All ETDs from UAB

Advisory Committee Chair

Katia J Bruxvoort

Advisory Committee Members

Jodie Dionne-Odum

Ryan M Irvin

Document Type


Date of Award


Degree Name by School

Master of Science (MS) School of Public Health


Background: Nigeria has the highest malaria burden globally, and antimalarials have been commonly used to treat malaria without parasitological confirmation. In 2012, Nigeria implemented RDTs to reduce use of antimalarials for those without malaria and to increase the use of artemisinin-combination therapies (ACTs) for malaria treatment. In this study, we examined trends in antimalarial receipt among children aged 6-59 months during a 12-year period of increasing RDT availability. Methods: We conducted a cross-sectional analysis using nationally representative Nigeria Malaria Indicator Survey (NMIS) data from 2010 (before RDT implementation), 2015, and 2021. NMIS surveys used histidine-rich protein 2 (HRP2)- based RDTs to test for malaria in children, which remain positive for several weeks after treatment. We assessed trends in malaria prevalence by survey RDT, prevalence of fever in the 2 weeks prior to the survey, and antimalarial/ACT receipt. We used multivariable logistic regression accounting for the complex survey design to examine factors associated with antimalarial receipt, stratified by survey RDT result. Results: Of a weighted sample of 22,757 children aged 6-59 months, malaria prevalence was 51.2% in 2010, 44.3% in 2015, and 38.5% in 2021 (p<0.0001), Fever prevalence remained stable, but population-level antimalarial receipt decreased from 19% in 2010 to 10% in 2021 (p<0.0001), accompanied by a slight increase in ACT iii receipt (2% in 2010 to 8% in 2021; p<0.0001). Among children who had experienced fever, 30.6% of RDT-positive and 36.1% of RDT negative children received antimalarials. The proportion of antimalarials obtained from the private sector increased from 2010 (61.8%) to 2021 (80.1%) for RDT-positive children; although in 2021 most antimalarials from them were ACTs, 43.2% of non-ACTs were chloroquine. Factors associated with antimalarial receipt for both RDT-negative and RDT-positive children included geographic region, greater household wealth, higher maternal education, and older child age. Conclusion: From 2010 to 2021 in Nigeria, malaria prevalence and antimalarial receipt among children aged 6-59 months decreased, despite increasing RDT availability. Among children who had prior fever, antimalarial receipt was higher for children with negative survey RDT results. These results indicate persistent challenges in reducing inappropriate use of antimalarials and ensuring that children with malaria receive ACT.

Included in

Public Health Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.