CHAPTER ONE

GENERAL INTRODUCTION

1.1.Background of the Study

Malaria constitutes one of the major public health problems worldwide with about 3.4 billion people living in endemic areas of the world (CDC, 2014). In 2013, malaria accounted for 584,000 deaths worldwide; people in sub-Saharan African countries accounted for 90% of these deaths with children being the most vulnerable (Fru-Cho et al., 2014; WHO, 2014). Malaria is the leading cause of death for children under 5, with a fatality recorded every 45 seconds; of the 584,000 malaria deaths in 2013, children accounted for 78% of the deaths (WHO, 2014). Malaria affects the most vulnerable; children under 5 years of age whose immune systems are not fully developed, pregnant women whose immune systems are weakened as a result of pregnancy, people with HIV, and those living in poor and low resource areas (Cameroon Coalition Against Malaria, [CCAM], 2012).

 Recommended prevention, treatment, and vector control interventions to combat malaria include artemisinin-based combination therapy (ACT), intermittent preventive treatment in pregnancy (IPT), indoor residual spraying of insecticide (IRS), and ITNs, (WHO, 2015a). However, according to Roll Back Malaria (RBM; 2015), in 2013 about 278 million people at risk of malaria in SSA lived in households without access to ITNs. Also in 2013, about 15 million of the 35 million pregnant women each year did not receive a single dose of the IPT and about 140 million children with malaria did not receive ACT for treatment (RBM, 2015).

 Furthermore, malaria treatment constitutes 40% of SSA’s public health expenditure and greatly contributes to poor growth and development in Africa, especially in vulnerable communities (Richardson et al., 2011). According to recent WHO estimates, about 60% of malaria cases in Africa and 80% of malaria related deaths go unreported, especially in rural communities (Shah, 2010). In Cameroon, malaria affects more than 90% of the population and is responsible for about 73% of mortality in the whole country (Antonio-Nkondjio et al., 2012; WHO, 2011). Malaria is the prime cause of morbidity and mortality in Cameroon, responsible for 45% of medical consultations and 30%-47% of hospitalizations, which still result in death for 50% of the children less than 5 years old. Malaria accounts for 26% of workplace absences and 40% of household health expenses (CCAM, 2012; Kimbi et al., 2014a; National Malaria Control Program [NMCP], 2012; Nsagha, et al., 2011b).

According to the Cameroon Ministry of Public Health (2011), children below 5 years of age and pregnant women represented 22% of the total population who are in the most vulnerable group, followed by those with HIV and those living in rural areas, especially those located in the tropical regions of the country. Cameroon, as is the case with most African countries, is poor, and as such, the government does not allocate any political capital to fight malaria despite the high death toll (Shah, 2010). In recent years, Cameroon and partnering organizations have designed various strategies to control and prevent malaria through mass distribution of bed nets (Ndo, et al 2011). Since 2003, the Cameroon government has promoted the free distribution of ITN to pregnant women and children under 5, subsidized the cost of ACT, and provided training to local health officials on how to properly manage both malaria prevention and prevalence among women and children (Ndo et al., 2011). However, Shah (2010) points out that most of these free bed nets do not get to the rural people. Furthermore, based on the observation of two German epidemiologists, only 20% of people in rural communities with malaria went to a clinic, and about 70% of people do not have a medical record of malaria history (Shah, 2010). Moreover, about 20% of people are prescribed the wrong drugs or the wrong dose and 10% do not buy malaria drugs from clinics; 30% do not take the right dose as prescribed by a health professional and only 3% of local people get effective malaria treatment (Shah, 2010).

Many studies have shown that malaria can be prevented and controlled by owning and sleeping under ITNs to avoid mosquito bites (Antonio-Nkondjio, et al, 2012; Kimbi 8 et al, 2014a; Nsagha et al., 2011a). Based on evidence from trial studies which have shown decreases in children mortality by 18% and in the prevalence of malaria by 13% as a result of routine ITN use among children, many countries have focused on more free distribution of ITNs. However, Rowe et al (2007), and Nahlen and Low-Beer (2007) point out that it is important to ensure that efforts in malaria prevention and control not only focus on measuring ITN coverage but also their impact on the overall health outcome, especially for those in rural areas. This study considers integrated malaria prevention and control approach an efficient model in malaria prevention and, eventually, elimination of malaria in rural Cameroon.

1.2 Statement of the Problem

 Malaria constitutes a major public health problem worldwide, with approximately 3.4 billion people living in endemic areas of the world. In Cameroon, more than 90% of the population are at risk of contracting malaria and is responsible for 73% of the country’s mortality. Malaria affects about 54% of rural communities in Cameroon, and the prevalence rate is 37% higher than in urban areas. Regardless of the several studies which have shown that proper use of antimalarial drugs can reduce malaria prevalence, minimal attention has been given to the low level of knowledge among community pregnant women, which impedes the proper use of antimalarial drugs (including taking the right dosage of antimalarial drugs). In view of the lack of in-depth research on the level of knowledge of pregnant women, proper use of ITNs and antimalarial drugs, as well as on the effects of education, healthcare service preference, and socioeconomic status on malaria prevention at Ndongo community level, it is against this backdrop that the researcher sought to explore how these factors impact pregnant women at Ndongo community in Buea.

1.3 Research  Question

       1: How can malaria be prevented in pregnancy

2: What are the challenges faced in the prevention of malaria in pregnancy

3: What are the consequences of malaria in pregnancy

 1.4 Aim of the study

To assess the challenges faced in the prevention of malaria in pregnancy at the ndongo community.

1.5 Objectives

1.5.1. General objectives

To assess the knowledge of pregnant women in the prevention of malaria in pregnancy at the Ndongo community

1.5.2. Specific objectives

1: To find out how pregnant women prevent malaria

2: To identify the challenges faced by pregnant women in the prevention of malaria.

3: To find out the consequences of malaria in pregnancy