Assessing Care-Seeking Behavior and Adherence to Malaria Diagnosis Guidelines for Fever in Children below five years in Nigeria: A Comparative Analysis of 2010 and 2021 Malaria Indicator Survey Data

Introduction: Malaria remains a significant public health challenge, particularly in sub-Saharan Africa, with Nigeria carrying a substantial burden. The National Malaria Strategic Plan (NMSP) was established in the country to attain malaria eradication. One of its core interventions is prompt diagnosis and adequate treatment at all levels of health care.
Objectives: The primary objectives sought to determine the proportion of facilities that adhered to the diagnosis guideline and to identify the socioeconomic factors associated with care-seeking behavior following the implementation of Nigeria's NMSP 2014–2020.
Methods: The study is a repeated cross-sectional study of the 2010 and 2021 Nigeria Malaria Indicator Surveys. Mothers of children below five years who had fever 2 weeks before the survey. The main outcome measures were mothers who sought treatment from formal health facilities for their febrile children within 24 hours of fever onset, and whether children received a malaria diagnostic test before treatment. We used descriptive statistics to evaluate the proportion of facilities that complied with the diagnosis guideline and logistic regression to assess appropriate care-seeking behavior. Results were presented as percentages and odds ratios with 95% confidence intervals (CIs) and level of significance set at < 5%.
Results: In 2010, care was sought from formal sources for 42.1% of children, and it increased to 74.4% in 2021. However, prompt care-seeking within 24 hours remained low (41.9% in 2010 and 52.2% in 2021), with the increase being statistically significant. Overall compliance with diagnosis guidelines by the different treatment sources had a statistically significant 24.8% increase. Appropriate care-seeking was consistently more likely among people with primary education for 2010 and 2021 (OR 1.97 (0.95-4.09) and OR 1.99 (1.29 – 3.06)), respectively. In 2010, mothers aged 15-24 years (OR 2.22 (1.5-4.3)), recent exposure to malaria messages (OR 1.78 (1.07-2.96)), being in the rich economic status (OR 1.26 (0.63-2.51)), and being from the Northeast (OR 4.40 (1.28-15.15)) and Northwest regions (OR 9.65 (2.96-31.47)) predisposed mothers to seek appropriate care. In 2021, the mother’s region was also associated with seeking appropriate care: with North central (OR 2.58 (1.48-4.50)) and Northeast (OR 2.8 (1.46-5.35)) regions having higher chances compared to the southwest region.
Conclusion: Significant improvements were evident in both the care-seeking behavior of mothers and in adherence to blood testing for febrile cases among the different places of treatment; therefore, periodic strategic malaria interventions are essential for malaria eradication. Furthermore, improvement in the social determinants of health is necessary to foster good health practices among caregivers.