Impact of Integrated Malaria Control Interventions: A Comparative Analysis of Pre- Intervention, Post-Intervention, and Combined Intervention Approaches in Rural and Urban settlement Southeastern Nigeria

Abstract Background Malaria remains an important public health challenge in Nigeria, particularly in rural and urban communities where environmental and socioeconomic conditions favours malaria transmission. This study evaluated malaria prevalence and compared the effectiveness of single and combined malaria control interventions in selected rural and urban communities of southeastern Nigeria. Methods A comparative intervention-based study was conducted among 1,600 participants from eight communities in Obowo and Owerri-North Local Government Areas, southeastern Nigeria. Malaria prevalence was assessed before and after implementation of selected interventions, including insecticide-treated nets (ITNs), antimalarial drugs, indoor residual spraying (IRS), sanitation, and health education. Descriptive statistics were used to determine malaria prevalence, while Pearson’s chi-square test was used to determine the association between malaria infection status and selected demographic and intervention-related categories. Statistical significance was considered at a threshold of p < 0.05. Results Overall malaria prevalence was 26.12%. Prevalence was significantly higher in Obowo (36.38%) than in Owerri-North (15.88%) (χ² = 87.10, p < 0.001). Males had significantly higher prevalence (36.23%) than females (18.46%) (χ² = 64.21, p < 0.001), while prevalence differed significantly across age groups (χ² = 25.53, p < 0.001). Following implementation of single interventions, malaria prevalence declined to 9.52% (70/735), with the lowest prevalence recorded in the ITN group (4.59%) and the highest in the control group (17.14%). The difference among intervention categories was significant (χ² = 25.41, p < 0.001). Combined interventions produced a further reduction to 4.62%, with infection prevalence of approximately 2.55%, 2.14%, and 3.89% among the ITN + sanitation, drug + education, and IRS + ITN groups, respectively. The combined intervention categories differed significantly (χ² = 11.00, p = 0.012). Conclusion Malaria prevalence was significantly associated with geographical location, sex, age, and intervention strategy. Both single and combined malaria control interventions were associated with substantial reductions in malaria prevalence, with combined interventions demonstrating a stronger overall reduction. Integrated malaria control incorporating vector control, appropriate treatment, sanitation, and health education may therefore provide a more effective strategy for reducing malaria transmission in rural and urban communities of southeastern Nigeria.