Decades of efforts by various governments and their partners to roll malaria out of Nigeria have not been successful. Weekend Trust reports that rather than mitigate prevalence, malaria has remained high in the country.
As Nigerians are grappling with increase in prevalence, a bigger cause of worry for families lately has been the skyrocketing cost of treating malarial infections due to rising prices of the drugs.
In the last one year, the country has witnessed rising cost of medicines due to high import duties, as well as the exit of some multinational pharmaceutical companies like GlaxoSmithKline (GSK).
Weekend Trust searches revealed that many families are increasingly finding it difficult to meet up with the costs of over-the-counter medicines for malaria, as well as cost of treatment when they fall ill or are diagnosed with the ailment.
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Some of the families that spoke to our correspondents said they spent as much as N10, 000 for a single treatment for one person in the family and over N50, 000 if they had to go to health facilities to run tests and get treated.
Weekend Trust learnt that the cost for treatment is usually higher if the malaria is severe and the patient had to be admitted. The impact on the family’s finances is huge when three or more persons treat malaria in a month or frequently.
Checks by our correspondents confirmed the increase in cost of drugs. Some malaria medicines that used to cost N2,000 have risen to N8, 000 in the last few months, while the cost of some malaria injections have also risen by 100 per cent.
About the disease
Experts say malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female anopheles mosquitoes. The symptoms include fever, headache, vomiting, diarrhea, profuse sweating and anaemia.
Medical researches suggest that 70 per cent of payment for health care services in Nigeria is out-of-pocket expenditure, meaning that people pay most of their health care bills from their income.
As a result, some medicines have become scarce, while the cost of available ones increased.
Burden of malaria in Nigeria
Over 90 per cent of the population in Nigeria is estimated to be at risk of malaria.
A 2022 World Health Organisation (WHO) World Malaria report indicates that over 66 million cases of malaria occur annually in Nigeria.
The report states that Nigeria contributes 27 per cent to the malaria burden and 31 per cent to malaria deaths globally, implying that one out of every four persons who suffer from malaria, and one out of three deaths from malaria globally occur in Nigeria.
These translate into 22 persons dying every hour due to malaria in Nigeria; and according to the 2018 National Demographic and Health Survey (NDHS), children are the worst affected.
This is happening when some countries in the region have achieved elimination of the disease or are near elimination
The Coordinating Minister for Health and Social Welfare, Prof. Muhammad Ali Pate, confirmed recently that malaria continues to exert an unacceptable toll on Nigeria.
Speaking during the recent inaugural meeting of the Advisory on Malaria Elimination in Nigeria (AMEN) in Abuja, he said, “In 2022, over 180,000 Nigerian children under the age of five lost their lives to malaria – a tragedy we have the tools to prevent.”
The minister added that malaria reduces productivity, increases out-of-pocket health expenditures and compounds the challenges of poverty.
He said, “The annual loss to Nigeria’s Gross Domestic Product (GDP) from malaria exceeds $1.1 billion, a stark reminder of the economic imperative of elimination.”
Pate said the federal government was resolute in its commitment to eliminate malaria, revealing that the National Malaria Strategic Plan 2021-2025 targets to, amongst others, reduce malaria prevalence to below 10 per cent and halve malaria-related mortality by 50 deaths per 1,000 live births.
Impact of treatment on finances
Checks by our correspondents in some states showed that the rising cost of treatment is deeply felt.
‘It hasn’t been easy coping with treatment’
Families complain about high cost of drugs against the harsh economic condition in the country.
In Benue State, many families are groaning under the burden of malaria treatment, which cost they say weighs heavily on their finances.
Fidelis Tyobee decried how his family of seven spent at least N12,000 monthly to treat malaria despite their struggle for survival because he is jobless.
“At least four out of my five children come down with malaria monthly. We source money through my wife’s petty trading to buy drugs for them at the pharmacy and none of these treatments are below N2,500. In some instances, it would become severe and we would go to the hospital, where more money is spent. For instance, in October, one of my child’s malaria case was so severe that we had to rush her to the hospital in the middle of the night. She was admitted and we spent at least N35,000 for her treatment. After spending that money, which was my wife’s business capital, the business collapsed,” he said.
For Florence Ede, a single mother of one who earns N15,000 monthly as a cleaner, the high cost for malaria treatment alone takes out N5,000 from her income, leaving her with N10,000 to take care of feeding and transportation throughout the month.
She said, “It hasn’t been easy coping with the treatment of malaria from my meagre income. I rely on friends and family most times to feed me and my son. Sadly, we treat malaria on a monthly basis despite precautions to avoid falling ill.”
In the same vein, Dennis Tyo, who engages in manual labour for survival, decried the extent to which the high cost of malaria treatment has affected his daily income.
“I don’t have a regular job, so I often engage in manual labour in other people’s homes, for which I am paid between N5,000 and N8,000. The job does not come every day, so when I get home with such money and has to treat one or two of my children of malaria, sometimes including myself, I am left with nothing, so I have to borrow to sustain the family.
“The burden of malaria is really weighing me down,” Tyo said.
‘We have resorted to herbal medicines’
In Kebbi State, residents lamented their expenses in treating malaria. Some of the families that spoke with Weekend Trust said that after spending so much money on orthodox medicine, they resorted to herbal concoctions.
Hajiya Halima Yusuf, a petty trader at the old market in Birnin Kebbi, said her husband was still owing the hospital where three of their children were recently treated for malaria.
“The hospital charged us N56,000 to treat each of our children because they fell sick at the same time. Despite this, we were still asked to buy drugs from the pharmacy. It was too much for the family, whose breadwinner is a civil servant,” she said.
A father of five, Malami Sa’ad Alhassan, said he had expended a huge amount treating malaria in three months.
“I spent a lot until I couldn’t afford more charges, so had to resort to treating malaria with herbs,” he said.
Also, Amina Shehu explained that she treats malaria regularly because she lives near stagnant water at the Makera area of the state.
She said, “I only take Islamic medicine to treat malaria because of the high cost of drugs and hospital bills. Now, a single-dose drug for malaria treatment costs as much as N25,000, and hospital bills is as much as N46,000. I can’t afford it.”
Half of our monthly earnings spent on malaria – Bayelsa residents
Some residents of Yenagoa, Bayelsa State, also flayed the high rate of malaria infection due to mosquito bites, saying more than half of their incomes are spent on the treatment of the disease for themselves and family members.
They said that due to various swamps, creeks, unclean gutters, lack of potable water and yearly flooding, mosquitoes have found a safe haven for breeding in the state, causing frequent infections on residents.
A resident of Yenagoa, Mrs Ebiere Jury, said the major challenge for her and her family was that they don’t have much income to cater for their needs and treat malaria at the same time.
The mother of three disclosed that even the Control Malaria Department in the state Ministry of Health that used to give free insecticide treated nets is no longer doing so, a situation she said made most people sleep without nets because of the high price they are sold at the markets.
She said: “We are yet to receive the N80,000 minimum wage recently approved by the governor. And judging from the current salary, how much does it take for feeding and other family needs, before treating malaria?
“Usually, my family spends about N25,000 on a monthly basis to buy malaria drugs, that is if the case is not severe to warrant going to the hospital, like if it is just exhaustion. If it is the type that someone is already down and needs to go to the hospital, the price is higher.”
She, however, said the introduction of an insurance scheme in the state helped subscribers to get medical attention at cheaper rates.
“The major problem we have in Yenagoa and Bayelsa as a whole is malaria, maybe because of our terrain. If you look at the back of this compound, you would find a canal; and it is like that everywhere here. Mosquitoes have found this place a breeding ground; that is why, no matter how careful one is, mosquitoes will still bite one.
“Before now, drugs were cheap, but check patent medicine shops and see how expensive malaria drugs are. Even the insecticide fluid is very costly,” she said.
As a solution, she said if the government could fumigate the airspace and residents also do their part by keeping gutters and canals around them clean, the rate of mosquito bites would reduce.
“The government should also ensure that there is potable water in Bayelsa. The state water board should be functional because drinking from these boreholes could also cause malaria infection,” she added.
A trader at Opolo market, Kemenanabo Abama, said he and his family didn’t have enough money to feed, let alone treat malaria.
As an alternative, Abama said he had taken to drinking local herbs called ‘apo’ every morning, believing that it would flush any malaria infection caused by mosquitoes bites.
He said, “In today’s Nigeria, everybody is struggling to feed. What is left is used to pay school fees and house rent and you are talking about malaria treatment? Can you even buy those drugs? Go and ask for the price of Paracetamol now, not to talk of malaria and typhoid drugs. Maybe people that work for the government or oil companies can afford that, but certainly not people like us when our businesses are no longer moving.
“I burn mosquito coil every evening before I sleep so as to reduce the menace of mosquitoes in my room; and leave the rest to God, who protects his children from infections. My children are hardly sick after drinking the apo; and it is not even costly—with N200 you can drink a glass of the mixture.”
He suggested that the government should make the treatment of malaria free in hospitals.
Patients resort to herbal medicines in Kano
Kano is also another state battling malaria scourge with a prevalence rate of about 32.4 %. Malaria continues to be a major public health concern in the state.
Weekend Trust gathered that the disease is taking a toll on income of low and medium income earners.
Mustapha Awwalu, a public servant and father of three, said he spent N8,500 to treat his young daughter of malaria while another N16,500 was spent to treat his wife.
“Malaria is so common and it is robbing us of our hard-earned money. They prescribed injection for three days and a dosage of malaria drugs. After that, they prescribe pain killers among others. Poor people sometimes resort to herbal treatment because treating malaria is costly now,” he said.
It was gathered that several persons go to patent medicine vendors instead of the hospital to treat the illness. Ibrahim Babanliyo, a patent medicine vendor said he charges a minimum of N2,000 for treatment of children suffering from malaria while adults pay N3,000 and above.
Mujaheed Aliyu, a petty trader said he resorted to herbal treatment because he could not afford treatment in the hospital.
“Taking tea with lemon gives me relief from fever or malaria. There are several tea bags that are medicinal which I prefer to take than conventional medicine because of the cost implications,” said Aliyu.
Director, Centre for Infectious Disease Research Centre at Aminu Kano Teaching Hospital, AKTH, Professor Abubakar Isa, said malaria is endemic in Kano because of environmental factors and its population.
“Previously, with N500, one could treat malaria but that is not possible today. A minimum of N5,000 is required for treatment because prices of essential commodities have gone up. What can bring succour is perhaps health insurance for people,” he said.
‘How Nigeria can be malaria free’
Experts have called for increased efforts to bring malaria to zero level in Nigeria as funding for the disease is still majorly donor-driven.
Olugbenga Mokuolu, a professor of Pediatrics at the University of Ilorin and national malaria technical director to the National Malaria Elimination Programme (NMEP), said four strategies that could fast-track malaria elimination in the country were political will, strategic information use, effective guidance and strengthening coordination.
He said some innovations being deployed in the country included keying into a vaccine that would prevent malaria and address inequity.
Other experts said every member of the public needed to play their parts by adopting preventive measures. The measures include use of Long Lasting Insecticidal Nets (LLN), administration of seasonal malaria chemoprevention to children at high risk, antenatal care for pregnant women, keeping their environments clean, among other measures.
Test before you treat malaria, take only recommended drugs – NMEP
The National Malaria Elimination Programme (NMEP) has advised Nigerians to get tested before treating malaria as some have been found to incur expenses on malaria drugs and treatment when they did not have the ailment in the first place.
The organisation also advised the public to only go for recommended anti-malaria medicines as some, such as mono-therapies, are ineffective.
The programme officer of NMEP, Wudi Natasha, said malaria could not be diagnosed based on clinical (signs and symptoms) assessment alone, adding that diagnosis requires testing confirmation of a clinical suspicion.
Wudi said, “Case management intervention through prompt diagnosis and treatment with recommended anti-malarial is pivotal for reduction of malaria burden.”
Natasha said the use of monotherapy for malaria treatment remains banned in the country.
She said mono-therapy referred to the use of only one anti-malarial medicine to treat malaria, such as Artesunate and Artemeter injection, chloroquine and sulfadoxine/pyrimethamine (SP).
She said, “Mono-therapies are not recommended for treatment of uncomplicated malaria and cannot cure it. Chloroquine and SP are failed drugs with 39 per cent and 56 per cent efficacy respectively. Artesunate and Artemeter injection have very short shelf live. They attack malaria parasite fast but do not sustain in the body to mop up residual parasites.
“Use of mono-therapies for uncomplicated malaria is abuse.”
She said the danger of mono-therapies was incomplete cure, increased disease severity and development of drug resistance.
The NMEP programme officer highlighted that Artemisinin-based combination therapies (ACTs) were the recommended treatments for uncomplicated malaria. She added that ACTs were medicines consisting of an artemisinin derivative and another schizonticidal antimalarial medicine.
Way out
Experts say one of the ways of preventing malaria is through vaccination. There is currently a vaccine available for children alone.
The WHO recommends prioritisation of the vaccine in areas of high to moderate transmission.
In October, the federal government received one million doses of the R21/Matrix-M malaria vaccine donated by Gavi, the Vaccine Alliance.
The National Primary Health Care Development Agency (NPHCDA) had earlier said the first phase of the malaria vaccine rollout in Nigeria would commence in November in two states – Kebbi and Bayelsa – with high prevalence of malaria. The immunisation exercise was finally rolled out in the two states on December 2.
The vaccine is being administered to children aged five months to 15 months as part of routine immunisation.
“The introduction will be expanded to other states and integrated into our national routine immunisation schedule as we receive additional doses. The second phase will target 19 states and the Federal Capital Territory (FCT), while the third phase will target the remaining 15 states. Both phases are scheduled for 2025,” he added.
Dr Walter Mulombo, WHO representative in Nigeria said, “We are confident that this vaccine, in combination with other preventive measures, will drastically reduce the burden of malaria in Nigeria and help us move closer to achieving the goal of a malaria-free Africa.”
Executive order on pharmaceutical products will impact cost of malaria medicines, others – Experts
In June, President Bola Tinubu signed an Executive Order on zero VAT for pharmaceutical manufacturers, which became operational in October.
The Federal Ministry of Health and Social Welfare had in October announced the finalisation of the Executive Order Harmonised Implementation Framework, which has now been cleared for gazetting.
Experts said the order would, among other things, address the skyrocketing cost of medicines, which is currently bedevilling the country.
The order is geared towards increasing local production of pharmaceutical, diagnostics and medical devices.
The immediate past national publicity secretary of the Association of Community Pharmacists of Nigeria (ACPN), Kenneth Edeh Ujah said, “When the cost of production of medicines at various stages is lower, of course, it is going to have that direct impact on the eventual cost of the medicine when people visit the pharmacy to buy their drugs.”
Also, Prof Cyril Odianose Usifoh, the president, Pharmaceutical Society of Nigeria (PSN), said the potential for success in the order was boosted because specified items include Active Pharmaceutical Ingredients (APIs), excipients, essential raw materials required for manufacturing of crucial products, including drugs, long lasting insecticidal bed nets, rapid diagnostic kits and others.
He said, “We are particularly grateful that this order introduces zero tariffs, excise duties and VAT-specified machineries, equipment and raw materials aimed at reducing production cost and enhancing our local manufacturers’ competitiveness.”
The national president of the Association of Medical Laboratory Scientists of Nigeria (AMLSN), Dr Casmir, Ifeanyi Casmir, said with the removal of tariffs, excise duties and VAT on specified machinery, equipment and raw materials, in the next two years, local production would be boosted, thereby making the medicines affordable.
Additional reports by Bassey Willie (Yenagoa), Hope Abah (Makurdi) & Ismail Adebayo (Birnin Kebbi) & Ahmad Datti (Kano)
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