Malaria: Knowledge and prevention practices among school adolescents in a coastal community in Calabar, Nigeria

Background: Malaria prevention and treatment constitute an unbearable economic burden to most African countries, especially south of the Sahara, where about 500 million cases occur annually. The problem of malaria among adolescents has largely been overshadowed by the huge burden of the disease among young children. Attention to malaria among adolescents has also been diverted by the huge burden of HIV/AIDS among adolescents. Some surveys reveal a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Such a knowledge gap could have an adverse effect on school children, who could be used as change agents and as role models for their siblings and peers in the malaria control strategy. Objectives: To determine the malaria prevention practices of school adolescents in the coastal community of Calabar, Nigeria. Method: This was a cross-sectional survey involving secondary schools in southern Calabar. Four hundred adolescents were randomly selected from the 4565 learners in 5 out of 17 secondary schools in southern Calabar, Cross River State, Nigeria. A self-administered, semi-structured questionnaire was administered to the respondents. Results: Most respondents (77.5%) were aware that the vector transmits the malaria parasite through biting. Fewer respondents would prevent malaria attacks by clearing the vegetation in the peri-domestic environment (13.5%), filling up potholes (16.9%), opening up drainage (11%), using insecticide-treated nets (25.7%) or using antimalarial drugs (11.2%). Less than one-tenth (8%) would use various other methods such as not accepting unscreened blood, while only 11% obtained the information from their teachers. Conclusion: The study identified knowledge gaps among school children. There is a need to empower teachers with information about the cause of malaria and prevention strategies. Vol. 2 No. 1 Page 1 of 4 INTRODUCTION More than 20% of humanity is affected by malaria.1 The human and economic costs associated with declining quality of life, consultations, treatments, hospitalisation and other events related to malaria are enormous and often lead to low productivity and lost incomes.2 In sub-Saharan Africa, where 90% of the world’s malaria occurs, about 500 million cases are recorded annually with hundreds of thousands of child deaths. In Nigeria, like in many west-African countries, malaria is a major cause of morbidity and mortality. It is estimated that over 50% of Nigerians suffer at least one bout of malaria every year.3 Among school adolescents, malaria is responsible for school absenteeism, poor performance in school, examination failures, school dropouts and even death. The problem of malaria among adolescents has largely been overshadowed by the huge burden of HIV/AIDS among this younger age group.4 The younger age group has been identified as bearing half of the burden of HIV worldwide.5 As much as 60% of school children’s learning may be impaired by malaria.6,7,8,9,10 Experiences with malaria have shown that prevention is better and cheaper than cure; however, the practice of malaria preventive measures has been related to the knowledge and belief of people.11 Malaria-related knowledge, attitudes and practices have been examined in many rural and partly urban multi-ethnic populations in Africa.12,13,14,15 Within Nigeria, surveys of residents of the Atlantic coast revealed a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy.16 The 1998 Roll Back Malaria (RBM) initiative, launched in Geneva by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and the World Health Organization (WHO), is a people-oriented programme that emphasises community participation. School children could contribute immensely to its success. Malaria-intervention goals in endemic areas should be to prevent mortality and reduce morbidity, as well as associated socio-economic losses. This requires the progressive creation of capacities for assessing the local malaria situation and selecting appropriate control measures.2 Correct knowledge of a health problem, when combined with the right attitude, can lead to healthy behaviour and practice.17 Being the most educated in most rural communities, school adolescents’ knowledge, attitude and practice regarding a health problem can easily influence those of their peers, parents and other members of their communities. School adolescents, therefore, constitute a formidable community entry point for the control of malaria under the people-oriented malaria control strategy, the RBM programme. A critical mass of knowledgeable school adolescents, with the right attitude towards the RBM programme, could act as a catalyst for community involvement in rolling back malaria. This is critical for the right practice of the RBM programme as well as programme sustainability. Studies of malaria-related knowledge, attitudes and practices, have been widely used in research on malaria and have proved useful tools in shaping policy formulations as well as guiding programme implementation.11,12,16 Original Research Udonwa, Gyuse & Etokidem PHCFM http://www.phcfm.org A fri ca n Jo ur na l o f P rim ar y H ea lth C ar e & F am ily M ed ic in e