ABSTRACT

Globally there has been an increase in Internally Displaced Persons (IDP). IDPs are a disadvantaged population and prone to numerous challenges including insecurity, sexual violence, poverty and malnutrition among others. For IDPs in malaria endemic countries, malaria is a major cause of morbidity and mortality, especially among vulnerable populations of under-five aged children and pregnant women.This study was conducted to determine the prevalence of malaria and utilization of Long Lasting Insecticidal Treated Nets among IDPs aged 6 – 59 months in FCT-Abuja.

A cross-sectional community based survey was conducted in the 3 IDP Camps located in Abuja and a total enumeration of children aged 6-59 months was done. Mother – child pairs of children aged 6-59 months were interviewed using a structured interviewer administered questionnaire. Finger prick blood samples were collected from eligible consenting children and tested for malaria parasitaemia.

A total of 393 children from 242 households were recruited. The prevalence of malaria was

found to be 32% and 51% via RDT and malaria microscopy respectively. The LLIN ownership and coverage was 76.7% and 11.2% respectively. Utilisation was high with 89.7% of children aged 6-59 sleeping under an LLIN the night before the survey. The odds of LLIN utilization was higher in nets that were hanged (OR:55.9, 95% CI:18.12-172.14), those that lived near stagnant water (OR: 2.9, 95% CI: 1.33-6.59 ),had owned the LLIN for 6 months or less, (OR: 2.6, 95% CI:1.20-5.57 ),Christians (OR:2.4, 95% CI: 1.10-5.62 ),and nets with holes (OR: 2.2, 95% CI:1.01-4.90),The odds of Malaria parasitaemia was significantly higher in females (OR: 1.7, 95% CI: 1.08-2.61) and children who had traveled but not statistically significant (OR: 1.9, 95% CI: 0.73-4.70) while those who owned LLINs for less than 6 months were less likely to have parasitaemia. (OR: 0.6, 95% CI: 0.31-0.97).

The prevalence of malaria among IDPs aged 6-59 months was high in spite of high ownership and utilization of LLIN.LLIN coverage was low and factors significantly associated with LLIN utilization were type of breeding sites near dwellings and net factors. There is need to improve coverage of LLIN among IDPs and explore other malaria preventive strategies like the use of pre-treated tarpaulins among IDPs.

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Key words: Malaria, prevalence, internally displaced persons, long lasting insecticidal treated nets, children

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CHAPTER ONE

INTRODUCTION

1.1       Background Information

Malaria is a major cause of morbidity and mortality in tropical and subtropical countries

particularly in Africa. It is the most common cause of death in children less than five years of

age and also the most common cause of outpatient hospital visits in the general population.1, 2

Thus it has been targeted for elimination in the year 2020 and malaria preventive strategies have

been employed. These strategies are the use of Long Lasting Insecticide Nets (LLIN),

Intermittent Preventive Therapy (IPT), prompt diagnosis with Rapid Diagnostic Tests Kits

(RDTs) and treatment with Artemisinin Combination Therapy (ACT) .Of these, LLIN is

considered the cornerstone of malaria prevention and its preventive effect is comparable with

that of immunization in the prevention of malaria in children.1, 3,4,5

An estimated 1.5 billion people globally live in conflict affected countries which results in

people becoming internally displaced or refugees as they flee from emergencies, either manmade

or naturally occurring such as wars, conflicts, communal strife and floods, earthquakes

respectively. Malaria prevention and control is hindered during strife and disaster.2,6, 7 Countries

which have suffered or been greatly affected by displacements include Syria, Afghanistan, Iraq

in the middle East, DRC, Nigeria, Ethiopia, Sudan in Africa, India, Nepal, China and the

Philippines in Asia among others. Countries which have suffered from protracted conflicts for

more than ten years include the DRC, Sudan and South Sudan, Colombia and Iraq.

In recent times, there has been an upsurge of internally displaced persons both internationally

and locally as a result of insurgency, communal clashes, strife of all forms as well as natural

disaster. Countries mainly affected by conflict, violence and strife in the last five years include

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Nigeria, Syria, Ukraine and Yemen. Globally, 27.8 million people were displaced in the year

2015 alone and about one third of this was from conflict bringing the global estimate of

internally displaced persons (IDPs) to 40.8 million people at the end of the year, the highest

figure ever recorded.2 Though malaria has been targeted for elimination, the community of I