Malaria – Prevalence of Malaria in Pregnancy among Mothers: A Case Study of Ebonyi State University Teaching Hospital, Between 2010 To 2011
Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world. In most endemic areas of the world, pregnant malaria. Malaria in pregnant woman has been most widely evaluation in sub-sahararan Africa, malaria in pregnancy is caused by plasmodium species, which include plasmodium falciparum, plasmodium ovale, and plasmodium vivax. To order the Complete Project Material, Pay thr Sum of N3,000 to: BANK NAME: FIRST BANK PLC ACCOUNT NAME: CHIBUZOR TOCHI ONYEMENAM ACCOUNT NUMBER: 3066880122 Then send the Project Topic, Your Email Address and Full Name to 07033378184.
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In terms of its effects on mothers, severe anaemia increases the risk for maternal mortality, and malaria anaemia is estimated to cause as many as 10,000 maternal deaths each year in Africa.
The impact of the other three human malaria parasites (plasmodium, plasmodium malaria, and plasmodium ovale) is less clear. Despite the tell that malaria exercts on pregnant women and their babies, until recently material during pregnancy was a relatively neglected problem. The promising news is that during the past decade potentially more effective strategies for control of malaria in pregnancy have been developed and demonstrated to have a remarkable impact on improving the health of mothers and their new born.
Malaria in pregnancy has increased morbidity and mortality rate annually form direct and indirect causes of malaria. Pregnant mothers experience severe anemia, miscarriages, stillbirths, low birth weight babies and death. Also psychological traumas on families and significant other cannot be quantified. Malaria in pregnant is the most common causes of out patients visit in the state(MOH 2003) and second to the cause of all admission studies by who in different areas show that woman suffering an average of 5 bouts in a year each lasting 2-7days and is responsible of absenteeism from school and work place thus loss in economic tems is enormous arising from cost of treatment and prevent, cost of illness or looking after an ill person and cost of years lost from premature death.
The national and international agencies involved in this program are the UPICEF, DFID, and Medical record document fresh data on the prevalence of malaria among pregnant woman especially in Abakaliki, Ebonyi State.
Ebonyi State in early 2004 started the roll back malaria program which was lunched in 4th August 2005 several malaria control measures were incorporated into this program. 21 malaria focal managers were trained in Abakaliki areas.
Cases dealing with plasmodium species causing malaria have overtime been gaining upper hand among pregnant women antenatal clinic of the Ebonyi State University Teaching Hospital. Materials were distributed from the state level facilities to be given free to pregnant women. Roll back material in pregnant woman in antenatal clinic client in Ebonyi State University Teaching Hospital.
The consistent increamnet of malaria among pregnant woman of Abakaliki is not unconnected to be indiscriminate logging of water in every street corner which hardours and hatches mosquito egg.
Morbidity and mortality rates of diseases due to malaria are increasing in Ebonyi State despite all these efforts as a result of the favourable conditions offered to the survival and multiplication of its mosquito vectors. Millions of mosquitos are being hatched every minute in the thick warm, rain forest zones of most towns in the state.
An effective malaria control measure requires a good awareness of every aspects of disease epidemiology by every member of the community.
What measures therefore, have they taken to combat malaria and what factors exist that influence their choices, effectiveness and adoption of these measures? What actually are the real causes of the disease? It is an attempt to answer these questions that this research was conceived.
Objective of the Study
To ascertain the awareness of the women attending antenatal clinic in EBSUTH about dangers of malaria in pregnancy.
To identify the number of case of malaria in pregnancy in EBSUTH between 2010 January to 2011 November.
To identify the factors that influences the distribution of malaria in pregnancy.
To determine the prevalence rate of malaria in pregnancy in EBSUTH.
Significance of the Study
The study is of great important to investigating the methods of prevalence of malaria in pregnancy in antenatal clinic client in Ebonyi state university Teaching hospital.
The information ascertain from the study will guide public as regards to save lives of pregnant women through the prevalence of malaria in pregnancy in antenatal clinic client in Ebonyi state University Teaching Hospital.
This study of this work will be expose the predisposing factors & control measures for malaria attack and the awareness will be very important to the pregnant women in antenatal clinic client and the public in Ebonyi state. This is because it will help them to take a adequate precautions to prevent rather than treat malaria.
Research Question (S) Hypothesis
Research question 1
How can we ascertain the awareness of the women attending atenatal clinic in EBSUTH about dangers of malaria in pregnancy?
Research Question 2
What are the numbers of case malaria in pregnancy in EBSUTH ‘‘between’’ January 2010 to November 2011?
Research question 3
What are the factors that influence the distribution of malaria in pregnancy?
Research question 4
How to prevalence rate of malaria in pregnancy in EBSUTH.
Scopes of Study & Limitation
This research work is limited to Abakaliki and its environs. The scope on the other hand covers the pregnant women of Abakaliki and the effect of malaria on them, especially those of the state university teaching hospital.
The state teaching hospital has been selected as a result of the frequent cases being recorded and complains being lodged by most pregnant women of the town.
Operational Definition of Terms
This section defines some of the terms which we regard as being central to be study at hand;
MALARIA: Disease that cause fever and shaking of the body caused by the bite of some types of mosquito regions
PREGNANCY: The state of being pregnant. Many woman experience sickness during pregnancy a pregnancy test *unplaced/ unwanted pregnancies the increase in teenage pregnancies.
ANTENATAL: is relating to the medical care given to pregnant women antenatal care/classes/screening antenatal clinic.
MORTALITY RATE: The death rate due to malaria infecting.
MORBIDITY RATE: The rate of incapacitation as a result of malaria infection.
KNOWLEDGE/AWERNESS OF TRANSMISSION: Ability to answer correctly the case and mode of malaria transmission.
Concept of Malaria
Malaria, a life threatening parasitic disease has been known since time immemorial. Previously, it was thought that “miasma” (bad air gas from swamps) causes malaria: this and a host of others are the misconceptions that many theorist have about malaria.
Malaria is a life threatening parasitic disease transmitted by the female anopheles mosquitoes. Malaria is the mot highly prevalent tropical disease, with high morbidity and mortality as well as high economic and social impact (World Health Organization, 2001).
According to the world Health organization (2003) malaria remains one of the most important threats to the health of pregnant woman and their new born. Infect, its control is one of the most challenging in Africa where 45 countries, including Nigerian are endemic for malaria, and about 588 million people are at risk (WHO, 2001). The protection of pregnant women living in malaria endemic countries has been of peculiar interest to many National malaria control programmes because of their reduced immunity.
This is not unconnected to the fact that malaria during pregnancy presents a unique problem. Pregnant woman are at higher risk of developing severe and fetal malaria because normal immune responses are reduced during pregnancy.
Most cause of malaria in pregnancy areas of stable malaria transmission is asymptomatic. Also pregnant women than usually acquire partial immunity to malaria (Nostan elta 2005). In areas of unstable malaria transmission, pregnant women lack protective immunity and are at serious risk of developing severe life threatening facipanium malaria. The principal impact of malaria infection is due to the presence of parasites in the placenta causing maternal anemia (potentially responsible for maternal death and low birth weight (LBW (A gomo, el ta 2001)
Prevalence of Malaria
A very salient point of discussion is the issue concerning malaria in African, most especially in Nigeria.
Malaria has been known to be a cause of a world wide infection especially in children and pregnant women (Alo,2001) Epidemiological work carried out by maeno, et al in 1993 placed pregnant women on high risk group in malaria infection as placenta malaria were discovered when placenta tissue of infected pregnant women were examined.
Recently, world malaria Report, which indicated that Nigerian accounts for quarter of all malaria cases in the 45 malaria –endemic countries in Africa, clearly shows the challenge malaria posses to Nigeria.
The might not be less due to large population of be country approximately, 150 million people live in areas of high malaria transmission. In Nigeria, (1% of maternal death are attributed to malaria (meeusen, el ta 2005.
Works of many researcher have reported high prevalence rates of malaria in pregnancy in different parts of Nigeria, ranging from 19.7% to 72.0%; Ebonyi state indusive.
Thus, pregnant women who are within this group/range of higher risk effect of malaria infection need special protective measures to ensure their survival and improve birth outcome.
In line the work of okpere (2004), malaria in pregnancy is more frequent and also more severe Primigravidae are most affected due to inevcased parasite prevalence and density with the risk higher in the first and second trimester.
Effects of Malaria during Pregnancy
Over the years, researchers have come to a free with the fact that malaria has a disked effect, especially on pregnant women.
Malaria pregnancy is an obstetric, social and medical problem requiring multidisciplinary and multidimensional solution pregnant woman constitute the main adult risk group for malaria and 80% of deaths due to malaria in Africa occur in pregnant women. In Africa, prenatal mortality due to malaria is at about 1500/ day.
Malaria during pregnancy reduces birth height. In this case, newborn babies which normally perbs between 2.5kg and 3.2kg approximately 71/2 ibs). Measures less us a result of the malarious condition of the mother during pregnancy. This in the long run could lead to premature death of the neonate if not properly taken care of Infant, it’s regarded as the major determinant of infant mortality (American journal of Epidemiology 2001).
Malaria also causes severe anemia in pregnant women, especially in pramigrauidae .For these reasons, it’s generally advocated that women living in a malaria endemic area should be given chemoprophylaxis during pregnancy even when they are partial immune.
Malaria and pregnancy are matronly aggravating conditions. The physiological changes due to malaria have a synergistic effect on the course of each other, thus making the life difficult for the mother, the child and the treating physician. In pregnant women, especially in Ebonyi State, the morbidity due to malaria include anemia, fever illness, hypoglycemia, cerebral, malaria, pulmonary adema, puerperal sepsis and mortality, in cases of severity. The effect of malaria along side those earlier discussed in the newborn includes prematurity IUGR, malaria illness and mortality.
Causes of Malaria during Pregnancy
Malaria is a protozoa disease caused by infection with parasite of the genus plasmodium transmitted though the bite of infected mosquitoes. There are four species of human malaria parasite. They include
1. Plasmodium falciparium
2. Plasmodium ovale
3. Plasmodium vivar
4. Plasmodium malaria.
The most serious falcipanium malaria may present in a quite varied clinical picture, including fever and sweating is repeated, either daily, every other or every third day. This cycle may progress picterus, coagulation defects, shock, renal and liver failure, acute encephalopathy and coma.
Malaria in pregnancy can also be transmitted by blood transfusion contaminated needles and syringes and in rare causes, from mother to fetus.
Diagnosis of Malaria Infection
Smear microscopy can be used to determine the species of malaria parasite and quantify the parasitemia both of which are necessary pieces of information for providing the most appropriate treatment.
Pregnant women who have symptoms of malaria should be advised to seek medical consultation.
Polymerase chain reaction (PCR) tests are also available for detecting malaria parasites; however, none are FDA approved. Although these tests are slightly more sensitive than routine microscopy, results are not usually available as quickly as microscopy results should be, thus limiting the clinical utility of this test.
PCR testing can be used to determine the species of the parasitic if the microscopic results are ambiquous.
In sub-Saharan African the rate of false positive blood films for malaria may be very high. Tranelers to this region should be aware that they may be diagnosed with malaria in correctly; even they are taking a reliable antimalaria negimen. Acutely ill travelers in such conditions, should be advised to seek the best available medical services and follow the treatment effered locally.
Control of Malaria during Pregnancy
Chloroquuine prophylawa is generally recommended in highly endemic areas like Ebonyi State, most especially for pregnant women and children. Non- or semi immunes travelling to endemic areas may also be advised to take prophylaxis for the period they are there.
There are a number of candidate vaccines against malaria and some field trials are taking place, but until there was a safe and effective vaccine, the primary approach taken is that of control. In most places where malaria is endemic, the control objectives are to minimize vector-human contract and to treat malaria disease promptly.
Reducing breeding sites of mosquitoes, screening of door and windows, use of mosquitoes nets and insecticide sprays, and prompt treatment of malaria episodes can reduce the impact of malaria. However, people’s ability to comply with interventions and to treat sickness is affected by their acceptance of the interventions, their understanding of the native of the illness and the relationship between vector and infection, as well as other social, economic and cultural factors. For instance, poor households may not have the cash to provide chemoprophylaxis for pregnant women or to purchase bed nets for all household members, even if they accept these interruptions in theory.
Role of Nurses in Control of Malaria in Pregnancy
Malaria infection in pregnancy is the disease of both young and old. Malaria is one of the most serious health problems facing the world today. Nurses being part of the health team to part in its control. The roles of nurses in controlling malaria in pregnancy include the following.
One of the major roles is health education/ attitudinal change. Under health education, the nurse have to educate on the preventive measures towards malaria control such as adequate environmental sanitation cleaning the bushes around their houses/homes discarding empty tins or broken containers that may encourage mosquito breeding sites/use of insecticide spraying such as DDT on breeding sites, use of nets on the doors. While outside, they should wear cloths that will cover their body well or use mosquito repellant cream to put off mosquitoes.
The nurse should also advice those living in mud huts in rural areas to white wash the walls to avoid attracting mosquitoes, cracks on the walls should be seales.
Adequate nutrition is very important, the nurse should educate the populace on good nutrition in order to maintain a food standard of health with good health condition, attack of malaria will not have a very disastrous affection the individually and it will also ensure quick recovery once treatment is ensured.
Tepid sponge in case of high fever, where there is no appetite, the nurse should advice on nutritional fluid intake and fruits until appetite improve. Give anti-malaria drugs. In severe conditions diet and fluid may be through intravenous infusion.
In malaria in pregnancy endemic areas, the nurse should ensure good clinic management of malaria. Advice the patient on copious fluid in talking encourages good diet.
Empirical Review of Related Literature
In cause and transmission of malaria this discussed that malaria is caused by one of the four protozoan parasites from the genus plasmodium namely. P.falciparum, P.vivax, P.ovale and P.malaria. This is transmitted when one is bitten by an infected female anopheles mosquito. This is in agreement with the study done by Osuafor (1997) also other studies include John Macleod (1978); malaria foundation international (2005)
The physiological effect of malaria is discussed that it occurs in three phases, from the first phase when an individual is bite by an infected anopheles female mosquito, the movement of the parasite to the liver, their multiplication, to the stage of bursting of the liver, releasing the parasites into the blood stream leading to clinical symptoms of malaria, then to the stage of parasite re-production ready for malaria foundation international (2005) Osuafor (1997).
The role of nurses in the control of malaria is much involved in health education by the nurse to the populaces with emphasis being laid on environmental and personal hygiene, adequate nutrition and early visit observed. Also to avoid patronizing the quacks for treatment, this discussed is based on practical experience and interaction with people.
The socioeconomic effect of malaria cannot be overemphasized malaria exacts an enormous toll in the lives medical costs and days of labours cost, children miss several weeks of the school year. This is agreement with the finding of malaria international fact pack (2005), issues Trends-malaria Nigeria report on Roll Back Malaria summit held in Abuja Nigeria (2000).
The prevention of malaria in pregnancy in developing and developed countries differs. Developing countries are most bitten by malaria attack due to their tropical climate (for example is Nigeria) some developed countries like East Asia and pacific, Taji kistan in Europe are also affected. This discussed agrees with finding of Steve Lindsay (2009), Roll Back Malaria in Abuja Nigeria (2000).
Discussion on management of malaria reveled both traditional and scientific management. The traditional management stated even without the people knowing the actual cause of malaria. Scientific management is based on the use of scientifically prepared drugs like chloroquine. Recent observations have shown increased resistant of the malaria parasite combined therapy is instituted, details of these is in the discussion of the management of malaria. The aggress with the studies by malaria international foundation (fact pack 2005) Osuafor (1997) John Macleod) (1978).
Control of malaria has been from time immemorial. In this discussion, the historical review of malaria control is divided into pre-eradication, eradication and control era as studied by Ayalde and Oliver (1990) also included are other methods of malaria control.
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