Burden, challenges, and control of malaria among under-5s in Nigeria

Malaria remains a leading cause of morbidity and mortality among children under five years in Nigeria, a country accounting for over a quarter of global malaria cases. Despite the availability of interventions, Nigeria continues to face persistent challenges in controlling malaria, especially in the under-five population, thus, the need for this review. This narrative review synthesizes peer-reviewed literature, national reports, and policy documents published since 2010. A structured search was conducted across PubMed, Google Scholar, Scopus, and relevant grey literature from the WHO, UNICEF, and the Nigerian Ministry of Health. The review adhered to SANRA guidelines to ensure methodological rigour and focused on studies reporting malaria epidemiology, interventions, and control efforts targeting children under five in Nigeria. Findings revealed a high malaria burden among children in Nigeria, with notable regional disparities. Northern states report the highest prevalence, with rural areas disproportionately affected. Contributing factors include socioeconomic deprivation, climate variability, and suboptimal coverage of interventions. Key challenges include diagnostic limitations, drug resistance, and inconsistent use of preventive measures. While interventions such as long-lasting insecticidal nets (LLINs), intermittent preventive therapy, and indoor residual spraying have shown effectiveness, gaps remain in coverage and implementation. Innovations in diagnostics, vaccines, and surveillance systems are promising but underutilized. Despite progress, Nigeria faces multifaceted challenges in malaria control among under-fives. A coordinated, multisectoral response involving innovative strategies, stronger health systems, and policy reforms is essential. Attention must also be directed to enhancing the acceptability, fidelity, and longevity of these interventions.