ABSTRACT
The study compared the accessibility and utilization of insecticide treated nets between urban and rural farm households in Akwa Ibom State. The specific objectives were to: identify the socio-economic characteristics of respondents, ascertain perceived factors that influence access to insecticide treated nets, ascertain perceived factors that influence the use of insecticide treated nets, determine the extent of accessibility to insecticide treated nets and determine the level of utilization of insecticide treated nets in the study area. Purposive and random sampling techniques were used to select 208 farm households for the study. Structured questionnaire was used for data collection. Data were analyzed using descriptive and inferential statistics such as mean, frequency, percentages and Z-test. The result showed that the mean age of urban households was 44 years while the mean age of rural households was 42 years. Incapacitation ( = 2.92), financial insecurity ( = 2.87) and reduced farm labour ( = 2.73) were perceived effect of malaria incidence on urban households. Financial insecurity ( = 3.02), reduced farm labour ( = 2.98) and reduced agricultural output ( = 2.69) were perceived effect of malaria incidence on rural households. Long period of time to process in the hospital ( = 2.66) and health workers not distributing ITN at home ( = 2.63) were positive factors influencing access to insecticide treated nets among urban households. Location of hospital ( = 2.68) and health workers not distributing ITN at home ( = 2.53) were positive factors influencing access to insecticide treated nets among rural households. Perceived risk in using insecticide treated net due to chemical used in treating the net ( = 2.88), no electricity to put on fan ( = 2.87) and hot weather ( = 2.85) were regarded as positive factors influencing utilization of insecticide treated net among urban households. Community beliefs ( = 2.95) and hot weather ( = 2.92) were regarded as positive factors influencing utilization of insecticide treated nets among rural households. The result also showed that there was high level of utilization of insecticide treated nets by children ( = 2.66), pregnant mothers ( = 2.62) and during rainy season ( = 2.57) among urban households, while there was also low level of utilization of insecticide treated net by children ( = 2.44) and during rainy season ( = 2.39) among rural households. The results revealed that there was significant difference between the extent of accessibility to insect treated nets among urban and rural farm households at 5% significance level. There was also significant difference in the level of utilization of insect treated nets between urban and rural households at 5% significance level. The study concluded that access and utilization of insecticide treated nets was generally higher among urban households than rural households in the study area. It therefore recommended that the government and non-governmental organizations should educate rural and urban farm households on the effective use of insecticide treated nets for malaria control/prevention to improve farmers’ health and agricultural productivity.
TABLE
OF CONTENTS
Title
Page i
Declaration ii
Certification iii
Dedication iv
Acknowledgements v
Table
of Contents vi
List
of Tables ix
List
of Plates x
List
of Figures xi
Abstract xii
CHAPTER
1: INTRODUCTION
1.1 Background
of the Study 1
1.2 Statement
of the Problem 4
1.3 Research
Questions 7
1.4 Objectives
of the Study 7
1.5 Hypotheses
of the Study 8
1.6 Justification
of the Study 8
1.7 Definition
of Terms 9
CHAPTER
2: REVIEW OF RELATED LITERATURE
2.1 Symptoms of Malaria 13
2.2 The
Impact of Malaria on Urban and Rural Households 14
2.3 Agriculture
in Nigeria 15
2.3.1 Malaria
and agriculture 17
2.4 Urban/Rural
Area and Poverty in Nigeria 18
2.4.1 Malaria
and poverty 18
2.4.2 WHO
and health intervention in Nigeria 20
2.4.3 WHO
and malaria intervention in Nigeria 21
2.4.4 Preventive/control
measures of malaria 22
2.5 Agriculture
and Health for Increased Food Production 24
2.5.1 Health
situations in Nigeria 25
2.6 Malaria
Scourge among Farmers and Farming Activities 27
2.7 Communication-
Its Role in Malaria Control 29
2.7.1 Communicative
intervention on insecticide treated net (ITN) 31
2.7.2 Strategies raising and consciousness of
pre-defined issues on
communication 33
2.8 Mosquito
Nets Treated With Insecticides (ITNs) 35
2.8.1 Construction
of insecticide treated net 38
2.8.2 Usage
of insecticide treated net 39
2.8.3 Misuse
of insecticide treated net by farmers 39
2.8.4 Scientific trials 40
2.8.5
Reduction of mosquito by ITN 41
2.8.6 The role of mass media in ITN
as the health message for productive
agriculture 42
2.9 Major
Differences between Rural and Urban Areas 44
2.9.1 Farming
in urban and rural areas 46
2.9.2 Linkage
between malaria and agriculture 51
2.10 Perceptions,
Attitudes, Knowledge and Beliefs of Using Insecticide
Treated Net 56
2.10.1 Ownership
versus utilization of insecticide treated net (ITN) 58
2.10.2 Insecticide
treated nets (ITNs) versus malaria prevention 59
2.11 Theoretical
Framework 62
2.12 Conceptual Framework 63
CHAPTER 3: METHODOLOGY
3.1 Study
Area 65
3.2 Population
of the Study 67
3.3 Sample
and Sampling Procedure 67
3.4 Method
of Data Collection 67
3.5 Validity
of Instrument 67
3.6 Test of
Reliability of Instrument 68
3.7 Data
Analysis 68
3.8 Hypotheses
Testing 68
3.8.1 Model
specification 69
3.9 Measurement
of Variables 70
CHAPTER 4: RESULTS AND
DISCUSSION
4.1 Socio
Economic Characteristics of Respondents 73
4.1.1 Age
73
4.1.2 Sex
73
4.1.3 Marital
status 75
4.1.4 Level
of education 75
4.1.5 Religion 76
4.1.6 Household
size 76
4.1.7 Farm
size 77
4.1.8 Farming
experience 77
4.1.9 Monthly
income 78
4.2 Perceived
Effect of Malaria incidence on Urban and Rural Farm
Households 80
4.3 Perceived
Factors Influencing Access to Insecticide Treated Net in the
Study Area 83
4.4 Perceived
Factors Influencing Utilization of Insecticide Treated Net in
Urban and Rural
Areas 85
4.5 Extent
of Accessibility to Insecticide Treated Net 87
4.6 Level
of Utilization of Insecticide Treated Net
90
4.7 Results of Hypotheses Tests 93
4.7.1 Hypothesis 1 93
4.7.2 Hypothesis
2 95
CHAPTER 5:
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 97
5.2 Conclusion
99
5.3 Recommendations
101
References 102
Appendices 116
LIST
OF TABLES
4.1 Socio
economic characteristics of respondents 74
4.2 Distribution of respondents according to
perceived effect of malaria
incidence
on urban and rural farm households 82
4.3 Distribution
of respondents according to perceived factors influencing
access to
insecticide treated net in the study area 84
4.4 Distribution of respondents according to perceived
factors influencing use
of
insecticide treated net in the study area 86
4.5 Distribution
of respondents according to extent of accessibility to ITN 89
4.6 Distribution
of respondents according to the level of utilization of ITN 92
4.7.1
Z-test of significant difference in the
extent of accessibility to insect
treated
nets between urban and rural farm households 94
4.7.1
Z-test of significant difference in the
level of utilization of insect treated
nets
among urban and rural farm households 96
LIST OF PLATES
1. Different
species of mosquito 123
2. Insecticide
treated net preventing mosquito from biting
123
3.
Different ways of using insecticide
treated net for malaria control 123
4. Different
ways of constructing mosquito nets (e.g Tents, Frame, Ceiling
Hung, Window) 124
5.
Misuse of insecticide treated net (ITN) by
farmers for water leaf coverage 124
6.
Farming activities in rural and urban
areas 125
7.
Farm households using insecticide treated
nets in urban and rural areas 125
8.
A researcher in a focus group discussion
with respondents in Nto Udo
Ikgwe cell of Urua
Inyang block in Abak zone 126
9.
A researcher in a focus group discussion
with respondents in Ikot Ekwere
cell of Ntiat
block in Uyo zone - 126
LIST OF FIGURES
1. Conceptual framework on access and
utilization of insecticide treated
nets among urban and rural farm households
in Akwa Ibom State 64
2.
Map of Akwa Ibom State 66
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Even
though, the World has documented a remarkable success in the fight against
malaria in sub-Saharan Africa in the last decades, malaria still remains a
global public health and big contributor to the economic burden (Onwujekwe, 2010).
Malaria is a life-threatening disease caused by parasites that are transmitted
by the bites of infected female anopheles mosquitoes called malaria vectors.
This disease is a major threat to the health of thousands of farmers throughout
the tropics and sub-tropics (World Health Organization, 2012).
Malaria
is the commonest cause of loss of man days on the farm. Also the disease
represents one of the major causes of morbidity and mortality throughout
Nigeria, where it is holoendemic in status (Center for Disease Control, 2009). However,
while poverty does acerbate the negative effects of malaria, Saches, Malaney
and Gallup (2011) argued that malaria contributed to poverty.
Malaria
is a major cause of maternal death, abortion, stillbirth, premature delivery
and anemia (Federal Ministry of Health, 2014). In Nigeria, it is responsible
for a huge economic loss of about 132 billion naira (US$ 880 million) annually
from cost of treatment, loss of farm hours and school absenteeism and other
indirect cost (Asenso, Chiang, Thangata, Andam and Mekonnen, 2011). Healthy
farmers are bound to have sound mind which enhances positive development and effective
production. The burden is largely borne by Africa where 91% of deaths occurred,
with pregnant women and children under five years of age most at risk of
infection and adverse outcome (WHO, 2012).
Rural
area refers to an area that is predominantly agrarian in nature. Other indices
used in determining rural areas are the population and size, infrastructural
facilities usually lacking, such as electricity, good road, pipe-borne water,
banking services, industrial establishment, commercial centers and recreational
facilities while the urban area is the opposite of the rural area (Ekong,
2010). Agriculture is the main occupation in the rural areas as well as the
urban areas in Akwa Ibom State, thus farmers need to be free from malaria
disease and be in sound health for effective agricultural production. Treatment,
prevention and control of malaria continue to pose a serious health challenge
in Sub-Saharan Africa. The disease threatens 300-500 million people and kills
more than one million annually (Moorthy, Reed and Smith, 2007). Thus to attain
good health, a well packaged health information is very necessary. It makes
substantial demand on Africa’s fragile health infrastructure and affects the
live of almost all people in urban and rural areas (Brinkamann, 1991).
Insecticide
treated nets are nets dip-treated using a synthetic pyrethroid insecticide such as deltamethrin or permethrin which
will double the protection over a non-treated net by killing and repelling
mosquitoes. It was developed in the 1980s for malaria control/prevention (WHO, 2006).
Insecticide treated net (ITN) is one of the main malaria control strategies in
most malaria endemic countries to reach the roll back malaria (RBM) targets to
reduce the malaria burden by 50% in 2010 compared to 2000 levels and at least
75% in 2015 (Philip, 2003).
Accessibility
of insecticide treated nets is the ability to access insecticide treated net
for malaria control and prevention. Utilization of insecticide treated net is
the profitable or effective use of insecticide treated net for malaria control.
It is the practical use of insecticide treated nets among farm households. Use
of ITNs offer a potential strategy for reducing man-vector contact as well as
reducing disease mortality and mobility rate. Insecticide treated net (ITN) has
been proven to offer significant personal protection against malaria infections
in areas with drug resistant and insufficient health infrastructure (Oluko and
Oluwatosin, 2012). Thus, to increase net possession, the NMCP launched in
August 2011 a campaign for distribution of free ITNs to households, for
universal coverage of the population (Ordinioho, 2012).
The
impact of malaria morbidity and malaria related mortality may be minimized if
ITNs are properly and consistently used by vulnerable population. Although ITNs
are increasingly accessible in Nigeria, getting people to correct and
consistently use ITNs has proven difficult. In 2010, there was enough ITNs,
primarily LLINs, procured in the African continent to cover 73% of the risk
population, yet achieving effective use of the nets remain a challenge (Marin,
2008). Use of ITNs message form an important component of information that both
urban and rural farmers must receive to curb the scourge of malaria for their
overall well- being.
Despite
the awareness and free distribution of insecticide treated nets among urban and
rural areas in Akwa Ibom State, the use of ITNs continue to face major
socio-economic and cultural challenges. Insecticide treated nets as tools for
malaria control can present challenges, such as coverage, proper use and
replacement of old and torn nets. Previous studies (Ajani and Ashagidibi, 2008;
Amaechi and Ukpai, 2013; Chukwuocha, 2010) have shown that several factors
influence net use. At individual level, these include: knowledge, beliefs,
risks perceptions about malaria and perceived benefits of ITNs, age, sex and
education level. Household level factors include: density, hanging position,
paying for a net instead of obtaining free, household size, occupation of
household head structure, space, types of sleeping units and intra-household
decision making process. In addition, colour, condition, climate and
temperature also associated with increased net use in the rainy season or
reduced use during excessive heat as well as socio-cultural and socio-economic
which can temporary reduce net use among farmers (Alaii and Phillips, 2003).
A household is a task-oriented
residence unit made up of a group of people who share the same physical space
for the purpose of eating, sleeping, taking rest and leisure, growing up, child
rearing and procreation. Relative and non-relatives who are living under the
same roof and share the same health, as well as servants who participate in
some common activities, are all considered to be members of the household or
domestic group (Baume, 2007).
1.2 STATEMENT OF THE PROBLEM
Malaria
is a threat to more than 40% of the world’s population in about 100 countries.
The disease remains a public health problem in 51 counties outside Africa,
particularly affecting poorer populations especially those in Africa (Roll Back
Malaria, 2002). Statistics have shown that poor rural and urban families living
in malaria endemic areas are said to spend close to 25% or more of their annual
income for prevention and treatment (Roll Back Malaria fact sheet, 2005). In
Nigeria it is responsible for a huge economic loss of about 132 billion naira
(US $ 880 million) annually from cost of treatment, loss of farm hours and
school absenteeism and other indirect costs (Asenso et al., 2014).
The
use of insecticide treated nets (ITNs) is one of the cost effective methods as
well as global strategies in decreasing the burden of malaria among individuals
and households (RBM fact sheet, 2015). Following the report on Akwa Ibom
Strategy Health Development Plan (AKS-SHDP) in 2010, malaria is one of the
major causes of illness and death among adults; as well as the major driver of
childhood illness and death in the State. The report added that only 14% of the
State population own ITN, while 14% and 4% of children and pregnant women
respectively accessed ITN in the State. This report is worrisome, considering
the following facts: more than 60% of the State population lives and are
engaged in agricultural activities in the rural and urban areas noted for high
prevalence of malaria vectors; more than 50% of the State population lives
below the poverty line, implying that affordance of efficient orthodox
treatment on malaria could be an illusion, and the presence of deplorable and
weak health care system in the State make individuals and families more
vulnerable to malaria attack.
Despite
these well-known benefits of ITNs and the efforts of the Nigeria government to
promote the intervention through mass distribution campaigns, many rural and urban
households do not use ITN (Owoseni, 2018). However, access to nets has remained
poor across many communities in Nigeria. As part of the efforts to encourage
individuals and households to use the ITNs, the Government of Akwa Ibom State
in collaboration with Exxon Mobil and AKBC (Akwa Ibom State Broadcasting
Corporation) embarked on creating awareness and free distribution of ITNs to
rural and urban dwellers in the State using multiple outlets (Akwa Ibom State
Ministry of Health, 2015).
Most
of our urban and rural farmers know that malaria is a threat; many are aware
that ITN is an effective tool for malaria control and some are ignorant of the
use of insecticide treated nets. Many farmers in the urban and rural dwellers
are attacked by malaria which result to farm absenteeism and due to their poor
health, their agricultural productivity is affected. Effect of malaria on
farmers in the urban and rural areas give rise to man day loss, reduction in
farm output and household expenditure on drugs. Tangible agricultural
production cannot be achieved when the farmers are infected by malaria. Despite
the fact that strong attempts to eradicate malaria have been made, the disease
burden is still on the rise? The question then arises, upon the availability
and large scale distribution of ITNs, why is there still high malaria attack
among urban and rural farm households in the State? This implies that there is
an urgent need for corrective intervention on several socio-economic groups in
the State on the access and use of ITNs. Such intervention must be built on
sound empirical evidence about accessibility and utilization of ITNs. This
situation calls for a global concerted effort towards management and control of
the diseases. Expanded ownership of ITNS can only make substantial reduction in
malaria mortality if the nets are used properly among urban and rural farm
households. But to what extent are the nets accessible and actually used by the
people? If a farm household owns a net, which farm household members are most
and least, likely to sleep under a net, and what are the most common groupings
under a net? What happens to these patterns when the farm household acquires
more than one net? There seemed to be unanswered questions which this study
sought to provide.
Several
studies on children under five years have concentrated on availability, accessibility
and ownership of ITNs, no study to the knowledge of the researcher has been carried
out on the comparative analysis of accessibility and utilization of insecticide
treated net among urban and rural farm households in Akwa Ibom State which this
study sought to investigate. This fills the gap in the literature to compare
the level of insecticide treated nets usage among urban and rural farm
households in the State. This is because agricultural production among other
things depends on the health of farmers and one of the greatest challenges of
malaria control is the effective use of ITNs by households.
1.3 RESEARCH QUESTIONS
The
following research questions guided the study;
i.
What are the
socio-economic characteristics of urban and rural farm households in the study
area?
ii.
What are the perceived
effect of malaria incidence on rural and urban farm households?
iii.
What are the perceived factors
that influence accessibility of ITNs among urban and rural farm households?
iv.
What are the perceived
factors that influence utilization of ITNs among urban and rural farm
households?
v.
What is the extent of
accessibility to ITNs among urban and rural farm households?
vi.
What is the level of
utilization of ITNs among urban and rural farm households?
1.4 OBJECTIVES OF THE STUDY
The broad objective of the study was
to compare the accessibility and utilization of insecticide treated nets
between urban and rural farm households in Akwa Ibom State.
The specific objectives were to;
i.
describe the
socio-economic characteristics of urban and rural farm households in the study
area;
ii.
ascertain the perceived
effect of malaria incidence on urban and rural farm households;
iii.
ascertain perceived
factors that influence the accessibility of ITNs among urban and rural farm
households;
iv.
ascertain perceived
factors that influence utilization of insecticide treated nets among urban and
rural farm households;
v.
determine the extent of
accessibility to insecticide treated nets among urban and rural farm households
and;
vi.
determine the level of
utilization of insecticide treated nets among urban and rural farm households in
the study area.
1.5 HYPOTHESES
OF THE STUDY
The following null hypotheses were
postulated to guide the study:
HO1: There is no significant difference in
the extent of accessibility to insecticide treated nets between urban and rural
farm households in Akwa Ibom State.
HO2: There is no significant difference in the
level of utilization of insecticide treated nets between urban and rural farm households
in Akwa Ibom State.
1.6 JUSTIFICATION OF THE STUDY
Effective
agricultural production cannot be achieved if the problem of malaria disease is
not put under control. Effective use of insecticide treated net is a tool for
malaria control. Here in lies the importance of the study. This study was
justified since urban and rural farmers were the suppliers of food and farm
labour upon which Akwa Ibom State depends on.
For
the purpose of control/prevention of mosquito attack, this study will aid
planners in collaboration with urban and rural communities in having a baseline
data on the factors influencing use of insecticide treated nets as well as the level
of accessibility and utilization of insecticide treated nets.
This study also helps to fill the existing
research gap by comparing the level of use of insecticide treated net for
malaria control and prevention among urban and rural areas in Akwa Ibom State.
The findings of this research will be useful to policy makers, government and
non-government organizations in general and other research centers for tropical
disease control targeted towards ensuring improved agricultural production and areas
where they can assist rural and urban households with insecticide treated nets.
1.7 DEFINITION OF TERMS
·
Malaria:
Malaria is a mosquito-borne infectious
disease of humans and other animals caused by parasitic protozoans (a group of
single-celled micro-organism) belonging to the genus plasmodium (WHO, 2004).
·
Insecticide
treated net: For this study, it entails the net
that are one dip-treated using a synthetic pyrethroid insecticide such as
deltamethrin or permethrin which will double the protection over a non treated
net by killing and repelling mosquitoes form malaria attack.
·
Accessibility
of insecticide treated net: This is the ability to
access insecticide treated net for malaria control and prevention.
·
Utilization
of insecticide treated net: This refers to the level
of use of insecticide treated net for malaria control. It is the practical use
of insecticide treated nets among farm household.
·
Rural
household: In this study, this implies an
agricultural household living in a rural area when at least one member of the
household or the household head, or main income earner is economically active
in agriculture.
·
Urban
household: For this study, this refers to a
household that is resident in the urban area.
·
Socio-economic
factors: They are used here in its comprehensive
sense to include those social and economic attributes of individuals of people
that tend to predispose them to certain forms of behaviour.
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