ABSTRACT
This study was conducted to assess the knowledge, attitude and practice of malaria prevention strategies among mothers of under-five children in North Central Zone, Nigeria .
To achieve this purpose, ex-post facto research design was used. A total sample of 768 mothers of under-five children in North-central zone, Nigeria from a population of 3,641,445 were selected through multi-stage sampling procedures of simple random sampling and proportionate sampling. The instrument used for the study was researcher‟s structured questionnaire which was pilot tested using Cronbach Alpha reliability test which was 0.833. Out of the 768 copies of questionnaire distributed, 765(99.6%) were valid for analyses. Inferential statistics of one sample t-test and Pearson Products Moment Correlation Coefficients were used to test the formulated hypotheses at 0.05 level of significance. The results revealed that Knowledge of malaria prevention strategies among mothers of under – five children in north-central zone, Nigeria was significant (p = 0.001), attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria was significant (p = 0.000), practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria was not significant (p = 0.7). Based on the results, the following conclusions were drawn, that mothers of under-five children have the knowledge of malaria prevention strategies. Also mothers of under -five children have positive attitude towards malaria prevention strategies in North-central zone of Nigeria .
Mothers of under-five children do not practice of malaria prevention strategies in Northcentral zone Nigeria. Based on the conclusions, it was recommended that health educators should carry out awareness campaigns through rendering health talks which would help to further sustain the already existing knowledge of malaria prevention strategies among the mothers of under-five children in North-Central Zone, Nigeria. Health educators in collaboration with other non-governmental and governmental agencies should conduct sensitization campaigns (through mass media or community-based outreach) that would help to further sustain the existing attitudes of mothers of under-five children in North-Central, Nigeria. Health educators should conduct periodic symposia and conferences for mothers of under-five children and women of child-bearing age so as to educate the mothers which would help them to understand the need to apply their knowledge into healthful practices of malaria prevention.
TABLE OF CONTENTS
Cover page – – – – – – – –
Title Page – – – – – – – –
Declaration – – – – – – – – –
Certification – – – – – – – – –
Dedication – – – – – – – – –
Acknowledgements – – – – – –
Abstract – – – – – – –
Table of Contents – – – – – – –
List of Tables – – – – – – – –
Appendices – – – – – – – –
Abbreviations – – – – – – – – –
Operational Definition of Terms – – – – – –
Chapter One: Introduction
1.1 Background to the Study – – – – –
1.2 Statement of the Problem – – – – –
1.3 Purpose of the Study – – – – – – –
1.4 Research Questions – – – – – – –
1.5 Basic Assumptions – – – – – –
1.6 Hypotheses – – – – – – –
1.7 Significance of the Study – – – – –
1.8 Delimitations of the Study – – – – –
Chapter Two: Review of Related Literature
2.1 Introduction – – – – – –
2.2 Conceptual Framework – – – –
2.2.1 Concept of Malaria – – – – –
2.3 Theoretical Framework – – – – –
2.3.1 Knowledge, Attitude and Practice Theory – – –
2.3.2 Health Belief Model – – – – –
2.4 Knowledge, Attitude and Practice of Malaria Prevention Strategies among
mothers of under-fie children
2.4.1 Knowledge of Malaria Prevention Strategies among mothers of under-five
children – – – – –
2.4.2 Attitude towards Malaria Prevention Strategies among mothers of under-five
children – – – – –
2.4.3 Practice of Malaria Prevention Strategies among mothers of Under-five 44
children
2.5 Prevention Strategies of Malaria among Mothers of Under – five Children – 46
2.5.1 Effects of Malaria Infection on Biological Profile of the Infected
Child – – – – – – –
2.6 Malaria in Africa – – – – –
2.6.1 Economic Burden of Malaria – – –
2.6.2 Risk Factors of Malaria among Mothers of under-five children 69
2.6.3 Roll Back Malaria (RBM): A Prevention Programme –
2.7 Empirical Studies – – – – – –
2.8 Summary – – – – – –
CHAPTER THREE: METHODOLOGY
3.1 Introduction – – – – – – – –
3.2 Research Design – – – – – – –
3.3 Population of the Study – – – – – –
3.4 Sample and Sampling Techniques – – – – –
3.5 Instrument – – – – – – –
3.6 Validity of the Instrument – – – – – –
3.6.1 Reliability of the Instrument – – – – – –
3.7 Procedure for Data Collection – – – – –
3.8 Procedure for Data Analysis – – – – – –
CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 Introduction – – – – – –
4.2 Results – – – – – – –
4.3 Discussion – – – – – – – –
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary – – – – – – –
5.1.1 Summary of Findings – – – – –
5.1.2 Contributions to Knowledge – – – – –
5.2 Conclusion – – – – – – –
5.3 Recommendations – – – – – –
5.4 Implication of the Study – – – –
5.5 Suggestions for Further Studies – – – –
References – – – – – – –
Appendices – – – – – – –
LIST OF TABLES
Table Page
Table 2.1: RBM, MDGs and Abuja Target 77
Table 3.1: Distribution of Sample size 99
Table 4.1: Demographic Characteristics of the Respondents 104
Table 4.2: Mean scores of the responses on the knowledge of malaria prevention 105
strategies among mothers of under-five children in North Central Zone,
Nigeria
Table 4.3: Mean scores of responses on the attitude of mothers of under -five 107
children towards malaria prevention strategies in North Central Zone,
Nigeria
Table 4.4: Mean scores of responses on practice of malaria prevention strategies 108
among mothers of under-five children in North Central Zone, Nigeria
Table 4.5: Mean scores of responses on the influence of knowledge on attitude 110
towards malaria prevention strategies among mothers of under-five children
Table 4.6: Mean score of responses on the influence of knowledge on the practice 110
of malaria prevention strategies among mothers of under-five children in
North Central Zone, Nigeria
Table 4.7: Mean score of responses on the influence of demographic variables (age, 111
level of education, number of children and occupation) on knowledge of
malaria prevention strategies
Table 4.8: Mean scores of responses on the influence of demographic variables (age, 112
level of education, number of children and occupation) on attitude of
malaria prevention strategies
xiii
Table 4.9: Mean scores of responses on the influence of demographic variables (age, 113
level of education, number of children and occupation) on practice of
malaria prevention strategies
Table 4.10: One sample t-test analysis of knowledge of malaria prevention strategies 113
Table 4.11: One sample t-test analysis on attitude towards malaria prevention strategies 114
Table 4.12: one-sample t-test analysis on practice of malaria prevention strategies 114
among mothers of under-five children
Table 4.13: Pearson Product Moment Correlation coefficients on the influence of 115
knowledge on attitude towards malaria prevention strategies
Table 4.14: Pearson Product Moment Correlation coefficient on the influence of 116
knowledge on practice of malaria prevention strategies
Table 15: Multiple Regression analysis on influence of demographic variables 117
on knowledge of malaria prevention strategies
Table 4.16: Multiple Regression analysis on influence of demographic variables 118
on attitude of malaria prevention strategies
Table 4.17: Multiple Regression analysis on influence of demographic variables 119
on practice of malaria prevention strategies
APPENDICES
Appendix I: Questionnaire – – – – – – 140
Appendix II: Reliability Test – – – – – 145
Appendix III: Letter for Vetting – – – – – 148
Appendix IV: Letter of Introduction for Pilot Study – – 149
ABBREVIATIONS
ACT – Artemisinin-Based Combination Therapy
DDT – Dichlorodiphenyltrichloroethane
FBO – Faith-Based Organisations
FGN – Federal Government of Nigeria
HBM – Health Belief Model
HSR – Health Sector Reform
IPT – Intermittent Prevention Treatment
IRS – Indoor Residual Spraying
ITN – Insecticide-Treated Net
ITNs – Insecticide-treated mosquito
FMOH – Federal Ministry of Health
KAP – Knowledge, Attitude and Practice
LLIN – Long-Lasting Insecticide Nets
MDGs – Millennium Development Goals
MKAP – Malaria related Knowledge, attitude and practice
NDHS – Nigeria Demographic Health Survey
NGO – Non Governmental Organization
NMCP – National Malaria Control Programme
NMSP – National Malaria Strategic Plan
NNMCP – Nigerian National Malaria Control Programme
NPC – National Population Commission
RDT – Rapid Diagnostic Tests
RBM – Roll Back Malaria
SPSS – Statistical Package for Social Sciences
SSA – Sub-Saharan Africa
SCMs – Social Cognition Models
UN – United Nations
UNDP – United Nations Development Programme
UNICEF – United Nations Children‟s Fund
WHO – World Health Organization
OPERATIONAL DEFINITION OF TERMS
Knowledge: this is the general understanding mothers of under-five children who are
respondents in this study have about malaria prevention strategies.
Knowledge of malaria prevention strategies: these are facts or experiences known by
mothers of under-five children on the awareness, consciousness, or
familiarity gained by experience about malaria prevention strategies.
Attitude towards malaria prevention strategies: is the feeling and opinion of mothers of
under-five children towards malaria prevention strategies.
Practice: this is what mothers of under-five children do regularly to prevent their children
being exposed to malaria fever.
Practice of malaria prevention strategies: is an action towards malaria prevention.
Malaria: is a disease that is transmitted by female anopheles mosquito bite.
Malaria Prevention strategies: activities and steps engages in by mothers of under-five
children used in this study to prevent their children and themselves from
contracting malaria fever.
Under-five children: children aged 0 – 59 months whose mothers served as respondents in
this study.
Mothers of under-five children: nursing mothers of children aged 0 – 59 months who are
participants in this study.
CHAPTER ONE INTRODUCTION 1.1 Background of the Study Malaria has continued to be a leading cause of mortality particularly among under-five year‟s children and pregnant women in tropical African countries. The estimate showed that 3.3 billion people were at risk of contracting the disease worldwide (World Health Organization, WHO, 2010; Ahmed, Haque, Haque, & Hoissan, 2009). In Africa, malaria is known to be a disease of the poor and severe cause of poverty (Roscoe, 2012). This was revealed in a recent economic analysis of 150 countries where 44 countries with intensive malaria transmission grew 1.3 per cent less per year than countries without high levels of malaria. The study further revealed that a 10 per cent reduction in malaria was associated with 0.3 per cent higher economic growth. Thus, malaria reduces a country‟s productivity through loss of investment and reduced income from tourism (Gallup & Sachs, 2011; Guyatt & Snow, 2004) .
In Nigeria, malaria is responsible for around 60% of the out-patient visits to health facilities, 30% of childhood death, 25% of death in children under one year and 11% of maternal deaths (Noland et al., 2014). Similarly, about 70% of pregnant women suffered from malaria, which contributes to maternal anaemia, low birth weight, stillbirths, abortions and other pregnancy-related complications (Federal Ministry of Health Abuja, 2015). The financial loss due to malaria is estimated to be about 132 billion Naira annually in form of treatment costs, prevention costs and loss of man-hours (World Health Organization, 2012) .
Malaria, a debilitating febrile and life-threatening illness, is caused by a parasite called Plasmodium. Its route of transmission still remains as bites from infected female anopheles mosquitoes. Environmental factors and behavioural patterns of vectors and 2 human populations combine to provide favourable conditions for malaria transmission (Boutin, 2015). Proven effective options to reduce morbidity and mortality include early diagnosis, combined with prompt effective therapy and malaria prevention through reduction of human-vector contact, especially with the use of Insecticide Treated Nets (ITNs) (World Health Organization, 2007). Perceptions about malaria illness, particularly households‟ perceived susceptibility and beliefs about the seriousness of the disease, are important preceding factors for decision-making concerning prevention and curative actions (Radey, 2011). The understanding of the possible causes, modes of transmission, and individual preference and decision-making about the adoption of prevention and control measures vary from community to community and among individual households. There have been a considerable number of reports about knowledge, attitude, and practice relating to malaria and its control from different parts of Africa. These reports concluded that misconceptions concerning malaria still exist and that practice for the control of malaria has been unsatisfactory (Laver, Wetzels & Behrens, 2011; Obol, Lagoro & Christopher, 2011) .
According to WHO (2014), there are four types of malaria parasites: falciparum, vivax, malariae and ovale. Plasmodium falciparum is responsible for most malaria deaths, especially in Africa. The infection can develop suddenly and produce several life-threatening complications, Plasmodium vivax is the most geographically widespread of the species, and produces less severe symptoms. Plasmodium malariae infections not only produce typical malaria symptoms but also can persist in the blood for very long periods, possibly decades without ever producing symptoms. A person with asymptomatic (no symptoms) P. malariae, however, can infect others, either through blood donation or mosquito bites. Relapses, however, can occur for up to 3 years, and chronic disease is debilitating and Plasmodium ovale is rare, can cause relapses, and 3 generally occurs in West Africa (WHO, 2015). Distinction on the basis of clinical symptoms is difficult without laboratory examination. Falciparum parasite produces the most fatal form of malaria (WHO, 2014) .
Malaria is a major cause of child mortality in Nigeria with approximately 100 million episodes in children under-five years of age every year (Federal Ministry of Health (FMOH), 2008). The mortality rate among children under-five years is 143 per 1,000 live births in the country (World Health Organisation, 2012) and deaths among this category of children often occur within two days of developing symptoms of malaria (Diallo, De Serres, Beayogui, Lapointe & Viens, 2011; Federal Ministry of Health, 2008). Malaria increases susceptibility to other infections and retards growth and development in children. It is associated with considerable economic burden including direct loss to government productivity. Malaria kills Nigerian children every 30 seconds, hence, pregnant women and their unborn children are also vulnerable to malaria which serves as a major cause of maternal anaemia and prenatal death (Davidson, 2010) .
Attempts at different periods by governments and concerned organizations in these regions aimed at control and eradication have not been satisfactory. This perhaps informed the shifts in campaign from eradication to control. Findings have shown that good knowledge, attitude and practice of any public health disease by individuals and communities seems necessary if effective prevention measures are to be realistic (Ahmed, Haque, Haque and Hoissan, 2009; Iwueze, Ezugbo-Nwobi, Umeanaeto, Egbuche and Anaso, 2013) .
Knowledge is the ability to recall or recognize something such as a fact concept, principle or custom (Kalua, 2011). It is further stated that knowledge can be acquired through formal or informal settings either by the help of someone or alone. Ashikeni, Envuladu and Zoakah (2013) stated that the mothers of children less than five years in 4 Kuje had poor knowledge of the cause of malaria, its prevention and possible complications, good knowledge of the prevention of malaria among mothers such as the use of ITNs, insecticide sprays, nets on windows and doors or protective clothing, was found to be 5.4% at baseline in the intervention group but this increased to 25% at post – intervention. It showed that adequate and proper health education to women especially in the language they understood increased their knowledge and improved their practice of the treatment of malaria in children .
Mothers attitude towards disease are challenging and economically, as well as scientifically, important. It is further stated that people define their personal needs rather than good health. Houmsou, Amuta, Wama, Bingbeng and Hile, (2014) stated that with regards to the attitude of mothers regarding malaria, 73.20% of the mothers always referred their children to hospital with 54.72% of them having post-secondary education and it was also reviewed that mothers prefer the use of one prevention strategy than the other especially the use of insecticide-treated mosquito net. This simply shows that malaria is easily perceived among mothers that have higher educational level. A positive association between level of education and improved perceptions of malaria was also reported in Southeast Nigeria. Oyewole and Ibidapo (2007) in a study of mothers attitude to malaria prevention, treatment and management strategies associated with the prevalence of malaria in a Nigerian urban centre, reported that prevention measures adopted against mosquito bite include sleeping under net (treated and untreated), door and window screening, cover cloth, mosquito repellent/insecticides spray, environmental hygiene, herbal decoction and chemoprophylaxis .
Practice is an action or behaviour that an individual engages in and is normally induced by attitude either consciously or unconsciously. It can also be referred to as behaviour, specifically referring to a behaviour that a person engages in (Williams, 5 2015). Despite the urgent need for the eradication of malaria, the practice of its prevention measures remains a major challenge in Nigeria especially with respect to the three-pronged prevention measures recommended by Roll Back Malaria (RBM) for under-five children. The practice of prevention of malaria has been globally accepted as a significant aspect of malaria control but majority of mothers of under-five often do not learn the tenets of prevention (Falade, Ogundiran & Bolaji,2016; Obrist, Mayumana, & Kessy, 2010). Falade et al., (2016) found out in their study that many of the mothers do not even believe malaria can be prevented because of series of myths and misconceptions they associated with fever in children, that practice of prevention measures like screening of windows and doors with nets, spraying the house with insecticides aerosol, application of insecticide repellant cream, wearing of long-sleeved clothes and destruction of mosquito breeding sites are not common .
The importance of information on KAPs in designing and improving malaria control activities has been emphasised. An understanding of mothers perceptions and practice on malaria is crucial for policymakers to incorporate disease preventions into the socio-cultural dimensions of the affected communities (Afolabi, 1996; Obi, Nwanebu, Okangba & Nwanebu, 2012). KAP studies are also essential in establishing epidemiological and behavioural baselines and may be used to identify indicators for monitoring malaria control programmes .
Achieving sustainable control of the disease depend on extensive public health promotion programmes which focus on current and proven methods of malaria prevention and management. While much is known about vector biology and behaviour and the malaria parasites, the importance of human behaviour in malaria transmission has not been critically evaluated. Studies focusing on the current practice of malaria 6 prevention and treatment options in the population are sparse. Thus, it is expedient to evaluate current knowledge of malaria prevention practice and management options as well as the uptake of the management options. In most high-burden countries (including Nigeria), ITN coverage is still below agreed targets (Minja & Obrist, 2015). This may be related to the perception of its use among the community members. The knowledge about prevention measures of malaria is an important preceding factor for the acceptance and use of ITN for malaria control by the community members (Minja, 2011). Therefore, it becomes necessary to assess knowledge, attitude and practice of malaria prevention strategies among mothers of under-five children in North-central zone, Nigeria .
1.2 Statement of the Problem Malaria presently remains one of the worst menaces of tropical countries of the world. It is a killer and debilitating disease that affects the physical and economic well – being of people living in endemic areas of Africa. The high intensity of the spread of malaria makes it an enormous public health problem. African countries are most hard hit by the disease, where it ravages communities. In most parts of Nigeria, malaria remains endemic, even though it is a preventable and curable disease .
The researcher observed that there is an increase in the number of malaria cases in North Central zone. Most of the clinically diagnosed malaria cases were children under five years. This growing number of cases suggested that malaria preventive strategies are either not known or practiced by the mothers of these children. The researcher also observed that there is an increase in the number of infant mortality due to malaria-related cases, 157 deaths per 1,000 live births which translates to one in every six children born in Nigeria dying before their fifth birthday (National Population Commission and Macro, 2010). This high numbers continues to be an issue of great concern to public health practitioners. The ultimate goal of the Roll Back Malaria 7 programme is to see that disease transmission and burden is reduced drastically across the country, however, despite the effort put in place by the Government and Nongovernmental organizations,the disease continues to be endemic in the country today .
The researcher also observed that mothers of under-five children in North-Central zone may not be knowledgeable on the various malaria prevention strategies, for example the use of insecticide treated nets and mosquito repellent among others.Therefore, this prompted the researcher to assess knowledge, attitude and practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
1.3 Purpose of the Study The main purpose of this study was to assess knowledge, attitude and practice of malaria prevention strategies among mothers of under-five children in North central zone, Nigeria. The specific purposes are to assess; 1. the knowledge of malaria prevention strategies among mothers of under-five children in the north-central zone, Nigeria .
2. the attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
3. the practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
4. the influence of knowledge on attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
5. the influence of knowledge on the practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
8 6. the influence of demographic variables (age, level of education, number of children and occupation) on knowledge of malaria prevention strategies among mothers of under five children in north central zone, Nigeria .
7. the influence of demographic variables (age, level of education, number of children and occupation) on attitude towards malaria prevention strategies among mothers of under five children in north central zone, Nigeria .
8. the influence of demographic variables (age, level of education, number of children and occupation) on practice of malaria prevention strategies among mothers of under five children in north central zone, Nigeria .
1.4 Research Questions On the basis of the purposes of the study, the following research questions are raised; 1. Do mothers of under-five children have the knowledge of malaria prevention strategies in north-central zone, Nigeria? 2. What is the attitude of mothers of under-five children on malaria prevention strategies in north-central zone, Nigeria? 3. What is the practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria? 4. What is the influence of knowledge on attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria? 5. What is the influence of knowledge on the practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria? 6. What is the influence of demographic variables (age, level of education, number of children and occupation) on knowledge of malaria prevention strategies among mothers of under five children in north central zone, Nigeria? 9 7. What is the influence of demographic variables (age, level of education, number of children and occupation) on attitude towards malaria prevention strategies among mothers of under five children in north central zone, Nigeria? 8. What is the influence of demographic variables (age, level of education, number of children and occupation) on practice of malaria prevention strategies among mothers of under five children in north central zone, Nigeria? 1.5 Basic Assumptions On the basis of the research evidence, the following basic assumptions are made; 1. Mothers of under-five children may not have adequate knowledge of malaria prevention strategies in north-central zone, Nigeria .
2. Mothers of under-five children would not have a positive attitude towards malaria prevention strategies in north-central zone, Nigeria .
3. Mothers of under-five children might have a good practice of malaria prevention strategies in north-central zone, Nigeria .
4. Knowledge is not related to attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
5. Knowledge is not related to the practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
1.6 Hypotheses Based on the research questions, the following hypotheses are formulated 1. Knowledge of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria is not significant .
10 2. Attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria is not significant .
3. The practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria is not significant .
4. There is no significant influence of knowledge on attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
5. There is no significant influence of knowledge on the practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
6. There is no significant influence of demographic variables (age, level of education, number of children and occupation) on knowledge of malaria prevention strategies among mothers of under five children in north central zone, Nigeria .
7. There is no significant influence of demographic variables (age, level of education, number of children and occupation) on attitude towards malaria prevention strategies among mothers of under five children in north central zone, Nigeria .
8. There is no significant influence of demographic variables (age, level of education, number of children and occupation) on practice of malaria prevention strategies among mothers of under five children in north central zone, Nigeria .
1.7 Significance of the Study The findings of this study would be significant to mothers of under -five, government and non-governmental organization, health educators and future researchers .
11 The findings of this research would be significant to the mothers of under-five children. Publications from the study would provide them with information on malaria prevention strategies and also help to improve their knowledge, correct attitudes and encourage the right practices towards malaria prevention strategies among mothers of under-five children .
The findings of the study would benefit government and non-governmental organizations (NGO) by providing them with information‟s on the level of knowledge, attitude and practice of malaria prevention strategies among mothers of under-five children through publishing articles from the study. This would help to encourage them to place more emphasis on providing awareness on malaria prevention strategies to mothers of under-five children by organizing seminars, workshop, posting of health issues on billboard and conducting mass media campaigns that would enlighten mothers of under-five on malaria prevention strategies .
This study would be relevant to health educators by providing them with information on the knowledge, attitude and practice of malaria prevention strategies among mothers of under-five children. This would help them in creating awareness through health campaign/ rally, one on one persuading, house to house visitation and community discussions so as to enlighten them more on how to prevent malaria and how to improve their knowledge, attitude and practice of malaria prevention strategies .
This study would be of paramount importance to other researchers, by providing them with additional information on knowledge, attitude and practice of malaria prevention strategies through publications that would be made, which could be of relevance to future researchers in the field of health education who may desire to conduct similar studies .
1.8 Delimitations of the Study 12 This study was delimited to: 1. knowledge of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria 2. attitude towards malaria prevention strategies among mothers of underfive children in north-central zone, Nigeria 3. the practice of malaria prevention strategies among mothers of under-five children in north central zone, Nigeria 4. influence of knowledge on attitude towards malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria 5. influence of knowledge on the practice of malaria prevention strategies among mothers of under-five children in north-central zone, Nigeria .
6. All mothers of under-five children living in north-central zone of Nigeria.
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