CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

Malaria makes up one of the major public health concerns worldwide particularly amongst people living in tropical and sub-tropical regions of the world. It is caused by the Apicomplexan parasite of the genus Plasmodium the major species of Plasmodium worldwide include Plasmodium falciparium, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and the zoonotic Plasmodium knowlesi common in the South East Asian countries. Generally, Plasmodium falciparium is the most prevalent, virulent and pathogenic in African regions which includes Cameroon.^[1]. Malaria is transmitted from the bite of a Female Anopheles mosquito. There is an estimated value of 228 million cases of malaria that have occurred worldwide, accounting for nearly 405000 deaths globally compared to 416000 estimated deaths in 2017, and 585000 in 2010, of which 94% were in WHO African region.

The estimated suspected malaria cases in Cameroon were seen to be 3.3-3.7 million in health services. Malaria is endemic in Cameroon with the level of endemicity varying from one ecological zone to another [2]. Asymptomatic malaria infections refer to the presence of asexual parasites in the peripheral blood without symptoms. Individuals with asymptomatic infections, especially in the adult population have been identified as providing a reservoir for malaria transmission and a pre cursor in the progression to symptomatic malaria [3]. Uncomplicated malaria most at times presents itself with nonspecific symptoms including malaise, headache, fatigue, abdominal discomfort, fever, chills, nausea and a lot more [4].

Most studies on malaria focus on clinical manifestations, severity, and its complications which aim to investigate and address the principal cause of malaria-related deaths [5]. Insecticide treated net (ITNs) and indoor residual spraying (IRS) have both been demonstrated to reduce malaria and are till date the main methods used in controlling malaria vectors and associated malaria transmission [2]. A significant decrease in entomological and epidemiological indicators was reported in Cameroon since the introduction of ITNs/LLINS [8]. Persistent malaria transmission is caused by outdoor biting and the resting behavior of vectors. Understanding factors that contribute to the limited or even attenuated performance of control interventions could better enable in improving the approaches for better disease prevention [6]. Also, the effect of hygiene and sanitation on the reduction of mosquito breeding sites cannot be over emphasized [8]. The occurrence and transmission of malaria parasite in Camerron is influenced by climatic conditions such as temperature and humidity. Some studies have reported high malaria transmission in lower altitudinal regions in Cameroon [7].  

1.2 PROBLEM STATEMENT

 In 2022, an estimated 608000 people died if malaria and within the last decade, increasing numbers of partners and resources have rapidly increased malaria control efforts. Despite all the methods put in place to reduce malaria, the prevalence is still high because malaria occurs mainly in areas of the world where people lack access to certain resources, such as housing with screens or medical facilities with proper testing and treatment capabilities.                                   It is most at times the leading cause of death in many countries and its costs to individuals, families, communities, and nations are quite enormous. Most pregnant women are vulnerable to the disease since their immunity has been altered by the pregnancy and it places the unborn baby at a high risk of death.

 This disease costs a lot to individuals and families which include; purchase of drugs for treatment of malaria at home, lost days at work, absence from school, expenses for preventive measures and expenses for burial in case of deaths thus this research is aimed at investigating why the prevalence of malaria continues to soar to shed more light on the severity of malaria prevalence and its associated factors hoping to help remedy the situation.

1.3 RATIONALE

Additional to the fact that malaria in itself is deadly, it also leads to a range of health problem such as anemia, brain damage and seizures, respiratory distress and much more. Malaria infecting healthy adults can greatly cripple the community. most of this is due to a decrease in the work force and many other reasons. As such, prevalence of malaria poses a very big risk to the society as a whole.

Malaria symptoms may become more severe and if not treated right may lead to kidney failure, seizures, mental confusion, coma and death. Deaths caused by malaria may lead to underpopulation which will affect the country as a whole.

This work can help sensitize people and communities on the dangers of malaria and also help them implement certain measures so as to combat the continues spread of the disease such as the use of mosquito nets, draining of mosquito breeding grounds, using insecticides and much more. It may also help to promote prompt diagnosis and treatment with appropriate antimalarial drugs which are very much vital in preventing severe complications.

1.4 RESEARCH QUESTIONS

• What is the prevalence of Symptomatic and Asymptomatic malaria among adult patients consulting at the Regional Hospital Bamenda.
• What are the factors associated with symptomatic and asymptomatic malaria among adult patients consulting at the Regional Hospital Bamenda.

1.5 RESEARCH HYPOTHESIS

According to research, the prevalence of asymptomatic malaria is significantly higher than symptomatic malaria, with studies often reporting that around 70% of malaria infections in adults are asymptomatic, meaning they have the parasite without showing symptoms while the remaining 30% are symptomatic. Asymptomatic carriers can still transmit malaria to mosquitoes which contributes to the spread of the disease. Prevalence of malaria may also be higher in people that were previously infected with the disease. Certain factors such as age, sex or gender may not be significantly associated with malaria infection. Factors that may also affect the prevalence of malaria are the type of vector, type of parasite, population movement or migration, insecticide resistance to mosquitoes or drug resistance to parasites.

1.6 OBJECTIVES

MAIN OBJECTIVE:

Prevalence of symptomatic and asymptomatic malaria and its factors associated among adult patients consulting at the Regional Hospital Bamenda.

Specific Objectives

• To determine the prevalence of Symptomatic and Asymptomatic malaria among adult patients consulting at the Regional Hospital Bamenda.
• To access the factors associated with symptomatic and asymptomatic malaria among adult patients consulting at the regional hospital Bamenda.