PREVALENCE OF MALARIA PARASITE INFECTIONS AMONG SCHOOL AGED CHILDREN IN RURAL AREAS
Chapter One
Introduction
1.1 Background of the study
School-aged children are rarely targeted by malaria control, yet the prevalence of Plasmodium infection in this age group often exceeds that seen in younger children. It can also be anticipated that current successes in lowering transmission may, through delaying the acquisition of immunity, lead to an increase in the incidence of clinical malaria in school-aged children in previously highly endemic areas in the future. Malaria among school children has received increasing research attention over the last 10 years, with an expanding body of knowledge on the negative impacts that asymptomatic infection can have on health and education, as well as the deleterious effects of clinical attacks in this group. Nonetheless, there remains a paucity of evidence on the optimal control strategies in schoolchildren, and how these might vary between different malaria transmission settings.20 21 Intermittent preventive treatment in schools has previously been shown to reduce malaria infections and anemia and to improve sustained attention in an area of intense perennial transmission in western Kenya12 but has not been evaluated in areas of seasonal transmission. Seasonal malaria chemoprevention in the Sahel region, when expanded to target children up to 10 years of age, is associated with significant improvement in malaria and anemia in all ages13 22 but impacts on cognition or learning have not been examined. We undertook a cluster-randomized trial, in an area of highly seasonal malaria in southern Mali, to investigate the impact of a comprehensive malaria control strategy in schools, which combined vector control using long-lasting insecticidal nets (LLINs) supported by teacher-led participatory malaria prevention education and mass treatment to clear residual parasitaemia (termed intermittent parasite clearance in schools (IPCs)), in reducing malaria infections and anemia and improving children’s capacity to pay attention in class.
Malaria is one of the most climate sensitive vector-borne diseases which are of public health concern. It accounts for 110 million clinical cases annually1. Nearly half of the Nigerian population suffers from malaria and majority of outpatient’s attendance to health facilities can be attributed to this disease as identified by the National Malaria programme. The Fed MOH in Nigeria revealed that about N132billion is lost to the treatment and prevention of malaria. About 90 percent of the country’s 167 million people are at risk of malaria infection and it has continued to remain a major public health challenge in Nigeria2. Chioma Amajoh, national coordinator of National Malaria Control Programme, speaking with Business Day during the commemoration of 2012 World Malaria Day in Lagos, Nigeria stated that malaria has placed enormous pressure on the already strained health system in Nigeria. Malaria is said to be responsible for about 66 percent of all clinic visits and 30 percent of hospital admissions and it is a heavy burden on Nigeria’s families, communities, health system, and workforce2. Malaria causes about 350 to 500 infections in humans and approximately 1.3 million deaths annually, mainly in the tropics. Sub Saharan Africa accounts for 85% of these fatalities3. Malaria is a number one killer of annually with 1% mortality rate4. Over 100 million of cases of malaria are reported annually, out of which 1million result in death5. Malaria is holoendermic in Nigeria6. Oparaocha explained that apart from malaria causing morbidity to millions of people in endemic communities and actual mortality, the disease also reduces their resistance to infection by other diseases7. The useful man-hours are lost leading to low productivity, loss of revenue, social and economic depression and there may be absenteeism among school children due to malaria, leading to poor academic performance and low standard of education8.
From the above, it is sad to note that more than half the population of Nigeria is entrapped by poverty, malnutrition, low income and high mortality due to malaria. The poor are caught in vicious circle, they are sick because they are poor; they become poorer because they are sick and sicker because they are poorer9. Malaria disease imposes its heaviest socioeconomic burden on the rural population that depends on farming for their livelihood.
Malaria infection is largely distributed throughout warmer regions of the world especially in the tropics, where the vectors of malaria are found8. Malaria caused by protozoan parasites of the genus Plasmodium, remains the most children and accounting for about one million episodes
Nigeria infectious human parasites that infects and kills higher percentage of people than any other single infectious disease. The five known species of Plasmodium genus that cause human malaria are Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi. They are spread from one person to another through the bites of haematophagous anthropophilic female adults of mosquitoes belonging to the insect genus Anopheles. These adult female Anopheles mosquitoes are, hence said to be carriers or malaria parasites. Ezugbo et al identified the clinical symptoms of malaria as fever, headache, chills, fatique, nausea, chest and abdominal pain6. They further stated that there is an enlargement of spleen, kidneys and liver in malignant malaria.
1.2 Statement of the Problem
Stagnant water is a factor identified to be contributing to malaria transmission. Nigeria is endemic due to noncompliance on the part of Nigerians to malaria preventive measures such as sleeping under Insecticide Treated Nets (ITNs), using Artemisinin-based Combination Therapy (ACTs) correctly, using intermittent preventive treatment of malaria in pregnancy and proper environmental sanitation2. Chioma Amajoh also stated that factors militating against significant success in the fight against malaria include insufficient funding, poor utilization of available health care services, weak supply chain system, inadequate strategic information network, and various infrastructural challenges