Health Systems Barriers to Malaria Diagnosis and Treatment Among Marginalised Urban Poor in Kaduna City

Marginalised urban poor populations face compounded health system barriers to malaria services in Nigeria's rapidly growing secondary cities, including financial hardship, geographic proximity issues, and provider attitudes. This study identified and characterised health system barriers to malaria diagnosis and treatment among urban poor households in selected slum communities of Kaduna City, Kaduna State, Northwest Nigeria. A qualitative study design employed 12 focus group discussions with 96 community members and 20 in-depth interviews with healthcare providers at proximate health facilities. Data were analysed thematically using the WHO health system building blocks framework. Five dominant barrier themes emerged: out-of-pocket cost of rapid diagnostic testing, perceived provider stigmatisation, structural facility overcrowding, physical distance to public health facilities in informal settlements, and unreliable drug availability. Community members described self-treatment with herbal medicines and patent medicines as the default first response due to cost and time constraints. Providers cited understaffing and inadequate diagnostic supplies as limiting quality care. The study recommends targeted health systems strengthening interventions for informal urban settlements, including community health worker integration and community-based health insurance linkages in Kaduna City. Keywords: health systems barriers, malaria, urban poor, Kaduna City, qualitative research.