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The Extent and Determinants of Use of Bed Nets Among Children Under 5 Years Old and Their Effect on Parental Diagnosis of Malaria in Kibera, Nairobi______

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The Extent and Determinants of Use of Bed Nets Among Children Under 5 Years Old and Their Effect on Parental Diagnosis of Malaria in Kibera, Nairobi______ DETERMINANTS OF USE OF BED NETS AMONG CHILDREN UNDER FIVE YEARS OLD AND THEIR EFFECT ON PARENTAL REPORT OF MALARIA IN KIBERA, NAIROBI NYAWIRA WAMBUI NDEGWA MASTER OF SCIENCE (Public Health) JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND TECHNOLOGY Determinants of use of Bed Nets among Children under five years old and their effect on Parental report of Malaria in Kibera, Nairobi Nyawira Wambui Ndegwa A Thesis submitted in Partial fulfilment for the Degree of Master of Science in Public Health in the Jomo Kenyatta University of Agriculture and Technology 2015 DECLARATION This thesis is my original work and has not been presented for a degree in any other University Signature: _______________________ Date :_________________ Nyawira Wambui Ndegwa This thesis has been submitted for examination with our approval as University Supervisors Signature: ________________________ Date:_________________ Prof. Linus M. Gitonga Karatina University, Kenya Signature:________________________ Date:__________________ Dr. Charles Mbakaya KEMRI, Kenya Signature: _______________________ Date: ___________________ Dr. Virginia Kimani Pesticides and Agricultural Resource Centre, Kenya ii DEDICATION I dedicate this thesis to my parents, Prof. Elijah Ndegwa and Mrs. Rosemary Ndegwa who have given me inestimable support all through. iii ACKNOWLEDGEMENTS I would like to acknowledge the kind assistance of my supervisors Prof Linus M. Gitonga of Karatina University (formerly at JKUAT), Dr Charles Mbakaya of KEMRI and Dr. Virginia Kimani of Pesticides and Agricultural Resource Centre (PARC). In addition, I would like to acknowledge the assistance given by various staff members at the Centre of Public Health Research (CPHR), Kenya Medical Research Institute (KEMRI) and Jomo Kenyatta University of Agriculture and Technology (JKUAT). I would also like to acknowledge the valuable assistance afforded by my research assistant Mrs Catherine Njeru of Diverse Gifts Community Based Organisation, Mama Emily and other members of the organisation. I would like to recognise the moral support, encouragement and prayers afforded by my parents, Prof. and Mrs Ndegwa, my sisters Nyambura and Wanjiku and nephew Mathew. I would also like to acknowledge the people in Kianda, Raila, Kambi Muru, Soweto West and Gatwekera villages in Kibera who willingly opened their homes and shared their experiences in dealing with malaria with me. Most important, I recognise that it is God who has enabled me to complete this work. May He receive the glory. iv TABLE OF CONTENTS DECLARATION ....................................................................................... ii DEDICATION ........................................................................................... ii ACKNOWLEDGEMENTS ..................................................................... iv TABLE OF CONTENTS .......................................................................... v LIST OF TABLES ................................................................................. viii LIST OF FIGURES ................................................................................. ix LIST OF PLATES..................................................................................... x LIST OF APPENDICES.......................................................................... xi LIST OF ABBREVIATIONS ................................................................ xii ABSTRACT ............................................................................................ xiv CHAPTER ONE........................................................................................ 1 1.0 INTRODUCTION ...................................................................... 1 1.1 Statement of the problem.............................................................. 3 1.2 Justification................................................................................... 4 1.3 Hypothesis .................................................................................... 5 1.4 General Objective ......................................................................... 5 1.4.1 Specific objectives ................................................................ 5 1.5 Study Assumptions ....................................................................... 6 1.6 Expected Utilisation of Results .................................................... 6 1.7 Study limitations ........................................................................... 6 CHAPTER TWO ...................................................................................... 8 2.0 LITERATURE REVIEW BACKGROUND ............................ 8 v 2.1 Malaria in children under five years ............................................. 8 2.2 Malaria in Urban Areas ................................................................ 9 2.3 Awareness of Malaria ................................................................. 10 2.4 Methods used to control malaria................................................. 11 2.5 Use of bed nets ........................................................................... 13 2.6 Challenges in the use of ITNs ..................................................... 14 2.7 The gold standard of a bed net .................................................... 16 CHAPTER THREE ................................................................................ 18 3.0 MATERIALS AND METHODS ............................................. 18 3.1 Study Location ............................................................................ 18 3.2 Study Design ............................................................................... 22 3.3 Study Population ......................................................................... 23 3.3.1 Inclusion Criteria ................................................................. 23 3.3.2 Exclusion Criteria ................................................................ 23 3.4 Sample Size Calculation ............................................................. 23 3.5 Sampling Procedures .................................................................. 24 3.6. Outcome Variables ..................................................................... 24 3.6.1 Independent Variables ......................................................... 24 3.6.2 Dependent Variables ........................................................... 25 3.7 Data Collection ........................................................................... 25 3.8 Data Management and Analysis ................................................. 25 3.9 Ethical Considerations ................................................................ 26 CHAPTER FOUR ................................................................................... 27 4.0 RESULTS, DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS……………………………………… 27 vi 4.1 Results ........................................................................................ 27 4.1.1 Demographics of the Respondents ...................................... 27 4.1.2 Perception of cause and symptoms of malaria .................... 28 4.1.3 Bed net use .......................................................................... 32 4.1.4 Factors related to bed net use .............................................. 35 4.1.5 Net condition and placement ............................................... 38 4.1.6 Parental report of malaria among children .......................... 39 4.1.7 Report of malaria in medical facilities ................................ 41 4.1.8 Parental action to malaria-like symptoms ........................... 42 4.2 Discussion................................................................................... 44 4.2.1 Parental knowledge of the proper use of bed nets............... 44 4.2.2 Households with bed nets and characteristics of the nets ... 46 4.2.3 Parental knowledge of malaria ............................................ 47 4.2.4 Parental Report of malaria ................................................. 48 4.3 Conclusions ......................................................................... 50 4.4 Recommendations ............................................................... 51 REFERENCES .................................................................................... 53 APPENDICES ...................................................................................... 61 vii LIST OF TABLES Table 2.1: PCPB Registered LLINs in Kenya…………………………………...…18 Table 4.1: Association of village of residence and use of bed net……………….…29 Table 4.2: Number of children under 5 years old in each household………………30 Table 4.3: Kibera residents knowledge of symptoms of malaria……………….......32 Table 4.4: Association of bednet and parental knowledge of cause of malaria.........33 Table 4.5: Association of bednet and parents knowledge of malaria prevention…..34 Table 4.6: Origin of bed nets used by Kibera residents in 2010.……………….......36 Table 4.7: Association of use of bed net and parental report of malaria…………...37 Table 4.8: Kibera residents suggested price of bed nets (2010)……………………38 Table 4.9: Association of use of bed net and use of other mosquito repellents…….39 Table 4.10: Association of use of bed net and parental medication of child……….40 Table 4.11: Association of holes on bed net and parental report of malaria………..41 Table 4.12: Report of malaria among children at Mbagathi District Hospital….......44 Table 4.13: Report of malaria among children at Ushirika Clinic (MOH 240)…….45 viii LIST OF FIGURES Figure
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