Knowledge and perception of caregivers of febrile children with malaria at the Dalhatu Araf Specialist Hospital Lafia Nasarawa state, Nigeria

INTRODUCTION

Malaria has remained a leading public health problem and causes of morbidity and mortality in tropical and subtropical countries.^[1] This avoidable disease has reached epidemic proportions in many regions of the world especially the sub-Saharan Africa which accounts for over 90% of the global malaria cases.^[2]

Malaria cases have reduced from 251 million in 2010 to 228 million in 2019.^[3] Furthermore, the deaths from malaria had decline from 585,000 in 2010 to 405,000 in 2018.^[3] Globally, malaria affects more than 3 billion people while deaths from it is ravaging the African countries, where we belonged.^[4] In Nigeria, malaria accounted for over 60% outpatient visit and 30% of admission among children.^[5,6] It is the most common cause of death among children aged 5 years and below.^[7]

Malaria is an infectious disease caused by Plasmodium and transmitted by the bite of an infected female Anopheles mosquito.^[8] These mosquitoes primarily inhabit the tropical and subtropical parts of the world.^[9] The four known species of Plasmodium genus that causes human malaria are Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae and they contribute to majority of human health problem in malaria endemic regions of the world.^[10] Occasionally, humans become zoonotically infected with Plasmodium species that normally infect Macaques (monkeys) such as Plasmodium knowlesi.^[11] Malaria is the predominant cause of elevated body temperature in our environment.^[12]

A study by Nmadu et al. reported a higher proportion of malaria in children 2–5 years.^[1] This study was to determine the knowledge and perception of parents/caregivers about malaria in a health facility in Lafia.

MATERIAL AND METHODS

RESULTS

DISCUSSION

This study revealed a high knowledge on the causes and preventive strategies of malaria. Majority, however, admitted that the source of the information was the healthcare workers. Despite this “high” knowledge, there is a relatively high (29.6%) proportion not using insecticide treated mosquito net (ITN).

A high percentage does not know about environmental cleanliness and use of indoor residual spraying in addition to the ITN. The possible reason for this may be because most of the participants reside in the rural areas, where they may not have access to electricity to enable them listen to or watch news on the Television. The low level of education in this study where half of the participants were either with no any formal education or with only primary school certificate, may be partly responsible for the poor knowledge on the preventive strategies of malaria. This is worrisome as it means those that did not have contact with the healthcare workers will not have the needed awareness.

Most participants in this study have heard about malaria and most are aware that mosquito bites cause malaria. Almost a third of the respondents, however, do not use the insecticide-treated bed nets (ITNs) as they do not know that it has protective properties against malaria. This study result compares with (although lower) to the reports of National Malaria Control Program 2016 which estimated 45% ITN utilization in 2015 among children under 5 years in Nigeria. This is much lower than the 61.7% found in a study in Port-Harcourt Nigeria.^[5] The difference with our finding may be due to the varied study population and the geographical locations. Our study was among children <15 years and in the North with limited rainfall compared to the study in Port-Harcourt.^[5] Similarly, the oil rich city of Port-Harcourt is more likely to be educationally and socially more advanced than Lafia, hence a better awareness and ITN utilization in the former compared with the latter. The prevalence of ITN use in the present study is higher than the 19% reported among under five children in Uganda.^[14] The difference may be because ours was a prospective study compared to the Ugandan study (a retrospective study).

Risk factors associated with febrile malaria in children include access to and utilization of malaria care which might be a challenge in rural areas. Most of the participants in this study (66.9%) were from the rural area. This creates barriers that might include bad roads and transportation means as a risk factor. Another risk factor could be the caregiver educational qualification. About 25% of the caregivers are not educated at all while 21.5% had primary school certificate. This low level of education might be a barrier for the participant on clear understanding of health-care services including the free ones. It may also account for the close to 30% who do not know and or used the ITN. Furthermore, the fact that, 53.2% of the participants in this study were unemployed, could explain our findings. This hinders the resources for transportation as well as for visiting the hospital for appropriate investigation and treatment. In addition, this study found that most (92.6%) of the caregiver feels fever is the only symptom associated with malaria. This study has demonstrated that caregivers had insufficient knowledge about malaria symptoms and signs. This low level of perception of the features of malaria could be due to the low education level, high unemployment (in one quarter), and rural dwellers in most of the participants. These decreased access to mass media, ability to purchases educational materials, and to read even if provided at no cost to them.

CONCLUSION

There is good awareness about malaria, it cause and some preventive strategies. However, more efforts are required in educating the populace about the various symptoms/signs, the full preventive strategies, encouraging use of ITN, and devising means of creating mass awareness such as through town criers, market women, religious, and traditional houses on its risk factors.