregnant women on different occasions infected with the malaria parasite. This baffled the investigator and decided to carry out this research to assess on the effective use of mosquito nets by pregnant women in Mokindi village.

1.3 RESEARCH QUESTION

• Do pregnant women in Mokindi village effectively use mosquito nets in the prevention of malaria?

1.3.1 Specific research question

• Do pregnant women of Mokindi know how to install mosquito bed nets over their sleeping area?
• Do pregnant women of Mokindi village know when to unfold a mosquito bed net over a sleeping area?
• Do pregnant women of Mokindi village know how to manage a torn mosquito bed net?

1.4 RESEARCH OBJECTIVES

1.4.1 General objectives

• The purpose of this study is to assess if pregnant women of Mokindi village effectively use mosquito nets in the prevention of malaria

1.4.2 Specific objectives

• To determine the effective use of mosquito nets among pregnant women of Mokindi village
• To assess if pregnant women in Mokindi actually unfold their nets at the early hours of the evenings
• To assess if pregnant women of Mokindi know how to manage a dirty or torn net.