Mintage Journal of Pharmaceutical & Medical Sciences

Vol 8, Suppl 2 Apr-June, 2019 ISSN: 2320-3315

Research Article

PERCEPTION, KNOWLEDGE AND SEASONAL DISTRIBUTION OF SYMPTOMATIC

MALARIA IN CALABAR, CROSS RIVER STATE, NIGERIA
1 1 1
BEN SOLOMON A , ADIE G.A AND INYANG-ETOH, P. C
1
Medical Microbiology/Parasitology Unit, Department of Medical Laboratory Science, University of Calabar. Cross River State,
Nigeria. Email:benasuquo@gmail.com
Received - 25.03.2019; Reviewed and accepted - 25.04.2019

ABSTRACT
Background: Malaria is a major public health problem in Nigeria and sub-Saharan Africa. The disease kill an estimated 660,000 people yearly, mostly children under five
years in this region, with Nigeria and the Democratic Republic of Congo responsible for about 40% of world deaths. Malaria infection is increased during the rainy season due
to high rain fall which provides a conducive environment for the breeding of the vector. This study aimed to determine the seasonal effect on the prevalence of Plasmodium
infection, and also to assess the perception and knowledge of the aetiology agent of the infection among study subjects.
Methods: Blood films stained with Giemsa were examined microscopically for the detection of the parasite. Structured questionnaire was also administered.
Results: The prevalence of malaria parasite in the study area was 16%. Males (17%) were more infected than females (16%). The difference in the infection rate was not
statistically significant (P˃ 0.05). Those in the age group 0-10 years had the highest infection rate (21%) while those in the age group 41-50 and 51-60 had the least infection
rate (10%) respectively. The difference in infection rate by age group was statistically significant (P˂ 0.05). P.falciparum was the most detected specie of the parasite (16%),
while P. malariae was 0.04%. No infection with P. ovale and P. vivax was detected. Infections were more during the rainy season with 19% than dry season with 13%. The
difference in infection rate was statistically significant (P˂ 0.05). Subjects who had knowledge of Plasmodium as the causative agent were 52.8%, while those who had
knowledge of mosquito as vector agent were 77%, whereas (8.8%) had knowledge of grasses, stagnant water, and bushes as a predisposing factor. Subjects who did not
know any preventive measures for malaria infection were 1%, while 99% knew of at least one of the malaria preventive measures.
Conclusion: This study shows that malaria infection is higher during the rainy season than the dry season. We, therefore, recommend preventive and control measures to
reduce the high prevalence of malaria infection in the study area during the rainy season.
Keywords: Malaria, Mosquito, Climate Change, Calabar, Nigeria.
INTRODUCTION
Malaria infection leads to over one million deaths, of which over the proliferation of anopheline breeding habitats, in addition to
75% occur in Africa and affects mostly children and pregnant providing favorable humidity for the survival and dispersal of adult
women [1]. The distribution of malaria relies on climate factors mosquitoes [8].
such as rainfall. This promotes the breeding of anopheline
mosquito, the vector of malaria responsible for transmitting the In a related study in Uganda, both rainfall and relative humidity
parasite from one host to another. “Rainfall and temperature affect showed significant positive correlations with malaria infection [14].
the development of larvae in the aquatic environment and the In a similar study in North Eastern Nigeria, “the month of
survival of adult mosquitoes. An increase in rainfall increases the September recorded the highest Geometric Mean Asexual-
availability, persistence, and dimensions of Anopheles larval Densities of 13,655 while the lowest parasite densities were
habitats, although this depends on parameters such as local observed at the peak of the dry season, especially during March
evaporation rates, soil percolation and slope of the terrain”. and April” [11].
Vectors and parasites survival is temperature dependent, with
“too cold and too warm temperatures generally having a negative” In Calabar, Cross River State malaria parasite infection has been
impact. Some studies suggest that probabilistic seasonal climate reported to be responsible for about 60% of all out-patient
forecasts can be used to predict malaria incidence in epidemic- attendances and 30% of all hospital admissions [2].
prone areas. The influence of climatic parameters is “complex and
varies according to the region and the ecology” of the vectors. This work aimed to determine “the seasonal effect on the
Climatic conditions considered suitable for the development of the prevalence of Plasmodium infection in Calabar”.
malaria parasite and its transmission through the mosquito stage METHODOLOGY
of its life cycle are temperatures within the range from 18°C to
32°C. Below 18°C, the parasite development decreases Study Area
significantly, while above 32°C the survival of the mosquito is
affected [10]. Plasmodium species exhibit a complex, This study was carried out in the University of Calabar Teaching
heterogeneous life cycle involving a vertebrate human host and Hospital, Calabar, Cross River State, Nigeria. Calabar is the
capital of Cross River State in the South-South geopolitical zone
invertebrate mosquito host.
of Nigeria. Calabar lies between 4⁰ 34ʹ 27ʹʹ North and 6⁰ 58ʹ 32ʹʹ
In a related study in Mali, the prevalence of malaria infection East. Calabar has a population of approximately 372,000 [5]. The
ranges was reported to have from “70–85% in the south of Mali vegetation in Calabar is typical of the tropical rain forest which
with 1,000 mm of annual rain to 0.5% in the north, where the makes malaria transmission stable throughout the year but more
annual rainfall is below 400 mm [3]. Malaria parasite prevalence intense between April and early October (wet season) with a peak
was also reported to be higher in the cold season than during the period in June/July due to relatively heavy downpour during this
hot period” in Mali [4]. period which usually helps to propagate the vector of malaria
resulting in malaria being hyper-endemic in the area with about
In a similar study in Ilorin, Kwara State, Nigeria, a higher 43.7% of the population infected with malaria infection [2].
prevalence of malaria infection were reported during “the rainy Calabar is one of the coastal areas in Nigeria and is considered a
season compared to the dry season” [8]. This has been attributed hyper-endemic malaria state due to heavy rain and typical
to the high precipitation during the rainy season which results in rainforest vegetation. The transmission of malaria has a seasonal

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Solomon et al. Mintage Journal of Pharmaceutical & Medical Sciences│7-10

variation in Calabar, with a peak prevalence rate of 43.7% in the The difference was statistically significant (X2=34.273; df=6; P =
wet season [2]. 0.004).
Calabar has an average annual temperature of 26.10c and Table 2 shows that males were more infected in the study with
average annual rainfall of 2750mm. Calabar has four main 17% than females 16%. There was no statistically significant
hospitals around it namely, University of Calabar Teaching difference in the infection rate by gender (P ˃0,05).
Hospital, Nigerian Navy Hospital, General Hospital, and Federal
Neuropsychiatric Hospital, Police clinics, and other private Table 3 shows the occurrence of different species of Plasmodium
hospitals. in the study area. P. falciparum had the highest occurrence of
16% and P,malariae had 0.04% where there were no cases of P.
Ethical Approval/ informed consent ovale and P. vivax. The difference in occurrence rate was
statistically significant (P˂ 0.05). Malaria parasite was highest in
Ethical approval was obtained from the Health Research Ethics the rainy season with 19% and dry season with 13%. The
Committee of the University of Calabar Teaching Hospital, difference in infection rate was statistically significant (P˂ 0.05).
Calabar. Informed consent was also signed by patients before (X2=15.645; df=1; P = 0.005).
being incorporated into the study group.
The perception of the aetiology of malaria infection among the
Study population citizens of Calabar, Cross River State, Nigeria shows that, of the
Subjects were patients visiting the University of Calabar Teaching 2329 subjects that filled the questionnaire, 1230 (52.8%) had
Hospital with clinical symptoms consistent with malaria infection. knowledge of Plasmodium as the causative agent of malaria,
1800 (77%) had knowledge of mosquito as the agent of
Sampling Method transmission while 205(8.8%) had knowledge of grasses,
stagnant water, dirty gutter and bushes as risk factors for malaria
This study used a convenient sampling method
as shown on Table 5.
Questionnaire Administration
Table 6 shows the knowledge of control measures in controlling
A structured questionnaire was administered to consenting and or preventing mosquito bite, where (31%) correspondents use
subjects to obtain information on the following Bio-data, insecticides treated net in their homes, 982(42%) correspondents
Awareness, perception, and knowledge of the causative agent make use of door/window net, 595(26%) correspondents use
and preventive measures for the control of malaria. residual insecticides whereas 20(1%) subjects had no knowledge
of any control/preventive measures.
Inclusion criteria
Table 1: The distribution of malaria parasite by the age of
 Subjects who had clinical signs and symptoms related to subjects.
malaria-like chills, headache, high fever, and vomiting and
agreed to sign the informed consent form. Age (year) No. examined No(%) infected No.(%)not
 Subjects who were not on antimalarial therapy. infected
0-10 550 155 (21) 435 (79)
Exclusion criteria 11-20 235 32 (16) 197 (84)
21-30 416 68 (16) 348 (84)
 Subjects without any of the clinical signs and symptoms of 31-40 310 76 (25) 234 (75)
malaria. 41-50 400 38 (10) 362 (90)
 Subjects who refuse to sign the consent form. 51-60 260 18 (10) 242 (93)
 Subjects who were on antimalarial therapy. ˃ 61 158 26 (17) 132 (84)
Sample Size Total 2329 379 (16) 1950 (84)

The number of samples for this research was determined using Table 2: The occurrence of malaria infection among study
the formula by Amin et al. [6], using a malaria prevalence rate of subjects by gender.
68% reported for Calabar in 2016 by Monjol et al. [7]. Gender No. examined No.(%) positive No. (%) negative
Approximately Two Thousand Three Hundred and Twenty Nine
Male 1,003 172 (17) 831 (83)
(2329) subjects were involved in the study.
Female 1,326 207 (16) 1119 (84)
Blood Collection/Processing Total 2,329 379 (!6) 1950 (84)

Finger-prick was used to collect samples for the thick and thin film Table 3: Distribution of the different Plasmodium species
after swabbing the area with 70% alcohol. Thin films were made among the study subjects
by using 2µl of blood on a clean slide, and a spreader was used at
an angle of 45o firmly to make a thin film with a length of 25mm on No. No (%) No (%) No (%) No (%)
the glass slide, whereas Six microliters (6µl) of blood was used to examined infected infected infected infected
make a thick film. Absolute methanol was used to fixed the thin with P. with P. with with
film before they were stained with 2% Giemsa stain for 30 falciparum malariae P.ovale P.vivax
minutes. Both the thin and thick slides were examined under the 2329 378 (16) 1 (0.04) - -
light microscope using X 100 oil immersion objective for malaria Table 4: The occurrence of malaria parasite infection by
parasite. seasons
Data Analysis Season No. No.(%) infected No.(%) not
Data obtained from this study were analyzed using the statistical Examined infected
package for Social Science Program (SPSS version 22.0 Rainy 1448 268 (19) 1180 (81)
Chicago). A 95% confidence interval was be used to allow for a season
workable probability value of 0.05 (p=0.05). Dry 881 111 (13) 770 (87)
season
RESULTS Total 2,329 379 (16) 1950 (84%)
Table 1 shows the prevalence of malaria parasite by the age of Table 5: Perception of the aetiology of malaria among the
the subjects examined. Subjects aged 31-40 years had the study participants
highest infection rate of 25%. while those aged 41-50 years and
51-60 years had the lowest infection rate of 10 % respectively. Criteria No of
awareness

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Solomon et al.
Knowledge of Plasmodium as causative agent 1230
of malaria
Knowledge of mosquito as vector agent 1800
Knowledge of grasses, stagnant water and 205
bushes as risk factors for malaria
Table 6. Knowledge of control measures in preventing
mosquito bite
Control measures No (%) of awareness
Use of insecticide-treated net 732 (31)
Use of door/window net 982 (42)
Use of insecticides 595 (26)
No knowledge about any one 20 (1)
Total 2329
DISCUSSION
The high difference in the occurrence of malaria parasite infection
in the study may be due to “a high rainfall and location of Calabar
in the Tropical rainforest in Southern Nigeria.” Female anopheline
mosquitoes were more abundant in Calabar during rainy season
due to the presence of stagnant water, blocked gutters, grasses,
and bushes as a result of heavy rainfall. The result obtained in
this study is in agreement with other works in Nigeria and other
African countries with similar climatic conditions [11, 13]. This may
be due to high rainfall associated with the rainy season, which
provides a good breeding environment for the vector agent. This
agrees with work done by Olayemi [8] in Nigeria and Delley [6] in
Mali which records high malaria prevalence during the rainy
season than the dry season.
This situation has been largely attributed to the high precipitation
during the wet season which leads to the high breeding habitat
and creating favorable humidity for the breeding and dispersal of
an agent of the malaria parasite (mosquito). However, the result
of this study indicates that malaria transmission in Calabar, South-
south of Nigeria is influenced by the season with very high
transmission occurring in the rainy season. Intensive malaria
control measures must be extended to the other seasons when an
appreciable number of malaria transmission are also recorded.
Significantly, the infection rates were greatly reduced in the dry
season because of a reduced level of stagnant water, little or no
rainfall and bushes which leads to a reduce humidity which favors
the breeding of the vector agent.
The finding of this study aligns with the report of Beier [14] who
reported a high malaria transmission rate in Kenyan during the
rainy season. The rainy season also increases the life expectancy
and increase the breeding rate of the vector because of favorable
humidity.
The destruction of mosquito breeding sites during the rainy
season clearing of grasses, clearing of gutters and proper
disposal of cans that harbours water will help in reducing the
population of anopheline mosquitoes (vector agent of malaria).
Good sanitary conditions around residential buildings and
maintenance of high hygiene in refuse dump site also help in the
reduction of mosquito breeding during both seasons.
CONCLUSION
The results of this study shows that “seasonality of climate
influences the variation in malaria transmission in Calabar, Cross
River State, Nigeria.” Rainfall plays an important role in the
distribution of breeding sites for the mosquito vector and thereby
influences malaria transmission. The findings of this study are
relevant from a” public health perspective to better understand the
ecoepidemiology of malaria infections."
The climate change in Calabar, Cross River State, South-South of
Nigeria is markedly seasonal, and it affects malaria distribution in
the area, as shown by the result of the prevalence of malaria
parasite by microscopy which is the gold standard for malaria
diagnosis. The study records high prevalence of 19% in the rainy
season and 13% in the dry season, which may be due to the
optimal humidity in the environment that favors the breeding of
vector (anopheline mosquito). Knowing how “climate and
environmental factors affect malaria transmission dynamics is an
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Mintage Journal of Pharmaceutical & Medical Sciences│7-10
important first step in developing policies and programs to prepare
for changing weather patterns associated with climate change,”
changes in temperature and precipitation lead to increase in the
burden of malaria without additional interventions. This study has
provided “a better understanding of the aetiology and perception
of malaria in Calabar” hence, the use of educational
enlightenment programme and other control measures to target
the breeding site to prevent multiplication and also prevent
mosquito bite by susceptible individuals.
RECOMMENDATIONS
Knowledge of the aetiology of the infectious agents will help in the
education of the citizens in controlling and modification of life style
to avoid mosquito bites.
Knowledge of measures to the prevention of mosquito bite which
includes the use of insecticide-treated nets, use of door/window
nets, use of residual insecticides also helps in the reduction of
mosquito bite in both seasons.
Acknowledgment
We acknowledged the effort of associate Professor P.C.Inyang-
Etoh for his careful corrections and guidance and all those who
contributed to the success of this article.
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