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Effect of Seasonal Malaria Chemoprevention on Malaria Episodes among Children Under Five in Northern Nigeria

Abstract

Malaria remains a major public health concern in Nigeria, with children under five years of age particularly vulnerable to severe disease and malaria-related complications. In northern Nigeria, seasonal patterns of malaria transmission may create periods of increased risk, particularly during and following the rainy season. Seasonal malaria chemoprevention provides children with antimalarial medicines at predetermined intervals during periods of high seasonal transmission, with the aim of preventing malaria infection and reducing the occurrence of clinical malaria episodes. However, variations in programme coverage, medication adherence, accessibility of healthcare services, caregiver awareness, and implementation practices may influence its effectiveness. Against this background, this study investigates the effect of seasonal malaria chemoprevention on malaria episodes among children under five in northern Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Prevention Theory. The Health Belief Model explains how caregivers' perceptions of children's susceptibility to malaria, perceived severity, perceived benefits of seasonal malaria chemoprevention, perceived barriers, and cues to action may influence participation in preventive programmes. The Social Ecological Model emphasizes the interaction of individual, household, community, healthcare-system, and environmental factors in malaria prevention and control. Prevention Theory provides a framework for understanding the use of preventive interventions to reduce the occurrence and recurrence of disease before complications develop. Collectively, these theoretical perspectives provide a suitable framework for explaining how seasonal malaria chemoprevention may influence malaria episodes among children under five in northern Nigeria. The study will adopt a quantitative quasi-experimental or analytical cohort research design. The study population will comprise children under five years of age residing in selected communities in northern Nigeria and their caregivers. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible children. Seasonal malaria chemoprevention will be measured using indicators such as receipt of recommended chemoprevention doses, number of doses received during the transmission season, timeliness of administration, programme coverage, adherence to the recommended dosing schedule, accessibility of chemoprevention services, caregiver participation, missed doses, and documentation of administration. Malaria episodes will be assessed using indicators such as number of malaria episodes during the transmission season, laboratory-confirmed malaria cases, malaria test results, fever episodes associated with malaria, malaria-related healthcare visits, antimalarial treatment, severe malaria episodes, and malaria-related hospitalization where applicable. Data will be collected using structured questionnaires, child health records, malaria surveillance registers, laboratory records, chemoprevention programme records, and relevant healthcare facility documentation. Descriptive statistics will be used to summarize children's demographic and clinical characteristics, chemoprevention coverage, and patterns of malaria episodes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, incidence rate comparisons, logistic regression, Poisson or negative binomial regression, and other appropriate regression techniques, will be used to determine the effect of seasonal malaria chemoprevention on malaria episodes. Where a quasi-experimental design is adopted, malaria episodes before and after programme implementation or between intervention and comparison groups may be compared. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that seasonal malaria chemoprevention has a significant negative effect on malaria episodes among children under five in northern Nigeria. Children who receive the recommended chemoprevention doses during the malaria transmission season are expected to experience fewer malaria episodes, fewer malaria-related healthcare visits, and a lower risk of severe malaria compared with children with inadequate or no chemoprevention exposure. Regular administration of preventive antimalarial medicines during periods of high transmission may provide additional protection alongside other malaria control measures such as insecticide-treated nets, environmental management, prompt diagnosis, and effective treatment. However, missed doses, poor programme coverage, caregiver concerns, medicine availability, geographical barriers, health-system limitations, and variations in malaria transmission may reduce the effectiveness of seasonal chemoprevention. The study therefore expects high-coverage, timely, accessible, and properly implemented seasonal malaria chemoprevention programmes to contribute significantly to reducing malaria episodes among children under five in northern Nigeria. The study is expected to contribute to the literature on seasonal malaria chemoprevention, malaria episodes, children under five, malaria prevention, child health, malaria control, preventive chemotherapy, community health, and public health in northern Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Malaria Elimination Programme, National Primary Health Care Development Agency, state ministries of health, local government health authorities, healthcare facilities, malaria control programmes, community health workers, development partners, and policymakers regarding strategies for strengthening malaria prevention among young children. The study will also provide evidence-based recommendations for improving seasonal malaria chemoprevention coverage, strengthening caregiver education, ensuring timely availability of preventive medicines, improving programme monitoring, strengthening community-based delivery systems, integrating chemoprevention with other malaria-control interventions, and developing sustainable malaria prevention programmes for children under five across northern Nigeria.

Keywords: Seasonal malaria chemoprevention, malaria episodes, children under five, malaria prevention, malaria control, preventive chemotherapy, child health, malaria transmission, community health, northern Nigeria, public health.