CHAPTER ONE

GENERAL INTRODUCTION

1.1 Background of the Study.

For thousands of years traditional herbal remedies have been used to treat malaria and the first effective treatment for malaria came from the bark of cinchona tree, which contains quinine. After the link to mosquitos and their parasites were identified in the early 20th century, mosquito control measures such as widespread use of DDT (a synthetic insecticide used in malaria-endemic counties that causes harm to the environment and human health), swamp drainage, covering or oiling the surface of open water sources, indoor residual spraying and the use of insecticide treated nets was initiated. Prophylactic quinine was prescribed in malaria endemic areas and therapeutic drugs including chloroquine and artemisinins were used to resist the scourge. Malaria researchers have won multiple Nobel Prizes for their achievements, although the disease continues to afflict some 200 million patients each year, killing more than 600,000(Fievet  et al. 2016).

According to the World Health Organisation (W.H.O.2020) report, malaria in endemic in 87 countries in the World with 229 million cases and 409, 9000 deaths in 2019. Of this global burden, 215 million cases and 384,000 deaths occurred in Africa. Globally, 125 million women are at risk of malaria every year (WHO, 2012). A review of studies, carried out in sub-Saharan Africa between 2011, reports that prevalence of malaria in pregnant women attending  antenatal clinics was 29.5% in East and Southern Africa and 35.1% in West and central Africa (Takem et al., 2015). Malaria infection in pregnant women is a major problem in sub-Saharan Africa (SSA) precisely Cameroon with significant risks for the mother and their offspring.

Malaria in pregnancy is characterized by a secondary anaemia and the presence of parasites in the placenta known as placental malaria, leading to low birth weight, source of perinatal morbidity and mortality. In areas of high plasmodium falciparum transmission, where a high proportion of the population is semi-immune, most pregnant women with malaria are asymptomatic (Nosten et al., 2018). The history of malaria stretches from its pre-historic origin as a zoonotic disease in the primates of Africa in the 21^st century. Its prevention and treatment have been targeted in science and medicine for hundreds of years. (Greenwood et al., 2019).

Malaria was the most important health hazard encountered by U.S. troops in south pacific      during World War 2, where about 500,000 men were infected. According to Joseph Patrick Byrne,sixty thousand American soldiers died of malaria during the African and south pacific campaigns. At the close of the 20^th century,malaria remained endemic in more than 100 counties throughout the tropical and subtropical zones, including large areas of Central and South America, Africa and the Middle East,the Indian subcontinent,Southeast Asia and Oceania.Resistance of plasmodium to anti-malaria drugs,as well as resistance of mosquitos to insecticides and the discovery of zoonotic species of the parasite have complicated control measures(Vander et al., 2015).

1.2. Problem Statement.       

Globally malaria infection is a public health issue in both developed and developing countries due to high unmet needs. Different studies have been written on malaria in general and malaria in pregnancy in particular on how to prevent this deadly disease but yet pregnant women and children 0-5 years of age still suffer from this infection. Malaria is caused by the bite of an infected mosquito specifically the female anopheles mosquito. People learn about malaria parasites from different sources such as during health talks, on television, newspapers, school, parents, and friends yet little is  known on how to prevent the spread of this very deadly disease(Armstrong Schellenberg et al., 2017).

Malaria among pregnant women has become very rampant and this could be due to increase in population and human activities that have resulted in increase in temperature creating a favourable condition for malaria. The hygienic condition has significantly deteriorated especially as household waste are been dumped along the streets which takes more than a week for the hygiene and sanitation company to collect for disposal. Factors that also contribute to malaria include standing water in gutters which promotes the survival of mosquito larvae, bushes and poor hygiene and sanitation (Perimann and Troye-Blomberg 2019).

This condition is further worsening by the fact that the mosquito nets allocated for the fight against malaria are often used for different purposes other than what they are intended for.

Notwithstanding malaria causes significant consequences in pregnancy in terms of still birth, preterm delivery, miscarriages, infant mortality, low birth weight and equally maternal anaemia. Thus this research seeks to assess the level of knowledge on the prevalence of malaria amongst pregnant women attending Antenatal care at the Mount Mary Hospital

1.3. Rationale

Inter population growth remains high in the group of 48 countries designated by the United Nations as the least developed countries (LDCs), of which 27 are in Africa, Cameroon, one among the most populous country in Africa, still have high prevalence rate of Malaria and Malaria in pregnancy. Despite the enormous benefits of using treated mosquito nets, the utilization of mosquito nets remains low in sub-Saharan Africa including Cameroon. Pregnant women are been advised to sleep under treated mosquito nets but many do not follow this orders (Perimann et al 2015).

Despite recent improvements in the use of treated mosquito nets amongst pregnant women in Cameroon, the utilization rates are still far below the national figures in the emerging regions of the country.

Even though there is no written evidence, some pregnant women have inadequate knowledge with regards to Malaria in pregnancy at the Mount Mary Hospital. It was noticed that most pregnant women lack knowledge on the consequences of not taking adequate treatment for malaria which is severe in pregnancy. This is a call for concern especially in the case of Mount Mary Hospital where pregnant women do not see the need of sleeping under a treated mosquito net, going to the hospital if signs and symptoms of malaria are visible, take malaria treatment seriously till the end of the dose. Thus, the purpose for this study will create awareness on the prevention of malaria in pregnancy.

1.4. Research Questions.

1. What do women attending ANC at the Mount Mary Hospital Buea know regarding malaria in pregnancy?
2. What do pregnant women attending ANC at the Mount Mary Hospital know regarding the strategic measures used to control malaria in pregnancy?
3. What risk factors do pregnant women attending ANC at the Mount Mary Hospital know regarding malaria in pregnancy?

1.5. Research Objectives.

1.5.1. General objective.

To assess the knowledge of malaria in pregnancy amongst pregnant women attending ante natal care at the Mount Mary Hospital.

1.5.2. Specific objectives.

1. To assess the knowledge of pregnant women attending ANC at the Mount Mary Hospital
2. To identify the strategic measures used in the prevention of malaria in pregnancy amongst pregnant women attending ANC at the Mount Mary Hospital.
3. To identify the risk factors of malaria in pregnancy amongst pregnant women attending ANC at the Mount Mary Hospital.