EVALUATION OF ROLL BACK MALARIA PROGRAMME IN IGBO-EZE SOUTH LOCAL GOVERNMENT AREA OF ENUGU STATE

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Abstract

The study was to evaluate RBM programme in Igbo-Eze South Local Government Area. The study evaluated the availability and adequacy of RBM services, qualified service providers, materials and health facilities, the factors that influenced the utilization of RBM materials and the extent of utilization of RBM materials, community participation and patient attendance in health facilities. The factors evaluated in relation to the utilization of the materials and services were weak health system, community participation, drug resistance, discontinuity of programme and non vaccine development. To achieve the purpose of the study twelve research question were posed and three null hypotheses were postulated. The study adopted a descriptive survey research design. It covered all the government health facilities. All the four LGA team members, 326 professional health staff, 26 RBM role model caregivers and 57 community/opinion leaders were used. There was no sampling as the entire population was studied through the use of two sets of questionnaires and programme data stored in the LGA headquarter and health facilities. Data collected were analyzed quantitatively using frequency and percentages in respect of research questions one and then while mean and standard deviation for research questions two through nine and eleven and twelve. The student t-test hypotheses and ANOVA were used to verify the three null hypothesis formulated for the study at .05 level of significance. The data generated from programme records were used to confirm information got from respondents. The study revealed that artemisimin based combination therapies, intermitted preventive treatment in pregnancy and insecticides treated bed nets distribution health education and rapid diagnostic treatment were available while environmental techniques was virtually absent. It also reveal that some RBM materials and service providers were available and adequate. The study further revealed that majority of the respondents indicated that majority of the factors influenced the utilization of RBM services. The study further revealed that the utilization of these RBM services did not differ by age, gender and occupation. Based on the major findings and conclusion, it was recommended among others that environmental health techniques should be incorporated into RBM control programme intervention. More Doctors, Environmental Health Officers, Nurses should be trained and employed for RBM control programme services delivery.

  

CHAPTER ONE

Introduction

Background to the Study

Malaria is a major public health problem and poses a major challenge as it impedes human and economic development. According to World Health Organization, WHO (2001) malaria is both a cause and consequence of leading causes of morbidity and mortality in the world including Nigeria today. It has proven to be the most horrendous and intractable among the health problems confronting countries in the sub-Sahara Africa. In Nigeria, the disease is responsible for sixty per cent of out patient visits to health facilities, thirty per cent childhood death, twenty five per cent death in children under one year and eleven per cent maternal deaths (Federal Ministry of Health (FMOH), 2007). FMOH, (2005) submitted  that about fifty per cent of adult population in Nigeria experience at least one episode of malaria yearly while children under five years of age have up to 2-4 attacks of malaria annually. The financial loss due to malaria annually is estimated to be 132 billion Naira in form of treatment costs, prevention, loss of man-hours and so on. Yet, it is a treatable and completely evitable disease. Therefore, malaria contributes to both poverty and under development of Nigeria families and individuals because people spend huge part of their yearly income on prevention and treatment of malaria.

Malaria is an infectious disease caused by protozoa parasite plasmodium from the plasmodium family that can be transmitted by the sting of the anopheles mosquito (Beare; Taylor; Harding, Lewallen and Molyneux (2006). It is characterized by cycles of chills, fever, muscle aches and sweating that recur every few days. There can also be vomiting, diarrhea, coughing and jaundice of the skin and eyes. Historically, records suggested that malaria has infected human since the beginning of mankind. Today, approximately 40 per cent of the world’s population mostly those living in the world’s poorest country are at the risk of malaria. This present study adopt the definition of malaria as provided by Beare, Taylor, Harding, Lewallen and Molyneux (2006).

Based on the recognition of the unacceptable morbidity and mortality rates in Africa and the availability of number of evidence based on cost effective interventions, health reform was carried out in 1998 with the adoption of a health policy. Within the policy, malaria was to be controlled by using the concept and technology of Primary Health Care (PHC). The implementation of malaria control in the context of PHC strategy demands national commitment, community participation and intersectoral co-operation which are the diverse strength of expertise of Roll Back Malaria (RBM) partners. In an effort to combat the growing threat of malaria, RBM programme was launched in 1998 to reduce the burden due to malaria in Africa region by fifty per cent by the year 2010.

Roll Back Malaria (RBM) is a global partnership established in 1998 by World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Development Programme (UNDP) and World Bank with the goal of halving the world’s malaria burden by 2010. RBM is an initiative to improve malaria control in the context of health sector reform (FMOH, 2009). It serves as a strategic approach to disease control, mitigation and the overall fight against malaria. In this study, it is a tool for executing health projects which are carried out in partnership with public, private, research institutions, professional Associations, UNICEF, WHO, UNDP and World Bank.

Nigeria hosted Africa summit on RBM in Abuja in the year 2000. The summit concluded with the signing of declaration and plans of Action. The declarations stated that at least 60 per cent of those suffering from Malaria should have access to affordable and appropriate treatment within 24 hours of the onset of symptoms. It further stated that at least 60 per cent of those at risk of malaria particularly pregnant women and children under 5 years of age should benefit from the most suitable combination of personal and community protective measures such as insecticide treated nets (ITNs) and other interventions which should be accessible and affordable to prevent infection and sufferings. As part of the declaration, it was also agreed that’ at least 60 per ‘cent of all pregnant women who were at risk of malaria especially those in their first and second pregnancies should have access to chemoprophylaxis and chemotherapy medicine (FMOH, 2002). WHO, UNICEF and UNDP promised reliab1e, sustainable case management, prevention, research, effective and affordable tools, human and institutional resources to fight against malaria scourge.

Also, in the declaration RBM partnership supports effort to tackle Malaria wherever it occurs but the burden of the disease and death falls mainly on two venerable groups. The venerable groups are children and pregnant women. As a result, the focus of RBM and its greater challenges are to reduce the burden of malaria in the two vulnerable groups in the African regions. The objectives of RBM are to reduce morbidity and mortality by keeping malaria under effective control (less than 2 per/1000 per year) so that it does not become a major public health problem. It also promised to halt malaria by 2010 and begun to reverse the incidence of malaria. It will help to strengthening community participation (Burton and Thomas 1990). The RBM objectives were targeted to achieve universal access and utilization of preventive measures and its sustenance. It also hope to accelerate development of surveillance system and achieve universal access to case management at health facility and community level. RBM in Nigeria anchors on three global strategic approaches for malaria control which are multi-pronged and of proven efficacy. These include prompt and effective case management, promotion of intermitted preventive treatment in pregnancy (IPTp) and multiple prevention with promotion of the use of insecticide treated nets, indoor residual spraying (IRS) and environmental management (FMOH, 2010).

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