Background of the study
The Malaria remains one of the most serious global health problems. There are an estimated one million deaths each year, with nearly seventy five percent (75%) occurring in children living in sub-Saharan Africa. The history of malaria stretches from its prehistoric origin as a zoometric disease in the primates of Akwa-ibom through to the twenty first (21st) Century. The name malaria was derived from two Latin words “mal” “aria”; where “Mal” means bad and “aria” Air. It is due to the mistaken belief that it was caused by bad air, following the observation that it occurs mostly around damp places and marsh areas. Malaria is a tropical disease caused by a parasitic called plasmodium falciparum carried by infected female anopheles mosquito and the disease causes periods of fever and shivering. Malaria can also be a disease caused by a parasite transmitted from person to person by certain types of mosquito. They feed on human body (anopheles mosquito). It uses its mouth called the proboscis to suck the blood of a person and deposits plasmodium on the person’s blood vessels. This plasmodium travel to the liver of a person where they increase in number and later the parasite enters the blood stream of the person and invades the red blood cells. Toxins are produced and circulate through the blood stream and the symptoms which appear about nine to fourteen (Okwa 2015) days after the infection from mosquito bites includes; fever, vomiting, headache, and other flu – like symptoms. If the parasites bare resistant to drug, then the infection can leads to severe anemia and destruction of red blood cells that result in clogging of blood capillaries that carries blood to the brain resulting in cerebral malaria. The government general hospital, Ikot-Abasi which is located in the south-west corner of Akwa-ibom state was established in 1933 by Anglican missionaries as a missionary hospital and later became a government own general hospital in 1982 in the then Calabar Province, for good reasons. This general hospital was used during the Nigeria Civil War, as a combined hospital for military personnel and the public. In 1989, the hospital management board was created as a parastatal from ministry of health to manage the activities of the hospital by the Calabar Province. The hospital has several departments such as eye clinic, a dental clinic, ante-natal clinic, radiology department, laboratory department, pharmacy department and medical records department with an outstanding operating theatre with a special treatment centre. Tremendous gains have been made in the fight against malaria in the past few years. Between 2000 and 2012, the malaria incidence rate reduced by 25% globally, and by 31% in the WHO African Region. About 90% of all malaria deaths in the world today occur in Africa south of the Sahara. This is because the majority of infections in Africa are caused by Plasmodium falciparum, the most dangerous of the four human malaria parasites. It is also because the most effective malaria vector – the mosquito Anopheles gambiae – is the most widespread in Africa and the most difficult to control. An estimated one million people in Africa die from malaria each year and most of these are children under 5 years old (Onyabe and Conn 2019). Malaria affects the lives of almost all people living in the area of Africa defined by the southern fringes of the Sahara Desert in the north, and a latitude of about 28° in the south. Most people at risk of the disease live in areas of relatively stable malaria transmission – infection is common and occurs with sufficient frequency that some level of immunity develops. A smaller proportion of people live in areas where risk of malaria is more seasonal and less predictable, because of either altitude or rainfall patterns. People living in the peripheral areas north or south of the main endemic area or bordering highland areas are vulnerable to highly seasonal transmission and to malaria epidemics The estimated malaria mortality rates fell by 42% in all age groups and by 48% in children under 5 years of age. This success has been attributed to the adoption of the artemisinin combination therapy (ACT) as first line drug treatment in malaria endemic regions and also the scale - up of intervention efforts such as the use of long lasting insecticide nets (LLIN), intermittent prevention treatment (IPT) for pregnant women, vector control measures and more importantly increased funding. Despite these gains, malaria still remains a major health challenge in Nigeria with high morbidity and mortality. The country is one of the two countries which accounts for 40% of all deaths associated with the disease. The disease reportedly accounts for an estimated 60% of outpatient hospital visits in Nigeria, 30% of hospitalizations, 30% of under-five mortalities, 25% of infant mortalities and 11% of maternal mortalities. Malaria is holoendemic in Nigeria, with a steady transmission rate throughout the year which comprises of a distinctive rainy and dry season. Nigeria is made up of several hundreds of communities and settlements with their own indigenous people, microclimate, topography, population densities, cultural practices and general way of life. These parameters greatly influence the transmission intensity and management of the disease. The Nigerian Ministry of Health had a targeted goal of reducing all malaria-related morbidity and mortality to as much as 50% by the year 2013 but have so far been unable to achieve this. Generating data on malaria epidemiology and transmission dynamics, risk factors associated with infection, efficacies of available antimalarials are necessary and essential for effective interventions, planning strategies and implementation of control measures tailored to the requirements of individual communities or settings.
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