Academic journal article Journal of Health Population and Nutrition

Sleeping under Insecticide-Treated Nets to Prevent Malaria in Nigeria: What Do We Know?

Academic journal article Journal of Health Population and Nutrition

Sleeping under Insecticide-Treated Nets to Prevent Malaria in Nigeria: What Do We Know?

Article excerpt

INTRODUCTION

Malaria currently accounts for nearly 110 million clinically-diagnosed cases per year, 60% of outpatient visits, and 30% of hospitalizations in Nigeria alone (1,2). Pregnant women and children are most at risk of malaria transmission and its effects (3). About 300,000 children die of malaria and over 30 million pregnancies threatened throughout Africa each year (2). It accounts for 11% of maternal mortality and 12-30% of mortality in children below 5 years in Nigeria, the hardest-hit country in Africa (4). Malaria in pregnant (MIP) women is a major risk factor of child death in the first month of life (5,6). It causes about 15% of maternal anaemia and about 35% of preventable low birthweight, which is

a leading cause of neonatal mortality (7). MIP prevalence in Nigeria is estimated at 48% in 2000 and 2001 (8), and the prevalence in the first, second and third trimester is 37.5%, 47.3%, and 47.5% respectively (9).

The burden of malaria, its prevention and control remains a challenge despite the existence of effective technologies (10). Garner et al. (11) estimated that effective prevention of malaria with chloroquine prophylaxis or intermittent presumptive treatment (IPT) reduces the risk of low birthweight by as much as 43%. Fegan, et al. (12) also reported 44% reduction in mortality due to the use of insecticide-treated bednets (ITNs). In realization of the effectiveness of ITN against malaria, there have been improvements in the production of ITNs. Between 2008 and 2010, a cumulative total of 289 million ITNs were delivered to sub-Saharan Africa, enough to cover 76% of the 765 million persons at risk (13).

However, the use of ITN in Nigeria falls short of global targets (14). The 2008 Nigeria Demographic and Health Survey (NDHS) results indicate that 17% of households in Nigeria own a mosquito-net (treated or untreated), and 8% of households own more than one mosquito-net. Sixteen percent of households own at least one ever-treated mosquito-net, and 7% own more than one ever-treated mosquito-net. The average number of ITNs per household was less than one, which could be attributed to a weak supply and distribution mechanism (1).

Net distribution in recent years has been epileptic, with only a few Local Government Areas (LGAs) targeted in various states. This has made it impossible to attain full saturation in any one area. The approach since 2009 has been to start afresh a coordinated strategy to deliver 2 nets to every household across the country through a series of standalone campaigns to achieve universal coverage. In 2010, the World Bank Booster-supported states (Kano, Jigawa, Bauchi, Gombe, Anambra, Akwa Ibom, and Rivers) conducted net campaigns, and health workers distributed free nets to households. The aim was to promote net-use in households, especially among pregnant women and children below five years of age.

However, involvement of communities in malaria control raises several complex questions about the perceptions of malaria, its causes, prevention, and control. Answers to these complex questions reside in the people who are the end-users and the heartbeat of all efforts to control malaria through promotion of ITN-use. Often, the views of the people are missing from the so-called "people-centred" discussions on malaria control intervention. This paper documents outcomes of the study to assess people's knowledge of malaria and their perceptions of ITN in preventing malaria.

MATERIALS AND METHODS

Study design and sites

The study was designed to allow a description and analysis of community perceptions/views of ITN distribution and malaria control in Nigeria, employing qualitative inquiry in Anambra, Bauchi, and Rivers states

Study population and sampling

The study population consisted of residents of communities where ITN distribution took place. Persons aged 18 years and above, who are statutorily adults in Nigeria, were included in the study. …

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