Background and aims: Integrated vector control especially use of insecticide-treated bed nets have been reported as effective malaria preventive strategies. This study aimed at documenting factors that influence regular use of insecticide-treated nets in under-fives and impact of vector control methods on malaria outcome (severe malaria prevalence and mortality) in under-fives presenting in a tertiary health institution in Nigeria.

Methods: Cross-sectional study carried out from June 2012 and July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy.

Results: 329 caregiver (31.2 ± 6.0 years) /child (20.7 ± 14.0 months) pair were recruited. Netting of doors/windows (80.0%) was the most practiced vector control method. 177 (53.8%) caregivers possessed insecticide-treated bed nets, and only a quarter of their under-5s regularly sleep in these nets. Children from lower social class statistically significantly sleep in the nets (p = 0.03), however, presence of 2 or more nets in a household independently predicted its regular use for the under-5s (β = 1.09, OR = 3, p = 0.02). Prevalence of severe malaria was 36.2% and mortality was 52 per 1000. Combination of regular use of insecticide treated nets, environmental sanitation, indoor insecticide spray and netting of household doors/windows significantly predicted low prevalence of severe malaria compared to each of the malaria vector control methods used singly by the caregivers (β = 1.66, OR =5.0, p = 0.04).

Conclusions: Integrated vector control remains the most effective method of malaria vector control at the community.