Background: Despite recent improvements in malaria prevention strategies, malaria case management remains a
weakness in Northern Nigeria, which is underserved and suffers the country’s highest rates of under-five child
mortality. Understanding malaria care-seeking patterns and comparing case management outcomes to World
Health Organization (WHO) and Nigeria’s National Malaria Control Programme (NMCP) guidelines are necessary to
identify where policy and programmatic strategies should focus to prevent malaria mortality and morbidity.
Methods: A cross-sectional survey based on lot quality assurance sampling was used to collect data on malaria
care-seeking for children under five with fever in the last two weeks throughout Sokoto and Bauchi States. The
survey assessed if the child received NMCP/WHO recommended case management: prompt treatment, a diagnostic
blood test, and artemisinin-based combination therapy (ACT). Deviations from this pathway and location of
treatment were also assessed. Lastly, logistic regression was used to assess predictors of seeking treatment.
Results: Overall, 76.7% of children were brought to treatment—45.5% to a patent medicine vendor and 43.8% to a
health facility. Of children brought to treatment, 61.5% sought treatment promptly, but only 9.8% received a
diagnostic blood test and 7.2% received a prompt ACT. When assessing adherence to the complete case
management pathway, only 1.0% of children received NMCP/WHO recommended treatment. When compared to
other treatment locations, health facilities provided the greatest proportion of children with NMCP/WHO
recommended treatment. Lastly, children 7–59 months old were at 1.74 (p = 0.003) greater odds of receiving
treatment than children =6 months.
Conclusions: Northern Nigeria’s coverage rates of NMCP/WHO standard malaria case management for children
under five with fever fall short of the NMCP goal of 80% coverage by 2010 and universal coverage thereafter. Given
the ability to treat a child with malaria differs greatly between treatment locations, policy and logistics planning
should address the shortages of essential malaria supplies in recommended and frequently accessed treatment
locations. Particular emphasis should be placed on integrating the private sector into standardized care and
educating caregivers on the necessity for testing before treatment and the availability of free ACT in public health
facilities for uncomplicated malaria