Abstract

Malaria remains a public health problem in Africa and sub-saharan Africa, Cameroon not left out and especially in the vulnerable groups such as pregnant mothers. However, misconceptions about it exist. This study Assessed mothers’ knowledge and practices on the prevention of Malaria in pregnancy with the mile 16 health area of the Buea health district.

A community based and descriptive cross-sectional study design was conducted in the mile 16 health area of the Buea health district. A questionnaire was used to collect data on socio-demographic variables, knowledge and practices on the prevention of Malaria in pregnancy from 122 respondents. Of the 122 respondents interviewed,100% had heard about Malaria.

The health facility, community health worker, and Personnel from Malaria campaign was the most popular source of information (73.0%). Family members, friends, television, radio also provided considerable information on Malaria awareness. 84.4% accepted high temperature as the most common sign of Malaria. With all aspects of Malaria combined, there was significant knowledge inadequacy (P<0.001, far <0.05). There was no significance of knowledge with educational level(P=0.454).

Overall, 93.4% accepted that Malaria can be prevented and 86.9% used mosquito nets to prevent Malaria,72.1% accepted draining stagnant water as another preventive measure. Prevention of Malaria showed no significance with the level of education (P=0.105) as, irrespective of educational level, the majority accepted that Malaria can be prevented.

Irrespective of the level of education, a good number of respondents still did not have bed nets (P=0.755)

CHAPTER ONE

GENERAL INTRODUCTION

Introduction

Malaria is a serious parasitic infection caused by a parasite called plasmodium that commonly infects a certain type of mosquito that feeds on humans called the Female Anopheles mosquito. It is characterized by very high temperatures, chills, headache, muscle aches, tiredness, nausea, vomiting, and diarrhea. (Center for Disease Control and Prevention; 2021).

In the past years and centuries, it was initially referred to as “bad air”. Malaria has been predominant in developing countries especially in the tropical rainforest zones.it has been a public health problem up to date in developing countries. (CDC; 2021).

It is ancient but still remains a major public health problem in Cameroon and the major cause of death worldwide. Despite being preventable and treatable, Malaria continues to have devastating effects on people’s health and livelihood around the world. Globally, approximately about 216milion cases of Malaria occur annually.

Approximately 445.000 deaths were attributed to Malaria in 2016 with 91% of deads recorded in Sub-saharan Africa. In Cameroon, about 2milion cases were registered by the national surveillance system with up to 4000 deads attributed to Malaria yearly. In malarious endemic areas, pregnant mothers are at high risk of contracting the disease with severe outcomes compared to their non-pregnant peers. (CBK Seilinous: 2020).

Malaria is commonly associated with poverty and has a significant negative effect on economic development. In Africa, it is estimated that it results in losses of US$12billion a year due to increase cost, cost ability to work, and adverse effects on tourism. (Greenwood BM, Bojangk, Whitty CJ, Target GA:2005).

Malaria affects people of all ages groups, from neonates to the elderly. It affects both men and women. People are always in constant exposure to mosquito bites, especially in the developing world. As it continues to affect everyone, pregnant mothers and lactating mothers are not left out. In spite of the available medical equipment and skilled personnel, the spread of Malaria is still rampant.

Pregnant Mothers with Malaria usually become severely ill if immediate interventions are not met. Additionally, lack of preventive measures and the possible knowledge about Malaria especially in pregnancy can cause severity and complications such as anemia, stillbirth, and even death. Mothers may be protected but still emerge infected presenting with signs and symptoms such as pyrexia, headache, joint aches, muscle aches, and so on.

Adults who have survived repeated Malaria attacks throughout their lifetime may become partially immune. In mothers including pregnant mothers, changes in the immune system during pregnancy and the presence of a new organ (the placenta) with new binding sites for parasite, pregnant mothers lose some of their immunity to Malaria infection (CDC; 2018).

Malaria in pregnancy is a public health concern and is a major cause of maternal morbidity and infant mortality worldwide and leads to poor birth outcomes most especially in the developing countries of Africa, South America, and some parts of Asia.

Pregnant mothers are more prone to complications of Malaria infection than non-gravid women despite preventive measures employed by health care facilities. It’s still a call for concern (Blair J Wylie; 2020). Malaria is a broader problem but the researcher is concerned with assessing mothers’ knowledge and practices on the prevention of Malaria in pregnancy.

The researcher being a nurse has discovered that despite measures put in place, Malaria in pregnancy is still rampant causing high maternal morbidity and pregnancy complications. Mothers and pregnant women despite ANC, still presented with Malaria in pregnancy and its fatal complications.

It is well known that everyone exposed to this infection taking precautions and preventive measures stays strong and healthy and delivers safely excluding complications that could arise from Malaria. Due to the continuous presence and occurrence of cases in pregnancy, the researcher is out to Assess mothers’ knowledge and practices on the prevention of Malaria in pregnancy.

The study assessed mothers’ knowledge and practices on the prevention of Malaria in pregnancy. This chapter will discuss the background of the study, problem statement, research questions, hypothesis, research objectives, the scope of study and limitations of the study, the significance of the study, and definition of terms.

Background to the Study

Adequate knowledge and practices in the prevention of Malaria can help in reducing the growing burden of Malaria amongst the vulnerable particularly mothers and pregnant women. Malaria is a major public health problem in ninety-one countries worldwide with Sub-saharan Africa bearing 80% of the disease (Malar J;2019).

Malaria remains endemic in the majority of the towns and villages in Cameroon, the mile 16 health area not left out, where the parasite disproportionately affects mothers both pregnant and non-pregnant. In pregnancy, Malaria increases the risk of maternal anemia, spontaneous abortions, stillbirths, premature deliveries, IUGR, low birth weight babies.

The scope of malaria control is changing worldwide with more emphasis on community and individual participation. Health education can improve participation in Malaria control, when such Education is designed to address gaps in knowledge and practices of individuals in the communities (CDC; 2016).

Adequate knowledge in Malaria and preventive measures and practices is of vital importance as it guarantees the safety of not only the mother in pregnancy but also of the growing fetus. This study assessed the knowledge and practices of mothers on the prevention of Malaria in pregnancy in the mile 16 health area of the Buea health district, South West Region of Cameroon.

Buea Health District is in the South West region of Cameroon, Buea subdivision, Fako division. The Buea health district covers an area of 366km². It is divided into the Molyko health area, Bova health area, Muea health area, Mile 16 health area, Buea town heath area, and so on. Mile 16 is one of the health areas in the Buea health district.

Malaria is caused by five species of parasites of the genus Plasmodium that affect people (P. falciparum, P. vivax, P. malariae, P. ovale, P. knowlesi). Malaria due to P. falciparum is the deadliest, and it predominates in Africa, Cameroon in particular. P. vivax is less dangerous but widespread and the other three species are found much less frequently. (WHO 2013).

Late presentation of patients in the health facilities is associated with fatal outcomes. This is largely due to modes of approach to Malaria treatment known by mothers which include buying drugs from chemist shops, taking traditional medicine, attending prayers, and sometimes taking no actions at all. Several factors such as educational level, family income, and occupation are known to increase mothers’ knowledge about Malaria and its prevention (Norah & Sarma 2012).

Mothers who are knowledgeable about the disease are likely to use proper preventive measures by employing appropriate practice measures and reporting to the health facility in time. Knowledge, therefore, plays a very crucial role in the reduction of morbidity, mortality rates, and pregnancy complications associated with Malaria (Delibew et al., 2012).

Despite detailed understanding of the complex epidemiology of the parasite, vector host interaction, and treatment, Malaria continues to be a leading cause of maternal morbidity and infant mortality amongst mothers, pregnant and non-pregnant living in impoverished communities across Africa, Cameroon in particular (Charlier et al 2007).

It is therefore important that health care providers understand the mother’s knowledge and practices on the prevention of Malaria in pregnancy so as to avoid complications that may arise because of this infection and hence maximize maternal and child health.

Problem Statement

Every year the government and the private sector have been training health care professionals in health care training schools and institutions and sending them to various hospitals in various communities.

This is in line to educate especially pregnant or non-pregnant mothers about Malaria and practices aimed at preventing its hazardous effects in pregnancy. This is to help solve some of the problems and complications that arise with this infection in pregnancy.

In the same vein, seminars are being organized for nurses, midwives, epidemiologists, and so on, to share considerable knowledge, skill, and expertise in educating, introducing new approaches, and above all identifying the areas of endemicity and others. Malaria is a disease that’s clearly observed in every community and neighborhood.

As a nurse in the field, I have observed that, even with the existing medical equipment and knowledge, when not properly used in the community, neighborhood, or in hospital, mothers face a lot of challenges combatting Malaria, especially in pregnancy.

The surge in cases of pregnancy with Malaria has become a problem in the community and health care team leading to a poor prognosis. In our hospitals, little is being done to curb the incidence of Malaria as greater effort is focused on treatment rather than education on practices aimed at preventing its endemicity.

Although education is an important measure in the prevention of Malaria especially in pregnancy, it is often neglected by many health professionals including nurses who believe that mothers already have the knowledge about this pathology and how to prevent it.

They also believe that treatment is more important than prevention mindful of treatment by prophylaxis. Malaria in pregnancy limits the chances of a safe at-term delivery in mothers and also increases maternal morbidity and mortality. In our communities, little is being done to remedy this situation.

Literature has revealed that Malaria is deadly via its severe complications, especially in pregnancy. The absence of good medical equipment, good Education, and knowledge deficit affects pregnant women. Failure of women to use LLITNs has exposed health care workers to difficulties when catering for these Patients or clients.

As a result, our society keeps witnessing a constant presence of Malaria and the rise in cases regarding pregnancy.

This endemicity of Malaria and its incidence is being attributed to knowledge deficit and other factors such as ignorance, noncompliance to preventive practices, poor environmental hygiene, the influence of some cultural practices, and sometimes socioeconomic factors. It’s as a result of these consequences to this problem that the researcher set in to Assess mothers’ knowledge and practices on the prevention of Malaria in pregnancy in the mile 16 health area.

Research Questions

General research question

What are mothers’ knowledge and practices on the prevention of Malaria in pregnancy in mile 16 health area of Buea Health District?

Specific research questions.

1. How knowledgeable are mothers on the prevention of Malaria in pregnancy in the mile 16 health area of Buea Health District?
2. What are the various practices employed by mothers in the prevention of Malaria in pregnancy in the mile 16 health area of Buea Health District?
3. What are the challenges mothers face in preventing Malaria in pregnancy in the mile 16 health area of Buea Health District?