CHAPTER ONE

INTRODUCTION

Background of the study

Malaria is caused by parasites of the genus Plasmodium and transmitted by female Anopheles mosquitoes. There are five different human malaria species such as P. falciparum, P. vivax, P. malariae, P. knowlesi and P. ovale.

In 2016, an estimated 216 million cases of malaria and 445,000 deaths occurred worldwide. Most, (90%), malaria cases and 91% of all malaria death in 2015 and 2016 were reported from the WHO African Region. Of the 91 countries reporting indigenous malaria cases worldwide, around 80% of the total cases were from sub-Saharan African countries (WHO, 2015).

Malaria during pregnancy is a serious public health problem in sub-Saharan Africa. It is estimated that each year approximately 25 million pregnant women in sub-Saharan Africa live at risk of P. falciparum malaria infection (WHO, 2016). Two institution-based studies done among pregnant women attending antenatal care (ANC) in Nigeria showed the prevalence of malaria to be 41.6% and 7.7%.

Another institution based study in Eastern Sudan showed 13.7% of pregnant women were infected with P. falciparum. Studies conducted in Burkina Faso, and Malawi also showed the prevalence to be 18.1%, and 19% respectively. Besides, two institution and one community-based studies conducted in different parts of Ethiopia also showed the prevalence of malaria among pregnant women to be between 2.83 and 16.3%. (WHO, 2017).

Malaria infection during pregnancy causes an enormous risk to the mother, fetus, and neonates. Indeed although malaria during pregnancy might be asymptomatic due to a high level of acquired immunity in mothers residing in high transmission areas, it is still associated with an increased risk of maternal anemia, spontaneous abortion, stillbirth, prematurity, and low birth weight. Moreover, severe maternal anemia increases the mother’s risk of death. Malaria related anemia is estimated to cause as many as 10,000 maternal deaths each year in Africa.

Different risk factors for malaria among pregnant women were identified by previous studies. These include educational status, age, ANC visit, gestational age, parity, gravidity, and ITN utilization.

Beyond the impact of malaria on children and pregnant women, it affects the general population. 100% of the total population of Nigeria is at risk of malaria and at least 50% of the total population suffers from at least one episode of malaria each year (WHO, 2011). About 51% of malaria cases and deaths in Nigeria occur in rural villages away from effective diagnostic or treatment facilities (WHO, 2013).

Malaria cases and deaths have been increasing in the country, mainly due to injudicious use of antimalarial drugs, delayed health seeking, and reliance on the clinical judgment without laboratory confirmation in most of the peripheral health facilities (Vander et al., 2015). Despite evidence of the cost effectiveness of improving because of a lack of health care close to their homes or because their condition is not diagnosed by health workers (WHO, 2016).

1.2 Study area

Hadejia (also Hadeja, previously Biram) is a Hausa town in eastern Jigawa State, northern Nigeria. The population was approximately 105,628 in 2016. Hadejia lies between latitude 12.4506N and longitude 10.0404E. It shared boundary with Kirikasamma Local Government from the East, Mallam Madori Local Government from the North, and Auyo Local Government from the West. The Hadejia Local Government consist of eleven (11) political wards namely: Atafi, Dubantu, Gagulmari, Kasuwar Kofa, Kasuwar Kuda, Matsaro, Majema, Rumfa, Sabon Garu, Yankoli and Yayari. Inhabitant are dominantly Hausa, Fulani and Kanuri with some other groups such as Tiv, Yaroba, Igbo, Igala etc.

The dominant occupation of the inhabitants is crop farming and animal rearing which a considerable percentage, engaged in trading, fishing and services including civil service. The people of Hadejia arelargely Muslim, although some follow indigenous belief systems. The town lies to the north of the Hadejia River, and is upstream from the Hadejia-Nguru wetlands. Hadejia is an internationally important ecological and sensitive zone.

Figure1.1: Map of Jigawa state, showing the study area in pink colour. Source filed survey, 2015.

1.3 Statement of problem

Of the estimated 50 million pregnancies that happen every year worldwide, roughly 25 million is thought to happen in developing nations. The pregnant women and their children are believed to be the mostly attackable to malaria. Whereas several initiatives have been implemented over the years to control malaria in pregnancy, none of these has succeeded in its entirety.

Without any intervention, malaria would cause 10, 000 of these women and 200, 000 of their infants death as a result of malaria infection and severe malarial anaemia. Developing countries (or rather tropical countries) are thought to bear the global brunt of malaria in pregnancies in addition to the unfinished business of HIV/AIDS and other communicable disease like Tuberculosis.

Malaria in Nigeria and the rest of African countries is recognized as the leading public health problem. Jigawa State implemented anti malaria control programme which is called National Malaria Elimination Programme (NMEP) with the goal of significantly reducing the burden of disease consequent upon malaria. In spite of the successes chalked in the implementation, there is still a lot to be achieved by way of reduction in the incidence of malaria. Apart from the uptake of Intermittent Preventive Treatment (IPT) by the pregnant women, there is also a default in the doses of those who take drugs otherwise not prescribed by any medical practitioners which is very dangerous to their health. A significant proportion of the expectant mothers take IPT only once, twice or sometimes the thrice which is the recommended dosage regimen of IPTP.

Malaria is endemic in Nigeria and in Jigawa State. It is both a cause and consequence of underdevelopment and remains one of the leading causes of morbidity and mortality in the State. Hospital surveysss8   show that it represents over 60% of outpatient visits and similarly answerable for 30% and 11% mortality in children under five and pregnant women respectively. It is on this note that this study sets to investigate the prevalence of malaria among pregnant women and its health implication among selected patients in Hadejia General Hospital, Jigawa State, Nigeria.

1.4 Objectives of the Study

The aim of this study was to determine the prevalence of malaria among pregnant women and its health implication among selected patients in Hadejia General Hospital, Jigawa State, Nigeria

1.4.1 Specific objectives of the study

1. To examine the prevalence of malaria infection among selected patients in Hadejia General Hospital, Jigawa State
2. To investigate the knowledge and practice of pregnant women to malaria diagnosis in Hadejia emirate
3. To find out the awareness programme on malaria infection made available by the Jigawa State Ministry of Health to control malaria among pregnant women

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