Introduction

Researchers have been studying the link between maternal education and children’s health for many years. The indirect advantages that educated mothers receive as their household’s socioeconomic position increases, best represents the social benefits achieved from investing in women’s education (Njau et al., 2014). Even after adjusting for household variables affecting child health outcomes, mother education has been proven to have a substantial impact on child survival. 

Malaria in Under-5 Children

It’s a well-known fact that malaria infection rates are still high in Sub-Saharan Africa, despite recent considerable investments aimed at reducing these rates (Masuda, 2020).

Children under five and pregnant women in Sub-Saharan Africa are most susceptible to the life-threatening disease malaria, which is spread by the bite of a female anopheles mosquito. The disease is also costly to households and the economy, so it’s regarded endemic and a public health concern. According to the World Health Organization (1992), malaria alone is responsible for four sick days per month and 6.4% of Nigeria’s lost revenue. 

Malaria-positive children were 4.7% less likely to have mothers who had completed at least primary school (The Roll Back Malaria Partnership, 2015). Governments, international organizations, and nonprofits joined together to fight malaria, and the worldwide morbidity and death rates fell by 37% and 60% between 2003 and 2015 as a consequence. However, 3.2 billion individuals remain at risk of contracting this disease. The worldwide malaria load is particularly heavy in Sub-Saharan African areas. Roughly 88.8% of worldwide malaria infections and 90.0% of malaria fatalities occurred in this area in 2015 (WHO, 2015). Given the high rates of pediatric malaria infection and death caused by the disease, it is critical to have a better knowledge of predisposing factors and possible solutions to reduce its burden. Millennium Development Goal (MDG) 4: Reduce child mortality by 2015 is a major aim for the world’s governments, and understanding how maternal education affects children malaria infection as well as access and usage of treatment and prevention programs is critical, according to Glewwe, (1999).

Figure 1: Malaria prevalence rate (CDC, 2021)

Relevant Data on the Global Malaria Prevalence

In 2019, there were about 229 million malaria cases globally, and this resulted in 409,000 mortalities. Children under the age of 5 years are the most vulnerable group affected by the global challenge and accounts for 67% which translates to about 274,000 of all malaria deaths globally (WHO, 2021). 

Africa has a disproportionate high share of the global malaria burden and approximately 94% of all the malaria cases and deaths occur in this region. Six countries account for about half of all the malaria deaths worldwide: Nigeria  (23%), United Republic of Tanzania (5%), Burkina Faso (4%), Niger (4%) and the Democratic Republic of Congo (11%).

The incidence rate of malaria declined globally between 2010 and 2018, from 71 to 57 cases per 1000 population at risk (WHO, 2021). In 2018, the prevalence of exposure to malaria infection in pregnancy was highest in the West African region and Central Africa (35%) followed by the East and Southern part of Africa (20%). Of the 11 million pregnant women that were exposed to malaria infection in 2019, about 872,000 children delivered low birth weight babies, with West Africa having the highest prevalence of low birth weight children due to malaria in pregnancy (WHO, 2019).

Figure 2: Distribution of Prevalence of malaria in children <5 years (microscopy positive) across the country. Source: The MSDAT.

In 2018, an estimated 23% of children under the age of 5 had malaria in Nigeria (NDHS, 2018). In addition, all states (with the exception of Lagos) exceeded the national target of 5% (Fig. 2).

As shown above, Kebbi state was the state with the highest prevalence of childhood malaria (52.2%) while the least was Lagos with about 2%, hence its absence from the prevalence map (Fig. 3).

Figure 3: Nigeria’s Map showing prevalence of malaria among states. Source: The MSDAT.

In figure 4, we see that the North West and South South geopolitical zones had the highest and lowest prevalence of malaria among under 5 children  (approximately 34% and 16% respectively.)

Figure 4: A geopolitical zonal chart showing the prevalence of malaria among under five children (microscopy positive). Source: The MSDAT.
Figure 5: Malaria prevalence rate by countries (Centers for disease control and prevention, 2017)

The map above shows the sub-Saharan Africa region has malaria transmission throughout the region in comparison with the other regions.

Relationship between Maternal education and malaria

A number of studies have described the association between maternal education and childhood vaccination, nutritional status, and death rates. However, the association between maternal education and malaria, a prominent cause of infant death in Africa, has not gained enough study interests. Interventions to reduce the burden of malaria in both pregnant women and children ages less than 5 years old (children under 5 years of age) have primarily focused on vector control through use of insecticide-treated nets (ITNs), malaria case management, and intermittent preventive treatment during pregnancy (IPTp). Despite the fact that the usage of ITNs has increased significantly, they have not always met expectations (Nangaly, Doumbo, Thuilliez & d’Albis/2017). In areas where malaria incidence is high, poor usage of ITNs has been linked to a variety of variables, including perceived malaria risks, demography, and other intra-household socioeconomic factors. At least five of the eight MDGs can only be achieved with greater awareness of these connections. On the list: cutting the death toll from childhood disease and malnutrition in half; increasing access to excellent primary education for everyone; advocating for gender equality; and improving maternal health (Hobcraft, 1993).

There are several theories as to how maternal education affects child health in poor nations. The influence of maternal education on child survival rates by age-specific segments was examined in many countries, and the results showed that child survival rates by mother’s education levels were significantly greater for children aged 1–5 years than for neonatal and post-neonatal periods (WHO, 2006). For this reason, mothers who have little or no awareness about the causes of malaria are less likely to notice or treat their children if they get ill. Women with higher levels of education were more aware of proper vaccination regimens, which led to greater usage of childhood immunizations in children overall (Kibreab et al, 2020). Educated mothers are more likely to be able to safeguard their children from disease. According to one study, educated mothers also have better problem-solving abilities and self-confidence when it comes to dealing with the difficulties of caring for a sick kid than untrained mothers. When it comes to installing a mosquito net in her bedroom, a mother who has gone through vocational training may be better equipped than one who never had the chance to go to school. This is based on the work of David and Lleras-Muney (2006).

In order to improve women’s ability to deal with their children’s health issues, economic constraints based on gender might be a barrier. When mothers have the freedom to choose where and when to seek medical attention and how to safeguard their children from infections, they are nonetheless dependent on financial security to exercise this freedom. Women with higher levels of education may also have more freedom to make their own decisions and have greater socioeconomic mobility when it comes to choosing the health care services their children will get. (Loha, Lunde & Lindtjørn, 2012). Maternal education not only helps with decision-making, but it also gives women a greater feeling of financial stability, which makes it easier to carry out their decisions. Mothers with greater education earn more money than those with less education, and their higher salaries benefit the family as a whole. The more money educated mothers make, the more they have to spend on child care, but for men, a better salary does not always mean more money for child care. Mothers with higher levels of education are also more likely to reside in areas with greater access to healthcare and more modern infrastructure, such as improved water and sewage systems. As a result, intervention maternal education would be a crucial part of a successful pediatric malaria prevention program, as it gives mothers both financial and emotional empowerment (Hobcraft, McDonald, & Rutstein, 1984).

Fig 6: Showing the relationship between the number of maternal years of schooling and the probability of a child contracting malaria in Uganda (Mauda et al, 2020). The results show that there is a positive association between low number of maternal years of schooling and increased probability of child contracting malaria.

Prevention and control  

The Global Malaria Programme of the WHO recommends indoor residual spraying (IRS) and ITNs as the two primary malaria control strategies. For the fight against malaria transmission, IRS is considered one of the most effective vector control methods. Long-acting chemical pesticides are sprayed on building walls and roofs as part of this process. Adult mosquitoes that breed on these surfaces can be killed this way (Centers for Disease Control and Prevention, 2021). There is substantial scientific evidence to support IRS’s significance in lowering malaria infection. Nigeria’s usage of IRS has benefited the country’s economy. For instance, thanks to IRS, work absenteeism caused by malaria infection decreased from 6,983 man-days in 2005 to 163 days in 2010 (gamble et al, 2006). However, the IRS’s exercise has become less frequent as the expense of pesticides for spraying has risen (Afoakwah, Nunoo & Andoh, 2015).

ITNs, like IRS, act as a vector control measure to decrease the spread of diseases like malaria and other parasitic ailments. Using insect-repellent nets (ITNs) means draping treated netting over beds to keep mosquitoes away. As part of a multi-pronged distribution approach, the Nigerian government began distributing ITNs to specific groups. A policy known as “Universal Coverage” was also implemented, with the goal of distributing a mosquito net to every two people in a family by door-to-door delivery. As a result, school children are targeted for bed-net distribution. Pregnant women receive ITNs as part of their prenatal care, and everyone else can purchase them from a variety of sources, including shops/markets, pharmacies, and street sellers. ITNs have also been proven in studies to lower death rates among children under five by roughly 18.8% in Nigeria (Mabaso, Sharp & Lengeler, 2004).

A key technique for spreading malaria knowledge to communities is through the use of bed nets and collars, or Behavior Communication Change (BCC). This is especially true in malaria-prone regions. Media such as television, radio, newspapers and magazines, posters, booklets and brochures are used to provide malaria education in Nigeria. Health workers and community volunteers also help spread the message. To raise Nigerians’ knowledge and awareness of malaria, the Ministry of Health  and the National Malaria Control Programme (NMCP) have taken this strategy to spread malaria information to the country’s population (Barrera, 1990).

Conclusion and recommendation

In order to effectively combat malaria, efforts should be guided by more than just epidemiology. Governments should make investments in malaria control that take into account a wide range of socioeconomic, cultural, and educational challenges. In spite of the importance of studying malaria epidemiology, improved malaria policy design and execution require a more holistic approach that addresses factors such as improving socioeconomic conditions, cultural norms, and educational attainment.

In places where the usage of ITN is less likely to be effective, such as the poor and rural families, policymakers should provide better resources. To achieve the optimum protection, ITN distribution must be complemented by education campaigns.

References

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