Knowledge, Attitude and Practice of Malaria Control among FUTO Students

Introduction

Malaria is the most important parasitic disease of human being. It is transmitted in 108 countries inhabited by roughly 3 billion people, and, in 2010, caused an estimated 216 million cases and 655 000 deaths [1]. More than 85% of malaria cases and 90% of malaria deaths occur in sub- Saharan Africa, mainly in young children (i.e., those younger than 5 years). Malaria is a protozoan disease transmitted by Anopheles mosquitoes. Five species of the genus Plasmodium cause all malarial infections in human being. Most cases are caused by either Plasmodium falciparum or Plasmodium vivax, but human infections can also be caused by Plasmodium ovale, Plasmodium malariae, and, in parts of south-east Asia, the monkey malaria Plasmodium Knowlesi [2]. Almost all deaths are caused by falciparum malaria.

Scientific investigations revealed many pathological effects of malaria on man which include varying degrees of anaemia, splenic enlargement and various syndromes resulting from physiological and pathological involvements of certain organs like the brain, liver and the kidneys [3]. Plasmodium falciparum malaria is the most prevalent and virulent in Nigeria [4], capable of causing mental apathy, weakness and generally slowing down economic development; accounting for up to 98% of severe cases with significant mortality and morbidity [5]. Malaria accounts for several deaths daily in Nigeria, especially in children less than five years of age in the rural, peri-urban and urban settlements; with high index of child mortality from the disease [6].

There have been a considerable number of reports about knowledge, attitudes, and practices relating to malaria and its control from different parts of Africa. These reports concluded that misconceptions concerning malaria still exist and that practices for the control of malaria have been unsatisfactory [7, 8, 9]. In their studies, Mgbemena, et al. [10] highlighted differential misconceptions about mosquito and associated diseases as reported by the respondents which included: malaria being caused by yellow fever and mosquitoes carry AIDS virus etc. Some of other studies have reviewed that communities now regard malaria as a dangerous disease that can kill and affects more children under five years than the adults while other qualitative studies have indicated that malaria in pregnancy being a normal thing [11, 12]. In a coastal area of Lagos State it was confirmed that the perception of malaria by the inhabitants were not helpful. Many believe that malaria is caused by such factors as excessive heat, malnutrition, eating too much palm oil and other superstitious considerations. Thus, an advanced knowledge of the community beliefs and practices with respect to the disease is required to obtain and maintain its participation in surveillance and control activities [13]. In this same vein, knowledge is improved upon through relevant information feeds while attitude deals with the mindset [14]. Attitude basically is always influenced by beliefs and existing bodies of knowledge. In fact, anything that contributes to stronger attitude may likely increase attitude-behavior consistency. Mgbemena, et al. [10] reported the attitudes of the studied population towards mosquito-borne diseases which revealed that 80(17.4%) believed mosquito-borne diseases were mild diseases, 23(5.0%) considered them ‘not a serious diseases’ together with 70(15.2%) that reported no knowledge on the seriousness of mosquito-borne diseases, may however, impose a serious impact on control [15]. Appropriate Knowledge is relevant for solving daily challenges and the right knowledge, attitude, and practice towards malaria prevention and control will go a long way to reducing the burden associated with malaria infection in Nigeria and the world in general. This work aims at eliciting information on the knowledge, attitude and practice of malaria control among students of Federal University Technology, Owerri (FUTO).

Results

Of the 160 students whose peripheral blood was sampled for the infection of malaria parasitaemia, 25% were positive. All were infections of Plasmodium falciparium. The result also showed that based on students’ residential area, students living in the school hostel had the highest prevalence rate of infection (52.0%). This is followed by Eziobodo (31.3%) and Ihiagwa (25.0%), Umuchima had the lowest prevalence (14.5%) (Table 1).

Discussion

Malaria is a life-threatening disease of man causing great suffering and loss of lives. The days of labor lost, the cost of treatment of patients and the negative impact of the disease make malaria a major social economic burden [19].

Results from this study indicate that one quarter (25%) of the students examined were positive for malaria parasite in their blood. Table 1 shows the prevalence of malaria infections with regards to students’ residential areas with students living in school hostels recording the highest prevalence (52%). The trend of this result agrees with Adesina, et al. [20] who reported (80%) for students living in school public hostels. As observed, in these study sites, there is poor and inadequate drainage system while in the school hostels; there is overpopulation with ratio 8 to 12 students per room thus making use of mosquito net as preventive measure cumbersome. The transmission of this parasite in this study area could be enhanced by socio- economic and cultural factors when considering hostel location and its structures which can invariably play a vital role in influencing susceptibility to infection. However; Carter, et al. [21] remarked that malaria transmission is not homogenous through an endemic area but spotty and depends on two primary factors; location of the breeding sites and clustering of humans habitations where people are serving as reservoirs of malaria parasites.

It was impressive to observe that knowledge about what causes malaria was high among the study population, with most respondents indicating mosquito bite as the cause of malaria. This is in line with the observations of Obianumba, et al. [22] in endemic settings. Yet a fraction (3.1%) of the studied population believed eating too much oil (oily food) is responsible for malaria while on the other hand a student stated not knowing the actual cause of malaria. However, it has been widely assumed that local ideas about disease etiology may explain the underlying motivation in the context of disease prevention and control. Generally, the misconception observed in this work may as a consequence impact considerably on the practice of control as their efforts may fail to be directed to proper application of anti - vector and anti - parasitic measures. Evans, et al. [23] corroborated this by stating that the high prevalence of alternative explanation for disease causation has significant implication for the potential efficacy of intervention programme. Community knowledge and attitudes to diagnosis demonstrate the importance of providing patients with a reliable explanation for their illness. This will improve treatment-seeking behaviour and compliance. The WHO Guidelines for the treatment of malaria emphasizes the importance of malaria case management as a vital component of malaria control strategies [18]. It goes to say that early diagnosis and treatment of malaria reduces disease and prevents deaths and also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT). WHO recommends that all cases of suspected malaria be confirmed using parasite- based diagnostics before treatment. Among the methods of diagnosis examined in this study, RDTs had the lowest respondents. Rapid Diagnostic Tests (RDTs) have been recommended to improve diagnostic efficiency, which is important for preventing indiscriminate use of Artemisinin- Based Combination Therapy (ACT), thereby preventing or delaying the development of parasite resistance to this new first-line drug [24]. RDTs can be used as a stop-gap when microscopy services are not operating (e.g. evenings/ weekends/public holidays) or as a primary diagnostic tool for rural/remote areas without microscopy services [24]. Disappointedly, survey on knowledge of students in this study on malaria diagnostic methods showed that only a few participants (11.9%) in the study area reported knowing what RDTs are or had used this test. This was also seen in work of Rushika, et al. [25] where none of the participants in the urban area and very few from the rural village knew what RDTs were. Their opinion on malaria laboratory diagnosis showed poor mindset towards the importance. This poor attitude to malaria confirmatory diagnosis could possibly be as a result of their poor knowledge of its importance.

On a general attitude towards the control measure for malaria (Table 5), a total of 17.5% students agrees with the use of ITNs and Sanitation as best control methods for mosquito bites, thereby ensuring prevention of this disease. Other students rated other means such as insecticides and the use of every possible control measure as better. Notwithstanding, quite a number of them disagrees with the above options, stating that they do nothing to prevent or control malaria. This may be as a result of the cumbersome processes involved in some control measures or as a result of inconveniences experienced when these methods are apply.

Some of the students do not fancy the relevancy of going for laboratory diagnosis. From the study, a total of 29.38% of the students rated that it is “barely important” going to laboratory, while 10.63% rated “not important”. Although a good number (60%) believes on the importance of going for laboratory diagnosis by rating “very importance”. However, the prevalence of malaria within this university community is moderately high as reflected by the high malaria parasitaemia among the students but their poor attitude/knowledge towards laboratory diagnosis, methods of diagnosis and control measures available could impact negatively on their health. Improving hygienic conditions and periodic insecticides spray in hostels and their surroundings can go a long way in reducing the prevalence of malaria burden alongside creating public awareness on the importance of diagnosis and control measures for malaria.

Acknowledgement

The authors wish to express their profound gratitude to the staff and management of Pillars Medical Laboratory for their assistance in the analysis of samples for this work.