ASSESSMENT OF EARLY DIAGNOSIS AND TREATMENT OF

MALARIA AMONG STUDENTS

{60 PAGES}

DEPARTMENT OF PUBLIC HEALTH

SCHOOL OF HEALTH TECHNOLOGY

i
 TABLE OF CONTENTS

CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
ABSTRACT viii
TABLE OF CONTENTS v
LIST OF TABLES viii
LIST OF FIGURES ix
CHAPTER ONE: INTRODUCTION 1
1.1 BACKGROUND TO THE STUDY 1
1.2 STATEMENT OF THE PROBLEM 5
1.3 OBJECTIVES OF THE STUDY 6
1.3.1 General Objectives 6
1.3.2 Specific Objectives 6
1.4 HYPOTHESIS OF THE STUDY 7
1.5 RESEARCH QUESTIONS 7
1.6 SIGNIFICANCE OF STUDY 7
CHAPTER TWO: LITERATURE REVIEW 9
2.1 CONCEPTUAL FRAMEWORK 9
2.1.1 Overview of Malaria 10
2.1.2 Symptoms of Malaria 11
2.1.3 Transmission of Malaria 12
2.1.4 Parasitological Diagnosis 13
2.2 THEORETICAL STUDIES 16
2.2.1 Rationale for School-Based Early Diagnosis and Treatment (Edt) 16
2.2.1 Specific Antimalarial Treatment 18
2.2.2 Goal of Antimalarial Treatment 18
2.2.3 Antimalarial Treatment Policy 19
2.2.4 Antimalarial Drug Situation in Nigeria 20

ii
 2.2.5 Antimalarial Drug Resistance 20
2.2.6 Essential Antimalarial Drugs 21
2.2.7 The List of Essential Antimalarial Drugs 22
2.2.8 Rational Use of Antimalarial Drugs 22
2.2.9 Disease Management at The Home 22
2.2.10 Management of Antimalarial Drug Supply 23
2.2.11 Treatment Strategies/ National Responses 23
2.3 EMPERICAL STUDIES 26
2.3.1 Rapid Diagnosis of Malaria 26
2.3.2 Rapid Diagnostic Tests (RDTs) 28
CHAPTER THREE: RESEARCH METHODOLOGY 31
3.1 STUDY DESIGN 31
3.2 AREA OF STUDY 31
3.3 STUDY POPULATION 32
3.4 SAMPLE SIZE AND SAMPLING METHODS 32
3.4.1 Sample Size 32
3.4.2 Sampling Methods 33
3.5 INSTRUMENT FOR DATA COLLECTION 33
3.6 METHOD OF DATA COLLECTION 33
3.8 ETHICAL CONSIDERATION/ INFORMED CONSENT
34
CHAPTER FOUR: RESULT AND DISCUSSION 35
4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS 35
4.2 AWARENESS ON EARLY DIAGNOSIS OF MALARIA 37
4.3 KNOWLEDGE ON EARLY TREATMENT OF MALARIA 41
4.4 PATTERN OF MALARIA TREATMENT 44
4.5 AWARENESS ON ARTEMISININ-BASED COMBINATION THERAPY 45
4.6 DETERMINANTS OF THE RELATIONSHIP BETWEEN EARLY DIAGNOSIS OF
MALARIA AND THEIR PATTERN OF TREATMENT 47
4.7 TEST OF HYPOTHESIS 49
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION 50

iii
5.1 DISCUSSION 50
5.2 CONCLUSION 52
5.3 RECOMMENDATION 52
REFERENCE 54
APPENDIX 58

iv
 ABSTRACT

This study assessed the level of early diagnosis and treatment of malaria among students.
It identified the level of awareness on early diagnosis of malaria before treatment;
identified the reasons why early diagnosis of malaria is not done before treatment;
assessed the pattern of treatment for malaria; and determined the level of awareness of
Artemisinin-based Combination Therapy (ACT). The study also examined the influence
of early diagnosis to their pattern of treatment. A total of 255 students constituted the
sample size for the study. Data for the study were collected through structured
questionnaire. Frequency, Percentages, Mean statistics, Regression estimates and
ANOVA were used in data analysis. Result shows that majority (57%) of the students
were male, 40% use symptoms like running nose, headache and pains to confirm malaria;
majority (97%) of students have not been tested using RDT, (40%) of the few that tested,
had their test carried out in the hospital, majority (90%) of the students are not aware that
early diagnosis of malaria can detect the level of malaria parasite in the blood, (83%) of
students do not know about other diseases that exhibit similar signs with malaria and
majority (70%) do not know that early diagnosis can lead to effective and prompt
treatment of malaria. Survey on the knowledge of early treatment of malaria showed that
majority (73%) of the students take treatment for malaria immediately after symptoms,
and (37%) get their drug recommendations from patent medicine store. However, the
majority (73%) of students have not heard about complicated malaria which can cause
cerebral malaria; and the majority (83%) are not aware that early treatment of malaria can
reduce the risk of complicated malaria. Data on the pattern of treatment showed that
majority of the students treat malaria with malaria drugs; and majority (80%) do not
continue with treatment after the symptoms have gone. Survey on awareness on ACT
made it obvious that the majority (73%) of the students have not heard about ACT as an
effective treatment for malaria, and majority (87%) do not know that ACT is a standard
anti-malaria, set by WHO for effective treatment of malaria. In conclusion, the result
showed that there is a significant influence of Early diagnosis of malaria and pattern of
treatment among students. It is therefore recommended that there should be proper
enlightenment for students on early diagnosis of malaria and the use of ACT drugs to
avoid cases of complicated malaria and/or death of the patient.

v
 CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Malaria remains a major cause of morbidity and mortality throughout the world,
with 32% of the world’s population living in areas of risk (WHO, 2017). In 2008,
109 countries were reported to be endemic for malaria, with 45 of the countries
within the African region (WHO, 2008). According to roll back malaria, there were
an estimated 247 million episodes of malaria in 2006, with 86% of cases reported
in African countries.
Despite the progress that has been made in reducing the burden of malaria through
improved access to preventive interventions, (WH0.2017), there remain many
challenges to the eventual eradication of the parasite. Perhaps one of the greatest
challenges is the continual battle with resistance, to both the drugs used to treat the
cases and the insecticides used to kill the mosquito hosts (Ashley, Dhorda, and
Fairhurst, 2014), (Hemingway, Ranson, and Magill, 2016).
In Nigeria, 98% of all cases of malaria is due to Plasmodium falciparum and this
is the specie that is responsible for the severe form of the disease that leads to
death (FMOH, 2005). Early diagnosis and treatment of malaria involves finding
the disease earlier before symptoms begin and the complete cure, that is the rapid
and full elimination of the plasmodium parasite from the patient’s blood, in order
to prevent progression of uncomplicated malaria to severe disease or death and to
prevent chronic infection that leads to related anaemia (WHO, 2018). Malaria is
caused by infection of red blood cells with protozoan parasites of the genus
Plasmodium (WHO, 2009). The parasites are inoculated into the human host by a
feeding female anophelese mosquito.
The first symptoms of malaria are nonspecific and similar to the symptoms of a
minor systemic viral illness. They comprise: headache, lassitude, fatigue,
abdominal discomfort, and muscle and joint aches, usually followed by fever,
chills, perspiration, anorexia, vomiting and worsening malaise. Malaria is,
therefore, frequently over-diagnosed on the basis of symptoms alone, especially in

6
endemic areas like Nigeria, because of this non-specificity of symptomatology
(Uzochukwu, Obikeze, Onwujekwe, Onoka, and Griffith, 2009).
Malaria has continued to be a major public health problem being responsible for an
estimated 350 to 500 million people being affected every year in Africa and
approximately one million people die (Facts About Malaria, 2014). In Nigeria, the
burden of malaria is well documented and has been shown to be a big contributor
to the economic burden of disease in communities where it is endemic and is
responsible for annual economic loss of 132 billion Naira (Onwujekwe, Chima,
Okonkwo, 2010) (Jimoh, Sofola, Petu, and Okorosobo, 2007). It is estimated that
300,000 deaths occurring each year, 60% of outpatient visits and 30%
hospitalizations are all attributable to malaria (FMOH, 2009-2013). According to
annual report on National Malaria Control Committee Programme in Nigeria
(National Malaria Control Committee, 2005), the financial loss due to malaria is
estimated to be 132 billion naira in form of treatment cost, prevention and loss of
man hours. Furthermore, the report on Nigeria malaria fact sheet noted that malaria
has the greatest prevalence, close to 50% in children age 6-59 months in the south
west, north central, and North West regions and malaria is also the third leading
cause of death for children under five years worldwide, after pneumonia and
diarrhoeal disease (WHO, 2010).
In the last five years, treatment of malaria caused by Plasmodium falciparum
infections in endemic countries has been transformed by the use of combinations
of drugs containing an artemisinin derivative (ACT). Severe malaria is treated with
intravenous or intra muscular quinine or increasingly, the artemisinin derivatives
artesunate (Borrman, Szlezak, Binder, Lell, and Kremsner, 2005). Early diagnosis
and Prompt treatment with effective antimalarial therapy is essential and African
leaders were committed to ensuring that 80% of malaria episodes are adequately
treated within 24 hours of onset of symptoms by 2010. But 3 years after the
situation remains largely the same. Treatment of malaria is challenged by factors
which include inadequate health care infrastructure in many parts of Africa. Health
facilities are often resource limited, and access to care may be limited by distance,
fees, inadequate staffing and lack of essential medicines. The direct and indirect
costs of seeking health care from formal facilities may be substantial, providing a
major barrier for many households. Poor perception about malaria have hindered
adequate care at home in most endemic areas. In parts of South-Western Nigeria,

7
overwork, stress, excessive sex, noise, sunlight, powers from humans, as well as
forces of darkness are thought to be the cause of the disease. In rural parts of South
Eastern Nigeria where these perceptions are also largely the same, the type of care
given at home is usually informed by the perceived cause of the illness episode
(Chukwuocha, 2011). Despite recent significant progresses towards elimination in
several countries in Asia, Africa and South America, malaria remains a major
health issue in many tropical regions where it thrives in countries with a weak
health- care system (White, Pukrittayakamee, Hien, Faiz, Mokuolu, and Dondorp,
2014).
In the last 20 years’ significant increases in investment have resulted in the
development of new tools to combat this parasitic disease, the most common of
mankind. Some of the newest tools require expensive and complex technologies
that are not available to national malaria programmes, or are still under trial (vac-
cines, insecticides, genetically modified mosquitoes), (Goncalves and Hunziker,
2016). Others are already available such as, long lasting insecticidal bed nets
(LLINs), rapid diagnostic tests (RDTs) and artemisinin-based combination
treatment (ACT). However, in order to control malaria (reduction of morbidity
and mortality) and eliminate it (interruption of the transmission cycle), it is
essential to identify and treat infected individuals early in the course of the illness.
To achieve this goal, everyone living in malaria-endemic areas must have easy
access to reliable diagnostics and effective treatment. This is one of the most
difficult tasks encountered by national malaria programmes (Barnes, Chanda and
Barnabas, 2009).

1.2 STATEMENT OF THE PROBLEM

It is obvious that malaria is a killer disease. The world Health Organization (WHO)
estimates that in 2010, there were about two hundred and nineteen (219) million
cases of malaria outbreak resulting to six hundred and sixty thousand (660,000)
deaths (WHO, 2016). Malaria is an eminently preventable, treatable and curable
infection. The World Health Organization (WHO) estimated that in the African
region, approximately one half of suspected malaria cases received parasitological
confirmation (WHO, 2012). The number of courses of artemisinin combination
therapy (ACT) still exceeds the total number of malaria diagnostic tests by a factor
of 2, indicating that many patients receive ACT without confirmatory diagnosis

8
(WHO, 2012). Malaria continues to be a leading cause of morbidity and among
students inspite of the intervention being pursued to combat the disease.
This work seeks to critically look at early diagnosis and treatment of malaria
among students by undergoing rapid diagnostic test (RDT) or microscopic test to
confirm cases of malaria before treatment and the use of WHO recommended
artemisinin-based combination treatment (ACT) for effective treatment of
uncomplicated malaria.

1.3 OBJECTIVES OF THE STUDY

1.3.1 General Objectives

The overall objective of this study is to assess the level of early diagnosis and
treatment of malaria among students.
1.3.2 Specific Objectives
i. To determine the level of awareness on early diagnosis of malaria before
treatment.
ii. To determine reasons why early diagnosis of malaria is not done before
treatment among students.
iii. To assess the pattern of treatment when they have malaria.
iv. To assess the first-line of action when malaria is being suspected.
v. To determine the time of anti-malarial drug intake after symptom.
vi. To determine the level of awareness of Artemisinin-based Combination
Therapy (ACT).
vii. To assess the influence of early diagnosis to their pattern of treatment.

1.4 HYPOTHESIS OF THE STUDY

Ho; There is no significant influence of early diagnosis to their pattern of

treatment.

1.5 RESEARCH QUESTIONS

i. Is there knowledge on early diagnosis of malaria in order to confirm cases

before treatment?
ii. What is the pattern of treatment when malaria have been confirmed through
test?

9
1.6 SIGNIFICANCE OF STUDY
Malaria case management remains a vital component of the malaria control
strategies. This entails early diagnosis and prompt treatment with effective
antimalarial medicines (Uzochukwu et al, 2010). Malaria is an eminently
preventable, treatable and curable infection. Drugs and other interventions for its
prevention and treatment are widely available. Many of these are easy to apply and
are affordable and accessible. Early diagnosis and proper treatment are key to
addressing morbidity and mortality due to malaria. The introduction of malaria
rapid diagnostic tests (RDTs) has become a crucial component of malaria control
in Nigeria. This is because of the higher-priced artemisinin-based combination
therapy (ACT), which was introduced in Nigeria in 2005 as the first-line anti-
malarial drug as a result of extensive resistance to chloroquine and sulphadoxine-
pyrimethamine. In addition, WHO has recently recommended that laboratory
diagnosis be done before patients are treated with Artemisinin-based Combination
Therapy (ACT). Therefore, the aim of this study is to assess the early diagnosis
and treatment of malaria among students to ensure complete cure and in order to
prevent progression of uncomplicated malaria to severe disease or death and to
prevent chronic infection that leads to malaria related anaemia (WHO, 2018).

GET FULL MATERIAL

To get the complete material (Chapters One to Five), Pay N5000 to the following bank.

BANK DETAILS:

UNITED BANK OF AFRICA PLC [UBA]

Account Name: Irokah Emmanuel

Account Number: 2084311379

Call/WhatsApp Emmanuel:

Phone Number: +2347065429999

Send Mail:

emmairokah@gmail.com

Contact us also for upgrade and quality assurance:

10
porientre@gmail.com

11