A Theoretical Framework for Malaria Elimination in Nigeria: Integrating Epidemiological, Entomological, and Health Systems Evidence

Nigeria contributes the highest global share of Plasmodium falciparum malaria cases, and theoretical frameworks guiding elimination strategy must reconcile complex, multi-level evidence spanning entomological, epidemiological, and health systems domains. This doctoral study developed and validated a context-specific theoretical framework for malaria elimination in Nigeria, drawing on a comprehensive synthesis of evidence from the country's six geopolitical zones. A mixed-methods design combined a systematic review of Nigerian malaria epidemiology literature published between 2019 and 2024, primary cross-sectional entomological surveys in six sentinel states, qualitative health systems analyses using the WHO building blocks framework, and a two-round modified Delphi process engaging 42 malaria experts. The resulting framework identifies four strategic pillars: stratified transmission targeting informed by high-resolution prevalence mapping, adaptive vector control integrating resistance management, health systems infrastructure for sustained diagnostic quality, and community engagement models ensuring equity in coverage. The framework proposes a phased elimination pathway with milestone indicators calibrated to Nigeria's sub-national epidemiological heterogeneity. Structural equation modelling of integrated indicator data validated the framework's predictive validity (CFI = 0.94, RMSEA = 0.048). The study makes an original theoretical contribution to the malaria elimination science literature and offers an operationally grounded roadmap for the Nigerian National Malaria Elimination Programme. Keywords: malaria elimination, theoretical framework, Nigeria, health systems, epidemiological stratification.