1. INTRODUCTION
Malaria is of great endemic in Nigeria (Hemingway and Bates 2003).Malaria is one of the most common infectious diseases and of great threat to human`s health worldwide, especially in the tropical and developing countries like Southeast Asia and Africa. However, Malaria is a parasitic diseases transmitted through the bite of an infected female Anopheles mosquito when it feeds on the host (Rawlins et al 2008). An estimated approximately 30% of the Nigerian population are faced with high level of malaria transmission intensity while 67% live in moderate transmission zone (FMOH, 2008).Children at the under age of five and pregnant women are the more likely to be at high risk with the Plasmodium falciparum which is the main cause of the severe clinical Malaria and death toll (TDR and WHO 2002). Furthermore, the presence of these Plasmodium falciparum can be confirmed in the laboratory by the examination of blood. In Nigeria, these affects the social well-being and is one of the major cause of poverty exacerbates the malaria situation. Moreover, because of the seriousness and enormous problem caused by the parasite, the W.H.O, UNICEF, UNDP and WB have joined the forces globally to deal and to strategize the means to control the effect/effort of the malaria with the aim of reducing the mortality rate (World Bank 2001). In developed country several methods are applied in order to curtail the spread of the disease by the use of insecticide treated net, Indoor residual spraying, Anti- malaria drugs, and creation of an awareness through education and so on.
However, lack of knowledge on how to control these endemic disease in Nigeria have led to the high cases of the disease all over the country. Therefore, the aim of this essay is basically to examine the common ways the spread and the existence of these disease (Malaria) can be control in Nigeria.
2. WAYS OF CONTROLLING MALARIA.
2.1 Use of Insecticide Treated Nets.
Frequent use of ITNs in Africa reduces mortality rate by 20% (Lengeler, 2004), and these have a substantial impact on malaria morbidity in pregnant women and in children. Where there is high community coverage, ITNs does not only protect those who sleep under the net but also protects those near the dwelling (Hawley et al 2003). However, promoting or encouraging the quick and sustained scale up in the use of ITNs is one of the key approach by the Roll Back Malaria partnership to the reduction of malaria morbidity and mortality in Nigeria. Furthermore, in order to obtain the maximum public health in Nigeria, ITN needs to be spread amongst population groups which are more vulnerable to the malaria infection and its result/effects, especially pregnant women and infants under the age of five (WHO and UNICEF 2005). Habitual practices of these method (ITN) in Nigeria can reduce the biting rate and daily survival rate of the malaria vector mosquitoes, thus reducing the victim cases in the area.
2.2 Community Participation and Education
Community engagement is an important means for a successful malaria control (Atkinson et al 2011).For an environmental management strategy to progress in reducing the malaria threat in Nigeria, full participation of the community is of highly demanded. When only small percentage of people destroys mosquito breeding habitant (sites) around their residential homes, mosquito will just breed in a close by bodies of water and hence, there will be no reduction in the total mosquito population. However, a threshold amount of stagnant water ought to be drained in order to significantly reduce the mosquito population in the area. This pinpoint the important or benefit of viewing environmental based malaria control as a collective action problem. However, if most Nigerians will at least contribute a small amount of time in performing environmental sanitation, the entire nation will benefit from the reduced malaria incidence.
Furthermore, using school education can further increase the community awareness and promote the knowledge among the children, the parents and the entire communities in Nigeria, in order to take additional action for malaria control, therefore, educational program can be used in many situations to promote national participation in controlling malaria activities. Indian program used folk theatre to educate people about malaria prevention and control (Ghosh et al 2006).This program led to significantly increase in knowledge and in participatory bioenvironmental malaria control activities Furthermore, in Sri Lanka full participatory exercises were carried out in the field to identify the bleeding sites of the mosquito (Yasuoka et al 2006b). When all these practices can be seen among the Nigerians the effect of malaria spread will drastically lowered.
2.3 Antimalarial Therapy
This is one of the method that could be used to treat and control malaria infection. The use of Artemisinin derivatives are highly active antimalarial with a rapid onset of action, hence when administered with combination of other antimalarial drugs will slow the elimination rate of the drug example Lumefantrin short courses of treatment have been known to be highly effective (WHO 2006). These can equally decrease the parasite load. Furthermore, Artemisinin have gametocidal features which can have an important effect on the malaria incidence. Therefore, these therapy can lower the transmission of the infection of the infection by inhibiting its gametocyte development, hence reducing the dissemination of resistant parasites. Evidence shows that a more quick time to gametocyte clearance with Artemether/Lumefantrin (AL) than any other antimalarial combination (Lefevre et al 2001). When these drugs are administered among the infants and the pregnant women in Nigeria, however, it will reduce the number of malaria cases in Nigeria.
2.4 INDOOR RESIDUAL SPRAYING (IRS)
IRS is one of the main and effective method of malaria control recommended by the WHO. But nevertheless, it remains underutilized in the Sub-Saharan Africa (WHO, 2010). IRS is proven and highly active malaria control measure, involves the coordinated, orderly spraying of the interior walls of the homes with an insecticides. The mosquitoes are killed when therely on the walls. Sprayed houses can be protected up to 4-10months, depending on the insecticide used and the housing construction. Initially the WHO had recommended IRS only in the area of sporadic malaria transmissions, however in 2006, the recommendation extended to the endemic areas, Therefore, this method can be considered as one of the major vector control intervention which can be used in Nigeria.
3. MATERIALS and METHODS
The study was carried out at Lagos Island Maternity hospital, Lagos State Nigeria .Lagos is located in the South-western part of Nigeria, an area of tropical rain forest with humid climate where malaria transmission occurs all year round, like any similar part of the country (W.H.O, 2008). However, the study was conducted over a period of 6months between July and December 2009. All the pregnant women who were sick of malaria or any illness were not among the study. Furthermore, those that took antimalarial drugs were also exempted. Questionnaires were administered to the participant in order to get information about their socio-demographic features, insecticide treated net (ITN) usage and intermittent preventive therapy (IPT).
Moreover, the questionnaires generate information about the usual mosquito control method adopted by the participant and which has been used in the previous nights. Hence, they were also specifically questioned about the number of doses of IPT that has been taken during the antenatal visit under the supervision of the health workers.
3.1 Results
Table 1. Effects of Insecticide Treated Nets (ITN) and other control measures on malaria distribution (Efunshile et al 2011).
CONTROL MEASURES NUMBER OF PATIENTS PERCENTAGE OF PATIENT (%) NUMBER OF INFECTED PERCENTAGE OF INFECTED P-VALUE
INSECTICIDE TREATED NET 62 15.50 2.00 3.20
UNTREATED BEDNET 50 12.50 14.00 28.00
INSECTICIDE SPRAY 131 32.80 3.00 2.30 0.0001
MOSQUITO COIL 110 27.50 7.00 6.20
OTHERS 47 11.80 8.00 17.00
TOTAL 400 100.00 34.00 8.50
Table 2.Effects of intermittent Preventive Therapy (IPT) usage on malaria infection. (Efunshile et al 2011).
INTERMITTENT PREVENTIVE THERAPY NUMBER OF PATIENTS PERCENTAGE OF PATIENTS (%) NUMBER OF INFECTED PERCENTAGE OF INFECTED (%) P-VALUE
>1 DOSE 73 18.30 3.00 4.10
1 DOSE 47 11.80 3.00 6.40 0.086
NOT USED 280 70.00 28.00 10.00
TOTAL 400 100.00 34.00 8.50
3.2 Discussion
The most commonly used malaria preventive measures was use of Insecticide spray (32.8%) as shown in Table 1, accompanied by the of mosquito coil usage (27.5%). Only 15.5% depended on the ITN usage as the major method to control mosquito, however, it shows an improvement in the rate of ITN use among the pregnant women in Nigeria which was 4.4% in 2004 (Baume and Marin 2008).Meanwhile, the highest prevalence of infection was seen among those that slept under untreated net as their major method of malaria control with (28.0%). However, the rate of infection was the lowest among pregnant women that used insecticides spray (2.3%), followed by those that used ITN (3.2%) to control mosquito (P=0.0001).
Furthermore, as shown in Table 2, only (18.3%) of the pregnant women took more than one dose of IPT, while (11.8%) had taken a single dosage, therefore, their infection rate among them were (4.1%) and (6.4%) respectively. Moreover, malaria prevalence was highest among the pregnant women that do not received any dose of IPT with (10%).
4. CONCLUSION
This study shows the tremendous effects of malaria in the developing country especially Nigeria, however, this have been as a result of lack of well and informed knowledge of people on which method can be used to tackle the devastating effects of these parasite imposed on the Nigeria especially on Infants and Pregnant women. Furthermore, different methods can be used to control the rate at which malaria cases are seen among the people living in