Evaluation of Malaria Parasitaemia and Assessing the Knowledge, Attitude and Practice of Pregnant Women Attending Health Facilities in Owerri Metropolis towards Malaria Prevention and Control

There are a few investigations on malaria in pregnancy; however, examinations zeroing in on the discernment and current acts of malaria counteraction and treatment among pregnant women are scanty. This examination was pointed toward evaluating the information, recognitions about malaria anticipation with accentuation on information about placental malaria too consistence to utilization of LLIN and IPTP among pregnant women in Owerri, South Eastern Nigeria. A cross-sectional descriptive study was conducted at an emergency department, Federal Medical Centre, Owerri using a pretested questionnaire from 200 randomly selected consenting pregnant women. Acknowledgment of malaria manifestations during pregnancy, information about IPTP and placenta malaria were things used to survey the degree of information about malaria in pregnancy. Their blood tests were additionally diagnosed for malaria parasitaemia. Malaria prevalence in the examination populace by microscopy was 13.5%. mosquitoes to malaria contamination while 31% and 14% related reason for malaria disease to messy encompassing and stale water individually. Malaria Prevention Mentality and Practice in this examination was acceptable (60%) while 18.5% had reasonable practice. All the more so and 15.5% of the respondents had been associated with helpless practice. About 34% of the pregnant ladies rested under a mosquito net frequently study watched factual criticalness between age, occupation and malaria counteraction rehearses (p = 0.014, 0.0089). There was likewise measurably huge relationship between respondent’s training and respondent mentality (p = 0.0034). Information with respect to the utilization of Sulphodaxine primethamine (SP) as medica-tion of decision during pregnancy was restricted (12.0%) as utilization of chloroquine was positioned most elevated (48%). The study showed low peripheral malaria prevalence and furthermore exhibited that pregnant wom-en’s knowledge, mentality and practice towards malaria avoidance was im-pressively all things considered. Be that as it may, there was helpless information about discontinuous preventive treatment of malaria (IPTP) or suggested antimalarial during pregnancy.


Introduction
Malaria is one of the greatest medical issues in sub-Saharan Africa [1], making a colossal weight wellbeing and economy. Malaria disease during pregnancy is a critical general medical condition with considerable dangers for the pregnant lady, her embryo, and the infant kid. Pregnant women are bound to get contaminated with malaria and other extreme disease than non-pregnant women.
Unconstrained fetus removal, preterm conveyance, low birth weight, stillbirth, inherent disease, maternal demise, maternal and fetal passing because of maternal weakness intra uterine development hindrance are a portion of the impacts of malaria contamination during pregnancy. It is more continuous and serious in primigravidae, both during pregnancy and at the hour of conveyance [2].
The seriousness of clinical appearances is dictated by the degree of insusceptibility before pregnancy, which relies upon the power and soundness of nearby malaria transmission. Women gain a defensive resistance preceding pregnancy in regions of high malaria transmission. Malaria contaminations in such zones are commonly asymptomatic, and the current control procedure depends on the avoidance of diseases which includes the organization of intermittent preventive treatment (IPT) of malaria in pregnancy utilizing sulfadoxine pyrimethamine (IPTp-SP) during pregnancy, joined with the utilization of enduring insecticidal nets (LLINs) and case the executives [3] [4] [5] [6].  [5]. A few examinations indicated that the utilization of IPT was imperfect [7] [8] [9]. Regardless of a few progressing malaria end endeavors, the pace of use of preventive measures, particularly IPTp, is as yet inadmissible and is a long way from being general [10].
Organization of IPTp-SP during antenatal visits is viewed as one of the three key mediations suggested by the World Health Organization (WHO) for controlling MiP in stable malaria transmission territories [10]. Prophylactic organization of SP has been discovered to be compelling in forestalling the outcomes of malaria in pregnancy (MiP) (e.g., low birthweight) [11]. WHO suggests in any event three dosages of SP during pregnancy.
In the study, territory little data exists fair and square of information, mentality and consistence of pregnant women to malaria anticipation and treatment.
Great information about the preventive proportions of malaria is a significant propelling power that decides the acknowledgment and severe consistence being used of ITN just as wise take-up of recommended IPT. In this way, it is of need to assess current information about malaria, demeanor and practice towards its avoidance among pregnant women going to a tertiary wellbeing office in Imo state, south eastern Nigeria wherein the results will be emphatically pushed for use in production of sharpening and mindfulness on malaria anticipation and Treatment among pregnant women.

Study Area/Population
The study region is Imo State. Imo State is one of the 36 states of the Federal Republic of Nigeria. It is explicitly in South Eastern Nigeria. It lies between geographic co-ordinates of scope 4045' and 7015'N and longitude of 6050'E with a region of around 5100 sqkm [12] (Imo State Government, 2010). Malaria is endemic and lasting around there, with a top during the blustery season (April to September). The individuals of Imo State are generally open and government employees, nearby economy depends on farming, and the proficiency level is high

Study Design
The plan of the study was descriptive and cross-sectional. Questionnaire was regulated to 288 pregnant women who were going to antenatal centers in both public and private wellbeing offices, among July and December 2017. Medical Center, Owerri. A very much organized arbitrary inspecting technique was utilized to enlist understanding into the study and educated assent was gotten from the women remembered for the study. The incorporation measures for the study included pregnant women with fever or 2 days history of fever with no sign recommending serious malaria going to different antenatal centers in the chose Health offices. The women in this study included primigravida, and multigravida, and were of various instructive foundations and equality.

Data Collection
A structured questionnaire was pretested and administered to the respondents. Data were analyzed using the Statistical Package for Social Sciences (SPSS version 16). Associations between variables were tested using Chi-square tests. A P-value less than 0.05 were considered statistically significant.

Sample Collection
Blood samples were collected and analysed for malaria parasitaemia using Malaria Rapid Diagnostic kit (RDT-SD BIOLINE) and Malaria Blood film microscopy following the standard operating procedures [13]. Parasite density was measured as the number of parasites per 500 leucocytes on a thick film and was calculated as parasites per microlitre of blood assuming an average white blood-cell count of 8000 per µl of blood [14]. The parasite density of blood is expressed as: No of Parasite Count 8000 Parasite density per μl of blood No of Leucocytes WBC count

× =
As part of the Standard Operating Procedures (SOPs) for slide reading in this study another WHO certified Malaria Microscopist re-read each slide and only parasite counts with less than 20% discordance between the first and second reader were accepted. Parasite counts with >20% discordance were read by a third reader, who served as the tie breaker.

Demographic Characteristics of the Pregnant Women
The demographic characteristics of the respondents are summarized in Table 1.  level of education, majority of the respondents had a tertiary education (56.5%) and just about 9% had an informal education.

Respondent's Knowledge about Malaria
From Table 2, we observed that 54% of respondents believed that everyone is susceptible to getting a serious case of malaria, followed by the pregnant women (32.5%). The major signs of malaria infection as observed in this study were Fever (80%), headache (69%), body weakness (59.5%), poor appetite (37.5%) and the least is convulsion (5%).
In the course of this research work, various questions were administered to the various respondents to examine their knowledge level of malaria such as: avoidance, can it be treated, signs, causes, and most vulnerable etc as seen in Table 3.    Figure 1 shows the occurrence of different Symptoms encountered in the present study. Analysis shows that fever (80%) had a significant higher occurrence followed by headache (69%), body weakness (59.5%), poor appetite (37.5%) and

Symptoms and Signs of Malaria in Pregnancy Mentioned by Respondents
the least is convulsion (5%) (p < 0.05).

Malaria Prevention/Avoidance Methods Practiced by the Respondents
Respondents answered questions which gauged their knowledge on malaria prevention. From the results as shown in Table 4      A chi square test of association was performed and result demonstrates a statistical significant between age, occupation and malaria prevention practices p = 0.014, 0.008 (Table 9) respectively. Result also indicated that the knowledge about malaria is associated with age since p = 0.029 whereas no significant association was observed between occupation and Knowledge about malaria p = 0.15 (Table 10). The attitude of respondent on malaria is associated with age and occupation since p = 0.022 and 0.0301 respectively (Table 10).  (Table 14).      Other study done in Nigeria demonstrates that information on the outcomes of malaria during pregnancy was poor among pregnant women [22]; however Obol et al. [21] in their study showed that pregnant women knew at any rate one of the outcomes of malaria disease during pregnancy. This has indicated that 17.5% of the respondents don't realize that malaria in pregnancy may affect them.
As to respondent's information on antimalaria drugs during pregnancy and in youngsters, 13% and 25% showed having no information on antimalaria utilized during pregnancy and kids separately. While greater part (48%) of the respondents actually considered Chloroquine as suggested antimalaria drug despite that the nation through an approach has removed chloroquine as a decision antimalaria drug since 2005. There was holes in information by 13.4% of the respondents expressing that they didn't have the foggiest idea about the antimalarial medications to be utilized during pregnancy and the greater part (88.0%) of the study members didn't know about sulphodaxine primethamine (SP).
This study concurs with Easman et al. [23], that there was a critical relationship between age, occupation and malaria avoidance information, disposition and practice. The huge relationship between respondent's information and respondent's demeanor proposes the degree of training is straightforwardly corresponding to that respondent's information on malaria. World Health association (WHO) and Roll back malaria (RBM) advocates for standard and convenient utilization of LLIN and IPTP as malaria preventive procedures during pregnancy. There should be a significant high information on the abbreviation IPTP among pregnant women. Moreso, Placenta malaria should not to be an unusual wonder among them. The study anyway exhibited low information (26%) of what IPTP infers while just 13.5% of the respondents have caught wind of placental malaria. This calls for more refinement during antenatal visits with the goal that mindfulness is expanded among pregnant women about malaria contamination during pregnancy.

Conclusion
The study demonstrated low peripheral malaria prevalence and good knowledge, attitude and practice (KAP) towards malaria prevention among pregnant women. However, there was poor knowledge about IPTp-SP and/or other anti-malaria drugs recommended during pregnancy. The knowledge of the phenomenon "placenta malaria" was also limited. There is therefore need for further creation of awareness on malaria prevention with IPTp-SP among pregnant women or women of child-bearing age. A conscious scale up on the use of behavioral change communication (BCC) tools is recommended to boost uptake in utilization of long lasting insecticide treated nets.