4.1 Sociodemographic Characteristics
Table 4.1 highlights the socio-demographic information of mothers of under-five children the respondents of the study. The data revealed that most (37.8%) of the mothers were within the age groups 30-34 years. Majority (89.7%) of the mothers were married while 10.7% were unmarried, divorced, widowed or remarried. Again, more than half (53.8%) of the mothers were Muslims, 5.1% were Christians while less than 2% were traditional religious practitioners. Significant majority (97.8%) of the mothers were literate and most (44.4%) had secondary education. Majority (83.2%) of the mothers were gainfully employed, 48.4% were civil servants in government establishments while 20% were employed in the private sector, 14.1% were employed in the agricultural sector, 1.0% were corporate workers and 16.6% of the mothers were unemployed,. An appreciable number (45.6%) of the mothers earn income between #20,001 and #30,000 which is relatively small to afford the cost of treatment malaria.
Table 4.1: Percentage Distribution of Respondents by Sociodemographic Characteristics
Characteristics
|
Categories Frequency Percentage
|
Age Group
|
20-24 years 25 4.5
25-29 years 159 28.3
30-34 years 212 37.8
35-39 years 93 16.6
40-44 years 44 7.8
45 and above 28 5.0
Total 561 100.0
|
Marital Status
|
Never been married 33 5.9
Married 503 89.7
Widowed 15 2.7
Separated - -
Divorced 10 1.8
Remarried 1 0.2
Total 561 100.0
|
Religion
|
Christianity 253 45.1
Islam 302 53.8
Traditional 6 1.1
Total 561 100.0
|
Education
|
No Formal Education 12 2.1
Primary Education 201 35.8
Secondary Education 249 44.4
University Education 24 2.3
HND 30 7.0
NCE/OND 45 8.3
Total 561 100.0
|
Occupation
|
Unemployed 93 16.6
Agriculture 82 14.1
Civil Service 271 48.3
Clergy - -
Corporate Organization 4 1.0
Private Business 112 20.0
Total 561 100.0
|
Data source – field work 2019
Perception of Signs and Symptoms of Malaria
Figure 4.1 shows that majority (53.5%) of the mothers perceived fever as the common sign and symptom of childhood malaria. This finding aligns with the observation of Akogun and John (2005). This finding indicates that majority of mothers correctly identified the symptoms of malaria which conforms to the clinical manifestations. This revelation has significant implication for the type of health-seeking behaviour of mothers for childhood malaria management. This finding was elaborated in group narrative discussion that childhood malaria is always accompanied with fever. According to a mother:
When I observed that my child is running temperature, feeling restless and loss of appetite for food, I know he is having malaria. At times his breathing becomes fast and he throws up at the smell of food. Similarly, he develops nasty mouth-sores and sweats profusely. Once these symptoms manifest, certainly it is malaria (FGD/Educated Young Mother/Osogbo/2019).
Another mother reported: Malaria remains the main sickness that afflicts my children. At times when they have malaria, it comes with extreme feverish condition. However, mothers should be very careful because sometimes fever may be an indication of another illness. For instance, the last time my three-year-old son had fever, I thought it was malaria not until went for laboratory test that it was discovered it was to be measles (FGD/Educated Middle Aged Mother/Osogbo/2019).
The foregoing narratives emphasize the importance of confirmatory laboratory blood test before commencement of malaria treatment because typhoid and some opportunistic diseases childhood diseases manifest similar and overlapping symptoms of fever (Ukaegbu, Nnachi, Mawak, and Igwe, 2014).
Perceived Causes of Childhood Malaria
Table 4.2: Distribution of Mothers by Perception of Causes of Childhood Malaria
Perceived Causes of Childhood Malaria
|
Frequency
|
Percent
|
Eating of palm oil
|
117
|
20.9
|
Eating of sugar
|
42
|
7.5
|
Mosquito bite
|
271
|
58.3
|
Genetic factors
|
33
|
5.9
|
Heat from the sun
|
48
|
4.6
|
Don’t know
|
50
|
2.8
|
Total
|
561
|
100.0
|
A table 4.2 shows that 58.3% of mothers reported that mosquito bite was the main cause of malaria. This finding was corroborated by (Talipouo, Ngadjeu, Doumbe-Belisse, Djamouko-Djonkam, Bamou, Awono-Ambene et al. 2019: Espinoza, 2019). This finding was elaborated further in narrative group discussion by mothers that among the factors responsible for malaria, mosquito bite remains the main cause of malaria. According to a mother:
The source of malaria is mosquito bite which is transmitted to the infected person mostly at night. From its silvery gland, the parasite is passed into the blood stream of the child. The child in response develops symptoms such as aching body, feverish feeling among others causing a child to pass out yellow urine (FGD/Young Uneducated Mother/Osogbo/2019).
The narrative above is correct to the extent that mosquito bite causes malaria however, yellow urine, as indication of childhood malaria remains a speculation than a fact. The extraction of surplus B vitamins from body, food and water consumed and outcome of the metabolic processes in the body can gave rise to yellow coloration of urine (Emyibe, 2014). Therefore, coherent healthcare information is required to counter such misconception.
Several others causes of childhood malaria apart from mosquito bite were identified and reported by the mothers in FGD which revealed that the direct causal agent associated with malaria is not yet understood by the mothers notwithstanding the fact that malaria is a prevalent health issue among under-five children. The study revealed that some mothers opined that when a child consumes too much oily food, he or she is bound to contract malaria. Consuming of much sugar, exposing a child to intensive heat, and genetic factors would make a child venerable to malaria. This finding aligns with (Amzat. 2009: Orimadegun, 2015: Tobin-West and Kanu, 2016: Oladimeji, Tsoka-Gwegweni, Ojewole, and Yunga, 2019), this explains why malaria seems unpreventable as there is no way a child cannot be exposed to these factors. This finding was emphasized in narrative group discussion which revealed that misconception is inimical to malaria management because it wrong treatment of malaria. According to a mother:
There is no stage of malaria that ‘agbo’ (herb) cannot cure. Yoruba believe strongly on the efficacy of herbs. This is why we do not fall sick to ‘Iba’ so often. When a child is administered with ‘agbo’ at the onset of malaria, it is eliminated from the body system from the urine which can be seen as it evaporates from the ground (FGD/Uneducated Old Mother/Osogbo/2019).
Another mother said:
When malaria is caused from eating of too much oil, it will appear as yellow foams on the ground during urination. On the other hand, if the malaria was caused by ‘Abiku’ (evil spirits), the urine will dry up immediately with whistling sound as it touches the ground (FGD/ Uneducated Old Mother/Osogbo/2016).
Another mother reported:
I am aware that mosquito bite is the main cause of malaria. However, a child who plays in the sun may contract malaria. Furthermore, a mother or family member can pass malaria to their children (FGD/Uneducated Young mother/Osogbo/2019).
The study revealed that mothers were unaware of how mosquitos transmit malaria. In the FGDs, significant number of mothers could not really explain how malaria transmitted except the educationally sophisticated mothers who mentioned from the silvery gland of infected mosquito to the host body. This ignorance is indicates a lacuna in health communication techniques because most people are unaware of the real causes and transmission of malaria.
Studies have shown that despite the fact that miscomputations are inimical to malaria management, yet they are acceptable in the society as invaluable part of healthcare maintenance system. For instance, Africans and various ethnic groups in Nigeria have their own beliefs and values that have implication for their conception of health and illness and so have fashioned mechanisms aimed at resolving emergent health issues within their cultures (Kahissay, Fenta, & Boon, 2019). The study shows that misconceptions are not limited to any age group of mothers as both young and old do not differ in terms of their causal explanations of perceptions of malaria.
Furthermore, the perception of the causes of malaria is influenced by level of education attainment of mothers. The study revealed that most of the educated mothers were aware of the connection between mosquitos and malaria. However, some of the educated mothers were guilty of mentioning other factors instead of mosquito bite as the cause of malaria. For instance, significant numbers of mothers in narrative group discussions, particularly uneducated mothers were unable to explain the link between malaria and mosquitos. Given the high spread of malaria, there is the need for better causal issues of malaria for proper comprehension of malaria management in children.
Perception of Consequences of Childhood Malaria
Table 4.3: Distribution of Mothers by Knowledge of Perception of Consequences of Childhood Malaria
Perceived Consequences of Malaria
|
Frequency
|
Percent
|
Convulsion
|
286
|
51.0
|
Anaemia
|
55
|
9.8
|
Loss of Appetite
|
45
|
8.0
|
Loss of Concentration for work
|
45
|
8.0
|
Death
|
44
|
7.8
|
Coma
|
32
|
5.7
|
Breathing difficulty
|
28
|
5.0
|
Low Body Immunity
|
26
|
4.6
|
Total
|
561
|
100.0
|
Table 4.3 examines the perceived consequences of childhood malaria among mother. The finding shows that majority (51.0 %) of the mothers reported that febrile convulsion was the major consequence of childhood malaria. This finding aligns with the discovery of Amzat (2009) which maintained hat febrile convulsion ‘Giri’ in local parlance was reported by the mothers as the leading outcome of malaria in children and accompanied by breathing difficulty, contraction of the muscles, faints, involuntary moaning, crying, and passing of urine.
The study also reveals most of the most the mothers explained clearly in FGDs the connection between convulsion and malaria which has been reported to be very fundamental because convulsion is a physical, psychological and behavioural disorders that affect children, creates fear and anxiety for parents which may subsequently affect the family’s quality of life (Kanemura, Sano, Mizorogi, Tando, Sugita and Aihara, 2013: Sajadi and Khosravi, 2017: Westin and Sund, 2018). According to a mother FGD stated that:
Convulsion is a terrible experience to behold because the last time my child had convulsion it stretched him out to the point of death, rolling him on the floor. My consolation is that conceived legitimately. It is a child borne from adulterous sex affairs that experience convulsion in his/her developmental stages of life except the parents confess their illicit act to each order, the child (FGD/Uneducated Young Mother/Osogbo/2019)
Another mother maintained:
Febrile convulsion emanates from witches and wizards sent by people of evil intent to punish children people who offended them. However, herbalists have the power to stop convulsion from occurring through pacification of the spirits concerned with convulsion (FGD/Uneducated Old Mother/Osogbo/2019).
Another mother reported:
Convulsing children lack physical strength to perform domestic activities at home. We make sure that they are excluded from carrying out task that may subject them to stress because the evil spirits in them are very lazy and would not like to be disturbed through energy sapping activities. This spirit called Ogbanje in Igbo dialect or Abiku in Yoruba dialect may come repeatedly in a child’s the life time if nothing drastic is done to stop such reappearance (FGD/Uneducated Old Mother/Osogbo/2019).
Misconceptions such as expressed above by mothers in the study can influenced their decision on the type of treatment given to children with febrile convulsion. It is important to note that connection between febrile convulsion and the mystic perceptions of the consequence of childhood malaria has not been substantiated medically. However, convulsion has been linked to the malfunction in the brain causing unusual emission of electrical waves by several cranial cells, simultaneously devastating these cranial cells leading to muscular seizures, loss of consciousness and more related complications (Seinfeld and Pellock 2013).
Table 4.4: Percentage Distribution of Mothers by Selected Socio-demographic Variables
Socio-demographic
|
Consequences of childhood malaria
|
Convulsion
|
Anaemia
|
Loss of Appetite
|
Coma
|
Breathing
Difficulty
|
Low body immunity
|
Loss of
concentration
|
Death
|
Total
|
Age in Groups
|
20-24 years
|
9 (1.6)
|
5 (0.9)
|
1 (0.2)
|
3 (0.5)
|
2 (0.4)
|
2 (0.4)
|
2 (0.4)
|
1 (0.2)
|
25 (4.5)
|
25-29 years
|
79 (14.1)
|
17 (3.0)
|
15 (2.7)
|
7 (1.2)
|
6 (1.1)
|
8 (1.4)
|
13 (2.3)
|
14 (2.5)
|
159 (28.3)
|
30-34 years
|
109 (19.4)
|
21 (3.7)
|
16 (2.9)
|
9 (1.6)
|
9 (1.6)
|
11 (2.0)
|
21 (3.7)
|
16 (2.9)
|
212 (37.8)
|
35-39 years
|
58 (10.3)
|
3 (0.5)
|
9 (1.6)
|
4 (0.7)
|
7 (1.2)
|
3 (0.5)
|
4 (0.7)
|
5 (0.9)
|
93 (16.6)
|
40-44 years
|
21 (3.7)
|
4 (0.7)
|
2 (0.4)
|
6 (1.1)
|
2 (0.4)
|
1 (0.2)
|
3 (0.5)
|
5 (0.9)
|
44 (7.8)
|
45+ years
|
10 (1.8)
|
5 (0.9)
|
2 (0.4)
|
3 (0.5)
|
2 (0.4)
|
1 (0.2)
|
2 (0.4)
|
3 (0.5)
|
28 (5.0)
|
Total
|
286 (51.0)
|
55 (9.8)
|
45 (8.0)
|
32 (5.7)
|
28 (5.0)
|
26 (4.6)
|
45 (8.0)
|
44 (7.8)
|
561 (100.0)
|
X2 =34.518, df35, P= .491
|
Education
|
|
|
|
|
|
|
|
|
|
No formal Edu
|
6 (1.1)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
4 (0.7)
|
2 (0.4)
|
0 (0.0)
|
0 (0.0)
|
12 (2.1)
|
Primary Edu.
|
94 (16.8)
|
24 (4.3)
|
17 (3.0)
|
10 (1.8)
|
4 (0.7)
|
9 (1.6)
|
22 (3.9)
|
21 (3.7)
|
201 (35.8)
|
Secondar Edu
|
137 (24.4)
|
26 (4.6)
|
18 (3.2)
|
15 (2.7)
|
15 (2.7)
|
6 (1.1)
|
16 (2.9)
|
16 (2.9)
|
249 (44.4)
|
Tertiary Edu
|
49 (8.7)
|
5 (0.9)
|
10 (1.8)
|
7 (1.2)
|
5 (0.9)
|
9 (1.6)
|
7 (1.2)
|
7 (1.2)
|
99 (17.6)
|
Total
|
286 (51.0)
|
55 (9.8)
|
45 (8.0)
|
32 (5.7)
|
28 (5.0)
|
26 (4.6)
|
45 (8.0)
|
44 (7.8)
|
561 (100.0)
|
X2 =50.df 553, 21, P= .000
|
|
|
|
|
|
|
|
|
|
|
|
|
Table 4.4 shows that there is no significant relationship between age of mothers and their perceptions of malaria since p> 0.05. The table shows thatvalue = 34.518, df = 35 and p- value calculated is 0.491.
Table 4.4 also shows a strong relationship between education of mothers and their perceptions of malaria consequences given that p< 0.05. =50.553, df = 21 and p-value calculated = 0.000.
Furthermore, table 4.4 shows there is no relationship between income and perception of malaria consequences because p>0.05. The table indicates that =33.675, df= 35 calculated P-value = 0.532.
Perception of Preventive Methods of Childhood Malaria
Figure 4.2 shows that significant number (65.6%) of mothers reported that mosquito net is the most effective method of childhood malaria prevention. This finding aligns with Lindblade, Steinhardt, Gimnig, Shah, Wong, Wiegand, & Howell (2015) which reported that mosquito net use remains the most reliable device for malaria prevention especially in children because it can reduce both transmission and mortality rates by at least 25% when used properly. This finding indicates that majority of mothers in the study are conscious of the potential contributions of use of mosquito nets in malaria management. This finding be adopted to give important insight in formulating policies that will improve the allocation and utilization of mosquito nets by mothers in Osogbo where the distribution and ITNs use are at the lowest ebb (Osun State Ministry of Health, 2012). Also, the
Similar findings were reported in a study in Ghana that most of the respondents were highly convinced that use of bednets is capable of preventing malaria (Konlan, Amu, and Japiong, (2019). The high level of awareness of malaria prevention knowledge among the population in northern Ghana was the outcome of the health education messages continually given to them by health workers in the area which, in turn, accounts for the appreciable understanding of malarial management measures. Also, it was reported that the use of ITNs can lower to a large extent the threat from malaria death and illness (Afoakwah, Nunoo, & Andoh, 2015). In conclusion, Macintyre, Littrell, Keating, Hamainza, Miller and Eisele (2011) reported that insecticide treated nets (ITNs) are the most effective protective means against malaria death among children in high malarial transmission setting. In the FGD sessions expressed their perception of ITN use in malaria management thus:
Sleeping under the cover of ITN prevents children from developing malaria because mosquito cannot bite them. However, I have stopped using it in my home since the one we had got torn and worn out. Nonetheless, I have applied to the relevant health officials for another bednet instead of buying it from the open market to avoid buying fake bednets (FGD/Young Literate Mother/Osogbo/2019).
When the mothers were asked of the source of the ITNs they use in FGDs, an overwhelming majority of them claimed that they got theirs from Non-Government Organizations (NGOs) free of charge and they were impregnated with chemical. The study revealed further that not all the nets used by mothers were impregnated with chemicals. Factors such as ignorance, scarcity of funds, limited treated nets and long waiting time before the nets were made available at the officials designated centres were the main reasons why mothers went for the non-treated mosquito nets. This finding was corroborated by a mother that:
The bednet we use in our house is not insecticide treated. I bought it at the market because it is difficult to get from the health facility. During the day time, I keep it aside and tie it up at night. However, I was advised by healthcare providers the last time my child had malaria to sleep under it day and night always because some species of mosquitos bite during the day time (FGD/Middle Aged Educated Mother/Osogbo/2019).
The study also revealed that possession of bednet may not guarantee its usage due to some underlying inconveniences reported by most of the mothers that bednets generation a lot of heat because the chemical used in coating them have irritating smell. Some of the mothers reported in FGD sessions that they stopped using bed nets because of the inconvenience they encountered while sleeping under it. They claimed that sleeping under bednet cover gave their children body rashes, cough, catarrh and restlessness. According to a mother:
Sleeping under the ITN is very inconveniencing. My children sweat a lot from the heat it emits, feel restless, roll from one side of the bed to another in an attempt to get air. The smell of the chemicals used in treating the net is very irritating, thereby giving them cough and catarrh. They develop skin itching and rashes all over their bodies which made us to stop using bearing in mind the consequence of doing so (FGD/Old Uneducated Mother/Osogbo/2019).
Despite some of the reported difficulties encountered with the use of bednet in the narrative above, practical evidence suggests that the advantages of using mosquito nets are far greater than the difficulties experienced in its use. Parent have spent substantial amount of money in treating severe malaria complications. A critical search of literature has not reported death linked to sleeping under ITNs. The non-use of ITN by some mothers to prevent malaria infection in their children does not, in any way, reduce its acceptance and usage as the most effective method of controlling malaria (Kyalo, 2013). Therefore, efforts should be expended to scale up the use of ITNs through effective public enlightenment education programmes.