CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria is a life threatening parasitic disease transmitted by female Anopheles mosquitoes. In Nigeria, malaria is responsible for around 60% of the out-patient visits to health facilities, 30% of childhood death, 25% of death in children under one year and 11% of maternal deaths (National Population Commission, 2008; Noland et al., 2014). Similarly, about 70% of pregnant women suffer from malaria, which contributes to maternal anemia, low birth weight, still births, abortions and other pregnancy-related complications (Federal Ministry of Health Abuja, 2005).

Presently, malaria remains one of the worst menaces of tropical countries of the world. It is a killer and debilitating disease that affects the physical and economic well-being of people living in endemic areas of Africa (WHO, 2008). Pregnant women are among those in the higher risk group (Okwa, 2003). Recent global estimate shows that there are between 300 – 500million clinical cases of malaria and between 1.50 – 2.70million deaths attributed to malaria annually (Greenwood, 2005). Pregnant women are at immense risk of malaria due to natural immune depression in pregnancy (Fievet, 2008). Hence, it is one of the most important health issues affecting pregnant women as it has a risk of jeopardizing the life of the woman or the fetus (WHO, 2010).

Traditional herbal medicine could be described as “herbs, herbal materials, herbal preparations and finished herbal products whose content includes active ingredients parts of plants, or other plant materials, or combinations”. Herbal medicines can be in the form of liquids, powder, capsules, tablets or ointments. Some are pre-packaged while others are prepared when needed and are used not only to cure illness but to maintain or boost one’s health (WHO, 2002). In Africa, reliance on herbal medicines is relatively high and the global use of herbal medicine is growing. Most pregnant women believe that these medicines are ‘natural’ and ‘safe’ com­pared to modern drugs. Besides, traditional medicine is believed to treat medical problems and improve health status during pregnancy, birth and postpartum care in many rural areas (Khadivzadeh and Ghabel, 2012).

Erhun, Agbani and Adesanya, (2004) opted that many pregnant women that are involved in such practice acquire the knowledge from relatives, neighbours, friends, traditional medicine dealers and sometimes media (Shah, 2004). The situation is predominant due to the limited antenatal health delivery centers and defective functional health institutions (Rohra, 2008); poor medical services and attitude of medical staff; lack of professional control of pharmaceutical products (Abrahams and Jewkes, 2002) as well as high illiteracy level and cost of synthetic malaria medicine over traditional orthodox ones (Dossou-Yov, 2001).

In addition, several factors such as; socioeconomic status of the women, poverty issues, cultural perception, age, sex, income level, religion and belief of certain diseases’ entity and their perceived responses to indigenous medications have been widely reported as indicators that influences their attitude (WHO, 2002); Hence, herbal traditional medication for curing malaria has become a norm and is widely practiced and patronized by pregnant women owing to general ease of access, social and cultural influences, perceived efficacy and beliefs about its safety (Langloid-Klassen, 2007).

Kyomuhendo (2005) noted that pregnant women decisions regarding health and antenatal care attendance are influenced by the patriarchal system of society that gives men control over resources to the disadvantage of women. This study therefore, aims at examining the use of traditional medicine in the treatment of malaria among pregnant women in Abraka, Delta State, Nigeria.

1.2 Statement of the Problem

Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world and Nigeria in Particular. The burden of malaria infection during pregnancy is caused mainly by Plasmodium falciparum, the most common malaria species in Africa (WHO, 2010). Pregnant women and the unborn children are particularly vulnerable to malaria, which is a major cause of prenatal mortality, low birth weight, and maternal anaemia (Greenwood, 2007). Malaria during pregnancy compounds or provokes anaemia, which, when severe, increases the risk of maternal death (estimated at around 10,000 deaths annually), low birth weight (linked to around 100,000 annual infant deaths in Africa), pre-term delivery, congenital infection and reproductive loss of overwhelming morbidity and mortality (Fakeye, 2009).

There have been a considerable number of reports about poor knowledge, attitudes, and practices among pregnant women relating to malaria and its control from different parts of Africa. The disease remains the world’s most important tropical health challenge. Access to medical care is limited in many malaria-endemic areas and where medical services exist, they commonly lack facilities for laboratory diagnosis, and treatment option. This forces these pregnant women to use various forms of substances and traditional herbs for curing malaria.

1.3 Purpose of the Study

The main objective of the study is to examine the use of traditional medicine in the treatment of malaria among pregnant women in Abraka, Delta State. While, the specific purpose includes;

    To determine influence of socio-economic status on the use of traditional herbs in the treatment of malaria among pregnant women.

    To find out the extent to which the age of pregnant women determine the use of traditional herbs for the treatment of malaria.

    To find out the extent to which the level of education of pregnant women determine the use of traditional herbs for the treatment of malaria.

    To examine the extent to which the locality of pregnant women determine the use of locally made herbs for treatment of malaria.

1.4 Research Question

The following research questions were raised in this study;

    What is the difference in socio-economic status on the use of traditional herbs in the treatment of malaria among pregnant women?

    What is the difference in the ages of pregnant women on the use of traditional herbs for the treatment of malaria?

    What is the difference in the level of educational background of pregnant women in the use of traditional herbs for the treatment of malaria?

    What is the difference in the locality of pregnant women in the use of traditional herbs for the treatment of malaria?

1.5 Research Hypotheses

The following null hypotheses were formulated in the study:

    There is no significant difference between the Socioeconomic status in use of traditional medicine for the treatment of malaria among pregnant women in Abraka.

    There is no significant difference between the age groups in the use of traditional medicine for the treatment of malaria by of pregnant women in Abraka.

    There is no significant difference between the levels of Education in the use of traditional medicine for the treatment of malaria among pregnant women in Abraka.

    There is no significant difference between Urban and Rural areas in the use of traditional medicine for the treatment of malaria by pregnant women in Abraka

1.6 Significance of the Study

The findings from this study would be useful to the following; pregnant women, ministries of health, parastatals, health sectors, policy makers and government.

Women:

the study will help them to develop a positive attitude towards antenatal care and the possible dangers in the use of traditional herbal medicine in malaria prevention and treatment among pregnant women.

Health sectors: Health practitioners would benefit from this study; as it would help them in caring adequately and planning well for pregnant women attending antenatal clinic when treating them for malaria.

Ministries:

This study would be of great importance to ministries of health by informing them on the importance of this study is to address the issue concerning the attitude towards the use of traditional herbal medicine for the treatment of malaria among pregnant women attending antenatal care and to organize enlightenment programmes aimed at enhancing the attitudes of pregnant women towards frequent antenatal clinics.

Policy makers:

This study will help policy makers to formulate relevant policies on malaria prevention while making informed decisions on the steps to follow in increasing antenatal care attendance levels among pregnant women attending Teaching Hospital in River State

Government:

This study would be useful to government and parastatals by educating them on the need to provide concerted health education intervention to improve the attitude and knowledge of pregnant women regarding poor health seeking behavior and adequate strategies for malaria prevention especially with the use of insecticide, treated Net, adequate funding, etc. necessary for controlling and reducing incidence of malaria in the general public.

1.7 Scope/Delimitation of the Study

The study is delimited in scope to the use of traditional medicine in the treatment of malaria among pregnant women in Abraka Delta State, Nigeria. The researcher would chose this site because it is easily accessible and students are sent there for their clinical experiences and cases are referred from primary and secondary health facilities to the institution for expert management.

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