CHAPTER 1
INTRODUCTION
1.1 Background to the Study
Malaria contributes substantially to the
poor health situation in Africa. It is on record that, subSaharan Africa (SSA)
accounts for 90% of the world‟s 300 to 500 million cases of malaria and 1.5 to
2.7 million deaths annually. About 90% of these deaths in Africa are of young
children, suggesting some serious demographic consequences for the continent.
Malaria is a great burden on the health system in Africa, as it is responsible
for 20 to 40% of outpatient visits and 10 to15% of hospital admissions, according
to the World Health Organisation (WHO, 1999). In subSaharan Africa (SSA), 10.8%
of all disability-adjusted life years (DALYs) were lost to malaria in 1990.
Again, among the 10 leading factors in DALYs in the world in 1998, malaria
ranked eighth with a share of 2.8% of the global disease burden. In SSA
however, malaria ranks second after HIV/AIDS, accounting for 10.6% of the
disease burden. According to the World Bank, malaria accounted for an estimated
35 million DALYs lost in Africa in 1990 due to ill health and premature death
(World Bank, 1993). The estimate was 39 million DALYs in 1998 and 36 million
DALYs in 1999 (WHO, 1998, 1999, 2000). Furthermore, while malaria contributed
2.05% to total global deaths in 2000, it was responsible for 9.0% of all deaths
in Africa (WHO, 2002).
The
WHO also estimated that the total cost of malaria to Africa was US$1.8 billion
in 1995 and US$2 billion in 1997 (WHO, 1997). Malaria is therefore a massive
problem that affects all segments of society. While its effect on people of all
ages is quite immense, the most serious impact of malaria is on pregnant women
and children because they have less immunity. When a malaria infection is not
properly treated in pregnant women, it can cause anaemia and also lead to
miscarriages, stillbirths, underweight babies and maternal deaths. Also,
frequent cerebral malaria can lead to disabling neurological consequences. With
regard to school children, malaria is a major cause of absenteeism in endemic
countries. It is estimated that about 2% of children who recover from cerebral
malaria suffer brain damage including epilepsy (WHO/UNICEF, 2003). Hence, among
young children, frequent episodes of severe malaria may harm their learning
abilities and educational attainment. This is a threat to human capital
formation, which constitutes a key factor in economic development. The
debilitating effects of malaria on adult victims are very disturbing. In
addition to the time and money spent on preventing and treating malaria, it
causes considerable pain and weakness among its victims, thereby affecting
their ability to work. The adverse impact of the disease on household
production and gross domestic product can be substantial. Malaria therefore is
not only a public health problem but also a developmental problem.
At the national level, apart from the
negative effect of lost productivity on the major sectors of the economy,
malaria has negative effects on the growth of tourism, investment and trade,
especially in endemic regions.
It
constitutes a major socio-economic challenge to African countries since they
are the region most affected by the disease. This challenge must be faced with
resolve since good health is not only a basic human need but also a fundamental
human right and a prerequisite for economic growth (Streeten, 1981).
The malaria burden is a challenge to human
development. It is both a cause and consequence of under-development. As has
been observed elsewhere, the disease is not homogeneous and uniform in Nigeria.
It is a localized problem with great differences from place to place.
Prevalence shows diversities and variations to the extent that neighbouring
communities can display complete difference in transmission patterns. This is
due to a combination of factors: meteorological and ecology of both human host
and the vectors and proximity between human habitat and the breeding places.
The peak period of malaria transmission occurs during the rainy season and
often coincides with the peak period of agricultural activities such as planting
and harvesting. Parasite strains appear to be including an increasing human
tool with services on productivity. There is some reduction during the dry
season.
1.2 Problem Statement
The malaria burden is a challenge to human
development. It is both a cause and consequence of under-development. In
Nigeria, malaria is the number one cause of morbidity, accounting for 40 to 60%
of outpatient visits. It is also the leading cause of mortality in children
under 5 years of age, a significant cause of adult morbidity, and the leading
cause of workdays lost to illness.
Despite the devastating effects of the
disease, the importance of a malaria-free environment in promoting economic
development and poverty reduction has not been fully appreciated in Nigeria.
Perhaps the impact of malaria has not been demonstrated in quantitative terms
that might convince politicians, policy makers, programme managers and
development partners to devote the needed attention and resources to combating
this dreadful disease. This study is an attempt to fill this gap with
appropriate information.
1.3 Objectives of the Study
The objectives of the study are to:
(i)
provide us clues about the behaviour of the time
series data
(ii) develop
a statistical model that will aid in forecasting the incidence of the disease
in the
state.
1.4
Scope
The study is confined to the morbidity of
malaria cases reported at the University of nigeria teaching hospital in the
Enugu State. The project is seeking information on monthly outpatient morbidity
returns for ten (10) consecutive years (2001-2010) of the disease.
1.5 Justification of the Research
Several
programmes have been initiated in this country to combat this disease of the
poor people but its prevalent rate is still high and accounts for 40% out of
the 70% communicable disease in Nigeria in 2008. The National Malaria Control
Programme (NMCP) is the mother agent for controlling the disease in this
country. Other companies like Zoomlion Company Limited and
AngloGold Ashanti have also joined in the
fight against the disease.
Considering the concomitant loss of lives,
cost in the medication and loss of productive hours, it requires renewed
commitment from the government, non-governmental organizations and all and
sundry to fight for complete eradication of the disease. Since the cost of
treatment of the disease is directly proportional to the size of the potential
benefits to be derived for the country, for a successful malaria control
programme, this study will try to identify areas of high prevalence of malaria
in the state. Indeed, very few
research studies have been carried out on the incidence of malaria in the
Nigeriaian context to date. In particular, very little is known in the state
concerning this very important subject. Based on available empirical evidence,
it is necessary to furnish decision makers and other stakeholders with vital
information regarding the incidence of malaria in the state for possible policy
interventions. Additionally, it is important to contribute to knowledge on the
incidence of malaria with a view to, among other things, stimulate further
research.
1.5 Limitation of the Study
This project has successfully been
accomplished not withstanding constraints encountered. Inadequate logistical
arrangement to facilitate collection and storing information constituted a
major drawback. Officers of the statistical department of the hospital had to
search through bulk documents for the needed information. This made it a hard
task for me in obtaining the required data. Time allotted to carry out the
study wasn‟t sufficient enough to cover a broader scope like the whole of Ashanti
Region or country wide. The high cost of gathering and collection of data also
prevented me form covering a wider scope to achieve a desirable and
representative result.
1.6 Thesis Organization
Chapter 1 is the introduction which
comprises the background to the problem, statement of the problem, objectives
of the study, justification of the research, methodology and limitation.
Chapter 2 basically deals with the review
of literature on malaria and time
series modelling.
Chapter 3 deals with the methods used in
the analysis. It comprises of the introduction, describing basic statistics,
method and concept of time series and Box-Jenkins methodology.
The data used in the study and
characteristics of the study area, data analysis and results are considered in
Chapter 4.
The summary and conclusions including a discussion of the policy
implications of the study are presented in Chapter 5.
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