Socio-economic equity in access to malaria prevention and treatment in Nigeria: temporal and geographic variations

Abstract

Background: Malaria affects millions and kills over 400,000 people globally each year, two-thirds of whom are children under five years. The disease is concentrated in socio-economically vulnerable populations. Nigeria accounted for more than a quarter of the global malaria cases in 2019. Aims: Analyse the socio-economic equity in coverage of malaria preventions and treatment among children under 5 years in Nigeria’s 37 states, comparing the years 2008 to 2018. Method: Data was obtained from open access Demographic Health Surveys implemented in 2008 and 2018. Socio-economic status was defined using principal component analysis of selected household assets to construct a wealth index. Coverage of malaria prevention and treatment interventions were compared between the poorest and least poor quintiles. A concentration index was used to calculate the distribution of inequality by intervention. Results: Access to and use of insecticide-treated bed nets (ITNs) was more concentrated among rich in 2008 but slightly concentrated among poor in 2018, with the index closer to equality. In some states access and use of ITNs was still in favour of the wealthier household in 2008 and 2018, despite malaria prevalence being generally concentrated in poorest households. The access to care for children under 5 years that had fever and those who got appropriate treatment was overall still concentrated among the rich, although fever prevalence was higher in poorer households. Conclusions: The poor are the most vulnerable and the most exposed to malaria infection and disease. Despite some improvements in 2018 compared to 2008, inequity is still high in many states in access and use of malaria preventions and treatment. Further measures are needed to reduce this inequity with better targeting of interventions to the poorer households, including expansion of community level treatment of malaria.