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Background: Malaria continues to be a major cause of illness and death worldwide, particularly affecting children under the age of five and those living in high-burden countries like Nigeria. Long-lasting insecticidal nets (LLINs) are one of the effective interventions for malaria control and prevention. In response to funding constraints in the Global Fund Grant Cycle 7, Nigeria's National Malaria Elimination Programme (NMEP) aimed to develop an approach that maximizes the impact of limited malaria interventions by focusing on areas with the greatest need. We developed an urban LLINs distribution framework and a novel strategy, which was piloted in Ilorin, the capital of Kwara State. Methods: A participatory action research approach, combined with abductive inquiry, was employed to co-design a framework for guiding bed net distribution. The final framework consisted of three phases: planning, data review and co-decision-making, and implementation. During the framework's operationalization, malaria risk scores were computed at the ward level using four key variables, including malaria case data and environmental factors, and subsequently mapped. A multistakeholder dialogue facilitated the selection of the final malaria risk maps. Additionally, data from an ongoing study were analyzed to determine whether local definitions of formal, informal, and slum settlements could inform community-level stratification of malaria risk in cities. Results: Akanbi 4, a ward located in Ilorin South and Are 2, a ward in Ilorin East consistently had lower risk scores, a finding corroborated during the multistakeholder dialogue. A map combining malaria test positivity rates among children under five and the proportion of poor settlements was identified as the most accurate depiction of ward-level malaria risk. Malaria prevalence varied significantly across the categories of formal, informal, and slum settlements, resulting in specific definitions developed for Ilorin. Thirteen communities classified as formal settlements in Are 2 were de-prioritized during the bed net distribution campaign. Conclusions: The framework shows promise in facilitating evidence-based decision-making under resource constraints. The findings highlight the importance of stakeholder engagement in evaluating data outputs, particularly in settings with limited and uncertain data. Enhancing surveillance systems is crucial for a more comprehensive approach to intervention tailoring, in alignment with WHO's recommendations. [ABSTRACT FROM AUTHOR]

Background: Although Nigeria has made some progress in malaria control, there are variations across States. We investigated the factors associated with utilisation of long-lasting insecticide-treated net (LLIN) and parasitaemia among under-five children in 13 States with high malaria burden. Method: Data from the 2015 Nigeria Malaria Indicator Survey and 2018 Demographic and Health Survey were obtained and analysed. The 2015 and 2018 data were compared to identify States with increase or reduction in parasitaemia. Analysis was done for all the 13 study States; four States with increased parasitaemia and nine States with reduction. Random-effects logit models were fitted to identify independent predictors of LLIN utilisation and parasitaemia. Results: LLIN was used by 53.4% of 2844 children, while parasitaemia prevalence was 26.4% in 2018. Grandchildren (AOR = 5.35, CI: 1.09–26.19) were more likely to use LLIN while other relatives (AOR = 0.33, CI: 0.11–0.94) were less likely compared to children of household-heads. LLIN use was more common in children whose mother opined that only weak children could die from malaria (AOR = 1.83, CI: 1.10–3.10). Children whose mothers obtained net from antenatal or immunisation clinics (AOR = 5.30, CI: 2.32–12.14) and campaigns (AOR = 1.77, CI: 1.03–3.04) were also more likely to use LLIN. In contrast, LLIN utilisation was less likely among children in female-headed households (AOR = 0.51, CI: 0.27–0.99) and those in poor-quality houses (AOR = 0.25, CI: 0.09–0.72). Children aged 24–59 months compared to 0–11 months (AOR = 1.78, CI: 1.28–2.48), those in whom fever was reported (AOR = 1.31, CI: 1.06–1.63) and children of uneducated women (AOR = 1.89, CI: 1.32–2.70) were more likely to have parasitaemia. The likelihood of parasitaemia was higher among children from poor households compared to the rich (AOR = 2.06, CI: 1.24–3.42). The odds of parasitaemia were 98% higher among rural children (AOR = 1.98, CI: 1.37–2.87). Conclusion: The key drivers of LLIN utilisation were source of net and socioeconomic characteristics. The latter was also a key factor associated with parasitaemia. These should be targeted as part of integrated malaria elimination efforts. [ABSTRACT FROM AUTHOR]

Background: Malaria, remains one of the leading causes of high morbidity and mortality in Nigeria despite implementation of several public health interventions for its control. Operational limitations and methodological gaps have been associated with malaria control interventions and research, and these have necessitated the need for a well-tailored Malaria Operational Research (MOR) agenda. However, there is paucity of evidence-based information on relevant stakeholders’ experience, awareness, perceptions and use of MOR and suggestions on setting MOR agenda. As part of a larger study to provide data for national MOR agenda setting, we assessed the MOR research situation from the perspectives of key stakeholders in Nigeria and contribution of MOR to the malaria elimination agenda Methods: We conducted key informant interviews among 40 purposively selected stakeholders from the six geo-political zones in Nigeria. Data was collected using a pre-tested key informant interview guide which comprised issues related to experience, awareness, use of MOR and MOR needs, and suggestions for MOR. We conducted a detailed content analysis. Results: Half of the participants had participated in MOR. Participants perceived MOR as important. Only few were aware of existing framework for MOR in Nigeria while above half expressed that MOR is yet to be used to inform policy in Nigeria. Participants identified several MOR needs such as development of improved diagnostic techniques, and interventions for promoting early diagnosis, prompt treatment and quality programmatic data. Participants opined the need for country-specific prioritised MOR agenda that cut across malaria thematic areas including malaria prevention and case management. Participants suggested the involvement of various stakeholders and multi-disciplinary approach in setting MOR. Conclusion: Although some stakeholders have been involved in MOR, it is still rarely used to inform policy and several needs exist across thematic areas. A broad-based stakeholder involvement, multi-disciplinary approach to agenda setting and its wide dissemination have been suggested. [ABSTRACT FROM AUTHOR]

Background: Employing malaria operational research (MOR) findings in planning national malaria control programmes is gaining increased attention. The malaria control foci are diverse, resources are limited; therefore, agreeing on priority areas is critical. Hitherto, the process of prioritising MOR questions in Nigeria has been limited to few stakeholders. In support of the National Malaria Elimination Programme's (NMEP) effort at setting a MOR agenda, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) in collaboration with NMEP conducted preliminary exploratory study to identify key malaria research gaps and needs, and provide data to inform setting a robust national MOR agenda. The process of generating data is presented in this paper.Methods: A twelve-member task-team comprising NFELTP, university researchers and NMEP officers was commissioned. Following an inaugural meeting the task-team developed a framework of activities and held five planning meetings, conducted five-week online and self-administered paper-based surveys, key informant interview (KII), two-day desk review workshop, seven-day qualitative data analysis, ten-day result and five-day report writing workshops. Paired group members conducted the interviews across six geopolitical zones of Nigeria. Abridged study report was used for a two-day MOR setting agenda stakeholders' workshop.Results: A structured framework, study protocol and data collection instruments were developed and submitted for ethical approval. The instruments included survey questionnaire for detailed information on researchers and other stakeholders' experience with MOR, the gaps and needs in thematic MOR areas; KII and Delphi guides. After an initial scoping review, primary data were collected from purposively selected survey participants using mixed methods: - online survey (n = 100), self-administered paper-based survey (n = 85), KII (n = 40), desk review workshop (n = 22) and Delphi interviews (n = 8). Comprehensive lists of research gaps/bottlenecks and needs were generated for each thematic area in malaria control. These were used at a two-day national MOR setting stakeholder workshop (n = 54) to guide the development of national MOR agenda document.Conclusions: A systematic approach involving broad stakeholder engagement provided data and evidence-based information for development of a robust national MOR agenda. The processes involved are recommended for use in malaria endemic settings. [ABSTRACT FROM AUTHOR]