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VOLUME 54 | NUMBER 3 | JUNE 2019

Effectiveness of antimalarial interventions in Nigeria: Evidence from facilitylevel longitudinal data

Objective: To evaluate the effectiveness of a program of antimalarial interventions implemented in 20102013 in Niger State, Nigeria.

Data Sources: Utilization reports from 99 intervention and 51 nonintervention health facilities from the Niger State Malaria Elimination Program, supplemented by data on facilitylevel characteristics from the Niger State Primary Health Care Development Agency and Local Government Malaria Control units.

Study Design: Estimated with mixedeffects negative binomial modeling, a differenceindifferences method was used to quantify the impact of the program on the number of febrile illness cases and confirmed malaria cases. Potential confounding factors, nonstationarity, seasonality, and autocorrelation were explicitly accounted for.

Data Extraction Methods: Data were retrieved from hard copies of utilization reports and manually inputted to create a panel of 5550 facilitymonth observations.

Principal Findings: The program was implemented in two phases. The first phase (August 2010June 2012) involved the provision of free artemisininbased combination therapies, longlasting insecticidal nets, and intermittent preventive treatments. In the second phase (July 2012March 2013), the program introduced an additional intervention: free parasitebased rapid diagnostic tests. Compared to the preintervention period, the average number of monthly febrile illness and malaria cases increased by 20.876 (P < 0.01) and 22.835 (P < 0.01) in the first phase, and by 19.007 (P < 0.05) and 19.681 (P < 0.05) in the second phase, respectively. The results are consistent across different evaluation methods.

Conclusions: This study suggests that userfee removal leads to increased utilization of antimalarial services. It motivates future studies to cautiously select their investigative methods.

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