EXAMINING THE PREVALENCE AND RISK FACTORS OF SEVERE MALARIA AMONG CHILDREN UNDER FIVE YEARS IN ABA, ABIA STATE, NIGERIA

Abstract

Severe malaria continues to constitute a major public health challenge in many developing countries, especially within sub-Saharan Africa where children under five years remain the most vulnerable population. Despite global efforts aimed at malaria prevention and control, the disease continues to contribute significantly to childhood morbidity and mortality in Nigeria. This study examines the prevalence and associated risk factors of severe malaria among children under five years in Aba, Abia State, Nigeria. The study adopts a cross-sectional research design involving children diagnosed with severe malaria at Abia State University Teaching Hospital (ABSUTH), Aba. Data will be obtained through hospital clinical records, caregiver interviews, and laboratory investigations to evaluate the prevalence pattern and determinants of severe malaria. Particular attention will be given to factors such as age, gender, nutritional status, socioeconomic background, use of insecticide-treated nets, environmental sanitation, healthcare accessibility, and treatment-seeking behaviour. The study will further investigate the influence of delayed diagnosis, self-medication, and inadequate healthcare services on disease severity. Findings from this research are expected to contribute to improved malaria prevention strategies, strengthened healthcare interventions, and evidence-based policy formulation aimed at reducing malaria-related complications and deaths among children under five years in Aba and other malaria-endemic communities in Nigeria.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malaria remains one of the most devastating infectious diseases affecting millions of people globally, particularly in tropical and subtropical regions. The disease is caused primarily by Plasmodium falciparum parasites transmitted through the bites of infected female Anopheles mosquitoes. Although malaria is preventable and treatable, it continues to pose serious health and socioeconomic challenges in many developing nations, especially in sub-Saharan Africa. According to the World Health Organization, Africa accounts for the highest proportion of malaria cases and deaths worldwide, with children under five years constituting the most affected age group due to their underdeveloped immunity and increased susceptibility to severe infections.

Severe malaria is a life-threatening medical condition characterized by complications such as severe anemia, cerebral malaria, respiratory distress, metabolic acidosis, hypoglycemia, convulsions, and multiple organ dysfunction. The condition progresses rapidly and may result in death if early diagnosis and prompt treatment are not provided. In Nigeria, malaria remains endemic throughout the year due to climatic conditions that favour mosquito breeding, poor environmental sanitation, poverty, overcrowding, and inadequate healthcare infrastructure. Nigeria alone contributes a significant percentage of the global malaria burden, making the disease a major obstacle to child survival and national development.

Children under five years are disproportionately affected because of their weak immune systems and increased exposure to environmental risk factors. Severe malaria contributes significantly to hospital admissions, school absenteeism, malnutrition, neurological complications, and childhood mortality across Nigeria. In urban and semi-urban areas such as Aba in Abia State, the prevalence of malaria is further aggravated by poor drainage systems, stagnant water accumulation, overcrowded settlements, and inadequate waste disposal practices that encourage mosquito breeding.

Despite several malaria intervention programmes introduced by governmental and non-governmental organizations, including the distribution of insecticide-treated nets (ITNs), indoor residual spraying, rapid diagnostic testing, and Artemisinin-based Combination Therapy (ACT), severe malaria remains highly prevalent among young children. The persistence of the disease has been associated with several socioeconomic, environmental, behavioural, and healthcare-related factors. These include poverty, low educational level of caregivers, delayed healthcare-seeking behaviour, poor access to healthcare facilities, drug resistance, self-medication, malnutrition, and inadequate awareness regarding malaria prevention practices.

Recent public health concerns have also highlighted the growing challenge of antimalarial drug resistance and inconsistent adherence to treatment protocols, which contribute to worsening malaria outcomes among vulnerable populations. Additionally, climate variability, urbanization, and poor housing conditions continue to influence malaria transmission dynamics in many Nigerian communities. Understanding the prevalence and determinants of severe malaria among children under five years is therefore essential for designing targeted interventions capable of reducing the burden of the disease.

This study seeks to examine the prevalence and major risk factors associated with severe malaria among children under five years attending Abia State University Teaching Hospital (ABSUTH), Aba. The study is expected to provide updated evidence that will support healthcare planning, strengthen malaria control programmes, and improve child health outcomes within the study area and beyond.

1.2 Statement of the Problem

Malaria remains one of the leading causes of illness and death among children under five years in Nigeria despite ongoing national and international control efforts. Severe malaria, in particular, continues to account for a substantial proportion of pediatric hospital admissions and mortality cases in many healthcare facilities across the country. Although effective preventive and therapeutic measures are available, many children still present to hospitals with advanced and life-threatening malaria complications.

In Aba, Abia State, factors such as poor environmental sanitation, overcrowding, poverty, delayed medical intervention, and inadequate access to quality healthcare services may contribute significantly to the increasing burden of severe malaria among children. Many caregivers often resort to self-medication, traditional remedies, or delayed hospital visits due to financial constraints and limited health awareness, thereby increasing the likelihood of severe disease progression.

Furthermore, there is inadequate localized data on the prevalence and determinants of severe malaria among children under five years within the study area. Existing studies have largely focused on general malaria prevalence without adequately examining the socioeconomic, environmental, and healthcare-related factors associated with severe malaria complications in children. This gap in knowledge limits the development of evidence-based interventions tailored to the peculiar health challenges of the region.

Therefore, this study seeks to investigate the prevalence and risk factors associated with severe malaria among children under five years in Aba, Abia State, with the aim of generating reliable data that can improve malaria prevention, diagnosis, treatment, and policy implementation.

1.3 Aim of the Study

The aim of this study is to examine the prevalence and risk factors of severe malaria among children under five years in Aba, Abia State, Nigeria.

1.4 Objectives of the Study

The specific objectives of the study are to:

1. determine the prevalence of severe malaria among children under five years attending Abia State University Teaching Hospital (ABSUTH), Aba;
2. identify the socioeconomic and environmental factors associated with severe malaria among children under five years;
3. assess the influence of healthcare access and treatment-seeking behaviour on the severity of malaria among children;
4. evaluate the role of malaria preventive measures such as insecticide-treated nets and environmental sanitation in reducing severe malaria incidence;
5. examine the impact of delayed diagnosis and treatment on malaria complications among children under five years; and
6. provide practical recommendations for improving malaria prevention and management among children within the study area.

1.5 Research Questions

The following research questions will guide the study:

1. What is the prevalence of severe malaria among children under five years in Aba, Abia State?
2. What socioeconomic and environmental factors contribute to severe malaria among children under five years?
3. How does healthcare accessibility influence the occurrence of severe malaria in children?
4. To what extent do preventive measures reduce the risk of severe malaria among children under five years?
5. What is the effect of delayed diagnosis and treatment on severe malaria complications in children?

1.6 Research Hypotheses

The following hypotheses will be tested in the study:

Null Hypotheses (H?)

1. There is no significant relationship between socioeconomic status and severe malaria among children under five years.
2. There is no significant association between the use of insecticide-treated nets and the prevalence of severe malaria among children under five years.
3. Delayed healthcare seeking does not significantly influence the severity of malaria among children under five years.

Alternative Hypotheses (H?)

1. There is a significant relationship between socioeconomic status and severe malaria among children under five years.
2. There is a significant association between the use of insecticide-treated nets and the prevalence of severe malaria among children under five years.
3. Delayed healthcare seeking significantly influences the severity of malaria among children under five years.

1.7 Significance of the Study

This study is important because it will provide updated and evidence-based information regarding the burden of severe malaria among children under five years in Aba, Abia State. The findings will contribute to existing knowledge on malaria epidemiology and identify major factors responsible for the persistence of severe malaria among vulnerable children.

The study will benefit healthcare professionals by providing relevant data that can improve early diagnosis, treatment, and management of severe malaria cases. Public health authorities and policymakers may also utilize the findings in designing targeted malaria intervention programmes and strengthening child healthcare policies within malaria-endemic communities.

The research will equally assist non-governmental organizations, community health workers, and international health agencies involved in malaria control by identifying areas requiring urgent intervention and awareness campaigns. Furthermore, caregivers and parents will benefit from increased awareness regarding preventive practices, timely healthcare utilization, and environmental sanitation measures necessary for reducing malaria transmission.

Academically, the study will serve as a valuable reference material for students, researchers, and scholars conducting further studies on malaria, infectious diseases, pediatric healthcare, and public health management.

1.8 Scope of the Study

This study focuses on the prevalence and risk factors of severe malaria among children under five years attending Abia State University Teaching Hospital (ABSUTH), Aba, Abia State. The study will examine demographic, socioeconomic, environmental, and healthcare-related factors associated with severe malaria cases among children within the study population.

The research will involve the collection of data through caregiver interviews, clinical records, and laboratory investigations conducted between January 2025 and June 2025. The geographical scope is limited to Aba, Abia State, while the content scope covers severe malaria prevalence, associated risk factors, preventive measures, healthcare access, and treatment-related factors affecting children under five years.

1.9 Operational Definition of Terms

Malaria

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

Severe Malaria

Severe malaria refers to a complicated and life-threatening form of malaria characterized by severe anemia, cerebral complications, respiratory distress, convulsions, organ failure, or other serious clinical manifestations.

Risk Factors

Risk factors are conditions, behaviours, or characteristics that increase the likelihood of developing severe malaria.

Under-Five Children

Under-five children refer to children between birth and fifty-nine months of age.

Insecticide-Treated Nets (ITNs)

Insecticide-treated nets are mosquito nets treated with insecticides designed to prevent mosquito bites and reduce malaria transmission.

Healthcare Access

Healthcare access refers to the ability of individuals to obtain timely, affordable, and quality medical services when needed.

1.10 Organization of the Study

This research work is divided into five chapters. Chapter One presents the introduction, including the background to the study, statement of the problem, objectives, research questions, hypotheses, significance, scope, and operational definition of terms. Chapter Two reviews relevant literature and theoretical concepts relating to severe malaria and associated risk factors. Chapter Three discusses the research methodology, including research design, study population, sampling techniques, data collection methods, and methods of data analysis. Chapter Four focuses on data presentation, analysis, interpretation, and discussion of findings. Chapter Five provides the summary, conclusion, and recommendations based on the findings of the study.

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WHO Global Malaria Programme. (2023). Guidelines for Malaria Prevention and Control. Geneva: World Health Organization.  GET MORE NURSING PROJECT TOPICS AND MATERIALS IN NIGERIA