CAUSES, SIGNS AND SYMPTOMS, EFFECT AND MANAGEMENT OF MALARIA IN PREGNANCY

ABSTRACT

Malaria in pregnancy has remained a public health challenge in Bauchi Metropolis Nigeria, leading to stillbirths, low birth weight, spontaneous abortion, and maternal deaths. This study investigated the determinants of Causes, signs and symptoms, effect and management of malaria among pregnant women in Bauchi Metropolis, Nigeria. The target group were pregnant women between the ages of 15-49 years old. The study had the following specific objectives: To examine how demographic characteristics of the pregnant women influence malaria Causes, signs and symptoms, effect and management; to establish the prevalence of malaria among pregnant women in Bauchi Metropolis; to examine factors influencing malaria Causes, signs and symptoms, effect and management among pregnant women; and to determine pregnant women‘s knowledge, attitudes, and perceptions of treatment and preventive measures against malaria. The study guided by Kleinman‘s (1980) Explanatory Model (EM) and Health Belief Model (HBM) by Becker (1976). It was a cross-sectional survey research design that adopted a quantitative method of data collection and data analysis. The study used a simple random technique to collect data from respondents during antenatal sessions in Bauchi Specialist Hospital. The study used Krejcie and Morgan (1970) formula and arrived at the sample size of 317 respondents. Data was collected using a closed-ended questionnaire and was analyzed and managed using Statistical Package for Social Sciences (SPSS ver. 22). The study established that maternal age influenced malaria prevalence because more than half of the respondents infected with the disease fall within the age bracket 20 to 29. Poverty was also among the prominent factors that influence malaria Causes, signs and symptoms, effect and management among expectant mothers. On the knowledge of malaria preventive measure usage of insecticide treated nets among the respondents were very low. The study recommends collaboration between line ministries such as Health, Education, Environment, religious leaders, community leaders, and healthcare affiliated NGOs to create awareness and advocacy around malaria, its prevention, treatment and the importance of mosquito treated nets. The study also recommends that pregnant women should be given free ITNs with free malaria treatment as practice in other states of Nigeria.

CHAPTER ONE

1.1 Background of the Study

Malaria is a common disease predominant within tropical areas of the globe. Globally, around 216 million people are infected by malaria yearly killing about 445,000 persons with pregnant women bearing the highest burden of the infection (UNICEF 2017; WHO 2017). Usually, malaria in pregnancy causes distress poor persons in endemic nations, the poorest and most relegated individuals. Most malaria cases and deaths in pregnancy happen within low and middle-income nations, particularly Sub Saharan Africa (PMI 2015). A quite substantial number of pregnant women die unjustly of malaria because of their inability to buy Hospital recommended drugs especially where free malaria pills are not available (WHO 2010).

According to WHO (2007), the consequences of malaria infection during pregnancy for the mother and the fetus may include but not limited to maternal anaemia, spontaneous abortion, premature birth, low birth weight, stillbirth, and intra-uterine growth retardation. Expectant mothers are encouraged to adhere strictly to the three malaria preventive measures recommended by the WHO especially in their first trimester of pregnancy.

South Asia is also an endemic region for malaria transmission with about 1.4 billion persons at threat of contracting malaria. In spite of the improvement in dropping the weight of malaria in pregnancy within the area, pregnant women from deprived social groups or poor households are exposed because they live in poorly built houses that are absorbent for the entry of mosquitoes (Rijken et al., 2012). India, the nation with the maximum number of persons suffering from poverty, has a grave malaria problem among expectant mothers. A report by MOHFW (2014) found that pregnant women from poor households in India with low immunity to malaria were also more vulnerable to maternal anaemia and maternal deaths and those who survived had newborns with low birth weight or stillbirths.

However, in Brazil malaria in pregnancy is connected with poverty and this further makes disease treatment and management very expensive amongst the less privileged persons (Desai et al., 2007). The specified medical concerns of malaria during pregnancy are spontaneous abortion, cerebral malaria, maternal anaemia, low- birth weight, sti1lbirth, and (Guyatt & Snow 2004). According to Sachs and Malaney (2002) opined that apart from medical liability, malaria is a substantial economic problem in Brazil. Malaria, if it remains unmanaged or not well treated, has grave clinical concerns for a pregnant woman. The vulnerability and chances of death from malaria upsurges significantly as expectant mothers infected with malaria are probable to experience many health complications (Dellicour et al., 2010; WHO 2004).

Malaria during pregnancy is a significant public health issue, particularly in Sub-Saharan Africa where pregnant women pay the bill for anti-malarial drugs, bed nets, and transportation to health facilities (Dellicour et al., 2010). Malaria threatens approximately 25 million pregnant women in Africa, resulting in over 10,000 maternal and 200,000 neonatal deaths each year (WHO 2014). Malaria typically affects pregnant mothers residing in rural communities where access to medical care and effective malaria treatment is severely hampered by poverty and the state of the formal medical system (GMAP 2008). Despite the preventive and curative measures in place to tackle malaria in Sub Saharan Africa, in country like the former Gold Coast (Ghana), death due to the disease is common amongst children aged five years and expectant mothers (Adefioye et al., 2007; Alassane et al., 2005; Owusu et al., 2009; WHO 2001).

Filmer (2005) stated that malaria treatment costs can result to interruptions in treatment-seeking behaviour amongst pregnant women in Africa. The costs of malaria in pregnancy are extremely costly, with some households spending a considerably greater amount of their earnings on malaria detection and cure throughout pregnancy than others. Richer households can manage, and spend more on malaria prevention (Chuma et al., 2006). Winch (1996) report that financial burden, poor environmental sanitation are the major impediments to malaria treatment and control during pregnancy.

Malaria has continued to be Nigeria‘s most common parasitic infectious disease amongst pregnant women. Despite the involvement by government and international interventions to eliminate malaria amongst pregnant women, the infection remains quite rampant because of environmental and social factors coupled with unsuccessful intervention plans (PMI 2015). Malaria prevalence is high among low-income families living in rural communities devoid of access to primary health care that accounts for 11% of maternal deaths amongst pregnant women in Nigeria (Peter 2013; FMOH 2015).

Research in Enugu State, Nigeria had shown that the treatment of malaria among pregnant women constitutes a significant problem to families and the health sector. According to Obinna (2013), the financial weight of malaria treatment is high and households bear a larger percentage of this amount because of a high level of indirect costs. To some families, this can be devastating. Similarly, another research in Kwara State, Nigeria also shown that in families controlled by jobless people, expectant mothers find it problematic to show up in health-related centres and to take care of the medical bills for treatment of malaria infection compared to those families controlled by people who had job (Usman et al., 2011).

Bauchi State Agency for the control of HIV & AIDS, Tuberculosis, Leprosy, and Malaria (BACATMA) has been distributing free ITNs to the general public every year to shrink the problem of malaria (BSMOH 2015). Nevertheless, this effort has done little to decrease the load of the infection because considerable importance is given to HIV&AIDS and Tuberculosis. This study, therefore, investigated the determinants of Causes, signs and symptoms, effect and management of malaria amongst pregnant women in Bauchi Metropolis, Nigeria.

1.2 Statement of the Problem

Malaria to a pregnant woman is a grave disease that affects not only the mother but also her unborn child leading to substantial health complications. Previous studies conducted in Nigeria, have neglected the prevention aspect of malaria while investigating its prevalence predominantly in Kwara State in North Central and Enugu State in South-East part of the country. Bauchi Metropolis alone, among the twenty local government areas (sub-counties) of the Bauchi State, carries the highest burden of infection and vulnerability to the effects of malaria with more than 150 maternal deaths occurring in the area between 2017 and 2018 due to the infection. In 2019 alone around 32,000 cases of malaria were reported in Bauchi with about 200 maternal 600 neo-natal deaths (BSMOH 2020; BACATMA 2019).

As such, the potential vulnerability to malaria in the Bauchi Metropolis cannot be only discussed from a bio-medical perspective without looking at the other essential factors that increase vulnerability among people. In an attempt to decrease the weight of malaria incidence rate in the Bauchi Metropolis, it is important to acknowledge the presence of other essential determinants such as economic, socio-cultural settings, and religious beliefs of individuals, especially expectant mothers.

However, scholars have consistently neglected pregnant women in their study of malaria in Bauchi by given much emphasis on other diseases such as HIV&AIDs and tuberculosis even though malaria among pregnant women causes more harm than the two diseases combined. Additionally, because malaria infection among expectant mothers could harmfully impact the well-being of the fetus and his mother, it is significant to examine factors that affect malaria treatment and prevention amongst expectant mothers. This study, therefore, sought to examine the determinants of malaria treatment and prevention amongst expectant mothers in Bauchi Metropolis, Nigeria from a Sociological perspective.

1.3 Purpose of the Study

The objective of this study was to look into the factors that influence of Causes, signs and symptoms, effect and management of malaria amongst women who are pregnant in Bauchi Metropolis, Nigeria. The rationale behind this study was to understand if such determinants influence expectant mothers‘ malaria treatment and prevention. Additional goal of this work was to fill in the gap identified in this research.

1.4 Objectives of the Study

The general objective of the work is to examine the determinants of Causes, signs and symptoms, effect and management of malaria amongst pregnant women in Bauchi Metropolis. The specific objectives are:

1. To examine how demographic characteristics of pregnant women influence malaria Causes, signs and symptoms, effect and management in Bauchi Metropolis.

2. To establish the prevalence of malaria among pregnant women in Bauchi Metropolis.

3. To examine factors that influence malaria Causes, signs and symptoms, effect and management among pregnant women in Bauchi Metropolis.

4. To determine pregnant women‘s knowledge, attitudes, and perceptions of treatment and preventive measures against malaria in Bauchi Metropolis.

1.5 Research Questions

1. How do the demographic characteristics of pregnant women influence the Causes, signs and symptoms, effect and management of malaria?

2. What is the prevalence of malaria among pregnant women in Bauchi Metropolis?

3. What are the factors influencing malaria Causes, signs and symptoms, effect and management among pregnant women in the Bauchi Metropolis?

4. What knowledge, attitudes and perceptions of malaria Causes, signs and symptoms, effect and management do pregnant women have in the Bauchi Metropolis?

1.6 Significance and Justification of the Study

This study was meant to interrogate how determinants of malaria came into play in the Causes, signs and symptoms, effect and management of malaria amongst expectant mothers in Bauchi Metropolis, Nigeria. It is hoped that this study would inform the need to organize regular community meetings to educate the masses on health issues, particularly the risk of malaria in pregnancy and the need to attend ANC or health facilities when pregnant to protect both the mother and the unborn child from this deadly disease.

Malaria is the most common disease amongst women are pregnant that results in maternal morbidity, anaemia, low-birth weight and infant mortality. Thus, the present study is important since it would provide data on determinants or factors influencing Causes, signs and symptoms, effect and management of malaria amongst expectant mothers in the Bauchi Metropolis. It will also shed light on the influence of pregnant women‘s knowledge on preventive measures and health-seeking behaviour concerning the healthcare services provided and their effectiveness so that problems arising from this disease could be recognized early and measures are taken to resolve them appropriately and in good time.

The study will also serve as additional literature to scholars while forming a strong base for researches in related fields.

1.7 Scope of the Study

The study was conducted in Bauchi Metropolis, the Federal Republic of Nigeria. This area of study was selected because it is one of the endemic regions for malaria infection in Nigeria. The study focused on expectant mothers between the ages of 15-

49 years old because they are the most susceptible to malaria due to immunity suppression. Pregnant Women from 15 to 49 years of age were selected, and records obtained from hospital antenatal documentation did not include women over 49 years of age, hence women in this age bracket were excluded from the study. Bauchi specialist hospital was chosen for this study and during antenatal sessions at the hospital, data was collected from pregnant women.

The study examined how demographic characteristics of the pregnant mothers influence treatment and prevention of malaria in Bauchi Metropolis, established the prevalence of malaria among pregnant women in Bauchi Metropolis; examined factors influencing malaria Causes, signs and symptoms, effect and management among pregnant women in Bauchi Metropolis; determined pregnant women‘s knowledge, attitudes, and perceptions of treatment and preventive measures against malaria in Bauchi Metropolis;

1.8 Limitations

Several limitations were encountered during the study. Firstly, convincing some of the study participants to engage in the research was challenging. Therefore, there was a collaboration with health workers which helped in ensuring that respondents were reached. Several respondents were unwilling to disclose confidential information; this also constituted another limitation to the research. This was minimized by convincing the respondents that any information they provided would be treated with the utmost discretion.

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Item Type: Project Material  |  Size: 98 pages  |  Chapters: 1-5

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