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

Abstract

Malaria remains a major cause of illness and death among children under five years of age in Nigeria, particularly in areas with intense seasonal malaria transmission. Children under five are especially vulnerable to malaria because of their developing immunity and increased risk of severe disease and complications. In Northern Nigeria, seasonal variations in rainfall and mosquito breeding conditions contribute to periods of increased malaria transmission, placing young children at greater risk of infection. Seasonal Malaria Chemoprevention (SMC) is a preventive intervention involving the administration of recommended antimalarial medicines at predetermined intervals during the peak malaria transmission season to protect children from malaria infection and reduce the occurrence of malaria episodes. Malaria incidence refers to the occurrence of new malaria cases within a defined population and period. Although SMC has been implemented in several malaria-endemic settings, challenges related to programme coverage, medicine availability, caregiver acceptance, timely administration, community mobilization, and follow-up may affect its effectiveness. Assessing the effect of SMC on malaria incidence among children under five is therefore important for strengthening malaria prevention strategies in Northern Nigeria. Against this background, this study investigates the effect of Seasonal Malaria Chemoprevention on malaria incidence among children under five in Northern Nigeria. The study will be anchored on the Health Belief Model, the Health Systems Framework, and the Social Ecological Model. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action and provides a framework for understanding caregiver acceptance and participation in SMC. The Health Systems Framework emphasizes service delivery, health workforce, availability of medicines and health technologies, health information, financing, and accessibility as important components of effective malaria prevention programmes. The Social Ecological Model recognizes that child health outcomes are influenced by interacting individual, household, community, environmental, and health-system factors. Collectively, these theoretical perspectives provide a suitable framework for explaining how SMC implementation may influence malaria incidence among children under five in Northern Nigeria. The study will adopt a quantitative cohort or quasi-experimental research design, depending on programme and data availability. Data will be collected from children under five residing in selected malaria-endemic communities in Northern Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible children. SMC implementation will be assessed using indicators such as programme coverage, number of SMC cycles received, timeliness of medicine administration, availability of recommended medicines, community mobilization, caregiver participation, trained community distributors, adherence to administration schedules, follow-up activities, and programme continuity. Malaria incidence will be assessed using indicators such as the number of newly diagnosed malaria episodes among children during the malaria transmission season, laboratory-confirmed malaria cases, malaria-related healthcare visits, and malaria episodes occurring during and after SMC administration. Data will be obtained from caregiver interviews, SMC registers, community health-worker records, healthcare facility registers, malaria surveillance records, and laboratory records where available. Descriptive statistics will be used to summarize participants' characteristics, SMC coverage, and malaria incidence patterns. Inferential statistical techniques, including chi-square tests, incidence rate comparisons, correlation analysis, and regression analysis, will be used to determine the effect of SMC on malaria incidence. Where appropriate, comparative analysis between children who received adequate SMC and those with incomplete or no SMC coverage will be conducted. Diagnostic tests will also be performed to assess the reliability and robustness of the findings. The study is expected to find that Seasonal Malaria Chemoprevention has a significant negative effect on malaria incidence among children under five in Northern Nigeria, meaning that greater and more consistent SMC coverage is expected to be associated with fewer malaria episodes during the peak transmission season. Children who receive the recommended SMC doses at the appropriate intervals are expected to experience lower malaria incidence than children who receive incomplete or no SMC. By maintaining protective antimalarial drug concentrations during periods of high transmission, SMC may reduce the occurrence of malaria infections and malaria-related healthcare visits. High programme coverage, timely administration, effective community mobilization, and caregiver adherence are expected to strengthen the preventive effect of SMC. Conversely, missed SMC cycles, medicine shortages, inadequate community awareness, poor programme supervision, difficulties reaching remote households, and refusal or non-acceptance of medicines may reduce programme effectiveness. Environmental conditions, mosquito exposure, use of insecticide-treated nets, healthcare-seeking behaviour, and local malaria transmission patterns may also influence malaria incidence. The study is expected to contribute to the literature on Seasonal Malaria Chemoprevention, malaria incidence, child health, malaria prevention, epidemiology, community health, and infectious disease control in 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, malaria programme managers, community health workers, healthcare facilities, development partners, and policymakers regarding strategies for improving malaria prevention among young children. The study will also provide evidence-based recommendations for improving SMC coverage, ensuring uninterrupted availability of antimalarial medicines, strengthening community mobilization, improving caregiver education, enhancing programme supervision and monitoring, strengthening community-based distribution systems, improving identification of missed children, and integrating SMC with other malaria prevention and child health interventions across Northern Nigeria.

Keywords: Seasonal Malaria Chemoprevention, malaria incidence, children under five, Northern Nigeria, malaria prevention, malaria control, child health, malaria transmission, community health, epidemiology, antimalarial prevention, public health.