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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