Access, Utilization and Barriers to  Malaria Preventive Intervention  for Children under the Age of Five in Flood-Affected Region in South-South, Nigeria

Introduction: Malaria is a critical public health issue in Nigeria, particularly among children under five. In South-South Nigeria, frequent flooding exacerbates this problem by disrupting healthcare services and preventive measures. This study explores access and utilization of malaria preventive interventions, examines socio-demographic influences, and identifies primary barriers faced by caregivers in these flood-affected areas. Method: A cross-sectional survey was administered to 1,387 caregivers in Bayelsa, Delta, and Rivers states using web-based and interviewer-administered pre-tested questionnaires. Access and utilization of malaria preventive interventions, such as mosquito nets and preventive antimalarials, were assessed. Associations between socio-demographic factors and access/utilization levels were analyzed using chi-square tests. Data analysis was conducted with Stata 18. Results: Of the participants, 35.5% reported low access to interventions, 42.0% moderate access, and 22.5% high access. Utilization was reported as low by 31.0%, moderate by 34.1%, and high by 34.9%. Caregivers who were mothers had high access (81.4%, χ²=36.9, P<0.001), as did those with higher education (84.0%, χ²=23.6, P<0.001) and employed caregivers (88.1%, χ²=10.8, P=0.005). Rural residents showed high access (52.6%, χ²=15.7, P<0.001). Rivers state had the highest proportion of high access (49.4%, χ²=15.7, P<0.001). Recent flood experience was also associated with high access (98.1%, χ²=6.4, P=0.041). High utilization was seen among caregivers who were mothers (80.2%, χ²=28.3, P<0.001), caregivers with secondary education or higher (81.2%, χ²=27.4, P<0.001), and urban residents (56.4%, χ²=48.7, P<0.001). Delta state had the highest proportion of high utilization (44.2%, χ²=238.6, P<0.001). A history of child malaria admission correlated with higher utilization (76.6%, χ²=91.3, P<0.001), while flood experience did not significantly affect utilization (P=0.128). The main barriers were flooding (39.9%), lack of access to insecticide-treated nets (38.6%), and lack of access to preventive antimalarials (28.5%). Conclusion: The study identifies significant disparities in access and utilization of malaria preventive interventions, influenced by socio-demographic factors and flood experiences. Targeted interventions and increased education on malaria prevention are essential to overcome these barriers in South-South Nigeria's flood-affected regions.