Malaria remains a critical global health challenge, with Nigeria accounting for 27% of global cases and 31% of deaths despite the implementation of the National Malaria Strategic Plan (2021-2025). Persistent gaps between strategic goals and epidemiological reality highlight underexplored dimensions of health inequalities and illness experiences. The study seeks to analyse patterns of malaria prevalence and intervention coverage, examine and interpret the reported perceptions of malaria.

Using the Social Determinants of Health and Fundamental Causes Theory frameworks, this study analysed the 2021 Nigeria Malaria Indicator Survey (NMIS) to examine these disparities. The study examined health inequalities across wealth quintiles, maternal education, residence, and geopolitical zones in malaria prevalence and intervention access. The findings confirm significant national progress, with overall malaria prevalence falling from 42% (2010) to 22% (2021). However, stark inequalities persist. Children in the poorest wealth quintile had a prevalence of 31%, compared to 5% in the richest. Prevalence was more than twice as high in rural versus urban areas, with wide variation across geopolitical zones. While access to Insecticide-Treated Nets (ITNs) showed a pro-rich bias, utilization was highest among the poorest quintiles who had access.

The study concluded that perceptions of malaria susceptibility and severity varied systematically, with higher perceived severity linked to greater wealth and education. The study recommended that future research requires qualitative inquiry into illness experiences, geographically-targeted equity-focused interventions, culturally-adapted health education, and inclusion of hard-to-reach populations in surveys.