Background of the Study

Malaria continues to impose a heavy health and economic burden on Nigeria, which accounts for the highest number of global cases and deaths (World Health Organization [WHO], 2021). Despite national control efforts, an estimated 27?% of all malaria cases and 23?% of malaria deaths worldwide occurred in Nigeria as of 2020 (WHO, 2021). In rural settings such as Ngor?Okpala Local Government Area (LGA) in Imo State, the transmission of Plasmodium species remains perennial, with peaks during the rainy months from June to October. Malaria contributes to approximately 60?% of outpatient visits, 30?% of pediatric admissions, and 11?% of maternal deaths in Nigerian health facilities (Federal Ministry of Health [FMOH], 2020). Economically, the disease costs the country an estimated ?480?billion annually in direct treatment costs and productivity losses (Bassey & Uzochukwu, 2022).

To accelerate progress toward elimination, the National Malaria Elimination Programme (NMEP) developed the 2021–2025 Strategic Plan, which emphasizes community?based delivery of vector control interventions. Core strategies include universal access to insecticide-treated nets (ITNs) and targeted indoor residual spraying (IRS), both implemented through networks of village health workers and volunteer teams (NMEP, 2021). Studies across various Nigerian states have demonstrated that engaging community volunteers in distribution and monitoring significantly improves ITN ownership and consistent use, as well as sustainability of IRS campaigns (Uzochukwu et al., 2023; Ogundare & Okafor, 2021).

Despite these advances, there is a paucity of localized evidence on how such community-based approaches perform in Ngor-Okpala LGA. Characterized by dispersed settlements, limited formal health infrastructure, and predominantly agrarian livelihoods, the area presents unique logistical and socio-cultural challenges. Understanding the actual reach, fidelity, and community acceptance of ITN distribution and IRS in this context is therefore critical for optimizing resource allocation and tailoring interventions to local needs.

Statement of the Problem

Although national campaigns report over 80?% ITN distribution coverage, recent surveys in Imo State indicate that only about 50% of rural households possess a functional net, and fewer than 30?% use them consistently each night during high?transmission seasons (Bassey & Uzochukwu, 2022). IRS coverage is similarly uneven, often hampered by community resistance and logistical bottlenecks. In Ngor-Okpala LGA, health facility records reveal that malaria still accounts for over two-thirds of pediatric admissions during the rainy season. These statistics suggest that community-based malaria control programs may not be achieving optimal impact at the grassroots level. Without empirical assessment of intervention uptake, operational challenges, and local perceptions, policy refinements risk being misdirected and ineffective.

Aim and Objectives of the Study

The primary aim of this study is to evaluate the impact of community-based malaria control programs on preventive coverage and malaria incidence in Ngor-Okpala LGA, Imo State.

1.3.1 Specific Objectives

1. To determine the proportion of households in Ngor-Okpala LGA owning and correctly using ITNs.
2. To assess the frequency and quality of IRS activities conducted by community health volunteers.
3. To compare monthly malaria case incidence at local health facilities before and after program implementation.
4. To identify socio-cultural and logistical barriers to full uptake of community-based malaria interventions.

Research Questions

1. What percentage of households in Ngor-Okpala LGA currently own at least one ITN, and how many report consistent nightly use?
2. How regularly and how effectively are IRS activities carried out by village health workers in Ngor-Okpala?
3. Is there a significant change in monthly malaria case incidence at primary health centres following the introduction of community-based control measures?
4. What are the principal socio-cultural beliefs, knowledge gaps, and operational constraints that influence community participation in malaria control programs?

Scope of the Study

This study will be conducted across all twelve wards of Ngor-Okpala LGA, encompassing both peri-urban and rural communities where ITN distribution and IRS are administered by volunteer networks. Data collection will cover a full calendar year—from June 2024 through May 2025—to capture seasonal variations in transmission. A mixed-methods approach will be employed: quantitative household surveys and retrospective review of facility malaria registers will quantify intervention coverage and incidence trends, while qualitative focus group discussions and key informant interviews will explore community perceptions and implementation barriers.

References

Bassey, A. J., & Uzochukwu, B. S. C. (2022). Evaluation of malaria surveillance systems in Benue State, Nigeria. Malaria Journal, 21(1), 453. https://doi.org/10.1186/s12936-022-04367-4

Federal Ministry of Health. (2020). 4th edition: National guidelines for the diagnosis & treatment of malaria. Abuja, Nigeria: Author.

National Malaria Elimination Programme. (2021). National malaria strategic plan 2021–2025. Abuja, Nigeria: Federal Ministry of Health.

Ogundare, E. O., & Okafor, H. U. (2021). Community pharmacists’ roles in malaria case management in Enugu Metropolis, Nigeria. Journal of Tropical Pharmacy and Environmental Health, 14(2), 76–84. https://doi.org/10.5897/JTPEH2021.019

Uzochukwu, B., Onwujekwe, O., & Akpala, C. (2023). Community?based interventions for malaria prevention: A systematic review. BMC Public Health, 23, Article 410. https://doi.org/10.1186/s12889-023-15123-7

World Health Organization. (2021). World malaria report 2021. Geneva, Switzerland: Author.

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