Malaria Incidence and Associated Risk Factors Among Pregnant Women and Children Under Five Following Multiple Control Measures in Northwestern Nigeria

Abstract

This review critically examines the persistent burden of malaria among pregnant women and children under five years of age in Northwestern Nigeria, despite sustained national and regional control initiatives. Nigeria remains a global epicenter of malaria transmission, accounting for approximately 27% of the world's cases as of 2019, with the northwestern geopolitical zone exhibiting disproportionately high infection rates. Pregnant women and young children represent the most at-risk cohorts due to immunological vulnerability—characterized by gestational immunosuppression and undeveloped immune responses in early childhood. The analysis delineates a complex interplay of socio-demographic and environmental determinants, including age, educational attainment, income level, occupation, housing typology, and climatic conditions, which collectively sustain endemic transmission patterns. Although national programs such as the widespread distribution of insecticide-treated nets (ITNs), implementation of RTS,S malaria vaccination, and seasonal malaria chemoprevention (SMC) have been deployed, these efforts have yielded limited epidemiological impact in the region. The persistence of high malaria incidence and associated mortality underscores significant gaps in both programmatic coverage and community-level adoption. This review advocates for a recalibration of current strategies by prioritizing the deployment of accessible and user-friendly diagnostic technologies, the subsidization of effective antimalarial pharmacotherapies, and equitable ITN allocation with corresponding behavioral reinforcement. Moreover, it emphasizes the necessity of strengthening health system infrastructure and fostering robust community engagement to mitigate the entrenched vulnerability of these populations. Urgent, integrated, and context-sensitive interventions are critical to advancing malaria elimination goals in Northwestern Nigeria.

Key words : Malaria, Northwestern Nigeria, Pregnant Women, Children Under Five, Interventions, Vulnerability, Community Engagement