CHAPTER ONE

INTRODUCTION

1.1 Background To The Study

Malaria is still an important public health threat in Cameroon with the whole country exposed to the risk of transmission [1]. Malaria is a parasitic infection transmitted by mosquitoes, is one of the most devastating infectious diseases, affecting women, fetuses and newborns globally [2]. Malaria is transmitted when an infected female anopheles mosquito takes a human blood meal and the Plasmodium sporozoites are transferred from the saliva of the mosquito into the capillary bed of the host. Within hours, the parasite will migrate to the liver, where it undergoes further cycling and replication before being released back into the host’s bloodstream [3].

The incubation period, from the time of mosquito bite until clinical symptoms appear, is typically 7 to 30 days. Due to the cycling parasitemia in the bloodstream, patients will often experience symptoms every 2 to 3 days, depending on the type of Plasmodium with which they are infected. In the human, plasmodial infection is a complicated reproductive life cycle involving hepatic and erythrocytic infection. Although significant progress has been made in the recent past, the disease remains prevalent with a high number of suspected cases in health care facilities varying between 3.3–3.7 million per year [3].

Globally, it is estimated to affect between 350 to 500 million people annually and accounts for 1 to 3 million deaths per year [4, 5]. Over 40 per cent of the world’s population are at risk of infection from the parasite which causes malaria [6]. Sub-Saharan Africa (SSA) has the largest burden of malarial disease, with over 90% of the world’s malaria-related deaths occurring in this region [2].

It ranks second among the top ten causes of death in Africa [7,8,9]. Malaria parasite transmission is highly heterogeneous with high and perennial parasite transmission occurring in the forest, coastal and humid savanna areas and low parasite transmission in highlands and seasonal parasite transmission in Sahelian and dry savanna areas [10]. Plasmodium falciparum is the main parasite responsible for over 95% of the cases.

Other human-infecting Plasmodium species circulating in the country include Plasmodium malariae, Plasmodium ovale and Plasmodium vivax. The latter parasite species which was thought to be absent from West and Central Africa in more recent evolutionary times, has now been reported in the country, highlighting the changing pattern of malaria in Cameroon. However, the epidemiological role of this species as well as local vector species competence for this parasite is still to be determined. Up to 52 anopheline species have been reported in the country so far, with 16 recognized as main or secondary vectors [11].

Africa still has the heaviest burden of malaria as 95% of cases and 96% of deaths resulting from malaria are concentrated in SSA [12]. In Central Africa, Cameroon has the third highest number of malaria cases accounting for 12.7% of malaria cases [13]. In 2019, there were 243 malaria cases per 1000 of the population at risk, thereby accounting for 24.3% [14].

Malaria is still a major public health concern in Cameroon as more than 20 million people are at risk of the disease [15]. World Health Organization (WHO) estimates that about 11,000 people die from malaria in Cameroon every year and 30% of all out-patient visits to health care facilities are for malaria, making it a disease of importance in the country [16]. In the South West Region, the proportional morbidity rates of the disease in 2020 and 2021 were 28.4% and 26.7% respectively. The incidence of the disease in 2021 was 103 per 1000 in the region [17]. In the Tiko Health District (THD), there was a slight increase in proportional morbidity from 55.9% in 2020 to 56.5% in 2021[18].

In Cameroon, the disease remains prevalent, varying between 3.3–3.7 million per year [19]. It is the most important public health problem and the first cause of morbidity in all age groups [20]. Report show that it accounts for 40.01% morbidity and 2.2% mortality in the general population, and 4.2% mortality in children less than 5 years. Malaria parasite transmission is highly heterogeneous with high and perennial parasite transmission occurring in the forest, coastal and humid savanna areas and low parasite transmission in highlands and seasonal parasite transmission in Sahelian and dry savanna areas [21].

Plasmodium falciparum is the main parasite responsible for over 95% of the cases [22]. Studies have shown that most of pregnant women demonstrate good knowledge on the causes, symptoms and consequences of malaria in pregnancy. Equally, a study found out that, the dominant malaria prevention practices reported by women were the use of insect repellants (93.3%), netting of windows and doors (71.1%), use of insecticide-treated nets (ITNs) (62.2%) and use of prophylactics (48.9%) while herbal treatment (91.1%) was mostly used for malaria management [2,4].

Furthermore, the study found out that most dominant challenge faced by pregnant women in the management and prevention of malaria in pregnancy was limited access to malaria preventive and treatment drugs (41 or 91.1%), limited availability of ITNs (39 or 86.7%), high cost of malaria prevention and treatment drugs (36 or 80%), high over-the-counter cost of ITNs (25 or 55.6%) and high cost of insect repellant (22 or 48.9%) [5]. Hence, it was concluded that majority of the pregnant women had good knowledge on the causes, symptoms and consequences of malaria in pregnancy. Equally, most use a host of malaria in pregnancy (MiP) prevention and management practices that considerably reduces their vulnerability to the disease.

1.2 Statement Of Problem

Pregnant compared to non-pregnant women are at an increased risk for malaria [23]. Malaria and pregnancy are mutually aggravating conditions. The physiological changes due to pregnancy and the pathological changes due to malaria have a synergistic effect on the course of each other, thus making life difficult for the mother, the child and the treating physician. Falciparum malaria can run a turbulent and dramatic course in pregnant women.

Pregnancies in women living in malaria-endemic regions are associated with a high frequency and density of P. falciparum parasitemia with high rates of maternal morbidity including fever and severe anemia with abortion and stillbirth. This is also associated with high rates of placental malaria consequently low birth weight in newborns caused by both prematurity and intrauterine growth retardation [24]. Globally, prenatal mortality due to malaria is about 1500 per day and in areas where malaria is endemic, 20-40% of all babies born may have a low birth weight [25]. Africa still has the heaviest burden of malaria as 95% of cases and 96% of deaths resulting from malaria are concentrated in SSA [12].

In Central Africa, Cameroon has the third highest number of malaria cases accounting for 12.7% of malaria cases [13]. Malaria is a great problem in Cameroon hampering individual and national prosperity due to its influence on social and economic decisions. The risk of contracting malaria can deter investment both internal and external and affect individual and household decisions making in many ways that have a negative impact on economic productivity and growth.

According to WHO, in some heavy-burden countries, the disease accounts for up to 40% of public health expenditures, 30% to 50% of inpatient hospital admissions, up to 60% of outpatient health clinic visits.

1.3.1 General Research Objective

The general objective of this study was:

To evaluate the knowledge, attitude and practice on Sulfadoxine-pyrimethamine (SP) utilization as a method of malaria prevention among pregnant women in Tiko health district.

1.3.2 Specific Research Objectives

Specifically, the research work seeks;

1. To assess pregnant women’s knowledge of Sulfadoxine Pyrimethamine utilization in malaria in pregnancy in the Tiko health district.
2. To determine the attitude of Sulfadoxine Pyrimethamine utilization in malaria in pregnancy in Tiko health district.
3. To assess the practice of Sulfadoxine Pyrimethamine utilization in malaria in pregnancy among pregnant women attending ANC in Tiko health district.

Check out: Medical Laboratory Project Topics with Materials