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Prevalence of Malaria and Associated Factors among Children Below the Age of 5 Years in Fort Portal Town Kabarole District, Uganda

Muhereza Oscar

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.

ABSTRACT

Globally, it was noted that over 92 countries and territories have ongoing malaria transmission with an estimated 3.2 billion people who were at risk of getting infected. The WHO indicates that 207 million people are infected with malaria worldwide and of these 627,000 cases result in deaths. Children below five years are the most susceptible to malaria illness which accounts for estimated deaths of 303,000 before reaching age five globally and 292,000 occur in the Africa region. The general objective of the study was to determine the prevalence of malaria and the associated factors among children below 5 years in Fort Portal Town, kabarole district. The study also aimed at determining the socio-economic demographic, caretaker, household, and environment associated with malaria prevalence within the defined age group. The study employed quantitative and qualitative research designs where questionnaires and interview guides were used to collect data from the field. All data was grouped and analyzed in a statistical way where data was presented in tables showing frequencies and percentages. The prevalence of malaria was high 204 (53%) and the factors that were significant with malaria prevalence included; household sources of light and environmental factors about the presence of garbage heaps. The prevalence of malaria was high and it was influenced by the household source of light and garbage heaps around the homes. This study recommended that caretakers should not stop knowing malaria prevention transmission, but should have a positive attitude toward implementing the preventive measures. Health unit workers, community health workers, and VHTs together with stakeholders should put in more effort to ensure that information about malaria is communicated to the caretakers in languages best understood and should mainly target the vulnerable households in the community. The town council authorities and local leaders must work with the community to ensure proper garbage disposal.

Keywords: Malaria, Children below five years, Deaths, Garbage Heaps, Caretakers.

INTRODUCTION

Globally, malaria is the most prevalent vector-borne disease that claims endemicity in over 92 countries and territories [1–3]. It is one of the world’s most vital and significant public health challenges compromising development in poverty-stricken countries and accounting for up to approximately 207 million cases and overwhelming 627,000 deaths per annum with most of the cases, 80.0% and deaths, 90.0% occurring in Sub-Saharan Africa [3, 4]. In Sub-Saharan Africa, it remains one of the biggest threats to human lives, especially among the weak and vulnerable populations (children 0−5, pregnant women, and immune-compromised individuals), despite all the efforts put in by the various countries to control and eradicate the disease in these areas [5, 6]. According to the World Health Organization, more than 3 billion people (~40%) reside in areas of the world where malaria is prevalent. As such, the disease is largely responsible for the poor economic growth of these areas, which further contributes to more cases of malaria [1, 7]. In the 2014 World Malaria Report, Sub-Saharan Africa (SSA) where malaria is endemic, a substantial burden associated with morbidity and mortality shows an estimated 90% of those who contract malaria in Africa, die from it [8]. While children 0−5 years and other vulnerable populations are disproportionately affected by malaria, every 45 seconds, a child dies because of malaria [9]. Recent reports showed that preventive and control measures have significantly reduced childhood malarial morbidity and mortality in most parts of sub-Saharan Africa [10]. However, the rural areas remain uncontrolled with a subsequent increase in infections among children 0−5 years [11, 12]. Malaria is a complicated, life-threatening disease caused by infection through the bite of a female Anopheles mosquito. Children below 5 years of age have low immunity which makes them susceptible to malaria transmission with associated outcomes such as severe anaemia, cerebral malaria, and hypoglycemia /low glucose level [13]. Climatic conditions such as rainfall patterns, temperature and humidity affect the number and survival of mosquitoes and in many places, transmission is seasonal and high during and after rainy [14–16] The knowledge of and access to malaria preventive tools and the healthcare services distribution also significantly determine malaria transmission among the vulnerable population [17, 18].  In East Africa, Uganda has the highest malaria incidence with a rate of 478 cases per 1,000 populations per year[19]. Malaria is a major public health problem associated with slow economic development and poverty and is also the most frequently reported disease at both public and private health facilities in the country. It is the leading cause of morbidity with 90 -95% of the population at risk and contributing approximately 13% of the under-five mortality [20, 21]. It accounts not only for 30 – 50% of the outpatient visits at health facilities and 15 -20% of in-patients or hospital admissions but also for 27.7% of deaths amongst children under the age of five [19].Children under five years are most vulnerable to malaria infection as their immunity is not yet developed enough to fight any disease [22]. Though different strategies and programs like the Malaria Control Program aimed at total eradication of malaria in all the endemic areas of the country were initiated involving education of individuals and families to sleep under insecticide-treated nets (that are distributed free of charge), vector control through spraying (IRS), eliminating breeding places, and reducing infections through prophylaxis and treatment with ACTs, malaria transmission is still very high[23].  Furthermore, in efforts to accelerate the reduction of child mortality. The government has also through the years 2009 -2015 conducted several programs including integrated community case management (ICCM), integrated management of childhood illness (IMCI) and training of VHTs to offer curative malaria treatment at community level [24, 25]. Despite all these efforts, malaria cases continue to remain high, especially in remote areas among children below 5 years and one of the leading causes of ill health and deaths in Uganda. This implied that carrying out this research could help to offer a direction for improving preventive strategies.

CONCLUSION

The prevalence of malaria among children below age five was very high as almost half of the sample size of children tested positive with a proportion (47), negative. Similarly, the occurrence of malaria among children below five years was significantly influenced by the presence or absence of garbage heaps in the home environment.  The source of light was the only household factor that significantly influenced the prevalence of malaria among children below five years.

RECOMMENDATIONS

Enforcement of communication strategies and information dissemination to change individual and community behaviour and attitudes towards the control and prevention of malaria and insist that they should not only have knowledge of the transmission and control but also put in practice or implement the acquired knowledge practically both individually and as a community at large. This should be delivered by well and appropriately trained community health workers, VHTs, and health unit staff in the local languages that are most understood and mainly to vulnerable households.  Efforts should also be made for these caretakers to know and understand the different signs and symptoms of malaria especially those that significantly contribute to the high prevalence of malaria for example loss of appetite and loss of energy which are serious signs of severe malaria.  The municipality/town council administrators should find a way to dispose of garbage to avoid heaps around the households and also find and strategize a way of involving the entire town council community and the surrounding communities on how to avoid garbage in their households as this is another suitable breeding site for mosquitoes.

 REFERENCES

  1. Agomo, C.O., Oyibo, W.A.: Factors associated with risk of malaria infection among pregnant women in Lagos, Nigeria. Infect Dis Poverty. 2, 19 (2013). https://doi.org/10.1186/2049-9957-2-19
  2. Andrade, M.V., Noronha, K., Diniz, B.P.C., Guedes, G., Carvalho, L.R., Silva, V.A., Calazans, J.A., Santos, A.S., Silva, D.N., Castro, M.C.: The economic burden of malaria: a systematic review. Malaria Journal. 21, 283 (2022). https://doi.org/10.1186/s12936-022-04303-6
  3. Bekele, S.K., Ayele, M.B., Mihiret, A.G., Dinegde, N.G., Mekonen, H., Yesera, G.E.: Treatment Outcome of Severe Malaria and Associated Factors among Adults Admitted in Arba Minch General Hospital, Southern Nation Nationality and People’s Region, Ethiopia. J Parasitol Res. 2021, 6664070 (2021). https://doi.org/10.1155/2021/6664070
  4. Birhanie, M., Tessema, B., Ferede, G., Endris, M., Enawgaw, B.: Malaria, Typhoid Fever, and Their Coinfection among Febrile Patients at a Rural Health Center in Northwest Ethiopia: A Cross-Sectional Study. Advances in Medicine. 2014, 1–8 (2014). https://doi.org/10.1155/2014/531074
  5. Egwu, C.O., Aloke, C., Chukwu, J., Nwankwo, J.C., Irem, C., Nwagu, K.E., Nwite, F., Agwu, A.O., Alum, E., Offor, C.E., Obasi, N.A.: Assessment of the Antimalarial Treatment Failure in Ebonyi State, Southeast Nigeria. J Xenobiot. 13, 16–26 (2023). https://doi.org/10.3390/jox13010003
  6. Initiative, P.M.: Malaria Operational Plans (MOPs),https://www.pmi.gov/resources/malaria-operational-plans-mops/
  7. Egwu, C.O., Aloke, C., Chukwu, J., Agwu, A., Alum, E., Tsamesidis, I., Aja, P.M., Offor, C.E., Obasi, N.A.: A world free of malaria: It is time for Africa to actively champion and take leadership of elimination and eradication strategies. Afr Health Sci. 22, 627–640 (2022). https://doi.org/10.4314/ahs.v22i4.68
  8. WHO Malaria Policy Advisory Group (MPAG) meeting (October 2022), https://www.who.int/publications-detail-redirect/9789240063303
  9. Obeagu, E. I., Alum, E. U. and Ugwu, O. P. C. Hepcidin: The Gatekeeper of Iron in Malaria Resistance. NEWPORT INTERNATIONAL JOURNAL OF RESEARCH IN MEDICAL SCIENCES. 2023; 4(2):1-8. https://doi.org/10.59298/NIJRMS/2023/10.1.1400
  10. Erhabor, O.: Effects of Malaria Parasitaemia on Some Haematological Parameters of Pregnant Women of African Descent in Specialist Hospital Sokoto, North Western Nigeria. JOJ Nursing & Health Care. 10, (2019). https://doi.org/10.19080/JOJNHC.2019.10.555795
  11. Drakeley, C., Abdulla, S., Agnandji, S.T., Fernandes, J.F., Kremsner, P., Lell, B., et al. Longitudinal estimation of Plasmodium falciparum prevalence in relation to malaria prevention measures in six sub-Saharan African countries. Malar J. 16, 433 (2017). https://doi.org/10.1186/s12936-017-2078-3
  12. Ekpono, E. U., Aja, P. M., Ibiam, U. A., Alum, E. U. and Ekpono, U. E. Ethanol Root-extract of Sphenocentrum jollyanum Restored Altered Haematological Markers in Plasmodium berghei-infected Mice. Earthline Journal of Chemical Sciences. 2019; 2 (2):189203.https://doi.org/10.34198/ejcs.2219.189-203.
  13. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division, https://www.who.int/publications-detail-redirect/9789240068759
  14. Sawadogo, S., Nébié, K., Millogo, T., Kafando, E.: Blood transfusion requirements among children with severe malarial anemia: a cross-sectional study in a second level reference hospital in Burkina Faso. The Pan African Medical Journal. 37, (2020). https://doi.org/10.11604/pamj.2020.37.108.22384
  15. Prevention, C.-C. for D.C. and: CDC – Malaria – Malaria Worldwide – Impact of Malaria, https://www.cdc.gov/malaria/malaria_worldwide/impact.html
  16. CDC in Uganda | Global Health | CDC, https://www.cdc.gov/globalhealth/countries/uganda/default.htm
  17. Orimadegun, A.E., Ilesanmi, K.S.: Mothers’ understanding of childhood malaria and practices in rural communities of Ise-Orun, Nigeria: implications for malaria control. J Family Med Prim Care. 4, 226–231 (2015). https://doi.org/10.4103/2249-4863.154655
  18. Obeagu, E. I., Alum, E. U. and Ugwu, O. P. C. Hepcidin’s Antimalarial Arsenal: Safeguarding the Host. NEWPORT INTERNATIONAL JOURNAL OF PUBLIC HEALTH AND PHARMACY. 2023; 4(2):1-8. https://doi.org/10.59298/NIJPP/2023/10.1.1100
  19. UBOs, U.B. of S.-, International, I.C.F.: Uganda Demographic and Health Survey 2011. (2012)
  20. Kungu, E., Inyangat, R., Ugwu, O.P.C. and Alum, E. U. Exploration of Medicinal Plants Used in the Management of Malaria in Uganda. NEWPORT INTERNATIONAL JOURNAL OF RESEARCH IN MEDICAL SCIENCES. 2023; 4(1):101-108. https://nijournals.org/wp-content/uploads/2023/10/NIJRMS-41101-108-2023.docx.pdf
  21. Gone, T., Lemango, F., Eliso, E., Yohannes, S., Yohannes, T.: The association between malaria and malnutrition among under-five children in Shashogo District, Southern Ethiopia: a case-control study. Infect Dis Poverty. 6, 9 (2017). https://doi.org/10.1186/s40249-016-0221-y
  22. CDC: Disease Threats and Global WASH Killers, https://www.cdc.gov/healthywater/global/WASH.html
  23. UNICEF annual report 2018 | UNICEF, https://www.unicef.org/reports/annual-report-2018
  24. Nyirakanani, C., Chibvongodze, R., Fissehaye, M., Masika, M., Mukoko, D., Njunwa, K.: Prevalence and risk factors of asymptomatic malaria among under-five children in Huye District, Southern Rwanda. Tanzania Journal of Health Research. 20, (2018). https://doi.org/10.4314/thrb.v20i1.6
  25. Mensah, B.A., Myers-Hansen, J.L., Obeng Amoako, E., Opoku, M., Abuaku, B.K., Ghansah, A.: Prevalence and risk factors associated with asymptomatic malaria among school children: repeated cross-sectional surveys of school children in two ecological zones in Ghana. BMC Public Health. 21, 1697 (2021). https://doi.org/10.1186/s12889-021-11714-8
  26. Wiegand, H.: Kish, L.: Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s. Biometrische Zeitschrift. 10, 88–89 (1968). https://doi.org/10.1002/bimj.19680100122
  27. Mpimbaza, A., Walemwa, R., Kapisi, J., Sserwanga, A., Namuganga, J.F., Kisambira, Y., Tagoola, A., Nanteza, J.F., Rutazaana, D., Staedke, S.G., Dorsey, G., Opigo, J., Kamau, A., Snow, R.W.: The age-specific incidence of hospitalized paediatric malaria in Uganda. BMC Infect Dis. 20, 503 (2020). https://doi.org/10.1186/s12879-020-05215-z
  28. Drugs, I. of M. (US) C. on the E. of A., Arrow, K.J., Panosian, C., Gelband, H.: A Brief History of Malaria. In: Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance. National Academies Press (US) (2004)
  29. Mohammed, H., Hassen, K., Assefa, A., Mekete, K., Tadesse, G., Taye, G., Commons, R.J.: Genetic diversity of Plasmodium falciparum isolates from patients with uncomplicated and severe malaria based on msp-1 and msp-2 genes in Gublak, North West Ethiopia. Malaria Journal. 18, 413 (2019). https://doi.org/10.1186/s12936-019-3039-9
  30. Mitiku, I., Assefa, A.: Caregivers’ perception of malaria and treatment-seeking behaviour for under five children in Mandura District, West Ethiopia: a cross-sectional study. Malaria Journal. 16, 144 (2017). https://doi.org/10.1186/s12936-017-1798-8
  31. Mangusho, C., Mwebesa, E., Izudi, J., Aleni, M., Dricile, R., Ayiasi, R.M., Legason, I.D.: High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study. PLoS One. 18, e0283755 (2023). https://doi.org/10.1371/journal.pone.0283755
  32. Ezekwe, C.I., Uzomba, C.R. Ugwu O.P.C. The effect of methanol extract of Talinum triangulare (water leaf) on the hematology and some liver parameters of experimental rats. Global Journal of Biotechnology and Bioche.mistry,8(2): 51-60 (2013)..
  33. Enechi O. C., Okpe, C. C., Ibe, G. N., Omeje, K. O., Ugwu Okechukwu P.C.. Effect of Buchholzia coriacea methanol extract on haematological indices and liver function parameters in Plasmodium berghei-infected mice. Global Veterinaria,16(1); 57-66 (2016).
  34. Ugwu, O. P., Nwodo, O. F., Joshua, P. E., Odo, C. E., Bawa, A., Ossai, E. C., & Adonu, C. C.. Anti-malaria and hematological analyses of ethanol leaf extract of Moringa oleifera on malaria infected mice. International Journal of Pharmacy and Biological Sciences,3(1): 360-371(2013).
  35. Ugwu, O. P. C., Nwodo, O. F. C., Joshua, P. E., Odo, C. E., Ossai, E. C., & Aburbakar, B.. Ameliorative effects of ethanol leaf extract of Moringa oleifera on the liver and kidney markers of malaria infected mice. International Journal of Life Sciences Biotechnology and Pharma Research, 2(2), 43-52 (2013).

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