Abstract
BackgroundNigeria carries the greatest malaria burden among countries in the world. As part of the National Malaria Control Strategic Plan, free long-lasting insecticidal nets (LLINs) were distributed in 14 states of Nigeria through mass campaigns led by different organizations (the World Bank, UNICEF, or the Global Fund) between May 2009 and August 2010. The objective of this study was to evaluate the association between LLIN distribution campaigns and child malaria in Nigeria.MethodsData were from the Nigeria Malaria Indicator Survey which was carried out from October to December 2010 on a nationally representative sample of households. Participants were women aged 15–49 years and their children aged less than five years (N = 4082). The main outcome measure was the presence or absence of malaria parasites in blood samples of children (6–59 months).ResultsCompared with children living in communities with no campaigns, those in the campaign areas were less likely to test positive for malaria after adjusting for geographic locations, community- and individual-level characteristics including child-level use of insecticide-treated nets (ITNs). The protective effects were statistically significant for the World Bank Booster Project areas (OR = 0.18, 95% CI = 0.04-0.73) but did not reach statistical significance for other campaign areas. Results also showed that community-level wealth (OR = 0.51, 95% CI = 0.34-0.76), community-level maternal knowledge regarding malaria prevention (OR = 0.70, 95% CI = 0.50-0.97), and child-level use of ITNs (OR = 0.79, 95% CI = 0.63-0.99) were negatively associated with child malaria.ConclusionsThe observed protective effects on child malaria of these campaigns (statistically significant in the World Bank Booster Project areas and non-significant in the other areas) need to be corroborated by future effectiveness studies. Results also show that improving community-level maternal knowledge through appropriate channels might be helpful in preventing child malaria in Nigeria.
Highlights
Nigeria carries the greatest malaria burden among countries in the world
About 42% of children tested positive for malaria parasites overall: the lowest rate was associated with the World Bank Booster Project (34.4%), and the highest rate, with the Global Fund (62.5%) compared to 41.8% in areas with no campaigns
In Model 1, compared with areas having no campaigns, children living in areas covered by the World Bank Booster Project (OR = 0.18, 95% CI = 0.04-0.79) were less likely to have tested positive for malaria after adjusting for geographic variables, statelevel fever rates prior to the start of the campaigns, and time from campaigns to Nigeria Malaria Indicator Survey (NMIS)
Summary
Nigeria carries the greatest malaria burden among countries in the world. As part of the National Malaria Control Strategic Plan, free long-lasting insecticidal nets (LLINs) were distributed in 14 states of Nigeria through mass campaigns led by different organizations (the World Bank, UNICEF, or the Global Fund) between May 2009 and August 2010. Nigeria carries the greatest malaria burden among countries in the world with over 300,000 malarial deaths each year - most of them occurring in children under five years of age [2,3]. There has been a rapid scale-up of insecticide-treated net (ITN) or long-lasting insecticidal net (LLIN) distribution in African countries in the recent years [1], fuelled by randomized controlled trials (efficacy studies) of ITN on a variety of outcomes. A systematic review of randomized trials reported protective effects of ITN on all-cause mortality in children less than five years of age, anaemia, splenomegaly and prevalence of malaria infection [6]. While many studies have examined the efficacy of ITNs (under optimal conditions), relatively few studies have looked at the effectiveness of ITN mass distribution campaigns in preventing malaria (under real-world conditions in the general population). This study found protective effects of campaigns in two of the three districts but the lack of programme effects in the remaining district could not be explained
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