PUBLIC HEALTH PROJECT TOPICS AND MATERIALS ON CAUSES AND EFFECT OF MALARIA IN PREGNANCY AMONG PREGNANT WOMEN ATTENDING PHC GARAKU OF KOKONA LGA NASARAWA STATE
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CAUSES AND EFFECT OF MALARIA IN PREGNANCY AMONG PREGNANT WOMEN ATTENDING PHC GARAKU OF KOKONA LGA NASARAWA STATE
1.1 Background of the study
Malaria infection during pregnancy has also been a major public health problem in tropical and subtropical regions throughout the world. Every year, at least 30 million women in malarious areas of Africa become pregnant most of which live in areas of relatively stable malaria transmission. The physiological changes of pregnancy and the pathological changes due to malaria have a synergistic effect on each other. The risk of abortion, stillbirth, premature delivery, intrauterine growth retardation and low birth weight has been associated with malaria infection in pregnancy (Ebrahim, 2010). Malaria is a disease of wide distribution caused by sporozoa of the genus plasmodium. There are four species of parasites that infect man: plasmodium falciparum, plasmodium vivax, plasmodium malariae and plasmodium ovale. The burden of the disease malaria causes is considerably amounting to 300-500 million clinical cases per year – 80 percent of which occur in Africa. It is responsible for 1 million death per year (Lucas & Gilles, 2008).
The disease according to WHO (2013) is life threatening caused by parasites that are being transmitted from person to person through the bites of infected mosquitoes. Malaria is a major public health problem in Nigeria, accounting for about 60 percent of all out patient attendance and 30 percent of all hospital admissions. Malaria transmission is high all year round with estimated incidence rates of 3.5 and 1.5 percent for children aged 1-2years respectively and 1.5 to 2.5 cases per year to people aged 5 years older (FMOH, 2011).
This disease is caused by single cell parasitic protozoan that are transferred to humans by a particular kind of mosquito. The word “malaria” is derived from medival italiam word mal-aria meaning “bad air” and is based on the mistaken belief in the past that the disease was caused by bad swamp air (Michael, 2007).
According to the latest estimates, there were about 219 million case of malaria in 2010 alone (with an uncertain range of 154 million to 289 million) and an estimated 660,000 deaths with an estimated increase range of 490,00 to 836,000. Though malaria mortality rate have fallen by more than 25 percent globally since the increase campaign in the year 200 and about 33 percent in the African region, most deaths still occur among children living in Africa where a child dies every minute from malaria. Country-lever burden estimate available for 2010 shows that an estimated 80 percent of the disease mortality occur in just 14 countries and about 80 percent of cases occur in 17 countries. Together, the democratic republic of Congo and Nigeria accounts for over 40 percent of the estimated total number of death globally (WHO, 2013).
It is estimated that, there are nearly 110 million clinical cases of malaria and 300,000 deaths per year mostly in young children. The disease is known to account for about 25 per cent of infant mortality, 30 percent of under five child deaths and 11% of maternal deaths. Most death due to malaria occur at home, hence are not reported. Malaria is pregnancy is a public health concern due to its adverse effect on the mother as well as the foetus. In sub-Saharan African where malaria transmission is high and perennial, approximately 25 million pregnant women are at risk of plasmodium falciparum of pregnant women are reported to have evidence of peripheral/placental infection at the time of delivery. The consequences of malaria in pregnancy are grave danger to both mother and foetus (Falade, Fongo and Orimadegum, 2010).
The most common way malaria is transmitted through mosquito bites, it can also transmit via blood transfusion. Those at risk include pregnant women, children and infants and immune-compromised individuals have the highest morbidity and mortality and Africa bears the highest burden. The disease may not be complicated, when it occurs with only the usual signs without any danger sighs, such as fever, malaise, headache, abdominal pains (more in children), nausea and vomiting, bitterness of the month, body pains, weakness, chill, rigor, cough and gastro-intestinal upset. It may also be severe with signs and symptoms accompanied by one or more danger signs, such as convulsion, anaemia, poor development of the brain, abortion, law birth weight, splenonegaly, jaundice, impaired consciousness, bleeding, hypovolaemia, hypoglycaenia, renal failure, nephritic symdrome and death (Global Fund Malaria Round 8, 2012).
Mangiuim (2008), posits that, the single celled microscopic protozoa lives in the blood stream and inside the body organs. There are four different species known to cause malaria in human, plasmodium falciparum, plasmodium vivax, and plasmodium malariae and plasmodium ovale. The vector, female anopheles mosquito spreads the infection through bites. Like other mosquitoes, this species has an aquatic life cycle involving egg laid on the water surface which live and feed beneath the water, but occasionally visit the surface to take in atmospheric air via tubes at the tail end. The larvae then turn into pupae which also move in the water and fly away (usually not far from water).
The same author affirms that, the adult female anopheles takes red blood from human skin. The life cycle of plasmodium begins with a bite from an infected female anopheles mosquito which releases sporoziotes from its salivary gland and enters the blood stream during feeding quickly invading the liver cells (hepatocytes). Sperozoites are cleared from the circulation within 30 minutes. During 14 days in the case of plasmodium falciparum, the larva stage parasites differentiate and undergo sexual multiplication, resulting in tens of thousands of merozzoites which burst from the hepatocytes. Individual merozoites invade the red blood cell (crythrocytes) and undergo an additional round of multiplication , producing 12-16 millions of meroxoites within second. The length of these erythrocytic stage of the parasitic life cycle depends on the parasite species, irregular cycle of plasmodium falciparum, 48 hours for plasmodium vivax and ovale and 72 hours for plasmodium malariae.
The release meroxoites go on to invade additional erythrocytes not all the merozoites divide within seconds. Some differentiate into sexual form, the male gametocytes. These gametocyte are taken by female anopheles mosquitoes during a blood meal gametocyte undergoes a rapid nuclear division, producing eight flagellated micro gamete which fertilize the female micro gamete. The product of this fertilization transverses the mosquito gut walls and encyst on the exterior of the gut, walls as oocyst. The oocyst ruptures then, releasing hundreds of sporozoites into the mosquito body cavity, where they eventually migrates to the mosquito.
According to the Centre for Disease Control (CDC, 2012), prompt and accurate diagnosis of malaria is vital for effective case management the diagnostic investigation of malaria include;
- Examining blood smear for parasites, where there is suspicion of malaria, a various blood specimen in an EDTA (ethylene diamineted acetic acid) tube should be sent to the laboratory under an hour. Where blood films should be obtained over the subsequent 48 hours before excluding the diagnosis. One has to note, that an individual can have malaria despite the negative firm, this is particularly as the case of pregnancy were the parasites biomas can be sequestered in the placenta.
- Rapid diagnostic test (RDT) or dipstid test. This detects parasites antigens that are available and are easier to use for staff without microscopy training, it has less waiting time.
- Parasite nucleic acides are detected using polymerase chain reactioin (PCR).
The current global fund for malaria round 8 intervention for pregnant women are;
- use of insecticide-treated bed nets (LLTNs) or Long Lasting Insecticide Nets
- intermittent preventive treatment to pregnant women in high transmission area.
- Effect case management (diagnosis and treatment of illness).
Women should receive iron folate supplementation to protect them against anaemia, a common occurrence among all pregnant women. Other preventive measure includes
- Vector control is the main way to reduce malaria transmission at the community level
- Indoor-residual insecticide is a powerful way to rapidly reduce malaria transmission. Its full potential is realsed when at least 80 percent of houses in targeted areas are sprayed. Indoor spraying is effective for 3-6 months, depending on the insecticide used and the type of surface on which it is sprayed. DDT (Dichlorodiphenyl-tricholoroethane) can be effective for 9 – 12 months.
- Draining of swamps and paving streets to get rid of pot holes where mosquitoes can breed.
The treatment for uncomplicated malaria is now done with Artemisinin-Based Combination Therapies (ACTs). Arthemether-Lumefantrine (Coartem is the drug of choice). Other approved ACTs can also be used (WHO, 2013).
Plasmodium falciparum is a protozoan parasite one of the species of plasmodium that cause malaria in humans. It is transmitted by the female anopheles mosquito. Malaria caused by this species (also called malignant or falciparum malaria) is the most dangerous form of malaria with the highest rate of complication and mortality (Dondrop, Paraponrant and White, 2004).
As at 2006, there were an estimated 247 million human malarial infection (98% in Africa). It is much more prevalent in sub-Saharan Africa than in many other regions of the world. In most African countries, over 75 percent of cases were due to plasmodium falciparium, where as in most frequent in most other countries with malaria transmission other less virulent plasmodia species predominate. Almost every malaria death is caused by plasmodium falciparum (WHO, 2008).
Collins and Jeffery (2007) opined that plasmodium vivax is a protozoan parasite and a human pathogen the most frequent and widely distributed cause of recurring (Bengntertian) malaria. Plasmodium vivax is one of the species of malarial parasite that commonly infect humans. It is less virulent than plasmodium falciparum which is the deadliest of all the species and is selfom fatal and is carried by the female anopheles mosquito.
Plasmodium vivax is mostly found in the United States, Latin America and in some parts of Africa. It can cause death due to splenoniegaly (pathological enlargement of the spleen) but more often causes debilitating but non fatal symptoms. Over all, it account for 65 percent of malaria cases of Asia and South America. It has been estimated that 2.5 billion people are at risk of infection with this organism.
Plasmodium malariae is a parasitic protozoa that causes malaria in humans. It is closely related to plasmodium falciparum and plasmodium vivax which are responsible for most malarial infections, while found world wide it is also called “Benign” malaria and is not as dangerous as the effect produced by plasmodidum falciparum and plasmodium vivax. Plasmodium malariae causes fever that recur at approximately three days intervals (a quarter fever) than other malaria parasites. Hence, it’s alternate name quartan fever or quartan malaria.
Plasmodium ovale is a species of parasitic protozoa that cause tertian malaria in humans. It is closely related to plasmodium falciparum and plasmodium vivax, which are responsible for most malaria. It is rare compared to the other two parasite and substantially less dangerous than plasmodium falciparum and ovale (which has recently been shown by genetic methods to consist of two sub-species; plasmodium ooval cutisi and plasmodium ovale walokeri). The disease has been and still is the cause of many human morbidity and mortality. Although the disease has been eradicated in most temperature regions, it continues to be endemic throughout many of the tropic and sub-tropic regions of the world.
1.2 Statement of the problem
Malaria in pregnancy is a life threatening disease. The species that causes malaria thrive in tropical areas where the climate is more suitable for the specific mosquito that carry the disease. The people of Garaku of Kokona are suffering this malaria scorch as their pregnant women who form part of the vulnerable groups are constantly seen in their homes and in the clinic with complain of malaria and malaria related illnesses. Further enquiry into some of the causes of this persistent disease plaguing the pregnant women revealed that, there is lack of knowledge and awareness as to observed good environmental sanitation. Socio—economic factor also plays a major role as the cost of taking care of their pregnant state and other family members posses a great challenge. On the other hand accessing the services poses also a problem.
Abiodun (2008) also observed that malaria threaten the lives of over 40 percent of the estimated population of 2.2 billion people and that each year, there are estimated to kill one million people annually majority of whom are pregnant women and their infants. He further stated that, malaria is a leading cause of maternal morbidity and mortality in developing countries like Nigeria. Ahmed (2005) asserted that, malaria in pregnancy is an obstetric, social and medical problem requiring multi-disciplinary and multi-dimensional approach, because pregnant women constitute the main adult risk group for malaria and 8 percent of deaths due to malaria in Africa occur in pregnant women and children under the ages of five years.
Despite the effort of World Health Organization (WHO), Roll Back Malaria (RBM), Society for Family Health (SFH), Federal Ministry of Health (FMOH), Cross River State, Government, Health Care personnel and other government agencies in supporting individual community to prevent and treat malaria by providing free mosquito nets to pregnant women and the under-five children in different countries, intermitted preventive treatment (IPTP) for pregnant women in high transmission areas (currently with ulfadoxine-pyrimethamine) as the provision of arrangement-based combination therapy to children under 5 years of age, it has been observed that the incident of malaria during pregnancy is still on the increase.
It is based on the foregoing that the researcher is up to investigate and proffer solution and the way forward in order to curb or reduce both morbidity and mortality rate resulting from the prevalence of this disease. In the cause of this study, the researcher intends to look at causes and effect of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State.
1.3 Objective of the study
The general objective of this study is to examine the causes and effect of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State, with the following specific objectives:
- To identify the causes of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State
- To examine the effect of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State
- To determine measures that can be adopted in preventing malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State
1.4. Research questions
- What are the causes of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State?
- What is the effect of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State?
- What are the measures that can be adopted in preventing malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State?
1.5. Statement of the hypothesis
H0: There are no causes of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State
H0: There is no effect of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State
H0: There are no measures that can be adopted in preventing malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State
1.6. Significance of the study
The findings of this study will be beneficial to the following:
- Women of child bearing age since it will help them to have the necessary knowledge about the effect of malaria on their health.
- To the healthcare providers and professionals by showing them ways they can make up to meet up with the current strategic intervention to reduce maternal mortality and morbidity caused by malaria.
- The findings will provide new ideas to different organization on measures that could be adopted to eradicate malaria.
- The findings in this study will be of benefit for parents on community and society at large by improving their knowledge on measures of malaria prevention.
- The findings of this study will also be of benefit to environmental health officers because it will enable them discover better methods to adopt in the prevention of mosquito breeding sites.
1.7 Scope of the study
This study was delimited to the causes and effect of malaria in pregnancy among pregnant women attending PHC Garaku of Kokona L.G.A Nasarawa State. This study was in addition delimited to the use of questionnaire as the instrument for data collection. This study was also delimited to a descriptive cross sectional study design using quantitative method of data collection.
1.8 Limitation of study
This study is faced with a lot of limitations and some problems encountered during the project research must not be overlooked such as: problem of finance, a lot of expense was made on the process of collecting the data. Time factor is another problem that delays the collection of data.
1.9 OPERATIONAL DEFINITION OF TERMS
- Malaria: Is a disease caused by parasites that are transmitted from person to person via the bite of infected female anopheles mosquitoes.
- Plasmodium: A genus of protozoan parasites in the red blood cels of animals and human.
- Plasmodium falciparum: a protozoan parasite species of plasmodium that cause malaria in humans. It is transmitted by the female anopheles mosquito. Malaria caused by this species (also called malignant or falciparum malaria) is the most dangerous form of malaria with the highest rate of complication and mortality.
- Tertian: Denoting a form of malaria causing fever that recurs every second day.
- Malignant: Describing a tumour that invade and destroys the tissue in which it originates and can spread to other sites in the body via the blood system and lymphatic system.