FEBRILE ILLNESS, MALARIA TEST POSITIVITY, AND BREAKTHROUGH INFECTION AMONG CHILDREN UNDER FIVE DURING SEASONAL MALARIA CHEMOPREVENTION IN PLATEAU STATE, NIGERIA: A RETROSPECTIVE ANALYSIS OF ROUTINE HEALTH FACILITY DATA, 2024
Abstract
Seasonal Malaria Chemoprevention (SMC) with Sulphadoxine–Pyrimethamine and Amodiaquine (SPAQ) is a cornerstone strategy for reducing malaria among children under five in Nigeria, yet local, routine-data monitoring of its performance is limited. We examined trends in febrile illness, malaria test positivity, and SPAQ distribution among children under five during the 2024 SMC cycle in three Local Government Areas (LGAs) of Plateau State, Nigeria. This was a retrospective, descriptive analysis of routine health facility data reported through the District Health Information System 2 (DHIS2) and State Malaria Elimination Programme (SMEP) logistics records for Jos South, Mangu, and Shendam LGAs, covering the SMC period from June to October 2024. Monthly febrile case counts, fever testing rates, malaria test positivity rates, and SPAQ distribution volumes were summarised descriptively by LGA and month. A cumulative 11,960 febrile cases among children under five were recorded across the three LGAs between June and October 2024, with fever testing rates consistently at or near 100%. Malaria test positivity among febrile children remained high throughout the SMC period, ranging from 39% to 68% and declining from a three-LGA mean of 58.3% in June to 42.3% in October. A total of 156,616 SPAQ treatment courses were administered across the three LGAs, reaching 127,036 children through the lead-mother distribution model, with no stock-outs reported at any of the three highest-volume facilities. Despite high SPAQ distribution coverage and no reported stock-outs, malaria test positivity among febrile children under five remained substantial throughout the 2024 SMC period in these three Plateau State LGAs. These routine-data trends do not, on their own, establish drug efficacy or resistance, but they support prioritising individual-level, linked monitoring — including confirmed SMC-receipt tracking and periodic therapeutic efficacy and molecular resistance studies — to determine whether declining protection, reinfection, or diagnostic and health-seeking factors best explain the persistently high positivity observed.