Abstract
Malaria remains a leading cause of morbidity and mortality among children under five globally, with Nigeria accounting for a disproportionate 31% of global malaria deaths. Despite established World Health Organization (WHO) and national guidelines, a significant gap exists between policy and actual household practice, as only 20% of malaria cases in rural areas are treated in official health facilities. This study aimed to evaluate current home-based malaria management (HMM) practices, identify factors contributing to the high malaria burden, and define the specific roles of caregivers in bridging the management gap. A qualitative research approach was employed using a narrative review design. A total of fifty-four (54) literatures published between 2017 and 2025 was systematically synthesized from databases including PubMed, Google Scholar, and Scopus, alongside reports from the WHO and the Nigerian Federal Ministry of Health. Findings reveal that cases of malaria treated at home is significantly more than the cases of malaria treated in an official health facility. Home-based management is characterized by a high reliance on paracetamol monotherapy (45–69%), the use of herbal concoctions (22%), and widespread self-medication without diagnostic testing. These practices are driven by socioeconomic barriers (poverty and high transport costs), cultural misconceptions (attributing fever to teething or witchcraft), and a lack of awareness regarding Rapid Diagnostic Tests (RDTs). The review establishes that caregivers are the primary "first responders" in the malaria control framework. Optimizing their role through health education, ensuring access to subsidized RDTs at community drug stores, and enforcing adherence to full ACT regimens is critical to reducing under-five mortality. The study concludes that achieving malaria elimination targets in Nigeria requires a strategic shift from facility-centric models to caregiver-inclusive, household-level interventions. Recommendations include the institutionalization of Integrated Community Case Management (iCCM) and the intensification of behavioral change communication to empower caregivers as active public health agents.