CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF STUDY
Malaria is a life threatening parasitic disease transmitted by female Anopheles mosquitoes. In Nigeria, malaria is responsible for around 60% of the out-patient visits to health facilities, 30% of childhood death, 25% of death in children under one year and 11% of maternal deaths (National Population Commission, 2008; Noland et al., 2014). Similarly, about 70% of pregnant women suffer from malaria, which contributes to maternal anemia, low birth weight, still births, abortions and other pregnancy-related complications (Federal Ministry of Health Abuja, 2005).
Presently, malaria remains one of the worst menaces of tropical countries of the world. It is a killer and debilitating disease that affects the physical and economic well-being of people living in endemic areas of Africa (WHO, 2008). Pregnant women are among those in the higher risk group (Okwa, 2003). Recent global estimate shows that there are between 300 – 500million clinical cases of malaria and between 1.50 – 2.70million deaths attributed to malaria annually (Greenwood, 2005). Pregnant women are at immense risk of malaria due to natural immune depression in pregnancy (Fievet, 2008). Hence, it is one of the most important health issues affecting pregnant women as it has a risk of jeopardizing the life of the woman or the fetus (WHO, 2010).
Malaria has been the focus of multiple declarations, and a range of targets have been set since the beginning of the millennium (WHO, 2015). In Africa`s malaria endemic countries, an average of 30% of all outpatient clinic visits are for malaria (Roll Back Malaria, 2008). In these same countries, between 20% and 50% of all hospital admissions are a consequence of malaria (Roll Back Malaria Partnership, 2013). With high case-fatality rates due to late presentation, inadequate management, and unavailability or stock-outs of effective drugs, malaria is also a major contributor to deaths among hospital inpatients in Africa (Roll Back Malaria Partnership, 2013). People are at increased risk both of becoming infected with malaria and of becoming infected more frequently (Roll Back Malaria Partnership, 2013). Families live in dwellings that offer little protection against mosquitoes and are reluctant towards affording insecticide-treated nets etc (Roll Back Malaria, 2011).
The population at high risk of malaria incidence in Nigeria is estimated at 135,552,389 (WHO, 2015). The countrys’ confirmed and suspected cases of Malaria incidence as at 2015, stood at 19,555,575 people (WHO, 2015), with adults accounting for over 28% of the victims. Among vector borne diseases, the malaria is influenced by seasonal or spatial changes in the environment (Messina et al., 2011). Environmental factors such as the presence of bushes and stagnant water around homes, rainfall, low altitude and high temperatures favor the breeding of malaria vectors, as well as parasite reproduction within them (Messina et al., 2011). Malaria has, therefore, been defined as an environmental disease (Hay et al., 2000). The key to addressing the challenge of reducing malaria parasite prevalence is an integrated approach that combines preventative measures, such as Insecticide Treated bed Nets (ITNs), Indoor Residual Spraying (IRS), improved access to effective anti-malarial drugs (Kokwaro, 2009), as well as proper environmental management. Climate has been established as an important determinant in the distribution of vectors and pathogens (Odetoyinbo, 1969). Tropical areas including Nigeria have the best combination of adequate rainfall, temperature and humidity allowing for breeding and survival of anopheles mosquitoes (Efe and Ojoh, 2013). An increase in rainfall and temperature enhances mosquito development and improved breeding sites leading to incidence of malaria (Vincent and Sunday, 2015).