Noland, Gregory S., Graves, Patricia, Sallau, Adamu, Eigege, Abel, Emukah, Emmanuel, Patterson, Amy E., Ajiji, Joseph, Okorofor, Iheanyichi, Oji, Oji Uka, Umar, Mary, Alphonsus, Kal, Damen, James, Ngondi, Jeremiah, Ozaki, Masayo, Cromwell, Elizabeth, Obiezu, Josephine, Eneiramo, Solomon, Okoro, Chinyere, McClintic-Doyle, Renn, Oresanya, Olusola, Miri, Emmanuel, Emerson, Paul M., and Richards, Frank O. (2014) Malaria prevalence, anemia and baseline intervention coverage prior to mass net distributions in Abia and Plateau States, Nigeria. BMC Infectious Diseases, 14. 168.

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Abstract

Background: Nigeria suffers the world's largest malaria burden, with approximately 51 million cases and 207,000 deaths annually. As part of the country's aim to reduce by 50% malaria-related morbidity and mortality by 2013, it embarked on mass distribution of free long-lasting insecticidal nets (LLINs).

Methods: Prior to net distribution campaigns in Abia and Plateau States, Nigeria, a modified malaria indicator survey was conducted in September 2010 to determine baseline state-level estimates of Plasmodium prevalence, childhood anemia, indoor residual spraying (IRS) coverage and bednet ownership and utilization.

Results: Overall age-adjusted prevalence of Plasmodium infection by microscopy was similar between Abia (36.1%, 95% CI: 32.3%–40.1%; n = 2,936) and Plateau (36.6%, 95% CI: 31.3%–42.3%; n = 4,209), with prevalence highest among children 5-9 years. P. malariae accounted for 32.0% of infections in Abia, but only 1.4% of infections in Plateau. More than half of children ≤10 years were anemic, with anemia significantly higher in Abia (76.9%, 95% CI: 72.1%–81.0%) versus Plateau (57.1%, 95% CI: 50.6%–63.4%). Less than 1% of households in Abia (n = 1,305) or Plateau (n = 1,335) received IRS in the 12 months prior to survey. Household ownership of at least one bednet of any type was 10.1% (95% CI: 7.5%–13.4%) in Abia and 35.1% (95% CI: 29.2%-41.5%) in Plateau. Ownership of two or more bednets was 2.1% (95% CI: 1.2%–3.7%) in Abia and 14.5% (95% CI: 10.2%–20.3%) in Plateau. Overall reported net use the night before the survey among all individuals, children <5 years, and pregnant women was 3.4%, 6.0% and 5.7%, respectively in Abia and 14.7%, 19.1% and 21.0%, respectively in Plateau. Among households owning nets, 34.4% of children <5 years and 31.6% of pregnant women in Abia used a net, compared to 52.6% of children and 62.7% of pregnant women in Plateau.

Conclusions: These results reveal high Plasmodium prevalence and childhood anemia in both states, low baseline coverage of IRS and LLINs, and sub-optimal net use—especially among age groups with highest observed malaria burden.

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