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Open Access Research article

Malaria prevalence, anemia and baseline intervention coverage prior to mass net distributions in Abia and Plateau States, Nigeria

Gregory S Noland1*, Patricia M Graves19, Adamu Sallau2, Abel Eigege2, Emmanuel Emukah3, Amy E Patterson110, Joseph Ajiji4, Iheanyichi Okorofor5, Oji Uka Oji5, Mary Umar4, Kal Alphonsus2, James Damen6, Jeremiah Ngondi1, Masayo Ozaki1, Elizabeth Cromwell1, Josephine Obiezu3, Solomon Eneiramo2, Chinyere Okoro7, Renn McClintic-Doyle1, Olusola Oresanya8, Emmanuel Miri2, Paul M Emerson1 and Frank O Richards1

Author Affiliations

1 The Carter Center, 453 Freedom Parkway, Atlanta, GA 30307, USA

2 The Carter Center, Jos, Plateau State, Nigeria

3 The Carter Center, Southeast Owerri, Imo State, Nigeria

4 Plateau State Ministry of Health, Jos, Nigeria

5 Abia State Ministry of Health, Umuahia, Nigeria

6 University of Jos, Jos, Nigeria

7 Federal Medical Centre, Owerri, Imo State, Nigeria

8 Federal Ministry of Health, Abuja, Nigeria

9 Current address: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, QLD, Australia

10 Current address: Agnes Scott College, Decatur, GA, USA

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BMC Infectious Diseases 2014, 14:168  doi:10.1186/1471-2334-14-168

Published: 26 March 2014



Nigeria suffers the world’s largest malaria burden, with approximately 51 million cases and 207,000 deaths annually. As part of the country’s aim to reduce by 50% malaria-related morbidity and mortality by 2013, it embarked on mass distribution of free long-lasting insecticidal nets (LLINs).


Prior to net distribution campaigns in Abia and Plateau States, Nigeria, a modified malaria indicator survey was conducted in September 2010 to determine baseline state-level estimates of Plasmodium prevalence, childhood anemia, indoor residual spraying (IRS) coverage and bednet ownership and utilization.


Overall age-adjusted prevalence of Plasmodium infection by microscopy was similar between Abia (36.1%, 95% CI: 32.3%–40.1%; n = 2,936) and Plateau (36.6%, 95% CI: 31.3%–42.3%; n = 4,209), with prevalence highest among children 5-9 years. P. malariae accounted for 32.0% of infections in Abia, but only 1.4% of infections in Plateau. More than half of children ≤10 years were anemic, with anemia significantly higher in Abia (76.9%, 95% CI: 72.1%–81.0%) versus Plateau (57.1%, 95% CI: 50.6%–63.4%). Less than 1% of households in Abia (n = 1,305) or Plateau (n = 1,335) received IRS in the 12 months prior to survey. Household ownership of at least one bednet of any type was 10.1% (95% CI: 7.5%–13.4%) in Abia and 35.1% (95% CI: 29.2%-41.5%) in Plateau. Ownership of two or more bednets was 2.1% (95% CI: 1.2%–3.7%) in Abia and 14.5% (95% CI: 10.2%–20.3%) in Plateau. Overall reported net use the night before the survey among all individuals, children <5 years, and pregnant women was 3.4%, 6.0% and 5.7%, respectively in Abia and 14.7%, 19.1% and 21.0%, respectively in Plateau. Among households owning nets, 34.4% of children <5 years and 31.6% of pregnant women in Abia used a net, compared to 52.6% of children and 62.7% of pregnant women in Plateau.


These results reveal high Plasmodium prevalence and childhood anemia in both states, low baseline coverage of IRS and LLINs, and sub-optimal net use—especially among age groups with highest observed malaria burden.

Malaria; Plasmodium; Falciparum; Malariae; Anemia; Net use; Net ownership; Nigeria; LLIN; Bed net