Assessing the knowledge and preventive practices of pregnant women on the management of malaria in pregnancy at the Buea Regional Hospital
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Malaria in pregnancy remains a public health concern in Cameroon with far-reaching health and economic implications. The present study was conducted to assess the pregnant women’s knowledge, preventive and management practices of malaria in pregnancy at the Buea Regional Hospital. To this effect, a descriptive cross-sectional survey was conducted using 45 pregnant women attending ANC and pregnant women in the ward that were randomly selected. 45 close and open-ended questionnaires were interviewer-administered to the selected pregnant women. The data obtained were analyzed using descriptive statistics aided by the use of Statistical Package for Social Sciences (SPSS 20) and Microsoft Excel 2016. The study found out that most of the women demonstrated good knowledge of the causes, symptoms and consequences of malaria in pregnancies. Equally, the study found out that, the dominant malaria prevention practices reported by women were the use of insects repellants (93.3%), netting of windows and doors (71.1%), use of insecticide-treated nets (ITNs) (62.2%) and use of prophylactics (48.9%) while herbal treatment ( 91.1%) was mostly used for malaria management. Furthermore, the study found out that most dominant challenge faced by pregnant women in the management and prevention of malaria in pregnancy was limited access to malaria preventive and treatment drugs (41 or 91.1%), limited availability of insecticide-treated nets (ITNs) (39 or 86.7%), high cost of malaria prevention and treatment drugs (36 or 80%), high over-the-counter cost of insecticide-treated nets (ITNs) (25 or 55.6%) and high cost of insect repellant (22 or 48.9%). The study concluded that the majority of the pregnant women had good knowledge of the causes, symptoms and consequences of malaria in pregnancy. Equally, most use a host of malaria in pregnancy (MiP) prevention and management practices that considerably reduces their vulnerability to the disease. However, they are constrained in their malaria prevention and management practices by a host of factors. The study recommended among other things, the distribution of ITNs and anti-malaria drugs to pregnant women.
Keywords: Malaria in pregnancy, knowledge, practices, prevention, and management
Malaria is a parasitic infection transmitted by mosquitoes, is one of the most devastating infectious diseases, affecting women, fetuses, and newborns globally (Schantz-Dunn and Nawal, 2019). Malaria is transmitted when an infected mosquito takes a human blood meal and the Plasmodium sporozoites are transferred from the saliva of the mosquito into the capillary bed of the host. Within hours, the parasite will migrate to the liver, where it undergoes further cycling and replication before being released back into the host’s bloodstream (Menéndez, 2008).
The incubation period, from the time of mosquito bite until clinical symptoms appear, is typically 7 to 30 days. Symptoms include fever, headache, nausea, vomiting, and myalgias. Due to the cycling parasitemia in the bloodstream, patients will often experience symptoms every 2 to 3 days, depending on the type of Plasmodium with which they are infected. In the human, plasmodial infection is a complicated reproductive life cycle involving hepatic and erythrocytic infection. According to Bryan Bunch et al. (2012), the most severe form of malaria caused by plasmodium falciparum protozoan. This form of malaria does not last as long as others but is more life-threatening.
Globally, it is estimated to affect between 350 to 500 million people annually and accounts for 1 to 3 million deaths per year (Centers for Disease Control and Prevention, 2017; The Global Fund, 2019). Over 40 per cent of the world’s population are at risk of infection from the parasite which causes malaria. (Lee et al., 2019). Sub-Saharan Africa has the largest burden of malarial disease, with over 90% of the world’s malaria-related deaths occurring in this region (Schantz-Dunn and Nawal, 2019). It ranks second among the top ten causes of death in Africa (WHO 2015; Chiang et al 2016; WHO, 2018).
In Cameroon, the disease remains prevalent, varying between 3.3–3.7 million per year (Nkondjio et al, 2019). It is the most important public health problem and the first cause of morbidity in all age groups (MPH 2014). Reports show that it accounts for 40.01% morbidity and 2.2% mortality in the general population, and 4.2% mortality in children less than 5 years. In Cameroon, malaria parasite transmission is highly heterogeneous with high and perennial parasite transmission occurring in the forest, coastal and humid savanna areas and low parasite transmission in highlands and seasonal parasite transmission in Sahelian and dry savanna areas (National Malaria Control Program, 2015). Plasmodium falciparum is the main parasite responsible for over 95% of the cases (World \health Organization, 2015).
Globally, women and children are highly susceptible to malaria infection (WHO, 2015). It is estimated that twenty-five million pregnant women are currently at risk for malaria, with the highest risk for infection and morbidity in primigravidas, adolescents, and those coinfected with HIV (Desai et al, 2007. According to the World Health Organization (WHO), malaria accounts for over 10,000 maternal and 200,000 neonatal deaths per year.
The effects of malaria in pregnancy are mostly of adverse consequences from malaria infection including maternal anaemia placenta accumulation of parasite, low birth rate from premature intrauterine growth retardation and foetal parasite exposure and congenital infections and infant mortality (Lee et al 2019). In accordance with the fact that pregnancy comes with so many psychological changes, pregnant women are predisposed to a host of diseases due to their low immune system, so the effects of malaria infections in pregnant women are associated with a high risk of both maternal or prenatal mobility and mortality (WHO, 2015).
The effects of malaria in pregnancy remains an area of concern in Cameroon. Despite this importance, very limited study has been conducted to shed more light on it.
Pregnant compared to non-pregnant women are at an increased risk for malaria (Menedez, 2011). Malaria and pregnancy are mutually aggravating conditions. The physiological changes due to pregnancy and the pathological changes due to malaria have a synergistic effect on the course of each other, thus making life difficult for the mother, the child and the treating physician. Falciparum malaria can run a turbulent and dramatic course in pregnant women.
Pregnancies in women living in malaria-endemic regions are associated with a high frequency and density of P. falciparum parasitaemia with high rates of maternal morbidity including fever and severe anaemia with abortion and stillbirth. This is also associated with high rates of placental malaria consequently low birth weight in newborns caused by both prematurity and intrauterine growth retardation. (WHO, 2012). Globally, prenatal mortality due to malaria is about 1500 per day and in areas where malaria is endemic, 20-40% of all babies born may have a low birth weight (Kakkilaya, 2012).
Malaria is a great problem in Cameroon hampering individual and national prosperity due to its influence on social and economic decisions. The risk of contracting malaria can deter investment both internal and external and affect individual and household decisions making in many ways that have a negative impact on economic productivity and growth. According to WHO, in some heavy-burden countries, the disease accounts for up to 40% of public health expenditures, 30% to 50% of inpatient hospital admissions, up to 60% of outpatient health clinic visits.
It is with this background that a study to assess the knowledge and preventive practices of pregnant women in the management of malaria at the Regional Hospital Buea was conducted
This study which is based on assessing the knowledge and preventive practices of pregnancy at the Regional Hospital Buea will provide a better physical and psychological management strategy for pregnant women and the data obtained will also help in sensitizing the population on the preventive practices and measures of malaria in pregnancy.
The general objective of this study is to assess the knowledge and preventive practices of pregnant women in the management of malaria in pregnancy at the Buea Regional Hospital.
This study seeks to:
- Assess the knowledge of pregnant women on malaria in pregnancy and preventive measures.
- Identify the preventive practices undertaken by pregnant women for the prevention of malaria in pregnancy.
- Bring out the challenges faced by pregnant women in the management and prevention of malaria in pregnancy.
1.5 Research questions
What are the knowledge and preventive practices of pregnant women in the management of malaria in pregnancy?
1.5.2 Specific research question
- What knowledge and preventive measures do pregnant women have about the management of malaria in pregnancy?
- What preventive practices are undertaken by pregnant women for the prevention of malaria in pregnancy?
- What are the challenges faced by pregnant women in the management and prevention of malaria in pregnancy?