Project – Prevalence and Risk Factors Associated with Malaria Infection Among Children Under Five Years Attending Primary Healthcare Centres in Alimosho Local Government Area, Lagos State

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria remains one of the most important infectious diseases affecting global health, particularly among populations living in tropical and subtropical regions. Despite decades of malaria control efforts, the disease continues to pose a major public health challenge, with children under five years of age representing one of the most vulnerable groups due to their immature immune systems and limited acquired immunity. Malaria is caused by protozoan parasites of the genus Plasmodium, which are transmitted primarily through the bites of infected female Anopheles mosquitoes. Among the various species responsible for human malaria, Plasmodium falciparum is the most prevalent and deadly species, especially in sub-Saharan Africa (World Health Organization [WHO], 2023).

Globally, malaria remains a significant cause of illness and death, particularly in low- and middle-income countries. According to the World Health Organization, an estimated 249 million malaria cases and approximately 608,000 malaria-related deaths occurred worldwide in 2022, with the African Region accounting for the majority of cases and deaths (WHO, 2023). Children under five years accounted for a substantial proportion of malaria deaths because they are more likely to develop severe disease manifestations such as severe anaemia, cerebral malaria, respiratory distress, and organ failure when infected. The continued burden of malaria among young children highlights the need for sustained prevention, early diagnosis, and effective treatment strategies.

The high prevalence of malaria among children under five years is associated with multiple biological, environmental, socioeconomic, and behavioural factors. Biological vulnerability is a major contributor because young children have not developed sufficient immunity against malaria parasites. In malaria-endemic regions, repeated exposure to mosquito bites gradually leads to partial immunity among older children and adults; however, children under five remain highly susceptible to severe infection (Desai et al., 2007). Consequently, improving malaria prevention and treatment interventions among this age group remains a critical component of global child survival initiatives.

Sub-Saharan Africa bears the greatest burden of malaria worldwide due to favourable climatic conditions that support mosquito breeding, limited access to healthcare services, poverty, and challenges in implementing preventive interventions. Although malaria control programmes have achieved considerable progress through interventions such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention, rapid diagnostic testing, and effective antimalarial medicines, malaria transmission remains persistent in many African communities (WHO, 2023). The effectiveness of these interventions depends greatly on community participation, consistent utilization, and access to quality healthcare services.

Nigeria contributes significantly to the global malaria burden and is among the countries with the highest number of malaria cases and deaths worldwide. The country’s tropical climate, extensive mosquito breeding environments, population density, and socioeconomic challenges contribute to sustained malaria transmission. The Nigeria Malaria Indicator Survey reported that malaria remains widespread among Nigerian children, with variations in prevalence according to geographical location, environmental conditions, household characteristics, and preventive practices (National Malaria Elimination Programme [NMEP], National Population Commission [NPC], & ICF, 2022).

Children under five years in Nigeria experience a disproportionate impact of malaria due to frequent exposure to mosquito vectors, inadequate preventive measures, delayed healthcare seeking, and limited access to early diagnosis and treatment. Common risk factors associated with childhood malaria infection include inadequate use of insecticide-treated nets, poor environmental sanitation, stagnant water accumulation, overcrowded housing conditions, lack of parental knowledge about malaria prevention, poverty, and delayed presentation at healthcare facilities (Akinyemi et al., 2020). Understanding these factors is essential for developing effective interventions tailored to specific communities.

Lagos State presents a unique context for malaria transmission because, although it is one of Nigeria’s most urbanized and economically developed states, malaria remains endemic. Urbanization has created environmental conditions that may support mosquito breeding, including poor drainage systems, indiscriminate waste disposal, stagnant water accumulation, and densely populated residential areas. These conditions create suitable habitats for malaria vectors and increase the risk of transmission, especially among children living in vulnerable communities.

Alimosho Local Government Area is one of the most densely populated local government areas in Lagos State. The area comprises rapidly expanding residential communities with varying socioeconomic conditions. Factors such as population density, housing characteristics, environmental sanitation challenges, and limited awareness of malaria prevention practices may influence malaria transmission patterns among children. Although healthcare facilities, including primary healthcare centres, provide malaria diagnosis, treatment, health education, and preventive services, malaria remains a recurring health challenge among young children attending these facilities.

Primary healthcare centres play a central role in malaria control because they serve as the first point of contact for many community members seeking healthcare services. These facilities provide essential services including malaria screening, rapid diagnostic testing, administration of antimalarial medication, health education, referral services, and monitoring of malaria trends. Effective utilization of primary healthcare services can significantly reduce malaria-related complications and deaths among children through early detection and appropriate treatment.

The prevalence of malaria infection among children under five years is influenced by several interconnected risk factors. Environmental factors such as rainfall patterns, temperature, vegetation, poor drainage, and stagnant water sources determine mosquito breeding and transmission intensity. Household factors, including sleeping arrangements, availability and consistent use of insecticide-treated nets, housing structures, and proximity to mosquito breeding sites, also influence infection risk. Furthermore, socioeconomic factors such as parental education, household income, and healthcare-seeking behaviour affect children’s vulnerability to malaria infection (Okunlola et al., 2021).

Behavioural practices of caregivers significantly influence malaria prevention and treatment outcomes among children. Caregivers who possess adequate knowledge about malaria transmission, symptoms, prevention methods, and the importance of early treatment are more likely to adopt protective measures and seek timely healthcare. Conversely, misconceptions about malaria causes, reliance on traditional remedies, delayed healthcare seeking, and inappropriate treatment practices may increase the risk of severe malaria among children (Adebayo et al., 2015).

Malaria control efforts in Nigeria have focused largely on improving access to preventive tools and strengthening healthcare delivery systems. Programmes promoting insecticide-treated net ownership and usage, environmental management, community health education, and improved malaria case management have contributed to reductions in malaria burden. However, persistent transmission indicates the need for continuous assessment of malaria prevalence and identification of locally specific risk factors affecting vulnerable populations.

Although several studies have investigated malaria prevalence among Nigerian children, variations in environmental conditions, population characteristics, and healthcare access make local-level assessments necessary. Evidence from Alimosho Local Government Area is particularly important because urban communities may experience unique malaria transmission patterns compared with rural areas. Understanding the prevalence of malaria infection and associated risk factors among children attending primary healthcare centres will provide useful information for healthcare providers, policymakers, and public health practitioners.

Therefore, this study seeks to assess the prevalence and risk factors associated with malaria infection among children under five years attending primary healthcare centres in Alimosho Local Government Area, Lagos State. The findings will contribute to improved malaria prevention strategies, enhanced healthcare interventions, and evidence-based decision-making aimed at reducing childhood malaria morbidity and mortality.

1.2 Statement of the Problem

Malaria remains a major public health challenge in Nigeria despite significant investments in prevention, diagnosis, treatment, and control programmes. The disease continues to contribute substantially to childhood morbidity and mortality, particularly among children under five years who are highly vulnerable to severe complications. Although interventions such as insecticide-treated nets, malaria vaccination initiatives, rapid diagnostic testing, and effective antimalarial therapies have been introduced, malaria transmission persists in many Nigerian communities.

One major concern is the continued occurrence of malaria infections among children who frequently attend primary healthcare centres with symptoms such as fever, weakness, anaemia, and other malaria-related complications. These repeated cases suggest that existing malaria prevention strategies may not be adequately addressing the underlying risk factors responsible for transmission. While healthcare facilities provide treatment services, prevention requires a comprehensive understanding of environmental, socioeconomic, household, and behavioural factors contributing to infection.

In urban areas such as Lagos State, malaria transmission presents a complex challenge. Rapid population growth, unplanned settlements, inadequate drainage systems, environmental pollution, and poor waste management practices create conditions favourable for mosquito breeding. Alimosho Local Government Area, being one of the most populated areas in Lagos State, experiences many of these urban environmental challenges, which may increase the risk of malaria infection among vulnerable children.

Another challenge is that many malaria control programmes are often implemented at broader regional or national levels without sufficient consideration of local risk patterns. Factors influencing malaria infection among children may differ significantly between communities due to variations in environmental conditions, socioeconomic characteristics, caregiver practices, and healthcare utilization. Therefore, community-specific studies are necessary to identify factors contributing to malaria transmission and guide targeted interventions.

Furthermore, inadequate knowledge among caregivers regarding malaria prevention, inconsistent use of insecticide-treated nets, delayed healthcare seeking, and reliance on alternative treatment practices may contribute to continued childhood malaria infections. Without accurate information regarding these behavioural and household factors, efforts aimed at reducing malaria prevalence may not achieve optimal results.

Despite the availability of primary healthcare centres in Alimosho Local Government Area, there is limited current evidence on the prevalence of malaria infection and the specific risk factors associated with infection among children under five years attending these facilities. This knowledge gap limits the ability of healthcare planners and community health practitioners to design interventions specifically addressing local malaria challenges.

Therefore, this study is necessary to determine the prevalence and risk factors associated with malaria infection among children under five years attending primary healthcare centres in Alimosho Local Government Area, Lagos State. The findings will provide evidence for strengthening malaria prevention strategies, improving caregiver education, and enhancing child health outcomes within the community.

1.3 Aim of the Study

The aim of this study is to determine the prevalence and risk factors associated with malaria infection among children under five years attending primary healthcare centres in Alimosho Local Government Area, Lagos State.

1.4 Objectives of the Study

The specific objectives of the study are to:

1. Determine the prevalence of malaria infection among children under five years attending selected primary healthcare centres in Alimosho Local Government Area, Lagos State.
2. Identify the demographic characteristics of children under five years associated with malaria infection in the study area.
3. Examine household and environmental factors associated with malaria infection among children under five years.
4. Assess caregivers’ knowledge and preventive practices regarding malaria infection among children under five years.
5. Determine the relationship between malaria prevention practices and the occurrence of malaria infection among children under five years attending primary healthcare centres in Alimosho Local Government Area.

1.5 Research Questions

The study will answer the following research questions:

1. What is the prevalence of malaria infection among children under five years attending primary healthcare centres in Alimosho Local Government Area, Lagos State?
2. What demographic characteristics of children under five years are associated with malaria infection?
3. What household and environmental factors contribute to malaria infection among children under five years?
4. What level of knowledge do caregivers possess regarding malaria prevention among children under five years?
5. What preventive practices are adopted by caregivers to reduce malaria infection among children under five years?

1.6 Research Hypothesis

The following null hypothesis will be tested at a 0.05 level of significance:

H₀: There is no significant relationship between household/environmental risk factors and malaria infection among children under five years attending primary healthcare centres in Alimosho Local Government Area, Lagos State.

1.7 Significance of the Study

This study will be significant to public health authorities, healthcare providers, caregivers, researchers, and policymakers because it will provide evidence regarding the prevalence and factors associated with malaria infection among children under five years in Alimosho Local Government Area.

Public Health Authorities

The findings of this study will provide useful information to public health agencies, including the Lagos State Ministry of Health and malaria control programmes, regarding the current malaria situation among children under five years. The evidence generated may assist in planning targeted malaria prevention interventions, improving surveillance activities, and strengthening community-based malaria control strategies.

The study may also support malaria elimination efforts by identifying specific environmental, household, and behavioural factors contributing to malaria transmission within the study area. Such information can guide the implementation of localized interventions rather than relying solely on generalized malaria control approaches.

Healthcare Providers

Primary healthcare workers, including nurses, community health extension workers, laboratory scientists, and other healthcare professionals, may benefit from the findings of this study. The results will improve understanding of the factors responsible for malaria infection among children attending healthcare facilities and may support improved diagnosis, treatment, caregiver counselling, and preventive health education.

Healthcare providers may use the findings to strengthen caregiver education on appropriate malaria prevention practices, including consistent use of insecticide-treated nets, environmental sanitation, early recognition of malaria symptoms, and prompt healthcare-seeking behaviour.

Caregivers and Parents

The study will increase awareness among parents and caregivers regarding the risk factors associated with malaria infection among children under five years. Improved understanding of malaria transmission, prevention methods, and early treatment-seeking practices may encourage caregivers to adopt protective behaviours that reduce childhood malaria infections.

The findings may also help caregivers recognize the importance of maintaining clean household environments, preventing mosquito breeding sites, and ensuring that children receive timely medical attention when malaria symptoms occur.

Government and Policy Makers

The findings will provide evidence that may assist policymakers in developing and strengthening child health policies and malaria control programmes. Understanding the specific factors associated with childhood malaria infection in Alimosho Local Government Area may support better allocation of resources for malaria prevention, environmental management, and primary healthcare improvement.

Researchers and Academic Institutions

This study will contribute to existing knowledge on malaria epidemiology among children under five years in Nigeria. It will serve as a reference material for students, researchers, and public health professionals interested in malaria prevalence, childhood infections, environmental health, and disease prevention.

The findings may also stimulate further research on malaria transmission dynamics in urban communities and support comparative studies across different regions of Nigeria.

1.8 Scope of the Study

This study focuses on determining the prevalence and risk factors associated with malaria infection among children under five years attending primary healthcare centres in Alimosho Local Government Area, Lagos State, Nigeria.

The study will assess malaria infection among children below five years of age through clinical and laboratory indicators where applicable. It will also examine factors associated with malaria occurrence, including children’s demographic characteristics, household conditions, environmental factors, caregivers’ knowledge, and malaria prevention practices.

The study population will consist of children under five years attending selected primary healthcare centres in Alimosho Local Government Area and their caregivers. The geographical scope of the study is limited to selected primary healthcare centres within the local government area.

1.9 Operational Definition of Terms

Malaria

A mosquito-borne infectious disease caused by Plasmodium parasites and transmitted mainly through the bite of infected female Anopheles mosquitoes.

Malaria Infection

The presence of Plasmodium parasites in the blood of a child, confirmed through appropriate diagnostic methods such as microscopy or rapid diagnostic testing.

Prevalence

The proportion of children under five years who have malaria infection at a specific period among those assessed in the study.

Children Under Five Years

Children from birth to 59 months of age who are considered highly vulnerable to malaria infection and severe disease complications.

Risk Factors

Conditions, behaviours, characteristics, or environmental exposures that increase the likelihood of malaria infection among children.

Household Factors

Characteristics within the home environment that may influence malaria transmission, including sleeping arrangements, use of mosquito nets, housing structure, and caregiver practices.

Environmental Factors

External conditions such as stagnant water, poor drainage, waste accumulation, vegetation, and climate-related conditions that influence mosquito breeding and malaria transmission.

Caregivers

Parents, guardians, or individuals responsible for the care, protection, and health decisions of children under five years.

Primary Healthcare Centres

Community-based healthcare facilities that provide basic healthcare services, including malaria diagnosis, treatment, prevention, health education, and referral services.

Malaria Prevention Practices

Actions taken to reduce the risk of malaria infection, including insecticide-treated net use, environmental sanitation, mosquito control measures, and prompt treatment-seeking.

Alimosho Local Government Area

A densely populated local government area in Lagos State, Nigeria, where selected primary healthcare centres and children under five years attending these facilities constitute the study population.

Project – Prevalence and Risk Factors Associated with Malaria Infection Among Children Under Five Years Attending Primary Healthcare Centres in Alimosho Local Government Area, Lagos State