Empirical Investigation Into The Patterns and Trends of Occurrences of Malaria Cases in Ekiti State, Nigeria: An Analysis of The Skewed ARMA

International Journal of Banking, Finance, Management &
Development Studies Vol. 3, No. 1, 2015
Empirical Investigation into the Patterns and Trends of

Occurrences of Malaria Cases in Ekiti State, Nigeria: An Analysis
of the Skewed ARMA
1Abatan, S. Matthew:
2Afolabi Babatunde (Ph.D):
Abstract
The paper empirically investigated the patterns and trends of

occurrences of malaria cases in Ekiti State, Nigeria, using the Skewed
ARMA. Data of reported malaria cases and treatment for the period
between 2010 and 2013 were obtained from some selected
government hospitals which included 2 Teaching Hospitals, 3 General
Hospitals and 2 Local Health Centers. The group autoregressive
shows significant relationship at 5% level of significance with Fisher
Chi-Square value =50.3238, p=0.000 at maximum lag (1), the
individual effects also give a p-value <0.05 for Teaching Hospitals,
General Hospitals and Local Health Centers. The increasing trends
seen in annual cases, when comparing the mean of each category
during the post intervention period to the pre intervention period, the
results show equality of mean and even greater than mean in the
case of teaching hospitals. Seasonal peaks also appeared higher in
the post intervention period compared to pre intervention period. The
implication is that the interventions do not necessarily reduce the
malaria cases among hospitals categories in Ekiti State.
The study therefore recommends that solution to the occurrences of
malaria should not be limited to anti malaria and laboratory methods
alone but should encompass multifaceted interventions such as
immunization, sanitation, health education, nutrition supplementary,
portable water, exclusive breastfeeding and maternal health
(antenatal and postnatal care).
Key words: Malaria cases, Mosquitoes, Prevention, Vulnerability, Nigeria
1
Abatan, S. Matthew: Statistician II at the Department of Demography and Social
Statistics, Federal University Oye; Oye Ekiti, Nigeria; abatansmo@yahoo.com; +234 806
6066 473,
2
Afolabi Babatunde (Ph.D): Department of Banking and Finance, Afe Babalola University,
Ado Ekiti Nigeria; atunne@gmail.com; +234 803 5029 400;
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Abatan, S. Matthew & Afolabi Babatunde (Ph.D): Empirical Investigation into the
Patterns and Trends of Occurrences of Malaria Cases in Ekiti State, Nigeria: An
Analysis of the Skewed ARMA
Background of the Study
The geographical location of Ekiti State, Nigeria makes the climate suitable for
malaria transmission throughout the State and in Nigeria as a whole. Nigeria is
estimated to have 97% of his population at risk of contracting the disease while the
remaining 3% of the population who live in the mountains in southern Jos( Plateau
State) at an altitude ranging from 1200 to 1400 meters are relatively low risk to
malaria infection (NMIS;2010).
Malaria-related mortality account for up to 11% of maternal mortality and

contribute up to 25% of infants mortality and 30% of under 5years mortality
resulting into 300,000 childhood death annually. The disease is highly seasonal
with varying of transmission owing to altitudinal and climate variations. The
occurrence of malaria epidemic remains a major cause of morbidity and mortality in
sub-Sahara African with about 75% of death in children less than age 5 ascribed to
the diseases. Most malaria endemic countries are deploying indoor residual
spraying (IRS), artemisinin-based combination therapies (ACTs) and/or long-lasting
insecticidal nets (LLINs) to combat malaria transmission (Emmanuel Chanda & co,
Malaria Journal 2012). Despite different efforts to combat this epidemic, malaria
still remains a major issue in most developing countries. Malaria affects 3.3 billion
people in the world every year (MIS, 2010). ―World Health Organization (WHO)
estimates 216 million world cases of malaria occurred in 2010 with 81% from the
African Region. WHO estimated that there were 655,000 malaria deaths in 2010,
with 91%f from the African Region and 86% were children under 5yrs of age.
Malaria is the second leading cause of deaths from infectious diseases in Africa
after HIV/AIDS. Almost 1 out of 5 deaths of children under 5 in Africa is due to
malaria and 97% of Nigerian population is at risk of contracting malaria‖ (NDHS
Malaria Facts sheet, 2010).
In Ekiti state, the most prevalent species of malaria parasite is plasmodium

falciparium having the prevalent rates greater than 97% (MIS, 2010). It is
responsible for most severe forms of infection while other types are found to play
minor role.
Types of Malaria Parasites
There are four species of Plasmodium that can cause malaria. Each species of the
protozoa exhibit slightly different symptoms in the infected patient as noted by
Abatan (2014).
The most common parasite that affects millions of people in Africa, South East Asia
as well as South America is Plasmodium falciparum. It is said to be the deadliest
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parasite that leads to the majority of deaths. Those infected with Plasmodium
falciparum show the following signs of infection: Dizziness, Fatigue, Abdominal
pain, Muscle pain, Enlargement of the spleen, Back Pain, Joint aches,
Seizures, vomiting, fever, severe anemia, Headache, etc.
One needs immediate treatment for this infection or else the disease may affect the
central nervous system. This may lead to complications such as convulsions, loss of
consciousness as well as paralysis.
Plasmodium Vivax: The most common species of Plasmodium found around the
world is Plasmodium vivax. This parasite causes a minor illness and deaths are very
rare. Some symptoms caused by Plasmodium. vivax are as follows: Diarrhea,
fatigue, Chills, fever.
Plasmodium Ovule: This is a very rare species of the parasite Plasmodium. It is

found in the African region. Plasmodium ovule causes symptoms similar to
Plasmodium vivax. It can cause a relapse and infect the Red Blood cells (RBCs) in a
few months to years in a cured patient. This is because the parasite tends to live
in the liver of the patient.
Plasmodium Malaria: Plasmodium malaria causes the least number of infections

worldwide. It commonly causes infections in South and Central America, Africa and
South East Asia. An infection with Plasmodium malaria causes high grade fever
and chills.
World Malaria Day
World Malaria Day was established in May 2007 by the 60th session of the World
Health Assembly, the decision-making body of the World Health Organization. The
day was established to provide "education and understanding of malaria" and
spread information on "year-long intensified implementation of national malaria-
control strategies, including community-based activities for malaria prevention and
treatment in endemic areas."
Prior to the establishment of World Malaria Day, Africa Malaria Day was held on
April 25. Africa Malaria Day began in 2001; one year after the historic Abuja
Declaration was signed by 44 African malaria-endemic countries at the African
Summit on malaria. (World Malaria Report 2010)
Strategic Intervention for Malaria Control
The initiative known as the Malaria Eradication Programme (MEP) relied on massive
indoor residual spraying of Dichloro-Diphenyl-Trichloroethane (DDT) with the goal
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of eradicating malaria completely-Alilio, et al (2004). Over the years, the strategies

for malaria control in Nigeria since 2000 was an agreement league signed by other
African Countries on Declaration and Plan of Action to halve the burden of Malaria
in 2010 through:
 Prompt diagnosis and treatment with effective medicine –artemisinin-based

combination therapies (ACTs).
 Distribution of insecticide-treated nets (ITNs) to achieve coverage of
population at risk, especially pregnant women and children under 5 years.
 Indoor residual spraying (IRS) to curtail transmission.
 Prevention of malaria in pregnancy through intermittent preventive
treatment.
Nigeria has implemented two strategic plan that prioritized the most biologically
vulnerable groups; the first covering was 2001-2005 and the second which was
originally planned to cover the period of 2006 -2010 was revised to cover the 2009-
3013 to respond to new global direction of malaria control effort—which request the
building up interventions not only among the biologically vulnerable groups but
also among all population at risk for malaria. The 2009-2013 National Strategic
Plan for Malaria Control (NSPMC) in Nigeria was developed by the National Malaria
Control Programme (NMCP), the Roll Back Malaria (RBM) partner.
Ekiti State has benefited from this national health strategic plan of the Federal
Ministry of Health which aims to increase access to effective healthcare by
deploying health extension worker to provide treatment at local health centers and
general hospitals. The implementation of the catch-up strategy has involved house-
to-house distribution of nets cards, which entitles every household to at least two
LLINs. This strategy was meant to deliver over 63 million nets to the 150 million
Nigeria population by the end of 2010 and 2014 respectively.
Ekiti in particular was covered November/December 2010 by Global Fund-National

Malaria Control Programme. Other LLINs distribution campaign include
government that have distributed million of LLINs to increase net coverage levels,
Global Fund Malaria grants have also allowed distribution of more than 4 million
LLINs in 18 states between 2007 and 2009, world bank Booster Programme also
commensurate the effort.
The main objectives of this study are:
i. To investigate the patterns and trends of malaria cases in Ekiti State.

ii. And also, to examine the relationship between malaria intervention and the
occurrences of malaria cases in Ekiti State.
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Attempts will also be taken into consideration into factors which affect malaria
cases in hospitals and to employ statistical approaches focused on assessing
changes in trends of malaria cases before and after intervention since 2010.
The results are discussed in light of the target impacts.
Research Methodology
Ethical Clearance
Ethical clearance was received from Ekiti state Ministry of Health, research and
Ethic Committee, Ekiti State Teaching Hospital, (ESUTH) Ado-Ekiti and Federal
Medical Centre (FMC) Ido-Ekiti before the release of permission to get records from
the health facilities in the state.
Intervention Coverage
Malaria Control Intervention Information on LLINs, IRS and ACTs was obtained
from the Nigeria Malaria Indicator Survey and Malaria Department Primary Health
Division, Ekiti State Ministry of Health. As the programme started implementation
of LLINs between 2001 and 2010
The number of LLINs distributed to each local government was recorded. The
number of insecticide treated mosquito nets available before 2010 was assumed to
be small compared to the population at risk. The proportion of the population
potentially protected by LLINs in a given year was very small (<50%) The proportion
of availability of ACT treatment in the hospital was assessed and was found to be
1.08 patients but the hospitals that were visited disclosed that most patients
engaged in self-medical and just a few percentages visited the hospital to access the
treatment.
Malaria Cases
Data on malaria outpatient case were obtained from the three categories of health
facilities provide in-patients services; local health centers, general hospital and
teaching or specialist hospitals. The public health facilities in the state were divided
into three categories in the sample frame: Teaching Hospitals (2), General Hospitals
(3) and local Health Centers (2)
The total numbers of patients who visited hospitals for malaria treatment were
recorded in two age groups (less than 5years of age and above 5years old, suspected
outpatient malaria cases define a visit in which malaria was the preliminary
diagnosis in the outpatient record.
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Statistical Preliminaries
Let rt denote the malaria cases at time t. Then, the returns process can be defined
as
……………………………….(1)
Where is the conditional expected returns function which may be time

variant; corresponds to innovation in the return at time t and is set of
conditioning information based on past history of . In the classical time series
analysis framework, it is common to model a stationary Autoregressive-Moving-
Average (ARIMA) model. The general formulation of a stationary ARIMA (m, n)
models is
∑ ∑ …………………… (2)
Where , i= 1, 2, 3…m and , j=0, 1, 2 ….n are real constants, (

and is a white noise process with constant variance . An ARIMA (m,0) model
is referred to as an autoregressive model of order m denoted by AR(m); while an
ARIMA (0,n) modeling referred to as moving average model of order n and is denoted
by MA(n). The disadvantage of the ARMA models for modeling malaria series is the
assumption of constancy of the innovation variance.
In this study the ARIMA framework for modeling conditional mean is retained and
we allow denote an GARCH process which may have Gaussian or non-
Gaussian distribution denotes standard deviation of innovation at time t.
Statistical Methods
Eview 7 and SPSS 20 were used to compute data, Statistical analysis was carried
out on malaria cases by hospital categories.
Change indicator was evaluated in three (3) ways:
(i) Comparing the mean of annual value of malaria cases by hospitals between
2010 and 2013.
(ii) Using segmented regression model of an interrupted time series comparing
observed values in 2011 to predicted values in 2010 and 2011 to predict
values in 2012 and 2013 which was assumed to be pre-intervention time and
post intervention time respectively.
(iii) The magnitude of change indicator was expressed as relative percentage for
pre-intervention period.
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The time series regression model for the segmented regression model using ARIMA
model was used, a correlogram and partial autocorrelation plot were used to guide
selection of the best model. Month-to-month variability in indicator was examined
using monthly values of the indicators during pre and post intervention periods
using sinusoidal functions to observe and removed the short-term seasonal
fluctuation. The monthly trends were extracted using a Hodrick-Prescott filter with
monthly smoothing parameter spectral analysis was done to detect the fundamental
frequency components of the series.
To provide insight into whether changes in malaria cases were related to

introduction of malaria intervention or insufficient intervention strategy in time, a
sensitivity analysis was done by dividing the time series into two segments a pre-
intervention and post intervention period and varying the dividing point and
evaluating the segmented regression model for each break point. The optimal
breakpoint or the month with the maximum change in the trend line was consider
to be the point where the amount of variation account for the segmented regression
model R2 was greatest.
Findings and Results
The trend and patterns of malaria cases in local health center shows an upward
trends in 2010 and later experienced a down ward drop before making stability and
oscillation pattern 2012 and 2013 showed an upward trend from second to fourth
quarter (See figure 1)
General Hospitals have a downward slope in the 3rd quarterly and 4th quarterly in
2010 but later increased in 2011 and later maintained stationarity in 2012 but
arbitrary upward shot in the last quarter of 2013. (See figure 2)
Also, Teaching Hospitals witnessed a downward trend in the said period and later
showed upward trend from the 4th quarter in 2010 till 3rd quarter of the same year
(See figure 3)
The irregularity series led to the unit root test that was carried out , the null
hypothesis of having unit root was rejected in favor of stationarity at lag 1 using
Augmented Dickey-Fuller test statistic at p-value < 5% level of significance.
Page | 169
Table 1: Magnitude of annual reduction and increase in average malaria cases

by hospital categories
Percentage Percentage Percentage

YEAR Annual Annual Annual
Increase/ Increase/ Increase/
mean(LHC) mean(GH) mean(TH)
Reduction Reduction Reduction
2010 582.08 0 40.83 0 244.88 0
2011 410.92 71% 56.83 139% 280.50 115%
2012 538.00 131% 58.75 103% 379.75 135%
2013 567.33 105% 84.75 144% 507.08 134%
Overall
Monthly 524.58 102% 60.29 128.67% 353.05 128%
Mean
Source: Computed from data
The autoregressive moving average from the sample of 8 hospitals visited the data
on malaria cases covering the 2010-2013 which were the basis for the analysis of
this study. Although there are some missing records these were the periods the
health facilities were on strike these occur in local health centers and general
hospitals when the trends fall to zero in 2011 and 2010 respectively. The annual
average malaria cases confirmed in the 3 local health centers decrease by 29% form
2010 – 2011, but increase by 31% form 2011 -2012 and later percentage of annual
increase reduced to 5% from 2012 – 2013. The annual average malaria cases
confirmed in the 3 general hospitals increased by 39% form 2010 – 2011, but the
annual percentage increase reduced to 3% form 2011 -2012 and later increased to
44% from 2012 – 2013.
The annual average malaria cases confirmed in the 2 teaching hospital (Ekiti State
Teaching Hospital and Federal Medical Center) increased by 15% form 2010 – 2011,
also increase by 35% form 2011 -2012 and annual percentage increase reduced to
34% from 2012 – 2013. The group autoregressive shows significant relationship at
5% level of significance with Fisher Chi-Square value =50.3238, p=0.000 at
maximum lag (1), the individual effects also give a p-value <0.05 for Teaching
Hospitals, General Hospitals and Local Health Centers, the seasonal pattern of
average is given below in figure 1-4.
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THE TRENDS OF MALARIA CASES IN LOCAL HEALTH CENTRESIN EKITI STATE (PILOT SURVEY)
2010-2013
1,200
1,000
800
600
400
200
Figure 1 0
I II III IV I II III IV I II III IV I II III IV
2010 2011 2012 2013
THE TRENDS OF MALARIA CASES IN GENERAL HOSPITALS IN EKITI STATE (PILOT SURVEY)
2010-2013
350
300
250
200
150
Figure 2 100
50
0
2010 2011 2012 2013
TEACHING HOSPITAL
900
800
700
600
500
Figure 3 400
300
200
100
0
2010 2011 2012 2013
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The trend can study better using the mean seasonal variation of malaria cases in
the hospital categories, the red line cutting the graph follows an upward trends
The graphical presentation shows the pattern of mean seasonal variation of

malaria cases in Local Health centre (LHC), General Hospital (GH) and
teaching Hospital (TH)
LHC by Season
1,200
1,000
800
600
400
200
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Figure 4
GH by Season
400
300
200
100
0
Figure 5
TH by Season
1,000
800
600
400
200
0
Figure 6
Means bySeason
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International Journal of Banking, Finance, Management
& Development Studies Vol. 3, No. 1, 2015
Respectively
Regression line with relationship between the malaria cases in local health centre
to that of General Hospital and Teaching Hospital. The scatter plots show a
progressive upward relationship from teaching hospital but a dropping slope
from General hospitals.
400
300
GH
200
100
0
0 200 400 600 800 1,000 1,200
LHC
Figure 7
1,000
800
600
TH
400
200
0
0 200 400 600 800 1,000 1,200
LHC
Figure 8
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Abatan, S. Matthew & Afolabi Babatunde (Ph.D): Empirical Investigation into
the Patterns and Trends of Occurrences of Malaria Cases in Ekiti State, Nigeria:
An Analysis of the Skewed ARMA
SEGMENTED REGRESSION LINE
Local Health Center
The segmented regression line making the preliminary period of intervention as

the predictor variables (Xi) and Yi as post intervention in the local health centers
is given by Y = 647.877755556 - 0.0830237178773*X . the residual, fitted and
actual line graph is given in figure 4 below.
Malaria cases by age group

500
400
300
200
100
0
2010 2011 2012 2013
under 5yrs above 5yrs
Figure 9
1,200
1,000
800
600 600
400 400
200 200
0 0
-200
-400
-600
2 4 6 8 10 12 14 16 18 20 22
Residual Actual Fitted

Figure 10
Page | 174
The test of equality of means between pre- intervention and post intervention
shows an insignificance difference at 5% in the t-test and Satterthwaite-Welch t-
test. This therefore indicates that the means of malaria cases between the
periods are the same.
Table: Test for Equality of Means Between Series
Method df Value Probability
t-test 42 -1.048971 0.3002
Satterthwaite-Welch
t-test* 38.60799 -1.048971 0.3007
Anova F-test (1, 42) 1.100341 0.3002
Welch F-test* (1, 38.608) 1.100341 0.3007
*Test allows for unequal cell variances
Analysis of Variance
Source of Variation df Sum of Sq. Mean Sq.
Between 1 41297.82 41297.82
Within 42 1576337. 37531.83
Total 43 1617635. 37619.41
Sources: Computed from data
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General Hospital

the predictor variables (Xi) and Yi as post intervention in the general hospitals
is given by Y = 0.752883859128*X + 34.9841715459 . The residual, fitted and
actual line graph is given in figure 5 below.
Figure 11
400
300
200
300
100
200
0
100
-100
2 4 6 8 10 12 14 16 18 20 22 24
shows an insignificance difference at 5% in the t-test and Satterthwaite-Welch t-
test. This therefore indicates that the means of malaria cases between the
periods are the same
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Table: Test for Equality of Means Between Series
t-test 46 -1.716438 0.0928
Satterthwaite-Welch t-test* 31.16656 -1.716438 0.0960
Anova F-test (1, 46) 2.946161 0.0928
Welch F-test* (1, 31.1666) 2.946161 0.0960
Between 1 6302.083 6302.083
Within 46 98397.83 2139.083
Total 47 104699.9 2227.658
Sources:
Computed
from Data
Page | 177
Teaching Hospital

the predictor variables (Xi) and Yi as post intervention in the selected teaching
hospitals is given by Y = 0.189913261743*X + 393.528826723. The residual,
fitted and actual line graph is given in figure 6 below.
Figure 12: Teaching Hospital Residual, trend and actual graph
1,000
800
600
400
400
200 200
0 0
-200
-400
2 4 6 8 10 12 14 16 18 20 22 24
shows an significance difference at 5% for both the t-test and Satterthwaite-
Welch t-test. This therefore indicates that the means of malaria cases during pre-
intervention between post-interventions periods are not equal.
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Test for Equality of Means Between Series
A
t-test 46 -4.716531 0.0000
Satterthwaite-Welch t-
test* 44.93045 -4.716531 0.0000
Anova F-test (1, 46) 22.24566 0.0000
Welch F-test* (1, 44.9305) 22.24566 0.0000
Between 1 391956.4 391956.4
Within 46 810494.7 17619.45
Total 47 1202451. 25584.07
Sources:
Computed
from Data
Page | 179
Discussion and Conclusion
This study reviewed data from selected hospitals in Ekiti state, data obtained
showed that malaria cases kept increasing between 2010 and 2013. Among all
age groups, the number of confirmed malaria cases, malaria inpatient cases and
while malaria inpatient cases and among children under 5 years old are not
necessarily decreased from the numbers predicted if levels at the start of the
decade had persisted. The observed declines in malaria cases in LHC at the
beginning of the trends were seen across all categories where malaria
transmission occurs and could not be accounted for whether the intervention is
the cause of upward changes in outpatient visits or by the number of diagnostic
tests performed.
The Pattern of Malaria Frequencies
The pattern of malaria infection in Ekiti as seen in the selected hospitals showed
that the frequency of incidence were highest between the late first quarter and
early third (3rd) quarter among hospital categories year in year out which happen
to be rainy season (See Figure 1-3) which favours the breeding place of the
malaria vector mosquito such as bushes, swampy areas, stagnated drainage,
water log to mention but a few (Madukosiri, 2012). The upward trend in malaria
cases among hospital categories was consistent across several approaches in the
time series analysis. Comparing the observed number of cases in 2010 -2011 to
the level predicted in 2012-2013 by extrapolating trends from the first 2 years of
the time period of malaria interventions, resulted into non significance p-value at
5% measured decrease in cases. For confirmed cases, this can be explained in
part by a huge increase in cases during the baseline period resulting in a lower
predicted level in 2012 -2013 than the actual mean level during the 2012 -2013.
In addition to the increasing trends seen in annual cases, when comparing the
mean for each month during the post intervention period to the same month in
the pre intervention period the results show equality of mean and even greater
than mean in the case of teaching hospitals. Seasonal peaks also appeared
higher in the post intervention period compared to pre intervention period. The
implication is that it does appear that the interventions do not reduce the
malaria cases among hospitals categories in Ekiti State.
The pattern of mean seasonal variation of malaria cases in local health Centers
(LHC), General Hospitals (GH) and Teaching Hospitals (TH) follow the same
pattern with least mean in October to February and pick up again from April
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through June and August (see Figure 4-7). Therefore, any intervention
techniques concentrate on this critical period so as to properly eradicate
mosquito vector inhabiting malaria.
Malaria Infection of Less than 5 years old and other Population
The reported Malaria cases has shown patterns that appear positive outcome in
the less than 5 years old in the population during intervention period of 2011 but
later shot up in late 2012 and 2013. Unfortunately, the mean cases of other
population did not show any implication of intervention whatsoever see Figure 9.
Hence, the intervention strategies should be well funded to carter for all
population.
Malaria and Rollback Malaria 2020
The hospital data analyzed for this study also indicated that there were increases
in reported cases even after interventions which suggest that the interventions
were not effective because of high population. The proportion of population
potentially protected with LLINs increased but negligible prior to mass LLIN
distribution in 2010-2011. The population at risk keeps increasing because of
the new federal university, Oye Oye Ekiti just created in 2011 and influx of
students since 2012 and 2013.
By analysis of data on routines at hospitals on malaria, ACTs were available in

more than 90% of facilities after they were introduced but were not sufficient
recent years (during 2012-2013) compared to that of the early post intervention
period (2010–2011). This may be partly due to high population increase in the
state which therefore has effect on interventions provision. It may also be
attributed to relatively relaxed attitude of health facilities to changes to the new
trend by increasing their requisition on some of the common. A portion of LLIN
distributed in 2010–2011 may also have been lost or rendered less effective
during 2012–2013 due to reduced physical integrity and insecticidal waning after
their estimated three year effective lifespan. The measure of ACT availability used
in this study, based on documentation of ACT showed stock outs at facilities, so
it does not provide a direct measure of what proportion of patients with malaria
actually received adequate treatment, therefore it is unknown if changes in
treatment patterns had an any desired effect.
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Implication of Malaria Pattern on Policy Formulation/Planning and

Economic Development
Medical statistics or health statistics has been a helpful instrument for

formulating government policy relating to health issues. It has been identified
that health data is one of the benchmark for health policy to curb increase
incidences and achieving government goals such as under utilization of economic
resources. Policy formulation and planning are government actions taken to
achieve its goals and objectives (Oni Tope, 2014). Projects not well funded will be
abandoned no doubt about that. This could be the situation in Ekiti state, for
examples ignoring the other member of the population could be due to lack of
fund. One single bite from an infective female anopheles mosquito vector is
enough to starts the transmission circle all over thereby making the Roll Back
Malaria Vision 2020 an effort in futility.
Economic and Demographic Implications of Malaria Infection
Scholars have estimated that the economic cost used in preventing and in the
treatment of malaria infection in Africa alone was adequate to feed the continent.
Madukosiri (2012) reported that about 12 billion US dollars is spent annually to
combat malaria. Malaria had also been estimated to be responsible for high
infant mortality rate, child mortality and maternal mortality (MIS, 2010) and
huge amount of money been spent yearly has little to show for it. It should be
noted that the population growth rate in Ekiti is faster than the rate of
intervention. With the influx of students, staff and businessmen, is another
indicator for lack of effectiveness of the intervention. This study by extension is
looking at the 97% population at risk of being infected with malaria and
considering most of these populations seek for self-medications. This means that
Ekiti will be spending a large part of their income on malaria treatment. These
resources could be channeled to other productive sector of the economy that
could help to enhance economic development. We urgently need to fight the
scourge of malaria once and for all like the western world through collective
efforts with clean environment and sleeping under the provided treated nets.
Malaria and Malnutrition
Different scholars have discovered that there is a positive relationship between

malnutrition and malaria infection. Chanadra,1980 was quoted by Madukorisi
(2012) who said that malaria and malnutrition relationship is strengthened by
the facts that many children and adult from developing countries including
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Nigeria are deprived of quality nutrition as such when they are infected with
malaria, the overwhelming experience tell on the individual nutritional status.
Children who lack sufficient nutrition will experience weakened immunity and
strength to fight the infection thereby leading to severity of infection of the
individual. Therefore solution to the problem should not be limited to anti
malaria and laboratory methods but encompass multifaceted interventions such
as immunization, sanitation, health education, nutrition supplementary, portable
water, economic and environmental development, breastfeeding, maternal health
and the likes.
Challenges
A key challenge in assessing the patterns and trends in the occurrences of

malaria cases in Ekiti State, Nigeria is the challenge of getting the historical
variability in referenced years on malaria transmission reliable sources. The
method of health records system really affected the accessibility of the data as
many data are lost due to paper records, misplaced or lost due to change of
heads. Other key challenge is the cost to run the study. However, given the
number of hospitals and the time period reviewed may have been too little to
reveal longer term trends in malaria transmission that may have been unrelated
to malaria interventions. Visiting hospitals and reviewing data at hospitals
helped in minimizing reporting bias present in routine surveillance.
Recommendations
This study was undertaken to empirically investigate the patterns and trends in
the occurrences of malaria in Ekiti State, Nigeria. Also attempt was made to
account for reporting inconsistencies among health record office in Ekiti State. It
is on the premise of the above that the study offers the following policy
recommendations:
 It is suggested that to effectively check malaria infection in Children, the

solution to the problem should not be limited to anti malaria and
laboratory methods but encompass multifaceted interventions such as
immunization, sanitation, health education, nutrition supplementary,
portable water, and exclusive breastfeeding, maternal health (antenatal
and postnatal care).
 Also, government expenditure used in acquiring preventive interventions
to combat common ailment like malaria can be channeled to other
productive sector of the economy that could help to enhance economic
Page | 183
development. We should aim to fight the problem of malaria infection once

and for all like the western world through collective efforts with clean
environment and by sleeping under the provided treated mosquito nets.
 There is the urgent need to have accurate data will help authorities to
know the pattern and prevalent rate in order to provide the necessary and
adequate intervention to fight this epidemic.
 Lastly, the intervention strategies should be well funded to carter for all
population at risk for better effectiveness of the intervention efforts.
Acknowledgments
We thank Ministry of Health of the Ekiti State Government Nigeria, Ekiti

databank and the health staff who were involved in data collection and
supervision in all hospitals and ethical committees in Ekiti State University
Teaching Hospital (EKSUTH) Ado-Ekiti and Federal Medical Centre (FMC), Ido
Ekiti, especially Dr. Obi Makinde and Dr Alao respectively. Also our appreciation
goes to the different health record officers in hospitals visited: Mr. Afolabi
(General Hospital Oye), Mrs. Oni (General Hospital Ifaki), Mrs. Akinyemi
(EKSUTH), High Chief (Mrs.) Adeleke (Health Centre Ado-Ekiti) Mrs. Oba (Health
Centre, Oye-Ekiti) and others in Ikole General Hospital.
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Empirical Investigation Into The Patterns and Trends of Occurrences of Malaria Cases in Ekiti State, Nigeria: An Analysis of The Skewed ARMA

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International Journal of Banking, Finance, Management &

Development Studies Vol. 3, No. 1, 2015

Empirical Investigation into the Patterns and Trends of

The paper empirically investigated the patterns and trends of

Key words: Malaria cases, Mosquitoes, Prevention, Vulnerability, Nigeria

Background of the Study

Malaria-related mortality account for up to 11% of maternal mortality and

In Ekiti state, the most prevalent species of malaria parasite is plasmodium

Types of Malaria Parasites

Plasmodium Ovule: This is a very rare species of the parasite Plasmodium. It is

Plasmodium Malaria: Plasmodium malaria causes the least number of infections

World Malaria Day

Strategic Intervention for Malaria Control

of eradicating malaria completely-Alilio, et al (2004). Over the years, the strategies

 Prompt diagnosis and treatment with effective medicine –artemisinin-based

Ekiti in particular was covered November/December 2010 by Global Fund-National

The main objectives of this study are:

i. To investigate the patterns and trends of malaria cases in Ekiti State.

Where is the conditional expected returns function which may be time

Where , i= 1, 2, 3…m and , j=0, 1, 2 ….n are real constants, (

Change indicator was evaluated in three (3) ways:

To provide insight into whether changes in malaria cases were related to

Findings and Results

Table 1: Magnitude of annual reduction and increase in average malaria cases

Percentage Percentage Percentage

The graphical presentation shows the pattern of mean seasonal variation of

SEGMENTED REGRESSION LINE

Local Health Center

The segmented regression line making the preliminary period of intervention as

Malaria cases by age group

under 5yrs above 5yrs

Residual Actual Fitted

Table: Test for Equality of Means Between Series

Method df Value Probability

t-test 42 -1.048971 0.3002

Anova F-test (1, 42) 1.100341 0.3002

Welch F-test* (1, 38.608) 1.100341 0.3007

*Test allows for unequal cell variances

Source of Variation df Sum of Sq. Mean Sq.

Between 1 41297.82 41297.82

Within 42 1576337. 37531.83

Total 43 1617635. 37619.41

Sources: Computed from data

The segmented regression line making the preliminary period of intervention as

Residual Actual Fitted

Table: Test for Equality of Means Between Series

Method df Value Probability

t-test 46 -1.716438 0.0928

Satterthwaite-Welch t-test* 31.16656 -1.716438 0.0960

Anova F-test (1, 46) 2.946161 0.0928

Welch F-test* (1, 31.1666) 2.946161 0.0960

*Test allows for unequal cell variances

Source of Variation df Sum of Sq. Mean Sq.

Between 1 6302.083 6302.083

Within 46 98397.83 2139.083

Total 47 104699.9 2227.658

The segmented regression line making the preliminary period of intervention as

Figure 12: Teaching Hospital Residual, trend and actual graph

Residual Actual Fitted

Test for Equality of Means Between Series

t-test 46 -4.716531 0.0000

Anova F-test (1, 46) 22.24566 0.0000

Welch F-test* (1, 44.9305) 22.24566 0.0000