Socio Economic and Environmental Factors Associated with Malaria Prevalence in Bushenyi-Ishaka Municipality, Bushenyi District, Uganda

ABSTRACT Malaria is among the top causes of morbidity and mortality in sub-Sahara Africa. It has high prevalence and case fatality rates especially the most vulnerable groups; pregnant women and children below the age of five years. Despite efforts put up in the fight against malaria, prevalence is still high especially in Uganda where the prevalence is as high as 19%, with regional variations of course. Bushenyi has been on record as to have high malaria prevalence rates and data on factors as to why this might be so, is still so scanty. A descriptive, population based, cross-sectional study set out to assess the household socioeconomic and environmental factors associated with malaria prevalence in Bushenyi-Ishaka Municipality and involved 370 respondents who had a case of malaria within the household within 6 months preceding the study. The 6-month prevalence of malaria was high at 28.01% with distance of the nearest health facility from home found statistically significant (p-value: 0.0024, C.I. 95%). Monthly domestic expenditure, education level, use of insecticide treated nets, and indoor residual spraying were all not found to be statistically significant.

Table of Contents

ABSTRACT................................................................................................................................i

DECLARATION.......................................................................................................................ii

APPROVAL ............................................................................................................................ iii

ACKNOWLEDGEMENT........................................................................................................iv

LIST OF APPENDICES............................................................................................................v

LIST OF FIGURES ..................................................................................................................vi

LIST OF TABLES...................................................................................................................vii

LIST OF ACRONYMS ......................................................................................................... viii

CHAPTER ONE: INTRODUCTION........................................................................................1

1.0 Introduction..........................................................................................................................1

1.1 Background of the study ................................................................................................1

1.2. Problem statement...............................................................................................................3

1.3. Research Objectives............................................................................................................3

1.3.1. General Objective: ...........................................................................................................3

1.3.2. Specific Objectives: .........................................................................................................4

1.3.3. Study Hypotheses.............................................................................................................4

1.3.3.1. Hypothesis 1..................................................................................................................4

1.3.3.2 Hypothesis 2...................................................................................................................4

1.4. Significance of the Study....................................................................................................4

1.4.1. Contribution to science ....................................................................................................4

1.4.2. Importance to the community ..........................................................................................4

1.5. Scope of the study...............................................................................................................4

1.5.1. Content scope...................................................................................................................4

1.5.2. Geographical scope..........................................................................................................5

1.5.3. Time scope.......................................................................................................................5

1.6. Conceptual Framework..................................................................................................6

CHAPTER TWO: LITERATURE REVIEW............................................................................7

2.0. Introduction.........................................................................................................................7

2.1. Epidemiology of Malaria in Uganda...................................................................................7

2.1.1. Prevalence of Malaria in Uganda.....................................................................................7

2.2. Factors Associated with Malaria Prevalence ......................................................................8

2.2.1. Household Socio-economic Conditions...........................................................................8

2.2.1.1 Level of Education.........................................................................................................8

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2.2.1.2 Basic Knowledge about Malaria....................................................................................9

2.3. Household Environmental Conditions................................................................................9

2.3.1. Availability and use of ITNs............................................................................................9

2.3.1. Indoor Residual Spraying (IRS) ....................................................................................10

2.3.2. Distance to Healthcare Facilities ...................................................................................10

CHAPTER THREE: METHODOLOGY ................................................................................11

3.0. Introduction.......................................................................................................................11

3.1. Study Design.....................................................................................................................11

3.2. Study Area ........................................................................................................................11

3.3. Study Population...............................................................................................................11

3.4. Target Population..............................................................................................................11

3.5. Sample size determination ................................................................................................11

3.6. Sampling Procedure..........................................................................................................12

3.6.1. Inclusion and Exclusion Criteria....................................................................................12

3.6.1.1. Inclusion Criteria ........................................................................................................12

3.6.1.2. Exclusion Criteria .......................................................................................................12

3.7. Data Collection Methods.............................................................................................12

3.8. Data Quality Control....................................................................................................12

3.8.1. Validity of Data Collection Tools................................................................................12

3.8.2. Reliability of Data Collection Tools............................................................................13

3.9. Data Processing............................................................................................................13

3.10. Data Analysis...............................................................................................................13

3.11 . Study Limitation and Delimitation ............................................................................13

3.12. Ethical Consideration.....................................................................................................13

3.12.1. Informed Consent.........................................................................................................13

3.12.2. Autonomy ....................................................................................................................13

3.12.3. Confidentiality .............................................................................................................14

3.12.4. Human Right................................................................................................................14

3.12.5. Benefits and Risks........................................................................................................14

3.13. Dissemination of Study Findings....................................................................................14

CHAPTER FOUR: DATA ANALYSIS AND PRESENTATION .........................................15

4.0. Introduction.......................................................................................................................15

4.1. Prevalence of malaria........................................................................................................15

4.2. Demographic characteristics of respondents ....................................................................15

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4.2.1. Age of the respondents (N=370)....................................................................................15

4.2.2. Sex of respondents (N=370) ..........................................................................................15

4.2.3. Religion of respondents (N=370) ..................................................................................16

4.2.4. Marital status of respondents (N=370) ..........................................................................16

4.3. Factors associated with malaria ........................................................................................16

4.3.1. Household socio-economic factors................................................................................16

4.3.1.1. Employment status and monthly expenditure.............................................................16

4.3.1.2. Education level............................................................................................................17

4.3.2. Household environmental factors..................................................................................18

4.3.2.1. Availability and use of ITNs.......................................................................................18

4.3.2.2. Indoor residual spraying .............................................................................................18

4.3.2.3. Distance from the nearest health facility ....................................................................19

CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS.............20

5.0. INTRODUCTION ............................................................................................................20

5.1. DISCUSSION...................................................................................................................20

5.1.1. Prevalence of malaria.....................................................................................................20

5.1.2. Household socioeconomic conditions and malaria........................................................20

5.1.3. Household environmental conditions and malaria.........................................................21

5.2. CONCLUSIONS...............................................................................................................21

5.3. RECOMMENDATIONS..................................................................................................22

REFERENCE LIST .................................................................................................................23

APPENDICES .........................................................................................................................27

Appendis I: Map of the study area...........................................................................................27

Appendix II: Consent form......................................................................................................28

Appendix III: Study questionnaire...........................................................................................30

Appendix IV: Approval letter from IREC, KIU ......................................................................32