Examining the paradox: increased malaria risk in children under 5 in female-headed households in Nigeria – Malaria Journal

This study aimed to compare male-headed households (MHHs) and female-headed households (FHHs) in Nigeria regarding their malaria prevention practices and infection rates. The findings reveal some intriguing conclusions that shed light on the complex dynamics between household types and malaria risk.

The analysis showed that MHHs had greater ownership of insecticide-treated nets (ITNs) and a greater number of children sleeping under ITNs, indicating that MHHs performed better than FHHs in terms of malaria prevention. These findings align with previous studies highlighting the importance of ITNs in reducing malaria transmission [22, 23]. The higher rates of testing for malaria among febrile children in MHHs further support the notion that these households are more proactive in seeking appropriate healthcare when needed. Moreover, the higher rate of positive malaria tests in MHHs suggests that children under the age of five in FHHs are at greater risk of malaria infection. These results emphasize the vulnerability of FHHs and the need for targeted interventions to address this disparity.

Contrary to the initial expectations, FHHs exhibited higher educational attainment, wealth index scores, and urban residence. These factors are commonly associated with better socioeconomic status and improved access to healthcare services [24, 25]. However, this approach does not translate into superior malaria prevention and testing capabilities within FHHs. It is possible that additional considerations, such as access to healthcare facilities, quality of care, and cultural norms, contribute to the observed disparities between household types.

To assess poverty status across household types, MIS employed the consumption expenditure approach [21]. The consumption expenditure approach primarily focuses on economic indicators, such as income and consumption. In contrast, an alternative approach, the livelihoods approach, involves examining the multidimensional nature of living conditions, encompassing aspects such as access to assets, social networks, and capabilities (such as education, skills, and health) [26]. Through this framework, Kpoor et al. discovered that FHHs lack access to essential assets, indicating that they are not as economically secure as MHHs [27]. The findings in this study confirmed that FHHs lack access to essential assets and are economically less secure than MHHs are. These results highlight the importance of adopting a multidimensional perspective when evaluating poverty and its implications for health outcomes.

The gender dynamics within households play a significant role in decision-making processes and resource allocation [28, 29]. Sub-Saharan Africa (SSA) stands out as one of the regions with the highest levels of gender inequality [30]. Women face systematic disadvantages in accessing education, owning assets, and pursuing economic opportunities [31,32,33]. Furthermore, in Nigeria, traditional norms typically designate men as household heads, with some exceptions [12]. This study underscores the need to recognize the diverse nature of FHHs, ranging from young mothers to older women with grown children [34]. The assets and resources available to these households can vary significantly, further complicating the relationship between household type and malaria risk.

One intriguing finding is that FHHs exhibited better awareness of preventive measures, such as sleeping under ITNs and engaging in environmental sanitation. However, these behaviours did not correlate with reduced malaria infection rates. This discrepancy suggests that factors beyond individual-level practices, such as vector control strategies, healthcare access, and community-level interventions, may influence malaria transmission dynamics in these households [35, 36].

Moving forward, the implementation of culturally appropriate, sustainable, and effective interventions is crucial for successful malaria control strategies. Mosquirix, the first malaria vaccine recommended by WHO, also known as RTS,S/AS01, has successfully reduced early childhood mortality in Ghana, Kenya and Malawi by 13%, but it has only modest efficacy and its protection soon wanes [3]. Now, a second vaccine is poised to join the fight, with the approval by the World Health Organization (WHO) of a shot called R21/MatrixM [37]. Similar to RTS,S/AS01 in design, it can be produced more cheaply and in greater quantities [38]. It should help fill the huge gap between supply and demand for malaria vaccines, potentially preventing tens of thousands of children’s deaths a year. The R21/MatrixM vaccine was highlighted as a 2023 Breakthrough Of The Year by Science Journal, being lauded as ‘‘New hope against malaria.’’ [39]. If the vaccine is widely used and combined with other recommended malaria control interventions, it is expected to have a significant impact on public health [37]. Widespread adoption and uptake among both MHHs and FHHs are necessary to effectively reduce malaria-related mortality in children under five years of age.

Several limitations should be acknowledged. First, relying on self-reported data introduces potential sources of bias, including recall bias and social desirability bias. Additionally, the seasonal nature of malaria and the timing of data collection may have impacted the outcomes. Moreover, the limited number of households with febrile children seeking malaria testing might have affected the statistical power, warranting cautious interpretation of the results.

In summary, this study provides valuable insights into the differences between MHHs and FHHs regarding malaria prevention practices and infection rates. This highlights the vulnerability of children under five in FHHs and the need for targeted interventions to address this disparity. The findings underscore the importance of considering multiple dimensions of poverty and the complex interplay between household type, socioeconomic factors, and cultural norms. Moving forward, a comprehensive approach that integrates preventive measures, healthcare access, and community-level interventions is essential for effective malaria control strategies in Nigeria.