Cost Analysis of Malaria Prevention and Treatment Among Pregnant Women With Under-Five Children Attending Antenatal Clinics in Public And Private Health Care Facilities in AMAC, Abuja, Nigeria

Malaria remains a major public health and health-financing challenge in Nigeria, with pregnant women experiencing increased vulnerability to infection and its associated maternal and neonatal complications. Evidence on the magnitude of these differences in the Abuja Municipal Area Council (AMAC) remains limited. This study assessed the perceived cost, accessibility and affordability of malaria prevention and treatment services among pregnant women attending selected public and private antenatal clinics in AMAC, Abuja, Nigeria. Methods - A comparative cross-sectional analytical study was conducted among 300 pregnant women attending antenatal care in selected public and private health facilities across five wards of AMAC: Gwarinpa, Jikwoyi, Nyanya, Karu and Kabusa. The final analytical sample comprised 150 women attending public facilities and 150 attending private facilities. Participants were selected using a multistage sampling approach. Data were collected using a structured interviewer-administered questionnaire covering sociodemographic characteristics, malaria prevention and treatment costs, perceived accessibility and perceived affordability. Descriptive statistics were used to summarize participant characteristics and outcomes. Chi-square tests assessed associations between sociodemographic characteristics and perceived cost/accessibility, while independent-samples t-tests compared mean costs and perception scores between public and private facilities. Statistical significance was set at p<0.05. Results - The majority of respondents were aged 25–34 years (58.3%), married (85.0%), and had at least secondary education (83.3%). Women attending private facilities were more likely to have tertiary education and higher household income, whereas lower-income respondents were disproportionately represented in public facilities. The mean reported cost of malaria prevention was ₦2,450 (SD ₦850) in public facilities compared with ₦4,600 (SD ₦1,100) in private facilities, representing an absolute difference of ₦2,150 (t=-18.72, p<0.001). Similarly, mean malaria treatment cost was ₦4,850 (SD ₦1,450) in public facilities and ₦8,100 (SD ₦1,750) in private facilities, a difference of ₦3,250 (t=-17.35, p<0.001). Perceived accessibility was significantly higher among public-facility attendees (mean 3.28, SD 0.72) than private-facility attendees (mean 2.82, SD 0.64; t=5.87, p<0.001). Perceived affordability was also significantly higher in public facilities (mean 3.76, SD 0.81) than private facilities (mean 2.88, SD 0.84; t=9.24, p<0.001). Educational attainment, occupation, household income and ward of residence were significantly associated with perceived prevention and treatment costs and accessibility. Conclusion - Malaria prevention and treatment among pregnant women in AMAC impose substantially higher reported financial costs in private healthcare facilities than in public facilities. Socioeconomic position and geographical location were important determinants of perceived cost and accessibility. Strengthening public-sector malaria financing, expanding financial-risk protection, improving commodity availability and establishing effective public–private malaria service arrangements could reduce financial barriers and promote more equitable access to malaria services during pregnancy.