Abstract

The 2021 Nigeria Malaria Indicator Survey (NMIS) was implemented by the National Malaria Elimination Programme (NMEP) of the Federal Ministry of Health (FMoH) in collaboration with the National Population Commission (NPC) and National Bureau of Statistics (NBS).

The primary objective of the 2021 NMIS was to provide up-to-date estimates of basic demographic and health indicators related to malaria. Specifically, the NMIS collected information on vector control interventions (such as mosquito nets), intermittent preventive treatment of malaria in pregnant women, exposure to messages on malaria, care-seeking behaviour, treatment of fever in children, and social and behaviour change communication (SBCC). Children age 6–59 months were also tested for anaemia and malaria infection. The information collected through the NMIS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Woman age 15-49

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample for the 2021 NMIS was designed to provide most of the survey indicators for the country as a whole, for urban and rural areas separately, and for each of the country’s six geopolitical zones, which include 36 states and the Federal Capital Territory (FCT). Nigeria’s geopolitical zones are as follows: • North Central: Benue, Kogi, Kwara, Nasarawa, Niger, Plateau, and FCT • North East: Adamawa, Bauchi, Borno, Gombe, Taraba, and Yobe • North West: Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, and Zamfara • South East: Abia, Anambra, Ebonyi, Enugu, and Imo • South South: Akwa Ibom, Bayelsa, Cross River, Delta, Edo, and Rivers • South West: Ekiti, Lagos, Ogun, Osun, Ondo, and Oyo

The 2021 NMIS used the sample frame for the proposed 2023 Population and Housing Census (PHC) of the Federal Republic of Nigeria. Administratively, Nigeria is divided into states. Each state is subdivided into local government areas (LGAs), each LGA is divided into wards, and each ward is divided into localities. Localities are further subdivided into convenient areas called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster unit for the 2021 NMIS, was defined on the basis of EAs for the proposed 2023 PHC.

A two-stage sampling strategy was adopted for the 2021 NMIS. In the first stage, 568 EAs were selected with probability proportional to the EA size. The EA size is the number of households residing in the EA. The sample selection was done in such a way that it was representative of each state. The result was a total of 568 clusters throughout the country, 195 in urban areas and 373 in rural areas.

For further details on sample design, see Appendix A of the final report.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were used in the 2021 NMIS: the Household Questionnaire, the Woman’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to Nigeria. After the questionnaires were finalised in English, they were translated into Hausa, Yoruba, and Igbo.

Cleaning operations

The processing of the 2021 NMIS data began immediately after the start of fieldwork. As data collection was being completed in each cluster, all electronic data files were transferred via the IFSS to the NPC central office in Abuja. Data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted on any inconsistencies and errors. Secondary editing, carried out in the central office, involved resolving inconsistencies and coding open-ended questions. The biomarker paper questionnaires were compared with electronic data files to check for any inconsistencies in data entry. Data entry and editing were carried out using the CSPro software package. Concurrent processing of the data offered a distinct advantage because it maximised the likelihood of the data being error-free and accurate. Timely generation of field check tables also allowed for effective monitoring. Secondary editing of the data was completed in February 2022. The data processing team coordinated this exercise at the central office.

Response rate

A total of 14,185 households were selected for the survey, of which 13,887 were occupied and 13,727 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 14,647 women age 15-49 were identified for individual interviews. Interviews were completed with 14,476 women, yielding a response rate of 99%.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and in data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, or incorrect data entry. Although numerous efforts were made during the implementation of the 2021 Nigeria Malaria Indicator Survey (NMIS) to minimise this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2021 NMIS is only one of many samples that could have been selected from the same population, using the same design and expected sample size. Each of these samples would yield results that differ somewhat from the results of the selected sample. Sampling errors are a measure of the variability among all possible samples. Although the exact degree of variability is unknown, it can be estimated from the survey results.

Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, and so on), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2021 NMIS sample was the result of a multistage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed via SAS programmes developed by ICF. These programmes use the Taylor linearisation method to estimate variances for estimated means, proportions, and ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

Sampling errors tables are presented in Appendix B of the final report.

Data appraisal

Data Quality Tables

• Household age distribution
• Age distribution of eligible and interviewed women
• Age displacement at ages 14/15
• Age displacement at ages 49/50
• Live births by years preceding the survey
• Completeness of reporting
• Observation of mosquito nets
• Number of enumeration areas completed by month of fieldwork and zone
• Positive rapid diagnostic test (RDT) results by month of fieldwork and zone, Nigeria MIS 2021
• Concordance and discordance between RDT and microscopy results
• Concordance and discordance between national and external quality control laboratories

See details of the data quality tables in Appendix C of the final report.

The do-file required to execute the regression models in the study have been provided. The 2021 Malaria Indicator Survey (MIS) dataset underlying the study is publicly available in the Demographic and Health Surveys (DHS) database: https://dhsprogram.com/Data/