Knowledge of Malaria and preventive practices among pregnant women attending antenatal clinic at Manhyia District Hospital , Ghana

Malaria is hyper endemic in Ghana with perennial transmission afflicting and affecting people of all ages and it is a major cause of illness and death in Ghana, particularly among pregnant women. The study sought to find out the knowledge of Malaria and preventive practices among pregnant women attending antenatal clinic at Manhyia District Hospital. The study was carried out at the Manhyia District Hospital. A descriptive study design was adopted employing a quantitative approach and a simple random sampling technique was used to select 103 pregnant women attending ANC at the Manhyia Hospital. The research made use of questionnaire as a data collection instrument and Closed ended questionnaire were used for data collection. Primary data were coded and analysed using Statistical Package for Social Sciences (SPSS version 16.0). After that, the primary data were summarised and displayed in tables and figures. Malaria was perceived as when body temperature rises and it can be transmitted by a mosquito bite. Fever was identified as a symptom of Malaria as well as pain in the joints, vomiting and loss of appetite. Practices that have been used to prevent malaria were the use of mosquito net (46%); keeping clean environment (24%) use of insecticide (28%) and wearing protective clothing (2%). Continuous efforts at providing necessary information by the health ministry are needed to control and reduce incidence of malaria and improve knowledge among the general public.


Introduction
Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world and it poses substantial risks to the mother, her fetus and the neonate (WHO, 2010).Pregnant women are at risk of been infected with malaria because their immunity reduces during malaria and this puts them at risk of anaemia and other health issues including death (Bouyou-Akotet et al., 2003).Malaria can double the risk of severe anaemia, triple the risk of preterm birth and quadruple the risk of foetal growth restriction in the uterus (Goldenberg et al., 2003).
Each year, more than 30 million women in Nigeria and malaria endermic areas such as Ghana become pregnant and are at risk of infection with Plasmodium falciparum.This result is high prevalence of patent parasitaemia and clinical malaria in pregnancy (Adefioye et al, 2007).Malaria is hyper endemic in Ghana with perennial transmission afflicting and affecting people of all ages and it is a major cause of illness and death in Ghana, particularly among pregnant women (Ministry of Health, 2010) Among pregnant women in Ghana, malaria accounts for 28.1% of out-patient department attendance, 13.7 % of ward admissions and 9.0 % of maternal deaths.Malaria infections are therefore, one of the major causes of maternal mortality in Ghana (Ministry of Health, 2010).From the hospital records and personal observations, it has been realised that despite numerous efforts by the health ministry and other stakeholders to reduce the incidence of Malaria in Ghana, Malaria seems to ac-count for majority of visits at the Manhyia Hospital.Records from the hospital indicate that the number of pregnant women who report to the hospital with malaria has been increasing over the years.From 2011 to 2015, the trend of hospital visits among pregnant women with malaria each month increased from 107 representing 32% of visits in 2011; 212 representing 38% of visits in 2012; 219 representing 39% of visits in 2013; 243 representing 42% of visits in 2014 and increased to 267 representing 43% of visits in 2015 (Manhyia hospital records, 2016).The researcher wants to find out the knowledge of Malaria and preventive practices among pregnant women attending antenatal clinic at Manhyia District Hospital.

Study Site
The study was carried out at the Manhyia District Hospital.The hospital was established as a clinic in 1966 and gained a health centre status in 1977.Currently, it serves as the District Hospital for Manhyia Sub-Metro and serves estimated total population of 304, 092, which forms 22.3% of the metro population.This hospital is noted as one of the health institutions championing antenatal health services in Kumasi.With bed capacity of 42 and OPD attendance of 450 clients per day the service providers are guided by the core values of Ghana Health Service in the service delivery processes at all times.

Study Design
A descriptive study design was adopted employing a quantitative approach in order to find out the knowledge of Malaria and preventive practices among pregnant women attending antenatal clinic at Manhyia District Hospital.
The study population were made of all pregnant women attending ANC at the Manhyia Hospital.

Sample Size and Sampling Procedure
A simple random sampling technique was used to select pregnant women attending ANC at the Manhyia Hospital.The sample was calculated using the formula; Where n = Sample size

N = Sample population
This was applied to obtain the sample size of 103.This sample was selected out of a total number of 144 pregnant women who were pregnant and had visited the antenatal clinic at Manhyia District Hospital within the month data for the study was collected.The purpose of the study was explained to them.Those who were readily willing to participate in the study were given the questionnaire to fill.The only exclusion criterion was the unwillingness to participate in the study.Response rate was 97% as 3 of the respondents declined to be part of the study therefore 100 questionnaire were administered.This research made use of questionnaire as a data collection instrument.Closed ended questionnaire were used for data collec-tion.Respondents were asked questions such as what is malaria.In what ways can one avoid getting malaria?Primary data were coded and analysed using Statistical Package for Social Sciences (SPSS version 16.0).After that, the primary data were summarised and displayed in tables and figures.
Traders were dominant in terms of the respondent's occupation with 46% and only 12% of the respondent had no formal education.From the table, the sampled respondents had been pregnant for 0-3 up to 9 months and above.
The figure 1 displays respondent's knowledge of what malaria is.From the figure,22 (22%) of the respondents indicated that Malaria is when one is shivering and vomiting,33(33%) also indicated that Malaria is when body temperature rises while 30(3%) indicated that malaria is when one has fever and 15 (15%) indicated that Malaria is when one cannot eat.
Figure 2 shows respondents knowledge of how Malaria is transmitted, from the figure, 87 of the respondents (87%) indicated that malaria is transmitted by a mosquito;9 of the respondents (9%) indicated malaria is transmitted through air while 2 (2 %) said they don't know and 1 (1%) mentioned touching others and dirty gutters as the means through which malaria is transmitted.Other means through which someone can become infected with malaria according to the respondents were taking much oily food (27%); working hard under the sun (15%); drinking infected water (18%) and using dirty hands to eat (2%).
Figure 3 shows respondent's views on the Symptoms of Malaria.From the figure, 53 (53%) mentioned fever; 39(39%) men-tioned body ache while 17 of the respondents constituting (17%) mentioned pain in the joints; 39 of the respondents (39%) mentioned vomiting while 28 of the respondents (28%) mentioned loss of appetite.
Respondents views of the practices that can be used to prevent malaria is displayed in Figure 4.From the figure,46 of the respondents constituting 46% mentioned the use of mosquito net;24 (24%) mentioned keeping clean environment while 28(28%) mentioned insecticide and 2(2%) mentioned wearing protective clothing.
Figure 5 shows how often respondents use bed nets.From the figure, 52 (52%) indicated that respondents use bed nets sometimes; 35 (35%) indicated that they use bed nets always and 13(13%) indicated that they never use bed nets.

Discussion
Respondent's knowledge of malaria was assessed when asked what malaria is.Some of the respondents indicated that Malaria is when one is shivering and vomiting.Others also indicated that Malaria is when body temperature rises as well as malaria is when one has fever and when one cannot eat.This implies that the respondents had a fair idea of what malaria is.The findings support the study of Erin et al (2015) where there was a good knowledge about the term "malaria".
Majority of the respondents constituting 87% indicated that malaria is transmitted by a mosquito.This contradicts with Terefe et al (2015) study which revealed that, only 15.6 % of the mothers associated mosquitoes with malaria; majority of them (65.6 %) responded that it is transmitted through poor personal hygiene and environmental sanitation.This study location may have influenced the responses as Manhyia is located at the center of the city and many of the respondents had at least basic education.The respondent's views of the Symptoms of Malaria also revealed that 53% knew of fever while 39% knew of body ache.The findings in a study by Iriemenam et al (2011), found that knowledge of malaria was very good (among 1.0%), average (among 78.9%), and poor (among 20.1%) of the participants.
Respondents further mentioned pain in the joints, vomiting and loss of appetite as symptoms of malaria.In a qualitative study about IPTp and ITN use in pregnancy in Busia district of Uganda, it was revealed that respondents observed that malaria related problems in pregnancy include miscarriages, malaise, anaemia, back and joint pains, labour complications, and maternal and child death (Mangeni, 2003).Practices that have been used to prevent malaria were the use of mosquito net (46%); keeping clean environment (24%) use of insecticide (28%) and wearing protective clothing (2%).This implies that respondents who approved the use of these preventive practices of Malaria were less than half of the sampled respondents.Insecticide Treated Nets ownership and use among pregnant women was good.This implies that the distribution and coverage of insecticides treated mosquito among high risk groups, such as pregnant women will go a long way to reduce malaria among pregnant women.

Conclusion
Based on the findings of the study, it can be concluded that; Malaria is perceived as when body temperature rises and it can be transmitted by a mosquito bite.Fever was identified as a symptom of Malaria as well as pain in the joints, vomiting and loss of appetite.Despite concerted efforts at malaria control nationwide, knowledge of malaria prevention was still low among certain groups in the study area.Myths and misconceptions about malaria prevention is still prevalent.The Preventive practices that were approved included the use of mosquito net, keeping clean environment, Continuous efforts at providing necessary information by the health ministry are needed to control and reduce incidence of malaria and improve knowledge among the general public.

Funding
No external funding was received for the purpose of this study.All cost related to this research was covered by the researchers themselves.
B = Confidence level of error of the estimate = 0.05 p = Population proportion with the required characteristics taken as 0.5 q = Population proportion without the required characteristics i.e. (1-P).

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Figure 1 Knowledge of what malaria is

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Figure 2 Malaria transmission methods Figure 3 Symptoms of Malaria

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Figure 4 Preventive practices Figure 5 Use of bed nets