EFFECT OF MALARIA ON MATERNAL MORTALITY RATE IN NIGERIA
CHAPTER ONE
INTRODUCTION
1.1    Background of the study
Among the most severe public health problems worldwide is malaria. In many developing countries, especially those in the sub Saharan region, malaria is a leading cause of mortality.
Malaria is a febrile illness characterized by fever and related symptoms. It is caused by plasmodia species of which four are important in human disease. As noted by Abatan (2014), each of the four species exhibit slightly different symptoms in the infected patients. Among these four species, is Plasmodium falciparum which is the deadliest and the main specie causing malaria in tropical Africa. Patients infected with plasmodium falciparum show the following signs of infection: Dizziness, fatigue, abdominal pain, muscle pain, enlargement of the spleen, back pain, joint aches, seizures, vomiting, fever, severe anemia, headache, etc (Abatan, Afolabi, 2015)
Malaria parasites are mostly transmitted through the bite of female anopheles mosquitoes (Jiliana and Nawal, 2009). On other occasions, it could be transmitted by design or action. The term design or action refers to transmission of malaria from an infected party.
The rate of malaria infection is higher in pregnant women because of their decreased immunity. Studies have shown that infection rates are highest in first and second parity women with lower rates in later pregnancies (Steketee 2001, Duffy 2005). Plasmodium falciparum, which was earlier said to be the main cause of malaria in tropical Africa, is generally accepted as a leading cause of anaemia in pregnant women (Guyatt, Snow, 2001). It is estimated that anaemia causes as many as 10,000 maternal deaths each year (Steketee, 2001).
Adolescent girls are particularly vulnerable to malaria. In many sub-Saharan African settings, adolescents are often parasitaemic and anaemic when they first become pregnant. (Brabin, Brabin, 2005). Every minute in the world, 380 women become pregnant and 190 face an unplanned or unwanted pregnancy (Garg, 2006).
Malaria is a global health challenge and remains a cause of mortality. In Nigeria, malaria is a major public health problem. It accounts for more cases and deaths than any other country in the world. According to Kelsey (2001), despite Nigeria’s deep involvement in the safe motherhood initiative which was launched in 1987, there is no strong evidence to demonstrate that much of the good ideas, good intentions and good work done over the years have yielded any positive results. This is due to the increase in the death rate of the women giving birth over the same period.
The WHO Factsheet (2008) indicates that globally, among the indirect causes of maternal deaths are diseases that complicate pregnancy such as malaria, anaemia, sickle cell anaemia etc. Poverty was also indirectly pointed as one of the causes of maternal mortality as Omoruyi (2008) opined that poor access to and utilization of quality reproductive  health services contribute significantly to the high maternal mortality level in the country (Sabrina, 2012). Many pregnant women mostly in rural areas in Nigeria, do not receive the care they need either as a result of absence of services where they live or as a result of inability to afford the services because they are too expensive or reaching them is too costly.
Formerly, when Millennium Development Goal was still considered, Mairiga (2008) opined that the world’s maternal mortality ratio i.e. the number of maternal deaths per 10,000 live births was declining too slowly to meet up with the Millennium Development Goal 5target. The aim of this target was to reduce the number of women who die in pregnancy and childbirth by three quarters by the year 2015. The figures released by WHO, UNICEF, UNFPA and the World Bank show an annual decline of less than 1 per cent in the world. This does not meet up to the annual decline of 5.5 per cent in maternal mortality ratio between 1990 and 2015 which is required to achieve the millennium Development Goal 5 (Mojekwu, Ibekwe, 2012).
By the year 2007, it was reported that more than one hundred and thirty four thousand women died from pregnancy complications (David 2016).
It should however be noted that although attempt have been made in the past aimed at reducing maternal mortality in Nigeria, such attempts especially by the state and federal governments, have generally not proved very successful in achieving the desired results (Mojekwu, Ibekwe, 2012).
So far, the relationship between malaria and maternal mortality is only an illusion. No known concrete evidence as to the impact of one against the other has been established functionally. Thus, this study is poised to examine this functional relationship between the two.
1.2    Statement Of The Research Problem
One of the serious problems in less developed countries is maternal mortality. In a bid to improve child and infant care in the past, mothers have been neglected. Chibuzo (2011) carried out a study on the socio-cultural factors influencing maternal mortality. The study is of the view that factors such as poverty and gender inequality contributed to the increase in the maternal mortality rate.
Breman , Eagan and Keusch (2001) opined that malaria and poverty are intimately connected. Their study was on “The Economic Burden of Malaria”. The study showed that in the year 1995, countries with intensive malaria had income levels of only 33% that of countries without malaria. A Nobel laureate in medicine, Weller 1958 in Breman 2001, noted that it had been recognized that a malarious community is an impoverished community.
In a study carried out by David (2016) on the Impact of Government Expenditure on Health on Infant mortality, he opined that an increase in government expenditure on health will reduce the infant mortality rate.
In 1990, 19% of the maternal deaths were attributed to anemia. Anand (1995) noted that the total iron needed during pregnancy is about 1000mg and the daily requirements for iron, as well as folate, are 6 times greater for a woman in the last trimester of pregnancy than for a woman who is not pregnant. The study also pointed out that lack of iron directly affects the immune system. This actually culminates into inadequate feeding or nourishment that gives room to weak resistance to infection and hence anemia.
Nazarene examined “The Effect of Illiteracy on the Prevalence of Malaria in Yekebe Liberia”. Results showed that both the literate and illiterate population had some knowledge on malaria, its effects, treatment, cure and possible eradication. While the literate population applied their knowledge to the prevention and treatment of the disease, the illiterate population did not.
All these studies mentioned above, though similar are different from this study in that the main focus of this study is the relationship between malaria and maternal mortality rate. Anemia may be a cause of maternal mortality but malaria is a disease that can bring about anemia. Poverty, illiteracy and government expenditure can also been seen as indirect causes of maternal mortality. Thus, the following research questions are raised.  
1.    What is the relationship between Malaria and Maternal Mortality Rate?
2.    Is there a significant relationship between literacy rate and Maternal Mortality Rate?
3.    What is the relationship between poverty rate and Maternal Mortality Rate?
4.    What is the relationship between government health expenditure and Maternal Mortality Rate?
1.3    Objectives Of The Study
The broad objective of the study is to examine the impact of malaria cases on maternal mortality rate.
The specific objectives are;
1.    To determine the relationship between malaria cases and maternal mortality rate.
2.    To verify the relationship between literacy rate and maternal mortality rate.
3.    To examine the relationship between poverty rate and maternal mortality rate.
4.    To determine the relationship between government health expenditure and maternal mortality rate.
1.4    Research Hypothesis
The following hypothesis will be tested in the course of this study.
HYPOTHESIS I
H0: There is no significant relationship between malaria cases and maternal mortality rate.
HYPOTHESIS II
H0: There is no significant relationship between literacy rate and maternal mortality rate.
HYPOTHESIS III
H0: There is no significant relationship between poverty rate and maternal mortality rate.
HYPOTHESIS IV
HO: There is no significant relationship between government health expenditure and maternal mortality rate.
1.5    Scope of the Study
This study is undertaken to examine the effect of malaria on maternal mortality rate. Relevant data shall be sourced from 1980 to 2014. This period is chosen because it marks the period when several regimes of governmentinitiated and implemented a number of health policies towards reducing malaria and maternal mortality. It is expedient to examine how much these effects have yielded.
1.6Significance of the Study
It is expected that this study would unite with existing literature on the issues surrounding the relationship between malaria and maternal mortality. This study would also enhance the examination of the effect of literacy rate, poverty rate and government health expenditure on maternal mortality rate and thus improving the empirical evidence from Nigeria.
Due to the empirical nature of the study, the outcome of the study would help policy makers and bodies in charge of regulations. It will also help policy simulation with respect to the variables assessed in the study.
The result of the study would be of importance to health institutions in examining the impact of malaria on maternal mortality rate.
Finally, this study will add to the available literature on the areas of study while also serving as a platform for researchers who may want to further this study.
1.7Limitation of the Study
This study makes use of time series data. For one thing, time series data are trusted with stationarity challenges. Thus, each of the series is tested for presence of unit root with the mechanism of Augumented Dicky Fuller. Those found not stationary were differenced once to attain stationarity before being utilized for the study.