Barriers to effective uptake of malaria prevention interventions in Ibadan, South West Nigeria: a qualitative study

Kelechi Elizabeth Oladimeji, Joyce Mahlako Tsoka-Gwegweni, Santhanalakshmi Gengiah, Amrita Daftary, Kogieleum Naidoo


Background: Although control measures have achieved considerable success, malaria is still a major public health problem in Nigeria and sub-Saharan Africa. The malaria burden is more among vulnerable groups like pregnant women and under-five aged children. This study explored barriers affecting uptake of current malaria prevention interventions in Ibadan, Southwest Nigeria.

Methods: The study was conducted using qualitative research methods between May and August 2016 among community residents in Ibadan, Oyo state-Nigeria. Six focus group discussions (FGDs) and 16 in-depth interviews (IDI) were conducted with community members who were purposively selected and consented to participate in the study. The participants were grouped into six homogenous focus groups which included; pregnant women, mothers of under-five children, husbands, fathers, civil society members, and health staff such as hospital manager, nurses, pharmacist, medicine vendors, doctors, state program staff and national program staff. Data were transcribed, manually coded and analysed using content and thematic method. The Biomedical Research Ethics Committee (BREC), University of KwaZulu-Natal, South Africa and Oyo state Ministry of Health Ethics Committee, Nigeria both approved the study.

Results: Knowledge on malaria causality and symptoms, prevention strategies, beliefs, fear of side effects from current malaria preventive measures, corruption and difficulty in obtaining nets, and poor environmental hygiene were some of the themes which emerged as barriers to the effective uptake of malaria prevention intervention.

Conclusions: Strategies at the community level are urgently needed to address and improve within socio-cultural context uptake of current malaria prevention interventions.


Barriers, Malaria prevention, Nigeria

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Abah AE, Awi-Waadu GDB NF, Richard A. Assessment of Mother’s Knowledge and Attitude towards Malaria Management among Under Five (5) Years Children in Okemesi–Ekiti, Ekiti–West Local Government, Ekiti State Estrjkl. Malaria Contr Elimination. 2016;5:142.

World Health Organization. Malaria Factsheet. 2017. Available at: mediacentre/factsheets/fs094/en. Accessed on 1 December 2017.

Roll Back Malaria Partnership. Action and investment to defeat malaria 2016–2030. For a Malaria free World. Geneva: World Health Organization (WHO). Available at: http:// les/ les/aim/RBM_AIM_Report_A4_EN-Sept2015. Pdf. Accessed on 16 November 2017.

National Population Commission (NPC) [Nigeria] and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International 2014.

National Population Commission (NPC) Nigeria. Available at Accessed on 16 November 2017.

Federal Ministry of Health and National Malaria Elimination Programme. Strategic plan 2009–2013. A Road map for malaria control in Nigeria. Abuja: FMOH and NMCP; 2009.

World Health Organization. Global Technical Strategy for Malaria 2016– 2030. Geneva: World Health Organization (WHO). Available at technical_strategy/en. 2015. Accessed on 16 November 2017.

National Population Commission (NPC) (Nigeria) NMCPNN, and ICF International. Abuja, Nigeria: NPC, NMCP, and ICF International, NMIS; 2012. Nigeria malaria indicator survey, 2010. 2010.

Federal Ministry of Health (FMoH) [Nigeria] and National Malaria Elimination Programme (NMEP) [Nigeria]. National Malaria Strategic Plan 2014-2020. Abuja, Nigeria: FMoH and NMEP; 2014.

World Health Organization. Nigeria Malaria Profile. 2016. Accessed on 01 December 2017.

Adebayo AM AO, Cadmus EO. Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria. Peer J. 2015;3:e792.

Bedford KJ, Sharkey AB. Local barriers and solutions to improve care-seeking for childhood pneumonia, diarrhoea and malaria in Kenya, Nigeria and Niger: a qualitative study. PLoS One. 2014;9(6):e100038.

National Malaria Elimination Programme - NMEP/Nigeria, National Population Commission - NPopC/Nigeria, National Bureau of Statistics - NBS/Nigeria, ICF. Nigeria Malaria Indicator Survey 2015. Abuja, Nigeria: NMEP/Nigeria, NPopC/Nigeria, NBS/Nigeria, and ICF, 2016.

Lagoro OD and Christopher G. Knowledge and Misconceptions about Malaria among Pregnant Women in a Post-Conflict Internally Displaced Persons’ Camps in Gulu District, Northern Uganda. Malaria Research and Treatment. 2011;1:1-7.

Diala CC, Pennas T, Marin C, Belay KA. Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and Cross River States in Nigeria. Malaria J. 2013;12(1):342.

Chukwuocha UM. Malaria Control in Nigeria. Primary Health Care. 2012;2:118. Despite ban, many Nigerians are still using chloroquine. Available at: Accessed on 01 December 2017.

Victor OA, Adekunle AJ, Tahiru IK, David OO. Influence of Meteorological Variables on Diversity and Abundance of Mosquito Vectors in Two Livestock Farms in Ibadan, Nigeria: Public Health Implications. J Mosq Res. 2017;7(9):70-8.

Ayoola OO GI, Omotade OO, Adeyanju OA, Cruickshank JK, et al. Maternal Malaria, Birth Size and Blood Pressure in Nigerian Newborns: Insights into the Developmental Origins of Hypertension from the Ibadan Growth Cohort. PLoS One. 2011;6(9):e24548.

Rahi S. Research Design and Methods: A Systematic Review of Research Paradigms, Sampling Issues and Instruments Development. Int J Econ Manag Sci. 2017;6:403.

Flemming K, Booth A, Hannes K, Cargo M, Noyes J. Cochrane Qualitative and Implementation Methods Group Guidance Paper 5: Reporting guidelines for qualitative, implementation and process evaluation evidence syntheses. J Clin Epidemiol. 2017. (Article in Press)

Chandler CIR, Reynolds J Palmer JJ and Hutchinson E. ACT Consortium Guidance: Qualitative Methods for International Health Intervention Research. Available at:; 2013. Accessed on 01 December 2017.

United Nations Children's Fund. Qualitative study to identify solutions to local barriers to care-seeking and treatment for diarrhoea, malaria and pneumonia in select high burden countries. Report on findings from Kenya (1 of 3 country reports). New York: UNICEF, 2012.

Federal Ministry of Health Nigeria. National guidelines and strategies for malaria prevention and control during pregnancy. Available at 2014. Accessed on 01 December 2017.

Federal Ministry of Health (FMoH) [Nigeria] and National Malaria Elimination Programme (NMEP) [Nigeria]. National integrated community case management of malaria. NMCP/FMOH 2012: p1.

Maslove DM, Mnyusiwalla A, Mills EJ, McGowan J, Attaran A, Wilson K. Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies. BMC Int Health Hum Rights. 2009;9:26.

Andrew EVW PC, Angwin A, Auwun A, Daniels J, Mueller I, et al,. Knowledge, Attitudes, and Practices Concerning Malaria in Pregnancy: Results from a Qualitative Study in Madang, Papua New Guinea. PLoS ONE 2015;10(4):e0119077.

Center for Disease Control and Prevention. Malaria: Insecticide-Treated Bed Nets. 28 December 2015 2015. Available at: malaria_worldwide/reduction/itn.html. Accessed on 01 December 2017.

Global fund. Message from the executive director, Nigeria reports. Accessed from 2016-05 03_Message_from_the_Executive_Director_ Nigeria_Reports/. 2016. Accessed on 01 December 2017.

Michael G, Aliyu I, Grema B. Knowledge of malaria and adherence to its preventive measures among adults attending out-patient clinics of a Nigerian tertiary hospital: Has anything changed? African J Med Health Sci. 2017;16(1):43-51.

A Abah AE; Awi-Waadu GDB, Nduka FO, Richard A. Malaria infection and socioeconomic status of some residents of Port Harcourt metropolis, Rivers State, Nigeria. J Appl Sci Environ Manage. 2017;21(2):299-304.

World Health Organization. Malaria Fact Sheet No. 94. WHO, Geneva 2015.

Cotter C, Sturrock HJ, Hsiang MS, Liu J, Phillips AA, Hwang J, et al. The changing epidemiology of malaria elimination: new strategies for new challenges. Lancet. 2013;382(9895):900-11.