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Malaria Morbidity among Under-Five Nigerian Children: A Study of its

Prevalence and Health Practices of Primary Care Givers (Mothers) in a
Resource-Poor Setting of a Rural Hospital...

Article in European Journal of Preventive Medicine · November 2013

DOI: 10.11648/j.ejpm.20130103.11

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European Journal of Preventive Medicine
2013; 1(3): 50-57
Published online November 30, 2013 (http://www.sciencepublishinggroup.com/j/ejpm)
doi: 10.11648/j.ejpm.20130103.11

Malaria morbidity among under-five Nigerian children: A

study of its prevalence and health practices of primary
care givers (mothers) in a resource-poor setting of a rural
hospital in Eastern Nigeria
Iloh GUP1, *, Orji Udo Nnorom2, Amadi AN3
1
Department of Family Medicine, Federal Medical Centre, Umuahia, Abia state, Nigeria and visiting Consultant Family Physician, St.
Vincent De Paul Hospital, Amurie- Omanze, Imo state, Nigeria
2
Department of Family Medicine, Federal Medical Centre, Umuahia, Abia state, Nigeria
3
Department of Public Health Technology, Federal University of Technology, Owerri, Imo state, Nigeria

Email address:
ilohgup2009@yahoo.com (I. GUP)

To cite this article:

Iloh GUP, Orji Udo Nnorom, Amadi AN. Malaria Morbidity among Under-Five Nigerian Children: A Study of its Prevalence and Health
Practices of Primary Care Givers (Mothers) in a Resource-Poor Setting of a Rural Hospital in Eastern Nigeria. European Journal of
Preventive Medicine. Vol. 1, No. 3, 2013, pp. 50-57. doi: 10.11648/j.ejpm.20130103.11

Abstract: Background: Malaria disease, a preventable and treatable disease has continued to plague under-five children
in rural Nigeria. Unhealthy health practices contribute to increased morbidity from malaria especially in a resource-poor
setting. Aim: This study was aimed at determining the prevalence of malaria among the under-five Nigerian children in a
resource-poor setting of a rural hospital in Eastern Nigeria and evaluating the health practices of their mothers as regards
home antimalaria and herbal medication practices, awareness and use of insecticide treated nets (ITNs) and the practice of
abdominal wall scarification. Materials and Methods: This was a descriptive hospital-based study carried out on 196 out of
244 mothers of under-five children who were treated for malaria and met the selection criteria. The mothers were
interviewed using a pretested, structured researcher administered questionnaire which elicited information on home
antimalaria and herbal medication practices, awareness and use of insecticide treated nets (ITNs) and the practice of
abdominal wall scarification. The period of assessment was in the previous six months for ITNs usage. An under-five child
was defined to have malaria if the mother gave complaints of fever, vomiting and other symptoms suggestive of malaria,
had body temperature exceeding 37.5oC with the asexual forms of Plasmodium falciparum detected on the peripheral blood
film. The data collected included age, sex and diagnosis made. Results: One hundred and ninety six (80.3%) out of a total
of 244 under-five children were treated for malaria. Of the 196 under-five children; 128 (65.3%) had home antimalaria
treatment, 53(27.0%) received herbal remedies while 15 (7.7%) had antibiotics. The awareness of ITNs was 87.2% while
user rate was 11.7%. Eighty three (42.4%) had upper abdominal wall scarification marks. Conclusion: This study has
shown that malaria still constitutes a significant health problem in the study area and home treatment of malaria with
antimalaria drugs or local herbal remedies and abdominal wall scarification were practised. The awareness of ITNs was
high but user rate was low. There is urgent need for effective methods to enlighten primary child care givers (mothers) on
appropriate under-five child health practices that are safe, timely, effective and under-five child health friendly and centred.
Keywords: Health Practices, Hospital, Malaria Morbidity, Mothers, Under-Five Children, Rural Nigeria

1. Introduction
Malaria diseases, a preventable and treatable disease has is responsible for over 10% of the overall African disease
continued to plague under-five children in Nigeria. [1,2] It burden. [4] Malaria is also the reason for outpatient
accounts for about one million deaths in Africa and 9 out of hospital attendance in 7 out of every 10 patients seen in
10 cases of malaria worldwide occur in Africa, south of the Nigerian hospitals and occurs in younger children up to 3
Sahara.[3] As a major cause of ill health in Africa, malaria to 4 times a year and is responsible for 25% of infant
 European Journal of Preventive Medicine 2013; 1(3): 50-57 51

mortality and 30% of childhood death in Nigeria.[5] related factors, health services, environmental and genetic
Non-immune individuals, under five children and factors. [13] Among the childcare givers-related factors are
pregnant women bear most of the morbidity and mortality home management of malaria disease by the child primary
due to malaria in sub-Saharan Africa. [1,4] Malaria has care givers particularly the mothers; utilization of herbal
been reported as the most common cause of morbidity remedies; utilization of available healthcare services such
among under-five children in urban [6,7], and rural as the use of ITNs [16, 17] and cultural practices and
[1,8,9]communities in Nigeria. It is associated with beliefs such as abdominal wall scarification practices for
considerable morbidity with life threatening complications malaria splenomegaly and hepatomegaly.
among the under-five children which manifest as severe Under-five child health is an important component of
malaria; severe anaemia and cerebral malaria among other integrated maternal, neonatal and child health services and
complications.[9] ensures that a child once born grows satisfactorily through
Globally, several interventional programs have been infancy, preschool and adolescent periods. In Nigeria, the
introduced to promote the health of the child aimed at cornerstone of malaria control has been early detection,
reducing childhood morbidity and mortality from malaria diagnosis and treatment of malaria in the community and
infection. [10, 11] These interventional strategies focus health facilities. However, it has been observed that many
primarily on the wellness and health of the whole child cases of malaria are not brought to the formal health sector
with the aim of reducing morbidity and mortality from for treatment [1,9] and that antimalaria drugs are widely
diseases. World Health Organisation (WHO) in partnership available in the market place and children are often treated
with United Nations Children Fund (UNICEF), other world at home with over-the-counter(OTC) medications bought
development and financial bodies and heads of from Patent Medicine Dealers(PMDs) and Patent Medicine
governments of United Nations established the Roll Back Vendors(PMVs). [18-20] More so, various herbal
Malaria (RBM) Initiative in 1998 [11] aimed at halving the medications have been administered to the febrile and
malaria mortality in the year 2010 using prompt diagnosis convulsing children by the child care givers which in most
and effective antimalaria treatment and the use of instances by primary care givers particularly the mothers.
insecticides treated nets (ITNs) among under-five children In some instances multiple scarification marks are made on
who had malaria. The African Malaria summit held in the abdominal walls of sick children by traditional medical
Abuja, Nigeria in April 2000, declared that at least 60% of practitioners as a form of treatment for malaria
the persons at risk of malaria especially the under-five splenomegaly and hepatomegaly.
children will benefit from ITNs and at least 60% of persons Unhealthy health practices contribute to poor treatment
suffering from malaria will have access to rapid, adequate and prevention of malaria infection and invariably cause a
and affordable treatment within 24 hours after the rise in family healthcare costs. Clinicians therefore should
beginning of the symptoms.[3,11] More so, the Primary be alert to these unhealthy health practices because most
Health Care(PHC) component of the Alma Ata declaration children’s care givers may be unwilling to admit that they
advocates the accessibility of a health post within 5 have health practice problems. It is against the background
kilometre distance or 30 minutes walk from where the of malaria disease among the under-five children, the most
patient lives. Furthermore, one of the strategies for vulnerable group of children in the rural endemic Nigerian
reducing childhood morbidity and mortality from malaria is communities that the researchers were motivated towards
presumptive treatment of fever in under-five children in ascertaining the health practices of mothers of the under-
malaria endemic areas with effective anti-malaria drugs. five children in the study area. In this regard, mothers being
[11,12] This is in consonance with WHO recommendation very close to the under-five children are usually the first to
for malaria endemic and resource-poor countries where the notice abnormal symptoms in them. Often times mothers
availability and use of laboratories for diagnosis of malaria respond by carrying out various health practices they
infection are limited. Surprisingly, most of these believe will alleviate and ameliorate the ill health of the
interventional programmes on child health have been under-five children. This study was therefore aimed at
elucidated for more than a decade now. However, determining the prevalence of malaria among the under-
eradication and elimination of malaria particularly in five Nigerian children in a resource-poor setting of a rural
Nigeria where it remains endemic is still largely hospital and evaluating the health practices of their mothers
elusive.[1,2,8,9] as regards home antimalaria drug treatment, herbal
The objectives of under-five child health include: medication practices, awareness and use of Insecticide
promotion of optimal physical and emotional growth, Treated Nets (ITNs) and the practice of abdominal wall
survival and development of the child; prevention and scarification.
reduction of diseases, illnesses, injuries, disabilities and
death as well as prompt diagnosis and treatment of diseases 2. Materials and Methods
especially malaria disease among under-five children.[1,8]
Several factors have been identified as important 2.1. Ethical Consideration
contributors to under-five morbidity and mortality. [13-15]
These factors are broadly classified into:- child care-givers- Ethical certificate was obtained from the Ethics
52 Iloh GUP et al.: Health Practices of Mothers of Under-Five Nigerians with Malaria

Committee of the hospital. Informed consent was also selected sample of 196 under-five children was used based
obtained from respondents included in the study. on the time frame for the study.
2.2. Study Design 2.6. Methods

This was a hospital-based cross sectional descriptive The clinical records of the under-five children who
study carried out from June 2008 to June 2009 on 196 out presented each day to the hospital were collected and
of 244 consecutive under-five children who were treated entered into a data collection schedule sheet. A proven
for malaria at St. Vincent De Paul Hospital, Amurie- diagnosis of malaria was based on blood film examination
Omanze, a rural General Hospital in Isu Local Government for malaria parasites. Thick blood film was carried out on
Area of Imo state, South-Eastern Nigeria. The hospital all the patients who had presumptive diagnosis of malaria.
renders twenty four hours service daily including public [15] The thick blood film was made immediately on the
holidays to the community and its environs. slide and processed by standard staining technique using
Giemsa stain.[15] The demonstration of asexual forms of
2.3. Study Setting Plasmodium falciparum on peripheral blood film was taken
Amurie-Omanze is a rural community in Imo State, as a proven diagnosis of malaria infection. A film was
South-East Nigeria. Imo State is endowed with abundant considered negative after fields were well examined and no
mineral and agricultural resources with supply of malaria parasite seen.[15]
professional, skilled, semi-skilled and unskilled manpower. The age, sex and diagnosis made were extracted daily
Economic and social activities are low compared to from the clinic records. A pretested, structured and
industrial and commercial cities such as Onitsha, Port interviewer administered questionnaire was used to collect
Harcourt and Lagos in Nigeria. . information from the patients’ mothers. Information on
The climate of Imo State is essentially tropical with very home antimalaria medication practice and herbal
high temperature within the months of November to March medication practice were obtained from the patients’
and seasonal rainfall. Two seasons are prominent in the mothers. Awareness of information on ITNs and its use
State, namely rainy and dry seasons. The dry season starts were also obtained from the patients’ mothers. The use of
in November and lasts until March while rainy season starts ITNs was assessed in the previous six months before
in April and ends in October. The mean monthly presentation to the hospital and was coded as yes for
temperature of Imo State during the dry season is 340c utilization and no for non use. Information on scarification
while it is 300c in rainy season. It has relative humidity of practice was also obtained from the mothers of the under-
about 60% to 80% throughout the year. Its mean annual five children who had scarification marks on the upper
rainfall is between 2000 and 2500 millimeters. abdominal wall.
The questionnaire was pre-tested externally at St.
2.4. Inclusion and Exclusion Criteria Damian Hospital Okporo, a similar General Hospital in
Orlu, Imo state using five mothers of under-five children
The study population were recruited from among who met the selection criteria. The respondents for the pre-
mothers whose under-five children were managed for testing were selected haphazardly. The pretesting was done
confirmed malaria at the study centre during the study to find out how the questionnaire would interact with the
period. The under-five children who were brought to the respondents and ensure that there were no ambiguities.
hospital by other care givers other than the biological However, no change was necessary after the pre-test as the
mothers were excluded from the study. More so, under-five questions were interpreted with the same meaning as
children who needed specialized diagnostic investigations intended.
and care were referred out and excluded from the study.
2.7. Operational Definitions
2.5. Sample Size Determination
An under-five child was defined to have malaria if the
Sample size estimation was determined using the mother gave complaints of fever, vomiting and other
formula [21] for calculating minimum sample size for symptoms suggestive of malaria, had body temperature
descriptive studies when studying proportion with entire exceeding 37.5oC with the asexual forms of Plasmodium
population less than 10,000 using estimated population size falciparum detected on the peripheral blood film.[15]
of 500 under-five patients based on the previous annual Health practice refers to the action mothers take when
under-five children population hospital attendance: dealing with an ill health in under-five child with malaria.
N=Z2pq/d2 [21] where N=Minimum sample size, The success of healthcare interventions for the under-five
Z=Standard normal deviation usually set at 1.96 which Nigerian children with malaria in malaria control needs
corresponds to 95% confidence interval, P=Proportion of proper and appropriate health practices especially by the
the population estimated to have a particular characteristic. primary care givers particularly the mothers. Primary care
Proportion was taken from prevalence of malaria from giver refers to care givers who give informal care such as
previous study in Owerri South-east Nigeria [7] = 60.7%. the mothers of under-five children. Awareness of ITNs
The estimated minimum sample size was 211. However,
 European Journal of Preventive Medicine 2013; 1(3): 50-57 53

refers to awareness of information on ITNs and was 11, 12, 15, 22] The outcomes of malaria in under-five
described as high when the awareness was ≥50% and low children have been documented to be influenced by
when less than 50%. High ITNs user rate refers to the interplay of epidemiological[15-17, 22] and immunological
utilization of ITNs in the previous six months and factors.[23-25] The malaria related health practices of
described as high when ≥50% and low when less than 50%. primary care givers especially the mothers of under-five
children are among the epidemiological factors that
2.8. Statistics influence malaria disease. Through the activities of
The results generated were analysed using software WHO/UNICEF and other UN agencies there has been a
Statistical Package for Social Sciences (SPSS) version 13.0, remarkable reduction of morbidity and mortality from
Inc. Chicago, IL, USA for the calculation of frequencies malaria disease globally. However, despite these gains and
and percentages for categorical variables. outstanding achievements in malaria control in other
tropical countries, under-five childhood morbidity in the
study area [1,9] and other parts of Nigeria is largely
3. Results attributed to malaria.[,6,7] Malaria has therefore remained
One hundred and ninety six out of a total of 244 under- as significant in under-five child health in the present
five children studied had malaria giving a prevalence of century in Nigeria as they were in the early 1900s in
80.3%. The ages of the study population ranged between 4 developed countries. Despite years of formulation and
days and 58 months with mean age of 30.4±5.6 months. implementation of malaria control programmes such as
There were 116(59.2%) males and 80(40.8%) females RBM initiative, the impact of programme targets in general
giving a male to female ratio of 1.5:1(Table 1). The age and under-five childhood morbidity specifically have been
group specific prevalence of malaria ranged between 11.2% below expectation especially in rural Nigerian communities.
and 49.0% in different age groups with the highest [1, 8, 9] The high prevalence of malaria among the study
prevalence of 49.0% in patients between 37-60 months and population could be attributed to its rural conduct in a
lowest prevalence of 11.2% in patients aged 0-12 holoendemic and stable malaria area of Nigeria. More so,
months.(Table 1). the under-five children have been documented as special
group at risk of malaria, even in stable malaria areas where
Table 1. Age and sex distribution of the under-five children with malaria some degree of acquired immunity for most adult
population is offered. [24-26]
Sex
Age(months) The prevalence of malaria was highest in patients aged
Male(Number(%)) Female(Number(%))
37-60 months and lowest in age group 0-12 months. This
0-12 16(13.8) 6(7.5
pattern of age distribution of prevalence of malaria among
13-36 49(42.2) 29(36.3)
the under-five children in this study is in keeping with the
37-60 51(44.0) 45(56.2)
reports that age and exposure to malaria infection are
Total 116(59.2) 80(40.8) essential to the development of natural immunity to malaria
disease.[24, 25] Although several factors have been
Of the 196 under-five children who had malaria, one documented that predispose the under-five children to
hundred and twenty eight (65.3%) had antimalaria treatment morbidity from malaria.[12-14] However, among the
at home, fifty three (27.0%) had treatment with herbal under-five children in endemic malaria areas, there is
remedies while fifteen (7.7%) had antibiotics. (Table 2) transient resistance to malaria infection from birth to 6
One hundred and seventy one (87.2%) out of the 196 months of age due to transplacentally transferred IgG
mothers of the study population was aware of ITNs. antibodies from the mother to the child.[24-26] The 6
However, twenty three (11.7%) out of the 196 under-five months to 3 years age group are especially regarded as non-
children who had malaria use ITNs in their homes. Eighty immune when they have lost the immunity(maternal
three (42.4%) out of the 196 patients who had malaria had antibodies) transferred from their mothers in highly
scarification marks on the upper abdominal wall. (Table 2) endemic areas. More so, even when surviving children
develop their own immunity between the ages of 3-5 years,
4. Discussion they will still be particularly vulnerable because they have
not developed the partial immunity conferred upon
The prevalence of malaria of 80.3% in this study is surviving repeated malaria infections.
higher than 60.7% reported in Owerri, South east Nigeria, Home treatment of malaria with antimalaria drug was
[7] 57.3% reported in Jos, Northern Nigeria,[27] and 39.4% practised by 65.3% of the mothers of the study population.
reported in other topical African countries such as Home treatment of malaria with antimalaria drugs is
Uganda.[22] This study has demonstrated that malaria is reportedly practised in several households in Nigeria [18-20]
still an issue of serious medical importance among under- and elsewhere in Africa.[27-29] Home treatment of malaria
five children in the study area.[1, 9, 15] This finding has with antimalaria drugs was reported in Nnewi, South-east
buttressed the reports that malaria accounts for most of the Nigeria(15.6%)[18], Ile-Ife, South-west Nigeria(83.2%)[19],
under-five morbidity in tropical African countries.[1, 6, 7, 9, Jos, Northern, Nigeria(48.1%)[20] and other African
54 Iloh GUP et al.: Health Practices of Mothers of Under-Five Nigerians with Malaria

countries such as Kenya(47%)[27], Malawi(72%)[28], and so, there appeared to be seemingly reduced trust in the
Burkina Faso(59%)[29]. Studies in Nigeria [18, 19] and formal public health care delivery system in Nigeria
other African countries [30, 31] have also shown that the [1,9,19,20] and apparently more reliance on the informal
initial treatment of malaria fever often takes place at home. health sector especially the use of herbal medicines in the
In malaria endemic areas, the main strategy for reducing treatment of malaria. Furthermore, the use of herbs is
under-five childhood morbidity and mortality from malaria probably a reflection of much level of financial incapability
disease is presumptive treatment of all fevers in under-five (direct and indirect costs of treatment) to access, afford and
children with antimalaria drugs.[12,32] This strategy is in avail treatment from formal health sector [1,9] as the
consonance with WHO recommendation for malaria locally available and accessible herbs can probably be
endemic countries where the availability and use of gathered at no cost. Although, some of these herbal
laboratories are limited. For many years, the cornerstone of remedies overtly may be beneficial, many of them are
malaria control across Nigeria has been early detection, harmful to the sick under-five children that they are
diagnosis and treatment through primary health care services. supposed to help as their active ingredients are unspecified,
However, studies in Nigeria[18,20] and other African dosages not clearly defined and their side effects may be
countries[30,31] have shown that many cases of malaria are grave and inimical to the under-five child health. Moreover,
not brought to the formal health sector for treatment, and that the actual efficacy of most of these local herbs in the
antimalaria drugs are widely available in the market place treatment of malaria has not been conclusively determined.
and that under-five children are often treated at home with Despite common use of herbal remedies in the treatment of
over-the-counter medications bought from patent medicine malaria, physicians and pharmacists in particular and the
stores. More so, most under-five children dying from malaria public in general are often uninformed as regards herbal
do so within 24 hours to 72 hours of the onset of severe medicines efficacy and safety. Therefore, in the absence of
symptoms,[9] the speed with which malaria is diagnosed and organized oversight lies the potential for harm. It is
treated is critical in reducing mortality. By minimizing the therefore important to sensitize medical practitioners and
delay before treatment, effective treatment with antimalaria pharmacists practising in study area and the rural populace
drugs at home can save many lives of the under-five children on the use of local herbs and its dangers. This calls for
in malaria endemic areas. Home treatment of malaria with basic research to widely investigate, identify and confirm
effective antimalaria drugs also circumvents any the efficacy, effectiveness and safety of local herbal
inadequacies in the formal health care system. Although, remedies used in the treatment of malaria.
home-based malaria treatment has the potential of positively This study showed that 87.2% of the mothers of the
impacting on malaria control, in terms of prompt recognition study population were aware of the use of ITNs to prevent
and treatment to prevent complications and also reduce malaria infection in under-five children but the ITNs user
childhood mortality, there can be problems with the rate for the study population was 11.7%. This finding has
antimalaria drug use, particularly where there is inadequate buttressed the reports in Nigeria that awareness of ITNs is
education of child care givers especially the mothers on the high but the user rate is low and inadequate.[16,17,19,26,35]
use of antimalaria drugs. The home antimalaria medication The low and inadequate ITNs user rates have been reported
practice by mothers of the study population coupled with in Ile-Ife, South-west, Nigeria(2.1%),[19] Sagamu, South-
inadequate dosing may lead to irrational drug use and west, Nigeria(22.8%)[35] and other African countries such
development of resistance to commonly used antimalaria as Malawi(20.5%)[37]. The low user rate of ITNs in this
drugs. With this high rate of home treatment of malaria in study negates the tenets and precepts of RBM initiative of
this study, there is need for effective methods to educate the Federal Government of Nigeria.[5,11] At the African
mothers of the under-five children on the use and the Summit on RBM held in Abuja, Nigeria in April 2000,[3,11]
potential dangers of irrational home antimalaria medication African leaders committed themselves to ensure that by the
practice. Rationally, home treatment of malaria in malaria year 2005, at least 60% of those at risk of malaria infection
endemic areas with effective antimalaria drugs is a strategy such as under-five children have access to an effective
that if properly done will reduce morbidity and mortality means of malaria prevention like the use of ITNs. More so,
from malaria. [32-34] the national malaria control programme in Nigeria
This study has demonstrated that 27.0% of the study identified ITNs as a key strategy to malaria control.[5] To
population had home treatment with local herbal remedies. achieve this, the Federal Government of Nigeria tried to
The use of local herbs to treat childhood malaria was improve net coverage by promoting awareness through
reported in Ile-Ife(1.9%), South-west Nigeria,[19] social marketing with emphasis on providing free ITNs for
Jos(2.3%), Northern Nigeria [20] and other African under-five children and pregnant women. Despite the
countries such as Uganda(48.4%).[34] These reports have efforts of WHO[10] and Federal Ministry of Health of
shown that the use of local herbs for treatment of malaria is Nigeria[5] the morbidity and mortality of the under-five
practised in Nigeria [19,20] and other parts of Africa such children from malaria remained high especially in rural
as Uganda.[34] The use of local herbs for the treatment of Nigeria.[1,8,9] The low and inadequate user rate of ITNs
malaria among the study population could be due to lack of among the study population calls for family and
access to formal health facilities in the study area.[9] More community wide campaign on the benefits of ITNs since
 European Journal of Preventive Medicine 2013; 1(3): 50-57 55

widespread use of ITNs has been documented to were minimized by structuring the questions as well as
significantly reduce morbidity and mortality from malaria assuring the mothers of the study population of
in Nigeria[26] and in other parts of the tropics such as confidentiality prior to the conduct of the interview.
Kenya.[37].
This study has demonstrated high abdominal wall 5. Conclusion
scarification practices for the treatment of upper abdominal
swelling due to malaria splenomegaly and hepatomegaly This study has shown that malaria still constitutes a
among the study population. If there is any malaria control significant health problem among the under-five children in
strategy that will greatly impact on the quick deterioration the study area. Home treatment of malaria with antimalaria
of sick under-five children and reduce the rapid drugs or local herbal remedies and abdominal wall
development of malaria-related anaemia or other severe scarification practices were practised by the mothers of the
malaria outcomes, passionate thoughts should be given to study population. The awareness about ITNs was high but
the education of child’s care givers particularly the mothers user rate was low. Clinicians attending to under-five
in malaria endemic areas with the ability to recognize children in the study area should screen for the obnoxious
malaria in every case of febrile illness in under-five health practices as these affect the quality of care rendered
children.[9,32] The abdominal wall scarification practice to these under-five children who are living in resource poor
may also cause delay in seeking and obtaining prompt and setting of a rural hospital in South-east Nigeria.
effective treatment for malaria and can result in serious
illness and ultimately death of the affected under-five child. Acknowledgement
Identification and exploration of indigenous traditional
beliefs of different cultures on the aetio-pathogenesis of The authors are grateful to Rev. Sister Francisca Eya of
malaria as a means to educate the people and the insistence St. Vincent de Paul hospital, Amurie-Omanze for
on their replacement with modern knowledge, attitude and permission for the study.
practice should be explored in the study area.
Table 2. Frequency of malaria-related health practices among mothers of
4.1. Implications of the Study the under-five children

The burden of malaria among the under-five Nigerian Health practices Number Percentage(%)
children in study area can be influenced by health practices Home antimalaria practice 128 65.3
of the primary care givers particularly the mothers. The Herbal remedies practice 53 27.0
unhealthy health practices by the mothers of the study Antibiotics administration 15 7.7
population may predispose the under-five children to the risk
Insecticide treated nets use 23 11.7
of disability and mortality from malaria. However, regular
health education and promotion activities are limited in Abdominal wall scarification practice 83 42.4
clinical consultation in Nigerian health facilities particularly
in rural Nigeria due to time constraints. Hence, there is
stronger need more than ever before to re-enforce the References
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