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REPUBLIC OF CAMEROON
Peace – Work – Fatherland REPUBLIQUE DU CAMEROUN
******** Paix – Travail - Patrie
MINISTRY OF HIGHER ********
EDUCATIONN MINISTERE DE
L’ENSEIGNEMENT SUPERIEUR
P.O BOX 875 P.O BOX 875

(MOTTO: HOPE IS THE KEY.)

ASSESSING THE KNOWLEDGE OF PREGNANT WOMEN ON

THE PREVENTIVE MEASURES OF MALARIA AT THE
BAMENDA REGIONAL HOSPITAL

A RESEARCH REPORT SUBMITTED TO THE SCHOOL OF MEDICAL AND BIOMEDICAL

SCIENCES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF A
HIGHER NATIONAL DIPLOMA (HND) IN NURSING

PRESENTED BY
CHE MERCY NGUM
MATRICULE NUMBER: 23NUS0211
SUPERVISOR
Mme. JINTEH PRECILIA

APRILi 2023
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CERTIFICATION

This is to certify that this research titled "ASSESSING THE KNOWLEDGE OF PREGNANT WOMEN
ON THE PREVENTIVE MEASURES OF MALARIA AT THE BAMENDA REGIONAL HOSPITAL" is
the original work of CHE MERCY NGUM. It has been read, supervised and approved by MADAM
JINTEH PRECILIA for submission. It meets the standard required for the HND. Corrections will be duly
made after the appreciation by the jury.

Student……………………………………….

Signature……………………………………..

Supervisor……………………………………….

Signature…………………………………………

Date………………………………………………

President of Jury……………………………………….

Signature. ………………………………………………

Date……………………………………………………..

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DEDICATION

To my son Fomekong Ngwa Phanuel

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ACKNOWLEDGEMENTS

My heart is deeply grateful and thankful to my supervisor, madam Jinteh Precilia for her unmeasured time
and a lot of sacrifice she made in order for me to realize the completion of this work.

Special thanks to the administrative authorities and entire staff of Capitol Higher Institute of Health
Science; for the knowledge, impacted on me throughout these years of training.

I will love to express my sincere thanks to the staff of Bamenda Regional Hospital and all my pregnant
women for their collaborations, cooperation and initiative to respond to my questionnaires.

I equally wish to give a big thanks to my brother Ndiformuche Salem for his unmeasured time and a lot
of sacrifice he made in order for me to realize the completion of this work. I remain indebted to you Saa
and your crew.

A special thanks to my lovely mother, Akwanwi Josephine, madam Ndinonki and my lovely husband
Fomekong Joel for your love, concern, support, assistance and encouragements. God bless you all.

Above all, all glory and honor to My Maker and King, God Almighty for keeping me sound and safe
through this very time till this moment.

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TABLE OF CONTENTS
CERTIFICATION ........................................................................................................................... i

DEDICATION .................................................................................................................................ii

ACKNOWLEDGEMENTS ............................................................................................................iii

LIST OF TABLES ......................................................................................................................... vii

LIST OF FIGURES ...................................................................................................................... viii

ABSTRACT.....................................................................................................................................x

CHAPTER ONE ............................................................................................................................. 1

GENERAL INTRODUCTION ....................................................................................................... 1

1.1 Background to the study ........................................................................................................ 1

1.2 Statement of the problem ...................................................................................................... 4

1.3 Justification of the study ....................................................................................................... 5

1.4 Purpose of Study ................................................................................................................... 5

1.5. Benefits of Study .................................................................................................................. 6

1.6. Research Hypothesis ............................................................................................................ 6

1.6.1. Null hypothesis (H0) ..................................................................................................... 6

1.6.2. Alternative hypothesis ................................................................................................... 6

1.7. Research Objectives ............................................................................................................. 6

1.7.1. General objective ........................................................................................................... 6

1.8. Research questions ............................................................................................................... 7

1.8.1 General research question ............................................................................................... 7

1.8.2 Specific research question .............................................................................................. 7

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1.9. Significance of Study ........................................................................................................... 7

1.10. Scope of the study .............................................................................................................. 8

CHAPTER TWO ............................................................................................................................ 9

REVIEW OF RELATED LITERATURE ...................................................................................... 9

2.0. INTERODUCTION ............................................................................................................. 9

2.1. MALARIA IN PREGNANCY .......................................................................................... 10

2.1.1. The burden of malaria in pregnancy ............................................................................ 10

2.1.3. Complications of malaria during pregnancy ............................................................... 12

2.1.4. Consequences of malaria in pregnancy ....................................................................... 12

2.1.5. Public health challenges posed by malaria .................................................................. 13

2.1.6. Transmission ................................................................................................................ 13

2.1.7. Maternal malaria .......................................................................................................... 14

2.1.8. Symptoms .................................................................................................................... 15

2.1.9. Diagnosis ..................................................................................................................... 15

2.1.10. Treatment ................................................................................................................... 16

2.1.11. Treatment of severe malaria in pregnancy ........................................................................ 17

CHAPTER THREE ...................................................................................................................... 19

RESEARCH METHODOLOGY.................................................................................................. 19

3.1. Research Design ................................................................................................................. 19

3.2 Area of the study ..................................................................................................................... 19

3.3 Study Period ............................................................................................................................ 21

3.4 Population of the study .......................................................................................................... 21

3.5 Inclusion and Exclusion Criteria ............................................................................................. 21

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3.5.1 Inclusion Criteria ................................................................................................................. 21

3.5.2 Exclusion Criteria ................................................................................................................ 21

3.2. Sample size and Sampling Techniques .............................................................................. 21

3.3. Instrument for data collection ............................................................................................ 22

3.3.1. Method for data collection ........................................................................................... 22

3.3.2. Method for data analysis.............................................................................................. 22

CHAPTER FOUR ......................................................................................................................... 24

RESULT AND DISCUSSION ..................................................................................................... 24

RESULT .................................................................................................................................... 27

CHAPTER FIVE .......................................................................................................................... 32

CONCLUSION AND RECOMMENDATION ............................................................................ 32

5.1. Discussion .......................................................................................................................... 32

5.2. Conclusion.......................................................................................................................... 33

5.3. Recommendations .............................................................................................................. 33

5.4. Limitation ........................................................................................................................... 34

REFERENCES ............................................................................................................................. 35

APPENDICES .............................................................................................................................. 37

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LIST OF TABLES

Table 1: WHO definition of severe malaria .................................................................................. 17

Table 2:World Health Organization recommendations for the treatment of severe malaria in pregnancy 18

Table 3: Results for Demographic and Socio-Economic Characteristics of the Participants. ...... 24

Table 4: Knowledge of pregnant women toward effect of malaria in pregnancy ........................ 25

Table 5: Knowledge of pregnant women toward prevention of malaria in Pregnancy ................ 26

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LIST OF FIGURES

Figure 1: The lifecycle of plasmodium parasite. ........................................................................................ 11

Figure 2: Front view of the Bamenda regional Hospital ............................................................................ 20

Figure 3: The study site; Regional Hospital Bamenda [Regional Hospital Bamenda Google map]. ......... 20

Figure 4: Gender of participants ................................................................................................................. 29

Figure 5: Age group of participants............................................................................................................ 29

Figure 6: marital status of participants ....................................................................................................... 30

Figure 7: Educational qualification of participants .................................................................................... 31

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LIST OF ABBREVIATION

ANC: Antenatal clinical

RHB: regional hospital bamenda

RDPH: Regional Delegate of public health

OPD: Out patient department

CBC: center for disease control

HND: higher national diploma

USA: United State of America

WHO: World health organization

LLINs: Long Lasting Insecticidal Bets

IPTp: Intermittent Prevenytive Treatment in Pregnancy

SP: Sulfadoxine-Pyrimethamine

MiP: Malaria in Pregnancy

LBW: Low Birth Weight.

HRP2: Histidine-Rich Protein 2

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ABSTRACT

Malaria in pregnancy remains a public health concern in Cameroon with far-reaching health and economic
implications. Although a significant decrease in entomological and epidemiological indicators was reported
in Cameroon since the introduction of insecticide-treated bed nets, malaria prevalence remains high also in
some parts of the Northwest Region of Cameroon. This study was designed to assess malaria preventive
measures among patients attending Antenatal Clinics at the Bamenda Regional hospitals of the North West
Region of Cameroon. This was a cross-sectional study carried out within a period of 1 month, from 10th
January to 10th February 2023. Data was obtained using a structured questionnaire and laboratory analysis.
The Plasmodium falciparum Malaria HRP2 qualitative rapid diagnostic test was used for malaria diagnosis.
The questionnaire was designed to collect information on respondent’s socio-demographic characteristics,
and the use of various malaria preventive measures. Data were analyzed using descriptive statistics, aided
by the use of Statistical Package for Social Sciences (SPSS 20) and Microsoft Excel 2019. The study found
out that most of the women demonstrated good knowledge of the causes, symptoms and consequences of
malaria in pregnancy. Generally, the result of this study showed that majority 26 (57.8%) of the pregnant
women know the effect of malaria on pregnany compared to 19 (42.2%) who had little or no knowledge on
the preventive measures of [Link] study also shows that 29 (64.4%) of the respondents know that
there are ways of preventing malaria in pregnancy leaving 19 (35.6%) who didn't have enough information
on the ways of preventing [Link] study concluded that the majority of the pregnant women had good
knowledge of the causes, symptoms and consequences of malaria in pregnancy. However, the study found
that about 13.3% of pregnant women cleared all bushes around their premises in a bit to prevent the malaria,
8.9% always ensured they put on long sleave clothes to reduce the risk of mosquito bites, and 15.6%
ensured that all stagnant water around their residential premises were properly drained, all in an attempt to
prevent malaria. As a result, the pregnant women, despite the fact that most of them used treated bed nets,
most of them were still diagnosed of malaria in pregnancy, possibly due to the negligence of basic primary
preventive measures like clearing all bushes around residential premises, putting on long-sleeved clothings,
ensuring that all stagnant water around their residential premises were properly drained.

Keywords: Malaria in pregnancy, knowledge, preventive measures.

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CHAPTER ONE

GENERAL INTRODUCTION

1.1 Background to the study

1.1.1. Historical Background

World health organization (WHO) latest estimates reported about 198 million cases of malaria in
2013, with an estimated 584,000 deaths (WHO, 2015a). About twenty-five million pregnant
women were at risk for malaria, the latter accounting for over 10,000 maternal and 200,000
neonatal deaths per year (Schantz-Dunn and Nour, 2009).
Malaria is a parasitic infection transmitted by mosquitoes, is one of the most devastating
infectious diseases, affecting women, fetuses, and newborns globally (Schantz-Dunn and Nawal,
2019). Malaria is transmitted when an infected mosquito takes a human blood meal and the
Plasmodium sporozoites are transferred from the saliva of the mosquito into the capillary bed of
the host. Within hours, the parasite will migrate to the liver, where it undergoes further cycling
and replication before being released back into the host’s bloodstream (Menéndez, 2008).

Malaria is a life-threatening parasitic disease caused by Plasmodium vivax, Plasmodium

malariae, Plasmodium five Plasmodium species: Plasmodium falciparum, ovale and
Plasmodium knowlesi, and transmitted to human by mosquito vectors. Although P. falciparum
and P. vivax are the most widespread species, P. falciparum is the deadliest. Known as the
malaria parasite in monkeys, P. knowlesi was recently identified as the one responsible of some
human cases of malaria (WHO, 2015a).
Pregnant women are among the most vulnerable groups to this parasitic disease. Malaria in
pregnancy consists in having a positive diagnosis of malaria during pregnancy, and is associated
with maternal anemia, prematurity, intra-uterine growth retardation, and low birth weight
(Luxemburger et al., 2001; Kamuliwo et al., 2015). P. falciparum infection, which occurs
predominantly in Africa, is associated with maternal illness and is one of the most important
determinants of low birth weight (Menendez, 1995).
In Cameroon, malaria is endemic in the 10 regions, with an estimated prevalence of 29%
(Mangham et al., 2012). According to the 2011 demographic and health survey, this infection is
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responsible for 40 to 45% of medical consultations, 30% of hospitalizations, and 24% (5% in
pregnant women) of death in hospitals. Also, malaria is the cause of 26% of work absences, and
40% of household health expenses.
To reduce the burden of the disease, increased efforts towards prevention and control have
been recommended. For malaria in pregnancy in particular, WHO recommends three evidence-
based packages of interventions for the prevention and treatment of the disease including long-
lasting insecticidal nets (LLINs), intermittent preventive treatment in pregnancy (IPTp) with
sulfadoxine-pyrimethamine (SP) in areas of stable malaria transmission of sub-Saharan Africa,
and prompt diagnosis and effective treatment of malaria infections (WHO, 2015b). The
implementation of these interventions has resulted in dramatic reduction in malaria mortality
rates by 54% since the years 2000 in the WHO African Region (WHO, 2015a). Indeed, the
assessment of the trends in malaria prevalence over seven years in a health centre of the North
West Cameroon have shown a very fluctuating pattern, with higher decrease observed after
implementation of insecticide treated net distribution (Ndong et al., 2014).
However, the widespread implementation of effective programmes remains highly challenging.
Indeed, many African women living in remote areas for example have limited access to medical
care and effective malaria control tools such as LLINs (Marchesini and Crawley, 2004). Also,
most high-burden countries are not capturing essential malaria data on a continuing basis,
making it difficult to optimize interventions, assess disease trends and respond to outbreaks.
Consequently, the disease still persists despite efforts of control programmes and stakeholders.
The World Health Assembly then recently adopted a new comprehensive strategy to help
endemic countries reduce global malaria incidence and mortality rates by at least 90% by 2030
(WHO, 2015c).
The incubation period, from the time of mosquito bite until clinical symptoms appear, is
typically 7 to 30 days. Symptoms include fever, headache, nausea, vomiting, and myalgias. Due
to the cycling parasitemia in the bloodstream, patients will often experience symptoms every 2 to
3 days, depending on the type of Plasmodium with which they are infected. In the human,
plasmodial infection is a complicated reproductive life cycle involving hepatic and erythrocytic
infection. According to Bryan Bunch et al. (2012), the most severe form of malaria caused by

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plasmodium falciparum protozoan. This form of malaria does not last as long as others but is
more life-threatening.

Globally, it is estimated to affect between 350 to 500 million people annually and accounts for 1
to 3 million deaths per year (Centers for Disease Control and Prevention, 2017; The Global Fund,
2019). Over 40 per cent of the world’s populations are at risk of infection from the parasite
which causes malaria. (Lee et al., 2019). Sub-Saharan Africa has the largest burden of malarial
disease, with over 90% of the world’s malaria-related deaths occurring in this region (Schantz-
Dunn and Nawal, 2019). It ranks second among the top ten causes of death in Africa (WHO
2015; Chiang et al 2016; WHO, 2018).

In Cameroon, the disease remains prevalent, varying between 3.3–3.7 million per year (Nkondjio
et al, 2019). It is the most important public health problem and the first cause of morbidity in all
age groups (MPH 2014). Reports show that it accounts for 40.01% morbidity and 2.2% mortality
in the general population, and 4.2% mortality in children less than 5 years. In Cameroon, malaria
parasite transmission is highly heterogeneous with high and perennial parasite transmission
occurring in the forest, coastal and humid savanna areas and low parasite transmission in
highlands and seasonal parasite transmission in Sahelian and dry savanna areas (National
Malaria Control Program, 2015). Plasmodium falciparum is the main parasite responsible for
over 95% of the cases (World \health Organization, 2015).

Globally, women and children are highly susceptible to malaria infection (WHO, 2015). It is
estimated that twenty-five million pregnant women are currently at risk for malaria, with the
highest risk for infection and morbidity in primigravidas, adolescents, and those coinfected with
HIV (Desai et al, 2007. According to the World Health Organization (WHO), malaria accounts
for over 10,000 maternal and 200,000 neonatal deaths per year.

The effects of malaria in pregnancy are mostly of adverse consequences from malaria infection
including maternal anaemia placenta accumulation of parasite, low birth rate from premature
intrauterine growth retardation and foetal parasite exposure and congenital infections and infant
mortality (Lee et al 2019). In accordance with the fact that pregnancy comes with so many
psychological changes, pregnant women are predisposed to a host of diseases due to their low
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immune system, so the effects of malaria infections in pregnant women are associated with a
high risk of both maternal or prenatal mobility and mortality (WHO, 2015).

The effects of malaria in pregnancy remain an area of concern in Cameroon. Despite this
importance, very limited study has been conducted to shed more light on it. Currently, most
women in Africa and Asia attend Antenatal Clinics at least once, which creates an opportunity
for health care providers to address not only issues affecting maternal and perinatal health, but
also other health care needs. Antenatal Clinics is designed as a platform for the delivery of
integrated services appropriate to the needs of the woman. It can also be an effective link to
interventions such as IPTp-SP and obtaining an ITN. Women can receive information about
malaria and learn about evidence-based care for malaria prevention and treatment. Integrating
malaria prevention and treatment into Antenatal Care is key to improved outcomes for women
and newborns in malaria-endemic areas.

The objective of this present study was to capture the situation of malaria in pregnancy in the
Bamenda Regional Hospital (North West Region, Cameroon), and assess the knowledge,
choices and practices of pregnant women regarding this deadly disease

1.2 Statement of the problem

Pregnant compared to non-pregnant women are at an increased risk for malaria (Menedez, 2011).
Malaria and pregnancy are mutually aggravating conditions. The physiological changes due to
pregnancy and the pathological changes due to malaria have a synergistic effect on the course of
each other, thus making life difficult for the mother, the child and the treating physician.
Falciparum malaria can run a turbulent and dramatic course in pregnant women.

Pregnancies in women living in malaria-endemic regions are associated with a high

frequency and density of P. falciparum parasitemia with high rates of maternal morbidity
including fever and severe anaemia with abortion and stillbirth. This is also associated with high
rates of placental malaria consequently low birth weight in newborns caused by both prematurity
and intrauterine growth retardation. (WHO, 2012). Globally, prenatal mortality due to malaria is
about 1500 per day and in areas where malaria is endemic, 20-40% of all babies born may have a
low birth weight (Kakkilaya, 2012).
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Malaria is a great problem in Cameroon hampering individual and national prosperity due to its
influence on social and economic decisions. The risk of contracting malaria can deter investment
both internal and external and affect individual and household decisions making in many ways
that have a negative impact on economic productivity and growth. According to WHO, in some
heavy-burden countries, the disease accounts for up to 40% of public health expenditures, 30%
to 50% of inpatient hospital admissions, up to 60% of outpatient health clinic visits.

It is with this background that a study to assess the knowledge and preventive practices of
pregnant women in the management of malaria at the Regional Hospital Bamenda was
conducted

1.3 Justification of the study

This study which is based on assessing the knowledge of preventive practices of malaria in
pregnancy at the Bamenda Regional Hospital will provide a better physical and psychological
management strategy for pregnant women and the data obtained will also help in sensitizing the
population on the preventive practices and measures of malaria in pregnancy.

1.4 Purpose of Study

Each year, approximately 25 million African women become pregnant in malaria-endemic areas
and are at risk of Plasmodium falciparum malaria infection during pregnancy. Most women in
the African Region reside in areas of relatively stable malaria transmission where the principal
effects of malaria infection during pregnancy are associated with malaria-related anaemia in the
mother and with the presence of parasites in the placenta. The resultant impairment of fetal
nutrition contributes to low birth weight (LBW), which is a leading cause of poor infant survival
and development in Africa

This study (Research) therefore seeks to assess the knowledge and choices of preventive
measures taken against malaria in pregnancy

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1.5. Benefits of Study

✓ This study is intended to improve the knowledge of women attending ANC at the
Bamenda Regional Hospital on the implementation of primary preventive measures
against malaria in pregnancy.

✓ It will guide them to modify their behavior using simple, affordable and cheap methods
to prevent malaria more effectively.

✓ It will also provide reliable and valid baseline findings that can incite advocacy and
competent organizations to sponsor large-scale research with more representative
attributes in order to profitably modify public health policy and interventions within the
framework of eliminating malaria from the North West Region and from the country as a
whole.

1.6. Research Hypothesis

1.6.1. Null hypothesis (H0)

✓ Pregnant women have a proper knowledge of the preventive measures of malaria, and
how these measures are effected.

1.6.2. Alternative hypothesis

H1: Pregnant women have the knowledge of preventive measures against malaria, but
lack the proper knowledge of applying these measures for malaria prevention.

H2: pregnant women lack the knowledge of preventive measures against malaria in
pregnancy.

1.7. Research Objectives

1.7.1. General objective

The general objective of this study is to assess the knowledge and preventive practices of
pregnant women in the prevention of malaria in pregnancy at the Bamenda Regional Hospital.

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1.7.2. Specific objective

This study seeks to:

➢ To assess the knowledge of pregnant women on the basic notion of primary prevention of
malaria in pregnancy.

➢ Identify the measures aimed at preventing malaria undertaken by pregnant women for the
prevention of malaria in pregnancy.

➢ Bring out the challenges faced by pregnant women in the prevention of malaria in
pregnancy.

1.8. Research questions

1.8.1 General research question

➢ What are the knowledge and preventive practices of pregnant women in the prevention of
malaria in pregnancy?

1.8.2 Specific research question

➢ What knowledge and preventive measures do pregnant women have about the prevention
of malaria in pregnancy?

➢ What preventive practices are undertaken by pregnant women for the prevention of
malaria in pregnancy?

➢ What are the challenges faced by pregnant women in the prevention of malaria in
pregnancy?

1.9. Significance of Study

To the women

This research is very important to the entire women of Bamenda-Northwest Region, government
and non-governmental organization as well as community of action and students like to conduct
research of this kind. The result of this study will present a true picture of the affect malaria on
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pregnant women malaria with view of finding a better preventive measure and also suggest ways
of improving access and utilization of these preventive measures and symptoms and differing in
nature from physical injury. A diseased organism commonly exhibits signs or symptoms
indicative of its abnormal state.

To the hospital

This study is also intended to improve the knowledge and choices of women attending ANC at
the Bamenda Regional Hospital on the implementation of primary preventive measures against
malaria in pregnancy. It will guide them to modify their behavior using simple, affordable and
cheap methods to prevent malaria more effectively. It will also provide reliable and valid
baseline findings that can incite advocacy and competent organizations to sponsor large-scale
research with more representative attributes in order to profitably modify public health policy
and interventions within the framework of eliminating malaria from the North West Region and
from the country as a whole.

1.10. Scope of the study

There was no standardization of respondents with respect to the criteria evaluated in the research
and there were also no controls for each variable assessed. Findings were based on clients'
judgments and reports. The socio-politically unfriendly environment hindered evaluation of the
liaison between the reports and the actual practice by each respondent. It was impossible to
obtain a sample that was equally representative by age, education, job, ethnic group, geographic
location of residence, genetic constitution and purchasing power. Also, the sample size would
have been doubled in order to ensure more representative results if there were sufficient means
and time.

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CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.0. INTERODUCTION
The current epidemiologic report of malaria communication, and advocacy, the impact of in
terms of aetiology, transmissibility, current therapeutic and preventive measures on diagnostic
and treatment options, global incidence rates will be evaluated, before identifying gaps in certain
areas requiring research and finally, in the light of the goals set by the WHO, a contextual
discussion of this work will be done, in order to improve implementation of measures, so as to
contribute to the achievement of the goals set by WHO before the stipulated deadlines.

In 2013, worldwide, there was an estimated 198million case of malaria. Most of these cases were
in the WHO African Region (82%) followed by the Southeast Asian Region (12%) and the
Eastern Mediterranean Region (5%). About 8% estimated cases globally are due to Plasmodium
vivax, although, the proportion outside the African continent is 47% (WHO, 2015).

It is estimated that 1.2 billion malaria cases and 6.2 million fewer malaria deaths occurred
globally between 2001 and 2015 than would have been the case had incidence and mortality
rates remained unchanged since 2000. In Sub-Saharan Africa, it is estimated that 943 million
fewer malaria cases occurred and that malaria prevention interventions were responsible for 70%
of this reduction, averting 663 million deaths (WHO,2016).

According to UNICEF Report (2007),between 350million and 500million episodes of clinical

malaria occur each year, leading to an estimated 1 million deaths, most in Sub-Saharan Africa
and among children under age five accounting for 1 death in 10 (8%) worldwide and nearly 1
death in 5 (18%) in Sub-Saharan Africa; 15% of children under age five sleep under any type of
mosquito net, the proportion of children under age five sleeping under an insecticide-treated net
is 8%; 18% of children under age five received anti-malarial medicines within 24 hours and 7%
of Cameroon children under age five were sleeping under an insecticide-treated net .

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2.1. MALARIA IN PREGNANCY

2.1.1. The burden of malaria in pregnancy

Globally, an estimated 3.2 billion people in 97 countries are at risk of being infected with malaria
and developing the disease, of which 1.2 billion are at high risk (WHO 2014).

Malaria primarily affects low- and lower-income countries and within endemic countries, the
poorest and most marginalized communities. Most of malaria cases and deaths occur in Sub
Saharan Africa, but Asia, Latin America and to a lesser extent the Middle East and part of
Europe are also affected. Approximately 25 million pregnant women are at risk of infection by P.
falciparum annually in Africa (WHO 2014).

A recent review of studies in East and Southern Africa found the following prevalence of malaria
in women attending antenatal clinics: 32 % for peripheral malaria and 38.2% for placental
malaria (Chico RM 2012).

In areas of stable transmission in Sub-Saharan Africa, 1 in every 4 pregnant women has evidence
of peripheral or placental infection with malaria parasites (Desai 2007)
In low transmission areas of the African continent, peripheral and placental parasitemia have
been shown to be 13.7% and 6.7% respectively, while in low transmission areas outside Africa,
placental infection is slightly higher (9.6%) than peripheral (6.2%). (Desai 2007). Placental
infection seems to persist outside seasons of high infection. (Desai 2007)
2.1.2. Lifecycle of plasmodium parasite
The lifecycle of this parasite is brocken down into five (5) stages.
➢ Plasmodium-infected Anopheles mosquito bites a human and transmits sporozoites into
the bloodstream.
➢ Sporozoites migrate through the blood to the liver where they invade hepatocytes and
divide to form multinucleated schizonts (pre-erythrocytic stage). Atovaquone-proguanil
and primaquine have activity against hepatic-stage schizonts.

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➢ Hypnozoites are a quiescent stage in the liver that exist only in the setting of P.
vivax and P. ovale infection. This liver stage does not cause clinical symptoms, but with
reactivation and release into the circulation, late-onset or relapsed disease can occur up to
many months after initial infection. Primaquine is active against the quiescent
hypnozoites of P. vivax and P. ovale.
➢ The schizonts rupture and release merozoites into the circulation where they invade red
blood cells. Within red cells, merozoites mature from ring forms to trophozoites to
multinucleated schizonts (erythrocytic stage). Blood-stage schizonticides such as
artemisinins, atovaquone-proguanil, doxycycline, mefloquine, and chloroquine interrupt
schizogony within red cells.
➢ Some merozoites differentiate into male or female gametocytes. These cells are ingested
by the Anopheles mosquito and mature in the midgut, where sporozoites develop and
migrate to the salivary glands of the mosquito. The mosquito completes the cycle of
transmission by biting another host.
These five stages are of the plasmodium lifecycle can be observed on the figure below.

Figure 1: The lifecycle of plasmodium parasite.

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2.1.3. Complications of malaria during pregnancy

Parity and age are important determinants of risk of infection among pregnant women.
Primigravidae and younger maternal age (adolescents) have poorer immunity to malaria
compared to their older and multiparous counterparts. The risk of infection is also highest during
the second trimester.
In Africa, a quarter of cases of severe anemia in pregnancy are attributable to malaria. The
percentage of maternal deaths attributed directly or indirectly to malaria is approximately 10%
in both hospital studies (0.5% to 23.0%) and community-based studies (2.9% to 17.6%). This
does not differ much from estimates in low-transmission regions outside Africa (0.6 to 12.5%).
Placental malaria doubles the risk of low birth weight. Compared to multiparous women,
primigravid women have a two- to seven times the risk of low birth weight deliveries. Low birth
weight in itself is a major risk factor for neonatal mortality but Malaria-induced low birthweight
is estimated to be responsible for 3 to 17 deaths per 1000 livebirths.
It is also estimated that 11.4% of neonatal deaths and 5.7% of all infant deaths in malaria
endemic areas of Africa may be caused by malaria in pregnancy-associated low birthweight.
Malaria may lead to low birthweight through causation of fetal growth restriction or preterm
delivery. In high-transmission areas, malaria-related fetal growth restriction may be twice as
high as malaria-related preterm delivery. Contrastingly, in low-transmission settings, the
predominant cause of low birthweight is preterm delivery.

2.1.4. Consequences of malaria in pregnancy

Stillbirths, spontaneous abortions, fetal anaemia may also be consequences of maternal
parasitaemia. Placental malaria diminishes fetal cellular and antibody response to P. falciparum
making the infant susceptible to malaria. Transplacental antibody transfer is also compromised,
increasing susceptibility to other pathogens such as tetanus and Streptococcus pneumonia.
HIV increases the risk of placental malaria infection, high density parasitemia, febrile illness and
worsens severe anaemia and low birthweight. HIV also eliminates the gravidity specific pattern
of malaria in areas with stable transmission from paucigravid to all pregnant women.

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2.1.5. Public health challenges posed by malaria

All 4 plasmodium species can infect pregnant women but Plasmodium falciparum and
Plasmodium vivax have been widely studied. Plasmodium falciparum is the most prevalent in
African continent, which is responsible for most deaths from malaria. (Desai 2007)

Plasmodium vivax has wider geographical distribution (can develop in lower temperatures,
survive in high altitudes, has a dormant liver stage known as hypnozoite). (WHO 2014)

Plasmodium vivax is more common in many areas outside Africa, where they are more prevalent
than P. falciparum. (WHO 2014)
Compared with P. falciparum, the effect of P. vivax on birthweight may be more pronounced in
multigravidae despite a higher incidence of P. vivax infection in primigravidae. (Desai 2007)

2.1.6. Transmission
Malaria is transmitted exclusively through the bites of female Anopheles mosquitoes. The
intensity of transmission depends on factors related to the parasite, the vector, the human host,
and the environment.

There are 20 different species of Anopheles. They all breed in water with different preference,
for example some prefer shallow collection of fresh water (rice fields, hoof prints).
Transmission is more intense in places where the mosquito’s lifespan is longer (giving the
parasite the time to complete its development inside the mosquito) and where the vector prefers
to bite humans rather than other animals. These characteristics are seen in African vector species
which explains the high rate (90%) of malaria deaths in Africa.
Endemicity of malaria refers to the intensity of malaria transmission in a community or region
that may be classified as follows:
Stable malaria areas, where transmission occurs all year round, though there may be seasonal
variations. Older children and adults in the community have partial immunity which protects
them from severe forms of malaria. Young children are susceptible to severe malaria.
Unstable malaria areas, where intermittent transmission may be annual, biannual or variable.

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Climatic changes such as rainfall patterns, temperature and humidity may affect the number and
survival of mosquitoes. In many places the transmission is highest during and just after the
rainy season.

Malaria epidemics can occur when the climate changes and other conditions intensify
transmission, particularly in areas where people have little or no immunity to malaria.
The epidemics can also occur when people with low immunity move to areas with intense
malaria transmission (for example those who move to find work or refugees).
Human immunity is also an important factor in areas with intense or moderate transmission.
Partial immunity is developed over years of exposure, but never provides complete protection. It
however reduces the risk of severe disease. This explains the high mortality rate due to malaria
among young children in Africa.

2.1.7. Maternal malaria

In areas of high and moderate (stable) malaria transmission, most malaria infections are
asymptomatic, because adult women have developed immunity. (WHO 2007)

But during pregnancy, these infections can contribute to the development of severe anaemia in
the mother, increasing the risk of maternal mortality and morbidity. Moreover, it affects the
health of the foetus during the second half of pregnancy. (WHO 2007)

Malarial infection of the placenta, and maternal anaemia due to malaria, contribute to low birth
weight and preterm birth as well as impaired development of the child. (WHO 2007)

Despite the high prevalence of placental infection, congenital transmission of malaria is rare.
(WHO 2012)
Stable transmission predominates in Sub-Saharan Africa. In these areas of high or moderate
(stable) malaria transmission, the negative effects are particularly apparent in the first and second
pregnancies exposed to malaria. (WHO 2007)

In areas of epidemic and low (unstable) malaria transmission, adult women have no significant
level of immunity and will develop clinical illness if they have parasitaemia.

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Pregnant women with no immunity are at risk of dying from severe malarial disease and/or
experiencing spontaneous abortion, preterm delivery, low birth weight or stillbirth. The
prevalence and intensity of malarial infection during pregnancy is higher in women who are HIV
infected.
All pregnant women are at similar risk for malarial infection, irrespective of parity. Abortion is
common in the first trimester, and prematurity is common in the third trimester.
Other consequences during pregnancy commonly associated with P. falciparum
infection include: hypoglycaemia, hyperpyrexia, severe haemolytic anaemia and
pulmonary oedema.

2.1.8. Symptoms
Malaria is an acute febrile illness. The incubation period is between 10-15 days after the
infective mosquito bite. (WHO 2014)

The first symptoms are fever, headache, chills and vomiting that are not specific to malaria. If
not treated within 24 hours, malaria due to P. falciparum can progress to severe illness that can
lead to death. (WHO 2014)
Children with severe malaria can develop one or more of the following symptoms: severe
anaemia, respiratory distress due to metabolic acidosis, or cerebral malaria. (WHO 2014). In
adults, multi-organ involvement is frequent. (WHO 2014)
In endemic area because of partial immunity development, asymptomatic infection can occur
(WHO 2010). Clinical relapse may occur with P. vivax and P. ovale, weeks to months after the
first infection. This is because of dormant liver forms known as hypnozoites (absent in P.
falciparum and P. malariae), which require special treatment. (WHO 2014)

2.1.9. Diagnosis

[Link]. Rapid diagnostics

WHO recommends parasitological confirmation by microscopy or by Rapid Diagnostic Test
(RDT) for all suspected cases of malaria before treatment is started. (WHO 2010)

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Rapid malaria tests require minimal skill to perform and interpret. The rapid antigen detection
test (RDTs) detects parasite proteins in finger-prick blood, but its sensitivity falls with a low
level of parasitemia. (PAHO 2008)

1.9.2. Traditional diagnostics

Thick and thin peripheral blood smears, stained with Giemsa stain, remain the gold standard for
routine clinical diagnosis that permits the identification of species and quantification of
parasites. (PAHO 2008). Malaria should not be excluded until at least 3 negative blood smears
are obtained within 48 hours. (PAHO 2008)

Diagnosis should be promoted in pregnant women in endemic areas in order to ensure accurate
diagnosis of malaria and to reduce unnecessary use of antimalarial in pregnancy. (PAHO 2008)

2.1.10. Treatment
Pregnant women with symptomatic acute malaria are a high-risk group, and they must promptly
receive effective antimalarial treatment.

[Link]. First trimester (treatment of uncomplicated Falciparum malaria)

Despite a limited number of prospective studies, antimalarial medicines considered safe in the
first trimester of pregnancy are quinine, chloroquine, clindamycin and proguanil.

Quinine plus clindamycin to be given for 7 days (artesunate plus clindamycin for 7 days is
indicated if this treatment fails). An ACT (artemisinin-based combination therapy) is indicated
only if this is the only treatment immediately available, or if treatment with 7-day quinine plus
clindamycin fails, or if there is uncertainty about patient compliance with a 7-day treatment.
[Link]. Second and third trimesters
ACT known to be effective in the country/region or artesunate plus clindamycin for 7 days or
Quinine plus clindamycin for 7 days. If clindamycin is unavailable or unaffordable, then the
monotherapy should be given.

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2.1.11. Treatment of severe malaria in pregnancy

Table 1: WHO definition of severe malaria

Clinical features: Laboratory findings:

• impaired consciousness or unrousable coma • • hypoglycaemia (blood glucose < 2.2 mmol/l or <
prostration, i.e. generalized weakness so that the 40 mg/dl)
patient is unable to walk or sit up without • metabolic acidosis (plasma bicarbonate < 15
assistance mmol/l)
• failure to feed • Severe normocytic anaemia (Hb < 5 g/dl, packed
• multiple convulsions – more than two episodes in cell volume < 15%)
24 h • haemoglobinuria
• deep breathing, respiratory distress (acidotic • hyperparasitaemia (> 2%/100 000/μl in low intensity
breathing) transmission areas or > 5% or 250 000/μl in areas of
• circulatory collapse or shock, systolic blood high stable malaria transmission intensity)
pressure < 70 mm Hg in adults and < 50 mm Hg • hyperlactataemia (lactate > 5 mmol/l) • renal
in children impairment (serum creatinine > 265 μmol/l). .
• clinical jaundice plus evidence of other vital
organ dysfunction • haemoglobinuria
• abnormal spontaneous bleeding
• pulmonary oedema (radiological)
In treatment of severe malaria, saving the mother’s life is the primary objective.
Intravenous artesunate reduces more deaths related to severe malaria than intravenous quinine.
WHO therefore recommends treatment of severe malaria in pregnancy with intravenous
artesunate in the second and third trimester.

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Table 2:World Health Organization recommendations for the treatment of severe malaria
in pregnancy

First trimester Second to third trimester

P. falciparum Either IV artesunate or quinine can be used IV artesunate should be used in preference
to quinine
P. vivax Either IV artesunate or quinine IV artesunate should be used in preference
to quinine
Suppressive prophylaxis with chloroquine
until delivery Suppressive prophylaxis with chloroquine
until delivery
Post-delivery, women should receive
radical treatment with primaquine Post-delivery women should receive
radical treatment with primaquine
All severe malaria Treatment must not be delayed. If only one of the drugs artesunate, artemether, or
quinine is available, it should be administered immediately

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CHAPTER THREE

RESEARCH METHODOLOGY

3.1. Research Design

The researcher employed a descriptive cross-section all study design to collect data from
eligible and voluntary respondents in January 10th and February 10th 2023, to achieve the
objectives of the research. The researcher used the design to collect primary data on the
knowledge and practice leading to exposures and outcomes associated with malaria infection
in pregnancy, in a single contact with the respondents.

3.2 Area of the study

The study was carried out in the Bamenda Regional Hospital. The Bamenda Regional Hospital is
located in the Azire Health area, Bamenda Health District in the North West Region of
Cameroon. It is one of the ten Regional Hospitals in Cameroon and it had had the status of a
second referral hospital and also serves as a teaching hospital. It is situated about 500meters from
the hospital round- about and about 300meters to the Regional Delegation of public health on the
way to Ntarinkon parked. The hospital has four hundred beds and staff strength of 457workers
offering both general and specialize care on out-patient and in-patient bases.

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Figure 2: Front view of the Bamenda regional Hospital

Figure 3: The study site; Regional Hospital Bamenda [Regional Hospital Bamenda Google map].

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3.3 Study Period

The study was carried out over a period of one month from January to February 2023.
3.4 Population of the study

All pregnant women attending antenatal at the Regional Hospital, Bamenda

3.5 Inclusion and Exclusion Criteria

3.5.1 Inclusion Criteria

Those who came for ANC and were willing to participate in the study
3.5.2 Exclusion Criteria

Those who not willing to part takes of the study were excluded

3.2. Sample size and Sampling Techniques

The sample size for this study involves 45 pregnant women who come for antenatal services and
attended Outpatient Department of the Bamenda Regional Hospital. The technique used for this
sampling is simple random one. Every pregnant mother who came for antenatal services was
eligible, with or without symptoms of Malaria. Laboratory number assigned to the subjects by
the Hospital clinical laboratory department was maintained, put on questionnaires and blood
smears of each individuals.

Sample size calculation

The population sample size was calculated using the Fishers formula as seen below/

Estimated population

Therefore,

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[But n=45, and E=0.05]

3.3. Instrument for data collection

The instrument used for data collection in this research is self-designed questionnaires
containing relevant questions.

3.3.1. Method for data collection

The self-designed questionnaires were distributed by the researcher in the study area and a time
given to the respondents to fill them after which she went back to collect the filled
questionnaires.

3.3.2. Method for data analysis

Data obtained was recorded, checked for completeness then compiled and analyzed using
statistical package for social sciences (SPSS) software and Microsoft Excel 2019 and presented
in form of frequencies and tables.

Prevention

Vector (mosquito) control is the main way to reduce malaria transmission at community level.

At the individual level, protection against mosquito bites is the main preventive measure.
There are two forms of vector control:

Insecticide-treated mosquitos net (ITNs)

Long-lasting insecticide nets (LLINs) are the preferred form of ITNs. It offers effective
protection against malaria. WHO recommends that all at-risk persons, particularly pregnant
women and infants, sleep under ITNs during the night.
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Indoor spraying with residual insecticides

Indoor residual spraying (IRS) refers to the spraying of all stable surfaces inside human
habitations using an insecticide with residual action. IRS is a powerful way to rapidly reduce
malaria transmission. It is effective for 3-6 months depending on the type of insecticide used.
DDT can be effective for 9-12 months. New forms of insecticides are under development.
Chemoprophylaxis

WHO recommends intermittent preventive treatment (ITP) with sulfadoxine-pyrimethamine for

pregnant women living in high transmission areas at each antenatal visit after the first trimester.

Three doses of sulfadoxine-pyrimethamine are also recommended alongside routine vaccination

of infants living in high-transmission areas of Africa.

Vaccination against malaria

There are currently no licensed vaccines against malaria or any other human parasite.

Insecticide resistance

In recent years mosquito resistance to pyrethroids (the insecticides currently recommended

for ITNs or LLINs) has emerged in many countries (particularly in India and Sub-Saharan
Africa) with a high prevalence of malaria.
This resistance has rarely been associated with decreased efficacy of IRS and LLINs, which
remain highly effective tools.

The development of alternative insecticide is a priority and several promising products are in
the pipeline.

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CHAPTER FOUR

RESULT AND DISCUSSION

This cross-sectional study on the knowledge of pregnant women on the preventive measures of
malaria gave the following raw data.

Table 3: Results for Demographic and Socio-Economic Characteristics of the Participants.

Frequency Percentage (%)

Gender

Female 45 100

Male 0 0

Total 45 100

Age group (years)

Frequency Percentage (%)

17–25 11 24.5

26–31 19 42.2

32 and above 15 33.3

Total 45 100

Marital Status /

Frequency Percentage (%)

Married 36 80.0

Single 3 6.6

Divorced 5 11.2

Others 1 2.2

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Total 45 100

Educational Qualification

Frequency Percentage (%)

Primary 13 28.9

Secondary 19 42.2

Tertiary 9 20

Others 4 8.9

Total 45 100

Occupational Status

Frequency Percentage (%)

Housewife 18 40.0

Business 15 33.3

Others 12 26.7

Total 45 100

Table 4: Knowledge of pregnant women toward effect of malaria in pregnancy

S/No Statement Yes No Total

1 Respondents view on the effect of malaria on pregnant 26 19 45

women

Respondents view on believe that malaria in pregnant women

2 28 17 45
will lead to anemia

3 Respondents knowledge on the mode of transmission of 27 18 45

malaria

4 Respondents view on whether the incidence of malaria in 24 21 45

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pregnancy can be reduced

Respondents’ knowledge on the ways of preventing malaria

5 29 16 45
in pregnancy

Table 5: Knowledge of pregnant women toward prevention of malaria in Pregnancy

S/No Statement Yes No Total

Respondents view on the knowledge in the prevention

1 31 14 45
measure of Malaria in pregnancy

Respondents view on whether the incidence of malaria in

2 27 18 45
pregnant mothers causes complication

Respondents view on whether they believe that malaria in

3 pregnant women is able to kill them if treatment is not 23 22 45
regularly taken.

Respondents view on whether they know any medicine that

4 can be used in the treatment of malaria in pregnant mothers 29 16 45
without negative side effect.

Respondents view on whether they are ready to accept to

5 33 12 45
promote health education on the effect of malaria in

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pregnancy women.

Tableau 1: What choice of preventive methods for malaria do you use and how effective is
it.

Choices Tick ( )

Netting of windows 22

Insecticide-treated mosquitos net (ITNs) 37

Indoor spraying with residual insecticides 3

Chemoprophylaxis 36

Clearing of bushes around the house 6

Wearing of long-sleeve clothes 4

Draining stagnant water around residential areas 7

RESULT
This was a cross sectional study of 45 pregnant women who attended antenatal clinic at the
Bamenda Regional Hospital. The result of the study shows that gender of the participants are all
females 45 (100%). As designed from the sample size of the study to be all pregnant women.
The result shows majority of the pregnant women 19 (42.2%) were in their middle age of
reproduction 26-31 years, 32 and above years 15 (33.3%) while 11 (24.5%) fell between 17-25
years respectively.

Based on the researcher’s findings, 31 (68.9%) of the sample population had adequate
knowledge of preventive measures of malaria, as opposed to 14 (31.1%) who had limited
knowledge of these measures. This point immediately confirms the findings of a study that was

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carried out in Bamenda stating that slightly above 50% of the population had sufficient
knowledge on the preventive measures of malaria.

This research also found out that, 27 (60.0%) of the said sample affirmed that malaria in
pregnancy causes complications, opposing 18 (40.0%) who confirmed their ignorance of these
complications.

It also pleases the researcher to mention the finding of 23 (51.1%) of the sample population who
believed that malaria is able to kill them if not properly managed. This is in opposition to 22
(48.9%) who didn’t believe malaria could go to the length of killing.

To the interest of the researcher and finding, 29 (64.4%) of the sample population knew some
immediate remedy to Malaria (whether traditional or modern), in comparison to 16 (35.6%) who
didn’t have sufficient knowledge of Malaria treatment.

Generally, a majority of pregnant women (82.2%) used one or more malaria prevention method,
birthing 17.8% of pregnant women who didn’t use any preventive measures. Equally, the study
found out that, the dominant malaria prevention practices reported by women were the use of
treated mosquito bed nets (82.2%), use of prophylactics (80.0%), and use of Indoor spraying
residual insecticides (6.7%). Meanwhile, 5 women (11.1%) of the pregnant women affirmed the
use of these preventive measures combined.

Furthermore, the study found out that most dominant challenge faced by pregnant women in the
prevention of malaria in pregnancy was limited access to malaria preventive measures
(Affordability), limited availability of insecticide-treated nets (ITNs) (86.7%), high cost of
malaria prevention (80%), high over-the-counter cost of insecticide-treated nets (ITNs) (25 or
55.6%) and high cost of insect repellant (48.9%). Moreover, the study found that about 13.3% of
pregnant women cleared all bushes around their premises in a bit to prevent the malaria, 8.9%
always ensured they put on long sleave clothes to reduce the risk of mosquito bites, and 15.6%
ensured that all stagnant water around their residential premises were properly drained, all in an
attempt to prevent malaria.

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The researcher also discovered that the majority of the sample population indicated their interest
to promote health education on the effects of malaria in pregnancy.

Figure 4: Gender of participants

The study also revealed greater percentage 36 (80%) of the women were married, single 3
(6.6%), divorced 5 (11.1%), and others 1 (2.2%).

Figure 5: Age group of participants

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The study also revealed majority of the pregnant women had basic education at secondary level
19 (42.2%) though many of them were lower secondary level two, followed by primary 13
(28.9%) and tertiary level 9 (20.0%) and others were 4 (8.9%) respectively.

Figure 6: marital status of participants

The result of this study had established occupation of participants as follows, housewife 30
(66.7%), Business 9 (20.0%), Civil servants 4 (8.9%) and others 2 (4.4%) respectively.

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Figure 7: Educational qualification of participants

The result of this study showed that majority 26 (57.8%) of the pregnant women knows the
effect of malaria on pregnant women compared to 19 (42.2%). The result in the Tables 1&2
shows that majority 28 (62.2%) of the pregnant women had believe that malaria on pregnant
women will lead to anaemia while 17 (37.8%) does not. The result also shows 27 (60.0%) of the
pregnant women are aware of the mode of transmission of malaria infection while 18 (40.0%)
are not. The study also shows that majority of the women 26 (53.3%) know that the incidence of
malaria in pregnancy can be reduced while 19 (46.7%) does not. The study also shows that 29
(64.4%) of the respondents know that there are ways of preventing malaria in pregnancy while
19 (35.6%) does not

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CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1. Discussion
This study was conducted to know the effect of malaria on pregnant mothers. According to the
data collected, 57.8% of the pregnant women know the effect of malaria on pregnant women
compared to 43.2% who don’t know. A majority (62.2%) knew at least one or more side effects
of malaria in pregnant women, with an example being that of anaemia.

They were able to give effects but not limited to anemia, abortion, fetal and maternal deaths. The
study also shows that majority 62.2% of the pregnant women believe that the malaria on
pregnant women will lead to anaemia compared to 38.8%. This support the finding of similar
study carried out in Nkwen District Hospital Bamenda, Cameroon which stated that (66.4%) of
the pregnant women know and believe that malaria in pregnant women were able to give effects
but not limited to anemia.

This study also shows 60.0% of the pregnant women are aware of the modes of transmission of
malaria infection. This supports the finding of similar study carried out in Bamenda, Cameroon
which stated that 70% of the pregnant women know exactly the mode of malaria transmission.
This sharply contrasts with a new study in Ndu, Northwest region, Cameroon 9 years ago which
stated that just 27.9% of the population where aware of the major malaria transmission modes.

This shows that knowledge on malaria was strongly associated with level of formal education as
can be explained by the 42.2% of those who have attained at least high school education and
have been taught lessons on malaria in schools and are also more liable to read, listen and
Comprehend malaria messages. Thus, education remains a powerful tool to empower people to
make positive decisions for themselves and their families. The result of this study also shows that
57.8% of the pregnant women know that incidence of malaria in pregnant women causes
complications compared to 42.2% who does not know. This supports the finding of another study
carried out in Bamenda, Cameroon which stated that (66.4%) know and believe that malaria in

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pregnant women causes complications leading to effects such as anemia, low birth weight, fetal
and maternal death (Dantata, Oyeyi and Galadanci, 2017).

Based on the researcher’s findings, 31 (68.9%) of the sample population had adequate
knowledge of preventive measures of malaria, as opposed to 14 (31.1%) who had limited
knowledge of these measures. This point immediately confirms the findings of a study that was
carried out in Bamenda stating that slightly above 50% of the population had sufficient
knowledge on the preventive measures of malaria.

5.2. Conclusion
This study concluded that malaria in pregnancy is a global burden which its present and future
effect is dangerous to the health of the individual (mother and the foetus in the womb), family,
society and the nation at large (as confirmed by the respondents). Hence an effort must be
channeled towards the prevention, diagnosis, treatment and control of malaria in pregnancy so
the resultant effects of malaria in pregnancy on the mother, unborn child, family, community,
nation and the world will be eliminated.

Although 68.9% of the sample population proved to have adequate knowledge of the
preventive measures of malaria, it still was not worth it. Therefore, the researcher found the need
to sensitize pregnant women of the preventive measures of malaria, giving them sufficient
knowledge of its prevention.

5.3. Recommendations
➢ Adequate health education on malaria control and preventive strategies should be
given to pregnant women when they visited health care facility for ante- natal care
services.

➢ More and more sensitization campaigns should be organized in order to keep pregnant
women informed of the cause, effect of malaria, and most importantly the appropriate
malaria preventive measures.

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5.4. Limitation
Sampling was limited to Bamenda Regional Hospital. Further studies are encouraged in more
hospitals within the Northwest region to broaden the scope of investigations.

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APPENDICES

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39