Impact of mass net distributions on malaria prevalence, anemia, and intervention coverage in Abia and Plateau states, Nigeria Open Access

Heilmann, Elizabeth (2017)

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Nigeria accounts for more than 25% of global malaria cases. As part of the National Strategic Plan for malaria elimination, scaled-up mass distribution of free long-lasting insecticidal nets (LLINs) began in 2009. Abia state, in South East zone, distributed 710,530 nets in 2012; Plateau state, in North Central zone, distributed 1.5 million nets in 2010 and 2.1 million in 2015. Modified malaria indicator surveys were conducted in 2010 (pre-distribution), 2012 (Plateau only) and in September 2015 (post-distribution) to assess the impact of mass net distribution on malaria and anemia prevalence. LLIN ownership increased significantly in both states: the proportion of households owning at least 1 net rose from 10.1% in 2010 to 58.7% in 2015 in Abia and from 35.1% to 85.5% in Plateau. Reported net use the previous night in all individuals increased significantly in Abia from 3.4% to 24.2% and in Plateau from 14.7% to 65.6%. Net use in children under 5 and pregnant women was 3-4 times higher in 2015 compared to 2010. Age-adjusted microscopy-diagnosed Plasmodium prevalence significantly decreased in Abia from 36.1% in 2010 to 26.4% in 2015. In Plateau, a non-significant increase from 36.6% to 43.4% occurred. Plasmodium infection was significantly associated with net use in Plateau, but not Abia. Over the same period, anemia in children 10 years and younger also significantly declined in Abia from 74.7% to 58.3%, with a non-significant reduction observed in Plateau from 57.1% to 52.5%. A behavior change communication project launched in Kanke local government area (LGA) aimed to maximize net coverage through regular net distribution, education and monitoring by community drug distributors--community volunteers responsible for distributing drugs to prevent lymphatic filariasis. No significant differences in net use were detected after implementation. In summary, significant gains in net coverage and use occurred in both states, with reductions in Plasmodium and anemia prevalence observed in Abia, but not Plateau. Despite the improvements, net ownership and use generally failed to meet national coverage targets. Additional efforts are needed to continue improving malaria intervention coverage in Nigeria.

Table of Contents

i. Table of Contents

ii. List of Tables

iii. List of Figures

iv. Abbreviations 1. Background.....1

1.1. Global burden of malaria.....1

1.2. Context for malaria in Nigeria.....5

1.3. Efforts for malaria control and elimination.....6

1.4. Specific thesis aims.....9

2. Methods.....11

2.1. The Carter Center Malaria Control Program and 2010 baseline survey.....11

2.2. Overview of BCC Project in Kanke LGA.....12

2.3.Follow-up survey s tudy area and sample selection.....12

2.4. Survey questionnaire.....13

2.5. Blood testing.....14

2.6. Data analysis.....16

3. Results.....18

3.1. 2015 follow-up survey descriptive statistics.....18

3.1.1. Characteristics of study population...18

3.1.2. Malaria prevention measures.....19

3.1.3. Plasmodium prevalence.....21

3.1.4. Anemia prevalence.....22

3.1.5. Malaria treatment in targeted populations.....23

3.1.6. Knowledge of malaria and LF.....24

3.2. Baseline and follow-up survey comparative analysis.....25

3.2.1. Net ownership and use.....25

3.2.2. Prevalence of malaria and anemia.....27

3.3. Evaluation of BCC Project in Kanke LGA.....28

3.3.1. Net ownership and use.....28

3.3.2. Prevalence of malaria and anemia.....30

3.3.3. Knowledge of malaria and LF.....30

4. Discussion.....33 5. References.....44 6. Tables.....53 7. Figures.....60

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