Assessment of parents/care givers malaria knowledge, home management & factors associated with practice of prevention towards under five children in Damot Gale woreda,wolayta zone, Ethiopia. By: Aklilu Abrham(BSc, MSc in pediatrics and child health) Tuesday, January 21, 2014 1
Presentation outlines Introduction Statement of the problem Objectives Methodology Result & Discussion Conclusion Recommendations Acknowledgement Tuesday, January 21, 2014 2
INTRODUCTION Each year, 300-500 million malaria infections, and 1.5 to 3 million deaths occur due to malaria worldwide, of which 90% occurring in sub Saharan Africa mostly in young children.( WHO, RBM, 2005) Most children die from malaria at home without receiving adequate therapy. Only a small number of children with fever are treated at health-care facilities. Approximately 75% of Ethiopia s landmass is endemic for malaria. An estimated 55.7 million people (68% of the population) are at risk for malaria and around 80% of the 736 districts (woredas) in Ethiopia are considered malarious. Tuesday, January 21, 2014 3
Introduction cont ed There were an estimated 216 million episodes of malaria in 2010, of which approximately 81 % were in Africa. Out of malaria deaths occurred in 2010, 91% were in Africa and 86 % involved children under-five years of age. Ethiopia is one of the most malaria-epidemic prone countries in Africa: up to 20% of U5 deaths by malaria Tuesday, January 21, 2014 4
Statement of the problem Today in Ethiopia, more children survive to their fifth birthday than ever before (UNICEF 2012, in EPS) Bringing basic health services to the doorstep of the rural population, the health extension programme has made a significant contribution. But, still every year, nearly 260,000 Ethiopian children never reach their 5th birthday that amounts to around 700 children dying every day, mostly from preventable diseases Tuesday, January 21, 2014 5
Statement of the problem Ethiopia FMOH has planned to achieve malaria elimination and control by 2015. But the recent data shows there is a gap b/n the plan and achievements (MIS2011 shows LLIN possession 55% and utilization 38%). Can Damot Gale Woreda achieve malaria control and elimination in despite of these current situation? To answer this Tuesday, January 21, 2014 6
Objectives General objective Assessment of parents/care givers malaria knowledge, home management & factors associated with practice of prevention towards under five children in Damot Gale woreda,wolayta zone, Ethiopia. Tuesday, January 21, 2014 7
Objectives cont ed Specific objectives: 1. Describe knowledge of parents towards malaria causes, method of transmission, and method of prevention. 2. Describe practice of parents regarding home management of fever/malaria in children less than five years. 3. Explore factors affecting practice of malaria prevention. Tuesday, January 21, 2014 8
METHODOLOGY Study area and period -Damot Gale woreda (district) is located in SNNPR, 366 km to south of Addis Ababa. The study was conducted from February to June, 2013. Study design -community based cross-sectional study was conducted. Study unit - parents/care takers of under five children Tuesday, January 21, 2014 9
Sample size determination n= (Zα2)2 (1 P) d2 Z = standardized normal distribution curve value for the 95% Confidence Interval, which is 1.96 P= 0.58 (58.0% of under five children slept under ITN in the previous night before the survey day from previous Ethiopian study. d = 0.05(the margin of error was taken as 5%) the total of 419 sample was taken(10% NR rate added) Tuesday, January 21, 2014 10
Data collection Parents were interviewed for knowledge and practice aspect of malaria, malaria prevention, and home managements. Axillary temperature was taken from every sick child in selected households. When Temp >37.5 oc, blood test was done by using RDTs. Tuesday, January 21, 2014 11
Data processing and analysis After data collection, data was checked for completeness and then entered in to Epi Info version 3.5.1 and exported to SPSS version 16 for analysis. Frequencies and percentages were used to describe the socio-demographic and other variables. Logistic regression (Bivariate and multi-variate analyses), and odds ratio were done to see the association between dependent and independent variables. Tuesday, January 21, 2014 12
Variables of the study Dependent Variable: Practice of malaria prevention Independent Variables Socio-demographic variables of care givers: age, marital status, occupation, literacy status, family size, and number of children less than 5 years of age. Knowledge variables: Malaria causes, method of transmission, and method of prevention. Treatment seeking behavior Tuesday, January 21, 2014 13
6. RESULTS and DISCUSSION Socio-demographic characteristics of respondents A total of 419 respondents were interviewed, and all of them responded for the questionnaire. 82% were mothers Around half of the respondents had no formal education 47% were house wives, and 87% were married. Tuesday, January 21, 2014 14
Result & Discussion cont ed Knowledge about malaria 396(94.5%) had heard about malaria. Three fourth of respondents knew that malaria could be transmitted from person to person. Of whom 95% correctly related it with the bite of infective mosquito. Tuesday, January 21, 2014 15
Result & Discussion cont ed This is similar with a study done in Nigeria (Adedotun OAMABO, 2010), Yaoundé city in Cameroon (Ndo. 2011), and Jimma (Ameyu Godeso, 2008), in which 93.2%, 88.2%, 88.6% perceived mosquito bite as the cause of malaria respectively. Tuesday, January 21, 2014 16
Result & Discussion cont ed 88% responded that malaria was a preventable disease. Regarding knowledge of malaria prevention methods, 322(92%) knew source reduction & bed net use concerning practice of prevention, 293(83.7%) practiced source reduction, 239(63.1%) have owned bed nets Tuesday, January 21, 2014 17
Result & Discussion cont ed Regarding bed net possession and utilization, 378(95.5%) of respondents heard about bed net 239(63.1%) had bed net in their families. Of whom 174(73.4%) possessed one, 51(21.5%) had two, and 12(5%) had possessed three ITNs. Tuesday, January 21, 2014 18
Result & Discussion cont ed Concerning purpose of utilization, 97(40.6%) were using it to prevent mosquito naissance 137(57.3%) to prevent malaria During survey time, 209(87.1%) children slept under a bed net prior night(reported utilization). Tuesday, January 21, 2014 19
Result & Discussion cont ed Compared to the Ethiopian malaria indicator survey of 2011,the ITN possession in this site was (73.4% own at least one ITN) higher than the national average (in areas <2,000m, 55.2% and >2,000m,37.9% own at least 1 ITN) and regional average (in SNNPR 57.2% have at least one ITN ) It was also higher than that of ITN possession(at least one) in Sub-Saharan Africa which was 53% by 2011 and 2012.( WHO malaria report, 2012) Tuesday, January 21, 2014 20
Result & Discussion cont ed Number of under-five children who had slept under LLINs the prior night during data collection in this site was 209(87.1%) which is higher than national references(in areas <2000m, 38.2%) and also regional average of 42.3% in SNNPR.(MIS 2011). This was also higher than that of Sub-Saharan average of 2011 and 2012 of 33%(WHO, malaria report of 2012). Tuesday, January 21, 2014 21
Result and Discussion cont ed Practice of malaria prevention in this site was also better than that of the findings of urban areas of Asosa zone, in which 258(44.4%) of respondents use bed nets, and 188(32.4%) practice clean environment during the time of data collection (Yared Legese, and et al, 2007). But it was less than WHO recommendation of universal access to LLINs (100% c0verage, WHO malaria report 2012). Tuesday, January 21, 2014 22
Factors associated with practice of malaria prevention Role of being mother (AOR=5.5, 95%CI=1.2-25.8), knowledge of method of malaria prevention (AOR=44.3, 95% CI=11.5-171), and treatment seeking behavior (AOR=18.9, 95%CI=5.3-67.5) had shown significant association. Mothers are 5.5 times more likely to use malaria prevention methods than non-mothers. Those who knew malaria prevention methods are 44.3 times more likely to practice prevention of malaria Tuesday, January 21, 2014 23
Result and Discussion cont ed Respondents who have good treatment seeking behavior are 18.9 times more likely to practice prevention methods when compared to those with poor treatment seeking behaviors. Table 7 Tuesday, January 21, 2014 24
Home management of fever/ malaria 38(9.1%) children developed fever/ malaria 32(91.4%) managed fever at home with modern antimalarial drugs. Majority 27(84.4%) of children started anti-malarial treatment after 24 hour while only 5(15.6%) started treatment within 24 hours. 29(90.63%) of respondents had access within 30 min Tuesday, January 21, 2014 25
Result & Discussion cont ed Prompt access to treatment is lower than that of Jimma town 26.6% (Ameyu Godeso, 2008), Dembia 35.1% (Worku Tefera, 2005 )and Ghana 84% (G. O. ADJEI AKD, and et al, 2008) within 24hrs. Promptness to treatment in this site was also very far from Roll Back Malaria recommendation of 60% of under-five children should have access to appropriate treatment for malaria within 24 hours of the onset of symptoms. Tuesday, January 21, 2014 26
Result & Discussion cont ed Regarding treatment seeking behavior of respondents, more than three fourth (78.12%) got treatment from health facilities first, and then managed at home. From those who seek treatment at home first and only at home 7(21.8%), 6/7 didn t recover Tuesday, January 21, 2014 27
Conclusions Bed net possession was 63.1%. According to Roll Back malaria and FMOH plan, this finding is very low to achieve 100% utilization rate by 2015. Fever/Malaria prevalence in children was 9.1% which is less than national average of 17%. Tuesday, January 21, 2014 28
Conclusion cont ed Health care facilities are accessible for 90% of study population with a walking distance of less than 30 minutes but only 15% of sick children started anti-malarial treatment within 24 hours. This indicates treatment seeking behavior was poor. 86% of children who were treated only at home or home first didn t recover. So, treating febrile children only at home or home first was not effective. Tuesday, January 21, 2014 29
Recommendations Bed net possession should be enhanced from 63.1% to at least 80% working strongly with HEWs and health development army. ITN utilization rate in U5 children was 87.1%. This is a good practice, so it should be appreciated and enhanced to 100%. Prompt access to modern anti-malarial treatment from health institutions was very low (15%). Increasing the community s knowledge and attitude towards prompt access to treatment within 24 hours is required. Tuesday, January 21, 2014 30
Acknowledgement AAU, Collage of HS, School of Nursing & Midwifery Haramaya University FMOH Malaria Consortium EPS Asrat Demissie(Assistant Professor) All of you Lastly, my families Tuesday, January 21, 2014 31
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