Assessment of Knowledge and Utilization of Intermittent Preventive Treatment for Malaria Among Pregnant Women Attending Antenatal Clinic in Jigawa State, Nigeria
– Assessment of Knowledge and Utilization of Intermittent Preventive Treatment for Malaria Among Pregnant Women Attending Antenatal Clinic in Jigawa State, Nigeria –
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ABSTRACT
Malaria remains the most devastating human parasitic infection in the world today. In Nigeria, malaria during pregnancy is responsible for 11% of maternal mortality.
There is low coverage and utilization of IPT services in Nigeria. This study was undertaken to investigate the knowledge and utilization of IPT among pregnant women attending ANC in Jigawa State.
A cross-sectional study was conducted and 420 respondents were recruited using multistage sampling technique.
Semi-structured questionnaire was used to obtain information on sociodemographic and knowledge of malaria and IPT. A total of 420 pregnant were interviewed with age ranged of 15 to 45 years (Mean 24.7±6.1).
Majority 257 (61.2%) of the respondents were within age group 20-29 years. Sixty-four (15.2%) were Primigravidae, 229 (54.5%) were multigravidae and 127 (30.3%) were grand multipara. Majority 413 (98.3%) were married with divorcee and widow making 7 (1.7%) none was single.
Most respondents 307 (73.1%) were rural dwellers. Sixteen percent had at least secondary education; the majority either had Quranic (45.2%) or Non formal education (24.5%) at all.
Most of the respondents (80.7%) were Hausa some 42 (10.0% were Fulani, Kanuri (6.4%) few 2.9%) is formed by other languages.
Majority of the respondents were fulltime House wife, few were Civil servants’ others (18.3%) engage in some petty trading at home.
TABLE OF CONTENTS
ATTESTATION …………………………………………………………………………………………………………………………iii
CERTIFICATION ………………………………………………………………………………………………………………………iv
DEDICATION…………………………………………………………………………………………………………………………….v
ACKNOWLEDGMENTS ……………………………………………………………………………………………………………vi
TABLE OF CONTENTS ……………………………………………………………………………………………………………vii
LIST OF TABLES………………………………………………………………………………………………………………………xi
LIST OF ACRONYMS ……………………………………………………………………………………………………………..xiii
SUMMARY………………………………………………………………………………………………………………………………xv
DEFINITION OF TERMS ………………………………………………………………………………………………………..xvii
CHAPTER ONE………………………………………………………………………………………………………………………….1
INTRODUCTION ……………………………………………………………………………………………………………………….1
1.1 Background Information………………………………………………………………………………………………………….1
1.2 Problem Statement………………………………………………………………………………………………………………4
1.3 Justification………………………………………………………………………………………………………………………..6
1.4 Research Questions……………………………………………………………………………………………………………..7
1.5 General Objectives and Specific Objectives……………………………………………………………………………7
1.5.1 General objectives…………………………………………………………………………………………………………….7
1.5.2 Specific objectives……………………………………………………………………………………………………………7
CHAPTER TWO …………………………………………………………………………………………………………………………8
LITERATURE REVIEW ……………………………………………………………………………………………………………..8
2.1 Malaria Overview of Malaria in Pregnancy…………………………………………………………………………….8
2.2 Malaria Transmission…………………………………………………………………………………………………………..8
2.3 Life cycle of malaria parasites………………………………………………………………………………………………9
2.4 Epidemiology of Malaria ……………………………………………………………………………………………………11
2.4.1 Group susceptible to malaria…………………………………………………………………………………………….12
2.5 Consequences of Malaria in Pregnancy ………………………………………………………………………………..12
2.6 Current Practices in Preventing Malaria in Pregnancy in Nigeria …………………………………………….13
2.7 Overview of Intermittent Preventive Treatment for Malaria (IPTp)………………………………………….14
2.8 Safety of Sulfadoxine-Pyrimethamine ………………………………………………………………………………….14
2.9 Use of SP for Intermittent Preventive Treatment……………………………………………………………………15
2.10 Determining Gestational Age for SP Administration ……………………………………………………………15
2.11 Dosage of SP…………………………………………………………………………………………………………………..16
2.12 Gestational Age at First ANC Visit ……………………………………………………………………………………17
2.13 Knowledge on Malaria……………………………………………………………………………………………………..18
2.14 Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp)………………………………………..19
2.15 Knowledge of Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) …………………..20
2.16 Factors that influence IPT Utilization…………………………………………………………………………………21
CHAPTER THREE ……………………………………………………………………………………………………………………23
METHODOLOGY …………………………………………………………………………………………………………………….23
3.1 Study Area ……………………………………………………………………………………………………………………….23
3.2 Study Designs …………………………………………………………………………………………………………………..24
3.3 Study Population……………………………………………………………………………………………………………….24
3.3.1 Inclusion Criteria ……………………………………………………………………………………………………………24
3.3.2 Exclusion Criteria …………………………………………………………………………………………………………..25
3.4 Sample Size Determination…………………………………………………………………………………………………26
3.5 Sampling Technique ………………………………………………………………………………………………………….27
3.6 Study Instruments ……………………………………………………………………………………………………………..30
3.7 Data Collection Methods ……………………………………………………………………………………………………30
3.8 Data Management ……………………………………………………………………………………………………………..31
3.8.1 Measurement of variables………………………………………………………………………………………………..31
3.8.1.1 The independent variables: ……………………………………………………………………………………………31
3.8.1.2. Dependent variables…………………………………………………………………………………………………….31
Use of IPTp (IPT Utilization) …………………………………………………………………………………………………..31
3.8.2 Statistical Analyses…………………………………………………………………………………………………………32
3.9 Ethical Considerations……………………………………………………………………………………………………….33
3.10 Limitations……………………………………………………………………………………………………………………..33
CHAPTER FOUR………………………………………………………………………………………………………………………35
RESULTS …………………………………………………………………………………………………………………………………35
4.1: Socio-demographic characteristics ……………………………………………………………………………………..35
4.2 Gestational Age at First ANC Booking ………………………………………………………………………………..37
4.3 Knowledge of Malaria ……………………………………………………………………………………………………….38
4.4 Knowledge of IPTp……………………………………………………………………………………………………………41
4.5 Utilization of SP among the studied subjects…………………………………………………………………………45
Table 10: Multi Variable Analysis of some Determinants 0f IPT immunization …………………………………49
CHAPTER FIVE ……………………………………………………………………………………………………………………….50
DISCUSSION……………………………………………………………………………………………………………………………50
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS……………………………………………………55
6.1 CONCLUSION…………………………………………………………………………………………………………………55
6.2 RECOMMENDATION ……………………………………………………………………………………………………..56
REFERENCES ………………………………………………………………………………………………………………………….57
APPENDICES …………………………………………………………………………………………………………………………..67
INTRODUCTION
Malaria remains the most devastating human parasitic infection in the world today.1 Currently, it is estimated that between 1-2 billion people throughout the world lives in areas at risk of malarial infection and
each year up to 500 million people contract the disease out of which 1.7 million to 2.7 million people die.1 Several recent reports indicate that more than 90% of these causalities are from Africa, south of the sahara where the most virulent species of the parasite Plasmodium Falciparum thrives.
Malaria is hyper endemic in all parts of Nigeria, which lies in the tropical region of Africa, with the entire population of an estimated one hundred and sixty million at risk.
Transmission occurs all year round with seasonal variations during the rainy season. Malaria is the number one cause of morbidity in Nigeria accounting for ninety percent of all out-patient illnesses, sixty percent of all admissions and thirty-three percent of all deaths in children under five years.
2,3 Clinical features of malaria appear around the fourteenth day after an infectious bite but may vary with the different species of the Plasmodium parasite.
Common symptoms include fever, headache, vomiting, joint pains, diarrhea, flu-like symptoms and others.
Anaemia occurs as a result of breakdown of the infected red blood cells, increased splenic sequestration of uninfected red blood cells as well as decreased erythropoesis in the light of malaria disease.
In pregnancy, haemodilution that occurs in addition to diminishing stores of iron and folate increases the rate of anaemia.
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