ABSTRACT
The malaria prevalence in Nigeria
is high despite numerous interventions to date. The study examined malaria
prevention, control and treatment practices among Tai Solarin University of
Education staff and students resident in Ijagun Community.
A cross sectional survey design was
adopted. Data was collected from 286 students, 31 academic staff and 67
non-academic staff. Most respondents were between 18 and 22 years old. More
than half of the respondents (57.8%) had either B.sc or HND educational
qualification. The instrument for data collection was a closed-ended
questionnaire. Ethical approval was obtained from Babcock University Health
Research Ethics Committee (BUHREC). The data obtained from the study was coded
and analysed using statistical package for social sciences (SPSS) version 21.0.
Findings showed that respondents
had knowledge mean score of 6.91 ± 2.05, attitudinal score of 12.96 ± 2.18 and
perceptions mean score of 17.42 ± 3.66.
In conclusion, poor treatment,
prevention and control of malaria have been attributed to individual’s
knowledge, attitude and perception. Public health intervention needs to be
implemented in improving attitude and perception of non-educated individuals as
evident from this study that educated individuals exhibit high level of
perception and positive attitudinal disposition towards treatment, prevention
and control of malaria.Education intervention aimed at improving knowledge of
malaria transmission is very important in control of malaria as this is a
predicting factor to behavioural change.There is need for a similar study to be
conducted among non-educated individuals as result from this study may only be
centered around educated personnel hence the varying result in comparison to
other studies.
CHAPTER
ONE
INTRODUCTION
1.1 Background to the Study
Malaria is one
of the most serious health problems facing the world. The World Health
Organization (WHO) reported that over 300million cases of malaria arise a year
with approximately 2-3million death resulting from complications (Roll Back
Malaria, 2012).Malaria has continued to be a major threat to the world’s
community posing its huge toll of morbidity and mortality in sub-Saharan
Africa. There are several reasons why Africa bears an overwhelming proportion
of the malaria burden. Most malaria infections in Africa, south of the Sahara
are caused by Plasmodium falciparum.The malaria morbidity and mortality
statistics in Nigeria has been an issue of great concern, Nigeria contributes
25% of the malaria burden in Africa and losses up to ₦12 billion annually in
form of treatment costs, absenteeism at work and loss of productivity
(Greenwood, Bojangk Whitty, & Targett, 2005). Malaria is a disease that is
deadly but preventable,the most severe and life threatening form of Malaria is
the prevalent parasitic endemic disease in Africa causing various problems such
as increased morbidity and mortality which is preventable, treatable and
curable, yet it remains one of the major health issues in Nigeria.
Malaria
is one of the major public health problems in Nigeria with an estimated 100
million malaria cases and over 300,000 deaths per year. It accounts for 60% of
outpatients visit, 30% of hospitalizations among children under 5 years of age,
and 11% maternal mortality (Nigeria malaria fact Sheet, 2011). The human and
economic cost associated with declining quality of life, consultations,
treatments, control, hospitalization and other events related to malaria are
enormous and often lead to low productivity and lost of incomes. Malaria is
unique among diseases because its roots lie so deep within human communities.
The beliefs and practices of malaria Prevention are often related to culture
and can influence the effectiveness of control strategies (Rodriguez, Penilla
&Henry, 2003). The transmission is seasonal and unstable and case fatality
is high due to lack of communal immunity. To make things worse, to date, there
is no vaccine or no safe, effective and affordable drug for mass
chemoprophylaxis against malaria. Globally, an estimated half of world
populations are at risk of malaria (FMOH, 2005).
However,
the practice of malaria preventive measures has been related to the knowledge
and belief of people. Within Nigeria, surveys of residents revealed a lack of
knowledge and many misconceptions about the transmission and treatment of
malaria, which could adversely affect malaria control measures and
anti-malarial therapy. The 1998 Roll Back Malaria (RBM) initiative launched in
Geneva by the United Nations Funds (UNICEF), the United Nations Development
Programme (UNDP), the World Bank and the World Health Organization (WHO) is a
people oriented programme that emphasizes community participation.The year 2011
Roll Back Malaria report (RBM, 2011) noted significant success in malaria
control effort worldwide, with the anticipation of “near-zero malaria death in
the next decade if the efforts are sustained”. As part of efforts towards
achieving near-zero death for malaria in the next decade, National and State
malaria control programmes for the development of plans and interventions in
six states (recently extended to four more States), including Ogun State have
contributed immensely to the achievements in malaria control targets in the
focal states, with better results, compared with the achievement in other
states. The transmission of malarial is related to socio-economic changes, such
as population movement and increasing poverty and have been associated with an
increase frequency of malaria epidemics on the African continent.
The
preliminary report of the February 2012 omnibus survey indicate that some
states fared better than other states in the country which gives the impression
of modest achievement through the malaria control indicators and targets.
Despite the modest achievements in focal States and participatory approaches
adopted the States programme reports indicate that there are sustainability challenges.
This is evidenced by the fact that the initiative for planning process (such as
the development of annual operational plan) and support to implement the plan
is yet to be fully adopted and owned by government,there is little or no budget
allocation from the government to malaria control. There is need for concerted
efforts and commitment from government, partner and stakeholders not only to
sustain the modest gains but to also continue to increase the scope and
coverage of the intervention regarding access and demand of interventions and
improving quality for malaria control products and services.
A
major strategy towards sustaining and surpassing the current gains in malaria
control require advocacy,this is described as a process of influencing policy
makers and leaders to show commitment, participate, and support developmental
programmes (The Communication Initiatives Network, 2012). The priority advocacy
issues identified in the State malaria include: institutional performance,
support and access to resource, and visibility for malaria programme. At the
policy and leadership levels, advocacy audiences include policy and decision
makers, community leaders (traditional, religious and social) and programme
managers of health service institutions and facilities collaborated with other
RBM partner organizations to develop the drafts of generic advocacy packages on
malaria control, while the advocacy activities targeted at LGAs authorities and
media organizations at the state level. As part of the sustainability
initiatives programme cycle, and beyond, it is most valuable to advocate
directly to highest policy and decision makers in government for ownership of
the planning process and for budget release to malaria control. An evidence
based advocacy forum with policy makers / decision makers will provide avenue
for achievement of the core elements of policy decision making namely:
understanding the issues; evaluation of the issue to form personal stand; and
weighing for action, based on evaluation of alternative strategies consider to
be achieved (Nicole & James,2007).The forum will provides avenue to
understand the issues through the presentation of policy issues, compare status
of malaria control achievements and programming gaps in the State and across focal
LGAs.
In addition to government, a similar
advocacy forum for mass media executives will serve as avenues to motivate the
mass media executives to own and disseminate messages on the media in order to
sustain the investment in using mass media for demand creation and generic
marketing for malaria control. The advocacy forum will be supported by advocacy
support materials to present hard data in a way that is meaningful to the
priority audiences. School adolescents therefore constitute a formidable community
entry point for the control of malaria under the people-oriented malaria
control strategy-the RBM programme. It is important to look at malaria problems
that grossly affect the morbidity and mortality rate in Ijagun community.
Ijagun is a suburb of Ijebu-Ode.It is the host community of the first
University of Education in Nigeria. It is a rural area with limited access to
portable water and other modern amenities. The environment has lot of bushes
with poor drainage system. The rate at which the staff and students report
malaria infection at the school clinic is on the high side. Therefore, this
study aims to investigate the prevention, control and treatment practices of
malaria among Tai Solarin University of Education staff and students residing in
Ijagun community in order to know the reasons for increase in prevalence of
malaria in study area.
1.2 Statement of the Problem
The increase in the prevalence of
malaria in Nigeria is due to lack of use of insecticide net, lack of use of
indoor residual spray due to high cost and incomplete use of anti malaria
dosage (Erhun, Agbani & Adesanya 2004) which are invariably due to both
behavioural and non-behavioural factors. The behavioural factors relate to some
cultural practices, which promote mosquito breeding and mosquitoes access to
the people as well as the failure of at risk population for the use
technologies proven to be effective for the Prevention, Control and treatment
of malaria promptly and adequately. The non-behavioural factors include geographical
or ecological peculiarities, the availability of mosquitoes and the presence of
plasmodia. While the advancement in technology and other innovations have
contributed a lot in the fight against the disease, the need for the adoption
of these innovations by policy makers and the populace at large is still a
challenge. Some people still see malaria as ordinary illness, while policy
makers at different levels are yet to come to terms with the malaria
burden. Previous studies have shown that
attempt by many professionals in the field of medicine to treat malaria have
met with resistance to the drugs applied (Stephanie, Valderramos & David
2006). Traditionally, chloroquinne is a
common drug for treatment of malaria, however, with the increase in chloroquinne
resistance resulting in the use and adoption of arthemisine combination therapy
(ACT) in the treatment of malaria. Records revealed that there has been a rise
in the incidence of malaria among the staff and student residence in Ijagun
Community. Over 65% of all cases of illness of inpatient and outpatient
reported at the University clinic are malaria infections (monitoring and
evaluation reports of Tai Solarin University of Education health centre, 2015).
Over 50% of the money budgeted for drugs were spent on procurement of
anti-malarials and sometimes not enough. To this end there is a need to explore
the community to find out the reasons for increase in prevalence of malaria in
the community.
1.3 Objective
of the Study
The main
objective of this study is to examine the prevention, control and treatment
practices of malaria among Tai Solarin University of Education staff and
students in order know the reason for increase in prevalence of malaria in the
study area. The specific objectives are to:
1. determine
the demographic characteristics of Tai Solarin University of Education staff
and students;
2. determine
the level of knowledge about malaria transmission among Tai Solarin University
of Education staff and students;
3. determine
the level attitudinal disposition towards malaria prevention and control of
malaria among staff and students of Tai Solarin University of Education;
4. determine
the level of perception about treatment of malaria among staff and students of
Tai Solarin University of Education;
5. determine
the relationship between knowledge of malaria transmission and demographic
characteristic (status) among Tai Solarin University of Education Staff and
Students and;
6. determine
the relationship between attitudinal disposition to prevention and control of
malaria practices and perception of treatment of malaria infection among Tai
Solarin University of Education Staff and Students.
1.4 Research Questions
The following
are the formulating questions for the study:
1. What
are the demographic characteristics of Tai Solarin University of Education
staff and students?
2. What
are the level of knowledge about malaria transmission among Tai Solarin
University of Education staff and students?
3. What
are the attitudinal dispositions against prevention and control of malaria
among staff and students of Tai Solarin University of Education?
4. What
are the levels of perception about treatment of malaria?
5. What
is the association between knowledge of malaria transmission and demographic
characteristic (status) among Tai Solarin University of Education Staff and
Students?
6. What
is the association between attitudinal disposition to prevention and control
practices of malaria and perception of treatment of malaria infection among Tai
Solarin University of Education Staff and Students?
1.5 Hypotheses
H1: There would be significant relationship between demographic
characteristics (status) and level of knowledge of malaria infection among Tai
Solarin University of Education staff and students.
H2: There
would be significant relationship between attitudinal dispositions to
prevention
and control
practices and demographic characteristic (status)
H3: There
would be significant relationship between levels of perception about treatment
of malaria and demographic
characteristic (status).
H4: There
would be significant relationship between levels of perception about of malaria
treatment
and attitudinal disposition to malaria transmission among Tai Solarin
University of Education Staff and Students.
1.6 Scope
of the Study
1. Descriptive
survey research method was adopted for the study
2. Four
hundred (400) staff and students of Tai Solarin University of education in
Ijagun community as sample size
3. The
study variables such as mentioned under the hypotheses: (i) killing adult
mosquito, (ii) killing malaria parasites, (iii) reduction of mosquito breeding,
(iv) use of insecticides treated mosquito net, (v) use of residual house
spraying, (vi)wearing protective clothing, (vii)adequate use of anti-malarial
drugs for treatment(viii) traditional healing, (ix) local shops prescription.
4. Multi-stage
sampling techniques
5. The
use of self-structured questionnaire as instrument for data collection.
6. Six(6)
trained research assistants for the purpose of the study
7. The
use of frequency counts and percentage for the demographic information of the
respondents and inferential statistics of chi-square to test the hypotheses at
0.05 level of significance.
1.7 Significance of the Study
This study would
provide insight into ways for using and maintaining good environmental control,
prevention and treatment of malaria among staff and students of Tai Solarin
university of Education and Ijagun community. This would help in reducing
hospitalization, illness as well as death caused by malaria in the study area.
It would be of benefits to both Federal and States Ministry of Health including
the Health Education Departments in Local Governments, non-governmental
organizations (NGOs), public health workers and the populace in Ijebu-Ode Local
Government. Furthermore, it is hope that the Ministry of Health Education and
Information would make decisions that would benefit members of the public on
Malaria control, prevention, and treatment. This work may also be useful to
future researchers as it would serve as source of information and guidelines
for their work in the area of research and other related topics.
1.8 Justification
for the Study
The malaria situation in the country is
deteriorating despite numerous interventions that have been instituted so far.
The obstacles to the success of these interventions are socio-cultural,
economic and political in nature.Findings from the national malaria situation
survey relating to the preventive health behavior in malaria included the fact
that bed-net use among staff and students was found to be generally low across
the whole country. The ultimate aim for this study is to ensure that staff and
students of Tai Solarin University of Education are taking preventive measures
against malaria, improve upon their recognition of malaria and use of anti-
malarial drugs rationally. Findings from this study would be useful for
bridging the gap in knowledge. In addition, such findings will have useful
implications for evidence-based policy formulation and design of health
promotion and education strategy utilized by the government at all levels
through the various ministries like, Ministry of Environment, Educational,
Health, and Information. The research findings will be a great help to other
researchers. Against this backdrop at the conclusion of this study, the staff,
students and general public should be able to see the factors influencing
control, prevention and treatment of malaria. It is important to promote the
concept of health as a result of the interaction of human beings and their
total environment.
1.9 Operational Definition of Terms
Malaria
Prevention: this is the process of prevention
of malaria before the introduction malaria parasite into the blood stream.
Malaria
Control:This is the process of preventing the
spread of malaria from an infected person to an uninfected person.
Malaria
Treatment: This is the use of drugs to kill
the malaria parasite in the blood.
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