Malaria prevention, diagnosis and treatment strategies in Kaduna State, Nigeria

ObjectiveWe aim to assess the implementation of malaria prevention,diagnosis and treatment strategies, to assess implementation trendsfrom 2011 to 2014 and if surveillance targets were met.IntroductionMalaria is a preventable disease but 3.4 billion people at riskglobally with 207 million cases and 627 deaths reported in 2013.Africa accounts for 80% of cases and 90% of all malaria deaths.Nigeria accounts for 25% of malaria burden in Africa. The goal ofmalaria control is to reduce malaria –related transmissions, cases anddeaths to a level where it is no longer a public health concernMethodsKaduna state, north western Nigeria with estimated populationof 7.3 million has 23 districts and 1252 health facilities. Of these461 sent malaria surveillance data to National Health ManagementInformation System monthly. Data from January 2011 to December2014 was analysed. We evaluated variables related to malariainterventions strategies such as malaria diagnosis, malaria treatment,malaria prevention in pregnancy. Frequencies, proportions andtrend analysis were done and odd ratios for associations betweenvariables were calculated with confidence interval set at 95%. Epiinfo statistical software was used for the analysis.ResultsData completeness was 89.8%. Of the 1,008,728 people thatvisited health facilities, 56.6% presented with fever. Among thefever cases, 34.2% was tested with rapid diagnostic test (RDT) and5.5% with microscopy. Artemisinin based combination therapy wasgiven to 361,464 of which 36.4% had confirmed malaria. Those aged< 5 years with suspected fever were 1.28 (95% confidential interval(C.I), 1.27-1.29; p<0.01)) more likely not to be tested with eitherRDT or microscopy and they are 2.62 (95% C.I., 2.63 – 6.67;p<0.01) times more likely to have ACT for confirmed malaria. ACTprescription to presumptive malaria increases from 31.8% in 2013to 200.2% in 2014. There is a progressive increase of long lastinginsecticidal net distribution and access to second dose of IntermittentPreventive Therapy (IPT-2) for pregnant women.ConclusionsGenerally, progress in Malaria control transition to Eliminationin Kaduna State, Nigeria is favorable with malaria prevalence at36.4%. Some targets were met within the period and recommendstrengthening of these malaria control strategies with focus onvulnerable groups and prevent uncontrolled ACT prescription forpresumptive malaria