title: Malaria prevalence, anemia and baseline intervention coverage prior to mass net distributions in Abia and Plateau States, Nigeria.
abstract: BACKGROUND
  Nigeria suffers the world's largest malaria burden, with approximately 51 million cases and 207,000 deaths annually. As part of the country's aim to reduce by 50% malaria-related morbidity and mortality by 2013, it embarked on mass distribution of free long-lasting insecticidal nets (LLINs).
  
  
  METHODS
  Prior to net distribution campaigns in Abia and Plateau States, Nigeria, a modified malaria indicator survey was conducted in September 2010 to determine baseline state-level estimates of Plasmodium prevalence, childhood anemia, indoor residual spraying (IRS) coverage and bednet ownership and utilization.
  
  
  RESULTS
  Overall age-adjusted prevalence of Plasmodium infection by microscopy was similar between Abia (36.1%, 95% CI: 32.3%-40.1%; n = 2,936) and Plateau (36.6%, 95% CI: 31.3%-42.3%; n = 4,209), with prevalence highest among children 5-9 years. P. malariae accounted for 32.0% of infections in Abia, but only 1.4% of infections in Plateau. More than half of children ≤10 years were anemic, with anemia significantly higher in Abia (76.9%, 95% CI: 72.1%-81.0%) versus Plateau (57.1%, 95% CI: 50.6%-63.4%). Less than 1% of households in Abia (n = 1,305) or Plateau (n = 1,335) received IRS in the 12 months prior to survey. Household ownership of at least one bednet of any type was 10.1% (95% CI: 7.5%-13.4%) in Abia and 35.1% (95% CI: 29.2%-41.5%) in Plateau. Ownership of two or more bednets was 2.1% (95% CI: 1.2%-3.7%) in Abia and 14.5% (95% CI: 10.2%-20.3%) in Plateau. Overall reported net use the night before the survey among all individuals, children <5 years, and pregnant women was 3.4%, 6.0% and 5.7%, respectively in Abia and 14.7%, 19.1% and 21.0%, respectively in Plateau. Among households owning nets, 34.4% of children <5 years and 31.6% of pregnant women in Abia used a net, compared to 52.6% of children and 62.7% of pregnant women in Plateau.
  
  
  CONCLUSIONS
  These results reveal high Plasmodium prevalence and childhood anemia in both states, low baseline coverage of IRS and LLINs, and sub-optimal net use-especially among age groups with highest observed malaria burden.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Noland
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Graves
authors.forename: Adamu
authors.initials: A
authors.lastname: Sallau
authors.forename: Abel
authors.initials: A
authors.lastname: Eigege
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Emukah
authors.forename: Amy E
authors.initials: AE
authors.lastname: Patterson
authors.forename: Joseph
authors.initials: J
authors.lastname: Ajiji
authors.forename: Iheanyichi
authors.initials: I
authors.lastname: Okorofor
authors.forename: Oji Uka
authors.initials: OU
authors.lastname: Oji
authors.forename: Mary
authors.initials: M
authors.lastname: Umar
authors.forename: Kal
authors.initials: K
authors.lastname: Alphonsus
authors.forename: James
authors.initials: J
authors.lastname: Damen
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Ngondi
authors.forename: Masayo
authors.initials: M
authors.lastname: Ozaki
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cromwell
authors.forename: Josephine
authors.initials: J
authors.lastname: Obiezu
authors.forename: Solomon
authors.initials: S
authors.lastname: Eneiramo
authors.forename: Chinyere
authors.initials: C
authors.lastname: Okoro
authors.forename: Renn
authors.initials: R
authors.lastname: McClintic-Doyle
authors.forename: Olusola
authors.initials: O
authors.lastname: Oresanya
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Miri
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.forename: Frank O
authors.initials: FO
authors.lastname: Richards
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology; D000818:Animals; D002648:Child; D002675:Child, Preschool; D009033:Culicidae / Q000254:growth & development / Q000469:parasitology; D003625:Data Collection; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007303:Insect Vectors / Q000254:growth & development / Q000469:parasitology; D008288:Malaria / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods; D057147:Mosquito Nets / Q000706:statistics & numerical data; D009549:Nigeria / Q000453:epidemiology; D010965:Plasmodium malariae / Q000469:parasitology; D011247:Pregnancy; D015995:Prevalence; D055815:Young Adult