“I have been down with Malaria fever several times and it’s most severe during exams period when I would have to write my exams from the school’s health centre. This situation stopped when I bought mosquito net and fixed it in my room. I wish there were centres for free distribution of mosquito nets,” – Uhunoma Osighena, a 400-Level Optometry student of the University of Benin, told healthnews.africa
In his view, Nigeria’s actions on malaria are very poor and little attention is being paid to it as it is assumed to pose little threat to the lives of Nigerians. This perception is shared by several Nigerians and Africans who daily bear the burden of a widely preventable and treatable disease that continues to kill one child every two minutes.
Malaria has been the top focus of health-focused organisations and established institutions and it has been tagged with its tropical peculiarities. In the United Nations’ SDG3, embedded among its target is to put an end to Malaria by 2030, therefore accentuating the seriousness of this deadly disease.
According to the World Health Organisation (WHO), the number of malaria cases globally fell from an estimated 262 million in 2000 (range: 205–316 million), to 214 million in 2015 (range: 149–303 million). Then the number of malaria deaths globally fell from an estimated 839,000 in 2000 (range: 653 000–1.1 million), to 438,000 in 2015 (range: 236,000–635,000), recording a decline of 48%.
The stats by WHO reveals the profound efforts and fight being put up to combat malaria across the world. Nevertheless, the Malaria Matter in Nigeria speaks less of the global effort put in place to battle its consequences.
Presently, Nigeria suffers the world’s greatest malaria burden, with approximately 51 million cases and 207,000 deaths reported annually (approximately 30% of the total malaria burden in Africa), while 97% of the total population (approximately 180 million) is at risk of infection. Moreover, malaria accounts for 60% of outpatient visits to hospitals and led to approximately 11% maternal mortality and 30% child mortality, especially among children less than 5 years.
Nigeria’s plan
Since 2008, the National Malaria Control Programme (NMCP) in Nigeria has adopted a specific plan, the goal of which is to reduce 50% of the malaria burden by 2013 by achieving at least 80% coverage of long-lasting impregnated mosquito nets (LLINs) together with other measures such as 20% of houses in targeted areas receiving indoor residual spraying (IRS), and treatment with two doses of intermittent preventative therapy (IPT) for 100% of pregnant women who visit antenatal care clinics.
What is causing the slurring response in the battle against malaria is still very bleak. according to Prof. Adeleye Efosa, a Professor of Paediatrics and Director, Centre for Malaria Care, Edo State General Hospital.
While speaking in Benin during a dinner hosted for media executives by the Family Health Department of the hospital, he delivered a lecture entitled: “Malaria Elimination In Nigeria: Where We Are & Where We Want To Be”. He stated that in the last five years, Nigeria recorded a decline in malaria prevalence in children under 5 and the situation of anaemia among pregnant women attending ante-natal clinics had reasonably declined, yet the standard target set by established institutions has not been attained.
“Nigeria is not yet out of the woods and the fight is far from over as millions of Nigerians remain at risk of malaria and new cases of malaria posing deaths still fluctuate,” he said.
Nigerian government agencies know the truth
Speaking to healthnews.africa, Managing Director of the Society for Family Health (SFH), Sir Bright Ekweremadu, blamed ignorance for the trend and noted that over US$ 3 billion is lost to malaria yearly due to out of pocket treatment and prevention costs. He said the sum lost to malaria annually could pay the annual salaries of 2.2 million Nigerians on minimum wage.
“Ignorance is deadly as studies have shown that a significant contributor to malaria’s deadly count in Nigeria is inadequate knowledge and information on the part of caregivers and the citizenry.
He said: “caregivers are inadequately empowered with appropriate health education to change their behaviour and use of malaria commodities” with consequences for prevention and treatment of the ailment.
Futhermore, the National Coordinator of the National Malaria Elimination Programme of Nigeria, Dr. Audu Mohammed told healthnews.africa that Nigeria may never get rid of malaria if private-sector agents like patent medicine vendors are not figured into delivery of malaria services.
“It is quite obvious a lot of people go to private sector to seek health care. If we don’t empower the private sector, we will not achieve malaria-free Nigeria,” said Mohammed. “Sixty percent of people go to private sector. If we don’t include them in implementation, we are missing a lot of people. When they are not included in area of data collection, it becomes a problem. We have to involve them in planning and implementation and collect their data for planning” he disclosed.
Regardless of the positive actions of the government towards rolling back malaria, several setbacks have been encountered which have actually made effective and sustainable control of the disease a mirage. These problems include: Drug resistance, drug dosage and compliance, dearth of quality control of drugs, inadequate malaria epidemiological data, dearth of effective rural drug distribution mechanism, widespread presumptive treatment and incorrect diagnosis/inadequate diagnostic equipment.
Malaria beyond #WorldMalariaDay
The struggle for emancipation of Nigeria from the malaria scourge should be a tactical, responsive and consistent one, the Federal Ministry of Health needs to show more attention to Non Communicable Diseases (NCDs) specifically Malaria. The government should sit up to place priority in sponsoring and implementing projects and polices formulated to cater for Malaria Cases.
In the light of beating down Malaria in Nigeria;
1). Tropical Disease Research (TDR) recommendations should be implemented to increase access to necessary drugs, more especially anti-malarial drugs. This will focus on home management and community directed models for malaria treatment.
2). Insecticide treated net (ITN) should be effectively distributed as it has shown prospects in malaria control in Nigeria. Presently there is a sluggish trend in the distribution of ITNs to local communities. Agencies like UNICEF and the Federal Ministry of Health are propagating the distribution of these effective and long lasting ITNs to primary health centers where its delivery to the local community level will be affected.
3). Indoor residual spraying which involves the treatment of all interior walls and ceilings with insecticides should be made a regular ritual because it is particularly effective against mosquitoes, since many will rest on an indoor wall before or after feeding.
4). Artemisin combination therapy (ACT) distribution must be urgently doubled to curb the rampant cases of Malaria. This drug comes in several brand names and should be subsidized and made widely available for prompt, effective and affordable treatment. This is in the hope that effective treatment will assist in reversing the apparently increasing death rates in African children.
‘There is still hope’
Notwithstanding, progress towards developing malaria vaccines has accelerated in the last decade. Increased funding, greater awareness, and advances in science and in vaccine technologies have reinvigorated a field that had been constrained by the absence of a traditional market, few developers, and the technical complexity of developing any vaccine against a parasite. It only requires more commitment and funding to give it a serious go.
The future still holds considerable promise with new dimensions being explored which include increased research funding especially towards vaccine development, policy formulation and implementation based on evidence, increased public health and environmental education, incorporation of the communities in activities towards malaria control as well as stepping up of ongoing control programmes and possibly integrating them into primary health care activities.
Malaria control in Nigeria and indeed other endemic countries will cease to be a mirage and become a reality with a little more strategic and prioritized effort. There is still hope.