DETERMINANTS OF MALARIA PREVALENCE AMONG PREGNANT

WOMEN: A CASE STUDY OF BUTABIKA HOSPITAL

BACKGROUND TO THE STUDY
Malaria remains a major public health challenge globally but especially in the African region.
According to the World Health Organization (WHO), there ere an estimated !"# million cases
of malaria in !$$%. &he 'ast majority of these cases (about %()) ere in the African region. *n
the same year, malaria accounted for about %+#,$$$ deaths, of hich about %,) ere in the
African region(WHO, !$$,). High malaria burden is major barrier to economic de'elopment. *t is
estimated that malaria costs African countries -./ 0! billion each year and about !() of household
income is spent on malaria treatment(WHO and 12M, !$$#).
&he World Health Organization3s 4lobal Malaria 5rogramme recommends the folloing three primary
inter'entions for malaria control6 early diagnosis of malaria cases and treatment ith effecti'e medicines7
distribution of *nsecticide8&reated 9ets (*&9s) to achie'e full co'erage of populations at ris: of malaria7 and *ndoor
1esidual .praying (*1.) as a major means of malaria 'ector control to reduce and eliminate malaria transmission
including, here indicated, the use of ;;&. Additionally, for control of malaria in pregnancy, use of
effecti'e chemo8prophylactic agents for intermittent pre'ention of malaria is
recommended(WHO, !$$+).
2utabi:a Hospital is a public psychiatric hospital, funded and administered by the -ganda
Ministry of Health and general care in the hospital is free. &he hospital is the only referral
psychiatric hospital in -ganda. Opened in 0,((, it has a bed capacity of ,$$, as of <ebruary
!$0$.
<or o'er "$ years, 2utabi:a Hospital has pro'ided comprehensi'e diagnosis, treatment and
follo8up care and training in mental health. 2utabi:a Hospital as established in 0,((, and
currently is the only 9ational 1eferral Mental Health *nstitution in the country. &he Hospital
pro'ides specialist care and management for all patients ith mental and psychosocial problems
on a referral basis. At the same time, it is a teaching hospital for all cadres specializing in mental
health ranging from nursing cadre to postgraduate students. 2utabi:a Hospital also pro'ides
4eneral Outpatient ser'ices to people from the surrounding area.
VISION
.afe, effecti'e and personalised care 8 e'ery patient, e'ery time, all the time
MISSION
*mpro'e health by putting patients at the centre of e=cellent specialist care
OBJECTIVES
0. >nhance the ?uality and safety of hospitals@ ser'ices pro'ided to patients.
!. *mpro'e the financial efficiency of member hospitals.
#. *ncrease the hospitals and medical centers capabilities to become competiti'e internationally.
MANAGEMENT GAP
&he incidence of malaria among pregnant omen in -ganda is higher than it is in other counties.
According to the district Health Management *nformation .ystem (HM*.) data of Auly !$$, to
May !$0$, there ere a total of !,0(+ cases of omen diagnosed ith malaria in pregnancy. *t is
difficult to attribute the difference in incidence of malaria among pregnant omen in the to
sub8counties to differences in reporting because the ;istrict Health &eam, ith support from the
malaria consortium, conducted HM*. training for all health or:ers in the district.
&here is currently no data at the district that highlights the conse?uences of the high burden of
malaria in pregnancy. Hoe'er, studies done else8here ha'e demonstrated that malaria in
pregnancy is associated ith poor pregnancy outcomes such as maternal anemia, abortions,
intrauterine groth retardation and lo birth eight.
A number of agent, host and en'ironmental factors may be responsible for this high incidence of
malaria among pregnant omen. .uch factors include lac: of use of malaria pre'ention
measures, presence of mos?uito breeding sites, poor housing, poor access and ?uality to health
care ser'ices.
&here ha'e been se'eral inter'entions geared toards pre'enting and controlling malaria in the
district. &hese include mass distribution of *nsecticide &reated 9ets, implementation of
*ntermittent 5resumpti'e &reatment of malaria among pregnant omen and beteen .eptember
and August !$$,, *ndoor 1esidual .praying (*1.) as conducted in the hole district.
2ut in spite of the abo'e inter'entions, the incidence of malaria among pregnant omen is still
higher compared to other countries and the differences in ris: factors for malaria beteen the
to sub8counties are not clear. *t is possible that malaria control and pre'ention measures that
ha'e been uniformly implemented in the district ha'e partly failed to achie'e the desired effect
because implementation does not ta:e into account the underlying determinants of malaria
distribution in the district.
*n light of the foregone, this study sought to understand the determinants of pre'alence of
malaria in pregnancy in these to communities in order to generate information that ould be
used by the ;H& to impro'e on malaria control inter'entions especially among pregnant omen.
SPECIFIC OBJECTIVES
0) &o estimate the pre'alence of malaria among pregnant omen.
!) &o identify health ser'ices factors that influence malaria pre'alence among pregnant
omen.
#) &o indentify socio8demographic factors that influence malaria pre'alence among
pregnant omen
SWOT ANALYSIS
STRENGTH
4ood e?uipment
Well supplied
5ro'ision of multiple facilities for people
5ro'ision of high ?uality medicine
Bualified and e=perienced staff
.ufficient funds
WEEKNESSES
9o accountability or transparency
&oo much reporting (not used
-nclear reporting structure
9o documentation
5oor or: ethics
.taff shortage
Alleged corruption (drug procurement)
OPPORTUNITIES
5olitical ill for impro'ing ?uality
Outside funding opportunities
9e building structures
Client satisfied
THREATS
Dac: of maintenance
&han:less community
Dac: of critical staff (orthopedics)
.taff conflicts
STRATEGIES TO ADDRESS THE PROBLEM
0. When implementing malaria control inter'entions, the ;H& should ta:e into account the
high pre'alence of malaria among pregnant omen and :noledge of this should inform
distribution of resources health or:ers, funds, mos?uito nets, and drugs.
!. &he ;H& should also ensure that malaria pre'ention inter'entions encompass measures to
impro'e housing conditions and encouraging people to li'e at least more than a :ilometer
from ater bodies.
#. *n addition to impro'ing housing conditions, pregnant omen should be encouraged to ta:e
fansidar for *5&.
". &he ;H& should also place more effort to increase onership and use of mos?uito nets.
CONCLUSION
&he study established that the pre'alence of malaria among pregnant omen in the to sub8
counties is higher than that indicated in the HM*. district data. *n addition, the pre'alence of
malaria among pregnant omen in -ganda as higher than in Other African Countries.
BIBLIOGRAPHY
Altma9, ;. 0,,(. .tatistical methods for medical researchers. O=ford press. -E
2a:o, 2. 4., Audu, 2. M., 4eidam, A. ;., Eullima, A. A., Ashiru, 4. M., Malah, M. 2., 9gadda,
H. A. F Musa, A. 2. !$$,. 5re'alence, ris: factors and effects of placental malaria in the
-M&H, Maiduguri, 9orth8eastern, 9igeria6 a cross8sectional study. J Obstet Gynaecol,
!,, #$G80$.
2ates, *., <enton, C., 4ruber, A., Dalloo, ;., Dara, A. M., .?uire, .. 2., &heobald, .., &homson,
1. F &olhurst, 1. !$$". Hulnerability to malaria, tuberculosis, and H*HIA*;. infection
and disease. 5art **6 ;eterminants operating at en'ironmental and institutional le'el.
Lancet Infect Dis, ", #+%8G(.
2land, A. M. !$$$. .ample size in guidelines trials. Fam Pract, 0G .uppl 0, .0G8!$.
2rentlinger, 5. >., Montoya, 5., 1ojas, A. A., Correia, M. A., ;gedge, M., .aute, <., 4imbel8
.herr, E., Mercer, M. A. F 4loyd, .. !$$G. 5re'alence and predictors of maternal
peripheral malaria parasitemia in central Mozambi?ue. Am J Trop Med Hyg, GG, !!%8#".
Hampton, 1. (!$0$). 5ast the e=piration date6 ;rug astage in -ganda. 1etrie'ed 0G <ebruary
!$00 from http6IIblog"globalhealth.ordpress.com
APPENDIX
Opera!"#a$!%a!"# "& re'"((e#)a!"#
O*+e'!,e% Srae-!e% A'!,!!e% Dae
.I#
/ee0%1
C"%
.ituation
analysis and
assessment
;isease
management
&reatment
;iagnosis
23 4 5,666
.er'ice
deli'ery
>lectronic
commerce
becomes the
standard ay of
doing business
On8site training of
health or:ers
78 476,666
5re'ention *nsecticide treated
mos?uito nets
(*&9)
House spraying
&reated nets
79 42,666