Background

Malaria is one of the world’s most deadly and life threatening parasitic diseases (Adefioye et al., 2007; Okonko et al., 2009; Idowu et al., 2009; Olasehinde et al., 2010; Abah and Temple, 2015). Dougnon et al. (2015) reported that it is one of the world’s deadliest diseases affecting people particularly in tropical and subtropical regions of the world. Malaria is typically caused by single-celled obligate protozoan parasites of the genus Plasmodium (Ani, 2004; Okonko et al., 2009; Olasehinde et al., 2010; Unata et al., 2015; Tela et al., 2015; Kunihya et al., 2016; Udoh et al., 2016). The genus of the Plasmodium that causes malaria has four major species including Plasmodium ovale, P. vivax, P. falciparuum, P. malariae and are mostly found in the sub-Saharan Africa (Ani, 2004; Alaba and Alaba, 2009; Okonko et al., 2010; Tela et al., 2015; Unata et al., 2015; Pam et al., 2015). Idowu et al. (2009) reported that majority of malaria infections in sub-Saharan Africa are caused by P. falciparum.

Of all the four species, P. falciparum has the highest frequency of occurrence followed by P. malariae. P. ovale has replaced P. vivax in West Africa and it occurs predominantly in East Africa (Pam et al., 2015). Ani (2004) reported that mixed infections of two or more species of Plasmodium is very common. Furthermore, Kolawole et al. (2017) reported that major death are caused by P. falciparum and P. vivax, while P. ovale and P. malariae usually cause a milder form of malaria that is hardly lethal. Of these, P. falciparum is responsible for most severe and fatal forms of malaria which is common in Africa just as P. vivax is common in in America and Asia (Ani, 2004). The authors further reported that malaria associated with P. malariae and P. ovale hardly occurs.

Globally, malaria is one of the main causes of morbidity and mortality affecting people of all age groups especially children (Enato et al., 2007; Oladeinde et al., 2014; Garba et al., 2014; Okoli and Solomon, 2015) especially in endemic areas such as Nigeria. According to Okafor and Oko-Ose (2012), malaria is one of the greatest threats to the modern society in terms of morbidity and mortality. In areas of endemicity such as Nigeria, it poses a major problem to both human capital, economic development among others factors (Enato et al., 2007; Nwanosike et al., 2015; Ukpong et al., 2015). It has been estimated to cause death of two million children globally per annum (Okafor and Oko-Ose, 2012).

Malaria is a common disease with public health challenges. Globally, nearly 50% of the world’s population (3.28-3.4 billion people) live in areas at risk of malaria infections (Tyndall et al., 2012; Orok et al., 2016), which are distributed in 106 nations (Nigeria Malaria Fact Sheet, 2011). Okonko et al. (2010) reported that 300 to 500 million clinical cases of malaria occur globally leading to over 1 million deaths. The World Health Organization estimated that 216 million malaria cases occurred in 2010, of which 81% occurred in Africa (Nigeria Malaria Fact Sheet, 2011). In the African region, 30 nations accounted for 90% of global malaria deaths and are found in Sub-Sahara Africa. Typically, Nigeria, Democratic Republic of the Congo, Tanzania, Uganda, Mozambique and Cote d’ivore account for approximately103 million malaria cases and 47% of the World total per annum (Orok et al., 2016). The Nigeria Malaria Fact Sheet (2011) further reported that Nigeria, Democratic Republic of the Congo, Uganda and Ethiopia account for about 50% of global malaria deaths.

In countries like Nigeria where malaria is endemic, malaria is common to children, young and even the elderly. Nwanosike et al. (2015) reported that malaria accounts for about 60% of out-patient hospital visits and 30% of hospitalizations among children less than five of age (Nwanosike et al., 2015). The Nigeria Malaria Fact Sheet (2011) reported that those at risk in Nigeria are about 97% while the rest 3% live in malaria free areas. Furthermore, malaria prevalence in children between 6 to 59 months in Nigeria based on geographical coverage is 41-50% in the North-West, North-Central and South-West; 31-40% in North-East and South-South; and 21-30% in the South-East (Nigeria Malaria Fact Sheet, 2011). Several studies have reported the prevalence of malaria among school age children in several locations in Nigeria (Okafor and Oko-Ose, 2012; Umaru and Uyaiabasi, 2015; Nmadu et al., 2015; Abah and Temple, 2015; Okeke et al., 2016; Bassey and Nwakaku, 2017). There are several deaths emanating from malaria and its co-infections. For instance, Nigeria Malaria Fact Sheet (2011) reported that 100 million malaria cases occur in Nigeria leading to about 300,000 deaths per annum, making malaria the leading cause to death after HIV/AIDS in Africa.

Several control approaches have been carried out toward the eradication of malaria. Some of these include the use of insecticides and destroying the habitats and breeding grounds of the vector, use of insecticide-treated bed nets, indoor residual spraying, and targeted chemoprophylaxis (Okonko et al., 2010). Furthermore, Adefioye et al. (2007) reported that improved sanitation, enlightenment could also reduce the prevalence of malaria.

Malaria infection has been attributed to poverty in African countries (Anumudu et al., 2006). Nigeria is currently estimated to have a population of 170-180 million. The country has a wide range of micro-weather conditions and cultures. As such the prevalence could be affected by life style of a given locality, microclimate, topography, population densities, and cultural practices among others (Umaru and Uyaiabasi, 2015). These are the main determinants affecting the transmission, intensity and management of malaria infection (Umaru and Uyaiabasi, 2015). However, several factors determine their prevalence in the region that they are endemic. Therefore, this study focuses on the determinant factors of malaria prevalence in Nigeria. The ecology of the malaria vector is discussed in brief.

The paper is arranged in different sections. Section 1 contains the introduction on the global and Nigeria prevalence of malaria and causative agents. Section 2 briefly reviews the ecology of mosquito. Section 3 explains the determinant factors that determine the prevalence of malaria in Nigeria. The last section concludes by presenting measures for controlling malaria based on the determinant factors.

2 Ecology of Vector that Transmits Malaria

Insects are major vectors that transmit several diseases especially in the tropics (Bassey and Izah, 2017). Mosquito, a blood sucking vectors (Kamaraj et al., 2011), transmits many life threating diseases caused by some viruses and protozoa including malaria, filariasis, yellow fever, dengue fever, encephalitis etc. especially in the tropical and Sub tropical regions (Becker et al., 2003; Ivoke et al., 2009; Borah et al., 2010; Okigbo et al., 2010; Bagavan and Abdul Rahuman, 2011; Ghose et al., 2012; Bhattacharya et al., 2014a; Bhattacharya et al., 2014b; Alayo et al., 2015; Mukherjee et al., 2015; Ndiok et al., 2016; Pal et al., 2016; El Maghrbi, 2016; Keziah et al., 2016).

Typically, Aedes, Culex, Anopheles and Mansonia transmit diseases in humans and animals (Ivoke et al., 2009). Each of the genera causes specific disease conditions. For instance, Anopheles, specifically female Anopheles, transmits malaria. Several species of Anopheles exist but some notable species include A. gambiae, A. funestus, A. arabiensis and A. melas which are the major vectors of human malaria (Nmadu et al., 2015). Owoeye et al. (2016), Hamza et al. (2014) further reported that A. gambiae and A. arabiensis are the main species that transmit malaria. Bhattacharya et al. (2014b), Ndiok et al. (2016) also reported that Culex quinquefasciatus transmits lymphatic filariasis. Adebajo et al. (2014) reported that Aedes aegypti transmits chikungunya, yellow and dengue fevers. The occurrence of the vectors may be attributed to climatic conditions. For instance, Ojo and Mafiana (2005) reported that the equatorial region favours the growth of mosquitoes, and the low incidence in Northern Africa may be due to the dry Sahara desert.

Malaria infection is mostly acquired in areas where human hosts carrying the Plasmodium parasites are found in addition to enough anopheline mosquitoes under suitable environmental conditions, especially temperature and humidity (Ani, 2004).

Morbidity and mortality rates associated with malaria in all age grades depend on several factors (Ojo and Mafiana, 2005; Egbuche et al., 2013). According to Nasir et al. (2015), Plasmodium has to undergo complex development and multiplication processes both in human and mosquito before it can be further transmitted (Nasir et al., 2015). As such their ecology is important in determining the eradication of malaria.

The ecology of mosquito could be traced to poor sanitation. As such sanitation conditions contribute to the severity of malaria. This is because poor sanitation such as dirty and non-flowing drainage systems, indiscriminate dumping of wastes without appropriate disposal mechanisms provides appropriate breeding grounds for the vectors (Pam et al., 2015). According to Okonko et al. (2010) environmental conditions that favour the breeding of mosquitoes enhances the proliferation of the Plasmodium species.

In addition, Ukpong et al. (2015) reported that the transmission dynamics of malaria is majorly influenced by a mixture of climatic and anthropogenic factors which impact on the vectors’ ecology and also capable of enhancing transmission rates and patterns in certain areas. Furthermore, the authors asserted that the attitude and activities of humans also enhance human-vector contact and as such affect the prevalence. Some of the associated attributes and attitudes include demography, environmental sanitation practices, drainage pattern among others (Ukpong et al., 2015).

Environmental attributes including rainfall and its pattern, relative humidity and temperature are some of the determinants that affect the ecology of the vector of malaria (Alaba and Alaba, 2009). According to Ukpong et al. (2015), temperature plays a significant role in determining the transmission dynamics of the vector as well as the parasite growth and development. The authors further reported that extrinsic incubation duration is significantly affected by temperature. As temperature increases and feeding rate and blood digestion frequency of the adult female Anopheles mosquitoes increase in warmer temperatures (Ukpong et al., 2015).

The prevalence of malaria appears to be higher in rural areas compared to the urban centers/areas. This could be due to lifestyle. Iloh et al. (2013), Nmadu et al. (2015), Bassey and Nwakaku (2017) reported that malaria is holoendemic in the rural areas and mesoendemic in the urban areas in Nigeria.

3 Determinants of Malaria Prevalence in Nigeria

Malaria is a major health challenge to humans living in endemic regions. As such it could cause obstruction and/or delay in daily activities there by leading to low productivity among the labour force due to absenteeism (Ughasoro et al., 2013). This could be due to the fact that malaria patients may end up visiting clinics and extreme cases on hospital admission (Ughasoro et al., 2013). Idowu et al. (2009) reported that malaria prevalence in Nigeria is about 80-85% leading to outpatient visits to clinics. Hence, malaria is a key etiological factor that leads to slow economic growth and development (Ughasoro et al., 2013). Several factors have contributed to the prevalence of malaria in countries of endemicity. Some of the predominant factor is grouped into three including medical condition, environmental factors and human status (age, gender, pregnancy, blood group and rhesus factors). These factors are discussed in the sub-sections below.

3.1 Medical condition

Malaria is endemic in Nigeria and over 97% of the inhabitants are at risk. Malaria could exist with other infections. Some of the common infections that are reported include HIV/AIDs, typhoid fever among other (Table 1). In recent times, the rate of malaria-typhoid co-infection has increased (Pam et al., 2015). Pam et al. (2015) suggested that socio-economic and environmental conditions that incline malaria prevalence in endemic regions also favor Salmonella typhi transmission. In as much that malaria has the tendency of occurring with other infections especially the ones that has similar symptoms. Some of the notable symptoms include fever, malaise and weakness (Pam et al., 2015), fever, chills, headache, nausea, anorexia and anemia (Tyndall et al., 2012).

Like malaria, typhoid fever is a disease of public health importance (Pam et al., 2015). Ukaegbu et al. (2014) reported that malaria and typhoid fever share fever in their symptomatology (Ukaegbu et al., 2014). As such the infection has different names including gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever and pythogenic fever (Ukaegbu et al., 2014). Ojo and Mafiana (2005) also reported that malaria and typhoid fever have overlapping signs and symptoms. It has been erroneously described as “Malaria-typhoid” in some rural areas in the Niger Delta region of Nigeria. This could be due to high co-infection of malaria parasite and Salmonella species rate in regions that malaria is endemic (Eze et al., 2011). Furthermore, detection of high antibody titre of Salmonella serotypes in malaria patients provides on look for some people to agree that malaria infection could advance to typhoid or that malaria infection continually co-infect with typhoid/paratyphoid in all cases (Eze et al., 2011). As such some patients treat malaria and typhoid simultaneously once they have high antibody titre for Salmonella serotypes (Eze et al., 2011).

The causative agent of both disease conditions differs though showing similar symptoms. For instance, malaria is caused by the protozoan Plasmodium while typhoid fever is caused by Salmonella. Within each of the genus that causes the infection several species exists. For instance, it has been widely document that four species of Plasmodium causes Malaria. Also, several species of Salmonella causes Typhoid fever. In addition, the mode of diagnosis is completely different. The species that causes the malaria or the typhoid fever may determine the severity of the illness. Sometimes the predisposing factors could also contribute to the severity of the infection. For instance, the physiological processes associated with human at risk of malaria could lower their immunity level against infections such as typhoid fever (Pam et al., 2015). This could be associated to exaggeration of anti-inflammatory steroid hormones, which makes pregnant woman more vulnerable to infections such as malaria and typhoid fever (Pam et al., 2015).

Typically individual with other infectious disease condition especially the ones caused by microbes may have their immune system compromised. As such they may be vulnerable to other forms of diseases. In addition to diseases like malaria, HIV/AIDs is also a major cause of mortality in developing country like Nigeria. For instance, Nigeria Malaria Fact Sheet (2011) reported that HIV/AIDS causes about 215,000 deaths per annum compared to malaria that causes about 300,000 deaths. As such malaria and HIV/AIDS death ratio is about 60: 43. Since the virus that causes HIV/AIDS and the parasite that causes malaria lead to decline in the immune system, understanding the interaction between malaria and HIV is an essential tool for the control of these infection diseases (Unata et al., 2015).

Furthermore, malaria infection is allied with anaemia (Kunihya et al., 2016). Children are more likely to suffer from anaemia associated to malaria infection. As such, the socio economic demography and educational status of the parent play a determinant role is the prevalence of anaemia associated with malaria especially in children. Anaemia associated with malaria has different prevalence rate depending of the life style, demography, compliance to preventive measures if any, belief, poverty, knowledge towards health care and nutrition (Kunihya et al., 2016).

3.2 Human status

Malaria parasite density in blood in human is basically affected by several factors including blood group and rhesus factor, age, gender, educational status and pregnancy in addition to other medical conditions.

Blood group and Rhesus factor

Blood group is one of the essential determinants in one’s life especially during blood transfusion. According to Oladeinde et al. (2014), blood transfusion and a quick and active therapeutic involvement used extensively for persons with life threatening anaemia cause by several factors including malaria, malnutrition etc. The authors further reported that evaluation of the haemoglobin is an essential criterion for screening blood especially by blood donor and recipient during blood transfusion. Table 2 and Table 3 present the prevalence of malaria among blood donors with regard to rhesus factor and blood group respectively. The malaria does not only affect a particular rhesus factor or blood group. The prevalence occurs in all situations. For instance higher prevalence have been reported among individual with rhesus positive (Tela et al., 2015), while some other authors have reported higher prevalence among individuals with rhesus negative (Ojo and Mafiana, 2005; Oladeinde et al., 2014) (Table 2). Similar situation have been have been reported in blood group (Table 3). Specifically, Oladeinde et al. (2014) reported that malaria parasite is significantly affected by age of blood donors. As such the non-uniform trend in prevalence rate of malaria among the same blood group and rhesus factor could be due to other factors such as demography, species of the Plasmodium causing the malaria, age, medical status, sex etc.

Age

Age is another important factor that determines prevalence of malaria. Several studies in different location have reported the prevalence of malaria based on locations (Okonko et al., 2010; Okafor and Oko-Ose, 2012; Iloh et al., 2013; Kuta et al., 2014; Austin et al., 2014; Tela et al., 2015; Umaru and Uyaiabasi, 2015; Ani et al., 2015; Nmadu et al., 2015; Abah and Temple, 2015; Dawaki et al., 2016; Okeke et al., 2016; Bassey and Nwakaku, 2017). Level of immunity differs especially in infants. The predisposing factors and environmental status together with personal hygiene which could also contribute to variation in malaria prevalence especially in adult. In children, Bassey and Nwakaku (2017) reported that in the 1-3 year old children, low prevalence of malaria could be associated maternally derived antibodies, social life style, awareness, prevention, early report of cases etc by parents; 2-3 years old could be due to loss of immunity derived from the mother, social status, irregular immunization; 4 years old children could be associated to social status and life style, poor prevention, late report of cases etc by parents. Generally high prevalence could be associated to environment with breeding ground for the vector (mosquito). Okonko et al. (2010) also reported that prevalence of malaria could be associated to have lost some degree of immunity due to poor living conditions, exposure to the vector.

Gender

Gender which could either be male or female is another important that determines the prevalence of malaria is a population. The present the prevalence of malaria based on gender have been widely reported in literature by authors (Okonko et al., 2010; Okafor and Oko-Ose, 2012; Austin et al., 2014; Kuta et al., 2014; Oladeinde et al., 2014; Tela et al., 2015; Umaru and Uyaiabasi, 2015; Ani et al., 2015; Nmadu et al., 2015; Abah and Temple, 2015; Dawaki et al., 2016; Okeke et al., 2016; Garba et al., 2016; Bassey and Nwakaku, 2017). Some author have reported higher prevalence in male (Oladeinde et al., 2014) while other in females (Okonkwo et al., 2010; Tela et al., 2015). Also instance of higher prevalence based on sex at particular age have been previously been documented by Bassey and Nwakaku (2017). As such the prevalence of malaria based on gender is compounding to determine. Other predisposing factor could cause high prevalence rate at particular gender in a given locality. Gerba et al. (2016) reported that variation in prevalence rate of malaria based on location could be associated to differences Anopheles species, environmental and climatic conditions, study period, lifestyle of study population and diagnostic test methodology.

Pregnancy

Malaria occurs in human exposed to predisposing factor such as female Anopheles mosquito. Malaria infection caused by Plasmodium falciparum is more perilous during pregnancy (Adefioye et al., 2007) compare to other species of Plasmodium. Pregnant women and infants with malaria are high risk group (Enato et al., 2007; Tyndall et al., 2012) causing maternal, perinatal and fetal morbidity and mortality (Enato et al., 2007). Furthermore, Alaku et al. (2015) also reported that pregnant women form a high risk group for malaria infection. As such malaria in pregnant women has major public health challenges with serious concerns to both the foetus and the woman leading to maternal anemia, spontaneous abortion, stillbirth, premature delivery (Bawa et al., 2014), neonatal death, low birth weight and intrauterine growth retardation (Tyndall et al., 2012; Odikamnoro et al., 2014), miscarriage, still births and premature labour (Alaku et al., 2015), prenatal mortality, low birth weight and maternal anaemia (Okonko et al., 2010). Idowu et al. (2009) reported that malaria during pregnancy account for about 10,000 maternal deaths per annum, 8-14% of all low-birth-weight in newly born children and 3-8% of all infant deaths.

High prevalence of have been reported in pregnant women of various age grade in different part of Nigeria (Adefioye et al., 2007; Obianumba, 2012; Bawa et al., 2015; Alaku et al., 2015). Also prevalence of rate in malaria parasite based on drugs used by pregnant women has been reported by Alaku et al. (2015), Adefioye et al. (2007). In pregnant women, educational status plays a significant role in the malaria prevalence. For instance Alaku et al. (2015), Adefioye et al. (2007) reported lower prevalence rate in educated pregnant women compared to their illiterate counterpart. On this context, Gunn et al. (2015) reported that education on best practices among the pregnant women is among the option to reduce high malaria prevalence.

Unwholesome health practices is a major contributor of poor treatment and prevention of malaria infection and habitually causing a rise in family healthcare costs (Iloh et al., 2013) especially in rural area or area with low educational background. For instance, Iloh et al. (2013) reported that instances several scarification inscriptions made on the abdominal walls of sick children by traditional/local medical practitioners as a form of treatment against malaria splenomegaly and hepatomegaly.

Educational status

Education, they say is power. Children are more likely to suffer from malaria infection and anaemia probably due partial immunity (Kunihya et al., 2016). Generally, the socio-demographic characteristics, life style, occupation, higher educational status, good personal hygiene and sanitation are some of the determinant factors of malaria prevalence. As such education is better option for managing the situation and improve the quality of life especially with regard to environmental/ sanitation component.

3.3 Environmental

In recent times, environmental problems are one of the major challenges facing its sustainability. Omonijo et al. (2011) stated that some of the environmental threats/ risk are related to climatology, as such the need to understand the multifaceted interrelationships between atmosphere and the various environmental hazards. Typically, climatic condition is peculiar to particular place over a given period of time. Also the duration and intensity may vary. As such the feature of climate is any given location is basically different. Some climatic/weather condition could impact some infectious diseases as well as their agents including protozoa, bacteria and viruses as well as their vector such as mosquitoes (Omonijo et al., 2011).

Specifically, malaria is prevalent in tropical and subtropical regions of the World especially in Africa. Ukaegbu et al. (2014) attributed its prevalence to rainfall, warm temperatures, and stagnant waters which provide ideal habitats for mosquito larvae. Other determinant environmental condition includes humidity, type and abundance, composition and distribution of vegetation cover. As such much of the incidence that triggers high prevalence rate is associated to environmental components.

Season affect a wide range of things including living and non-living things. Typically in Nigeria, two predominant season including raining (wet) and dry season. The wet season start from April to October, while the dry season begins from November to March of the following year. In recent times the seasonal pattern appears to be drifting. This is because is some years past rainfall in February is as high as rainfall in early rainy season month e.g April and May. Authors have also reported that season also affect water quality parameters (Izonfuo and Bariwari, 2001) and its related sediment composition (Seiyaboh et al., 2016). The occurrence of mosquito the vector for malaria appears to be higher during the wet season. This could be due to presence of breeding ground of mosquito. Garba et al. (2016) reported higher prevalence during wet season (9.2%) compared to dry season (4.9) among blood donors.

4 Conclusions and the Way Forward

Malaria is one of the major causes of mortality and morbidity in tropical and sub-tropical nations especially in Sub-Sahara Africa. Malaria is basically transmitted from one person to another by female Anopheles mosquito that carries the parasite, Plasmodium. At present, Nigeria is one of the main countries with high prevalence rate of Malaria in the world, as such its endemic in the area. Over 95% of Nigerian population is at risk to malaria infection especially in the rural area. Several factors tend to determine the prevalence of malaria in Nigeria. Some of which include medical condition, environmental factors/seasonal influence and human status (age, gender, pregnancy, blood group and rhesus factors among others). These factors are important indicator in controlling malaria within a given locality.

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