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countries. Altogether, around 2,000 cases of malaria are brought into the UK each
year.
Malaria predominantly affects countries in Africa, South and Central America, Asia
and the Middle East. The disease is particularly widespread in sub-Saharan Africa,
where over 90% of malaria-related deaths occur.
Almost two thirds of all malaria-related deaths occur among the poorest 20% of the
world's population.
In 1998 the World Health Organisation (WHO), UNICEF, World Bank and the
United Nations Development Programme (UNDP) joined forces to fund the Roll
Back Malaria programme. Roll Back Malaria aims to halve malaria-related deaths
by 20101.
Symptoms of malaria tend to appear between 10 days to 4 weeks after the initial
bite. However, in some cases, depending on the type of parasite you are infected
with, it can take a year before your symptoms start to show.
Preventing mosquito bites
Below are a number of measure that you can take to help prevent being bitten by
mosquitoes while travelling in countries where there is a risk of malaria.
Use insect repellent on your skin and in sleeping environments. The most
effective repellents contain diethyltoluamide (DEET). Insect repellents are
available in a variety of forms including, sprays, roll-ons, sticks, plug-in
devices and creams.
Wear trousers, rather than shorts, and shirts that have long sleeves. This is
particularly important during early evening and night time, as this is the
mosquitoes preferred feeding time.
Stay in accommodation that has screen doors, and close windows. In
addition to this (or if this is not possible), sleeping under a mosquito net that
has been treated with insecticide will help you to prevent being bitten.
It is very important that you are aware that any flu-like illness, or anaemia, that
occurs within three months of returning from travelling in places where malaria is
present, may be malaria, even if you took your medicine. If you become ill when
you get back, you should see your GP and mention where you have been on
holiday, and that you may have been exposed to malaria1
acute
respiratory
distress
syndrome,
hypoglycaemia,
jaundice,
All the countries of the region except Maldives have indigenous malaria
transmission . An estimated 1.3 billion people or 85% of the total population are at
risk of malaria . 30% of this population live in areas with moderate to high risk of
malaria mainly in India.
The burden of communicable dieses is no less in our country;
communicable diseases constitute 30% of deaths in the country more than 1.5
million people suffer from malaria. In an analysis of emerging infectious disease
between 1904 to 2004 it has been observed that the majority of 80% ,are caused
by vector born dieses are responsible for 23% of them .
It is observed that malaria is a major disease reported by house holds the
incidents of Malaria is more in rural, about 7% of the household also reported
Malaria, which is very common dieses in rural areas due to lack of drainage
facilities
It has been reported in 2001 Karnataka population census , Gulbarga
District is primarily a rural district 72% of total population lives in rural areas and
literacy level among these people is 42.28%.
In the year 2002, oxford university team at the welcome trust research
laboratory in Kenya created an extraordinary world map of malaria suffers. It is
said that there were 300-600 million clinical cases of malaria identified in world
and 1.84 million cases from India, and 132609 were reported from Karnataka.
In the year 2003, WHO burden report in India said it has 1.87 million cases
of malaria among these 0.86 million (45.85 %) are P,falciparum and the API rate
was 1.82 and there was 1006 death also reported .
In the year 2006, a total of 1.79 million cases of malaria form India and
62864 cases of malaria were reported from Karnataka state, among these 16446
cases of P. falciparum , and 29 deaths were reported from the Karnataka.
In the year 2010, a total of 92, 81,666 Blood slide are examined, and 44,319
cases of malaria were reported from Karnataka, of the 7936 cases were
P.falciparum and 11 deaths was reported.
During the community posting in village researcher found that the residents
of their study area are generally ignorant about the prevention of malaria, there
were no houses found to be having mosquito mesh on their doors & window,
many are storing water in open container and water tanks are also left opened. It is
found that environmental condition in nandoor village is poor and people living in
the area are more prone to get infections not only malaria but from other vector
born diseases, so researcher felt the need to conduct a study on malaria among
adults which help them to gain more knowledge about the disease condition and
its prevention.
REVIEW OF LITERATURE
Review of literature is a broad, comprehensive, in depth, systematic and
critical review of scholarly publication, unpublished scholarly print material,
audiovisual materials and personal communications.
Review of literature is the systematic and critical review of the important
published scholarly literature on a particular topic . this helps in investigator to
find out what is already known and what problem remain to be solved , since
effective research is based on past knowledge , this exercise provides useful
hypothesis and helpful suggestions for significant investigations.
A prospective study was conducted by Fernando D, De silva D , et al (1999)
in a malaria-endemic area of srilanka to determine the short term impact of an
acute attack of malaria on the cognitive performance of 648 school children
divided into three group in such as , children with malaria , children with nonmalarial fever and healthy control . cognitive performance in language and
mathematic at the time of presentation and two week later were assessed . at the
time of presentation , children with malaria scored significantly less in both
mathematics and languages than children with non-malarial fever and controls .
two week later , the mathematics and language scores of children with malaria
improved . but the scores were significantly lower than the scores of children with
non-malarial fever (p<0.001) and control s (p0.001). these finding suggest that an
acute attack of uncomplicated malaria causes significant short term impairment of
cognitive performance. The impairment persists for more than two week and
appears to be cumulative with repeated attacks of malaria.
A study were carried out in 2009 and 2010 by Rehman AM, et al in Bioko
Island, Mainland quaterial Guinea and Malavia to monitor infection with
plasmodium falciparum in children mosquito net use. Net condition and spray
status of houses nets were classified by their condition. The association between
infection and coverage of interventions was investigated. The result suggest that
there was reduced odds of infection with plasmodium falciparum in children
sleeping under ITNs (insecticide treated nets), that were intact (odds ; ratio(or);
0.65 that is 95% . CI : 0.55-0.77 and OR ;0.81,95% CI :0.56-1.18 in Equatorial
Guinea and in Malawi respectively ) but the protective effect become less with
increasingly worse condition of the net. There was evidence for a linear trend in
infection per category increase in deterioration of net .
WHO in 2009repoted that prevention of malaria focus on reducing the
transmission disease by controlling the malaria bearing mosquitoes. The two main
interventions for malaria control are:
Use of mosquito nets treated with long lasting insecticides, a long lasting effective
method
Indoor residual spraying of insecticides.16
A study was conducted in 2001 at Allahabad (UP) to evaluate the impact of
delta-methrin impregnated mosquito nets on malaria incidence, mosquito density
any adverse effect along user and collateral effects on bed bugs and house flies. A
field trial was carried out over a period of 3 years in 2 adjacent military stations,
keeping one as atrial and other as a control station . During 1st year baseline data
were collected, and during next two year residual spray was replaced with use of
deltamethrin impregnated mosquito nets in trial station. The use of deltametrin
treated bed nets resulted in a significant decline in malaria incidence and annual
parasite index (API).
In 2001 a study was conducted on a community based health education
programme for bio environmental control of malaria through folk theater
(kalajatha) in rural India , this study was carried out under the primary health care
system involving the local community and various potential partners. Impact of
this program was assessed after two months on exposed Vs non-exposed
respondents. The result suggest that the exposed had significant in knowledge and
change in attitude about malaria and its control strategies, especially on bio
environmental measures (p<0.001).they could easily associate clear water with
control of vector borne diseases was launched. Despite all these measures malaria
still prevails causing significant morbidity and mortality.
Causes of anemia in malaria are- hemolysis of infected RBCs, hemolysis of
non infected RBCs [black water fever],dyserthryopoesis, splenomegaly and folate
depletion.
Renal dysfunction can also arise due to hemoglobinuria [black water fever] ,
oliguria and anuria due to acute tubular necrosis.(7)Nephrotic syndrome is seen in
plasmodium malariae infection.(7) Plasmodium malariae infection is prevalent in
tumkur.(3) Renal dysfunction usually resolves , urine flow resumes in a median of
4 days and serum urea creatinine returns to normal in a mean of 17 days.
Hepatic involvement manifests commonly as mild hemolytic jaundice.
Severe jaundice can be seen due to hemolysis, hepatocyte injury and
cholestasis .When compared to other vital organ dysfunction, liver dysfunction
carries a poor prognosis.Another study has also shown that liver involvement has
poor outcome.
Hence this study is conducted to study the derangement in biochemical
parameters and its correlation with outcome of disease.
A study conducted by Lon et al between January 2006 and June 2009, a total
of 537 records from suspected severe malaria cases were reviewed from patients
collapse (15%), renal failure (27%), and pulmonary oedema (2%), though less
common, were also associated with increased mortality. In multivariate analysis,
only circulatory collapse and renal failure
(70%),
thrombocytopenia
(84%),
hepatic
dysfunction
(48%),
<40mg/dl),
b)
metabolic
acidosis
(plasma
bicarbonate
UM jadhav et al in
patients with uncomplicated FM without ARF, and 25 age- and sex matched
healthy subjects as controls. In patients with severe FM and ARF, renal failure was
non oliguric in 28% and oliguric in 72%. The average duration of renal failure was
10.53+4days. 60 % recovered and 40% died. All patients with non-oliguric
presentation recovered. The Acute Physiology Age and Chronic Health Evaluation
II (APACHE II) score, Sequential Organ Failure Assesment (SOFA) score, and
Acute Tubular Necrosis-Individual Severity Index (ATN-ISI) score were all
significantly higher in the expired group when compared to the survivor group.
Kaplan-Meir survival analysis showed that survival was low in patients with
delayed hospitalization and longer duration of symptoms
2. What are the factors contributing to the prevalence of malaria among the underfive In Muleba district
3. What is the coverage of ITN use among the community members
4. What is the coverage of IRS in the households in Muleba.
HYPOTHESIS
Hypothesis is a statement of predicted relationship between two or more
variables in a research study.
There will be a significant association between the knowledge score of
adults on the preventive measure of malaria and selected variables such as age ,
religion, education , monthly income , drainage system and environment.
OPERATIONAL DEFINITIONS:
Knowledge
Assess
Adults
METHODOLOGY
Study Design
The study design was a community based descriptive quantitative cross-sectional
household survey which was conducted between April and May, 2012 in four
selected villages
Description of the Study Area
This study was conducted in Kagera region, with a focus on Bareilly district.
Bareilly district was selected purposively as it is one on malaria endemic
areas.Bareilly District (145'N, 3140'E) is in the North-western part of Tanzania
with an area of 10,739 km2 , of which 62.0% consists of Lake Victoria. Most
parts of the district lie at 1200-1500 m above sea level. Administratively the
district has 5 divisions, 31 wards, and 134 villages. It has a population of 425,172
people with 85,035 (20%) being children under the age of five years with the
majority being the Haya. The district has 36 health facilities, 3 of them being
hospitals (Rubya, Kagondo and Ndolage). Others are health centres (4) and
dispensaries (29). The district has two rain seasons which occur in March - June
and September-December during which malaria transmission peaks. Agriculture
is the main economic activity in the Bareilly district. The main food crops grown
include banana and beans, while less important ones include maize, cassava,
sorghum, groundnuts, sweet potatoes, rice plant and yams. Cash crops include
coffee, cotton, and tea. Fishing is another important activity, particularly for
villages adjacent to the Lake Victoria shore; e.g., Nshambya village in Bareilly
district district.
Health information:
Bareilly district is known to be a malaria epidemic prone area with unstable
transmission of varying seasonality. The highest peak of malaria transmission is
usually reached between May - July and November-January, which results from
proceeding rain seasons The first most devastating malaria epidemic occurred in
1997/98 following the EL- Nino rains. The district experienced another malaria
epidemic in recent years (2006). The government responded to the epidemic by
changing the first line antimalarial drug from sulfadoxine-pyrimethamine to
artemether-lumefantrine in Bareilly district. This was followed by introducing of
indoor residual spraying in 2007. Three hospitals and two health centers that are
found within Bareilly District, with inpatient facilities saw malaria-related
admissions and death rates in children under five years of age in 2006 and 2010
drop dramatically from 145 to 23 per 1000 (84% reduction) and from 42 to 5 per
10 000 (89% reduction), respectively. IRS results in Bareilly district were
impressive. An average of 100 000 house structures were sprayed per round in the
selected areas up to 2009 and over 200 000 house structures between 2009 and
for
malaria
parasites
households/mother/guardians
with
using
the
underfive
mRDT,
years
(2)
children
Head
or
of
their
representative when the head of households was not around at the time of the
study
Sampling method
Random sampling design was employed as the sampling method.
Sampling Procedures
Study villages were selected using a multistage random sampling procedure and a
cluster sampling procedure as the final stage. Selection was made with the
assistance of village and sub village heads. In the first stage, names of divisions
were obtained from the office of DMO where by two divisions were selected
randomly out of the five division found in Bareilly district. Out of the randomly
selected divisions one ward from each division was selected randomly. A ward is
an administratively demarcated area below the district level, which may comprise
three to five villages (rural) In the third stage a list of villages found in each ward
were listed from records obtained from the district medical officer's office and
randomly two villages were selected In the fourth stage, out of the two randomly
selected villages, two sub-villages were randomly selected making a total of four
sub villages. From these list two divisions namely Bareilly and Kimwani were
randomly selected. Out of the randomly selected division two wards were
randomly selected namely Gwanseri and Kasharunga wards. Villages namely,
Kasheno, Nshambya, Nkomero , Kiteme were randomly selected. Another four
sub-villages were randomly selected from a list of randomly selected villages
namely Kimeya, Byantanzi, Kaina Kasheno, making a total of four sub villages.
With the assistance of sub village heads as well as the village health care workers,
a list of all household with under fives was made from which 16 to 20 households
per sub village were randomly selected to give an overall sample size of 391 study
participants which was considered sufficient for the study. In the fourth (final)
stage, level of parasitemia among the under-five children in the selected
households were ascertained during surveys using a rapid diagnostic test
(mRDTSD/bioline) with the aid of a well trained laboratory technician. Consent
to draw blood from the children was obtained from their parents/guardian.
Data Collection Method
A structured and pre-tested questionnaire was used to collect information on
sociodemographic factors, knowledge about the transmission and prevention of
malaria, utilization and coverage of ITNs were administered to the 391 eligible
participants, whereby every head of the selected household either female or male
present at home was interviewed in Kiswahili language.
Parasitological based
Presence of parasitemia among the under-five children was ascertained during
surveys using a rapid diagnostic test (mRDT) with the aid of a well trained
laboratory technician. Consent to draw blood from the children was obtained from
their parents/guardian.
DISCUSSION
This study was carried out in Bareilly District Council where the primary objective
of the study was to determine the prevalence, of malaria among the under-fives and
the associated factors. This study was done in mid April and this was a high
malaria season hence the high prevalence. The test was done using the mRDT
where by overall prevalence of malaria among the under-fives in the study area
was (26.3 %). The prevalence of other species (P.Vivax, P. Ovale, P.Malariae) were
also being observed higher (13%). This reflects that perhaps we are missing other
species with the microscopy. For the diagnosis of malaria, microscopy is
considered as the reference method, but expert microscopy may be lacking in both
endemic and non-endemic settings. In resource-poor endemic settings, there may
be problems related to equipment, expertise and workload, whereas I non-endemic
settings in industrialized countries, there may be a lack of routine among the
laboratory staff, resulting in low expertise. In these circumstances, the use of
malaria rapid diagnostic tests (MRDTs) can be valuable in the diagnosis of malaria.
MRDTs detect antigens specific to one or more of the Plasmodium species. The
prevalence of malaria infections found in this study was low as compared to a
previous study conducted in the same area of which indicated an overall
prevalence of malarial infection to be 49-53.3% in Bareilly district (Mboera et al.,
2006. However the findings were similar high when compared to the findings from
other studies carried out in developing countries. For example, Malaria has the
least prevalence, 27.6 percent, in children age 6 to 59 months in the South East
region of Nigeria. (Nigeria malaria fact sheet2010)
Furthermore it was observed that the prevalence of malaria was higher in Kimwani
division 50% as compared to Bareilly division of which was 17%. Several factors
were observed to be associated with the high prevalence, these includes:
socioeconomic factors, physical/environmental factors of which favors the
mosquito breeding sites as well as ineffective implementation of malaria control
measures such as the use of ITNs and IRS.
Employment status of the respondents was also being observed to be one among
the possible factor that were associated with the prevalence of malaria among the
under fives during the survey. This concurred with (Makundi EA et al (2007) who
reported that the burden of malaria is greatest among poor people, imposing
significant direct and indirect costs on individuals and households and pushing
households into in a vicious circle of disease and poverty. This was also being
observed in a study done by Wandiga SO, et al. (2006.) who stated that,
vulnerable households with little coping and adaptive capacities are particularly
affected by malaria hence they can be forced to sell their food crops in order to
cover the cost of treatment.
the Insecticide treated Nets Selective indoor residual spraying (IRS) remains one
of the key strategies of the NMCP, though primarily used for epidemic prevention
and response. Indoor residual spraying with insecticide has been shown to be
highly effective as a malaria control measure in reducing the incidence of malaria
infections and deaths in a number of settings. (Oaks SC Jr, et al 1991). However
the study findings supported that IRS, was associated with protection from
parasitemia in both bivariate and multivariate analysis, it was also being observed
that many of the residents who were residing in Kimwani division were migrants
who were coming for the purpose of cultivating rice plant. Due to the issue of
settlement then people were found staying in places which were not sprayed by
IRS hence this increased the chance of mosquito bites and thus the high
prevalence. Taken together, the results presented here illustrates that: ITNs use,
IRS, parents/guardians education status, economic status; physical/environmental
factors are the predictive factors of the prevalence of malaria among the underfives.
STUDY LIMITATIONS
1. To some of the houses no physical check was done at household levels
regarding ownership of LLITNs
2. The use of LLITNs in the previous night may not reflect the actual regular use
3. The issue of asking parents/guardian verbally whether their children have
experienced an episode of fever within the past six month to determine the
prevalence of malaria.
CONCLUSION
It can be concluded that bareilly district specifically kimwani divisions has the
prevalence of malaria that is more being observed among the under-fives as
compared with Bareilly Division. The higher prevalence could be the result of
several factors as explained in this study. The finding of the study reflects that if
the control measures will be implemented appropriately then the prevalence of
malaria will decrease. Carefully-coordinated surveillance and response are
required to address ongoing, low-level transmission hot spots as well as acute
outbreaks once sustained control of malaria will be eventually achieved.
RECOMMENDATIONS:
1. There is the need for a strong collaboration among major stakeholders including
the Government, District Assemblies, and Non- Governmental Organizations to
sensitize the communities on Malaria as a disease as well as developing the holistic
and effective methods for prevention and control of the disease.
2. Though the uses of IRS, LLITNs are identified as the major method of
prevention due to their availability and affordability for many households, the
implementation
of
these
methods
is
still
questionable.
Therefore
the
3. Efforts must be seriously made by the major players in the health sector to make
the net readily available in the communities at low prices to enable the ordinary
Tanzanians to purchase it.
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