Sociodemographic characteristics and spatial distribution of Malaria in Nigerian children
Date
2018
Authors
Ozougwu, Lovelyn Uzoma
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Abstract
Background
Malaria is a significant public health concern in the world. It causes mortality and morbidity especially in children under five years of age and pregnant women. Nigeria contributes about 25% to the malaria burden in Africa, with one million lives lost annually. Several factors including poverty, ownership of bed nets, socioeconomic status are associated with malaria morbidity. This study aimed to determine the factors associated with malaria morbidity and its spatial distribution in Nigerian regions among children under five years in 2010.
Methods
This study used cross-sectional data from the 2010 Nigeria Malaria Indicator Survey (NMIS) which was downloaded from DHS website. The primary sampling unit (PSU) which was referred as the cluster for the 2010 NMIS was defined based on the enumeration areas (EAs) from the 2006 EA census frame. The 2010 NMIS sample was selected using a stratified, two -stage cluster design consisting of 240 clusters, 83 clusters in the urban areas and 157 in the rural areas. The research was restricted to children under five years (6-59 months). The outcome variable was defined as the presence or absence of malaria. It was measured using rapid diagnostic test and microscopic examination of blood smear. Clustered adjusted Pearson’s chi-square test was used to show associations between explanatory variables and malaria. A clustered t-test was used to determine differences in the mean for continuous variables.Multilevel logistic regression models, taking into account random effects were fitted. Choropleth maps were used to display the distribution of malaria by geopolitical zones.
Results
There were 5137 children aged 6-59 months for this study out of 5612 children that were selected for the survey, 41.97%had malaria, and there was no difference in prevalence between males and females. The mean age was 34.96±0.33 months. There was a higher prevalence (60.19%) of malaria in the areas where there was no LLIN campaign coverage compared to areas with LLIN coverage (39.81%) (OR 0.65, 95% CI 0.43-0.97). Children from rural areas were three times more likely to have malaria than those from urban areas (OR 3.13,95%CI 2.18-4.49). The odds of malaria increased significantly with increasing age in months (OR 1.02, 95% CI 1.02-1.03, P-value<0.0001). The richest household children were less likely to have high prevalence of malaria compared to children from the poorest households (OR 0.23, 95%CI 0.15-0.37). Choropleth maps showed a high prevalence in the North-West and North-Central regions and lowest prevalence in the South-East region.
Conclusion
Although efforts have been made to control malaria in Nigeria, its elimination is not forthcoming. The prevalence in children under five years was high. Those who live in the rural areas, wealth index, geopolitical region and child’s age were the determining factors associated with the high prevalence of malaria in those children. There was a regional variation of malaria prevalence among the children. Children from the North-Central and North-West regions had the highest prevalence of malaria. All these factors could be as a result of policy issues, policy formulations, management, implementation, compliance and sustenance issues. However, a lot can be done in the malaria control and prevention programme in Nigeria towards vaccine development, policy formulation and implementation based on evidence, increased public health and environmental education, incorporation of the communities in activities towards
malaria control, mapping of the spatial distribution of malaria as well as stepping up of ongoing control programmes.
Keywords: children under five years, spatial analysis, Nigeria.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree ofMaster of Science in Epidemiology in the field of Epidemiology and Infectious Diseases
March 2018.