DEPARTMENT OF LABORATORY SCIENCES

DETERMINATION OF THE ASSOCIATION OF MALARIA WITH ANEMIA AMONG

PATIENTS ATTENDING NAKURU LEVEL 5 HOSPITAL IN RELATION TO PARASITIC
LOAD, PREVENTIVE MEASURES USED AND DIET,

BY
ADUDA BEN ODHIAMBO
INDEX NO: 7411050437

KISUMU NATIONAL POLYTECHNIC

This project was submitted to the Kenya National Examination Council in partial fulfillment for

the award of a diploma in medical laboratory technologists

 DECLARATION

I declare that the work presented in this project is my original work and has not been submitted
to any other institution of learning for academic award.

Name of student: ADUDA BEN ODHIAMBO

Index number:
Signature: ……………….....................
Date: ………………..............................

i
STATEMENT OF APPROVAL
I certify that this research was written under my supervision and guidance.

INTERNAL SUPERVISOR
Name: …………………………...........
Signature: ………………………….....
Date: ………………………………....

ii
DEDICATION
This study is dedicated to my brother, sisters, and entire Aduda’s family for their words of
encouragement, prayers and more support in terms of finance.

iii
Acknowledgment
I would like to give my sincere gratitude to the Almighty God for seeing me throughout the
research process. I would like to acknowledge and appreciate the support and participation
during the preparation of this document; my tutor Mr. Ojiayo for his good supervision
throughout the process.

iv
Table of Contents
DECLARATION...................................................................................................................................i
STATEMENT OF APPROVAL..............................................................................................................ii
DEDICATION....................................................................................................................................iii
ACKNOWLEDGEMENT....................................................................................................................iv
LIST OF TABLES...............................................................................................................................vii
LIST OF FIGURES...............................................................................................................................1
ABBREVIATIONS AND ACRONYMS...................................................................................................2
OPERATIONAL DEFINITIONS............................................................................................................ 3
ABSTRACT........................................................................................................................................ 4
CHAPTER ONE:.................................................................................................................................5
1.0 Background Information of Study Topic.................................................................................... 5
1.1 Problem Statement....................................................................................................................5
1.2 Study Justification......................................................................................................................6
1.3 Significance of the Study........................................................................................................... 6
1.4 Study Objectives........................................................................................................................ 6
1.4.1. Broad objectives....................................................................................................................6
1.4.2. Specific objectives..................................................................................................................6
1.5 Research Questions................................................................................................................... 6
1.6 Study Limitations and Delimitations..........................................................................................7
1.6.1 Limitation................................................................................................................................7
1.6.2 Delimitations...........................................................................................................................7
1.7 Basic Assumption.......................................................................................................................7
CHAPTER TWO: LITERATURE REVIEW..............................................................................................8
2.0 Introduction...............................................................................................................................8
CHAPTER THREE: METHODOLOGY................................................................................................ 12
3.0 Introduction.............................................................................................................................12
3.1 Study Area................................................................................................................................12
3.2 The Background Information about the Study........................................................................12
3.2.1. Location and climate............................................................................................................12

v
3.2.2. Demographic information................................................................................................... 12
3.2.3. Health profile.......................................................................................................................13
3.2.4. Top Ten Diseases..................................................................................................................13
3.3 Study Design............................................................................................................................13
3.4 Study Variables........................................................................................................................ 13
3.4.1. Dependent variables............................................................................................................13
3.4.2. Independent variable.......................................................................................................... 13
3.5 Inclusion and Exclusion Criteria...............................................................................................14
3.5.1. Inclusion Criteria..................................................................................................................14
3.5.2. Exclusion Criteria................................................................................................................. 14
3.6 Study population..................................................................................................................... 14
3.7 Sampling Procedure.................................................................................................................14
3.8 Sample Size.............................................................................................................................. 14
3.9 Data Collection Tools............................................................................................................... 14
3.10 Data Collection Procedure.....................................................................................................15
3.10.1. Specimen Collection..........................................................................................................15
3.10.2. Specimen Processing......................................................................................................... 15
3.11 Ethical Consideration.............................................................................................................15
CHAPTER FOUR: DATA ANALYSIS AND PRESENTATION.................................................................. 16
Figure 4.1. Pie chart showing the association of malaria with anemia among patients...............16
Figure 4.3: represents diet intake..................................................................................................19
CHAPTER FIVE: DISCUSSION AND INTERPRETATION..................................................................... 20
CHAPTER SIX: CONCLUSION AND RECOMMENDATION.................................................................21
APPENDIX I: REFERENCES.............................................................................................................. 22
APPENDIX III: WORK PLAN.............................................................................................................25

vi
LIST OF TABLES
Table 4.1: Those who slept under nets.......................................................................17
Table 4.2: Those who did not take full course...........................................................18
Table 4.3: Those that clear bushes around their homesteads.....................................18
Table 4.3: Those who drain stagnant water in homestead.........................................19

vii
LIST OF FIGURES
Figure 4.1: Association of malaria with anemia among patients.........................................................14
Figure 4.2: The association of malaria with anemia according to parasitic load.............................15
Figure 4.3: Represents diet intake..................................................................................................................17

1
ABBREVIATIONS AND ACRONYMS
RBCs - Red blood cells
Hb - Hemoglobin
LBW - Low child birth weight
IDA - Iron deficiency anemia
WHO - World Health organization.
DMLS - Diploma in Medical Laboratory Sciences.
HIV - Human immune Virus
MCHC - Martanal Child Health Care
UTIs - Urinary Tract Infections
CCC - Comprehensive Care Clinic
E.g. - For Example
P.vivax - Plasmodium vivax
P.malariae - Plasmodium malariae
P.ovale - Plasmodium ovale
P.falciparum - Plasmodium falciparum

2
OPERATIONAL DEFINITIONS
Mortality - Number of deaths within an area.
Morbidit - The proportion of a specific disease in a geographical locality.
y

3
ABSTRACT
Malaria is the most important parasitic disease worldwide, causing 225 million clinical cases and
an estimated 781,000 fatalities annually and represents a major global public health problem.
Africa and Asia is the most affected region with more than 85% of the absolute anemia burden.
Children and women of reproductive age are most at risk with global prevalence estimated of
48% in children younger than 5 years, 42% in pregnant women and 10% in non-pregnant women
aged 15-49 years. The study was to determine the association of malaria with anemia among
patients attending Nakuru level 5 Hospital in relation to parasitic load, preventive measures used
and diet. It was carried out between September and December 2018. The researcher adapted a
prospective study design was used and a random method was used to obtain the study samples of
300 patients. The data was collected and analyzed and presented in form of pie charts, tables and
graphs. Questionnaires and request form were used in data collection whereby the clients filled.
The researcher found out that the prevalence of malaria anemia is high among the patients which
interpreted to a prevalence of 15.7% (47). The research revealed that a prevalence of 10% (30) is
those who take balanced diet while 90% (270) are those who don’t take balanced diet. The
researcher concluded that malaria anemia is mostly caused by Plasmodium falciparum compared
to other species and this is brought about by poor preventive measures used to control malaria
and also low standards of economic life. The researcher also concluded that poor intake of food
results to malaria anemia. The researcher therefore recommended that community should be
mobilized in mosquito breeding grounds through draining stagnant water, clearing bushes,
sleeping under treated mosquito nets and using affordable insecticide sprays. He also
recommended that eating of balanced diet helps to reduce cases of malaria anemia.

4
CHAPTER ONE:
Introduction

1.0 Background Information of Study Topic.

Malaria is the most important parasitic disease worldwide, causing 225 million clinical cases and
an estimated 781,000 fatalities annually and represents a major global public health problem
(WHO 2010). The majority of malaria infections are associated with some degree of anemia and
severity depends upon patient specific characteristics e.g. age, innate and acquired resistance as
well as parasite characteristics e.g. species, adhesive and drug resistance phenotype hence can
cause severe morbidity and mortality especially in children and pregnant women infected with P.
falciparum (David J.et al, 2014). The greatest mortality is associated with cerebral malaria and
severe anemia mostly in children less than 5 years of age in malaria holoendemic areas (Guerra
et al 2010). In sub Saharan Africa, pregnant women are also at higher risk of cerebral malaria
and anemia, which are consequently the major causes of perinatal morbidity and mortality. Both
of the malaria complications are responsible for a great number of spontaneous abortions,
premature deliveries and low birth weight (Dicko et al 2003).

In African endemic countries, anemia is very common in pregnant women and in children under
five years. Although anemia is multi-factoral causative factors that include iron deficiency and
other nutritional deficiencies, helminthes infection and HIV over half of malaria related deaths
are attributed to severe malaria anemia (Rogerson S 2006). Anemia (Hb<11g/dl) affects 1.64
million people worldwide. Africa and Asia is the most affected region with more than 85% of the
absolute anemia burden. Children and women of reproductive age are most at risk with global
prevalence estimated of 48% in children younger than 5 years, 42% in pregnant women and 10%
in non-pregnant women aged 15-49 years (Roger Ck 2012).

1.1 Problem Statement

According to WHO (2009) estimation, 450 million new cases of malaria anemia are reported
annually. It is a common cause of childhood death. Malaria anemia infection is associated with
low socio - economic status and is more prevalent in developing countries than developed
countries. Recent evidence suggests that malaria anemia may be associated with low birth weight

5
in babies born by infected women. The aim of this study was to generate knowledge that formed
part of the skills on preventive measures.

Anemia in pregnancy is a common problem in developing countries and a major cause of

morbidity and mortality especially in malaria endemic areas. 25% of maternal deaths in Africa
have been attributed to anemia. In Sub Saharan Africa, anemia is highly prevalent due to
infections and malnutrition.

1.2 Study Justification

The research findings have increased awareness of malaria anemia its causes, symptoms,
prevention and measures to be undertaken in case one is infected. Therefore the study aimed to
determine the prevalence which provided useful data on factors leading to spread and ways of
controlling malaria anemia.

1.3 Significance of the Study.

The study will enable the government to lay down strategies that are aimed at reducing mortality
rate in Kenya. The study will help in creating community awareness, signs and symptoms of the
disease.

1.4 Study Objectives

1.4.1. Broad objectives.
To determine the association of malaria with anemia among pregnant women attending Nakuru
Level 5 Hospital.
1.4.2. Specific objectives.
1) To determine the association of malaria with anemia according to parasitic load.
2) To determine the association of malaria with anemia according to preventive measures used.
3) To determine the association of malaria with anemia according to diet.

1.5 Research Questions

1) What's the association of malaria with anemia according to parasitic load?
2) What is the association of malaria with anemia according to preventive measures used?
3) What's the association of malaria with anemia according to diet?

6
1.6 Study Limitations and Delimitations

1.6.1 Limitation
There was inadequate time due to the assignment given at hospital as well as lack of cooperation
from respondents.

1.6.2 Delimitations
There was enough finance for the research as the parents were willing to provide financial
support to carry out the research. There was no language barrier due to increased literacy in
Kenya in the least most of the population were able to express themselves in Swahili.

1.7 Basic Assumption

i. The colleagues in the research center were cooperative.
ii. The information given by the patients was true.

7
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction
Malaria is caused by a parasite of genus plasmodium which comprises of the following species;
P. ovale, P. malariae, P. falciparum, P. vivax. Malaria is transmitted via the bites of infected
mosquitoes. The parasites multiply in the liver and they inflect the RBCs leading to reduction of
Hb level. Frequent destruction of RBCs leads to anemia. P. falciparum causes the most severe
and profound anemia with a significant risk of deaths (WHO 2015). The disease is transmitted
most commonly by an infected female anopheles mosquito. The mosquito bite introduces the
parasite from the mosquito's saliva into a person's blood .The parasite travel to the liver where
they mature. The cause is explained by destruction of parasitized red blood cells of the time of
release of merozoites, a process caused by all the species (WHO 2014). Etiology basis of severe
malaria anemia are lysis of infected and uninfected RBCs, splenic sequestration of RBCs,
dyserythropoiesis and bone marrow suppression, co-infection with bacteremia, HIV and
hookworm (World Malaria Report 2008).

The pathophysiology of malaria is multifunctional and only partially understood, development of

pathogenic versus protective outcomes; ones an infection occurs is mediated by host and parasite
interaction depending on endemicity patterns acquisition of naturally acquired malaria immunity,
parasite virulence, antigenic variation and polymorphic variability in both the host and parasite.
(WHO, 2013).

2.1 The Association of Malaria with Anemia among Patients

Malaria is the most important parasitic disease worldwide, responsible for an estimated 225
million clinical cases each year; and an estimated 781,000 fatalities annually and represents a
major global public health problem (WHO 2010).
Although four species have been classically responsible for human malaria, plasmodium
falciparum has been the most prevalent overall, particularly in Africa (86%).On this continent,
the greatest mortality is associated with cerebral malaria and severe anemia, mostly in children
less than 5 years of age, in malaria holoendemic areas (Guerra et al 2010).
In sub Saharan Africa, pregnant women are also at higher risk of cerebral malaria and anemia,
which are consequently the major causes of perinatal morbidity and mortality. Both of these

8
malaria complications are responsible for a great number of spontaneous abortions, premature
deliveries and low birth weight (Dicko et al 2003).

2.2 The Association of Malaria with Anemia According to Parasitic Load.

A cardinal part of the plasmodium life cycle occurs as an obligate intra erythrocyte parasite;
where it differentiates and multiplies at the expense of the host cells' nutrients up to the induction
of its burst. The merozoites released either from the liver or from the erythrocyte invade a new
erythrocyte; in the case of vivax, its merozoites have a preference for reticulocytes, whereas in
the case of P. falciparum, its merozoites invade erythrocytes of any age (Simpson et al 1999;
Rayner et al 2005).

An obvious consequence of the parasite multiplication and the periodic burst of schizonts is the
rupture of infected erythrocytes. Although this dearly contributes to the development of anemia,
it does not appear to be sufficient to explain the levels of anemia attained in individuals exposed
to the infection. It has been established that levels of parasitemia of greater than 50,000 parasites
are indicative of severe falciparum malaria (WHO 2000).
An infection level that corresponds to the infection and destruction of approximately 1% of the
total erythrocyte mass could be easily replaced by erythropoiesis under normal conditions.
However, it seems that simultaneous to this mechanism, depuration of the parasitized
erythrocytes also occurs as a consequence of this phenomenon of erythrocyte rigidity. The
rigidity is induced by the transport of parasite antigens to the infected erythrocyte membrane and
is followed by the deformation of the membrane; opsonisetion by the antibodies and complement
and by macrophage activation (Wickrama Sigh and Abdalla 2000).
Complicated malaria warranting intensive clinical management is a problem every year at each
hospital. Previous cross sectional of the prevalence of Plasmodium falciparum infection in
homesteads in Kisii central during 2000 suggested infection rates between 4.5% and 13 %.
( Susan T,Blackburn DO. Maternal, fetal and neonatal physiology 2008).More recently (July
2010) the prevalence of P.falciparum infection was 10.3% (Hl Guyatt, Unpub.data).

9
2.3 The Association of Malaria with Anemia According to Preventive Measures Used
Malaria prevention in pregnancy with chemoprophylaxix is associated with reduced incidence of
malaria episodes, higher mean martanal Hb levels, and reduced incidence of LBW (Asa oo;
Onayade AA 2014).
Malaria also causes an immune response that suppresses erythropoietin (Burgmann et al 1996) as
well as direct effects on erythropoiesis (Skorokhood et al 2010). The host may also increase
hepcidin expression for protection from liver stage malaria (Portugal et al 2011). Of course,
increased hepcidin restricts iron and might delay erythroid recovery.
The study done by University of Nairobi in 2012 with a study sample of 374 revealed that in
western Kenya, 314(84.0%) respondents reported that they had mosquito bed nets. Among these
256(68.5%) mentioned they used mosquito bed nets consistently. The prevalence of anemia in
those who don’t use mosquito nets every night was 25(51.0%).
Research done by joint University of Nairobi-Kenyatta National Hospital in Rusinga Island in
Lake Victoria western Kenya revealed that most of the interviewees had a good theoretical
knowledge on how to prevent malaria, with bed nets frequently mentioned. A summary of all the
methods which the community members believed to be useful for preventing despite the fact that
it is established knowledge in the scientific community that clearing of vegetation is of no
benefit but might even worsen the malaria situation, of those that responded to know how to
prevent malaria only 34% listed solily biomedical correct method to target either the mosquito
adults (bed nets, repellants) larvae (destruction of holes with stagnant water) or malaria parasites
(drugs) but 72% listed only correct prevention measures with the one addition of bush clearing.
Another 25% mixed correct knowledge and beliefs e.g that increased hygiene, disposal of
rubbish or keeping warm would help to prevent malaria. Bush clearing was commonly used by
the community members. The activity was predominantly implemented by men, of the 492
respondents that practiced bush clearing 20% believed that bushes and other vegetation served as
larval habitats for mosquitoes hide in vegetation and can be prevented from entering the
compound. Despite that there was a very good knowledge in the community that the removal of
water containing borrow pits protects from malaria, a fact recently highlighted with particular
strength in nearby areas nobody actually practiced this ( Mutuku fm,walter ad, Vululu jm 2012).
Notably 13% of all respondents did nothing to prevent malaria.

10
2.4 The Association of Malaria with Anemia According to Diet
An estimated 243 million cases of malaria occurred in 2008 globally, most of which were
reported in Sub-Saharan Africa (WHO 2009).
Malaria in pregnancy is an immense public health problem that affects approximately 50 million
women per year in malaria endemic areas. Martanal anemia and LBW are two important
consequences of malaria in pregnancy (Brabin B 2012).
The etiology of anemia in pregnancy and children is often multifunctional with causes ranging
from nutritional deficiency of iron, foliate, vitamin A, hemoglobinopathies and infection by
parasites such as plasmodium.
Anemia is usually caused by lack of iron, the most common nutrient deficiency. IDA is typically
diagnosed by low Hb, accompanied by biochemical evidence of iron deficiency such as low
serum, ferritin concentration. Hb response to iron supplementation can also be used to confirm
that the anemia is caused by iron deficiency. Women and children have a higher prevalence of
nutrition anemia than men.
Vitamin B12 deficiency is common in many regions and folic acid deficiency. A severe
deficiency of the two vitamins can cause anemia by impairing RBC synthesis. Nevertheless it is
apparent that the prevalence of anemia in developing countries is about four times that of
developed countries. Current estimates for anemia in developing and developed countries
respectively are: for pregnant women, 56 and 18%; school children 53 and 9%; preschool
children 42 and 7%; and men, 33 and 5%.Study done in 2010 revealed that in western Kenya
among the study participants those who ate vegetables and meat less frequently the occurrence of
anemia was higher (vegetables 60.3% vs 24.6% and meat 39.8% vs 16.0%) than those who eat
these items more frequently (Www.putk/theinternet).

2.5 Laboratory Diagnosis

Test: Thick and thin blood film
Principle
In a thick malaria blood film the RBCs are lysed and dehaemoglobinized while the malaria
parasites are left intact and concentrated. This renders detection and identification of parasites
easily. The thin malaria blood film when fixed with the absolute methanol enables the RBCs to
retain their original morphology with malaria parasites, if present is being visible inside the cells.

11
CHAPTER THREE: METHODOLOGY
3.0 Introduction
This chapter contains the background information of the information of the study area, study
design, study population, study sample, inclusion criteria, methods of data collection and ethical
consideration.

3.1 Study Area

This study was carried out at Nakuru Level 5 Hospital, Nakuru County.

3.2 The Background Information about the Study

Nakuru Level 5 Hospital is located within the Town of Nakuru County. It can accommodate
more than 500 patients presently compared to the time it was built (1906).The hospital has
different departments which include; Outpatient Pharmacy Dental, Laboratory Amenity, MCHC,
Orthopedic, CCC, VCT, Physiotherapy, Casualty, Throat and X-ray Departments. The laboratory
is divided into sub departments which include microbiology, Virology, Parasitology, Hematology,
Biochemistry, Serology, Bleeding and Blood Bank.

3.2.1. Location and climate.

Nakuru County is located alongside Great Rift Valley and constitutes eleven constituencies
Molo, Njoro, Naivasha, Gilgil, Kuresoi South, Kuresoi North, Subukia, Bahati, Nakuru Town
West and Nakiru Town East. It is named after Nakuro Masaai name. The temperature range is
12-28 degrees celicius.
It occupies an area of 1317.4km. It has got the average rainfall range of 500 to 1800 mm per
annum.

3.2.2. Demographic information.

The county has a total population of 850,920 according to 2009 National census people. 47% of the
population consists of males and the rest consist of females. More than 52% of the total population
lives below the poverty line. Major economic activities are quarrying in Bahati and Salgaa, crop
farming in both commercial and subsistence, livestock farming and tourism which is

12
the largest contributor to the County economy has it hosts the Lake Nakuru National reserve.
There is a good road network infrastructure.

3.2.3. Health profile.

The county has a good number of health facilities. There is one Referral Hospital, 11 Sub county
hospitals, 52 Dispensaries, 72 health centers, many Medical clinics.

3.2.4. Top Ten Diseases

1) HIV/AIDS
2) Malaria
3) Diabetes mellitus
4) Tuberculosis
5) Pneumonia
6) Typhoid
7) Anemia
8) Brucellosis
9) UTIs

3.3 Study Design

A prospective study design was used. It included all patients who were sent to the laboratory for
malaria diagnosis.

3.4 Study Variables

3.4.1. Dependent variables

Association of malaria with anemia.

3.4.2. Independent variable

a) Parasitic load.
b) Preventive measures used.
c) Diet.

13
3.5 Inclusion and Exclusion Criteria

3.5.1. Inclusion Criteria

The study included all patients who attended Nakuru Level 5 Hospital for blood examination for
malaria.

3.5.2. Exclusion Criteria.

The study excluded all pregnant women with anemia at Nakuru Level 5 Hospital for other tests
and those from outside Nakuru County.

3.6 Study population

One thousand two hundred patients who were sent to the laboratory for malaria diagnosis during
the study were involved.

3.7 Sampling Procedure

A systematic sampling procedure was used for random selection.

3.8 Sample Size

It’s calculated by Yemen formula of 1986 to determine the sample size.
n=N/ (1+N (e) ²)
Where n=1200/ (1+1200(0.05)²)
n=1200/4
n=300
Where;-
n=samples size
N=study population
e=precision (5%)

3.9 Data Collection Tools

• Request form.
• Questionnaire
• Laboratory registers.

14
3.10 Data Collection Procedure
The recruited patients were asked to fill the questionnaire which was provided. Thick blood
smears were made stained with Giemsa stain and examined for malaria parasites to establish the
association of malaria with anemia.

3.10.1. Specimen Collection.

Blood samples were collected from patients with signs and symptoms of malaria anemia.

3.10.2. Specimen Processing

Giemsa Technique
Dried thick blood smears were immersed in diluted Giemsa stain for 30 minutes. They were then
washed off excess stain in buffer PH 7.2 for 5 minutes, the back of the slide was wiped off
excess stain and then air dried. The slide was then being examined under ×100 oil immersion for
malaria parasites.

3.11 Ethical Consideration

The research was done after being given permission from the college and ministry of Medical
Services. Permission to conduct the research in Nakuru Level 5 Hospital was granted by the
laboratory in charge. The information obtained during research work was for learning purposes and
privacy of the patients was observed to avoid physical and psychological harm to the patients.

15
CHAPTER FOUR: DATA ANALYSIS AND PRESENTATION
4.0. Introduction
This chapter covers the analysis of data collection and findings of the study and is presented
inform of pie-charts and tables.
4.1: Association of malaria with anemia among Patients.

positive negative

16%

84%

Figure 4.1. Pie chart showing the association of malaria with anemia among patients
Figure 4.1 represents the overall distribution of malaria anemia among patients attending Narok
level 5 Hospital. Out of the 300 patients sampled during the study 47 were positive (16%)
compared to 253 who were negative (84%).

16
4.2. The Association of Malaria with Anemia According to Parasitic Load.

8.5
4.2

12.8 p.falciparum
P.ovale
P.malariae
P.vivax

74.5

Figure 4.2.Shows the association of malaria with anemia according to parasitic load

Figure 4.2 represents the association of malaria with anemia according to parasitic load with an
occurrence of a higher rate exhibited by P. falciparum (74.5%) then P. ovale (12.8%) followed by
P.vivax (8.5%) and finally P.malaria which had the least with 4.2%

4.3 Association of Malaria with Anaemia According to Preventive Measures Used.

4.3.1. According to those who sleep under mosquito nets.

Table 4.1: Those who slept under nets.

Category Number of patients Percentage rate (%)
Always 152 50.7
Sometime 123 41
Do not 25 8.3
Total 300 100

17
Table 4.1 represents the association of malaria with anemia according to those who sleep under
mosquito nets with occurrence of higher rate exhibited by those who don’t sleep under mosquito
nets 25 (8.3%) then those who sleep sometime with 123 ( 41%) followed by those who sleep
under mosquito nets always with 152 (50.7%).

4.3.2. According to those who take full course of drugs after being diagnosed with malaria.

Table 4.2: Those who did not take full course.

Category Number of patients Percentage rate (%)
Yes 135 45
No 165 55
Total 300 100

Table 4.2 shows that majority of patients who don’t take full course of drugs with percentage rate
of 55% and 45% presented by those who take full course of drugs.

4.3.3: According to those who clear bushes around their house.

Table 4.3: Those that clear bushes around their homesteads

Category Number of patients Percentage rate (%)
Always 41 13.7
Sometimes 24 8.0
Don’t 235 78.3
Total 300 100

The table 4.3 represent those who do not clear bushes are represented by a total of 235 patients
(78.3%) while those who clear the bushes always are represented by 41 patients (13.7%) also 24
patients (8%) represented those who clear bushes sometimes.

18
4.3.4. According to those who drain stagnant water in homestead.

Table 4.3: Those who drain stagnant water in homestead

Category Number of patients Percentage rate (%)

Always 20 6.7
Sometimes 280 96.3
Total 300 100

Table 4.4 shows that 280(96.3%) are those who drain stagnant water sometimes while 20 (6.7%)
represents those who drain stagnant water in homestead always.
4.4. Association of Malaria with Anemia According to Diet

Figure 4.3: represents diet intake

90

90
80
70
60
50
40
30
10
20
10
0
Yes no

Figure 4.3 shows who take balanced diet are represented by 30 (10%) while 270 (90%) rate are
those who don’t take balanced diet.

19
CHAPTER FIVE: DISCUSSION AND INTERPRETATION
5.0. Introduction

This chapter contains discussion and interpretation of data obtained in chapter four on the
association of malaria with anemia among patients who attended Nakuru level 5 Hospital.
During the 3 months the total number of responds examined were 300, 47 cases were positive
representing 15.7% while 253 patients were negative accounting 84.3%.

Based on parasitic load, the study revealed that p.falciparum had a higher incidence of causing
malaria anemia with a frequency of 34 representing 72.3%. This is also revealed in a study done
by Susan et al where they found that p.falciparum was the specie which caused malaria anemia
with a prevalence of 10.3% high than the other species.

The prevalence of 36.2% is lower than 39.8% in a study done in 2010 (www.pubtk/theinternet)
this study revealed that most people don’t use balanced diet always. This agrees with study done
in Western Kenya which shows that those who don’t take balanced diet are a high risk of being
affected.

Based on preventive measures 50.7% said they used to sleep under nets always while 8.3% never
slept in nets. Majority of the clients with prevalence of 12.3% practiced bush clearing to prevent
mosquito together with draining stagnant water. This agrees with a study done by University of
Nairobi in 2012 revealed that 68.5% frequently slept under mosquito nets while those who don’t
sleep under mosquito nets are at risk of being affected by malaria anemia with a percentage of
51.0%.

20
CHAPTER SIX: CONCLUSION AND RECOMMENDATION
6.0. Conclusion
In conclusion the association of malaria with anemia in Nakuru level 5 Hospital is found to be
15.7%. This is brought about by poor preventive measures used to control malaria and also low
standards of economic life. This study showed that anemia is a moderate public health problem
.Less frequent meat and vegetables consumption is risk factors for anemia. Therefore reducing
parity taking balanced diet and use of mosquito nets are recommended.

6.1. Recommendation
Since the government of Kenya has expressed concern for the worsening situation of malaria
anemia. There is needed to form an effective partnership involving the community, governmental
agencies in malarial control programs. This ensures malaria prevention and curative services to
those of risk with an aim of reducing morbidity mortality.
The following are some of the malaria anemia strategies that need to be undertaken;

i) Health education: Enhance people`s knowledge about transmission and pathogenesis

of malaria.
ii) Community mobilization in vector control: Community should be mobilized in
mosquito breeding grounds through draining stagnant water, clearing bushes around
the home shed, using affordable insecticide sprays and personal protection by use of
insecticide treated nets.
iii) Surveillance: The district health management should conduct regular surveillance by
collecting data on malaria prevalence, distribution, intensity, seasonality and
efficiency. The effective management of malaria control activities and early
preparedness incase if disease outbreak.

21
APPENDIX I: REFERENCES

1. Abdalla S, Weatherall D.J, Wikramasigh S.N, (1980).The Anaemia of P.Falciparum

Malaria.
2. Asa OO, Onoyando AA, Dela Puente-Olertegui C (2000).
3. Brabin B, Desai M, Fer Kuile, Nosten F, Asamoa K. Epidimoplogy and burden of malaria
in pregnancy.
4. Connolly, David, Robert, Stanley L, Stephen Landlaw (1998). Anemia in malaria.
5. Dicko et al, James B. Hilter, Douglas J, Perkins (2003). Severe malaria Anaemia.
6. Guerra et al, Bardales Tuesta F, Ketela Tafess, (2010).
7. Portugal et al, Million Getachew, Delenesaw Yawhalaw and Ahmed Zeynudin (2011).
8. Roger C.K Tine, Magatte Ndianye, Helen Holm, Hasson, Barbara Faye (2012).
9. WHO (2011).
10. World Malaria Report (2008).
11. Www.pubtk/theinternet date 7/12/2015

22
APPENDIX 1: QUESTIONNAIRE
INSTRUCTIONS
a) Do not indicate your name or address on this questionnaire.
b) All information will be treated with strict confidentiality.
c) Answer question according to instructions given.
d) Tick where applicable.
1. Do you sleep under mosquito nets?
Yes ( ) No ( )
2. If yes, how often do you sleep under nets?
Always ( ) Sometimes ( )
3. Do you take full course of drugs after being diagnosed of malaria?
Yes ( ) No ( )
4. How often do you clear the bushes around your house?
Always ( ) Sometimes ( ) Not ( )
5. How often do you drain stagnant water in your homestead?
Always ( ) Sometimes ( )
6. Do you take balanced diet?
Yes ( ) No ( )
7. If yes, how often do you take?
Always ( ) Sometimes ( )

23
APPENDIX II: BUDGET

ITEM RATE QUANTITY TOTAL(Kshs.)

House rent 2,500 3 months 7500
Foolscaps 1 ream 450 450/=
Printing and binding - - 1,000/=
Shopping 2000 3 months 6,000
Ball pens 20 5 100
Pencils 20 2 40/=
Eraser 30 1 30/=
Browsing - - 400/=
Photocopying - - 600/=
Miscellaneous - - 3,000
TOTAL 19120

24
APPENDIX III: WORK PLAN
Month/ Topic Proposal Data Data Analysis Research
Selection Writing collection And
Year Presentation Submission

2017/2018

SEPT.

MAY -

JULY

SEPT.-

DEC.

JAN.-

APRIL

MAY

25