project work corrected
TRANSCRIPT
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
It is no longer in dispute that man is today faced with a catalogue of
environmental problems that seem to threaten the ecosystem and
indeed the human existence on earth.
Immediately after World War II, the pursuit of better life on earth was
solely anchored on vigorous industrialization, economic prosperity and
political stability. There is no doubt that these important factors
contribute to the descent living and prosperity. Thus the pursuit of
comfort and advancement in technology seem to have degraded the
‘Biosphere’ (FMEN, 2005)
There are various environmental problems facing the country today
which are presently being tackled by government through Federal
Ministry of Environment namely:
Drought
Desertification and Amelioration (DDA)
Deforestation
Erosion, flood and coastal management
Pollution, Environmental sanitation
Biodiversity etc
1
Most of the parasitic diseases experienced in the country occur as a
result of poor environmental management irrespective of the seasonal
trend of most of these diseases. One of the major challenges faced by
the Federal Ministry of Environment in combating this parasitic disease
is the implementation of environmental health programmes at the
state and local government levels in line with the policy/guidelines
document on Environmental Sanitation developed by the ministry.
In Nigeria, the geographical location and climatic conditions are
favourable for the transmission of Malaria with peak between the
months of June and October. The high incidence rate during this month
could be attributed to the climax of rainfall, crops growth and thick
vegetation cover during this period (Fatimehin, 2008; Patz et al.,
2004). It is worth noting that the mosquitoes breed well in
temperatures approximately 70 – 90 degrees. These conditions are
characteristics of the month of October in the tropic areas of Africa
(Carrington, 2001).
In the urban areas, refuse management problems further aggravate
the situation. Mosquitoes find breeding places in empty cans and
containers including the used partially empty pure water sachets
littered indiscriminately in refuse dumps and other places.
Malaria has been observed to be more prevalent in areas of poor social
economic development. Therefore, Malaria is not just a disease
commonly associated with poverty, but also, a cause of poverty and a
2
major hindrance to economic development. During the late 19th and
early 20th centuries, it was observed to be a major factor in the slow
economic development of American southern states (Humphreys,
2001).
In countries where Malaria is common, average per capita GDP has
risen (between 1965 and 1990) only 0.4% per year, compared to 2.4%
per year in other countries (Sachs and Malaney, 2002).
1.2 RATIONALE
Malaria is one of the major causes of mortality in Nigeria (FMEV, 2005).
In countries where Malaria is common average capital GDP has risen
(between 1965 and 1990) (Sach and Walney, 2002).
In Jabi area, of FCT Abuja the researcher observed Malaria to be one of
the major diseases affecting the community following the impact of
some environmental factors.
1.3 STATEMENT OF THE PROBLEM
Environmental factors or problems in Nigeria are diverse in nature and
are of significant dimensions. In recent years, as human population has
increased progressively, environmental problems have also become of
vital interest and importance. Some of these problems are poor
environmental sanitation, poor housing, poor weed/vegetation control,
poor control of pests and vectors of public health importance etc.
3
These environmental factors or problems pose health challenges on
the people despite all roles played by the government (FMOE,2005) to
combat this disease. Environmental management has become one of
the greatest challenges facing the world today. Unfortunately, it was
until recently, a neglected theme in Nigeria’s development plan
(Anijah-Obi, 2000). Indeed it was the 1987 koko toxic waste episode in
Edo state and the lessons from the 1969-70 sahelian drought disasters
that triggered off unprecedented government action and public
support for environmental protection in Nigeria.
Consequently, Nigeria established the Federal Environmental
Protection Agency (FEPA) in 1988, charged with the responsibility for
protection of the environment and conservation of natural resources
within the country. The following year, the government also put in
place a Natural Policy on Environment (NPE, 1989). In furtherance of
these objectives, the Nigerian government created a full Ministry of
Environment in 1999.
Malaria causes about 250 million cases of fever and approximately one
million deaths annually (WHO, 2005). The vast majority of cases occur
in children under five (5) years old, (Greenwood et al., 2005). Pregnant
women are also especially vulnerable.
Despite the efforts to reduce transmission and increase treatment,
there has been little change in whichpz areas are at risk of this disease
since 1992 (Hay et al., 2004).
4
The following areas or problems were looked into in this study:
1. Environment
Factors contributing to Malaria distribution
Man-made factors, for example, ponds, gardens etc.
2. Individual/Community
Attitudes towards the environment
Activities engaged into
3. Hospitals/Pharmacies
Facilities
Drugs used or purchased mostly
1.4 AIMS AND OBJECTIVES
The aim of this research study is to determine those environmental
factors that contribute to the distribution of Malaria in Jabi area of the
Federal Capital Territory, Abuja.
The objectives include:
5
1. To identify the human activities that promote the breeding of
mosquitoes in Jabi area.
2. To describe the preventive measures the residents or different
house-holds engage into, so as to avoid Malaria.
3. To identify the class of people or group of individuals mostly
susceptible to Malaria.
4. To identify physical or environmental factors that contribute to the
distribution of Malaria.
1.5 RESEARCH QUESTIONS
What are the environmental factors that contribute to the spread
of Malaria in Jabi?
What are the human factors that contribute to the spread of
Malaria in Jabi?
What are the most vulnerable household groups in the study
area?
What are the preventive measures adopted by the residents in
the fight against Malaria
1.6 SIGNIFICANCE OF THE STUDY
This study will lead to an identification of environmental factors that
contribute to the distribution of Malaria so as to seek ways to combat
these factors.
6
Man has responsibility for his environment; he can also control his
environment.
Environmental management and the control of parasitic diseases
reiterates on the policy on environment which seeks to secure for all
Nigerians, a quality environment suitable for good health and well-
being.
The goal of environmental health is to prevent health problems by
studying these relationships in order to identify what environment is
causing health concerns/problems; identify how and where in the
environment people are exposed to these contaminants or conditions;
identify what can be done to eliminate or minimize the level of
exposure to these contaminants or conditions; monitor these
environmental hazards over time to ensure conditioned safety of the
public. This study will help greatly in this aspect.
If such factors are identified, Malaria which has become a major
burden to the government and people of Nigeria will be prevented or
its transmission reduced.
1.7 SCOPE/DELIMITATIONS OF THE STUDY
The study is limited to 100 randomly selected households, three
private hospitals and three pharmacies in Jabi area of the Federal
Capital Territory, Abuja.
7
About one hundred and fifty (150) individuals were involved from the
selected households, hospitals and pharmacies respectively.
1.8 LIMITATIONS OF THE STUDY
The researcher used a lot of money and took time to visit the different
households, and health providers (hospitals and pharmacies). But it
was not easy going round into some of the houses as they were gates.
As a result, the questionnaires that were initially designed for one
hundred and fifty households was reduced to only one hundred
households. This was waste of money and resources.
Some respondents were careless in completing the questionnaires and
as such, materials wasted.
1.9 OPERATIONAL DEFINITION OF TERMS
1. ENVIRONMENT: Surroundings.
2. MALARIA: It’s a mosquito-borne infection disease caused
by a eukaryotic protist of the genus Plasmodium.
3. MORBIDITY: The state of condition of being disease.
4. MORTALITY: The death rate, which is the number of death per
100,000 or 1,000 of the population.
5. MOSQUITO: Flying insects which cause disease called Malaria.
6. POPULATION: A group of people in a particular place under
8
study.
7. ENVIRONMENTAL FACTORS: those things responsible for the
distribution of Malaria.
8. HEALTH: State of well being of an individual not merely in
the absence of a disease.
9. HOUSEHOLDS: People living in different houses in Jabi area.
CHAPTER TWO LITERATURE REVIEW
2.1 ENVIRONMENT AND HEALTH
In everyday use, the word ‘environment’ commonly means
surrounding. The term ‘environment’ thus encompasses many
variables and parameters which determine the existence, survival and
continuance of the organism or all conditions, circumstances and
influences surrounding and affecting all organism or a group of
organisms ( Kechnie, 1983).
Health is a state of completely, physical, mental, social well being, and
not merely the absence of disease or infirmity. The constitution of
9
WHO in conformity with the chapter of United Nations declares that,
health is basic to the happiness, harmonious relations and security of
all people.
The enjoyment of the highest attainable standard of health is one of
the fundamental rights of every human being without distribution of
race, religion and political belief, economic and social isolation.
The health of all people is fundamental to the attainment of peace and
security and is dependent upon the fullest cooperation of individual
states. The achievement of any state in the protection of health is of
value to all (WHO,2005).
According to Hippocrates the father of medicine in the fifth century BC,
he noted that, if you want to learn about the health of a population,
look at the air they breath, the water they drink, and the places the
live.
For many, the topic environmental health prompts pictures of smoke
stakes, pipelines and illegal dumps polluting our air, water and soil. But
environmental health involves more than just pollution that can affect
ones health. So, what is environmental health? To answer this, one has
to realize that, environmental health can be defined along side a series
of interacting continuum. In broad sense, environmental health is the
study of the interaction between living beings (human, animals, plants,
bacteria etc), and the environment (air, water, soil, sun, etc). and the
subsequent impact on health and quality of life (Robinson, 2001).
10
Environmental health can be viewed from the one end of the
continuum an ecological perspective to the other end of the
continuum, which focuses only on humans. The definition can also be
limited to chemical, physical and biological agents found in our air,
water, food, water, and soil.
It also include social issues created by man-made environment. For
example, violence, crime, housing etc (Butter, 2003).
2.2 LINK BETWEEN ENVIRONMENT AND PARASITIC DISEASES
The importance of environmental health in the well-being of mankind
and the key role the environmental health play in sustainable
development and the protection of human health from adverse
environmental factors cannot be over emphasized.
Environmental changes have begun to impinge upon human health on
an unprecedented national and global scale. The adverse effects of the
environment on human are many and appear to be growing in
intensity. It is common knowledge that the prevailing high morbidity
and mortality rate in the country is still largely attributed to the high
incidence of infection and parasitic diseases resulting from poor
environmental conditions (FMEN, 2005).
11
Nigeria’s geographical location and climatic conditions are favourable
for the transmission of Malaria. Malaria is seasonal with peak
transmission between the months June and October. Nigeria climate is
found to be conducive to the growth and development of Malaria
parasites (Adesina et al., 1999, Adesina, 2005, Laah and Zubairu,
2008).
2.3 ENVIRONMENTAL FACTORS CAUSING TRANSMISSION
Our environment affects our health. The quality of environment in
which a person lives, is thus, inextricably linked with the quality of life
he or she enjoys, especially his or her health and socio-economic
status. Therefore, if people are to enjoy good health, the prime
requisite is that they should live in a clean, safe and healthy
environment that is conducive.
Man’s seemingly unlimited power to dominate his environment and
exploit the natural resources therein for selfish reasons, needs, and
desires has obscured his appreciation of the fact that he or she is but
one unit, a part of a comprehensive system of dynamic inter-
dependencies that is more than the sum of its parts (Bernard, 1973).
Human activities may affect the environment while many factors in the
12
environment may also have negative or positive impact on peoples
health and welfare. Some of the major environmental concerns facing
the world today include the following:
Green house effects and global warming
Ozone depletion
Urbanization and its associated problems
Degradation of land
Air and water pollution
Loss of biological diversity
Large scale deforestation
Depletion of natural resources
Disposal of water.
Most of these environmental problems are the consequences of the
changes brought about by man’s intervention with the environment for
the satisfaction of his basic needs, as well as his pursuit of more
ambiguous goals.
For the benefit of this study, we shall be looking at the impact of the
following environmental factors that contribute to the distribution of
Malaria.
2.3.1 Poor Environmental Sanitation/Indiscriminate Waste
Disposal.
13
Closely linked to the provision of portable water is the provision of
adequate environmental sanitation. Our inability to remove refuse from
our streets and out of the range of constituting a nuisance to our
environment is a common phenomena, as only a fraction of the waste
generated daily is collected and disposed by the relevant authorities.
Most parts of our city centers do not benefit from the public waste
disposal services and therefore have to bury or burn their waste or
dispose of it haphazardly.
Presently about 49% of Nigerians dispose the refuse within their
premises, 38% dispose their waste in the bush and only 13% use
sanitary dustbins.
In all 87% of Nigerians use one method or the other adjudged to be
unsanitary. Both public and private waste collectors within the cities
have not kept up with the rate of generation of waste as a result of
increasing demand. Improper disposal of municipal waste encourages
the breeding and habitation of Malaria (FMEN, 2005) and other pests of
public health importance with attendant disease outbreak. The influx of
e-waste imported into the country is an eye sore this constitute
nuisance to the environment (Dada, 2010).
2.3.2 Poor Housing
Slums and poor housing are prominent features in our environment as
a result of our inability to adhere to urban development plan and also
14
because of the rapid rate of population growth which continues to
exert deleterious effects on the already critical housing condition (UN,
1987).
For example, our inability to adhere to the federal/state capital
development plan has created the upsurge of slumps shanty towns
that provides numerous pools of standing water for breeding of
mosquitoes in the immediate environment of the city. Spontaneous
squatter settlement continues to provide shelter for immigrants in an
environment of great…
It was often assumed that the disappearance of rain forest and use of
dichlorodiphenyltrichloroethane (DDT) as a control measure would be
accompanied at least by beneficial effects on vector borne diseases as
the habitat of the vectors will be destroyed and with this the
transmission of infectious Malaria disease would be reduced or even
eliminated (UNEP, 1986).
2.3.3 Flood and Erosion
Flooding has become one of the major environmental problems facing
the country today. In the Niger Delta region and other parts of the
west, flooding has led to the loss of lives and property, and has caused
serious environmental degradation especially during the annual
rainfall. Water log in potholes, unused tires and empty cans serve as
the breeding spots for mosquitoes ( Fatimehin et al., 2009).
15
Gully erosion especially which is renounced in the country is another
avenue for the breeding of pests and vectors of public health
importance particularly mosquitoes.
Malaria was singled out as vectors distributing diseases that affect
thousands of people living along wetland areas (coastal and riverside
areas) and tropical forest areas (Martens et al., 1999).
With climate and land use change resulting from large influx of
immigrants coupled with changes in socio-economic status of the
population and the adaptation of vectors to man-made environment,
the incidence of Malaria is increased (C Amargo, et a,l 1994, Cardelle
and Foley, 2003, Magnus and Bodmas, 2007).
2.3.4 Poor Weed/Vegetation Control
Overgrown weed and poor vegetation lead to breeding of vector and
other pest of public health importance. In an environment whereby
weed is overgrown result into drainage blockage or stagnant waters
where Malaria vectors are bred (UNEP, 1986).
2.3.5 Poor Control of Pests and Vectors of Public Health
Importance
Vectors transmit several disease of public health importance in Nigeria.
Malaria which is transmitted by the anopheles mosquitoes is
responsible for considerable morbidity and mortality rate particularly
16
among children less than five (5) years, and pregnant women
(Greenwood et al., 2005).
2.3.6Drought and Desertification
Frequent reduction in natural potential of the land and a depletion
surface along with ground water resources causes the earth ecosystem
to deteriorate. Desertification is the degradation of the land in arid,
semi-arid and sub humid dry area caused by climate change and
human activities.
Prolong drought lead to desertification. A combination of drought,
desertification and over population can lead to conflict. For example,
Darfur conflict human activities such as excessive farming irrigation
and deforestation and erosion also lead to flood.
Malaria still constitutes a serious public health problem in Nigeria
(Jimoh, 2005, FMOH, 2005, Olanrewaju, 2006, Mamah, 2007). Malaria
consistently maintained the lion share between 55 and 64.7% among
14 top diseases and Malaria was ranked second killer after measles
between 1973 and 1982 (Iyum, 1987).
Malaria in Nigeria is currently confined to all parts of the country but
with varying incidence and prevalence rate across the nation. Areas
17
such as coastal, riverine, forested and urban areas are endemic areas.
The contributing factors include, abject poverty, large-scale
deforestation, increase in urban agriculture and irrigation farming,
increase in urban and watershed flooding due to interference of water
ways, presence of surface water bodies and open water storage
facilities, indiscriminate dumping of refuse and the spatial pattern of
health care facilities and infrastructure (Adesina et al., 1999, Adesina
2005, Laah and Zubairu, 2008).
The risk of Malaria infection varies widely according to geographical
region, season, environment and socio-economic status of individuals.
2.4 MEASURES TO CONTROL PARASITIC DISEASES
This includes the following ways:
1. Physical Control: this is the killing of the pest physically through:
Removal of various containers: habitats such as abandoned
tins, cans, metal drums, disused water, storage pots and
old tires, to discourage the breeding of vectors for Malaria.
Repair of damaged septic tanks and soak-away pits, fitting
windows, doors and other openings with screens are some
of the physical control methods against vectors (UNEP,
1986).
2. Biological Control: this is the use of biological agent to terminate
the developmental stage of the vector. This may be done by a
18
use of predator to feed on the larval stage of an insect. For
example, the use of Gambusia affins (fish) to feed on the larval
stage of mosquitoes.
3. Mechanical Control: uses of mechanical devices such as nettings
on windows and doors.
4. Chemical Control: this is the use of chemical to destroy vectors
by fumigation or spraying. Non environmental friendly chemicals
are now being faced out the federal government of Nigeria.
5. Ecological Control: this involves the removal of weeds within
fields which provide less suitable environment (FMEN, 2008).
2.5 ENVIRONMENTAL CONTROL OF PARASITIC DISEASES
1. ENVIRONMENTAL SANITATION: this is the destruction of
receptacles that may serve as breeding places for mosquitoes.
Activities like cutting of overgrown weeds that may serve as
harbouring places for mosquitoes, proper disposal of waste, and
proper drainage system to prevent mosquitoes from breeding.
2. HEALTH EDUCATION: this is the process of teaching people
good habits as a way to improve on individual health and prevent
diseases. It involves the process of enlightening people and
urging them to accept measures that will improve their health
19
conditions and reject those habits that will have adverse effect
on them. (FMENV, 2008).
3. GOOD HOUSING: adequate and good housing to reduce
over-crowding, prevent emerging slums and shanties, and also,
to improve on proper lighting and ventilation.
4. GOOD DRAINAGE SYSTEMS: this is to avoid flooding and
breeding arena for mosquitoes that transmit Malaria.
5. PESTS AND VECTORS CONTROL: periodic fumigation and
spraying.
2.6 GOVERNMENT INTERVENTION
2.6.1 Waste Management: Federal Government has put up
series of programmes to intervene in this area, and they
include bailing centers, refuse transfer station, tank farm,
refuse farm, recycling plants etc…
2.6.2 Environmental Sanitation: for example, policy and
guideline on environmental sanitation, advocating for rural
sanitation, cleanest state capital award to boost the murals
of the inhabitants of the environment, etc…
2.6.3 Housing: demolition of illegal structures that block
streets and drainages, enforcing land reform programmes,
mega cities, etc…
2.6.4 Sanitary Inspection of Premises: policy guidelines
20
and the establishment of environment health offices.
2.6.4 Pests and Vector Control: fumigation, policy
guideline on pest and vector control.
2.6.5 Environment Assessment: environmental auditing
and monitoring.
2.6.6 Erosion/Flood Control: controlling erosion in major
cities, coastal zone management, and water harvesting.
2.6.7 Drought/Desertification and Amelioration Control:
this tackles the problem of deforestation, drought etc,
also prevents desert encroachment.
2.7 MALARIA HISTORY
Malaria has infected human for fifty thousand (50,000) years and
plasmodium may have been a human pathogen for the entire
history of the species (Joy et al., 2003).
Malaria may have contributed to the decline of Roman Empire
and was so pervasive in Rome that it was known as the ‘Roman
Fever’ (Robert, 2003). The term Malaria originates from the
medieval Italian Malaria – bad air, the disease was formerly due
to its association with swamps and marshland. Malaria was once
common in most European and North American countries
(Linderman, 1999) where it is no longer endemic though
imported cases do occur.
21
Scientific studies on Malaria made their first significant advance
in 1880 when a French army doctor working in the military
hospital of Constantine in Algeria named Charles Louis Alphonse
Laveran observed parasite for the first time inside the red blood
cells of people suffering from Malaria. He therefore proposed that
Malaria is caused by this organism, the first time a protist was
identified causing disease. The Malaria parasite was called
plasmodium by the Italian scientist Ettore Marchiafava and
Angelo Celli. A year later, Carlos Finlay, a Cuban doctor treating
patients with yellow fever in Havana, provided strong evidence
that mosquitoes were transmitting disease to and from human
(Tan and Sung, 2008).
It was Britain’s sir Ronald Ross who finally approved in 1898 that
Malaria is transmitted by Mosquitoes. He did this by showing that
certain mosquito species transmit Malaria to birds from their
salivary glands of the infected birds (Krotoski et al., 1982).
The first effective treatment of Malaria came from the bark of
Cinchono tree which contains quinine. The Jesuits noted the
efficacy of the practice and introduced to Europe during the
1640’s where it was rapidly accepted (Kauffman and Ruyeda,
2005). It was not until 1820 that the active quinine was extracted from
the bark isolated and named by French chemist Pierre Joseph Pelleter
and Joseph Bienaime Caventou, (Kyle and Shampu, 1974).
22
Four species of plasmodium parasites can infect humans most serious
of all is Plasmodium Falciparum. Malaria caused by Plasmodium Vivax
Plasmodium Ovale and Plasmodium Malariae is milder and not
generally fatal (Fong et al., 1971).
Malaria is naturally transmitted by the bite of a female anopheles
mosquito. When a mosquito bites an infected person, a small amount
of blood is taken which contains Malaria parasites.
2.8 SIGNS AND SYMPTOMS
Main symptoms of Malaria include fever, shivering, arthralgia (joint
pain, vomiting, and anemia, caused by haemolysis), hemoglobinuria,
retinal damage and convulsions (Beare et al., 2006). The classic
symptoms of Malaria is cyclical occurrence of sudden coldness followed
by rigor and then fever sweating lasting four to six hours, occurring
every two days in Plasmodium Vivax and Plasmodium Ovale infections,
while every three days in Plasmodium Malariae. Plasmodium
Falciparum can have recurrent fever every 36 – 48 hours or a less
pronounced and almost continuous fever (Malaria in Armenia, 2006).
For reasons that are poorly understood, but that may be related to
high intracranial pressure, children with Malaria frequently exhibit
abnormal posturing, a sign indicating severe brain damage. (Idro et
al.,2004). The neurological damage results from cerebral Malaria to
which children are vulnerable (Boirin, 2002). And (Holding and Snow
23
2001) cerebral Malaria associated with retinal whitening distinguishes
Malaria from other causes of fever (Beare et al., 2006).
Severe Malaria is almost exclusively caused by Plasmodium Falciparum
and usually 6-14days after infection (Trampuz et al., 2003).
Consequences of severe Malaria include coma and death if untreated.
Young children and pregnant women are especially vulnerable.
Splenomegaly (enlarged spleen), severe headache, cerebral ischeamia,
hepotomegaly (enlarged liver), hypoglycemia and hemoglobinuria with
renal failure may occur. In the most severe cases of the disease,
fatality rate can exceed 20% even with intensive care and treatment.
(Kain et al., 1988).
Chronic Malaria is seen in both Plasmodium Vivax and Plasmodium
Ovale but not in Plasmodium falciparum. Here the disease can relapse
months or years after exposure due to the presence of latent parasites
in the liver. Describing case of Malaria as cured by observing the
disappearance of parasites from the blood stream can therefore be
deceptive. The longest incubation period reported for a Plasmodium
Vivax infection is 30 years (Trampuz et al, 2003).
2.9 MOSQUITO VECTOR AND THE PLASMODIUM LIFE CYCLE.
The primary definitive and intermediate hosts and transmission vectors
are female mosquitoes of the anopheles genus, while humans and
other vertebrates are secondary hosts. When an infected female
24
anopheles mosquito bites a man, sporozoites are injected together
with saliva and circulate in the blood stream for less than an hour by
which time some of them have invaded the hepatocytes once ingested,
the parasite gematocytes taken up in the blood will further
differentiate into male and female gamates and then fuse in the
mosquito gut. This produces an ookinete that penetrates the gut lining
and produces oocyst in the gut wall. When the oocyst ruptures it
releases sporozoites that migrate through the mosquito’s body to the
salivary glands where they are then ready to infect a new human host.
The sporozoites are injected into the skin, along side saliva, when the
mosquito takes a subsequent blood meal. Only female mosquitoes
feed on blood, thus males do not transmit the disease. The females of
anopheles genus of mosquito prefer to feed at night. They usually start
searching for their meal at dusk and continue throughout the night
until taking a meal. Malaria parasites can be transmitted by blood
transfusion, although this is rare (Marcucci et al., 2004).
2.10 PATHOGENESIS
A mosquito infects a person by taking a blood meal. First, sporozoites
enter the blood stream and migrate to the liver. They infect liver cells
(hepatocytes), where they multiply into merozoites, rupture the liver
cells and escape back into the blood stream. Then, the merozoites
infect red blood cells, where they develop into ring form, the
25
trophozoites and schizonts which in turn produce further merozoites.
Sexual forms (gematocytes) are also produced, which if taken up by a
mosquito, will infect the insect and continue the life cycle.
Malaria in humans develop via two phases, an exoerythrocytic
(infection of the hepatic system) and erythrocytic phase (infection of
the blood stream or red blood cells). When an infected mosquito
pierces a persons skin to take a blood meal, sporozoites in the
mosquito’s saliva enters the blood stream and migrate to the liver.
Within 30 minutes of being introduced into the human host, the
sporozoites infect the hepatocytes, multiplying asexually and a
symptomatically for a period of 6 – 15 days. Once in the liver, these
organisms differentiate to yield thousands of merozoites which
following rupture of their host cells, escape into the blood and infect
the red blood cells thus beginning the erythrocytic stages of life cycle
(Bledsoe, 2005). The parasites escape from the liver undetected by
wrapping itself in the cell membrane of the infected host liver cells
(Sturm et al., 2006).
Within the red blood cells, the parasites multiply and further gain
asexually periodically breaking out of their host to invade fresh red
blood cells several such application cycles occur. Thus classical
descriptions of waves of fever arise from simultaneous waves of
merozoites escaping and infecting red blood cells. Some Plasmodium
vivax and Plasmodium ovale sporoites do not develop into merozoites
26
but remain dormant for period of several months (6-12 months) to as
long as three years. Hypnozoites are responsible for long incubation
and late relapses in these two species of Malaria (Logswell, 1992).
The parasites are relatively protected from attack by body immune
system because for most of its human life cycle it resides within the
liver and blood cells and is relatively invisible to immune surveillance.
However, circulating infected blood cells are destroyed in the spleen.
To avoid this fate, the Plasmodium falciparum parasites display
adhesive protein on the surface of the infected blood cell, causing the
blood cells to stick to the walls of the small blood vessels thereby
suppressing the parasites from passing through the general circulation
and the spleen (Chen et al., 2006).
The ‘stickiness’ is the main factor giving rise to haemorrhagic
complications of Malaria. High endothelial venules (smallest branches
of the circulatory system) can be blocked by the attachment of masses
of these infected blood cells. The blockage of these vessels causes
symptoms such as in placental and cerebral Malaria. In cerebral
Malaria, the sequestrated red blood cells can breach the blood brain
barrier possibly leading to coma (Adams and Turner, 2002).
Pregnant women are especially vulnerable to the mosquitoes,
(Lindasay et al., 2000) and Malaria in pregnant women is an important
cause of still births, infant mortality and low birth weight (Geetruyden
et al., 2004), particularly in plasmodium falciparum infection but also in
27
other species infection such as Plasmodium Vivax (Rodriguez et al.,
2006).
2.11 DIAGNOSIS
Since Charles Laveran first visualized the Malaria parasites in blood in
1880 (Sutherland and Hallet, 2009) fever and septic shock are
commonly misdiagnosed as severe Malaria in Africa. Recent
investigations suggests that Malarial retinopathy is better (collective
sensitivity of 95% specificity of 90%) than any other clinical or
laboratory feature in distinguishing Malarial from non Malarial coma
(Beare et al., 2006).
Although blood is the sample most frequently used to make diagnosis
both saliva and urine has been investigated as alternative, less
invasive specimen (Sutherland and Hallet, 2009).
2.11.1 Symptomatic Diagnosis
History of subjective fever as the indication to treat for Malaria is used
instead of laboratory diagnosis tests particularly in areas who can not
afford such tests.
2.11.2 Microscopic Examination of Blood Films
The most economic, preferred and reliable diagnosis of Malaria is
microscopic examination of blood films because each of the four major
28
parasites has distinguishing characteristics. Two sorts of blood films
are traditionally used. Thin films are similar to usual blood films, and
allow species identification because the parasites appearance is
observed in the preparation. Thick films allow the microscopist to
screen a larger volume of blood and are about eleven times more
sensitive than the thin film, so pocking up on low levels of infection is
easier on the thick film, but the appearance of the parasites is much
more distorted and therefore distinguishing between the different
species can be much more difficult. With the pros and cons of both
thick and thin smear taken into consideration, it is imperative to utilize
smear while attempting to make definite diagnosis (Warhurst and
Williams, 1996).
2.11.3 Antigen Tests
For areas where microscopy is not available or where laboratory staff
are not experienced at Malaria diagnosis, there are commercial
antigens tests that require only a drop of blood (Pattanasin et al.,
2003).
2.11.4 Molecular Method
Molecular methods are available in some clinical laboratories and rapid
real time assays (for example, QT-NASBA based on the polymerase
chain reaction) (Mens et al., 2006), are being developed with the hope
29
of being able to deploy them in endemic areas. PCR and other
molecular methods are more accurate than microscopy. However, it is
expensive and requires a specialized laboratory.
2.12 PREVENTION
Methods used to prevent the spread of diseases or to protect
individuals in areas where Malaria is endemic include prophylactic
drugs, mosquito eradication and the prevention of mosquito bites. The
continual existence of Malaria in an area requires a combination of
high human population levels, hands on technical and programmatic
support from partner agencies and sufficient flexible financing (Barat,
2006).
2.13 VECTOR CONTROL
Efforts to eradicate Malaria by eliminating mosquitoes have been
successful in some areas. Malaria was once common in the United
States and southern Europe but vector control programmes in
conjunction with the monitoring and treatment of infected humans,
eliminated it from the region. In some areas, the draining of wetland
breeding and better sanitation was adequate. Malaria was eliminated
in the northern parts of the USA in the early 20th century by such
methods and the use of DDT eliminated it from the south by 1951.
30
Before DDT, Malaria was successfully eradicated or controlled also in
several tropical areas be removing or poisoning the breeding ground of
the mosquito or aquatic habitats of the larva stage of the mosquito. For
example, by filling or applying oil to places with standing water. In
Africa, these methods are not commonly used for more than half a
century (Killen, 2002).
Density, high mosquito population density an high rates of
transmission from human to mosquito and from mosquito to human. If
any of these is lowered sufficiently, the parasite will sooner or later
disappear from that area as happened in North America, Europe and
much of the Middle East (Redds et al., 2006). However, unless the
parasite is eliminated from the whole world, it would become
reestablished if conditions revert to a combination that favours the
parasites reproduction. Many countries are seeing an increasing
number of imported Malaria cases due to extensive travel and
migration of the people.
Many researchers argue that prevention of Malaria may be cost
effective than treatment of the disease in the long run but the capital
costs required are out of reach of many of the worlds poorest people.
Economic adviser Jeffre Sachs estimates that Malaria can be controlled
for US and in aid per year (Medical News today, 2007).
31
Common success factors include approach using a condition a targeted
technical approach using a package of effective tools, data-driven
decision making active
2.14 PROPHYLATIC DRUGS
Several drugs, most of which are for treatment of Malaria, can be taken
preventively. Modern drugs used include mefloquine (Lariam)
doxycycline (available generally) and the combination of atovaquine
and proguanil hydrochloride (malarone). Doxycycline and the
antovaquin and proguanil combination, are the best tolerated with
mefloquine associated with higher rates of neurological and psychiatric
symptoms (Jacquerioz and Croft, 2009). The choice of which drug to
use depends on which drugs the parasites in the area are resistant to
as well as side effects and other considerations. The prophylactic effect
does begin taking the drugs one to two weeks before arriving and must
continue taking them for four weeks after leaving. Quinine was used
historically however the development of more effective alternatives
such as quinaorine, chloroquine, and primaquine in the 20th century
reduced its use. To quinine, is not generally used for prophylaxis. The
use of prophylactic drug where Malaria bearing mosquitoes are present
may encourage the development of partial immunity (Roestenberg et
al., 2009).
32
2.15 INDOOR RESIDUAL SPRAYING
Indoor residual spraying (IRS) is the practice of spraying insecticides on
the interior walls of homes with Malaria. While distributing mosquito
nets is a major component of Malaria prevention, community education
and awareness on the dangers Malaria are associated with the
distribution campaigns to make sure people who receive a net know
how to use it ‘hang up’ campaigns, such as the ones conducted by
volunteers of the internal Red Cross and Red Crescent movement
consisting of visiting households that received a net at the end of the
campaign or just before the rainy season ensuring that the nets are
being properly used, and that the people most vulnerable to Malaria
such and young children and elderly sleep under it.
2.16 VACCINATION
Immunity (or more accurately, tolerance) does occur naturally but only
in response to repeated infected people with multiple strains of Malaria
(Farnert et al., 1999).
The first promising studies demonstrating the potential for Malaria
vaccine was performed in 1967 by immunizing mice with live radiation,
providing protection to about 60% of the mice upon subsequent
injection with normal viable sporozoites (Nussenzwerg et al, 1976).
Since the 1970’s there has been a considerable efforts to develop
similar vaccination strategies within humans. It was determined that
33
an individual can be protected from a Plasmodium falciparum if they
receive over 1,000 bites from infected irradiated mosquitoes (Hoffman
et al., 2002).
2.17 OTHER METHODS
Education is recognizing the symptoms of Malaria has reduced the
number of cases in some areas of the developing world by as much as
20%. Recognizing the disease in the early stages can also stop the
disease from becoming a killer. Education can also inform people to
cover areas of stagnant, still water, e.g. water tanks which are
breeding grounds for the parasite and mosquito thus cutting down the
risk of the transmission between people. This practice is done where
there are large centers of population in a confined space and
transmission would be most likely in these areas.
The Malaria control project is currently using down time computing
power donated by individual volunteers around the world. To stimulate
models of the health effect and transmission dynamics in order to find
the best methods or combination of methods for Malaria control.
Other intervention of the control of Malaria includes mass drug
administration and intermitted prevention therapy. Alternative
proposed attempts to reduce mosquito transmission rate is the
mosquito laser and photonic fence which identifies female mosquitoes
and shoots them using a medium powered laser which the device is
34
currently undergoing commercial development (Laser Pest Control
Physics, 2010).
2.18 TREATMENT
The treatment of Malaria depends on the severity of the disease.
Uncomplicated Malaria is treated with oral drugs. Whether patients
who can take oral drugs have to be admitted depends on the
assessment and the experience of the clinician. Severe Malaria
requires the parental administration of anti-Malarial drugs. The
traditional treatment for severe Malaria has been quinine, but there is
evidence that the artemisinines are also superior for the treatment of
severe Malaria. This was published by CDC 2006. A large clinical trial is
currently on the way to compare the efficacy of quinine and artesunate
in the treatment of Malaria in African children. The cost of such
medicine is often too high for most people in the developing world,
therefore some herbal remedies (such as Artemisia annuatea) have
also been developed, supported by international organization such as
medicines san frontiers. When properly treated, someone with Malaria
can expect a complete recovery.
2.19 EPIDEMIOLOGY
Malaria causes about 250 million cases of fever and approximately one
million deaths annually. The vast majority of cases occur in children
35
under 5 years old (Greenwood et al., 2005). Pregnant women are also
especially vulnerable. Despite efforts to reduce transmission and
increase treatment, there has been little change in which area are at
risk of this disease since 1992 (Hay et al., 2004). Indeed if the
prevalence of Malaria stays on its present upwards course, the death
rate would double in the next twenty years as many cases occur in
rural areas where people do not have access to hospitals or the means
to afford health care (Breman, 2001).
By contrast in Africa, Malaria is present in both rural and urban
settlements though the risk is lower in the larger cities (Keiser et al.,
2004).
36
CHAPTER THREEMATERIALS AND METHODS.
3.1 RESEARCH DESIGN
The questionnaire is structured into two parts ‘I’ and ‘II’.
Part ‘I’ of the questionnaire contains information based on personal
data of the respondents which include, name, sex, age, religion,
address, and occupation.
Part ‘II’ of the questionnaire is based on the subject matter of the
research. It is composed of three sections
Section A: the response from individuals of different households.
Section B: responses from staff of private hospitals selected.
Section C: responses from the staff of pharmacies.
Respondents were expected to think against one of the options found
to be the answer or the idea of the respondents.
The answers were in options of A – D or Yes / No
Oral interview: the researcher held interviews with individuals of
different households about their environment and various activities of
their environment generally. Also, interactions with health providers
37
(hospitals and pharmacy staff) based on how many cases visit their
facilities, and how frequent.
Observation: apart from questionnaires and oral interviews,
observation was used by the researcher around the environment and
various human activities in the environment so as to note them and
their contribution to Malaria distribution in Jabi District, FCT, Abuja.
3.2 SAMPLING POPULATION OF STUDY
The study sample for this research comprised one hundred and fifty
questionnaires distributed to one hundred households, and the rest of
the fifty to health providers (hospitals and pharmacies). Houses were
randomly selected for this study in Jabi District, FCT, Abuja.
3.3 SAMPLING PROCEDURE
A total of one hundred and fifty individuals involving households,
private hospitals and pharmacies were involved in this investigation.
These groups were chosen because they live in the environment and
are affected directly or indirectly by the environmental factors. Both
hospitals and pharmacies deal with cases of Malaria on almost, daily
basis.
The table below shows the names of houses, hospitals and pharmacies
visited and the number of questionnaires issued/collected respectively.
38
Table 1: Distribution of Study Population
Place Respondents
Houses 100
Hospitals
Nissi Premier hospital 10
Arewa hospital 10
Rosez hospital 10
Pharmacies
Nil Pharmacy 10
Jaff Pharmacy 5
Winco Pharmacy 5
Total 150
39
3.4 DATA COLLECTION PROCEDURE
Data collection was based on primary and secondary source:
Primary data: data that had not been used or obtained before which
are usually collected from the field through administration of
questionnaires and oral interviews.
Secondary data: the main research instruments used for the collection
of data for the study, is the structured questionnaire, oral interviews
and observation.
3.5 DATA ANALYSIS TECHNIQUE
Descriptive statistical analysis was employed. The responses to the
questions were analyzed using Microsoft excel to obtain the frequency
tables drawn up. From these percentages were calculated as
appropriate.
3.6 ETHICAL CONSIDERATIONS
Permission was first of all sought from the Jabi area head before the
distribution of all questionnaires to various households, hospitals and
pharmacies. In some of the households, hospitals and pharmacies too,
it was necessary to seek the permission from the person in-charge of
these places so as to distribute questionnaires and carry out the
40
necessary investigations regarding this study. Households, hospitals
and pharmacies were randomly selected so as to get reliable results
that will represent the whole Jabi area.
41
CHAPTER FOUR
RESULTS, ANALYSIS AND FINDINGS
4.1 RESEARCH QUESTIONS
The research questions were derived from the objectives of the
study. Results were therefore analyzed based on the four
research questions, using tables and figures
1. What are the environmental factors that contribute to the spread
of Malaria in Jabi district?
2. What are the human factors that contribute to the spread of Malaria
in Jabi district.
3. What are the most vulnerable household groups in the area?
4. What are the preventive measures adopted by the residents in the
fight against Malaria.
42
4.2 RESULTS/ANALYSIS AND FINDINGS
Table 2. Sex related distribution of household and health facility based
respondents.
Table 2 shows the sex related distribution of household and health
facility based respondents. We observed that 45(45%) were females
and 54(54%) were males among household respondents, while
21(42%) were females and 29(58%) were males among health facility
based respondents. The total number of household respondents was
100 (66.7%) while the total number of health facility based
respondents was 50(33.3%).
Table 2: Distribution of Respondents According to Sex.
Sex Household Respondents
Health Facility Respondents
Total
Female
s
45(45.0%) 21 (42.0%) 66(44.0%)
Males 55(55.0%) 29(58.0%) 84(56.0%)
Total 100(66.7%) 50 (33.3%) 150 (100%)
43
Figure 1: Age related Distribution of Household and Health Facility Based Respondents.
Figure 1 presents the age related distribution of house hold and
health facility based respondents. Among household respondents, the
age range of 26 – 30 years was the most represented (32%).This was
followed by those less than 25(22%), then the age bracket of 31 -35
(20%), while those aged between 36 – 40 had 13% and finally house
hold respondents above 40 represented 13% as well. Among health
facility based respondents, the age range of 36 – 40 was the most
represented with 23(46%) respondents, followed by those more than
40 years with 13(26%), then the bracket of 31 – 35 with 12(24%)
respondents and finally the range of 26 – 30 with 2(4%) respondents.
44
Table 3: Sex Related Distribution of Respondents’ Knowledge
and Attitude in Relation Malaria among Household
Respondents
Knowledge and
Attitude indicator
Female Male total
Understand what
Malaria is
31 (68.8%) 30 (54.5%) 61 (61%)
Know how Malaria
is transmitted
22 (48.8%) 27 (49.0 %) 47(47%)
Ever suffered from
Malaria
40 (88.8%) 55 (100%) 95(95%)
Average number of
Malaria episodes
in a year
6 6
Table 3 shows the sex related distribution of respondents’ knowledge
and attitude in relation to Malaria. We found out that 31(68.8%) of
females and 30(55.6%) of males had good understanding of Malaria.
Total of 22 (48.8%) females and 27(49.0%) males only, knew that
Malaria was transmitted through mosquitoes bites to man. Total of 40
(88.8%) females and 55(100%) reported that they have suffered from
Malaria. Finally the average number of Malaria episodes per year was
seen to be 6 in both females and males
45
Figure 2: Common Symptoms of Malaria Reported among Male
Respondents.
Figure 2 illustrates the most common symptoms of Malaria reported
among male respondents. It was seen that only 17% of males reported
headache, 21% reported cold body,25% indicated the hot body was a
major symptom, while 37% of males said the three symptoms occurred
at the same time.
46
Figure 3: Common Symptoms of Malaria among Female
Respondents.
Figure 3 present the most common symptoms of Malaria among
female respondents. This figure indicates that 42% of females reported
hot body as the major symptom for Malaria, followed by cold body
(21%) , headache was found in 25% of females, while only 12% of
females mentioned the three symptoms at the same time.
47
Figure 4: Attitudes of Female Respondents in Relation to
Malaria.
Figure 4 reveals that 71% of females go to hospital when they have
Malaria, 25% visit pharmacies, none (0%) stays in the face of Malaria,
while about 4% do all the three.
48
Figure 5: Attitude of Male Respondent in Relation to Malaria.
In figure 5, 60% of males reported that they go to hospital in the face
of Malaria, 12% visit pharmacies and only 4% stay at home, while 24%
do the three.
49
Table 4: Distribution of Environmental Factors Contributing to
the Spread of Malaria in Jabi District.
Environmental Factors
Frequency Percent respondents
Dirty Houses 4 4%
Unkempt Ponds, gardens,
bushes
68 68%
Littered pure water bag 50 50%
Dirty gutters 16 16%
Unkempt grasses 2 2%
Jabi dam contribution 88 88%
Table 4 shows only 4(4%) of respondents had dirty houses, 68(68%)
reported that their ponds, gardens and bushes were unkempt, 50(50%)
said they had pure water bags littered around, 16(16%) mentioned
that their gutters were dirty, unkempt grasses accounted for 2(2%),
while 88(88%) of respondents felt that Jabi dam was a major
contributor to the spread of Malaria in Jabi district.
50
Table 5: Distribution of Human Activities Contributing to the
Spread of Malaria around Jabi Dam.
Human Activitie
s
Morning Afternoon
Evening All times total
Weddings 0 1(10%) 1(3.3%) 4(7.6%) 48(48%)
Pick nicks 1(12.5%) 1(10%) 3(10%) 9(17.4%) 10 (10%)
Recreation 0 1(10%) 1(3.3%) 4(7.6%) 8 (8%)
All of the
above
7(87.5%) 7(70%) 25(83.4%) 35(67.4%) 34 (34%)
Total 8(8%) 10(10%) 30(30%) 52(52%) 100
Table 5 presents the distribution of human activities contributing to
the spread of Malaria around Jabi dam. We observed that 48% of
respondents reported that weddings could contribute to the spread of
Malaria around the damp, 34% of respondent felt that all forms of
activities around the damp could spread Malaria, especially in the
evening (83.4%). Only 10% of respondents reported that pick nicks
could spread Malaria around the dam, while recreation was only
attributed 8% of respondents.
51
Table 6: Distribution of Preventive Measures among Household
Respondents.
Human Activities Morning Afternoon Evening
Clean house and
proper refuse
16(17.3%) 1(12.5%) 17(17%)
Avoid water logs
around house
4(4.5%) 1(12.5%) 5(5%)
Doors and Windows
Fitted with nets
6(6.5%) 2(25%) 8(8%)
All of the above 66(71.7%) 4(50%) 70(70%)
Total 92(92%) 8(8%) 100
Table 6 shows the distribution of prevention measure in relation to the
presence or absence of doors/windows fitted with nets among
household respondents. Total of 92(92%) of respondents had houses
fitted with nets, but only 66(71.7%) of them knew that the three
measures listed were necessary to prevent Malaria, while 16(17.3%)
knew only about house cleanliness and proper disposal of refuse,
4(4.5%) only knew about avoiding water longs and 6(6.5%) knew about
fitted nets. Total of 8(8%) of respondents reported that their house had
no fitted nets, of which 4(50%) knew about the three prevention
measure listed, while 2(25%) mentioned fitted nets, 1(12.5%) knew
about avoiding water longs and another 1(12.5%) knew about house
cleanliness and proper disposal of refuse.
52
Table 7: Distribution of Household Groups Affected by Malaria
According to Seasons.
Households Dry season Rainy
season
Both
dry/rainy
Total
Children 8(66.6%) 27(59.1%) 13(33.3%) 48(48%)
Adults 2(16.7%) 4(9.1%) 4(9.5%) 10 (10%)
Pregnant women 0(0%) 2(4.5%) 6(14.3%) 8 (8%)
All groups 2(16.7%) 13(27.3%) 19(42.9%) 34 (34%)
Total 12(12%) 46(46%) 42(42%) 100
The distribution of house hold groups affected by Malaria according to
seasons (table 7), indicates that children were the most affected group
(48% of respondents) and the rainy season appeared to be the most
vulnerable period according to 59.1% of respondents. Only 10% of
respondents said adults were affected and the period was both dry and
rainy seasons (9.5%). Total of 8(8%) of respondents reported that
pregnant women were affected by Malaria and the most infective
period was both dry and rainy season with 6(14.3%).Finally, 34(34%) of
respondents was of the opinion that all groups were equally affected
and the most infective period according to this group was both dry and
rainy season 19(42.9%) respondents.
Table 8: Distribution of Diseases per Group Among Hospital
Based Respondents.
53
Group Malaria HIV Hypertension Other Total
Children 27(54.0%) 0 0 0 27(54.0%)
Adults 9(18%) 0 0 0 9(18%)
Pregnant
women
6(12%) 0 0 0 6(12%)
Others 8(16%) 0 0 0 8(16%)
Total 50(100%) 0 0 0 50(100%)
The distribution of diseases per group among Hospital based
respondents in Table 7. Showed that Malaria was the only disease
respondents identified in Jabi. The most affected group was found to be
children with 27 (54%) of respondents, followed by adults with 9(18%),
then others 8(16%) and finally pregnant women 6(12%).
Table 9: Distribution of Diseases per Season Among Hospital
Based Respondents
Disease Dry season Rainy season Both dry/rainy season
Total
54
Malaria 9(18%) 30(60%) 11(22%) 50(100%)
HIV 0 0 0 0
Hypertension 0 0 0 0
Others 0 0 0 0
Total 9(18%) 30(60%) 11(22%) 50(100%)
The distribution of diseases per season among Hospital based
respondents in Table 7 shows that Malaria was the only disease
respondents identified in Jabi. The most infective season was found to be
the rainy season with 30(60 %) of respondents, followed by both dry/rainy
season with 11(22%), then dry season 9(18%).
Table 10: Distribution of Most Commonly sold Drugs per Group
among Pharmacy Based Respondents.
Group Anti-Malaria
Anti-Hypertensiv
e
Anti-Biotics
Others Total
55
Children 20(40%) 0 0 0 20(40%)
Adults 18(36%) 0 0 0 18(36%)
Pregnan
t women
12(24%) 0 0 0 12(24%)
Others 0 0 0 0 0
Total 50(100%) 0 0 0 50(100%)
Table 10 presents the distribution of most commonly sold drugs per
group among Pharmacy respondents. It was observed that the most
commonly sold drugs were Anti-Malaria drugs. Children were found to
account for 20(40%) of Anti-Malaria drugs sales, followed by adults
18(36%), then pregnant women 12(24%).
Table 11: Distribution of Anti-Malaria Drug Sales per Season in
Jabi
Season Frequency
and percent
Graphic
Dry season 9(18%)
Rainy Season 20(40%)
56
Both Dry/Rainy Season 12(24%)
9(18%)
Total 50(100%)
Table 11 shows the distribution of Anti-Malaria drugs sales per season
in Jabi. This table indicates that 20(40%) of respondents reported that
they had greater sales in rainy season, 12(24%) of respondents
mentioned that they had greater sales in both dry and rainy season.
The dry season was reported by 9(18%) of respondents. Other also
accounted for 9(18%) responses.
4.3 DISCUSSION
From observations made, interviews held with the house holds and
health care providers, and responses from the questionnaires, data
was analyzed and there were some environmental factors creating an
impact in the distribution of Malaria in the Jabi area of FCT, Abuja.
These include dirty houses, unkempt ponds, gardens and bushes,
littered pure water sachets, dirty gutters and the dam in the area. As
57
shown in table 4, 4(4%) of the respondents had dirty houses while 68
(68%) of the respondents also reported that their gutters were dirty,
with 88% attributing that Jabi dam is the major contributor to the
spread of Malaria in the district. These factors were also reported to be
contributors to the breeding of the vector responsible for the spread of
Malaria (Theresa et al., 2006).
Human activities around the dam such as weddings, picnics, recreation
etc, have also contributed immensely to the spread of Malaria. In table
5 of our findings 48% of respondents reported could contribute to the
spread of Malaria while 34% felt that, all forms of activities around
could lead to the spread of Malaria. This is so, as the water in the dam
is a good breeding ground for the vector (Malaria). More so as it is not
flowing water. This finding is in accordance with the findings of
Fatimehin et al. (2009), who reported that activities such as fishing,
picnics and recreational activities around the dam, river banks, could
lead to contacts of Malaria due to exposure to mosquito bites.
Table 6 of our results shows the distribution of preventive measures in
relation to the presence or absence of doors/windows fitted with nets
among household respondents. Majority of the households (92%) had
their houses fitted with nets while 8% has no fitted nets. This shows
that, the respondents were aware of the preventive nature of the fitted
nets on the spread of Malaria. Though questions on the use of
insecticides were not included in the questionnaire, interactions or
58
interview with the respondents during the administration of
questionnaires shows that majority of the respondents make use of
insecticides as a preventive measure.
These findings are in accordance with the findings of Snow et al (2005)
who reported that combined effect of nets and insecticides usage,
reduce the spread of Malaria.
The seasonal variation in Malaria parasite prevalence in Jabi can be
attributed to changes in mosquito abundance during the year. Table 6
of our results reviewed the distribution of household groups affected
by Malaria according to seasons. Rainy season appeared to be the
most vulnerable period according to 59.1% of respondents. High rain
fall in the rainy season produces pools and swamps due to poor
drainage, providing suitable conditions for mosquitoes. In the dry
season, the formation of water pools around some public water was
conducive for breeding of mosquitoes (table 9) similar research carried
out was reported by Fontendle et al (1997) in their studies on annual
and seasonal variation in Malaria transmission in Senegal.
Children however, are the most vulnerable group affected by the
Malaria as seen in our study. This can be seen in tables 7 and 8
respectively. This is in accordance with other findings, Azubuike and
Nkemene (1999), Redds et al 2006, and Shuaibu 2006.
59
Among the health provider that is hospitals and pharmacies, Malaria
remains the common abstinent attended to all seasons and antiMalaria
drugs in the major drugs sold in the pharmacies (Tables 10 and 11).
4.4 SUMMARY OF RESULTS
This was based on the respondents from different households,
pharmacies and hospitals. Research questions analyzed were four in
number in number with the following headings and findings.
1. The environmental factors that contribute to distribute Malaria
spread reveal 68(68%) based on unkempt gardens and bushes.
Among this, pure water bags littered accounted for 50(50%) while Jabi
dam accounted for 88(88%) to this disease Malaria.
2. Distribution of human activities contribute to the spread of
Malaria. Respondents reported that wedding activities contributes 48%
while 34% felt all forms of activities particularly at evening (83%)
3. Distribution of prevention measures among household
respondents. A total of 92(92%) of respondents had houses fitted with
nets, but only 66(71%) of them knew about this kind of preventive
measures. Respondents of humans without nets were about 8(8%) and
only (50%) had an idea of this preventive measure.
4. Distribution of household groups affected by Malaria according to
season. Vulnerable groups among households, the children were the
most affected (48%) during rainy seasons as the most vulnerable
60
period. (59%). Total of (8%) respondents reported that, pregnant
women were affected, while 10% of the respondents said adults.
About (34%) respondents were of the opinion that all groups had equal
chances of contacting Malaria. And both dry and rainy season were the
infective period for this group 19(42.9%)
Distribution of Malaria disease based on hospitals. Children were the
most affected group accruing 27(54%), adults 9(18%), and pregnant
women 6(12%).
Rainy season was the most infective period with 30(60%) respondents,
while the dry season infection was just about 9(18%).
Anti Malaria drugs were reported to be the most sold drugs 20(40%).
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
5.1 IMPLICATION OF THE STUDY.
Malaria remains a major burden especially in sub Saharan Africa.
Various environmental factors have played a major role in the
prevalence of this disease I this region. Our study takes a hard look at
the impact of environmental factors that contribute to the distribution
of Malaria in Jabi area, a district in Abuja municipal area of the federal
capital territory in Nigeria. Environmental health problems experience
today can be largely attributed to human activities on nature.
61
For the disease Malaria to be eradicated from our communities, our
environments must be kept neat and managed on a regular basis to
maintain the cleanliness. Environmental health thus seek to prevent,
control, disrupt, and environmental conditions of factors inimical to
human health or the environment.
In Jabi area, identified risks profiles such as dam, unkempt ponds,
garden, bushes, gutters, dirty houses, lack of fitted nets for windows
and doors, activities around the dam, improper disposal and other
environmental factors are the contributing factors of Malaria burden on
the population. Preventive measures such as bed netting, windows and
doors fitted with nets, use of insecticides clean environment,
prevention of water log, and good policy guidelines on solid waste
management -
a. Environmental sanitation is another aspect of this intervention.
During the colonial era, sanitation by laws were strictly enforced and
sanitary inspectors carried out regular and surprised inspection of
households and premises to ensure compliance. Since independence,
the federal government has made efforts in environmental
management by providing the legal framework. Policy and guideline on
environmental sanitation, advocacy award etc, were made in this
regard to help the people in complying with environmental sanitation
rules.
62
This exercise is carried out every month till date and if this is adhered
to strictly, our environment will be better and clean thereby, reducing
the breeding of mosquitoes. Various Non Governmental Organizations
have also made significant contribution towards creating an
environmental management. In Nigeria for example, the Nigerian
environmental study and action team (NEST), the Nigerian
Environmental Watch (NEW) etc.
b. Environmental assessments: this is also very important in the
prevention of Malaria. This will include environmental auditing,
monitoring, erosion and flood control in major cities and water
harvesting etc. drainage will go a long way in reducing contacts with
the mosquitoes, thus reducing the disease Malaria. The implications of
the above findings will surely affect government efforts towards
achieving her millennium development goals (MDGs) as consistent
disease burden on the population contributes to persistent hunger and
poverty, maternal and child mortality as well as decrease in child
literacy level.
5.2 RECOMMENDATIONS
The following recommendations or activities will go a long way in the
prevention and control of Malaria in Jabi area of Abuja and the country
as a whole if in place.
63
1. Environmental management: it has become one of the greatest
challenges facing the world today. Nigeria, in keeping with the global
imperative shares, with the worlds increasing concern over the
protection and maintenance of the environment, faces the challenge.
Unfortunately, environment was until recently, a neglected theme in
Nigeria’s development plan. In this study, we shall be looking at it in
the aspect of environmental waste management and sanitation.
2. Environmental waste management: it involves government’s
efforts involving community based waste management, recycling
plants, refuse transfer stations, tank farms and refuse farms.
3. Use of preventive measures: this includes use of such measures
like mosquito bed nets, insecticides, to prevent mosquitoes from
coming in contact with individuals. Presently, government is
distributing a lot of mosquito nets to people free of charge so as to
help reduce mosquito disease spread. Campaigns are also going on in
this regards.
4. Health education: is the process of teaching people good habits
as a way to improve health and prevent diseases. It involves the
process of enlightening people to accept measures that will improve
their health conditions and reject those that will have adverse effect of
their lives. Since we are concerned with the environment here, the aim
64
of this exercise is to cultivate in the people, a desire and willingness to
keep the environment clean not by coercion, but by self motivation,
through education. Communication is the method of this process which
involves demonstration, use of symbols, posters, mass media etc, this
could involve enlightening people on environmental sanitation, safe or
proper disposal of waste, vector control, good housing, and safe water
supply, to mention but a few.
5.3 SUGGESTIONS FOR FURTHER STUDIES
The researcher hereby suggests that the studies of this nature can be
carried out in other districts within the FCT so that the impact of this
disease burden and its preventive measures could be well appreciated
by the government.
5.4 CONCLUSION
Malaria is an ancient disease and continues to exert a substantial toll
on human life and sufferings, particularly in the tropics and subtropics.
It constitutes a serious public health problem in Nigeria. The future of a
country and of the mankind depends on the children, and for them to
grow healthy and able-bodied adults. Aside from other factors, there is
65
need for a clean and healthy environment. Majority of Malaria cases
occur in children under 5 years old.
Environmental factors have been observed to contribute immensely to
the distribution of Malaria, particularly in Nigeria. Most of the
environmental problems are consequences of the changes brought
about by man’s interaction with the environment to satisfy his basic
needs as well as his pursuit for more ambitious goals.
Intervention strategies for the control of Malaria include mass drug
administration and intermittent preventive therapy.
Both individuals, communities, government at all levels and non
governmental organizations must put efforts together in activities that
will help reduce the transmission of Malaria.
66
REFERENCES
Adams S.S, Brown H, Turner G, (2002). Breaking down the blood brain
barrier, signaling a path to cerebral Malaria.
Trends parasitol 18 (8): 360-6.
Barat I, (2006) Four Malaria success stories how Malaria was reduced
in brazil, Entrea, India and Vietnam.
American Journal for Tropical Medicine and Hygiene 74(1): 12-6.
Beare NA, Taylor TE, Harding SP, Lewallens, Molyneux ME, (2006)
Malaria retinopathy. A newly established diagnostic sign in severe
Malaria.
American Journal of Tropical Medicine and Hygiene 75(5): 790 – 7975.
Bledsore GH, (2005). Malaria Primer for Clinicians.
United States South Medical Journal 98 (12): 197-204.
67
Breman J (2001). The Ears of Hippopotamus. Manifestation,
determinants and estimates for the Malaria burden.
American Journal of Tropical Medicine and. Hygiene 64 (12): 1-11.
Bovin MJ (2005). Effects of Early Cerebral Malaria on Cognitive Bbility in
Senegalese Children.
Journal for Developmental Behaviour in Pediatrics. 23 (5): 353-64.
Chen Q, Schlichtherle M, Wahlgren M (2000). Molecular aspects of
severe Malaria.
Clinical Microbial Review 13 (3): 439-50.
Chermin E (1977), Patrick M, (1844-1922). The transmission of
filariasis.
American Journal of Tropical Medicine and Hygiene 26 (5): 1065-70.
Cogswell FB (1992). The Hypothesis and relapse in primate Malaria.
Clinical Microbial Review 5(1): 26-35
Fong YL, Cadigan FC, Coatney GR (1971). A presumptive case of
naturally occurring Plasmodium knowlesi. Malaria in man Malaysia.
Transact for Royal Society Tropical Medicine and Hygiene 65 (6): 839-
40.
Hoffman SL, Goh LM, Luke TC, et al., (2002). Protection of human
against Malaria by immunization with radiation attenuated Plasmodium
Falciparum sporozoits.
68
Journal of Infectious Disease. 185 (8): 1155-64.
Joy D, Feng X, Mu J, et al., 2003. early origin and recent expansion of
Plasmodium Falciparum.
Science 300(5617): 318-21.
Kain K, Harrington M, Tennyson S, Keystone J, (1998). Imported
Malaria, prospective analysis of problems in diagnosis and
management.
Clinical Infectious Disease 27 (1): 142-9.
Keiser J, Utzinger J, Caldas de Castro M, Smith T, Tanner M, Singer B,
(2004). Urbanization in sub Saharan Africa and implications for Malaria
control.
American Journal of Tropical Medicine and Hygiene. 71 (2): 118-27.
Krotoski W, Collins W, Bray R, et al., 1982. Demonstration of
hypnozoites in sporotozoites transmitted Plasmodium Vivax infection.
American Journal of Tropical Medicine and Hygiene 3 (16): 1291-3.
Kyle R, Shampe M, (1974). Discoverers of quinine.
JAMA 229 (4): e320.
Lindasay S, Ansell J, Selman C, Cox V, Hamilton K, Walraven G, (2000).
Effects of pregnancy on exposure to Malaria mosquitoes. Lancet 355
(9219): 6-7.
69
Meis J, Verhave J, Jap P, Sinden R, Meuwissen J (1983) Malaria in
parasites – discovery of the early liver form.
Nature 302 (5907): 424-6
Mens PF, Schoone GT, Kage PA, Schallig HD (2006). Detection and
identification of human Plasmodium species with real time quantitative
nucleic acid sequence based amplication.
Malaria Journal 5 (80): 60-62.
Nussenzweig R, Vanderberg J, Most H, Orton (1967) protective
immunity produced by the injection of x-irradiated sporozoites of
plasmodium berghei.
Nature 216(5111): 160-2.
Pates H, and Curtis C (2005) Mosquito Behaviour and Vector control.
Annual Review of Entomology (50): 53-70.
Pattanasin S, Proux S, Chompasuk D, Luwiradaj K, Jacquier P,
Looareesuwan S, Nosten F, (2003) Evaluation of a new Plasmodium
Lactate Dehydrogenase assay (Optimal-IT) for detection of Malaria.
Transaction of the Royal Society of Tropical Medicine 97(6): 672-4.
Redds, Kazembe P, Luby S, Nwanyanwu O, Hightowers A, Zuba C,
Wiring J, Chistsulo L, Franco C, Oliver M, (2006). Clinical algorithm for
treatment of Plasmodium Falciparum Malaria in children.
Lancet 347 (8996): 80.
70
Rodriguez – Morales AJ, Sanchez E, Vargas M, Piccolo C, Colina R, Arria,
Franco-Paredes C, (2006). Pregnancy outcomes associated with
Plasmodium Vivax Malaria in Northeastern Venezuela.
American Journal of Tropical Medicine and Hygiene 74(5): 755-757.
Sach J, Malany P, (2002). The economic and social burdens of Malaria.
Nature 415 (6872): 680-5.
Snow RW, Guerra CA, Nor AM, Myint HY, Hay SI, (2005). The global
distribution of clinical episodes of Plasmodium Falciparum Malaria.
Nature 434(7030): 214-7.
Sturm A, Amino R, Van de Sand C, Regen T, Retzlaff S, Revinenberg A,
Kruger A, Pollok JM, Menard R, Huessler VT (2006). Manipulation of the
host hepatocytes by the Malaria parasites for delivering into liver and
sinusoids.
Science 313 (5791): 1287 – 1490.
Tan SY, Sung H, (2008) Carlos Juamtinalay (1833-1915) of mosquitoes
and yellow fever (PDF).
Singapore Medical Journal 49(5): 370-1
Talman M, Domarle O, Mckenzie F, Ariey F. Robert V, (2004).
Gametocytogenesis, the puberty of Plasmodium Falciparum.
Malaria Journal. 3(23): 7-8.
71
Trampuz A, Jereb M, Muzlovic l, Prabhu (2003). Clinical review. Severe
Malaria.
Grit care 7(4): 315-23.
Warhurst DC, Williams JE, (1996). Laboratory diagnosis of Malaria.
Journal of Clinical Pathology. 49(7): 533-38.
Van Greertruyden J, Thomas F, Erhart A, D’Alessandro U, (2004). The
contribution of Malaria in pregnancy to prenatal mortality.
American Journal of Tropical Medicine and Hygiene. 71(2): 35-40.
72
APPENDIX
NATIONAL OPEN UNIVERSITY OF NIGERIA
FACULTY OF SCIENCE AND TECHNOLOGY
DEPARTMENT OF NURSING,ABUJA
QUESTIONAIRE GUIDE
I AM STUDENT OF THE ABOVE MENTIONED SCHOOL. THIS STUDY IS
STRICTLY FOR ACADEMIC PURPOSE AND INFORMATION PROVIDED SHALL
BE TREATED WITH UTMOST CONFIDENTIALITY .YOUR HONEST AND
ACCURATE RESPONSE TO THE QUESTIONS ASKED BELOW WILL BE
GREATLY APPRECIATD.
PLEASE KINDLY PROVIDE AND TICK ANSWERS WHERE NECESSARY,
ACCORDINGLY.
QUESTIONAINNARE
NAME:…………………………………………………………
AGE:……………………………………………………………
SEX:…………………………………………………………….
RELIGION:…………………………………………………….
ADDRESS:………………………………………………………
OCCUPATION:…………………………………………………
73
HOUSEHOLDS
1. WHAT DO YOU UNDERSTAND BY MALARIA?.
a. A Disease of mosquitoes to man
b. A Disease of flies to man
c. A Disease gotten from water
d. All of the above
2. HOW DO YOU GET MALARIA?
a. Through mosquitoes bites.
b. Through drinking dirty water
c. Through bathing in water that is dirty
d. All of the above
3. HAVE YOU EVER SUFFERED FROM MALARIA? YES/NO
4. HOW MANY TIMES IN A YEAR?
a. once
b. Twice
c. Thrice
d. State number of times
5. HOW DO YOU KNOW WHEN YOU GET MALARIA?
a. When my body is hot
b. When my body is cold
c. When I have headache
d. All of the above
6. WHAT DO YOU DO WHEN YOU SUFFER FROM MALARIA?
a. Buy drugs from the pharmacy
b. Go to hospital for treatment
c. Remain at home and take herbs
d. All of the above
7. AMONG YOUR HOUSEHOLDS ,WHAT GROUP SUFFER FROM
MALARIA MOSTLY?
a. Children b. Adults
c. Pregnant women d. All of the above
74
8. AT NIGHT DO STAY OUTSIDE YOUR ROOM? YES/NO
9. DO YOU SEE MOSQUITOES BREEDING INTO THESE PONDS ,GUTTERS
ETC? YES/NO
10. WHAT PERIOD DO YOU SUFFER FROM MALARIA MOSTLY?
a. Dry Season b. Rainy Season
c. Both Dry/Rainy Season d. State others.
11. HOW DO YOU DUMP YOUR REFUSE?
a. Into dustbins b. Into gutters/bushes
c. Burn it d. State others
12. DO YOU KEEP YOUR HOUSE ENVIRONMENT CLEAN? YES/NO
13. DO YOU HAVE PONDS , GARDENS, BUSHES OR REFUSE HEAPS
AROUND YOUR HOUSE? YES/NO
14. DO YOU LITTER WATER CONTAINERS (PURE WATER BAGS) AROUND
YOUR HOUSE ? YES/NO
15. ARE THE GUTTERS OF YOUR HOUSE ENVIRONMENT CLEAN?
YES/NO
16. DO YOU TAKE CARE OF THE GUTTERS AROUND YOUR HOUSE?
YES/NO
17. DO YOU WEED THE GRASSES AROUND YOUR HOUSE? YES/NO
18. ARE YOU AWARE OF JABI DAM? YES/NO
19. DO YOU THINK IS A CONTRIBUTOR TO MOSQUITOES IN JABI AREA?
YES/NO
20. WHAT ACTIVITIES GOES ON IN JABI AREA DAM?
a. Weddings b. Picnics/fun activities
c. Recreation c. All of the above
21. AT WHAT TIME OF THE DAY DO PEOPLE STAY AT THIS DAM?
a. Morning b. Afternoon
c. Evening d. All the times
22. DO YOU VISIT THERE? YES/NO
23. HOW DO YOU PREVENT MALARIA?
a. Keep your house clean and dump refuse properly
75
b. Avoid water logs around your house
c. Doors and windows should have nets fitted
d. All 0f the above
24. ARE YOUR HOUSE DOORS AND WINDOWS FITTED WITH NETS?
YES/NO
25. WHILE SLEEPING DO YOU CLOSE YOUR DOORS AND WINDOWS?
YES/NO
HOSPITALS
26. WHICH DISEASE DO YOU TREAT COMMONLY IN YOUR HOSPITAL?
a. Malaria b. HIV
c. Hypertension c. State others
27. WHAT GROUP VISIT YOUR FACILITY WITH THIS CONDITION?
a. Children b. Adults
c. Pregnant women d. State others
28. WHAT PERIOD DO YOU HAVE THE GREATER RECORD?
a. Dry Season b. Rainy Season
c. Both Dry /Rainy season d. State others
PHARMACIES
29. WHAT KIND OF DRUGS DO YOU SELL MOSTLY?
a. Anti –Malaria Drugs b. Anti-Hypertensives
b. Anti-Biotics c. State others
30. WHAT GROUP BUY THESE DRUGS ANTI-MALARIALS?
a. Children b. Adults
c. Pregnant women d. State others
31. WHAT PERIOD DO YOU HAVE GREATER SALES OF ANTI- MALARIA?
a. Dry Season b. Rainy Season
c. Both Dry /Rainy Season d. State others.
76