Project – Knowledge and Practice of Malaria Prevention Among Pregnant Women: A Study of Selected Primary Healthcare Centres in Wukari Local Government Area, Taraba State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malaria remains a major public health problem in many tropical and subtropical countries, particularly in sub-Saharan Africa, where climatic conditions support the survival and transmission of malaria parasites by infected female Anopheles mosquitoes. Although malaria is preventable and treatable, it continues to cause substantial illness and death, especially among vulnerable populations. The World Health Organization (WHO, 2024) estimated that there were 263 million malaria cases and 597,000 malaria-related deaths worldwide in 2023, with the African Region accounting for approximately 95% of the deaths. These figures demonstrate that malaria prevention remains an important public health priority, particularly in communities where access to preventive services, timely diagnosis, and effective treatment may be limited. Within this context, pregnant women require special attention because malaria infection can threaten both maternal health and the survival and development of the unborn child.

Pregnancy increases a woman’s vulnerability to malaria because physiological and immunological changes during pregnancy can reduce her ability to control malaria parasites effectively. Malaria infection during pregnancy may result in maternal anaemia, severe illness, placental infection, miscarriage, stillbirth, premature delivery, and low birth weight. The risks extend beyond childbirth because poor fetal growth and low birth weight may contribute to adverse health outcomes during infancy. The WHO (2024) identifies malaria in pregnancy as an important contributor to maternal and neonatal complications, while the WHO (2023) explains that preventive interventions can reduce maternal infection and improve birth outcomes. These consequences make it necessary for pregnant women to understand the dangers of malaria and to adopt appropriate preventive practices throughout pregnancy. Consequently, assessing women’s knowledge of malaria and their actual preventive behaviour is important for identifying areas where health education and antenatal services may need improvement.

One of the principal methods of malaria prevention during pregnancy is the consistent and correct use of insecticide-treated nets, particularly long-lasting insecticidal nets. These nets provide a physical barrier against mosquito bites and contain insecticides that help reduce contact with mosquitoes capable of transmitting malaria. The WHO (2023) recommends that pregnant women in malaria-endemic areas use insecticide-treated nets as early as possible in pregnancy and continue using them throughout pregnancy and the postpartum period. However, possessing a net does not necessarily mean that it is used consistently or correctly. Factors such as inadequate knowledge, discomfort, hot weather, overcrowded sleeping arrangements, damaged nets, and difficulties obtaining replacement nets may affect regular use. Therefore, the effectiveness of this intervention depends not only on availability but also on pregnant women’s understanding of its benefits and their willingness and ability to use it consistently.

Another essential strategy is intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP), administered according to national guidelines. Unlike treatment given after a confirmed infection, IPTp-SP is a preventive intervention intended to protect pregnant women from the harmful consequences of malaria during pregnancy. The WHO (2022, 2023) recommends IPTp for pregnant women in malaria-endemic areas, beginning in the second trimester and continuing at eligible intervals of at least one month, with the objective of receiving at least three doses where recommended. Antenatal care provides an important opportunity for healthcare workers to educate pregnant women about the purpose, timing, and benefits of preventive treatment. Nevertheless, knowledge of IPTp may not always translate into practice if women begin antenatal visits late, attend irregularly, do not understand the recommended schedule, or encounter barriers to receiving services. It is therefore important to investigate whether pregnant women understand malaria preventive treatment and whether their reported practices correspond with current recommendations.

Knowledge is an important factor in health behaviour because it can influence how individuals understand health risks, evaluate preventive measures, and make decisions about their wellbeing. In malaria prevention, relevant knowledge includes understanding how malaria is transmitted, recognising its potential effects during pregnancy, knowing the benefits of insecticide-treated nets, understanding the purpose of IPTp-SP, and seeking prompt professional assessment when symptoms suggest malaria. However, knowledge alone may not guarantee appropriate behaviour because preventive practices are also influenced by socioeconomic circumstances, cultural beliefs, household support, access to healthcare, and the quality of health education received. The WHO (2024) emphasises the importance of equitable access to malaria prevention and control services, particularly for populations facing barriers to healthcare. Similarly, the WHO’s antenatal care recommendations highlight the value of regular contact with healthcare providers for delivering preventive interventions and supporting informed health decisions (WHO, 2016). These considerations indicate that a study of pregnant women should assess both what they know about malaria prevention and what they actually do to protect themselves.

In Nigeria, malaria remains a significant public health concern, placing a considerable burden on the healthcare system and on households. The WHO (2023) reported that Nigeria accounted for a substantial proportion of the global malaria burden, while the National Population Commission (NPC) and ICF (2019) documented continuing challenges in malaria prevention during pregnancy in the 2018 Nigeria Demographic and Health Survey. That survey reported that 58% of pregnant women had slept under an insecticide-treated net the night before the survey, while 17% of pregnant women had received at least three doses of intermittent preventive treatment during pregnancy. These historical national figures illustrate the gap that can exist between recommended preventive measures and their uptake, although they should not be treated as current estimates or as specific findings for Taraba State. They also underline the importance of investigating the circumstances that shape preventive knowledge and practices at the local level. Findings from such studies can help health workers identify gaps in awareness, reinforce antenatal health education, and promote the appropriate use of malaria prevention services.

Wukari Local Government Area in Taraba State provides a relevant setting for examining knowledge and practices concerning malaria prevention among pregnant women attending selected primary healthcare centres. Primary healthcare centres are important points of contact for antenatal care, health education, preventive treatment, and referrals when complications arise. However, the extent to which pregnant women benefit from these services may depend on their knowledge, attendance patterns, understanding of health workers’ instructions, and ability to follow preventive recommendations at home. National evidence and WHO guidance establish the importance of insecticide-treated nets, IPTp-SP, and prompt professional care, but they do not by themselves establish the level of knowledge or the actual preventive practices of pregnant women in the selected healthcare centres in Wukari. A local assessment is therefore needed to determine what women know, which preventive measures they practise, and what factors may hinder adherence. Accordingly, this study examines knowledge and practice of malaria prevention among pregnant women attending selected primary healthcare centres in Wukari Local Government Area, Taraba State, with the aim of generating evidence that may support improved health education and maternal healthcare delivery.

1.2 Statement of the Problem

Malaria during pregnancy remains an important maternal and public health concern because it can result in serious complications for both the mother and the unborn child. Despite the availability of effective preventive measures, malaria continues to affect pregnant women in endemic areas, where exposure to infected mosquitoes and gaps in preventive service coverage may increase the risk of infection. The WHO (2024) reported that malaria during pregnancy can contribute to maternal anaemia, stillbirth, preterm birth, and low birth weight, making prevention a necessary component of antenatal care. In Nigeria, malaria prevention programmes promote the use of insecticide-treated nets, intermittent preventive treatment, and prompt diagnosis and treatment. Nevertheless, the availability of these interventions does not automatically ensure that all pregnant women understand their importance or practise them consistently. This creates a public health concern regarding whether pregnant women possess adequate knowledge of malaria prevention and whether their daily behaviours adequately protect them from infection.

A major concern is the possible gap between knowledge of malaria prevention and the actual adoption of recommended preventive measures. Some pregnant women may know that mosquitoes transmit malaria but may not understand the importance of sleeping under insecticide-treated nets every night, receiving the recommended doses of IPTp-SP, and attending antenatal care at appropriate intervals. Others may be aware of these measures but experience difficulties practising them because of discomfort, inadequate access to nets, financial constraints, misconceptions about preventive medicines, or irregular antenatal attendance. The Nigeria Demographic and Health Survey reported that, in 2018, only 17% of pregnant women had received at least three doses of IPTp, while 58% had slept under an insecticide-treated net the night before the survey (National Population Commission [NPC] & ICF, 2019). Although these figures are national and historical rather than specific to Wukari, they demonstrate why it is necessary to examine both knowledge and practice instead of assuming that awareness leads automatically to appropriate preventive behaviour.

Primary healthcare centres provide important opportunities to address these challenges through antenatal health education, distribution or promotion of insecticide-treated nets, administration of IPTp-SP in accordance with national guidelines, and counselling on malaria symptoms and care-seeking behaviour. However, the effectiveness of these services may depend on how clearly health workers communicate preventive information, how well pregnant women understand the instructions, and whether women can follow the recommendations in their homes and communities. The WHO (2016) recommends antenatal care as an opportunity to provide evidence-based interventions and support positive pregnancy experiences, while the WHO (2023) identifies insecticide-treated nets and preventive treatment as important components of malaria prevention during pregnancy. Where women do not receive adequate information or encounter difficulties accessing services, preventive practices may remain inconsistent. It is therefore important to determine whether pregnant women attending selected primary healthcare centres in Wukari have adequate knowledge of the recommended methods and whether they practise them appropriately.

Furthermore, national and international malaria reports cannot fully explain the specific knowledge levels, behaviours, and barriers experienced by pregnant women attending selected primary healthcare centres in Wukari Local Government Area, Taraba State. Without local evidence, healthcare providers may find it difficult to identify the particular areas of misunderstanding, the preventive practices that require reinforcement, and the challenges that may be addressed through health education and service improvement. The WHO (2024) emphasises that equitable access to effective malaria interventions is essential for reducing the disease burden among vulnerable populations. However, the extent to which pregnant women in the selected healthcare centres understand and adopt these interventions requires empirical investigation. This study therefore seeks to assess the knowledge and practice of malaria prevention among pregnant women attending selected primary healthcare centres in Wukari Local Government Area, Taraba State, and to determine whether knowledge is significantly associated with preventive practices.

1.3 Objectives of the Study

The main objective of this study is to assess the knowledge and practice of malaria prevention among pregnant women attending selected primary healthcare centres in Wukari Local Government Area, Taraba State.

The specific objectives are to:

1. Assess the level of knowledge of malaria transmission, risk factors, and effects of malaria among pregnant women attending selected primary healthcare centres in Wukari Local Government Area.

2. Identify the malaria prevention methods known to pregnant women attending the selected primary healthcare centres.

3. Examine the malaria prevention practices adopted by pregnant women attending the selected primary healthcare centres.

4. Determine the relationship between knowledge of malaria prevention and preventive practices among pregnant women attending the selected primary healthcare centres.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of malaria transmission, risk factors, and effects of malaria among pregnant women attending selected primary healthcare centres in Wukari Local Government Area?

2. What malaria prevention methods are known to pregnant women attending the selected primary healthcare centres?

3. What malaria prevention practices are adopted by pregnant women attending the selected primary healthcare centres?

4. Is there a significant relationship between knowledge of malaria prevention and preventive practices among pregnant women attending the selected primary healthcare centres?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no statistically significant relationship between knowledge of malaria prevention and malaria prevention practices among pregnant women attending selected primary healthcare centres in Wukari Local Government Area, Taraba State.

1.6 Significance of the Study

The findings of this study may be beneficial to pregnant women, healthcare workers, healthcare administrators, public health educators, government agencies, researchers, and future students.

Pregnant women: The study may help identify areas where pregnant women require additional information about malaria transmission, the dangers of malaria during pregnancy, the use of insecticide-treated nets, IPTp-SP, and appropriate care-seeking behaviour. The findings may support the development of health education activities that encourage women to adopt recommended preventive practices.

Healthcare workers: Nurses, midwives, community health extension workers, and other personnel in primary healthcare centres may benefit from evidence concerning pregnant women’s knowledge and preventive behaviours. The findings may help them identify misconceptions, improve antenatal counselling, and communicate preventive recommendations more effectively.

Primary healthcare administrators: The study may provide information useful for planning and improving maternal health services. By identifying gaps in women’s knowledge and practices, healthcare administrators may be better positioned to strengthen health education, improve the delivery of malaria prevention interventions, and identify service-related barriers requiring attention.

Government and public health agencies: Findings may provide local evidence to support malaria prevention programmes and maternal healthcare policies in Wukari Local Government Area and Taraba State. The results may also assist public health planners in prioritising health education, preventive supplies, and other interventions according to identified needs.

Researchers and students: The study may contribute to the available literature on malaria prevention during pregnancy and serve as a reference for further studies on maternal health, preventive healthcare behaviour, and malaria control in Nigeria.

1.7 Scope of the Study

The study focuses on knowledge and practice of malaria prevention among pregnant women attending selected primary healthcare centres in Wukari Local Government Area, Taraba State. Its content scope covers knowledge of malaria transmission, risk factors, and effects during pregnancy; awareness of preventive measures, including insecticide-treated nets and IPTp-SP; and reported preventive practices, such as net use, receipt of preventive treatment according to healthcare guidance, antenatal attendance, and appropriate care-seeking behaviour. The study will also examine the relationship between knowledge and preventive practices. The geographical scope is limited to the selected primary healthcare centres in Wukari Local Government Area, while the population scope comprises pregnant women attending those facilities during the period of data collection. The study will not assume that its findings represent every pregnant woman in Wukari or Taraba State.

1.8 Limitations of the Study

The study may encounter some limitations. First, the use of self-reported information may introduce recall bias or socially desirable responses, as some participants may report what they believe healthcare workers expect rather than their actual practices. Second, findings from selected primary healthcare centres may not represent pregnant women who receive antenatal care elsewhere or those who do not attend formal healthcare facilities. Third, limited time, financial resources, and access to participants may affect the size and coverage of the study. Finally, a cross-sectional design can establish whether knowledge and preventive practices are associated at the time of data collection, but it cannot establish that knowledge alone causes a particular practice. These limitations will be considered when interpreting the findings, and appropriate measures, including clear questionnaire items and confidentiality assurances, will be adopted to improve the quality of the data.

1.9 Operational Definition of Terms

Knowledge of malaria prevention: The level of understanding pregnant women demonstrate regarding malaria transmission, risk factors, consequences during pregnancy, and recommended preventive measures.

Practice of malaria prevention: The preventive behaviours reported by pregnant women, including sleeping under insecticide-treated nets, receiving IPTp-SP according to healthcare guidance, attending antenatal care, and seeking professional assessment when malaria is suspected.

Malaria: A parasitic disease transmitted to humans through the bites of infected female Anopheles mosquitoes.

Pregnant women: Women who are currently pregnant and attend the selected primary healthcare centres in Wukari Local Government Area during the study period.

Insecticide-treated net (ITN): A mosquito net treated with insecticide and used to reduce contact with mosquitoes that transmit malaria.

Intermittent preventive treatment in pregnancy (IPTp-SP): The administration of sulfadoxine-pyrimethamine to eligible pregnant women at recommended intervals during pregnancy, in accordance with applicable guidelines, to reduce malaria-related risks.

Antenatal care (ANC): Healthcare services provided during pregnancy to monitor the health of the woman and fetus, offer preventive interventions, provide health education, and identify potential complications.

Primary healthcare centre: A healthcare facility that provides first-contact services, including maternal and child health services, health education, preventive care, and referral when necessary.

Wukari Local Government Area: The local government area in Taraba State, Nigeria, within which the selected primary healthcare centres for this study are located.

Project – Knowledge and Practice of Malaria Prevention Among Pregnant Women: A Study of Selected Primary Healthcare Centres in Wukari Local Government Area, Taraba State.