FACTORS INFLUENCING MALARIA PREVALENCE IN CHILDREN UNDER FIVE YEARS OF AGE IN JINJA CITY, NORTHERN DIVISION

FACTORS INFLUENCING MALARIA PREVALENCE IN CHILDREN
UNDER FIVE YEARS OF AGE IN JINJA CITY, NORTHERN

DIVISION
NOVEMBER, 2022
FACTORS INFLUENCING MALARIA PREVALENCE IN CHILDREN UNDER
FIVE YEARS OF AGE IN JINJA CITY, NORTHERN DIVISION
A RESEARCH REPORT SUBMITTED TO SCHOOL OF HYGIENE MBALE IN

PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
AWARD OF A DIPLOMA IN ENVIRONMENTAL HEALTH
SCIENCE OF UGANDA ALLIED HEALTH
EXAMINATIONS BOARD
(UAHEB)
NOVEMBER, 2022
ii
TABLE OF CONTENTS
TABLE OF CONTENTS ................................................................................................................................... i
LIST OF ABBREVIATIONS .............................................................................................................................iv
DEFINITION OF OPERATIONAL TERMS ........................................................................................................ v
CHAPTER ONE ............................................................................................................................................. 6
BACKGROUND............................................................................................................................................. 6
1.0 Introduction ...................................................................................................................................... 6

1.1 Background Information ................................................................................................................... 6
1.2 Problem Statement ........................................................................................................................... 7
1.3 Objectives ......................................................................................................................................... 8
1.3.1 General Objective .......................................................................................................................... 8
1.3.2 Specific Objectives. ........................................................................................................................ 8
1.4 Research Question ...................................................................................................................... 8
1.5 Significance of the Study ................................................................................................................... 9
1.6 Scope of the Study. ........................................................................................................................... 9
1.7 Conceptual Framework ................................................................................................................... 10
CHAPTER TWO .......................................................................................................................................... 11
LITERATURE REVIEW ................................................................................................................................. 11
2.0 Introduction .................................................................................................................................... 11

2.1 Care Giver Factors Associated with Malaria Prevalence ................................................................. 11
2.2 Environmental Factors Associated with Malaria Prevalence .......................................................... 13
2.3 Household Factors Associated with Malaria Prevalence ................................................................. 15
CHAPTER THREE ........................................................................................................................................ 18
METHODOLOGY ........................................................................................................................................ 18
3.0 Introduction .................................................................................................................................... 18

3.1 Study Design. .................................................................................................................................. 18
3.2 Study Area....................................................................................................................................... 18
3.3 Study Population. ............................................................................................................................ 18
3.4 Sample Size Determination ............................................................................................................. 18
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3.5 Sampling Technique ........................................................................................................................ 19
3.6 Sampling Procedure. ....................................................................................................................... 19
3.7. Data Collection Method ................................................................................................................. 20
3.7.1 Interview Guide............................................................................................................................ 20
3.7.2 Questionnaires ............................................................................................................................. 20
3.8 Data Collection Procedure .............................................................................................................. 20
3.9 Study Variables ............................................................................................................................... 20
3.10 Quality Assurance ......................................................................................................................... 21
3.11 Data analysis and presentation ..................................................................................................... 21
3.12 Ethical Consideration. ................................................................................................................... 21
3.13. Dissemination of Results .............................................................................................................. 22
CHAPTER FOUR ......................................................................................................................................... 23
PRESENTATION OF FINDINGS.................................................................................................................... 23
4.0 Introduction .................................................................................................................................... 23

4.1 Socio demographic characteristics of respondents......................................................................... 23
4.2 Knowledge about the disease and health seeking behavior ........................................................... 26
4.3 Treatment seeking behavior ........................................................................................................... 30
4.4 Attitudes towards Malaria infection ............................................................................................... 32
4.5 Household factors ........................................................................................................................... 33
CHAPTER FIVE ........................................................................................................................................... 38
DISCUSSION OF THE FINDINGS ................................................................................................................. 38
5.0 Introduction .................................................................................................................................... 38

5.1 Discussion ....................................................................................................................................... 38
5.2 Conclusions ..................................................................................................................................... 42
5.3 Recommendations .......................................................................................................................... 43
5.4 Areas of further Study..................................................................................................................... 44
REFERENCES.............................................................................................................................................. 45
APPENDICES .............................................................................................................................................. 48
Appendix I: Informed Consent Form ..................................................................................................... 48

Appendix II: Questionnaire for the Parents and Caregivers of Children Under Five Years .................... 49
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Appendix III: Interview Guide................................................................................................................ 53
Appendix IV: Proposed Work Plan ........................................................................................................ 54
Appendix V: Proposed Budget for the Research Study ......................................................................... 55
Appendix VII: Introductory Letter from the School ............................................................................... 56
APPENDIX VI: A MAP OF JINJA CITY SHOWING THE LOCATION OF NORTHERN DIVISION ........................ 57
APPENDIX VII: A MAP OF UGANDA SHOWING LOCATION OF JINJA CITY .................................................. 58
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LIST OF ABBREVIATIONS
ACTs - Artemisinin Combination Therapies.
CDC - Center of Disease Control.
GDP - Gross Domestic Product.
ICCM - Integrated Case Control Program.
IMCI - Integrated Management of Childhood Illness.
IRS - Indoor Residual Spraying.
ITNs - Insecticide Treated Nets
LLINs - Long Lasting Insecticide Treated Nets.
MCP - Malaria Control Program.
MIS - Malaria Indicator Survey.
MOH - Ministry of Health.
NMCP - National Malaria Control Program.
NMCS - National Malaria Control Strategy
OPD - Outpatient Department.
RBM - Roll Back Malaria.
RDT - Rapid Diagnostic Test.
UNICEF - United Nations Integrated Children Fund
VHT - Village Health Team.
WHO - World Health Organization
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DEFINITION OF OPERATIONAL TERMS
Community: A group of people usually living in an identifiable geographical area, who share a
common culture and are arranged in a social structure that allows them to exhibit
some awareness of a common identity as a group.
Culture: Type of civilization.
Data: Is information on which decision is to be made.
Focus group discussion: It is a group discussion of 6 to 10 persons guided by a facilitator who

may be a researcher or his assistant during which group members talk freely and
spontaneously about the topic given.
Frequency: Rate of repetition or occurrence of an invent.
Health education: Is process of passing knowledge which focuses on helping people learn how
to change their behavior in order to promote their health.
Household: Is a homestead or family.
Malaria: Is an acute and chronic protozoan illness characterized by peroxins of fever, chills,
sweat, fatigue, anemia and splenomegaly.
Parasitemia: Number of malaria parasites contained in the blood.
Population: This is the totality of the items under consideration during a research study.
Sampling design: This is a definite plan that is used for selecting a sample from a given population
of interest.
Variable: This is a characteristic of a person, an object or phenomenon which can take on

different values.
Environment: The circumstances, objects, conditions by which one is surrounded
Caregiver: Someone who takes responsibility for those children below the age of five years
Malaria prevalence: Proportion of people who are infected with malaria at a given point of time.
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CHAPTER ONE
BACKGROUND
1.0 Introduction
This chapter discusses the background of the study, objectives, research questions for which the
study was carried out, significance of the research and explaining the scope of the study.
1.1 Background Information
Globally, over 95 countries and territories have on going malaria transmission with estimation of 3.2
billion people at a risk of getting infected. The world health organization (WHO) indicates that 214
million people are infected with malaria world wide and 438.000 cases result in deaths. Children
under five are particularly susceptible to malaria illness which kills an estimate of 303.000 before
their age of five years globally including 292.000 in the African region. (WHO world malaria report
2016).
Children under five years are most vulnerable to malaria infection as their immunity is not yet
developed to fight any disease. (CDC- Global health division for parasitic diseases and malaria,
2012). Statistics from the ministry of health show that malaria is still the leading cause of death in
Uganda accounting for 27% of deaths and that Uganda has the world’s highest malaria incidence
with a rate of 478 cases per 1.000 populations per year.
In 2020, nearly half of the world's population was at risk of malaria. Some population groups are at
considerably higher risk of contracting malaria and developing severe disease: infants, children under
5 years of age, pregnant women and patients with HIV/AIDS, as well as people with low immunity
moving to areas with intense malaria transmission such as migrant workers, mobile populations and
travelers. The WHO African Region carries a disproportionately high share of the global malaria
burden. In 2020, the region was home to 95% of malaria cases and 96% of malaria deaths. Children
under 5 accounted for about 80% of all malaria deaths in the Region (WHO world malaria report
2022).
According to WHO the malaria prevalence depends on the possible environmental factors related to
parasite, vector, the human host and the environment. The transmission is also observed more in
places where the life span of the mosquito is longer favoring the parasite to develop completely in a
mosquito increasing the transmission and therefore high prevalence of malaria. The climate
conditions such as rainfall patterns, temperature and humidity also affect the number and survival of
6
mosquitoes and in many places, transmission is seasonal and high always in rainy seasons and
immediately after the rainy season. More transmissions and epidemics can occur in people who have
little or no immunity to malaria. (WHO, 2022).
Sub Saharan- Africa continues to carry a high portion on global malaria burden with 90% of malaria
cases and 92% of malaria deaths, children being particularly vulnerable accounting for 70% of all
the malaria deaths. Malaria remains a major cause of morbidity in children in sub–Saharan Africa
under the age of 5 years and one child die after every 2 minutes (WHO world malaria report 2018).
In Uganda, despite a reduction in national under-five malaria prevalence from 30.4% in 2016
(UBOS, 2015), to 16.9% in 2018–2019 (UBOS, 2019), modelled projections, show that the country
experienced approximately 12.3 million malaria cases and 13,203 malaria deaths in 2018, with little
evidence of change since 2016 (WHO world malaria report 2018). Malaria continues to contribute
to 20–30% of all paediatric admissions to hospitals across the country (Uganda operational plan FY
2019. 2019), overwhelming emergency clinical services.
In Uganda, Malaria is the leading cause of morbidity and mortality, particularly among children
under five who do not have access to good quality health facilities at the community level. Integrated
Community Case Management (ICCM) was introduced as a national programme in the country in
2010 to extend case management of key childhood illnesses, including malaria, beyond health
facilities – increasing access to lifesaving treatment to more children. Since then, there have been
challenges in scaling up this programme due to limited funding, capacity shortfalls and restricted
stock availability of essential commodities (Dr Abwaimo F. & Beinomugisha.G)
In Jinja City, Contemporary estimates of infection prevalence are 7.5% compared to

an estimated historical prevalence above 50%. The age pattern and broad overall
rate of malaria hospitalisation were similar in Tororo compared to Jinja and
Mubende, with current transmission between 10 and 32% respectively, with 74%
of all paediatric admissions occurring before the 5th birthday and a peak in the
second year of life (Mpimbaza, A., et al, 2020).
1.2 Problem Statement
In Jinja City, Northern Division, malaria is the most common cause of death in children and the city
suffers the highest malaria burden in the country which creates a demand for quick and integrated
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intervention among children under 5 years. Malaria does not only cause ill health but also has socio
economic and cultural impact on the development of individuals, families, communities and the
nation in general. The major challenge to malaria control in Jinja City, Northern Division include
very high malaria transmission intensity, inadequate health care resources, a weak health system,
inadequate understanding of malaria epidemiology and the impact of control interventions,
increasing resistance of parasites to drugs and of mosquitoes to insecticides, which has contributed
to high level of hospitalization (Adoke et al. 2012)
While there are emphasis mainly on the prevention of malaria than its control, community members
of Jinja Northern Division still maintain a poor environmental and unhygienic household status such
as housing near swamps, near lake shores, presence of stagnant waters, bushy areas due to sugar cane
plantation and others; which has steadily promoted the breeding of mosquitoes which cause high
spread of malaria in children under 5 years hence high prevalence recorded annually (MOH, 2011)
However, the study intends to investigate the factors responsible for the high level of prevalence of
malaria amongst children under 5 years in Northern Division, Jinja city
1.3 Objectives
1.3.1 General Objective
To asses factors influencing the prevalence of malaria in children under 5 years of age in Northern
Division, Jinja city.
1.3.2 Specific Objectives.
The study was guided by the following research objectives

1. To identify the care giver factors associated with prevalence of malaria among children below
5 years who attend the OPD of Wakitaka Health Centre III, Northern division, Jinja city.
2. To assess the environmental factors contributing to the prevalence of malaria amongst
children below 5 years in Northern division, Jinja city.
3. To find out the house hold factors associated with prevalence of malaria amongst children
below age 5 years in Northern division, Jinja city.
1.4 Research Question
The study was guided by the following research objectives
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1. What are the care giver factors associated with the prevalence of malaria in children under
five years who attend out patient’s department of Wakitaka Health Centre III, Northern
division, Jinja city?
2. What are the environmental factors leading to prevalence of malaria in children below 5 years
in Northern division, Jinja city?
3. What house hold factors are associated with high malaria prevalence of malaria amongst
children below age 5 years in Northern division, Jinja city?
1.5 Significance of the Study
The study had the following significance:

The study generated information on the factors influencing the prevalence of malaria in children
under 5 years of age and this information that may be used by the City Health Team in planning and
monitoring to ensure efficient utilization of malaria control intervention.
This subsequently contributed to the reduction of the burden of malaria and its untoward
consequences among children under 5 years of age thereby leading to better health of the community.
The study was used by the student for the partial fulfillment of the requirements for the award of a
Diploma in Environmental Health Sciences of Uganda Allied Health Examinations Board (UAHEB).
The study also provides a valuable point of reference for researchers carrying out similar studies in
future and also contributed to the available literature on the factors influencing the prevalence of
malaria in children under 5 years of age.
1.6 Scope of the Study.
1.6.1 Content Scope
The study looked at the factors influencing malaria prevalence in children under five years of age.
1.6.2 Geographical Scope
The study was conducted in Northern division, Jinja city in the Eastern Region of Uganda.
1.6.3 Time Scope
The research study took a period of three months, that is, September to November 2022.
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1.7 Conceptual Framework
Independent Variable Dependent Variable
HOUSEHOLD
CARE GIVER
FACTORS
FACTORS
MALARIA Numbers of house-holds
Age of the care taker. PREVALENCE members
Health seeking behaviors.
Level of income.
Knowledge about the
Sleeping patterns
disease.
Use of ITNS
Care givers education level.
Marital status. ENVIRONMENTAL

FACTORS
Occupation.
Drainage system.
Attitude and practices.
Bushy surroundings.
Garbage heaps.
Climate and altitude.
Place of residence.
Type of house.
Source: Adopted from Fayoe (1841-1925), modified by the researcher (2022)
Figure1.1: A Conceptual Framework showing the relationship between the independent, dependent
and moderating variables. The conceptual framework above illustrates the factors influencing
malaria prevalence in children under five years of age. Basing on all the variables pointed out,
Malaria prevalence is the primary interest for the study being investigated.
According to the conceptual framework above three constructs that is, (Caregiver factors, Household
factors, and environmental factors) are used to explain the extent to which they can create an effect
on malaria prevalence in Northern division Jinja City.
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CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter deals with the existing information about the research topic “to investigate factors
influencing the prevalence of malaria in the children under five years in Northern division, Jinja
city.” This information was gathered from different areas.
2.1 Care Giver Factors Associated with Malaria Prevalence
In a study done in Ghana that used secondary data drawn from the 2008 Ghana Demographic and
health survey children’s data file showed that highest proportion of malaria among under five years
old was reported in children whose mothers had primary school education (22.7%) while mothers
with higher education reported the lowest malaria cases among children (17.4%).The highest
proportion of children with malaria was also seen among children of divorced mothers (29.7%) while
the lowest proportion was reported among children of mothers who were never married (17,3%)
(Nyarko, S.H & Cobblah, A, 2014).
According to the study that involved secondary data analysis of the 2014 malaria indicator survey
that employed a stratified multistage cluster design that involved 4,930 children under five years and
4,156 respondents who were mothers of the children showed that the higher the mothers education
attained directly correlated with a significant reduction in malaria parasitemia from a 25% reduction
among those with primary education to 89% reduction among those with tertiary education using
those with no education as the reference category(Humphrey Wanzira et al, 2017) .
In a study conducted in Uganda using data collected from the malaria indicator survey of 2014, a
sample of 4939 were subjected to the study and it showed that some care giver factors including care
giver level of education were associated to malaria prevalence. (Danielle Roberts and G. Mathews
2016).
Regarding malaria knowledge, 79.19% of rural versus 87.45% of urban care givers believed that
malaria is more dangerous in children (p=0.022). Care givers in rural households had one third the
odds of recognizing fever as a malarial symptom than those from urban households. Convulsions
were the second most common symptom (20.85%) mentioned in rural areas with nausea being the
second mentioned symptoms with (22.75%) in urban households. Of 64.74% of rural care givers
were unaware of malaria transmission patterns versus 41.96% of urban care givers. Only 35.26%of
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rural households and 58.04 of urban knew that a mosquito bite is the means of malaria transmission.
(Maria Romay-Barja et al).
In a community based cross sectional survey that was conducted in Nigeria in different households
among mothers with children below five years selected by systematic random sampling showed that
most respondents associated malaria with infected female anopheles’ mosquito bites at 99.7% and
reported to have sought treatment within 24 hours of noticing the first symptoms of malaria. 37%
preferred to use herbs while 17% would take their children to the clinic or dispensary for treatment.
28% of care givers were aware of preventive measures such as ITNs. There was low ownership and
use of ITNs among the respondents were only 19% was observed, 29% new about spraying, 29%
wearing long sleeved and 13% draining stagnant water. (Oluwasogo A O, et al. 2016).
In another study by Oluwasogo.et al, (2016), where qualitative descriptive survey was utilized
involved determining the care givers awareness about management and treatment of malaria in
Okomesi-Ekiti state, Nigeria in children below 5 years of age. This study involved stratified sampling
technique where 50 questionnaires were distributed among 50 care givers that were randomly
selected from the community. Majority of respondents (72.9%) were between the ages of 21 – 50
and only 10 (23.26%) and 2 (4.65%) were between ages of 15 -20 and 51-60 respectively.
This showed that only 55% of the care givers were aware that female anopheles’ mosquitos were
responsible for malaria while 2.5% believed that rats can cause malaria, 7.5% believed that dogs can
cause malaria, 5% believed that cockroach is a vector and can transmit malaria to humans and 30%
did not know the vector for malaria transmission. The care givers were able to ascertain some sign
and symptoms of malaria like chills vomiting, body pains, loss of 14 energy headache, loss of appetite
and high body temperature. The e study therefore showed that 92% care givers had knowledge about
the methods used in preventing the spread and control of malaria among children below five years
of age and only 8% were not aware of the prevention and control (Oluwasogo A O et al, 2016).
Some 1,939 care givers of young children were recruited through a school-based survey in two
states. A 20-item multidimensional survey instrument was developed and used to rank care givers
knowledge in five dimensions which included the cause, transmission, vulnerability, symptoms and
treatment. The predictors for ITN use were ITN ownership, however ownership only explains 43%
0f variance in net use. The total knowledge index for the study population was significantly
associated with ITN ownership. Care givers knowledge of malaria and its causes was found to be
poor were only 50% of the respondents knew that malaria is transmitted by female anopheles’
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mosquito and 65% still believe that too much exposure to the sun is a risk factor for malaria.
Knowledge about the population vulnerable to malaria was 83% and knowledge of malaria
transmission was 32% were the domain with highest and lowest average correct answers. (L. Ovadje
and Jerome Nriagu 2016).
2.2 Environmental Factors Associated with Malaria Prevalence
Environmental changes such as deforestation and housing structure could also influence malaria
transmission as they enhance mosquito breeding conditions. Ye et al. found that environmental
factors play in important role in distribution, abundance, and survival of the malaria vector (Raso et
al, 2019).
Malaria is a serious public health challenge in sub-Saharan Africa, with an estimated 200 million
cases of malaria in 2017 alone. This region accounts for 92% of the global malaria burden. A number
of environmental, climatic, seasonal, and ecological factors determine the occurrence and intensity
of malaria transmission. For instance, while rainfall limits the availability of breeding habitats for
mosquito vectors, temperature determines the length of mosquito larvae development and the rate of
growth of the malaria parasites inside the vector (WHO, 2018).
In Africa, dams have been demonstrated to enhance rates of malaria transmission in areas of unstable
transmission. Increased malaria incidence following dam construction was reported around several
African dams. Overall, dams have been shown to contribute to over 1 million malaria cases annually
in sub-Saharan Africa. However, the extent to which various environmental and climatic factors may
have contributed to enhanced rates of malaria transmission around these sites remains poorly
understood (Kibret et al, 2017).
Climatic variables such as precipitation and air temperature are important determinants of the spatial
distribution and relative abundance of malaria vector species in Africa. For instance, in Africa,
Anopheles gambiae is the predominant species in high rainfall environments, while Anopheles
arabinoses is more common in arid areas. However, climatic conditions are also inter-related with
elevation. For example, air temperature decreases as elevation increases, and consequently the
abundance and species composition of malaria vectors may change significantly with elevation
(Sinka et al, 2017).
Malaria is an acute public health problem in many countries. Globally, about half of the world’s
populations are at risk of malaria infection. Sub-Saharan Africa carries high global malaria burden.
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Children living in these poorest places die of malaria related deaths due to lack of access to diagnostic
test and quality treatment (WHO, 2018).
However, Insecticide Treated Nets (ITNs) accounted for an estimated 68% of malaria cases
prevented across Africa since 2000. However, 25% of children in Sub-Saharan Africa still live-in
households without ITN. Another method of malaria infection control is use of indoor residual
spraying (IRS) which is a very effective method, especially, in high-transmission areas [4]. Among
children <5 years of age in Uganda, IRS was associated with reduction in both malaria Parasitemia
and Anemia.
In a descriptive cross sectional study conducted in Bata district Equatorial Guinea were sampling
was carried out with a multi stage stratified cluster method showed that regarding to mosquito habits,
24.77% of the caregivers answered that garbage heaps served as breeding site for mosquitoes,
18.446% of both urban and rural said that puddles could serve as breeding sites and only 12.94% of
urban caregivers and 4.62% of rural knew that stagnant water was a breeding place for
mosquitoes.79.67% of caretakers knew that night time was the 17 risk time for mosquitoes to bite
while the rural households had less knowledge about this than urban ones (OR=0.45 95% Cl:0.24-
0.86). (Maria Romay –Barja et al, 2016).
According to a study which was conducted to investigate potential risk factors associated with
malaria transmission in Tubu village, It was observed that houses in the village were either grass
thatched, built of reeds, poles and mud or homemade bricks (traditional hut or built with bricks and
roofed with iron sheets (modern houses). Among those structures used as bed rooms by the
respondents, 52.1 % (37) were traditional and 47.9 % (34) were modern houses. In traditional houses
large eave openings were observed in 89.2 % (33) and the rest 10.8 % (4) had small eave openings.
In modern houses 2.9 % (1) had large eave openings and the rest 97.1 % (33) had no eave openings.
There was an association between history of malaria episode and use of traditional huts as bedrooms.
Majority of individuals who experienced a malaria attack used traditional huts as bedrooms. Low
vegetation cover surrounding homesteads was observed at 81.7 % (58) of the homesteads and
moderate vegetation cover was observed at 14.1 % (10) of the homestead only 4, 2 % (30) were
surrounded by dense vegetation cover. (Elijah Chirebvu et al, 2014).
The highest malaria prevalence was recorded in children living in houses surrounded by bushes and
swamps. There was a high Anopheles species population caught this environmental reduction of
malaria transmission in this area was to be achieved by control intervention involving environmental
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management alongside the use of bed nets. Implementation of an environmental control program was
to be achieved by improving drainage flooded areas and swamps, campaigns to clear bushes and
disposal of garbage. House improvement by sealing off of crevices and breaks on the walls and roof
(Armand Seraphin Nkwescheu et al 2015).
2.3 Household Factors Associated with Malaria Prevalence
The population of Africa is expected to double to nearly two billion between 2020 and 2040 and may
reach three billion by 2070. The need to invest in improving and expanding housing options is
therefore urgent. Previous studies have demonstrated the importance of house design as a
determinant of malaria risk and good house construction could prove an important future supplement
to long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS) (UN, 2019).
House structure is expected to affect malaria transmission since up to 80–100% of transmission in

sub-Saharan Africa occurs indoors. Anopheles gambiae, the major African malaria vector, enters
houses at night through open eaves, the gap between the top of the wall and the roof. Thus, closing
the eaves has been observed to be protective against malaria in Ethiopia and The Gambia. Screening
external doors and windows is also a simple method to reduce indoor transmission. In a recent
randomized controlled trial in The Gambia, house screening was associated with a 50% reduction in
indoor vector density and a similar 50% reduction in the risk of anemia in young children. Other
potentially protective features include the replacement of thatched roofs with tiled or metal roofs, as
observed in Tanzania, and the presence of ceilings, as observed in The Gambia and Kenya (Bayoh
et al, 2018).
In a study carried out in Ghana on social demographic determination, the highest proportion of
children below five years who contracted malaria was reported among mothers who came from poor
households (16.9%) and the lowest was reported among rich households (6.9%). The child’s age was
also one of the factors that had significant relationship with malaria among under five children, the
odd of malaria were quite higher among children aged 12-23 months (OR=2,514, P<0.05) times less
likely to contract malaria compared to their counterparts from household which owned no mosquito
net. (Nyarko, S.H & Cobblah, A, 2014).
According to a descriptive cross-sectional study conducted in Bata district in Equatorial Guinea, on

both rural and urban households when asked about the preventive measures 54.12% 0f urban
caregivers and 33.53% of rural reported bed nets as the best preventive measure (OR=0.43, 95% Cl:
15
o.28-0.64), some misconceptions like boiling drinking water could prevent malaria are still present
in both rural and urban. Regarding the best way to avoid mosquito bites, most of them mentioned
bed nets (71.76%) with no significant difference. The spraying of insecticide was significantly less
mentioned by rural care givers (OR=0.44.95% Cl: 0.24-0.81). Most caregivers would not allow the
government health workers to spray their houses (89.02%) urban and (91.91%) rural. (Maria Romay
–Barja et al, 2016).
A study that was done in Uganda using a secondary data of the 2014 MIS dataset on factors
associated with malaria parasitemia in children aged below 5 years had a sample taken by finger or
heel prick for determination of malaria parasitemia. This study showed that the chances of having
parasitemia among children from household that had received IRS was significantly reduced by 77%
as compared to those who had not received IRS. The opposite was observed from LLIN use with the
chances among children who had used an LLIN 16 significantly increasing by 1.33 times as
compared to those who did not use one. Children from wealthier households had reduced chances of
having parasitemia with a significant reduction trend with increasing wealth from 30% in the poorer
households to 80% in the richest households, using the poorest household as a reference. The entire
study showed that there were no statistically significant differences in chances of having parasitemia
for gender, residence-urban, rural and region. (Humphrey Wanzira et al, 2017).
In a study carried out by Elijah chirebvu et al, (2014) in Botswana in Tubu village showed that
94.4% (67) of the respondents indicated that they owned mosquito nets. More than half of the
respondents who possessed mosquito nets had not experienced any malaria attack indicating an
association between previous malaria episode and possession of mosquito net. Number of nets per
household were reported to range from zero 2.8 % (2) to more than six 5.6 % (4), with 39.4 % (28)
possessing one or two nets, 18.3 % (13) possessing five or six nets. There was no association between
history of malaria attack and the number of mosquito nets owned by a household. Insecticide treated
nets were possessed by 78.9 % (56) of the respondents whilst 50.7 36 also possessed untreated nets.
It was unusual to find some households with a mixture of both treated and untreated mosquito nets
at the same time.
In addition to the above, the 2.8 % (2) of the respondents were not sure of the status of whether nets
were treated or not indicating poor knowledge on mosquito net use. The 91.5% (65) of respondents
indicated that they always used mosquito nets, only l1.4% (1) mentioned that they used mosquito
nets more often whilst 5.6% 4 sometimes used them and 1.4% (1) never used mosquito nets. Usage
16
of mosquito nets, among those who always used them, was reported to be relatively high 46.2% 30
during summer and very low 3.1% (2) in winter. Most of the respondents were aware of
governments’ efforts to control malaria through indoor residual spraying (IRS) 97.2 % (69) and
distribution of ITNs 97.2 % (69). Only 2.8 % (2) 0f the respondents were not aware of what the
government did to control malaria in Tuba village. (Elijah chirebvu et al, 2014).
17
CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter highlights on the study area, study type, study variables, population, sampling
procedures, plan for data collection, quality assurance, plan for data processing, ethical
consideration, project management, staffing and work plan, administration and monitoring and plan
for utilization of results.
3.1 Study Design.
The study to be used was cross-sectional involving both quantitative and qualitative methods. It
enabled the researcher to quantify the distribution of the study variables in the study population. It
will also enable the researcher to collect data from both literate and illiterate respondents.
3.2 Study Area
The study was conducted in Northern division in Jinja City in Eastern Region of Uganda. Jinja city
is bordered by Jinja District to the north, Buikwe District to the south west, Mayuge District to the
south East, Kamuli District to the North, Luuka in the North east.
3.3 Study Population.
The study population includes the general community, individual health workers who Medical
doctors, Nurses, Laboratory Technicians, including internees from Northern division in Jinja City.
In total, they are 106 people.
3.4 Sample Size Determination
This was conducted by using Kish’s formula, sample size n, is given by;
N=Z2PQ/I2 (by Lwanga- 1988)
Where N= Number of Sample size was determined using the formula of measurement below.
Z=1.96 (Standard deviation, and it is a constant)
P= the prevalence of the disease in question
18
Q= 1- P
I = Derived error = 0.1 (required precision)
If N =100, Z =1.96 and P =25%= 0.25, therefore Q = 1- 0.25 = 0.75
By substitution using the formula N= Z2PQ/I2
100 = (1.96)2x 0.25 x 0.75 / I2
I2 = (1.96)2x 0.25 x 0.75 / 100
I2 = 0.007203
I = 0.08487 = 0.1
Therefore, from the formula N=Z2PQ/I2, by substitution,
N = (1.96)2 x 0.25 x 0.75 / (0.084870)2, N = 0.7203/ 0.007203 = 100.001388 = 100
N≈ 100 respondents
Therefore, the sample size to be taken is 100 respondents instead of 96 to cater for misreporting and
attrition.
3.5 Sampling Technique
The study employed purposive and convenient sampling in which participants were drawn from
attendants/caretakers of children admitted and discharged from the health facility, they were sampled
and consented to participate in the study daily for 2 weeks until the sample size is reached at the
convenience of the researcher. Then, Key informants were chosen purposively due to their
knowledge on the specific topic.
3.6 Sampling Procedure.
A ward was selected by simple random sampling by writing each ward on a piece of paper, the piece
of paper was folded together and put in a basin, and one was picked at random. 2 cells were selected
randomly from the ward. The respondents were also selected randomly by writing their numbers on
pieces of paper and then selected randomly from the pieces.
19
3.7. Data Collection Method
The methods of data collection used were interview guide and Questionnaires during the research.
3.7.1 Interview Guide
This is an interaction between the researcher and the respondent. The researcher asked questions to
the respondents as they provide information for the analysis of the researcher. The type of interview
that the researcher used was face to face interview or direct interview.
3.7.2 Questionnaires
Open ended and close ended questions were used to collect primary qualitative data from the
respondents. Questionnaires were administered to the attendants of children below 12 years in the
hospital. This was because the respondents were free to speak their mind without restrictions
3.8 Data Collection Procedure
First, research assistants were selected from the available people and were trained on how to use the
questionnaire for data collection.
After training the research assistants and the researcher himself proceeded to the Northern division
to collect data.
The researcher went to the Northern division and attained a letter that gave him permission to proceed
to the health center for data collection.
At the health center, the researcher gathered information from the already present records and also
from the caregivers of the children under 5 years. Questionnaires were administered to the people
and filled in. phone recorders were used where information was obtained and analyzed after the data
was collected.
3.9 Study Variables
The variables under study were both dependent and independent.
Table 3.1 Showing Study Variables.
Independent variables Dependent variables
20
• Care giver factors Factors influencing high prevalence of
• Environmental factors malaria amongst children under five
• Household factors years
Source: Researcher, 2022
3.10 Quality Assurance
Before actual data collection, the tools were pretested so as to compare the efficiency and real data
to be collected, field editing of data was done while in the field every day of the exercise and
compilation of work to see if no data is missing.
Inclusion Criteria
Caregivers willing to take part in the study and are willing to consent.
Caregivers whose child is under five years of age.
Exclusion
Any caregiver who is not willing to take part and has not consented.
Caregivers with children above five years of age.
Women and men without children below 5years of age
3.11 Data analysis and presentation
The researcher processed the data both manually using recordings by pen in note books as well as
through computer by using Microsoft excel for data analysis and MS Word for typing and printing
of the work. The data to be collected was presented in form of graphs, pie charts and tables for easy
interpretation.
3.12 Ethical Consideration.
The permission for carrying out the field study was granted by the Principal School of Hygiene-
Mbale to the relevant authorities in the city such as Senior Medical Officer (SMO) to the Senior
Health Inspector who introduced the researcher to the division authorities like the Health
Inspector/Health Assistant, Health Centre In Charge, Community Development Officer. The
researcher assured respondents of the confidentiality with the sole purpose of improving on the living
standards within the area as he worked hand in hand with the local authorities in place.
21
3.13. Dissemination of Results
The results were disseminated through a report submitted to UAHEB, and School of Hygiene- Mbale.
The results were also be put in a publication and also provided to the Northern division, Jinja city
for entry in their database.
22
CHAPTER FOUR
PRESENTATION OF FINDINGS
4.0 Introduction
In this chapter, the data is done in comparison of various variables in the study. The study involved
a sample size of 100 respondents. The findings were presented in figures and tables as shown below;
4.1 Socio demographic characteristics of respondents
Figure 4.1: Shows gender proportions of the respondents
Male, 25%
Female, 75%
From the findings, 75% (75/100) of the respondents were female and the rest 25% (25/100) of
the respondents were male. This was so because women were at home during the period of the study
and as well they were more preferable because they spend most of the time with children compared
to men.
23
Table 4.1: Shows distribution of the respondents by age bracket
Age bracket Frequency (n=100) Percentage (%)
15-24 10 10%
25-34 45 45%
35-44 30 30%
45 and above 15 15%
Total 100 100%

From the table above, majority 45% (45/100) of the respondents were in the age group of 25-34
years, followed by 30% (30/100) of whom they were 34-54 years, then 15% (15/100) who were 45
years above and the least 10% (10/100) who were 15-24 years.
Figure 4.2: Shows the distribution of respondents by Marital Status
60%
50%
50%
42%
Respondents (%)
40%
30%
20%
8%
10%
0%
0%
Single Married Widowed Separated/Divorced
Marital status of respondents

According to the findings above, the married 50% (50/100) covered the majority, followed by the
singles 42% (42/100) and the least 8% (08/100) belonged to those who had
separated/divorced from their spouses.
24
Table 4.2: Shows the distribution of respondents by Education level
Education level Frequency (n=100) Percentage (%)
None 15 15%
Primary 55 55%
Secondary 20 20%
Tertiary 10 10%
Total 100 100%

In reference to the table above, majority 55% (55/100) of the respondents had attained their education
up to primary level, then 20% (20/100) had attained secondary level of education, 15% (15/100) had
not attained any formal education and the least 10% (10/100) had attained up to tertiary level of
education.
Table 4.3: Shows the distribution of respondents by occupation
Occupation Frequency (n=100) Percentage (%)
Peasant 60 60%
Employed 25 25%
Business 09 9%
Others 06 6%
Total 100 100%

In the table above, majority 60% (60/100) were peasants, followed by 25% (25/100) who said
that they were employed by government and non-government organizations, then 9% (09/100) said
that they business persons and the least 6% (06/100) belonged to others which included the students
among others.
25
Table 4.4: Shows distribution of the respondents by Religion
Religion Frequency (n=100) Percentage (%)
Muslims 21 21%
Christians 70 70%
Others 09 09%
Total 100 100%

Majority 70% (70/100) of the respondents were Christians, 21% (21/100) were Muslims and the
least 09% (09/100) belonged to others. From the respondents interviewed one of every three
respondents was a Christian.
4.2 Knowledge about the disease and health seeking behavior
Figure showing distribution of respondents whether they have ever had About Malaria
30%
70%
YES NO
26
In respect to the figure above, majority 70% (70/100) of the respondents were aware about Malaria
and only 30% (30/100) of the respondents were not aware but instead kept relating to other
diseases.
Figure showing distribution of respondents on how Malaria is transmitted
70%
60%
60%
Respondents (%)
50%
40% 10%
17%
30%
20%
5%
10%
8%
0%
Rat Dog Mosquitoes Fly I don’t know

How Malaria is transmitted
Source; Researcher, 2022

According to the presentation in the figure above, majority 60% (60/100) said that malaria is spread
b y Mosquitoes 10% (10/100) said that it is spread by rats, 17% (17/100) and it preventive and
control measures from the health workers whilst at the health centre and during home visits,
followed by 17% (17/100) who said that they always heard from radios, then 10% (10/100) said
that they heard from friends and the least 5% (05/100) said that they heard from other sources
like the newspapers, journals, magazines among others.
27
Figure Showing distribution of respondents on how Malaria is controlled
Clearing Bushes
Using Repellants
Closing windows early

Response
Destroying Breeeding places
Spraying with insectcide
Wearing long sleeved clothes
Sleeping Undeer bed net
0% 5% 10% 15% 20% 25%

30%
Percentage
In respect to the figure above results showed that majority 28% (28/100) of the respondents said
that they control malaria by sleeping under treated mosquito nets, 7% (7/100) , 10% (10/100)
said that they spray using insecticides, 09%(9/100) destroying bleeding places for mosquitoes,
20% (20/100) close windows early, 01% (1/100) use repellants and only 25% (25/100) use
repellants to prevent malaria. This implies that there is still high prevalence of malaria and there
is need to sensitize communities on Malaria prevention.
28
Figure showing distribution of respondents on when Mosquitoes Bite
25% 30%
25% 20%
Day time Night Time Both day and Night I don’t Know
Findings from the figure above show that 30% (30/100) of the respondents said that mosquitoes
bite during day time, 20% (20/100) said that mosquitoes bite at night, 2 5 % (25/100) said that
mosquitoes bite both day and night while 25% (25/100) of the respondents said that they don’t
know when mosquitoes bite.
Figure showing distribution of respondents on the most common signs and symptoms of
malaria infection seen in children
40%
35%
30%
25%
20%
15%
10%
5%
0%

Results from the figure above showed that majority 34% (34/100) of the respondents said that
high temperature is the most common sign of malaria, 2%(2/100) said that loss of energy,
29
20%(20/100) said that vomiting is the common sign of malaria, 3% (3/100) said that sweating
the most common sign of malaria, 15% (15/100) of the respondents headache is the most common
sign, 12% (12/100) of the respondents said that they experience joint pains, 7% (7/100) identified
loss of appetite as a sign while other identified chill and convulsions.
4.3 Treatment seeking behavior
Figure showing distribution of respondents on whether they take children who have fallen
sick due to malaria to health care facility.
40%
60%
Yes No
In respect to the figure above, results showed that 40% (40/100) of the respondents said that take
their children to health care facilities while only 60% (60/100) do not seek health care facilities
incase their children fall sick.
Figure showing distribution of respondents on whether their children were given anti-
malaria
38%
62%
Yes No
30
From the figure above majority 62% (62/100) said that their children were not given anti Malaria
while only 38% (38/100) said their children were given anti malaria. This implies that majority
of the respondents had not given children anti Malaria hence high prevalence of Malaria among
children under five.
Table Showing distribution of respondents on how soon they would seek treatment after
suspecting malaria.
Response Frequency (100) Percentage %
One day (Within 24 hours) 13 13
2 – 3 days 20 20
4 – 6 days 12 12
7 days or more 55 55
Total 100 100
In respect to the table above, majority 55% (55/100) of the respondents said that they take 7 days
to seek treatment after suspecting malaria, 12 % (12/100) take 4 -6 days , 20% (20/100) takes 2
– 3days, and only 13% (13/100) said it takes them only one day (24 hours) to seek treatment
after suspecting malaria.
31
4.4 Attitudes towards Malaria infection
Table showing attitude towards Malaria infection

Response Frequency Percentage
Malaria is serious and threatening disease
Yes 25 25
No 75 75
Sleeping under mosquito nets during night is one way of preventing mys elf from getting
Malaria
Yes 40 40
No 60 60
I can treat the child if he or she gets malaria
Yes 70 70
No 30 30
Pregnant mothers are at great risk of getting malaria
Yes 18 18
No 82 82
One can recover from malaria without any treatment
Yes 65 65
No 35 35
Is it dangerous if malaria medicine is not taken completely
Yes 35 35
No 65 65
Is blood testing necessary to a child upon suspecting malaria
Yes 37 37
No 63 63
Total 100 100
Table above showed that 25% (25/100) take Malaria is a serious threatening disease, while 75%
(75/100) of the respondents said that malaria is not a threatening disease.
70% (70/100) of the respondents believed they could treat their children in case they got Malaria,
30% (30/100) of the respondents could not afford to treat their children in case they got malaria.
Out of those who could treat the children majority said they use herbal medicine to treat malaria.
Only 18% (18/100) of the respondents believed that pregnant mothers are at risk of getting malaria
while 82% (82/100) of the respondents believed that pregnant mothers are not at risk of getting
malaria since they go for antenatal which they thought it was an anti-malarial to pregnant mothers.
32
65% (65/100) of the respondents still believed that they can recover from Malaria without
treatment while 35% (35/100) of the respondents believed that malaria can only recover after
thorough treatment.
35% (35/100) of the respondents believed that it was dangerous if malaria medicine was not
taken while 65% (65/100) believed that it was not dangerous at all if malaria medicine was not
taken completely.
37% (37/100) of the respondents go to t h e health centre to have their child’s blood tested as
soon as they suspect malaria while 63% (63/100) of the respondents do not go to the health centres
to have their children’s blood tested as soon as they suspect malaria.
4.5 Household factors
Figure showing distribution of respondents on the type of house they sleep in
Grass thutched with Mud and Poles
Semi Permanent House
Permnanet House
0% 10% 20% 30% 40% 50% 60% 70%
In respect to the figure above, it indicated that majority 63% (63/100) of the respondents sleep in
semi-permanent houses, 20% (20/100) sleep in permanent houses and 17% (17/100) of the
respondents sleep in grass thatched houses with mud and poles. This implies that there is high
prevalence of malaria since majority of the respondents sleep in semi-permanent houses can be
breeding places for mosquitoes.
33
Figure showing distribution of respondents on the number of people with in a house hold
25%
75%
Less than 7 More than 7
Source: Researcher 2022

Results in the figure showed that majority 75% (75/100) of the respondents sleep over 7 people
in the same household, 25% (25/100) of the respondents sleepless than 7 people in the same
household. This implies that the big number of people staying in the house hold can l e a d to
congestion hence giving room for breeding of mosquitoes.
Figure showing distribution of respondents about the estimated monthly income
90%
80%
70%
Percentage
60%
50%
40%
30%
20%
10%
0%
Less than 100,000 More than
Response
34
Results in the figure above show that the biggest number of respondents 80% (80/100) earn less
than 100,000/= per month, while only 20% (20/100) of the respondents earn above 100,000/=.
According to the findings this indicated that majority of the respondents were living below the
poverty therefore they could not afford treatment for Malaria in case it was realized within their
family.
Figure showing distribution of household members whether they sleep under mosquito
nets
70%
60%
50%
Percentage
40% 65%
30%
35%
20%
10%
0%
Yes No
Response

Results in the figure above showed that 25% (25/100) of the respondents sleep under mosquito
nets while only 65% (65/100) of the respondents do not sleep under mosquito nets because they
believe that it attracts beg bugs and emits a lot of heat hence exposing their bodies to mosquito
bites.
35
Environmental factors
Response Frequency Percentage
Do you have a good water drainage system around your house

Yes 20 20
No 80 80
Do you always clear stagnant waters in broken pots, containers and ditches around your house
Yes 37 37
No 63 63
Do you have garbage close to your home
Yes 76 76
No 24 24
Where is your residence located
Close a swamp 55 55
Not close swamp 25 25
None of the above 30 30
Total 100 100
Source; Researcher, 2022
Results in the figure indicated that majority 80% (80/100) of the respondents do not have good water
drainage systems while only 20% (20/100) of the respondents have a good water drainage system.
This implies that majority of the respondents are prone to malaria since their water drainage system
is so poor that it can support breeding of mosquitoes hence spreading malaria.
37% (37/100) always clear stagnant water, broken bottles, containers and ditches around houses while
63% (63/100) are not bothered about clearing broken bottles and stagnant water not knowing that
they high contribute to the breeding of mosquitoes.
Proximity of garbage at homes was also estimated as 76% (76/100) of the respondents having it very
near their homes and 24% (24/100) did not have it near their homes. This implied that majority of
the respondents did not know the effect of having garbage near their homes. There is need to sensitize
them on its negative effect towards their life.
Concerning location of their resident, majority 55% (55/100) of the respondents had their residents
36
close to swamps, only 25% (25/100) of the respondents did not have it near the swamps and
30% (30/100) had their residents at dry land.
37
CHAPTER FIVE
DISCUSSION OF THE FINDINGS
5.0 Introduction
This chapter gives detailed discussion of the research findings as obtained from the respondents
and related studies on factors influencing Malaria Prevalence in children under five years of age
in Northern Division, Jinja City.
5.1 Discussion
5.1.1 Socio-demographic characteristics of people in Northern Division, Jinja City.

From the findings, 75% (75/100) of the respondents were female and the rest 25% (25/100) of
the respondents were male. This was so because women were at home during the period of the study
and as well, they were more preferable because they spend most of the time with children compared
to men so this gave the researcher a clear picture.
Results showed that, majority 45% (45/1000 of the respondents were in the age group of 25-34
years, followed by 30% (30/100) of whom they were 34-54 years, then 15% (15/100) who were
45 years above and the least 10% (10/100) who were 15-24 years.
According to research findings, it was indicated that married 50% (50/100) covered the majority,
followed by the singles 42% (42/100) and the least 8% (08/100) belonged to those who had
separated/divorced from their spouses. This gave the researcher a wider coverage since at least 7/10
of every respondent interviewed had children under five.
Results showed that, majority 55% (55/100) of the respondents had attained their education up to
primary level, then 20% (20/100) had attained secondary level of education, 15% (15/100) had not
attained any formal education and the least 10% (10/100) had attained up to tertiary level of
education. This is in line with the study done in Ghana by Nyarko, S.H & Cobblah, A, 2014 which
stated that highest proportion of malaria among under five years old was reported in children who
mothers had attained primary as their highest level of education.
38
Research findings revealed that, majority 60% (60/100) were peasants, followed by 25% (25/100)
who said that they were employed by government and nongovernment organizations, then 9%
(09/100) said that they business persons and the least 6% (06/100) belonged to others which
included the students among others.
Results also revealed that majority 70% (70/100) of the respondents were Christians, 21%
(21/100) were Muslims and the least 09% (09/100) belonged to others. From the respondents
interviewed one of every three respondents was a Christian.
5.1.2 Knowledge about the disease and Health Seeking Behavior
In respect results, majority 70% (70/100) of the respondents were aware about Malaria and only
30% (30/100) of the respondents were not aware but instead kept relating to other diseases.
According to the research findings, majority 60% (60/100) said that malaria is spread
Mosquitoes 10% (10/100) said that it is spread by rats, 17% (17/100) and it preventive and
control measures from the health workers whilst at the health Centre and during home visits,
followed by 17% (17/100) who said that they always heard from radios, then 10% (10/100) said
that they heard from friends and the least 5% (05/100) said that they heard from other sources
like the newspapers, journals, magazines among others. This is in line with a study conducted by
Oluwasogo A. O, et al. 2016 in Nigeria where most household mothers believed that Malaria is
spread by a female anopheles Mosquito.
In respect to the results, majority 28% (28/100) of the respondents said that they control malaria by
sleeping under treated mosquito nets, 7% (7/100), 10% (10/100) said that they spray using
insecticides, 09%(9/100) destroying bleeding places for mosquitoes, 20% (20/100) close windows
early, 01% (1/100) use repellants and only 25% (25/100) use repellants to prevent malaria. This
is in line with the study conducted i n Ghana by S.H Nyarko and Anastasi Cobbla 2014 which
stated children who do not sleep under treated mosquito nets are more likely to suffer from the
Malaria compared to their counter parts.
Findings also revealed that, 3 0 % (30/100) of the respondents said that mosquitoes bite during
day time, 20% (20/100) said that mosquitoes bite at night, 2 5 % (25/100) said that mosquitoes
39
bite both day and night while 25% (25/100) of the respondents said that they don’t know when
mosquitoes bite.
Results showed that majority 34% (34/100) of the respondents said that high temperature is the
most common sign of malaria, 2%(2/100) said that loss of energy, 20%(20/100) said that
vomiting is the common sign of malaria, 3% (3/100) said that sweating the most common sign
of malaria, 15% (15/100) of the respondents headache is the most common sign, 12% (12/100)
of the respondents said that they experience joint pains, 7% (7/100) identified loss of appetite as a
sign while other identified chill and convulsions. This is in line with the study conducted by Romay-
Barja et al who stated that convulsion is the second most symptom of Malaria.
5.1.3 Attitudes towards Malaria infection
Results showed that 25% (25/100) take Malaria is a serious threatening disease, while 75% (75/100)
of the respondents said that malaria is not a threatening disease.
Research findings revealed that 70% (70/100) of the respondents believed they could treat their
children in case they got Malaria, 30% (30/100) of the respondents could not afford to treat their
children in case they got malaria. Out of those who could treat the children majority said they use
herbal medicine to treat malaria.
Results also revealed that only 18% (18/100) of the respondents believed that pregnant mothers are
at risk of getting malaria while 82% (82/100) of the respondents believed that pregnant mothers are
not at risk of getting malaria since they go for antenatal which they thought it was an anti-malarial
to pregnant mothers.
In respect to the findings 65% (65/100) of the respondents still believed that they can recover from
Malaria without treatment while 35% (35/100) of the respondents believed that malaria can only
recover after thorough treatment.
Study findings showed that 35% (35/100) of the respondents believed that it was dangerous if
malaria medicine was not taken while 65% (65/100) believed that it was not dangerous at all is
malaria medicine was not taken completely.
37% (37/100) of the respondents go to t h e health centre to have their child’s blood tested as
soon as they suspect malaria while 63% (63/100) of the respondents do not go to the health centres
to have their children’s blood tested as soon as they suspect malaria.
40
5.1.4. Household factors
In respect to the research findings it indicated that majority 63% (63/100) of the respondents
sleep in semi-permanent houses, 20% (20/100) sleep in permanent houses and 17% (17/100) of the
respondents sleep in grass thatched houses with mud and poles. This implies that there is
prevalence of malaria since majority of the respondents sleep in semi-permanent houses can be
breeding places for mosquitoes. This is in line with a study conducted in Kenya by Bayoh et al,
2018 who said that the house structure also affects the transmission of Malaria more so semi
permanents house since there always have gaps between the roof and the wall which allows entrance
of Mosquitoes in the house.
Results revealed that majority 75% (75/100) of the respondents sleep over 7 people in the same
household, 25% (25/100) of the respondents sleep less that 7 people in the same household. This
implies that the big number of people staying in the house hold can lead to congestion hence giving
room for breeding of mosquitoes.
Results showed that the biggest number of respondents 80% (80/100) earn less than 100,000/=
per month, while only 20% (20/100) of the respondents earn above 100,000/=. According to the
findings this indicated that majority of the respondents were living below the poverty therefore they
could not afford treatment for Malaria in case it was realized within their family.
Results indicated t h a t 25% (25/100) of the respondents sleep under mosquito nets while only
65% (65/100) of the respondents do not sleep under mosquito nets because they believe that it
attracts beg bugs and emits a lot of heat hence exposing their bodies to mosquito bites. This was in
line with a study conducted by Elijah Chirebvu et al, 2014, which stated that majority of the
respondents did not use mosquito treated nets to control malaria.
5.1.5 Environmental factors

Results from the research findings indicated that majority 80% (80/100) of the respondents do
not have good water drainage systems while only 20% (20/100) of the respondents have a good
water drainage system. This implies that majority of the respondents are prone to malaria since
their water drainage system is so poor that it can support breeding of mosquitoes hence spreading
malaria. This conceded with the study conducted in rural Bolifamba, Cameroon to investigate
factors on Malaria parasite breed most in places with poor drainage system.
41
In respect to the findings 37%(37/100) always clear stagnant water, broken bottles, containers
and ditches around houses while 63% (63/100) are not bothered about clearing broken bottles
and stagnant water not knowing that they highly contribute to the breeding of mosquitoes. This
is in line with WHO, 2018 Report which revealed that broken bottle and stagnant water should
be cleared to reduce on the spread of Malaria.
Regarding Proximity of garbage at homes it was also estimated as 76% (76/100) of the
respondents having it very near their homes and 24% (24/100) did not have it near their homes.
This implied that majority of the respondents did not know the effect of having garbage
near their homes. There is need to sensitize them on its negative effect towards their life.
Concerning location of their resident, majority 55% (55/100) of the respondents had their
residents close to swamps, only 25% (25/100) of the respondents did not have it near the
swamps and 30% (30/100) had their residents at dry land. This was in line with a study conducted
by Armand Seraphin Nkwescheu et al, 2015 which stated that highest malaria prevalence was
recorded in children living in houses surrounded by bushes and swamps.
5.2 Conclusions
The research conclusions therefore were drawn according to research objectives

below
5.2.1 Social –demographic characteristics of the Participants
Majority of the Female respondents participated in the study compared to the Male. This was
so because women were at home during the period of the study and as well they were more
preferable because they spend most of the time with children compared to men so this gave the
researcher a clear picture.
Most of the respondents who participated in the study were in age group of 25-34 years. This
also gave the researcher a wider coverage since it is the most productive age as far as producing
children is concerned.
The researcher having the biggest number of married respondents gave the researcher a wider
coverage since at least 7/10 of every respondent interviewed had children under five.
The education level of most respondents was too low hence leading to high prevalence of
Malaria under five since most of them give birth while they are under age i.e. drop outs
of primary level. This was in line with the study conducted by Nyarko, S.H & Cobblah, A, which
42
revealed that low education level has greatly led to high prevalence of Malaria among children
under five.
Most of the respondents did not have reliable source of income hence making them fail to treat
malaria in case of realized in their home steads.
5.2.2 Knowledge about the disease and Health Seeking Behavior
Most of the were aware about Malaria and only but they just tended to ignore it by taking it as
a disease which could cure on its own the respondents were not aware but instead kept relating
to other diseases hence leading to its prevalence.
Knowledge concerning the spread of Malaria, majority knew that it is spread by mosquitoes but
they did not know the ways of preventing mosquitoes within their homesteads.
5.2.3 Attitudes towards Malaria infection
Most of the respondents don’t take malaria as a threat s i n c e they believed in treating that they
could treat their children in case they got it.
5.3 Recommendations
From the research findings, the researcher made following recommendations to the different
departments;
To the Government;
• The Government through its Ministry of health should increase on the number of
mosquito nets supplied to enable every person
• The Government of Uganda and its partners should increase on the supply of anti-
malarial drugs at all health centers countrywide to help reduce the disease.
Complications.
• The Government should invent and fund wealth creation programs. In order to support
the population financially and to reduce on poverty.
43
To Health Staff
• Health workers at all levels of Health Management system should integrated the
sensitization about malaria prevention to all clients as a measure of reducing its
prevalence in Northern Division, Jinja City.
• More health education about the preventive measures to combat malaria is highly
required
To the politicians and Law Enforcers
• There should be enforcement on the proper use of the supplied mosquito nets by the
Community members in order to avoid their misuse by irresponsible Ugandan.
• Local authorities should guide the population on settling in forested areas since
forests do harbor mosquitoes.
5.4 Areas of further Study
• Assess the effects of high prevalence of malaria on the people of Northern Division,
Jinja City.
• Assess the role of environmental health workers in control and prevention of malaria.
• Assess the cause of the high rates of malaria among pregnant women in Northern
Divison, Jinja City.
44
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Epidemiology and current control efforts. Kampala:Uganda
Armand seraphin nkwescheu et al, (2006) environmental factors affecting malaria parasite
prevalence in rural Bolifamba, south- west Cameroon, African journal of health
sciences, DOI:10.4314/ajhs.v13i1.30816OAI
Roberts, D & Mathews, G, (2016). Malaria prevalence and risk factors s12936-1290-x among
children under age of five years in Uganda –malaria journal 15:246 DOI:
10.1186/s1236-1290-x
Dr Abwaimo F. & Beinomugisha.G (2022). Sustain reductions in malaria incidence rates in
Uganda: a six-month analysis. August 2022. Malaria Consortium
Humphrey Wanzira et al, (2017) factors associated with malaria parasitemia among children
under age of five years in Uganda, malaria journal 16:191 DOI: 101186/s12936-017-
18888847-3
Israel Mitiku and Adane Assefa (2017) care givers perception malaria on malaria treatment,
biomedicentral.com malaria journal 16:144doi:10.1186/s12936-017-1798-8
Kazeem Adefemi, OlusegunAwolaran Caleb, social and environmental determination of

malaria in children under five years in Nigeria DOI:
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Kibret et al, (2017). Malaria impact of large dams in sub-Saharan Africa: maps, estimates and
predictions. Malar J.; 14:339.
Maria Romay –Barja et al, (2016). Malaria Household Knowledge and Behavior in Equatorial
Guinea:Lessons to be learned. J Infect Dis Preve Med 4: 134. Doi: 10.4172/2329-
8731.1000134
Mazigo H.D, Obasy. E, Mauka W, Manyiri. P, Zinnga M, Kweka E. J et al (2010) knowledge,

attitudes, and practices about malaria and its control in rural North west Tanzania,
malaria research and treatment ,1-9 Pubmed DOI:10.4061/2010/794261
Ministry of health (2011). Technical Report on Malaria.Uganda.
Mpimbaza, A., et al (2020). The age-specific incidence of hospitalized paediatric malaria in

Uganda. BMC Infect Dis 20, 503. https://doi.org/10.1186/s12879-020-05215-z
Oluwasogo AO, et al, (2016) Assessment of Mother’s Knowledge and Attitude towards
Malaria Management among Under Five (5) Years Children in Okemesi–Ekiti, Ekiti–
West Local Government, Ekiti State Estrjkl. Malaria Contr Elimination 5: 142.
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Ovadje and Nringu (2016) multidimensional knowledge of malaria among caregivers’

implication insecticide treated nets use by children, malaria journal 15:516 DOI:
10.1156/s12936-016-1557-2
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Parang N Mehta, MD consulting staff (2017), pediatric malaria differential diagnosis,
emedicine.mediscape.com, department of pediatrics Mehta hospital, India
Raso, G, Schur, N., Utzinger, J., et al. (2019) Mapping Malaria Risk among Children in Cote
d’Ivoire Using Bayesian Geo-Statistical Models. Malaria Journal, 11, Article No. 160.
https://doi.org/10.1186/1475-2875-11-160
Nyarko, S.H & Cobblah, A (2014) social demographic determinants of malaria prevalence
among children under age five in Ghana, malaria research and treatment, ID 304361.6,
https://dx.doi.org/ 10.1155
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Afara, Lama Eugene Kamani, Francis Bohissou et al (2015) malaria prevalence among
young infants in different transmission settings, Africa. EID journal 21(7):1114-1121
https://dx:doi.org/10:3201/eid2107.142036
Sinka ME, Bangs MJ, Manguin S, Coetzee M, Mbogo CM, Hemingway J (2017). The
dominant Anopheles vectors of human malaria in Africa, Europe and the Middle East:
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2014–15. Kampala and Rockville: UBOS and ICF International; 2015.
Uganda National Malaria Control Division (NMCD), Uganda Bureau of Statistics (UBOS),
and ICF. Uganda malaria indicator survey 2018–19. Kampala and Rockville: NMCD,
UBOS, and ICF; 2019.
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World Health Organization-malaria fact sheet (2017) www.who.int/mediacentre/factsheets
47
APPENDICES
Appendix I: Informed Consent Form
Dear Sir/Madam
I am Naloka Gerald, a student of School of Hygiene-Mbale pursuing a diploma in

Environmental Health Science carrying out research on; “Factors influencing the prevalence of
malaria amongst the under-fives in Northern division, Jinja city” which may be used by the
District Health Team and planners to come up with solutions to the problem.
Therefore, I request you to voluntarily give me information in regard to the questions I will ask.
All the information given will be kept confidential.
Thank you in advance
Signature……………………………………… Date……………………………
48
Appendix II: Questionnaire for the Parents and Caregivers of Children Under Five Years
Instructions:
Interview women of child bearing age/caregivers
Fill in the space provided.
Tick in the box provided
Date of interview …………………………
Ward……………………………………
SECTION A: PREVALENCE OF MALARIA:
What is the diagnostic test result?
1. Positive.
2. Negative.
SECTION B:
2. Social demographics factors:
Qn.1: name of village………………………………………………………………….
.Qn 2: gender of interviewee…………………………………………………………..
1. Female
2. Male.
Qn 3: how old are you?
1.15-24
2. 25-34
3. 35-44
4. ≥ 45
Qn 4. Marital status:
1. Single.
2. Married.
3. Separated/divorced.
4. Windowed.
Qn 5. What is your high level of education achieved?
1. None
2. Primary.
3. Secondary
4. Tertiary
49
SECTION C:
Knowledge about the disease and health seeking behaviors:
Qn.6 Have you ever heard about malaria?
1. Yes.
2. No.
Qn. 7 Malaria is transmitted by: (tick one correct answer).
1. Rat.
2. Dog.
3. Mosquito.
4. Fly.
5. Cockroach.
6. I don’t know.
Qn. 8 How can we prevent and control malaria: (tick what you do).
1. Sleeping under bed net
2. Wearing long sleeved clothes
3. Spraying with insecticide.
4. Destroying breeding places
5. Closing windows early
6. Using repellants
7. Clearing bushes
Qn.9 When do mosquitoes bite?
1. Day time.
2. Night time.
3. Both day and night.
4. I don’t know.
Qn. 10 What are the most common signs and symptoms of malaria infection seen in children?
1. High temperature/fever
2. Loss of energy
3. Vomiting
4. Sweating
5. Headache
6. Joint pains
7. Loss of appetite
8. Chill
9. Convulsions
50
SECTION D: Treatment seeking behaviors:
Qn. 11 Do you usually take any child who has fallen sick due to malaria to health care
facility?
1. Yes.
2. No.
Qn. 12. Was the child given anti malaria?
1. Yes.
2. No.
Qn. 13. How soon after suspecting malaria would you seek for treatment?
1. One day. (Within 24 hours).
2. 2-3 days.
3. 4-6 days.
4. 7 days or more.
SECTION E: Attitudes towards malaria infection:
Qn. 14 I think malaria isa serious and threatening disease.
1. Yes.
2. No.
Qn. 15 I believe sleeping under a mosquito net during the night is one way to prevent myself
from getting malaria.
1. Yes.
2. No.
Qn.16 Am sure that I can treat the child if he or she gets malaria.
1. Yes.
2. No.
Qn. 17 In my opinion children and pregnant mothers are at greater risk of getting malaria.
1. Yes
2. No.
Qn.18 I think that one can recover from malaria without any treatment.
1. Yes.
2. No.
Qn.19 I think that it is dangerous if malaria medicine is not taken completely.
1. Yes.
2. No.
Qn. 20 I think that I should go to the health center to have my child’s blood tested as soon as I
suspect that I have malaria.
51
1. Yes.
2. No.
SECTION F:
Household factors:
Qn.21 What type of house do you sleep in? (Tick one)
1. Permanent house. (Burn bricks with cement)
2. Semi-permanent. (Unburnt bricks, mud poles)
3. Grass thatched with mud and poles.
Qn.22 How many people live in your household?
1. ≤ 7 people.
2. >7 people.
Qn.23 What is your estimated monthly income?
1. ≤ 100.000.
2. > 100.000.
Qn.24 Do you and your household members sleep under a mosquito net(s)?
1. Yes.
2. No.
SECTION G:
Environmental factors:
Qn. 25 Do you have a good water drainage system around your house? (Tick one)
1. Yes.
2. No.
Qn.26 Do you usually clear stagnant waters in broken pots, containers and ditches around
your house?
1. Yes.
2. No.
Qn.27 Do you have garbage very close to your home?
1. Yes.
2. No.
Qn.28 Where is your residence located?
1. Close to a swamp.
2. Not close to swamp.
Thank you for participating.
52
Appendix III: Interview Guide
Section A: For Health Workers and Caregivers

Instructions:
• Fill in the right answers to the best of your knowledge in the spaces provided below.
• Circle the correct objectives of your choice.
Date: ……………………………………………………………………………………………
Name the health Centre
…………………………………………………………………………………………………
Title of the respondent
…………………………………………………………………………………………………
CARE GIVERS
1. What are the common illnesses your child suffers from?
…………………………………………
…………………………………………
2. How often do you visit the hospital when your child is sick?
…………………………………………
…………………………………………
HEALTH WORKERS
3. What is the average monthly attendance of the patients who seek treatment in the health
Centre?
………………………………………………………………………………………………
4. What is the daily average number of patients recorded per day for the last three months?
………………………………………………………………………………………………
………………………………………………………………………………………………
53
Appendix IV: Proposed Work Plan
S/n Activity Timeframe Responsible person Indicator
OCT NOV DEC JAN
1. Writing and submission of Researcher

the proposal
2. Issuance of introductory Researcher

letter from school to
relevant authorities
3. Pretesting of tools Researcher
4. Orientation in the study area Researcher
5. Training research assistants Researcher
6. Giving out questionnaires Researcher and

research assistants
7. Interview of the respondents Researcher and

research assistants
8. Collection of questionnaires Researcher and

research assistants
9. Data process and analysis Researcher
10. Correction and guide by the Supervisor

school supervisor
11. Typing and printing of Research

research report
12. Submission of research Researcher

report
54
Appendix V: Proposed Budget for the Research Study
S/n Item Quantity Unit cost Total amount

1. Meals (breakfast and lunch) 10 days 10,000/= 100,000/=
2. Transport (to and from) 10 days 5,000/= 50,000/=
3. Stationery
• Ream of paper 1 25,000/= 49,000/=
• Pens 1 box 30,000/=
• Pencil 1 dozen 10,000/=
• Rubbers 2 2,000/=
• Rulers 2 2,000/=
4. Typing and printing Lump sum 100,000/= 100,000/=

5. Photocopying and binding Lump sum Lump sum 150,000/=
6. Training of the research 3 days 50,000/= 150,000/=
assistant
7. Pretesting of tools Lump sum Lump sum 10,000/=
8. Miscellaneous Lump sum Lump sum 50,000/=
Total 659,000/=
55
Appendix VII: Introductory Letter from the School
56
APPENDIX VI: A MAP OF JINJA CITY SHOWING THE LOCATION OF
NORTHERN DIVISION
NORTHERN DIVISION
57
APPENDIX VII: A MAP OF UGANDA SHOWING LOCATION OF
JINJA CITY
KAABONG
KOBOKO YUMBE
WEST MOYO
DODOTH
KOBOKO ARINGA MOYO LAMWO LAMWO
OBONGI KITGUM
MARACHA CHUA
MARACHA EAST MOYO
TEREGO
ADJUMANI
AYIVU ARUA KILAK
ARUA MUNICIPALITY
PADER KOTIDO JIE
ASWA
AMURU ARUU AGAGO
VURRA GULU
MADI-OKOLLO GULU MUNICIPALITY
AGAGO
LABWOR MOROTO
OMORO
ABIM MATHENIKO
ZOMBO OTUKE
OKORO JONAM NWOYA NWOYA MOROTO MUNICIPALITY
OTUKE
PADYERE NEBBI
OYAM KOLE NAPAK BOKORA
ALEBTONG
KOLE KAPELEBYONG
OYAM LIRA MUNICIPALITY ERUTE MOROTO
LIRA AMURIA
KIRYANDONGO
AMURIA PIAN
BULIISA
KIBANDA
APAC DOKOLO
KWANIA DOKOLO USUK POKOT
BULIISA MARUZI KALAKI
SOROTI NAKAPIRIPIRIT
KATAKWI AMUDAT
KABERAMAIDO CHEKWII
BURUULI AMOLATARKABERAMAIDO SOROTI MUNICIPALITY
BUJENJE KIOGA SOROTI
BUGAHYA NGORA
MASINDI KASILO KWEEN
SERERE NGORA KUMI
HOIMA NAKASONGOLA BUKEDEA
SERERE KWEEN
KUMI BUKEDEA KAPCHORWA BUKWA
BUHAGUZI
BURULI BUYENDE TINGEY
BUDIOPE
PALLISA
PALLISA BULAMBULI KONGASIS
KYANKWANZI NAKASEKE BUTEBO BUDADIRI BULAMBULI
NAKASEKE KALIRO MBALE MUNICIPALITY
NTOROKO MANJIYA SIRONKO
BBAALE
KIBUKUBUDAKA
BULAMOGI KIBUKU BUDAKA BUDUDA
NTOROKO BUYAGA
BUGANGAIZI
KIBOGA
KAYUNGABUGABULA MBALE MANAFWA
BUNGOKHO
BUTALEJA
KIBAALE LUWEROBAMUNANIKA KAMULI LUUKA BUBULO
KIBOGA NAMUTUMBA
BUSIKI BUNYOLE
BUNDIBUGYO BUYANJA KATIKAMU
BUZAAYA IGANGA
BWAMBA FORT PORTAL MUNICIPALITY LUUKA KIGULU WEST BUDAMA (KISOLO) TORORO
NTENJERU TORORO MUNICIPALITY
MWENGE
BUGHENDERA KAGOMA BUGWERI
BURAHYA KYENJOJO NAKIFUMA TORORO
KYEGEGWA KASSANDA JINJABUTEMBE BUGIRI
BUNYANGABU
KABAROLE KYAKA
BUWEKULA MITYANA KYADONDO BUSIA
MUBENDE MITYANA KAMPALA
JINJA MUNICIPALITY SAMIA-BUGWE
BUSUJJU KAMPALA CITY COUNCIL BUIKWE

MAYUGE
KIBALE GOMBA
BUSONGORA
KAMWENGE GOMBA
KYADONDO BUIKWO
BUTAMBALA BUSIRO
BUKONJO BUTAMBALA
LWEMIYAGA WAKISO MUKONO
KASESE KITAGWENDA
KAZO MAWOKOTA
SSEMBABULE KALUNGU MPIGI ENTEBBE MUNICIPALITY BUNYA
IBANDA MUKONO
BUKOMANSIMBI KALUNGU
IBANDA BUKOOLI
BUNYARUGURU BUHWEJU KIRUHURA KABULA BUKOMANSIMBI
MAWOGOLA
RUBIRIZI BUHWEJU LYANTONDE MASAKA MUNICIPALITY NAMAYINGO
NYABUSHOZI BUJJUMBA BUVUMA
LWENGO
BUSHENYI IGARA KASHARI BUKOTO
BUVUMA
MBARARA MASAKA KALANGALA
BUJUMBURA RUHINDA SHEEMA
MITOOMASHEEMA MBARARA MUNICIPALITY KOOKI KYOTERA KYAMUSWA
KANUNGURUKUNGIRI RWAMPARA
ISINGIRO RAKAI
KINKIIZI KAJARA
BUKANGA
RUBABO RUHAAMA KAKUUTO
NTUNGAMO ISINGIRO
RUSHENYI
KISORO RUBANDARUKIGA
BUFUMBIRA
KABALE MUNICIPALITY
KABALENDORWA
JINJA CITY
58

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FACTORS INFLUENCING MALARIA PREVALENCE IN CHILDREN

UNDER FIVE YEARS OF AGE IN JINJA CITY, NORTHERN

A RESEARCH REPORT SUBMITTED TO SCHOOL OF HYGIENE MBALE IN

LIST OF ABBREVIATIONS .............................................................................................................................iv

DEFINITION OF OPERATIONAL TERMS ........................................................................................................ v

CHAPTER ONE ............................................................................................................................................. 6

1.0 Introduction ...................................................................................................................................... 6

LITERATURE REVIEW ................................................................................................................................. 11

2.0 Introduction .................................................................................................................................... 11

3.0 Introduction .................................................................................................................................... 18

4.0 Introduction .................................................................................................................................... 23

DISCUSSION OF THE FINDINGS ................................................................................................................. 38

5.0 Introduction .................................................................................................................................... 38

Appendix I: Informed Consent Form ..................................................................................................... 48

APPENDIX VII: A MAP OF UGANDA SHOWING LOCATION OF JINJA CITY .................................................. 58

CDC - Center of Disease Control.

GDP - Gross Domestic Product.

ICCM - Integrated Case Control Program.

IMCI - Integrated Management of Childhood Illness.

IRS - Indoor Residual Spraying.

ITNs - Insecticide Treated Nets

LLINs - Long Lasting Insecticide Treated Nets.

MCP - Malaria Control Program.

MIS - Malaria Indicator Survey.

MOH - Ministry of Health.

NMCP - National Malaria Control Program.

NMCS - National Malaria Control Strategy

OPD - Outpatient Department.

RBM - Roll Back Malaria.

RDT - Rapid Diagnostic Test.

UNICEF - United Nations Integrated Children Fund

VHT - Village Health Team.

WHO - World Health Organization

Culture: Type of civilization.

Data: Is information on which decision is to be made.

Focus group discussion: It is a group discussion of 6 to 10 persons guided by a facilitator who

Frequency: Rate of repetition or occurrence of an invent.

Household: Is a homestead or family.

Parasitemia: Number of malaria parasites contained in the blood.

Variable: This is a characteristic of a person, an object or phenomenon which can take on

Environment: The circumstances, objects, conditions by which one is surrounded

1.1 Background Information

In Jinja City, Contemporary estimates of infection prevalence are 7.5% compared to

1.2 Problem Statement

1.3.1 General Objective

1.3.2 Specific Objectives.

The study was guided by the following research objectives

1.4 Research Question

The study was guided by the following research objectives

1.5 Significance of the Study

The study had the following significance:

1.6 Scope of the Study.

1.6.1 Content Scope

1.6.2 Geographical Scope

1.6.3 Time Scope

Independent Variable Dependent Variable

Marital status. ENVIRONMENTAL

Climate and altitude.

Source: Adopted from Fayoe (1841-1925), modified by the researcher (2022)