Research Article Malariometric Survey of ... - Hindawi.com

Hindawi Publishing CorporationMalaria Research and TreatmentVolume 2013 Article ID 487250 7 pageshttpdxdoiorg1011552013487250

Research ArticleMalariometric Survey of Ibeshe Community in Ikorodu LagosState Dry Season

Oluwagbemiga O Aina Chimere O Agomo Yetunde A Olukosi Hilary I OkohBamidele A Iwalokun Kathleen N Egbuna Akwaowo B Orok Olusola AjibayeVeronica N V Enya Samuel K Akindele Margaret O Akinyele and Philip U Agomo

Malaria Research Laboratory Nigerian Institute of Medical Research 6 Edmond Crescent PMB 2013 Yaba Lagos 101212 Nigeria

Correspondence should be addressed to Oluwagbemiga O Aina gbengaaina2003yahoocom

Received 19 February 2013 Revised 30 April 2013 Accepted 7 May 2013

Academic Editor Polrat Wilairatana

Copyright copy 2013 Oluwagbemiga O Aina et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Malariometric surveys generate data on malaria epidemiology and dynamics of transmission necessary for planning andmonitoring of control activities This study determined the prevalence of malaria and the knowledge attitude and practice (KAP)towards malaria infection in Ibeshe a coastal community The study took place during the dry season in 10 villages of Ibeshe Allthe participants were screened for malaria A semistructured questionnaire was used to capture sociodemographic data and KAPtowards malaria A total of 1489 participants with a mean age of 267 plusmn 200 years took part in the study Malaria prevalence was147 (95 CI 130ndash166) with geometric mean density of 285 parasites120583L Over 97 of participants were asymptomatic Only40 (27) of the participants were febrile while 227 (181) were anemic Almost all the participants (958) identified mosquitobite as a cause of malaria althoughmultiple agents were associated with the cause of malariaThe commonest symptoms associatedwith malaria were hot body (899) and headache (849) Window nets (770) were preferred to LLIN (296) Malaria ismesoendemic in Ibeshe during the dry season The participants had good knowledge of symptoms of malaria however therewere a lot of misconceptions on the cause of malaria

1 Introduction

Malaria remains one of the greatest causes of morbidityand mortality in the world Global estimate shows thatthere are about 219 million cases of malaria in 2010 (withan uncertainty range of 154 million to 289 million) andan estimated 660 000 deaths (with an uncertainty rangeof 490 000 to 836 000) [1] Malaria mortality rates havefallen by more than 25 globally since 2000 and by 33in the World Health Organisation (WHO) African RegionMost deaths occur among children living in Africa wherea child dies every minute from malaria [1] Country-levelburden estimates available for 2010 show that an estimated80 of malaria deaths occur in just 14 countries andabout 80 of cases occur in 17 countries [1] Together theDemocratic Republic of the Congo and Nigeria account forover 40 of the estimated total of malaria deaths globally[1]

The artemisinins are new drugs developed from theChinese wormwood (Artemisia annua) and the derivativesnamely artemether artesunate and dihydroartemisinin havenow gained popularity as short-acting drugs which could beused in combination with drugs which have long life [2]

Malaria remains amajor cause ofmorbidity andmortalityin Nigeria in the era of improved control activities by theNational Malaria Control Program (NMCP) since 2005Thisis highly of concern and has necessitated the need to scale upinterventions and assess the impact of malaria control mea-sures in targeted areas To implement effective interventionsin an area knowledge of malaria epidemiology and transmis-sion dynamics risk factors associated with malaria infectionand delay in diagnosis and treatment are of utmost impor-tance Many settings suitable for malaria vector propagationand prone to endemicity or resurgence of malaria have notbeen characterized in Lagos state and Ibeshe is one of thesesettings

2 Malaria Research and Treatment

Currently there is lack of data on parasite burdenand inhabitantsrsquo knowledge attitude and practices towardsmalaria control Given its increasing population and coastallandmass that is amenable to malaria vector colonizationand propagation a malariometric survey of Ibeshe is highlyneeded to provide justification for expansion of malariaintervention settings in Lagos state

2 Methodology

21 Ethical Approval Ethical approval of the study wasobtained from Nigerian Institute of Medical Research Insti-tutional Review Board (NIMR IRB)

22 Study Site This cross-sectional study was carried outin the dry season January 2011 in Ibeshe community(6∘ 301015840 2610158401015840N 3∘ 201015840 53E) in Ikorodu LGA Lagos state Con-venient samplingmethod was adopted Ibeshe is a semiurbancommunity and is made up of 10 villages Ibeshe central(Oluwoye Ilemeri and Orubo) Oshorun Oke-Awori Oke-Ota Owode Abuja Agbowa and Malatori Ibeshe is about20 km from Lagos metropolis It has a population of about23850 people [3] Their occupation consists primarily ofpeasant fishermen farmers and sand collectors The com-munity has 27 primary schools which consist of 2 public and25 private schools Only one public secondary school is inthe community with one health centre There are 4 privatehospitalswith twopharmacy storesNumerous chemist storesare available in the community with seven traditional birthattendants

Before the commencement of the study the investigatorsvisited the site and explain the study to the Oba of Ibeshewho gave his consent and permitted the town announcer toannounce our mission to the community He also obtainedthe cooperation of the chiefs (Baales) of the villages TheBaales of the villages visited provided us with the venue(canopy chairs and tables) Each site consisted of one ormore villages A total of 10 villages were covered during theexercise Everybody in the community that came out for thesurvey were screened for fever (axillary temperaturege 375∘C)and malaria parasite by microscopy thick and thin malariablood films stained with Giemsa stain All persons that werepositive for malaria parasite were treated with artemether-lumefantrine Blood spots were made on filter paper formolecular studies on malaria parasite characteristics such aslevel of resistance to various antimalarial drugs

The anaemia status of the people of Ibeshe was definedusing the WHO haematocrit cutoff for mild anaemia PackedCell Volume (PCV lt 33) moderate anaemia (PCV lt24) and severe anaemia (PCV lt 15) [4] Knowledgeattitude and practices of the people towards malaria controlwere captured using interviewer-administered questionnaireStatistical analysis was done with Epi-info 351

3 Results

A total of 1489 participants were interviewed and screenedfor malaria and anaemia The majority of the respondents

were female 916 (623) The mean age was 267 plusmn 200 years(range 01ndash99 years) Children under the age of 5 were 237(166) while those above 65 years of age were 73 (51)Theage groupwith highest populationwas 5ndash14 years 272 (190)The respondents were mostly students 475 (326) followedby traders 417 (286) The famers were 16 (11) and thelowest occupation was clergy 12 (08) The number ofrespondents that attended secondary school was the highest513 (407) followed by primary 471 (374) Only 36 (29)respondents did not have any form of education Majority ofthe respondents 731 (856) who were 18 years and aboveearn N2000000 or less per month The major religions wereChristianity 859 (599) and Islam 551 (385) (Table 1)

The prevalence of malaria in Ibeshe community was147 (95 CI 130ndash166) The prevalence of malaria inchildren aged 2ndash9 years was 164 (95 CI 126ndash212) Thepredominant Plasmodium species found in the communitywas Plasmodium falciparum (936) The geometric meanparasite densitywas 285 parasites per120583Lof bloodThemeanplusmnSD body temperature for participants with temperature ge375was 40 (27) The participants that had normal PCV (ge33)were 1026 (819) while those that had severe anaemia were3 (02) (Table 2)

The baseline characteristics of participants in differentvillages of Ibeshe community are shown in Table 3

Figure 1 shows the malaria parasite carriage rate in thedifferent villages Agbowa and Abuja had the lowest malariaparasite rate while Ibeshe and Oke-Ota had the highest rate

Figure 2 shows that majority of the participants in Ibeshecommunity had normal haemoglobin levels mild anaemiawas less than 20 in most of the villages

There was no significant difference in comparing malariapositivity with temperature sex and age in the community(Table 4)

Parasite density above 500 parasites120583L of blood was notassociatedwith presence of fever in this study (Fisherrsquos exact =0484)

Themalaria infection rate was found to be higher in thoseaged 5 years and above (151) than in those under 5 years ofage (127)

Figure 3 shows that febrile cases were highest in childrenlt5 years (47) while malaria infection rate was found to behighest in the age group between 45ndash54 years (240)

Figure 4 shows the significant relationship betweenmalaria and level of PCV in the participants The lower thePCV is the higher the malaria infection rate observed

Chi square = 1237 119875 = 00006The respondents that reported fever in the past 24 hours

were 1243 (835) The number of respondent that considerthe health facility too far from their home was 747 (502)while 1021 (686) were satisfied with treatment given attheir health facilities Some of the common suggestions onimproving the health of people in Ibeshe were building morehealth facilities 1354 (909) availability of drugs in healthfacilities 1302 (874) erection ofmore public water taps 1300(873) and increasing the number of health workers 1274(856)

The respondents attributed the cause of malaria feverto be four major causes in which mosquito bite (958) is

Malaria Research and Treatment 3

Table 1 Baseline characteristics of study participants

Characteristic 119899 ()Sex

Male 554 (377)Female 916 (623)

Age (years)Mean plusmn SD (range) 267 plusmn 200 (01ndash990)Age grouplt5 237 (166)5ndash14 272 (190)15ndash24 168 (117)25ndash34 270 (180)35ndash44 211 (148)45ndash54 121 (85)55ndash64 78 (55)ge65 73 (51)

Weight (kg)Mean plusmn SD (range) 479 plusmn 263 (40ndash999)

OccupationStudent 475 (326)Trader 417 (286)Artisan 182 (120)Professional 73 (50)House wife 56 (38)Civil servant 35 (24)Farmer 16 (11)Clergy 12 (08)Others 192 (132)

EducationNone 36 (29)Primary 471 (374)Secondary 513 (407)Tertiary 102 (81)Non formal 138 (110)

Incomelowast

None 238 (279)ltN1000000 342 (400)N1000000ndashN2000000 151 (177)N2000100ndashN3000000 48 (56)N3000100ndashN4000000 29 (34)N4000100ndashN5000000 15 (18)gtN5000000 31 (36)

ReligionChristianity 859 (599)Islam 551 (385)Traditional 23 (16)

lowastThis is for age 18 years and above

the major cause followed by dirty water (882) while theother causes are working for too long (stress) (862) andstaying in the sun (858) see Figure 5

Majority of the respondents can recognize malaria symp-toms by hot body (899) headache (849) refusal to eat

Table 2 Malaria indicators

MalariaPrevalence 219 (147)Plasmodium species

P falciparum 205 (936)P malariae 12 (55)Mixed (P falciparum + P malariae) 2 (09 )

Parasite density120583L of bloodGeomean 285Range 21ndash2217141ndash500 161 (805)501ndash1000 24 (120)1001ndash5000 11 (55)gt5000 4 (20)

Axillary temperature (∘C)Mean plusmn SD 366 plusmn 05Range 35ndash403ge375 40 (27)lt375 1431 (973)

PCV ()Mean plusmn SD 363 plusmn 48Range 18ndash50

PCV groupNormal (ge33) 1026 (819)Mild anaemia (30ndash329) 142 (113)Moderate anemia (21ndash299) 82 (65)Severe anaemia (lt21) 3 (02)

(773) and body ache (770) The respondents said thatthe action they will take when malaria occur would be togo to the hospital (656) while 248 of the respondentwould go to chemistpharmacy The respondents that wouldgo to the traditional healers were (230) The percentage ofrespondents that would treat at home was 225 150 of therespondents would either go to the church or mosques while(05) of the respondent would do nothing

Most of the respondents lived less than 1 km from thehealth facilities (253) while only 109 of the respondentslived above 10 km from the health facilities

Measures taken for malaria protection 770 of therespondents sleep with window nets and 748 of therespondent clear bushes around them while 651 clear theirgutters Only 296 of the respondents sleep under the long-lasting insecticidal net while 277 sleep under the net

Majority of the respondents spent greater than N150000on malaria treatment in a month 385 (279) Those thatspent less thanN500 permonthwere 290 (210) while thosethat spent nothing per month were 208 (208) (Table 5)

4 Discussion

Malaria control inNigeria is essential it is therefore necessaryto know the burden of malaria in a community for planningand implementing appropriate interventions The base lineinformation on malaria and its control practices in an area


Table 3 The baseline characteristic of participants in different villages in Ibeshe community

Abuja Agbowa Ibeshe Malatori Oke-Awori Oke-Ota Oshorun Owode 119875

119873 192 269 239 103 150 63 237 236Mean age (plusmnSD) 272 plusmn 188 225 plusmn 192 313 plusmn 232 308 plusmn 163 235 plusmn 177 252 plusmn 186 264 plusmn 208 273 plusmn 199lt5 yrs () 27 (141) 56 (208) 31 (130) 7 (68) 27 (180) 13 (206) 37 (156) 39 (165) 007Males () 75 (311) 117 (435) 77 (322) 44 (427) 55 (433) 28 (444) 75 (316) 73 (309) 0002Malaria carriage rate () 52 07 259 126 200 254 139 225 lt0001Febrile cases (ge375∘C) 6 (31) 9 (33) 10 (42) 1 (1) 1 (07) 2 (32) 4 (17) 7 (30) 0411

Table 4 Malaria positivity comparing temperature sex and age

Character Malaria positivity 119899 () 119875

Temperature (∘C)lt375 210 (147) 017ge375 9 (225)

SexMale 85 (153) 0625Female 132 (144)

Age (years)lt5 30 (127) 0319ge5 181 (152)

52

07

259

126

20

254

139

225

0

5

10

15

20

25

30

Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

Carr

iage

rate

()

Community

POS

Figure 1 Malaria parasite carriage rate in Ibeshe community

enables the impact of malaria intervention programme tobe measured Good knowledge of behavior of people aswell as that of epidemiology of malaria enhances correctprioritization of control strategies [5]

Ibeshe community can be classified as being mesoen-demic for malaria at the time of this study based on theparasite rate in children aged 2ndash9 years old [6] The malariaprevalence of 147 was reported in Ibeshe community inboth children and adult in this study of which the malariaprevalence in young adult (15ndash34 years) was 126 A studycarried out by Anumudu et al [7] reported a prevalenceof 170 in young adult (17ndash33 years) in a community inIbadan another area in southwesternNigeria which is higherthan our result This could suggest that malaria prevalence is

0102030405060708090

100

Prop

ortio

n (

)

Community

NormalMild anaemia

Moderate anaemiaSevere anaemia

Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

Figure 2 The anaemia status in the different villages of Ibeshe

0

5

10

15

20

25

5ndash14 15-14 25ndash34 35ndash44 45ndash54 55ndash64

127158

137119

142

24

179

123

4733 18 15

3808 13

0

()

Age (years)

MalariaFever

127158

137119

142

179

123

4733 18 15

3808 13

0

lt5 ge65

Figure 3 Proportion of febrile and malaria cases by age

reducing in southwestern Nigeria probably due to the inter-ventions employed by the Federal Government to controllingmalaria in the region after the study carried by Anumuduet al [7]

In this survey malaria infection was observed to beassociated with anaemia This can be attributed to the abilityof P falciparum to invade and destroy red blood cells at


Table 5 Knowledge and practice of malaria control

119899 ()Cause of malaria feverlowast

Staying in the sun 1089 (858)Oil 474 (636)Alcohol 500 (435)Mosquito bite 1292 (958)Dirty water 1087 (882)Witchcraft 391 (345)Working for too long (stress) 1065 (862)

Recognition of malaria symptomslowastHot body 133 (899)Vomiting 877 (589)Refusal to eat 1151 (773)Body ache 1146 (770)Headache 1264 (849)Diarrhea 628 (422)Sweating 1030 (692)Fatigue 998 (670)Malaise 978 (657)Sleeping all day 478 (321)Dull 421 (283)Bitter taste 391 (263)Yellow urine 365 (245)

Action taken when malaria occur (119899 = 1243)lowastTreat at home 280 (225)Go to chemistpharmacy 308 (248)Go to hospital 815 (656)Go to churchmosque 15 (12)Go to traditional healer 23 (12)Do nothing 6 (05)

Distance to health facility (119899 = 1225)lt1 km 310 (253)1-2 km 238 (194)gt2ndash5 km 283 (231)gt5ndash10 km 260 (212)gt10 km 134 (109)

Malaria protective measures takenlowastSleeping under the net 413 (277)Sleeping under insecticide treated net 441 (296)Sleeping with windows closed 752 (505)Sleeping with window with net 1147 (770)Use of insecticide spray (Shelltox RaidBaygon) 854 (574)

Burning coilgrass 765 (514)Clearing bushes 1114 (748)Draining stagnant water 897 (602)Clearing gutter 969 (651)Covering the body with cloth 784 (527)

Amount spent on malaria treatment in a month(119899 = 1379)

None 287 (208)ltN50000 290 (210)N50000ndashN100000 271 (197)gtN100000ndashN150000 146 (106)gtN15000000 385 (279)

lowastMultiple responses

a more rapid rate than other human plasmodia parasites dueto its greater virulence properties The malaria infection rate

0

5

10

15

20

25

30

35

30ndash329 21ndash299

142

204

268

333

Mal

aria

infe

ctio

n ra

te (

)

PCV ()

ge33 lt21

142

204

268

Figure 4 Relationship between malaria and level of PCV

0102030405060708090

100

Communities

SunOilAlcoholMosquito

Dirty waterWitchStress

Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

Figure 5 Knowledge of cause of malaria in the communities

was low in two villages (Agbowa and Abuja) and this couldbe due to a dead lake resulting from industrial pollution closeto the villages

The age group with the highest malaria infection rate was45ndash54 years (24) though most of them were not febrileChildren under the age of 5 years were the most febrile agegroup in this study but their malaria infection rate was lowthis is could be due to the fact that children under 5 years areknown to have low immunity and are prone to other diseasesthat can cause fever This study confirms the fact that it is notall fever cases that is caused by malaria infection

The predominant species that was found in the com-munity was Plasmodium falciparum and this is consistentwith Federal Ministry of Health report on Plasmodiumspecies distribution in Nigeria [8] There was no significantassociation between malaria parasite and body temperatureas well as sex of the study participants The parasite density


in community was mostly low supporting the asymptomaticpresentation observed in the community

Knowledge about the cause of malaria is shrouded witha lot of misconceptions Most of the respondents attributedthe cause of malaria to more than one agent the frequentresponses being mosquito bite sun oil and stress Similarfindings on the causes of malaria were reported in a studycarried out in Akwa Ibom state by Ukpong et al [9] wheremosquito bite was reported to be the major cause of malariafollowed by contaminated food and water However stressand sun were not reported as major causal factors of malariain the Akwa Ibom study

Our findings show that females outnumbered the malesamong the respondents this is not surprising because this hasbeen the normal pattern in most community studies carriedout in many African disease endemic countries [10ndash12]

The success of malaria control programme at presentrelies on community perception of the disease incorrectbeliefs or inappropriate behavior can interfere with theeffectiveness of a control measures such as vector control orchemotherapy [12]

The knowledge about malaria symptoms was high in thestudied community This is expected considering the highlevel of formal education and the endemicity of malaria inthe area High patronage of health facilities (hospitals andchemistpharmacy)was report duringmalaria episodes in thecommunity

The use of long-lasting insecticide net in the communitywas low due to the fact that the rooms are hot becausepower supply is not regular rather they prefer to screen theirwindows with net and environmental management Oguonuet al [13] also reported low usage of insecticide treated netsin rural and urban communities of Enugu southeasternNigeria

Over 60 of the respondents aged 18 years and aboveearn less than N1000000 per month this implies that therespondents were mostly in the low social economic classIt therefore means that malaria treatment is putting hugeburden in the purse of the people in the community

The implication of this study is that due to the inter-vention of malaria control programme it has producedevidence of reduced malaria transmission and associatedmalaria burden in terms of parasite density in the studiedarea Ibeshe community is one of the communities in Lagosstate that had benefited frommalaria control activities includ-ing long-lasting insecticide nets (LLINs) distribution accessto intermittent preventive treatment of malaria (IPT) andartemisinin-based combination therapies (ACTs) in the last2 years

However the finding of this study suggests that malariatransmission is mesoendemic in this area In a mesoendemicsituation malaria is said to be unstable identifying reservoirsof the parasite and particularly under asymptomatic condi-tion becomes critical in elimination of the parasite in the areaThis study found participates of age group 45ndash54 years asreservoirs of Plasmodium falciparum in Ibeshe communityThis is not unexpected since most of the interventions onmalaria control are mainly on children under five years andpregnant women [8] Based on the finding of this study

it is suggested that malaria control interventions should beextended to the adults in Ibeshe community

41 Limitation of the Study This studywas carried out only inthe dry session it will be of interest to also carry out this studyin the rainy session to ascertain the prevalence of malaria inthe community

5 Conclusion

Malaria is mesoendemic in Ibeshe community with Plasmod-ium falciparum being the predominant species The partici-pants had a good knowledge of the symptoms of malaria inthe community however there are a lot of misconception onthe cause of malaria Anaemia is low in this community

6 Recommendation

Enlightenment campaign is needed to change the peoplersquosperception on the cause of malaria for effective malariacontrol in the community Focus onmalaria control interven-tions should be extended to the adults in Ibeshe community

Conflict of Interests

The authors declare that they have no conflict of interests

Acknowledgments

The authors acknowledge the management of Nigerian Insti-tute of Medical Research (NIMR) Yaba for providing thefund for the projectThe cooperation of the traditional rulersand people of Ibeshe community is appreciated The authorsalso thank the following pharmaceutical companies IPCAand May amp Baker for donating antimalarial medicine usedfor this project

References

[1] World Health OrganizationWorld Malaria Report 2012 WorldHealth Organization Geneva Switzerland 2012

[2] N J White ldquoAntimalarial drug resistancerdquo Journal of ClinicalInvestigation vol 113 no 8 pp 1084ndash1092 2004

[3] Nigerian National census 2006 httpwwwnigerianmusecom20070820063612zg

[4] WHO ldquoHaemoglobin concentrations for the diagnosis ofanaemia and assessment of severity Vitamin and Min-eral Nutrition Information System Geneva World HealthOrganizationrdquo (WHONMHNHDMNM11 1) 2011 httpwwwwhointvmnisindicatorshaemoglobin

[5] L A Salako ldquoMalaria control priorities and constraintsrdquo Paras-sitologia vol 41 no 1ndash3 pp 495ndash496 1999

[6] D Metselaar and P M Van Theil ldquoClassification of malariardquoTropical and Geographical Malaria vol 11 pp 157ndash161 1959

[7] C I Anumudu A Adepoju M Adediran et al ldquoMalariaprevalence and treatment seeking behaviour of young NigerianadultsrdquoAnnals of AfricanMedicine vol 5 no 2 pp 82ndash88 2006


[8] Federal Ministry of Health (FMOH) National AntimalarialTreatment Policy Federal Ministry of Health Nigeria NationalMalaria and Vector Control Division Abuja Nigeria 2005

[9] I G Ukpong K N Opara L P E Usip and F S Ekpu ldquoCom-munity perceptions about malaria mosquito and insecticidetreated nets in a rural community of the niger delta nigeriaimplications for controlrdquo Research Journal of Parasitology vol2 pp 13ndash22 2007

[10] T A Okeke and H U Okafor ldquoPerception and treatmentseeking Behavior for malaria in rural Nigeria implications forControlrdquo Journal of Human Ecology vol 24 pp 215ndash222 2008

[11] A I Oreagba A T Onaajole S O Olayemi and A F BMabadeje ldquoKnowledge of malaria amongst caregivers of youngchildren in rural and urban communities in Southwest NigeriardquoTropical Journal of Pharmaceutical Research vol 3 pp 299ndash3042004

[12] T Tilaye and W Deressa ldquoCommunity perceptions and prac-tices about urban malaria prevention and control in GondarTown northwest Ethiopiardquo Ethiopian Medical Journal vol 45no 4 pp 343ndash351 2007

[13] T Oguonu H U Okafor and H A Obu ldquoCaregiversrsquos knowl-edge attitude and practice on childhood malaria and treatmentin urban and rural communities in Enugu south-east NigeriardquoPublic Health vol 119 no 5 pp 409ndash414 2005

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Currently there is lack of data on parasite burdenand inhabitantsrsquo knowledge attitude and practices towardsmalaria control Given its increasing population and coastallandmass that is amenable to malaria vector colonizationand propagation a malariometric survey of Ibeshe is highlyneeded to provide justification for expansion of malariaintervention settings in Lagos state

2 Methodology

21 Ethical Approval Ethical approval of the study wasobtained from Nigerian Institute of Medical Research Insti-tutional Review Board (NIMR IRB)

22 Study Site This cross-sectional study was carried outin the dry season January 2011 in Ibeshe community(6∘ 301015840 2610158401015840N 3∘ 201015840 53E) in Ikorodu LGA Lagos state Con-venient samplingmethod was adopted Ibeshe is a semiurbancommunity and is made up of 10 villages Ibeshe central(Oluwoye Ilemeri and Orubo) Oshorun Oke-Awori Oke-Ota Owode Abuja Agbowa and Malatori Ibeshe is about20 km from Lagos metropolis It has a population of about23850 people [3] Their occupation consists primarily ofpeasant fishermen farmers and sand collectors The com-munity has 27 primary schools which consist of 2 public and25 private schools Only one public secondary school is inthe community with one health centre There are 4 privatehospitalswith twopharmacy storesNumerous chemist storesare available in the community with seven traditional birthattendants

Before the commencement of the study the investigatorsvisited the site and explain the study to the Oba of Ibeshewho gave his consent and permitted the town announcer toannounce our mission to the community He also obtainedthe cooperation of the chiefs (Baales) of the villages TheBaales of the villages visited provided us with the venue(canopy chairs and tables) Each site consisted of one ormore villages A total of 10 villages were covered during theexercise Everybody in the community that came out for thesurvey were screened for fever (axillary temperaturege 375∘C)and malaria parasite by microscopy thick and thin malariablood films stained with Giemsa stain All persons that werepositive for malaria parasite were treated with artemether-lumefantrine Blood spots were made on filter paper formolecular studies on malaria parasite characteristics such aslevel of resistance to various antimalarial drugs

The anaemia status of the people of Ibeshe was definedusing the WHO haematocrit cutoff for mild anaemia PackedCell Volume (PCV lt 33) moderate anaemia (PCV lt24) and severe anaemia (PCV lt 15) [4] Knowledgeattitude and practices of the people towards malaria controlwere captured using interviewer-administered questionnaireStatistical analysis was done with Epi-info 351

3 Results

A total of 1489 participants were interviewed and screenedfor malaria and anaemia The majority of the respondents

were female 916 (623) The mean age was 267 plusmn 200 years(range 01ndash99 years) Children under the age of 5 were 237(166) while those above 65 years of age were 73 (51)Theage groupwith highest populationwas 5ndash14 years 272 (190)The respondents were mostly students 475 (326) followedby traders 417 (286) The famers were 16 (11) and thelowest occupation was clergy 12 (08) The number ofrespondents that attended secondary school was the highest513 (407) followed by primary 471 (374) Only 36 (29)respondents did not have any form of education Majority ofthe respondents 731 (856) who were 18 years and aboveearn N2000000 or less per month The major religions wereChristianity 859 (599) and Islam 551 (385) (Table 1)

The prevalence of malaria in Ibeshe community was147 (95 CI 130ndash166) The prevalence of malaria inchildren aged 2ndash9 years was 164 (95 CI 126ndash212) Thepredominant Plasmodium species found in the communitywas Plasmodium falciparum (936) The geometric meanparasite densitywas 285 parasites per120583Lof bloodThemeanplusmnSD body temperature for participants with temperature ge375was 40 (27) The participants that had normal PCV (ge33)were 1026 (819) while those that had severe anaemia were3 (02) (Table 2)

The baseline characteristics of participants in differentvillages of Ibeshe community are shown in Table 3

Figure 1 shows the malaria parasite carriage rate in thedifferent villages Agbowa and Abuja had the lowest malariaparasite rate while Ibeshe and Oke-Ota had the highest rate

Figure 2 shows that majority of the participants in Ibeshecommunity had normal haemoglobin levels mild anaemiawas less than 20 in most of the villages

There was no significant difference in comparing malariapositivity with temperature sex and age in the community(Table 4)

Parasite density above 500 parasites120583L of blood was notassociatedwith presence of fever in this study (Fisherrsquos exact =0484)

Themalaria infection rate was found to be higher in thoseaged 5 years and above (151) than in those under 5 years ofage (127)

Figure 3 shows that febrile cases were highest in childrenlt5 years (47) while malaria infection rate was found to behighest in the age group between 45ndash54 years (240)

Figure 4 shows the significant relationship betweenmalaria and level of PCV in the participants The lower thePCV is the higher the malaria infection rate observed

Chi square = 1237 119875 = 00006The respondents that reported fever in the past 24 hours

were 1243 (835) The number of respondent that considerthe health facility too far from their home was 747 (502)while 1021 (686) were satisfied with treatment given attheir health facilities Some of the common suggestions onimproving the health of people in Ibeshe were building morehealth facilities 1354 (909) availability of drugs in healthfacilities 1302 (874) erection ofmore public water taps 1300(873) and increasing the number of health workers 1274(856)

The respondents attributed the cause of malaria feverto be four major causes in which mosquito bite (958) is




Male 554 (377)Female 916 (623)





Incomelowast

















4 Discussion









SexMale 85 (153) 0625Female 132 (144)

Age (years)lt5 30 (127) 0319ge5 181 (152)

52

07

259

126

20

254

139

225

0

5

10

15

20

25

30

Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

Carr

iage

rate

()

Community

POS




0102030405060708090

100

Prop

ortio

n (

)

Community

NormalMild anaemia


Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode


0

5

10

15

20

25


127158

137119

142

24

179

123

4733 18 15

3808 13

0

()

Age (years)

MalariaFever

127158

137119

142

179

123

4733 18 15

3808 13

0

lt5 ge65

















0

5

10

15

20

25

30

35


142

204

268

333

Mal

aria

infe

ctio

n ra

te (

)

PCV ()

ge33 lt21

142

204

268


0102030405060708090

100

Communities



Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

















5 Conclusion


6 Recommendation




Acknowledgments


References




















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















Male 554 (377)Female 916 (623)





Incomelowast

















4 Discussion









SexMale 85 (153) 0625Female 132 (144)

Age (years)lt5 30 (127) 0319ge5 181 (152)

52

07

259

126

20

254

139

225

0

5

10

15

20

25

30

Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

Carr

iage

rate

()

Community

POS




0102030405060708090

100

Prop

ortio

n (

)

Community

NormalMild anaemia


Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode


0

5

10

15

20

25


127158

137119

142

24

179

123

4733 18 15

3808 13

0

()

Age (years)

MalariaFever

127158

137119

142

179

123

4733 18 15

3808 13

0

lt5 ge65

















0

5

10

15

20

25

30

35


142

204

268

333

Mal

aria

infe

ctio

n ra

te (

)

PCV ()

ge33 lt21

142

204

268


0102030405060708090

100

Communities



Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

















5 Conclusion


6 Recommendation




Acknowledgments


References




















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of























SexMale 85 (153) 0625Female 132 (144)

Age (years)lt5 30 (127) 0319ge5 181 (152)

52

07

259

126

20

254

139

225

0

5

10

15

20

25

30

Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

Carr

iage

rate

()

Community

POS




0102030405060708090

100

Prop

ortio

n (

)

Community

NormalMild anaemia


Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode


0

5

10

15

20

25


127158

137119

142

24

179

123

4733 18 15

3808 13

0

()

Age (years)

MalariaFever

127158

137119

142

179

123

4733 18 15

3808 13

0

lt5 ge65

















0

5

10

15

20

25

30

35


142

204

268

333

Mal

aria

infe

ctio

n ra

te (

)

PCV ()

ge33 lt21

142

204

268


0102030405060708090

100

Communities



Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

















5 Conclusion


6 Recommendation




Acknowledgments


References




















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





























0

5

10

15

20

25

30

35


142

204

268

333

Mal

aria

infe

ctio

n ra

te (

)

PCV ()

ge33 lt21

142

204

268


0102030405060708090

100

Communities



Abuj

a

Agb

owa

Ibes

he

Mol

ator

i

Oke

-Aw

ori

Oke

-Ota

Osh

orun

Ow

ode

















5 Conclusion


6 Recommendation




Acknowledgments


References




















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




























5 Conclusion


6 Recommendation




Acknowledgments


References




















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















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