SOCIAL AND ENVIRONMENTAL DETERMINANTS OF PREVALENCE OF MALARIA IN UMUDIBIA NEKEDE, OWERRI WEST LOCAL GOVERNMENT AREA, IMO STATE

1.1 Introduction

Malaria has continued to be a major public health problem in the World today despite concerted efforts aimed at its control and elimination. The organism that causes the illness (Plasmodium) spends parts of its life cycle in the mosquito and the other in man (Gupta and Ghai, 2007). Malaria portends a serious present and future global concern. It is present in over one hundred countries worldwide and responsible for over 100 million clinical cases and an estimated 1-2 million deaths annually.

However, the burden of mortality and morbidity is worse in poor countries and amongst the most disadvantaged in these countries. The World Health Organization (WHO) suggests that Africa bear almost 90% of the global burden of malaria. Nigeria, due to its population of over 160 million people bears the largest share of the burden (300, 000 malaria related deaths annually, especially in children under 5 years). Nigeria with three other countries, suffer about 50% of global malaria mortality (WHO, 2012; 2010).

The last couple of decades, especially the 1950s onward, have witnessed unprecedented global interest and efforts towards eradication of malaria (Stratton et al., 2008). Programs such as the Roll Back Malaria Initiative (RBM) and the Multilateral Initiative on Malaria (MIM) have seen international donor organizations (public and private) spend millions of dollars on malaria eradication programs (Williams and Jones, 2004). Unfortunately, the results have not been completely positive. Today, despite decades of concerted global efforts, malaria related mortality is higher than half a century ago (WHO, 2010). Malaria has become the most important vector borne disease in Africa.

Today, scholars are arguing that the growing malaria epidemic in some African countries rest partly on the social, cultural and environmental factors peculiar to these countries that are often ignored in the design and implementation of malaria interventions (Jombo et al., 2010). There is a growing consensus that for interventions to succeed, they must focus on the fundamental causes of malaria by addressing the socio-cultural, behavioural and environmental dimensions of risks driving the malaria epidemic (WHO, 2012; 2010).

Many variables have been found to affect malaria transmission in addition to climatic changes. These are environmental modification (e.g., deforestation, increases in irrigation, blocked swamp drainage), population growth, limited access to health care systems, and lack of or unsuccessful malaria control measures (Patz and Lindsay, 1999). Most of the studies, however, do not take into account all of the factors that are related to malaria transmission.

Although malaria is one of the most climate-sensitive vector-borne diseases (Morse, 1995), several other factors have been identified as contributing to its emergence and spread. These include environmental and socio-economic change, deterioration of health care and food production systems, and the modification of microbial/vector adaptation (McMichael et al., 1998; Morse, 1995; Epstein, 1992).

---

1.2 Justification of Study

Malaria is a serious problem in Africa where one in every five (20%) childhood deaths ids due to the effects of the disease (Sachs and Malaney, 2002). There were an estimated 216 million episodes of malaria in 2010, of which approximately 81% or 174 million cases were in African Region.

The control of malaria involves three living beings (man, mosquito and larva) and their environment. Man is highly mobile and able to facilitate the spread of the disease far and wide mosquitoes are moving and highly adaptable (Najera and Zaim, 2003). Eggs and larvae are highly adaptable to various environmental situations.

This interrelationship of the various living beings sustaining the burden of malaria can be described as malaria chain. Thus, malaria control involves measures that are deployed to disrupt the chain in order to reduce malaria burden to a point where it is not of public health importance. Makuola et al., 2014).

Effective malaria control must leverage on the various opportunities to interrupt the critical challenge of man, mosquito and larva. Since the year 2000, great progress has been made in tackling the disease, with massive campaigns to distribute insecticide-treated mosquito bed nets, to spraying homes with insecticide to kill adult mosquitoes and use of drugs for disease prevention and treatment (all targeted towards man as host and mosquitoes) have been the focus of malaria control efforts.

These strategies have helped reduce global malaria mortality by a quarter in the past decade. However, this success is now threatened by resistance to drugs and chemicals in the malaria parasite and its mosquito carriers, which could render insecticide treated bed nets, indoor residual spraying and widely available drugs less effective.

The environmental dimensions of malaria chain as regarding egg and larval reduction through larviciding is not very prominent in discussions on malaria control. In addition, the impact of environmental factors, while generally acknowledged, has not been properly researched in Nigeria, especially in the Eastern part of the country, and Imo state, in particular, as is evident in very few publications on this area.

The absence of such knowledge among the inhabitants of the study may have contributed to their inability to prevent malaria transmission and thus increase disease prevalence. This dearth of research in this area thus makes it imperative for further research to be made in order to create awareness. This will in turn help to reduce the incidence of infection on the part of the populace.

---

1.3 Aims and Objectives of the Study

---

1.3.1 Aim

The main aim of this study is to investigate the social and environmental determinants of malaria in Umudibia, Nekede, Owerri-West, L. G. A, Imo State.

---

1.3.2 Specific Objectives Are;

1. To ascertain the overall malaria prevalence/status in the study area.
2. To determine the relationship between socio-demographic characteristics and malaria status in the area.
3. To ascertain the relationship between social and environmental factors and malaria status in the area.
4. To determine the relationship between housing characteristics and malaria status.
5. To ascertain the relationship between malaria status, environmental factors and level of awareness.

---

1.4 Research Questions

• What is the overall malaria prevalence/status in the study area?
• What is the relationship between the socio-demographic characteristics and malaria status in the study area?
• What is the relationship between social and environmental factors and malaria status in the area?
• What is the relationship between housing characteristics and malaria status in the area?
• What is the relationship between malaria status, environmental factors and level of awareness?

---

1.5 Research Hypothesis

• H0: There is no significant relationship in the overall malaria prevalence/status in the study area.
• Ha: There is significant relationship in the overall malaria prevalence/status in the study area.
• H0: There is no significant relationship between demographic characteristics and malaria prevalence in Umudibia, Nekede.
• H0: There is significant relationship between demographic characteristics and malaria prevalence in Umudibia Nekede
• H0: There is no significant relationship between social and environmental factors and malaria status in the area.
• Ha: There is significant relationship between social and environmental determinants and malaria status in the area.
• H0: There is no significant relationship between housing characteristics and malaria status in the area.
• Ha: There is significant relationship between housing characteristics and malaria status in the area.
• H0: There is no significant relationship between malaria status, environmental factors and level of awareness.
• H4: There is significant relationship between malaria status, environmental factors and the level of awareness.

---

1.6 Literature Review

Malaria is a mosquito-borne infectious disease of humans caused by eukaryotic protists of the genus Plasmodium (Phylum Apicomplexa). In humans, malaria is largely caused by P. falciparum, P. malariae, P. ovale, and P. vivax. Fong et al., (1971) and Singh et al., (2004) noted a fifth species, Plasmodium knowlesi, a zoonosis that causes malaria in macaques but can also infect human. Plasmodium falciparum is the most common cause of infection and is responsible for about 80% of all malaria cases, and is responsible for about 90% of the deaths from malaria (Mendis et al, 2001). Malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae is generally a milder disease that is rarely fatal.

These four major species causing human malaria differ morphologically, immunologically, in geographical distribution relapse pattern and in drug response.

1. Plasmodium vivax, which is synonymous with Haemamoeba vivax, is the cause of vivax or benign tertian malaria. It is the most common malaria is more common in the Americas and Asia than in the tropical region.
2. Plasmodium ovale is the cause of ovale malaria or ovale tertian. It is the least common malaria parasite of man and restricted to West Africa, principally on the West coast. Ovale malaria produces a mild illness.
3. Plasmodium malariae is the cause of malariae or quartan malaria. It is found in isolated places scattered across the globe such as tropical Africa, Burma, Sir Lanka, and some parts of India. Though it cause severe fever, quartan malaria is usually not life threatening.
4. Plasmodium falciparum is the cause of malignant sub-tertian or falciparum malaria. The specific name “falciparum” was derived by Welch from “falx” (sickle or crescent) and “parere” (P. falciparum is the cause of the most severe, often fatal form of the disease. It remains almost unchallenged as one of the greatest killers of human race over most part of tropical Africa and elsewhere in the tropics. in the past, Plasmodium falciparum used to be common in the southern United States of America and along the Mediterranean shores but now it is rare in these areas following malaria eradication programmes. (Beaver et al., 1984).

Malaria is widespread in tropical and subtropical regions, including much of Sub-Saharan Africa, Asia and the Americas. The disease results from the multiplication of malaria parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases progressing to coma, and death. Each year, Philips (2010) reported that there are more than 225 million cases of malaria, killing around 781,000 people each year.

The majority of deaths according to Snow (2005) are young children in sub-Saharan Africa. Ninety percent of malaria-related deaths occur in sub-Saharan Africa. Malaria is commonly associated with poverty, and can indeed be a cause of poverty (Institute for the Study of Labor, 2008), as well a major hindrance to economic development.