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Effect of Malaria Prevention Practices on Malaria Prevalence among Children Under Five in Nigeria

Abstract

Malaria remains a major public health challenge in Nigeria and continues to contribute substantially to illness, healthcare utilization, and mortality among children under five years of age. Young children are particularly vulnerable to malaria because of their developing immunity and the potential for infection to progress rapidly to severe disease and life-threatening complications. Malaria prevention practices include the consistent use of insecticide-treated nets, indoor residual spraying, environmental sanitation, elimination of mosquito breeding sites, appropriate use of preventive medicines where recommended, and adoption of measures that reduce exposure to malaria vectors. Malaria prevalence refers to the proportion of children infected with malaria within a defined population and period and provides an important indicator for evaluating the effectiveness of malaria control interventions. In Nigeria, malaria transmission remains widespread because of favourable climatic conditions, inadequate housing, environmental factors, inconsistent use of preventive measures, limited access to healthcare services, and challenges associated with malaria diagnosis and treatment. Although Nigeria has implemented several malaria control interventions, including the distribution of insecticide-treated nets and community-based malaria prevention programmes, malaria remains prevalent among children under five. This suggests that the availability of preventive interventions does not necessarily guarantee consistent utilization at household and community levels. Against this background, this study investigates the effect of malaria prevention practices on malaria prevalence among children under five in Nigeria. The study is anchored on the Health Belief Model (HBM), Social Ecological Model, and Preventive Health Behavior Theory. The Health Belief Model explains malaria prevention behavior based on caregivers' perceptions of susceptibility to malaria, perceived severity of malaria infection, perceived benefits of preventive practices, and perceived barriers to their use. The Social Ecological Model emphasizes that malaria prevention and infection are influenced by interacting individual, household, community, environmental, and health-system factors. Preventive Health Behavior Theory provides a framework for understanding the adoption and continued practice of behaviors intended to prevent disease and promote health. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how household malaria prevention practices may influence malaria prevalence among children under five in Nigeria. The study adopts a quantitative cross-sectional research design. Primary data will be collected from caregivers of children under five years of age in selected communities in Nigeria using a structured interviewer-administered questionnaire, while malaria infection status will be determined through appropriate malaria diagnostic records or testing where feasible. A multistage sampling technique will be employed to select states, local government areas, communities, households, and eligible caregivers and children. Malaria prevention practices will be measured using consistent insecticide-treated net use, indoor residual spraying, environmental sanitation, elimination of stagnant water and mosquito breeding sites, use of mosquito repellents, appropriate protective clothing, and other recommended malaria prevention measures. Malaria prevalence will be assessed based on the proportion of sampled children who test positive for malaria using an appropriate diagnostic method. Descriptive statistics will be used to summarize respondents' sociodemographic characteristics, household prevention practices, and malaria infection patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple logistic regression analysis, will be employed to determine the effect of malaria prevention practices on malaria prevalence. Appropriate diagnostic tests will also be conducted to assess multicollinearity, model specification, goodness of fit, and the robustness of the estimated relationships. The study anticipates that effective malaria prevention practices will have a significant negative effect on malaria prevalence among children under five in Nigeria. Children living in households where caregivers consistently use insecticide-treated nets, maintain appropriate environmental sanitation, eliminate mosquito breeding sites, and adopt other recommended preventive measures are expected to have a lower likelihood of malaria infection. Consistent use of insecticide-treated nets is particularly expected to reduce children's exposure to malaria vectors during sleeping hours, while environmental sanitation may reduce mosquito breeding opportunities around households. Conversely, inconsistent or inadequate prevention practices may increase children's exposure to mosquito bites and consequently increase the likelihood of malaria infection. However, the effectiveness of prevention practices may also be influenced by factors such as malaria transmission intensity, climatic conditions, housing characteristics, availability and quality of preventive commodities, caregiver knowledge, socioeconomic conditions, and access to malaria diagnosis and treatment. Consequently, sustained malaria prevention among children under five requires both consistent household practices and supportive community and health-system interventions. This study is expected to make significant contributions to the literature on malaria prevention, child health, environmental health, and public health in Nigeria by providing empirical evidence on the relationship between malaria prevention practices and malaria prevalence among children under five. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, National Malaria Elimination Programme (NMEP), National Primary Health Care Development Agency (NPHCDA), state ministries of health, local government health authorities, community health workers, development partners, and policymakers regarding the effectiveness of household-level malaria prevention practices. The study will also provide evidence-based recommendations for strengthening malaria health education, improving consistent insecticide-treated net use, promoting environmental sanitation, expanding community-based malaria prevention programmes, improving access to preventive commodities, and strengthening integrated malaria control interventions aimed at reducing malaria prevalence and improving child survival in Nigeria.

Keywords: Malaria prevention practices, malaria prevalence, children under five, insecticide-treated nets, environmental sanitation, malaria control, child health, mosquito prevention, malaria infection, Nigeria.