PREVALENCE OF MALARIA AMONG CHILDREN BETWEEN 0-5
YEARS IN SANGERE COMMUNITY OF GIREI LOCAL
GOVERNMENT, ADAMAWA STATE
BY
AINA SOLOMON
DL/HC/17D/0073
1
TABLE OF CONTENTS
CHAPTER ONE .................................................................................................................. 4
1.0 INTRODUCTION ......................................................................................................... 4
1.1 Background of the Study ............................................................................................... 4
1.2 Statement of the Problem ............................................................................................... 5
1.3 Aim of the Study ............................................................................................................ 6
1.4 Objective of the Study ................................................................................................... 6
1.6
Significance of the Study .......................................................................................... 6
1.7 Limitations of the Study................................................................................................. 6
CHAPTER TWO ................................................................................................................. 7
LITERATURE REVIEW .................................................................................................... 7
2.1 Epidemiology of Malaria. .............................................................................................. 7
2.2 The Role of Climate on the Spread of Malaria ............................................................ 11
2.3 The Parasite .................................................................................................................. 11
2.3.1. Life Cycle of Malaria Parasite ................................................................................. 12
2.3.1.1. Human Cycle ........................................................................................................ 12
2.3.1.2. Mosquito Cycle ..................................................................................................... 13
2.4 The Vector ................................................................................................................... 16
2.5 The Host Factor............................................................................................................ 16
2.6 Pathology and Clinical Manifestations ........................................................................ 17
2.7 Mode of Transmission ................................................................................................. 17
(a) Vector Transmission/Direct Transmission ............................................................... 17
(c) Congenital Transmission .......................................................................................... 18
2.8 Diagnosis and Treatment of Malaria............................................................................ 19
Treatment and Chemoprophylaxis of Malaria ................................................................... 19
2.9 Control of Malaria...................................................................................................... 21
2
CHAPTER THREE ........................................................................................................... 24
RESEARCH METHODOLOGY....................................................................................... 24
3.1 Research Design........................................................................................................... 24
3.2 Study Area ................................................................................................................... 24
3.3 Study Population .......................................................................................................... 24
3.4 Sampling Technique .................................................................................................... 24
3.5 Instrument of Data Collection ...................................................................................... 25
3.6 Method of Data Analysis ............................................................................................. 25
REFERENCES .................................................................................................................. 26
APPENDIX ........................................................................................................................ 30
3
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the Study
Malaria is an infectious disease caused by a parasite known as plasmodium which infects
red blood cells, is transmitted to human from person to person through the bite of an
infected female anopheles’ mosquito (Benson, 1985)
The disease is caused by one of’ the four (4) species of protozoa of the genus plasmodium
to which humans are susceptible; they are plasmodium falciparum, plasmodium malaria,
plasmodium ovale and plasmodium vivax. The disease occurs throughout the tropical and
subtropical regions and it can occur also in temperate climate if the condition of’ the
temperature is favorable for the plasmodium to complete their life cycle as mosquito. The
plasmodium falciparum is the most virulent in all parts of’ Africa, accounting for up to 98%
of the cases in Nigeria and is associated with significant morbidity, mortality and also
responsible for all features of severe malaria. The other species which include Plasmodium
malaria, Plasmodium vivax and Plasmodium ovale are still found sporadically in some
temperate regions in the Nigerian context and most levers are not all malaria Fever. The
rule of’ thumb is 24 hours before journey to malarious country and continuous 14 days after
exist. according to Djo and Briggs (2000) that the parasite can be transmitted through these
ways, firstly infected anopheles’ mosquito bite, secondly through transfusion of’ blood that
was already infected with malaria parasite and thirdly through the use of’ unsterilized
syringe and needles during injection that has been contaminated with the parasite.
Furthermore, malaria infection may have diverse catastrophic effect in pregnant women
and children under 5years raging from mild to severe which lead to miscarriage or maternal
abortion, anemia and maternal death to pregnant woman and also death of’ under five (5)
years children in Nigeria and our communities. The disease is characterized clinically by
fever, headache, chills, rigour vomiting, and malaise, general weakness of’ the body
anorexia (loss of’ appetite) and profuse sweating. The risk of malaria is higher in the rural
areas but the disease is also in urban areas where they have poor environmental sanitation.
The disease starts when an infected female anopheles mosquito bites and inject parasite
into the human blood stream while feeding. These threads make Parasite disappear from
the blood about half’ an hour known as “pre-erythrocyte schizoids’ this last for 5 to days,
schizoid burst to release Merozoites invade blood cell (RBC) and become trophoziote
4
which mature in the large schizoid. During the second feeding the mosquito inoculates the
ingested parasite into a healthy person and this is the commonest mode of infection (Ojo,
1982). The federal ministry of’ health (FMOH), (1990) stated that malaria remains one of’
the leading causes of’ morbidity and mortality among pregnant women and children in the
tropical especially in Nigeria communities. The Roll Back Malaria programme (RBM)
initiative came as a result of the commitment by the former Director General of World
Health Organization, Dr Gro Harlem Brundtland. She, in conjunction with other
organizations including, United Nations International Children Education Fund (UNICEF),
United Nation Development Programmed (UNDP) and WORLD BANK, initiated this
project targeted at reducing the morbidity and mortality of malaria in African region by
50% by year 2010. Nigeria showed a strong commitment by hosting the first Africa malaria
summit at Abuja on 25th April 2000. The malaria is a burden worldwide by the year 2000
through multination approach (Bola, 2004).
The federal government of’ Nigeria has demonstrated her political commitment to the
initiative by hosting the Africa summit on Roll back Malaria (RBM) in Ahuja in April 2000
which resulted in signing of’ the African summit on RBM. OBIONU (2001) defined as the
number of people in a population who have the disease, both new and old cases at a given
point in time. He further added that prevalence depends on the incident and the duration of
that prevalence disease and this relationship is expressed mathematically as thus.
Prevalence Rate = incidence rate X average duration. The disease is still a scourge of
mankind in Sengere Community, Girei LGA of Adamawa state. Where its’ average still
remains uncontrolled, the malaria disease in Sengere community for children from 059months of age.
1.2 Statement of the Problem
Malaria is a serious illness that negatively affects the wellbeing of human beings. The
disease has no restriction of age status and gender it has been revealed to be more severe
among children whose ages range between (O-5years). Records from public and private
clinics revealed that malaria and its related cases are still rampant in rural areas of Girei
local Government area of Adamawa State which affects Children, adults, old age,
especially pregnant mothers and Children between age 0— 59months old.
5
Observations indicate that most parents spend a lot on their children and other dependents
over the treatment of malaria, this affects their wellbeing and state of health of the families
lining in the area as well as their economic status respectively.
1.3 Aim of the Study
The aim of this study is to determine the prevalence of malaria disease among children of
0 to 5 years in Girei LGA Adamawa State.
1.4 Objective of the Study
1. To determine the prevalence of malaria among children between 0-5years of age in
both male and female
2. To suggest relevant drugs that are recommended for the management of malaria
disease.
3. To promote community sensitization and awareness of malaria control and
management at the community level
1.6 Significance of the Study
1. Assist the government to know the level of Malaria infection in that local
government among children.
2. Assist in identifying the relevant drugs to treat the disease.
3. Sensitize the inhabitants on health education such as keeping of healthy
environment.
1.7 Limitations of the Study
This work is limited to the study of prevalence of Malaria among children between the age
0-5years in Girei Local Government Area, Adamawa state.
6
CHAPTER TWO
LITERATURE REVIEW
2.1 Epidemiology of Malaria.
Malaria, a mosquito-borne Protozoa disease, is older than recorded history; and probably
plagued prehistoric man. The first record of a treatment for the disease dates from 1600
AD, in Peru, and utilized the quinine rich bark of the cinchona tree (Garnham, 1966).
Scientifically, it is not a newly described disease.
Approximately 40% of the world’s population lives in regions where malaria transmission
is endemic, mainly tropical and subtropical regions (Aultman et al., 2002). Malaria has
been successfully controlled, in fact effectively eliminated, in temperate regions of the
world (Sachs and Malaney, 2002). The control strategies employed in temperate regions
included changes in agricultural and construction practice reducing the availability of
standing water and targeted vector control using insecticides such as DDT (Greenwood and
Mutabingwa, 2002). Industrialization and improved housing conditions were instrumental
in the elimination of the disease in temperate countries (Budiansky, 2002). The role of
mosquito in the life cycle of P. falciparum requires that the parasite be able to maintain an
extended infection in order to ensure transmission ability during the following season (Kyes
et al., 2001). Now that the sequences of the three participants in the life cycle of human
malaria, Plasmodium species, Anopheles species, and Homo sapiens, are all complete and
available in endemic areas, perhaps new strategies of disease control will succeed.
Malaria is distributed mainly between latitudes 450-670 south (Clyde, 1981). These regions
embrace about 102 countries or areas of the world reported with indigenous malaria. These
areas are typically in the tropical belt.
In studying the malaria situation and distribution, China and India have continued to report
downward trends. However, the malaria situation continues to deteriorate in rural area
where intensive economic, social, behavioural and technical factors are taking place,
particularly in Asia and America, while in the remaining area, it is fluctuating.
African countries lying in the tropical belt have been known to be highly endemic for
malaria, particularly in the early 1970s when malaria deaths were estimated to be in the
order 9, 750,000 annually.
The most common type of malaria caused by P. vivax occurs in the temperate regions,
whereas P. falciparum is largely confined to the tropics, P. malariae is considerably rarer
and has a focal distribution, P. ovale, rather than P. vivax is the benign relapsing fever in
7
West Africa but it is found less frequently in other parts of Africa. This pattern of
distribution is because P.vivax (not P. ovale) requires Duffy blood group receptors on
erythrocyte membrane and these receptors are lacking in many Africans, particularly west
African (Miller et al., 1976).
Chloroquine-resistance and P. falciparum malaria has now been confirmed in more than 40
countries, but the situation tends to deteriorate further, especially in Africa, as the drug
pressure on the parasites increase in the absence of substantive vector control.
Sulfadoxine/pyrimethamine resistance has now been reported from 11 countries and
resistance to mefloquine reported in the Philippines, the United Republic of Tanzania and
Thailand. P. falciparum continues to be sensitive to these drugs in Middle America, the
Caribbean, West Africa and most countries in Asia, west of India.
Figure 1 shows global distribution of malaria as shown in the world map. The unshaded
region shows areas (which occupies 28% of world population) where malaria either never
existed or disappeared without specific anti-malaria measures, while the doted areas
correspond to region (16% of the world population), in which the disease has been
eliminated during recent decade by the general improvement of health service, changes in
the environment and successful anti-malaria activities and the striped regions correspond
to region (about 50% of world population), in which anti-malaria measures are carried out
because of the prevalence or endemicity of the malaria disease (WHO, 1986).
In many of these areas the health infrastructure is not sufficiently developed to ensure that
the favorable epidemiological situation is maintained. Their epidemiological situation is
precarious as they are under the constant threat of intensification and spread of specific
malaria problems, such as resistance of parasites to drugs or vectors to insecticides, thus
making control measure less effective and more costly. Although efforts are being made to
incorporate appropriate anti-malaria activities into developing primary health care systems,
progress appears to be slow, managerial and organizational problems persist (WHO, 1986).
In Africa north of Sahara, transmission continued to be limited to a small facet. The total
number of cases reported in this area increased from 453 in 1983 to 666 in 1984. An
increase of transmission was observed in the northern provinces of Morocco.
In Africa south of the Sahara, the malaria situation did not change. In the malarious areas,
endemicity varies greatly from place to place although in general, malaria prevalence has
remained unchanged. It has been estimated that some 115 million cases occur in mesoendemic zone and 231 in areas where malaria is hyper-endemic to holo-endemic. In most
of these countries, vector control operations are not feasible, especially in rural areas, for a
8
variety of technical, operational, administrative and financial reasons. The only action that
could be currently attempted in these countries is the prevention and reduction of mortality
and morbidity through the rational use of anti-malaria drug. But one of the major constraints
hampering the implementation of these anti-malaria actions is the lack or shortage of trained
personnel for the planning, organization, monitoring and evaluation of programmes that are
carefully designed with clearly stated objectives and targets that can actually be
implemented and maintained according to the available resources and local conditions
(WHO, 1986).
9
10
2.2 The Role of Climate on the Spread of Malaria
Climate can influence all three components of the life cycle of malaria parasites. It is thus
a key determinant in the geographic distribution and seasonality of malaria.
Rainfall can create collections of water (breeding sites) where Anopheles eggs develop into
adulthood, a process that takes place in damp areas. Such breeding sites may dry up
prematurely in the absence of rainfall, or conversely, they can be flushed, and destroyed by
excessive rains (Mouchet, 1998).
Once adult mosquito has emerged, the ambient temperature, humidity and rains determine
their chances of survival. To transmit malaria successfully, female Anopheles must survive
long enough after they have been infected (through blood meal on an infected human) to
allow the parasite they now harbor to complete their growth cycle (extrinsic cycle). The
cycle takes 9-12 days at 250C or 770F. Warmer ambient temperatures shorten the duration
of the extrinsic cycle /transmission. Conversely, below a minimum ambient temperature
(150C or 590F for Plasmodium vivax, 200C or 680F for P. falciparum), the extrinsic cycle
may not be completed. This explains in part why malaria transmission is greater in warmer
areas of the globe (tropical and semi-tropical areas and low altitudes particularly for P
falciparum (Mouchet, 1998). It has been speculated that current trends of global warming
may increase the geographic range of malaria and may be responsible for malaria epidemics
(Wilson, 1991).
Climate also determines human behaviours that may increase contact with Anopheles
mosquitoes between dusk and dawn, when the Anopheles are most active. Hot wheather
may encourage people to sleep outdoors or may discourage people from using bed nets.
During the harvest season, farmers may sleep in the fields or nearby locals, without
protection against mosquito bites (Mouchet, 1998).
2.3 The Parasite
Human malaria results from infection with Plasmodium falciparum, P. vivax, P. ovale, or
P. malariae. Plasmodium falciparum causes a large majority of the clinical cases and
mortalities (Bozdech et al., 2003). Plasmodium is a protozoan parasite of the Phylum
Apicompleza, Class Sporozoea. Reproduction generally is both sexual and asexual.
Locomotion of mature organisms is by body flexon, gliding, or undulation of the
longitudines ridges. Flagella is present only in microgametes, pseudopods ordinarily absent
(Cheng, 1986).
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2.3.1. Life Cycle of Malaria Parasite
Malaria is transmitted by the bites of infected female anopheline mosquitoes or by
inoculation of infected blood (e.g. transfusion malaria, congenital malaria) (Hendrick,
1972). Malaria parasite shows a complex life cycle involving alternating cycles of asexual
division (schizogony) occurring in man (intermediate host) and sexual development
(sporogony) occurring in female Anopheles mosquito (definitive host). (Arora and Arora,
2005). Therefore, Plasmodium shows alternation of generation and alternation of hosts
(Webster, 2000)
2.3.1.1. Human Cycle
The infective stage called sporozoites, are injected from the mosquito salivary glands into
subcutaneous capillaries and circulate to the liver where they invade parenchyma cells.
Arora and Arora (2005) outlined the process of Plasmodium life cycle in man as follows:
Within one hour of infection all the sporozoites leave the blood stream and enter into liver
parenchyma cells. The sporozoites which are elongated, spindle-shaped bodies become
rounded inside the liver cells. They undergo a process of multiple nuclear division,
followed by cytoplasmic division and develop into primary exoerythrocytic schizont. This
varies in size according to species from 24-60nm in diameter and contains 2,00050,000
merozoites (Bruce-Chwatt, 1985). Primary exoerythrocytic schizogony consists of only one
generation. The duration of this cycle varies, for P. falciparum, P. vivax, P. ovale and P.
malariae it is 6,8,9 13-16 days respectively (Breman, 2001). When primary exoerythrocytic
schizogony is complete, the liver cell ruptures and releases merozoites in the blood stream.
The merozoites liberated from primary exorythrocytic schizogony enter the blood stream
and invade red blood cells where they multiply at the expense of the host cells. The age of
erythrocytes is an important determinant of its susceptibility to invasion by different species
of the parasite. Only young erythrocytes are infected by P. vivax and P. ovale, and only old
subpopulation of erythrocytes is susceptible to P. malariae, in contrast, P. falciparum can
develop in erythrocytes of all ages. Here they pass through the states of trophozoites,
schizonts and merozoites. Depending on the species, about 6-32 nuclei are produced
followed by cytoplasmic division and the red cell ruptures to release the individual
merozoites, which then infect fresh red blood cells (Miller et al., 1976), it is at the time of
the escape of merozoites that chill and fever beset the host (Pyrexia) (Cheng, 1986).
Erythrocytic schizogony may be continued for a considerable period, but in the course of
12
time the infection tends to die out. P. falciparum differs from the other forms of malaria
parasite in that developing erythrocytic schizonts occur in internal organs, so that only ring
forms are found in peripheral blood. This process is approximately 72 hours for P. malariae
and 48 hours for the other three species.
After malaria parasites have undergone erythrocytic schizogony for certain period, some
merozoites develop within red cells into male and female gametocytes known as macrogametocytes and micro-gametocytes respectively.
They develop in the red blood cells of capillaries of internal organs like spleen and bone
marrow. Only mature gametocytes are found in the peripheral blood. They do not cause any
febrile condition in human host. These are produced for the propagation and continuance
of the species. The micro-gametocytes of all the four species of Plasmodium are small in
size. Cytoplasm stains light blue and the nucleus is diffuse and large, on the other hand, the
macro-gametocytes are large, the cytoplasm stains deep blue and the nucleus is compact
and small (Cheesbrough, 2005). Although the longevity for mature gametocytes may
exceed several weeks, their half-life in the blood stream may be only 2 or 3 days, while
waiting for the mosquito to take them up (Freyvogel, 1966).
In case of P. vivax and P. ovale, some sporozoites on entering into hepatocytes enter into a
resting (dormant) stage before undergoing sexual multiplication while others undergo
multiplication without delay. The resting stage of the parasite is rounded, 4-6um in
diameter, uninucleate and is known as hypnozoite. After a period of weeks, months or years
(usually up to 2 years), hypnozoites are reactivated to become secondary exoerythrocytic
schizonts and release merozoites, which infect red blood cells producing relapse of malaria.
Therefore, it is the situation in which the erythrocytic infection is eliminated and a relapse
occurs later because of a new invasion of the RBCs from liver merozoites. Hypnozoites are
not formed in case of P. falciparum and P. malariae, therefore relapse does not occur in
disease caused by the species (BruceChwatt, 1983).
2.3.1.2. Mosquito Cycle
Sexual cycle actually begins in the human host by the formation of gametocytes, which are
present in the peripheral blood. Both asexual and sexual forms of the parasite are ingested
by female Anopheles mosquito during its blood meals from the patient. In the mosquito,
only the mature sexual forms are capable of further development and the rest dies. In order
13
to infect a mosquito, the blood of human carrier must contain at least 12 gametocytes and
the number of female gametocytes must be in excess of number of males (Garnham, 1966).
Within the gut of the mosquito, the male gametocytes undergo a process of exflagellation
which results in the release of up to 8 male gametes. The fertilized macrogamete is known
as zygote. This occurs in 20 minutes to 2 hours, in the next
24 hours, the zygote lengthens and matures into ookinete, a motile vermiculate stage
(Freyvogel, 1966). It enters the epithelial lining of the stomach of the mosquito and comes
to lie between the external border of the epithelial cell and peritrophic membrane.
Here it develops into oocyst. It is rounded, 6-12nm in diameter with a single vesicular
nucleus. It increases in size to reach a diameter of 40-50 um. Inside this develop sporozoites.
The number of sporozoites in each oocyst varies from a few hundreds to a few thousands
and number of oocysts in the stomach wall varies from a few to more than a hundred. On
about the 10th day, the oocyst is fully mature, rupture and release sporozoites in the body
cavity of the mosquito. Through body fluid the sporozoites are distributed to various organs
of the body except the ovaries. They have special predilection for salivary glands and
ultimately reach in maximum numbers in the salivary ducts. At this stage the mosquito is
capable of transmitting infection to man (Garnham et al., 1961; Garnham, 1963, 1966).
14
15
2.4 The Vector
Anopheles gambiae, A. arabiensis and A. funestus transmit most of human malaria and are
all found in Africa (Besansky et al., 2004). A. gambiae, the most famous and significant of
these three, is one of sixty anophline mosquitoes able to transmit malaria to humans
(Budiansky, 2002). A. gambiae is the primary malaria vector; this can be attributed, in part,
to its relatively long life, strong anthropophily and endophily (the tendency to target
humans for blood meal and rest inside of houses, respectively) (Besansky et al., 2004).
Adult mosquitoes normally rest during the day inside human habitat and emerge to feed at
night (Holt, 2002). Their larvae tend to develop in temporary bodies of water, such as that
typically found near agricultural sites or even in flood hoof prints (Vogel, 2002). All these
characteristics combine to make A. gambiae a successful vector.
The behaviour is remarkable and can be highlighted with comparison of the entomological
inoculation rate (EIR) of infectious mosquitoes in Asia or South America and sub-Saharan
Africa. The EIR measures how often one person is bitten by an infected mosquito. In Asia
and South America a person’s EIR rarely exceeds 5 bites per year. In Sub-Saharan Africa,
a person may have an EIR of over 1000 bites per year (Greenwood and Mutabingwa, 2004).
Greenwood and Mutabingwa (2004) also reported that during a single night in sub-Saharan
Africa, hundreds of mosquitoes typically collect in a room occupied by humans; 1-5% of
these are infectious.
Some diseased control strategies deal with the Anopheline mosquito rather than the parasite.
One strategy for attacking mosquitoes is to develop more effective insecticides. The main
obstacles to this line of attack are growing insecticides resistance and environmental
concern. The publication of A. gambiae genome (Holt, 2002) should help to identify the
genes involved in resistance and to design chemicals for attacking new targets in the
mosquito. The failure of the WHO’s malaria eradication program was, to a significant
degree, due to increasing resistance to DDT and the fact that people did not want their
homes to be sprayed (Greenwood and Mutabingwa, 2002). The current and most widely
used technique for vector control is insecticide treated bed-nets. Genomics may prove key
in the development of new insecticides and may also improve the longevity of available
insecticides (Hemingway et al., 2002)
2.5 The Host Factor
Factors in humans that determine the status of malaria are acquired and inborn. An acquired
strain-specific immunity has been observed that appears to depend upon the presence of
16
low-level parasitaemia that somehow inhibits new infections or maintains the infection at
a non symptomatic level. This so called premunition or concomitant immunity, is soon lost
after the parasites disappear from the blood. Exoerythrocytic forms in the liver cannot alone
support premunition, and they elicit no host inflammatory response (Mckerrow and
Parslow, 2001).
Natural genetically determined partial immunity to malaria occurs in some populations,
notably in Africa, where sickle cell disease (AS genotype), glucose-6phosphate
dehydrogenase deficiency, and thalassemia provide some protection against lethal levels of
falciparum infection (Mckerrow and Parslow, 2001). Most blacks in West Africa, where
malaria is endemic are not infected by P. vivax because they lack the Duffy antigen (FyFy),
which acts as a receptor for P. vivax; in its absence, P. vivax cannot invade erythrocytes. P.
ovale frequently replaces P. vivax in this region (Mckerrow and Parslow, 2001; Voller,
1993).
2.6 Pathology and Clinical Manifestations
Periodic paroxysms of malaria are closely related to events in the blood stream. An initial
chill, which lasts from 15 minutes to 1 hour, begins as synchronously dividing generations
of parasites rupture their host red cells and escape into the blood. Nausea, vomiting and
headache are common at this time. The succeeding febrile stage lasting for several hours,
is characterized by a spiking fever that frequently reaches 400C or more. During this stage,
the parasites presumably invade new red cells. The third or sweating stages conclude the
episode. The fever subsides and the patient falls asleep and later wakes feeling relatively
well. In the early stages of infection, the cycles are frequently asynchronous and the fever
irregular, later paroxysms may occur at regular 48-72 hour intervals, although P. falciparum
pyrexia may last for 8 hours or longer and may exceed 410C. As the disease progresses,
splenomegaly and to a lesser extent, hepatomegaly appears, particularly in P. falciparium
infections (Peters and Pasvol, 2002).
2.7 Mode of Transmission
(a) Vector Transmission/Direct Transmission
The female Anopheles mosquito is the transmitter of malaria parasite, this is facilitated by
its blood meal from man and other vertebrate host. The proboscis plays a crucial role in the
blood meal. Transmission depends not only upon the presence of gametocytes in the blood,
but also upon the infectivity of these for mosquitoes. The growth rate of the larva of
mosquito determines transmission rate and is directly proportional to the suitability of the
17
environment to its requirements which vary from species to species. The distribution and
frequency of malaria in tropical Africa depend more or less directly on the climate and
among the various climatic factors involved, two surpass the others in importance: rainfall
and temperature (Mouchet, 1998).
The most striking feature of malaria is its high endemicity with hardly any seasonal
changes. The climatic condition favours an intense transmission of P. falciparum, the
prevailing parasite, through mosquito vector of which the notorious and ubiquitous A.
gambiae is the most important because of its wide distribution, breeding habits, large
numbers and preference for human blood. In a general way, the transmission of malaria
diminishes progressively from the equator as latitude increases (Bruce –Chwatt, 1984).
(b) Blood Transmission
Malaria can be transmitted by the transfusion of blood from an infected person to healthy
persons. In this way the sexual blood forms continue to develop in their own periodicities
and the peripheral blood forms producing attacks of fever in the recipient, but preerythrocytic and exo-erythrocyitc stages are not formed in the liver, because these forms
originate only from sporozoites inoculated by mosquitoes. Malaria transmitted in this way
is easily cured and relapses do not occur. The possibilities of acquiring malaria by heroin
intravenous infection has also been established, cases of induced malaria in narcotic abusers
due to P.
falciparum infection were also reported in Europe (Ring and Jepsen, 1979;
Orlando et al., 1982).
(c) Congenital Transmission
Congenital malaria was reported by Covell (1950) who concluded that intra uterine
transmission from mother to child is established. Congenital infection may be achieved
without damage to the placenta, infection of the placenta may break down the barrier. This
applies to all species of malaria parasite. This results in still birth, abortion and death in
new born babies.
Madecki and Kretscher, (1966) studied Nigeria women and found that in most cases, the
babies are infected during parturition. Malaria in pregnancy is a critical problem, various
studies show that parasitaemia increases between the first and second trimester of
pregnancy. Trasmammary transmission is also possible.
18
2.8 Diagnosis and Treatment of Malaria
Diagnosis of malaria involves identification of malaria parasite or its antigens/products in
the blood of patients (WHO, 1997). Early, prompt and accurate diagnosis and treatment of
malaria is crucial to the management of the morbidity and mortality caused by the infection.
Accurate diagnosis is one of the main interventions used in the global control of malaria
(Menakaya, 2000). Malaria is diagnosed by the examination of the blood (WHO, 1993).
Immunodiagnosis has limited clinical usefulness but positive indirect hemagglutination
(IHA) and indirect fluorescent antibody (IFA) tests are valuable for epidemiological
surveys and with the complement fixation test, for screening potential blood donors. The
diagnosis of malaria is confirmed by blood test and can be divided into microscopic and
non-microscopic (Makler 1998, WHO, 2000).
(a)
Microscopic Test: For nearly a hundred years, the direct microscopic visualization
of the parasite on the thick and/or thin blood smear has been the accepted method for the
diagnosis of malaria in most settings, from the clinical laboratory to the field surveys. The
careful examination for a well prepared and well stained blood film currently remains the
‘gold standard’ for malaria diagnosis.
This includes:
i.
Peripheral smear study,
ii.
Quantitative Buffy Coat (OBC) Test,
(b)
Rapid Diagnostic Test: Several attempts have been made to take malaria diagnosis
out of the realm of the microscope and microscopy. These tests involve identification of
parasite antigen or the antiplasmodial antibodies or the parasitic metabolic products.
Nucleic acid probes and immunofluorescence for detection of plasmodia within the
erythrocytes; gel diffusion, counter-immunoelectrophoresis, radio immunoassay, and
enzyme immunoassay for malaria antigens in the blood fluid, and hemagglutination test,
indirect
immunoflourescence,
optimal
assay,
polymerase
chain
reaction,
immunochromatography, and Western blotting for anti plasmodial antibodies in the serus
have all been developed. These are (RDTs) (Makler, 1998).
Treatment and Chemoprophylaxis of Malaria
Treatment for malaria was not available to Europeans until the 1600s, when the Incas in
Peru offered the concoction from the bark of a “fever tree” (Cinchona). Modern-day quinine
originated from it. Current drug to treat malaria such as doxycyline, proguanil and
19
primaquine attack liver stage, thus preventing the release of parasite into the blood stream.
Others, such as chloroquine, quinine sulfadoxine, pyrimethamine (fansider) and
mafloquine, kill the parasite within the red blood cells (Russel, 1996).
Chemoprophylaxis for malaria is recommended for non-immune persons entering areas
endemic for malaria to reduce, but not totally eliminate, the risk of infection.
Chemoprophylaxis is also recommended for high-risk group such as infant and young
children, pregnant women, recent immigrant from malaria-free area. Prophylaxis for
children is debated because of the risk of long-term side effects and selection for resistant
parasite strains (Collins and Paskewitz, 1995).
Chemoprophylaxis of malaria is directed at prophylaxis and presumptive treatment (Jeffery,
1984).
a.
Presumptive Treatment: This is the treatment of cases suspected of being
malarious on the basis of symptoms by the patient, but not symptoms diagnosed by blood
film examination prior to treatment. The drug used should be curative with a single dose,
have a minimum side effect and acceptable to population (Jeffery, 1984). The most
common single dose for suspected malaria has 600 mg (base) of chloroquine as the adult
dose, this is usually administered as 1.5 base over a 3 day period
b.
Prophylaxis: Since the segments at greatest risk are pregnant women and children
up to age 5, there is no doubt as to the benefit of regular prophylaxis in women (reduced
mortality and morbidity). The aims of therapy are to destroy the first hepatic schizonts
before they liberate their daughter (merozoite cells) which infect red cells, to destroy the
erythrocytes blood schizont form before their merozoites are released, to destroy the
gametocytes before they are taken up by a mosquito bite
Chemotherapeutic drugs used against the attack of malaria are classified into the following
depending on the parasite stage of attack:
i.
Blood Schizonticidal Drugs: These drugs are used in the treatment of acute malaria
attack, -4- aminoquinolines e.g. chloroquine are blood schizonticides most effective
against the blood form of the parasite.
ii.
Tissue Schizonticidal Drugs: Destroys the asexual form of the parasite. Some
drugs have a pronounced anti-relapse effect and are extensively used for radical
treatment of malaria.
20
iii.
The Gametocidal Drugs: Destroys the sexual form of the parasite.
iv.
Sporozoiticidal Drugs: Inhibits the development of oocysts on the stomach wall of
the mosquito. The UK malaria reference laboratory recommends that proguanil or
chloroquine may be used (as opposed to drugs found locally) as these drugs give
protection against P. vivax and susceptible strains of P. falciparum.
2.9 Control of Malaria
Control of malaria is undoubtedly the best method of protecting a community against the
disease. During the 20th century, human efforts to control malaria and general socioeconomic development including access to health care have markedly reduced the spread
of malaria (MacDonald, 1957). Control of this deadly menace would therefore involve three
living beings: man (the host), Plasmodium (the agent) and Anopheles mosquito (the vector).
Several methods are used to prevent the spread of malaria, to reduce transmission and
manage morbidity among the infected. Such methods are broadly divided into transmission
control and morbidity control. These controls include:
a. Chemotherapy: the treatment for various species is different (Goldsmith, 2004),
chloroquine and drugs like it will kill all four species of Plasmodium when they are
in the cell (Goldsmith, 2004) and prompt treatment is the best means for the
management of all species of malaria. This is because prompt treatment eliminates
an essential component of the cycle (the parasite) and thus interrupts the
transmission cycle (WHO, 2000). Chemotherapy of malaria is directed at
prophylaxis and presumptive treatment.
The artemisinin-based combined therapy (ACT) has in recent times been the most
effective treatment for malaria. The more recent drug is Coartem, which was
developed in 1994, and combines artemisinin (a compound from wormwood plant)
with lumefantirine. Designed by Chinese Scientists, Coartem not only kills the
parasite, it also stays long in the blood to help prevent any resistance by the malaria
parasite (Oyeniyi, 2009)
b. Biological Control: This method of control includes natural measures; natural
limiting factors are deliberately intensified without any reliance on chemical or
mechanical devices. Larvivorous fish are natural enemies of mosquito larva and
have been utilized with advantage for malaria control E.g. Gambusia affinis, gold
21
fish (Carasius quratus), Romanomermis jingdeensis, a newly identified mamethid
nematode has been found to parasitize larva of A. sinesis. In the semi-arid region
of North Somalia, it was shown that malaria can be controlled by introduction of
species for larvivorous fish (Oreochromis spilurur spiluru) into mosquito breeding
site (Zahar, 1984). Carp (Cyrinus capio) a species of tilapia eat aquatic plants,
floating algae and other vegetable shelter for Anopheles; Baccillus shaerious, a
larvicidal bacterium is toxic to several species of mosquito. It is capable of
recycling even in highly polluted water. Coelomyes, a fungus of the
Chytridomycete sub class is obligate parasite of mosquito and most are specifically
pathogenic, each to a single species complex of Anopheles mosquito (Ree, 1982).
c. Genetic Control: This method reduces the reproductive potential of insect by
altering the hereditary material of the vector species. Genetic control may be
achieved by the following methods;
i.
Irradiation – Males are sterilized by ionizing irradiation- the principle is that the
sterilized males seek out and mate with the wild female in the natural populations
thus preventing the hatching of the eggs and lowering their reproductive potential.
ii.
Another method of genetic control is based on crossing sibling species of an insect.
This leads to hybrid that are released, their competition with fertile male will
eventually reduce the size of succeeding generation below the normal threshold
where transmission of malaria is possible (Mouchet, 1998).
Arora and Arora (2005) outlined various measures in controlling malaria.
These include:
i. Spraying residual insecticides such as DDT or marathion.
ii. Spraying the breeding sites with petroleum oils and paris green (copper
acetoarsenite as larvicides.)
iii. Using larvivorous fish, Gambusia affinis
iv. Flooding and flushing of breeding places.
v. Eliminating breeding places such as lagoons and swamps
vi. Avoiding exposure to mosquito bites by;
a. Wearing long-sleeved clothing and trousers after sunset when the insects
are most active
22
b. Using an electric matt to vaporize synthetic pyrethroid or burning mosquito
coils.
c. Using bed nets impregnated with pyrethroid.
d. Application of mosquito repellents containing diethyltoluamide.
vii. Chemoprophylaxis
viii. Early diagnosis and prompt treatment of
patients.
23
CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Research Design
A cross sectional survey within the observational study design would use to find the
prevalence of malaria among children (0-5years) in Sengere community of Girei Local
Government Area of Adamawa State.
3.2 Study Area
Girei is a town and local government area of Adamawa State, Nigeria. It lies on the Benue
River. The dominant tribe in the area are the Fulɓe or Fulani; however, a substantial number
of Bwatiye also dwell in villages such as Greng, Ntabo, and Labondo within the Girei local
government area. The primary occupation of the people in the area is farming and cattle
rearing. Girei is also a home to Radio Gotel.
Girei has a latitude of 9°22'2.31"N and a longitude of 12°32'59.58"E or 9.367308 and
12.549882 respectively. Sengere is a ward in Girei Local Government Area of Adamawa
State.
The study would be carried out in Sengere health facility, which is located in Girei LGA
of Adamawa State, Northeastern of Nigeria. Adamawa has two season which include the
rain (wet) season ranges from May to October and the dry season that ranges from
December to March. The period is characterized by dry, dusty and hazy, Northern Trade
wind that blow over the area from Sahara desert. Adamawa has average annual rain fall of
969mm, the temperature ranging from 25.2 – 28.1oC.
3.3 Study Population
Clinical based records of children of age 0-5years would be analyzed to the prevalence
within that specific age groups.
3.4 Sampling Technique
With the assistance of health care workers, Secondary data were collected in respect to the
child birth, malaria cases and treatment of malaria in the Primary health Care centres of the
different wards and community of the locality.
24
3.5 Instrument of Data Collection
Refer to the exsting or secondary information, raw or treated from the facilities in Girei,
the total number of persons diagnosed with malaria including children ( 0-5 years) from
July 2021 to December 2021.
3.6 Method of Data Analysis
Results obtained from this study will be analyzed by using the statistical for social sciences
(SPPSS)
25
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29
APPENDIX
QUESTIONNAIRE
Modibbo Adama University,
Yola
Centre for Distance Learning,
Community Health Programme,
P.M.B 2076
Yola Adamawa State.
Dear Respondent,
I am a student of the Modibbo Adama University of Technology, Yola, undertaking
research on Prevalence of malaria among children between 0-5 years in Sangere
community of Girei Local Government, Adamawa state. Being part of the requirement for
the award of Bachelor of Science degree in Community Health.
You are please requested to answer all questions as every information provided will be
treated confidentially. No name is required but just fill in or tick () in the appropriate
column of your choice and fill in the gap where necessary.
30
Part I: Identification
1. Ward
__________________________
2. Village
__________________________
3. Sub – village __________________________
Part II: Socio – demographic factors
4. Sex: Male { }
Female { }
5. Level of education: Primary { } Secondary { } College { } Others { }
6. Employment position: CHO { }
CHEW { }
7. Rate of monthly child birth: 5 – 10 { }
Clerk { } lab staff { }
10 – 15 { }
15 – 20 { } Others { }
8. Rate of malaria cases among children between 0 – 5 years monthly: 5 – 10 { }
10 – 15 { }
15 – 20 { } Others { }
Part III: Knowledge on malaria given to the parent
9. What are the signs of malaria told to the parent
_______________________________________
_______________________________________
_______________________________________
10. What main preventive measures were the parent taught
__________________________________________
__________________________________________
__________________________________________
11. Was ways of keeping personal hygiene to prevent malaria taught:
Yes { } No { } Don’t know { }
12. Was parent taught how to use treated mosquito net:
Yes { } No { } Don’t know { }
31
13. Was self-medication one of the cures of malaria instructed to the parents?
Yes {
}
No {
Don’t know {
}
}
14. When were the parents instructed to use the treated net for the children ages 0 – 5
years? Seasonally { }
Daily { } Don’t know { }
Part IV: Treatment and Management of Malaria Among Children Aged 0-5 Years
15. What are the signs to be observed to be sure its malaria
______________________________________________
______________________________________________
______________________________________________
16. What is usually the first medication given to children aged 0 – 5 years suffering
from malaria as emergency ____________________________________
17. What drug is administered to children aged 0 – 5 years suffering from malaria
______________________________________________
18. Is anti – malaria given to children aged 0 – 5 years suffering from malaria?
Yes { } No { }
Don’t know { }
19. Is treated mosquito net issued to parents with children aged 0 – 5 years?
Yes { } No {
}
Don’t know {
}
20. Do you hold seminars for the community on how to prevent and control malaria?
Yes { } No { }
Don’t know { }
21. What type of seminars do you conduct?
House – House { } Community gathering {
} Don’t know {
22. How often do you conduct such seminar?
Monthly { } Weekly { }
Don’t know { }
23. What is the feedback from the seminars conducted?
Encouraging { } Not encouraging { }
32
Don’t know {
}
}