Malariometric surveys generate data on malaria epidemiology and dynamics of transmission necessary for planning and monitoring of control activities. This study determined the prevalence of malaria and the knowledge, attitude, and practice (KAP) towards malaria infection in Ibeshe, a coastal community. The study took place during the dry season in 10 villages of Ibeshe. All the participants were screened for malaria. A semistructured questionnaire was used to capture sociodemographic data and KAP towards malaria. A total of 1489 participants with a mean age of
Malaria remains one of the greatest causes of morbidity and mortality in the world. Global estimate shows that there are about 219 million cases of malaria in 2010 (with an uncertainty range of 154 million to 289 million) and an estimated 660 000 deaths (with an uncertainty range of 490 000 to 836 000) [
The artemisinins are new drugs developed from the Chinese wormwood (
Malaria remains a major cause of morbidity and mortality in Nigeria in the era of improved control activities by the National Malaria Control Program (NMCP) since 2005. This is highly of concern and has necessitated the need to scale up interventions and assess the impact of malaria control measures in targeted areas. To implement effective interventions in an area, knowledge of malaria epidemiology and transmission dynamics, risk factors associated with malaria infection, and delay in diagnosis and treatment are of utmost importance. Many settings suitable for malaria vector propagation and prone to endemicity or resurgence of malaria have not been characterized in Lagos state, and Ibeshe is one of these settings.
Currently there is lack of data on parasite burden and inhabitants’ knowledge, attitude and practices towards malaria control. Given its increasing population and coastal landmass that is amenable to malaria vector colonization and propagation, a malariometric survey of Ibeshe is highly needed to provide justification for expansion of malaria intervention settings in Lagos state.
Ethical approval of the study was obtained from Nigerian Institute of Medical Research, Institutional Review Board (NIMR IRB).
This cross-sectional study was carried out in the dry season, January 2011, in Ibeshe community (6° 30′ 26′′N, 3° 20′ 53E) in Ikorodu LGA, Lagos state. Convenient sampling method was adopted. Ibeshe is a semiurban community and is made up of 10 villages: Ibeshe central (Oluwoye, Ilemeri, and Orubo), Oshorun, Oke-Awori, Oke-Ota, Owode, Abuja, Agbowa, and Malatori. Ibeshe is about 20 km from Lagos metropolis. It has a population of about 23,850 people [
Before the commencement of the study, the investigators visited the site and explain the study to the Oba of Ibeshe who gave his consent and permitted the town announcer to announce our mission to the community. He also obtained the cooperation of the chiefs (Baales) of the villages. The Baales of the villages visited provided us with the venue (canopy, chairs, and tables). Each site consisted of one or more villages. A total of 10 villages were covered during the exercise. Everybody in the community that came out for the survey were screened for fever (axillary temperature ≥37.5°C) and malaria parasite by microscopy, thick and thin malaria blood films stained with Giemsa stain. All persons that were positive for malaria parasite were treated with artemether-lumefantrine. Blood spots were made on filter paper for molecular studies on malaria parasite characteristics such as level of resistance to various antimalarial drugs.
The anaemia status of the people of Ibeshe was defined using the WHO haematocrit cutoff for mild anaemia Packed Cell Volume (PCV < 33%), moderate anaemia (PCV < 24%), and severe anaemia (PCV < 15%) [
A total of 1489 participants were interviewed and screened for malaria and anaemia. The majority of the respondents were female 916 (62.3%). The mean age was
Baseline characteristics of study participants.
Characteristic |
|
---|---|
Sex | |
Male | 554 (37.7) |
Female | 916 (62.3) |
Age (years) | |
Mean ± SD (range) | 26.7 ± 20.0 (0.1–99.0) |
Age group | |
<5 | 237 (16.6) |
5–14 | 272 (19.0) |
15–24 | 168 (11.7) |
25–34 | 270 (18.0) |
35–44 | 211 (14.8) |
45–54 | 121 (8.5) |
55–64 | 78 (5.5) |
≥65 | 73 (5.1) |
Weight (kg) | |
Mean ± SD (range) | 47.9 ± 26.3 (4.0–99.9) |
Occupation | |
Student | 475 (32.6) |
Trader | 417 (28.6) |
Artisan | 182 (12.0) |
Professional | 73 (5.0) |
House wife | 56 (3.8) |
Civil servant | 35 (2.4) |
Farmer | 16 (1.1) |
Clergy | 12 (0.8) |
Others | 192 (13.2) |
Education | |
None | 36 (2.9) |
Primary | 471 (37.4) |
Secondary | 513 (40.7) |
Tertiary | 102 (8.1) |
Non formal | 138 (11.0) |
Income* | |
None | 238 (27.9) |
<N10,000.00 | 342 (40.0) |
N10,000.00–N20,000.00 | 151 (17.7) |
N20,001.00–N30,000.00 | 48 (5.6) |
N30,001.00–N40,000.00 | 29 (3.4) |
N40,001.00–N50,000.00 | 15 (1.8) |
>N50,000.00 | 31 (3.6) |
Religion | |
Christianity | 859 (59.9) |
Islam | 551 (38.5) |
Traditional | 23 (1.6) |
The prevalence of malaria in Ibeshe community was 14.7% (95% CI 13.0–16.6%). The prevalence of malaria in children aged 2–9 years was 16.4% (95% CI 12.6–21.2%). The predominant
Malaria indicators.
Malaria | |
Prevalence | 219 (14.7) |
|
|
|
205 (93.6) |
|
12 (5.5) |
Mixed ( |
2 (0.9 ) |
Parasite density/ |
|
Geomean | 285 |
Range | 21–221,714 |
1–500 | 161 (80.5) |
501–1,000 | 24 (12.0) |
1,001–5,000 | 11 (5.5) |
>5,000 | 4 (2.0) |
Axillary temperature (°C) | |
Mean ± SD | 36.6 ± 0.5 |
Range | 35–40.3 |
≥37.5 | 40 (2.7) |
<37.5 | 1431 (97.3) |
PCV (%) | |
Mean ± SD | 36.3 ± 4.8 |
Range | 18–50 |
PCV group | |
Normal (≥33) | 1026 (81.9) |
Mild anaemia (30–32.9) | 142 (11.3) |
Moderate anemia (21–29.9) | 82 (6.5) |
Severe anaemia (<21) | 3 (0.2) |
The baseline characteristics of participants in different villages of Ibeshe community are shown in Table
The baseline characteristic of participants in different villages in Ibeshe community.
Abuja | Agbowa | Ibeshe | Malatori | Oke-Awori | Oke-Ota | Oshorun | Owode |
| |
---|---|---|---|---|---|---|---|---|---|
|
192 | 269 | 239 | 103 | 150 | 63 | 237 | 236 | |
Mean age (±SD) | 27.2 ± 18.8 | 22.5 ± 19.2 | 31.3 ± 23.2 | 30.8 ± 16.3 | 23.5 ± 17.7 | 25.2 ± 18.6 | 26.4 ± 20.8 | 27.3 ± 19.9 | |
<5 yrs (%) | 27 (14.1) | 56 (20.8) | 31 (13.0) | 7 (6.8) | 27 (18.0) | 13 (20.6) | 37 (15.6) | 39 (16.5) | 0.07 |
Males (%) | 75 (31.1) | 117 (43.5) | 77 (32.2) | 44 (42.7) | 55 (43.3) | 28 (44.4) | 75 (31.6) | 73 (30.9) | 0.002 |
Malaria carriage rate (%) | 5.2 | 0.7 | 25.9 | 12.6 | 20.0 | 25.4 | 13.9 | 22.5 | <0.001 |
Febrile cases (≥37.5°C) | 6 (3.1) | 9 (3.3) | 10 (4.2) | 1 (1) | 1 (0.7) | 2 (3.2) | 4 (1.7) | 7 (3.0) | 0.411 |
Figure
Malaria parasite carriage rate in Ibeshe community.
Figure
The anaemia status in the different villages of Ibeshe.
There was no significant difference in comparing malaria positivity with temperature, sex, and age in the community (Table
Malaria positivity comparing temperature, sex, and age.
Character | Malaria positivity |
|
---|---|---|
Temperature (°C) | ||
<37.5 | 210 (14.7) | 0.17 |
≥37.5 | 9 (22.5) | |
Sex | ||
Male | 85 (15.3) | 0.625 |
Female | 132 (14.4) | |
Age (years) | ||
<5 | 30 (12.7) | 0.319 |
≥5 | 181 (15.2) |
Parasite density above 500 parasites/
The malaria infection rate was found to be higher in those aged 5 years and above (15.1%) than in those under 5 years of age (12.7%).
Figure
Proportion of febrile and malaria cases by age.
Figure
Relationship between malaria and level of PCV.
Chi square = 12.37,
The respondents that reported fever in the past 24 hours were 1243 (83.5%). The number of respondent that consider the health facility too far from their home was 747 (50.2%), while 1021 (68.6%) were satisfied with treatment given at their health facilities. Some of the common suggestions on improving the health of people in Ibeshe were building more health facilities 1354 (90.9%), availability of drugs in health facilities 1302 (87.4%), erection of more public water taps 1300 (87.3%), and increasing the number of health workers 1274 (85.6%).
The respondents attributed the cause of malaria fever to be four major causes, in which mosquito bite (95.8%) is the major cause followed by dirty water (88.2%), while the other causes are working for too long (stress) (86.2) and staying in the sun (85.8); see Figure
Knowledge of cause of malaria in the communities.
Majority of the respondents can recognize malaria symptoms by hot body (89.9%), headache (84.9%), refusal to eat (77.3%), and body ache (77.0). The respondents said that the action they will take when malaria occur would be to go to the hospital (65.6%), while 24.8% of the respondent would go to chemist/pharmacy. The respondents that would go to the traditional healers were (23.0%). The percentage of respondents that would treat at home was 22.5%; 15.0% of the respondents would either go to the church or mosques, while (0.5%) of the respondent would do nothing.
Most of the respondents lived less than 1 km from the health facilities (25.3%), while only 10.9% of the respondents lived above 10 km from the health facilities.
Measures taken for malaria protection, 77.0% of the respondents sleep with window nets, and 74.8% of the respondent clear bushes around them, while 65.1% clear their gutters. Only 29.6% of the respondents sleep under the long-lasting insecticidal net, while 27.7% sleep under the net.
Majority of the respondents spent greater than N1,500.00 on malaria treatment in a month, 385 (27.9%). Those that spent less than N500 per month were 290 (21.0%), while those that spent nothing per month were 208 (20.8%) (Table
Knowledge and practice of malaria control.
|
|
---|---|
Cause of malaria fever* | |
Staying in the sun | 1089 (85.8) |
Oil | 474 (63.6) |
Alcohol | 500 (43.5) |
Mosquito bite | 1292 (95.8) |
Dirty water | 1087 (88.2) |
Witchcraft | 391 (34.5) |
Working for too long (stress) | 1065 (86.2) |
Recognition of malaria symptoms* | |
Hot body | 133 (89.9) |
Vomiting | 877 (58.9) |
Refusal to eat | 1151 (77.3) |
Body ache | 1146 (77.0) |
Headache | 1264 (84.9) |
Diarrhea | 628 (42.2) |
Sweating | 1030 (69.2) |
Fatigue | 998 (67.0) |
Malaise | 978 (65.7) |
Sleeping all day | 478 (32.1) |
Dull | 421 (28.3) |
Bitter taste | 391 (26.3) |
Yellow urine | 365 (24.5) |
Action taken when malaria occur ( |
|
Treat at home | 280 (22.5) |
Go to chemist/pharmacy | 308 (24.8) |
Go to hospital | 815 (65.6) |
Go to church/mosque | 15 (1.2) |
Go to traditional healer | 23 (1.2) |
Do nothing | 6 (0.5) |
Distance to health facility ( |
|
<1 km | 310 (25.3) |
1-2 km | 238 (19.4) |
>2–5 km | 283 (23.1) |
>5–10 km | 260 (21.2) |
>10 km | 134 (10.9) |
Malaria protective measures taken* | |
Sleeping under the net | 413 (27.7) |
Sleeping under insecticide treated net | 441 (29.6) |
Sleeping with windows closed | 752 (50.5) |
Sleeping with window with net | 1147 (77.0) |
Use of insecticide spray (Shelltox, Raid, |
854 (57.4) |
Burning coil/grass | 765 (51.4) |
Clearing bushes | 1114 (74.8) |
Draining stagnant water | 897 (60.2) |
Clearing gutter | 969 (65.1) |
Covering the body with cloth | 784 (52.7) |
Amount spent on malaria treatment in a month ( |
|
None | 287 (20.8) |
<N500.00 | 290 (21.0) |
N500.00–N1,000.00 | 271 (19.7) |
>N1,000.00–N1,500.00 | 146 (10.6) |
>N1,5000.000 | 385 (27.9) |
Malaria control in Nigeria is essential; it is therefore necessary to know the burden of malaria in a community for planning and implementing appropriate interventions. The base line information on malaria and its control practices in an area enables the impact of malaria intervention programme to be measured. Good knowledge of behavior of people, as well as that of epidemiology of malaria, enhances correct prioritization of control strategies [
Ibeshe community can be classified as being mesoendemic for malaria at the time of this study based on the parasite rate in children aged 2–9 years old [
In this survey, malaria infection was observed to be associated with anaemia. This can be attributed to the ability of
The age group with the highest malaria infection rate was 45–54 years (24%), though most of them were not febrile. Children under the age of 5 years were the most febrile age group in this study, but their malaria infection rate was low, this is could be due to the fact that children under 5 years are known to have low immunity and are prone to other diseases that can cause fever. This study confirms the fact that it is not all fever cases that is caused by malaria infection.
The predominant species that was found in the community was
Knowledge about the cause of malaria is shrouded with a lot of misconceptions. Most of the respondents attributed the cause of malaria to more than one agent, the frequent responses being mosquito bite, sun, oil, and stress. Similar findings on the causes of malaria were reported in a study carried out in Akwa Ibom state by Ukpong et al. [
Our findings show that females outnumbered the males among the respondents; this is not surprising because this has been the normal pattern in most community studies carried out in many African disease endemic countries [
The success of malaria control programme at present relies on community perception of the disease; incorrect beliefs or inappropriate behavior can interfere with the effectiveness of a control measures such as vector control or chemotherapy [
The knowledge about malaria symptoms was high in the studied community. This is expected considering the high level of formal education and the endemicity of malaria in the area. High patronage of health facilities (hospitals and chemist/pharmacy) was report during malaria episodes in the community.
The use of long-lasting insecticide net in the community was low due to the fact that the rooms are hot because power supply is not regular, rather they prefer to screen their windows with net and environmental management. Oguonu et al. [
Over 60% of the respondents aged 18 years and above earn less than N10,000.00 per month; this implies that the respondents were mostly in the low social economic class. It therefore means that malaria treatment is putting huge burden in the purse of the people in the community.
The implication of this study is that due to the intervention of malaria control programme, it has produced evidence of reduced malaria transmission and associated malaria burden in terms of parasite density in the studied area. Ibeshe community is one of the communities in Lagos state that had benefited from malaria control activities including long-lasting insecticide nets (LLINs) distribution, access to intermittent preventive treatment of malaria (IPT), and artemisinin-based combination therapies (ACTs) in the last 2 years.
However, the finding of this study suggests that malaria transmission is mesoendemic in this area. In a mesoendemic situation malaria is said to be unstable, identifying reservoirs of the parasite, and particularly under asymptomatic condition becomes critical in elimination of the parasite in the area. This study found participates of age group 45–54 years as reservoirs of
This study was carried out only in the dry session; it will be of interest to also carry out this study in the rainy session to ascertain the prevalence of malaria in the community.
Malaria is mesoendemic in Ibeshe community with
Enlightenment campaign is needed to change the people’s perception on the cause of malaria for effective malaria control in the community. Focus on malaria control interventions should be extended to the adults in Ibeshe community.
The authors declare that they have no conflict of interests.
The authors acknowledge the management of Nigerian Institute of Medical Research (NIMR), Yaba, for providing the fund for the project. The cooperation of the traditional rulers and people of Ibeshe community is appreciated. The authors also thank the following pharmaceutical companies IPCA and May & Baker for donating antimalarial medicine used for this project.