CHAPTER ONE
- INTRODUCTION
Malaria is a major public health problem and cause of much suffering and premature death in the poorer areas of tropical Africa, Asia and Latin America particularly among young children (Cheesbrough, 2010). Children under five years of age are one of the most vulnerable groups affected by malaria. There was an estimated 438,000 malaria deaths around the world in 2015 of which approximately 69% were in children under five years of age. In high transmission areas, partial immunity to the disease is acquired during childhood. In such settings, the majority of malarial disease and particularly severe disease with rapid progression to death occurs in young children without acquired immunity. Severe anaemia, hypoglycaemia and cerebral malaria are features of malaria more commonly seen in children than in adults (WHO 2016).
Malaria is an infection caused by parasites of the Plasmodium species. There are four major species of the parasite that infect man. These are P. falciparum, P. vivax, P. ovale and P. malariae. P. Knowlesi  is rare.
The age distribution of cases of malaria is influenced strongly by the intensity of malaria transmission. In areas where the population is exposed only occasionally to an infectious bite, malaria occurs in subjects of all ages, often most frequently in adults who have occupational risk. In contrast, in areas of high transmission, the main burden of malaria including all malarial deaths is in young children. Until recently, malaria transmission in most endemic areas of sub Saharan Africa was moderate or high and control measure consequently focused on the protection of young children and pregnant women. However, enhanced control efforts have recently reduced the level of malaria transmission in many areas where transmission was previously hyper or holo endemic, it has become mesoendemic. As a consequence, children are acquiring immunity to malaria more gradually than in the past and clinical attacks, sometimes severe, are occurring in school age children more frequently. However, the epidemiology and management of malaria has until recently received little attention (Brooker et al., 2008, Brooker, 2009). In this review, information on the current burden of malaria in African school age children is presented and novel approaches that are being explored to control malaria in this increasingly important groups are reviewed (Nankabirwa et al., 2014).
1.1. STATEMENT OF THE PROBLEM
African children under five years and pregnant women are most at risk of malaria. The prevalence and consequences of malaria among infants are not well characterised and may be underestimated. A better understanding of the risk for malaria in early infancy is critical for drug development and informed decision making. Targeted preventive interventions, adequate drug formulations and treatment guidelines are needed to address the sizeable prevalence of malaria among young infants as well as children in malaria endemic countries (Ceesay et al., 2015). Fatally afflicted children die less than 72 hours after developing symptoms. In those children who survive, malaria drains vital nutrients from them impairing their physical and intellectual development (WHO 2000).
The diagnosis of malaria based on clinical symptoms alone is not reliable. It can result in unnecessary expenditure, incorrect use of antimalarial drugs with increased drug resistance spreading and a delay in establishing the correct diagnosis and treatment of a patient. Studies continue to show that malaria is being massively over diagnosed and over treated. Therefore, laboratory support is needed to diagnose malaria especially in children between ages 1-5 years and pregnant women in areas of stable malaria (intense malaria) transmission where serious epidemics may occur and diagnosis can be difficult during times of low malaria transmission (Cheesbrough, 2010). It is estimated that more than one million children living in Africa die yearly from direct and indirect effects of malaria infection. This preventable disease has reached epidemic proportions in many regions of the world and continues to spread unchecked. Malaria infections represent substantial costs due to school absenteeism and reduced economic productivity. Malaria costs Africa more than US $12 billion annually. A poor family living in malaria infected area may spend up to 25% or more of its annual income on prevention and treatment of malaria (Nwaorgu and Orajaka 2011).
1.2. STUDY JUSTIFICATION
Many studies have been carried out in order to check the spread of malaria in different parts of the world among different groups of individuals. This particular study seeks to determine the spread of malaria among school children in a rural area like Anambra state where there are stagnant water bodies and rivers which breed mosquitoes and poor housing thereby making the children vulnerable to attack by the disease. Though there are also limited number of enlightened parents; and health campaigns that have been taking place in the communities in the recent past.
1.3. AIMS AND OBJECTIVES
- To ascertain the prevalence of malaria parasite infections among school aged children (5-10 years) living in rural communities of Anambra state.
- To detect and identify the various species of Plasmodium in the blood samples of the children.
- To quantify the parasite load in each of the children.
- To ascertain relationship between parasite load and use of insecticide treated mosquito nets.
1.4. RESEARCH QUESTIONS
- What is the prevalence of malaria among school aged children (5-10 years)?
- What is the parasite density in the children studied?
- What type of Plasmodium species are prevalent in the study area?
- How does the use of insecticide treated mosquito nets relate to the parasite load of the children?
1.5. HYPOTHESIS
- There is no significant difference in the prevalence of malaria by age of children
- There is no significant difference in the prevalence of malaria by community.
- The number of male and female children infected by malaria does not differ significantly.
- Prevalence of malaria does not differ significantly by the use of insecticide treated bed nets.
