As Nigeria joins the rest of the world to mark this year’s World Malaria Day, experts have proffered ways to fast-track ending malaria in the country.
Malaria is a life-threatening disease caused by a parasite that is transmitted to people through the bite of the infected female anopheles mosquito.
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Some of the symptoms of malaria are fever, headache, vomiting, diarrhoea, profuse sweating and anaemia.
Dr Perpetua Uhomoibhi, national coordinator of the National Malaria Elimination Programme (NMEP) of the federal ministry of health, said nearly 61 million malaria cases and 90,000 malaria deaths were recorded in Nigeria in 2020.
Quoting the World Health Organisation (WHO) Malaria Report, she said there was a little increase in the number of malaria deaths in Nigeria and other African countries last year, adding that this could be probably due to the COVID-19 pandemic.
She said, “As at 2020 the contribution of Nigeria to the global malaria deaths was 23 per cent, but in 2021 it increased to 27 per cent. COVID-19 could have played a role because it adversely affected the health system.”
According to the WHO regional director for Africa, Dr Matshidiso Moeti, the theme for this year’s World Malaria Day: “Harness Innovation to Reduce the Malaria Disease Burden and Save Lives”, aligns with her call to urgently scale up innovation and the deployment of new tools in the fight against the disease, while advocating equitable access to prevention and treatment within the context of building health system resilience.
She said, “Landmark recommendations on the use of the first vaccine against malaria – RTS,S – were released by WHO late last year. This vaccine will be used to prevent malaria among children aged six months to five years who live in moderate-to high-transmission settings.”
Dr Moeti said while this was a groundbreaking advancement in the development of new tools to fight the disease with the potential to save millions of lives, supplies were currently limited, adding that it was important to ensure that the doses that were available were utilised for maximum impact, while ensuring continued availability of other preventive measures to those most at risk.
Olugbenga Mokuolu, a professor of paediatrics at the University of Ilorin and national malaria technical director to the National Malaria Elimination Programme (NMEP), said Nigeria had made progress in malaria control over the years with interventions such as insecticide-treated nets, targeted indoor residual spraying, seasonal malaria chemoprevention, intermittent preventive treatment in pregnancy and effective case management.
He said the four strategies that could fast-track malaria elimination in the country were: political will, strategic information use, effective guidance and strengthening coordination.
He said, “Somewhere between them innovation comes in, and innovation will require some political will, it will also require some data, it requires some policy statement to guidance, effective use and also how things are coordinated.”
He further said some innovations being deployed in the country included keying into the malaria vaccine which would prevent malaria and also address inequity.
He added that the country was also scaling residual spraying in places of high burden of the disease.
According to him, “In addition, the country is also currently looking at combining some of the existing drugs in a certain way to extend their use in the treatment of malaria.”
Dr Perpetua Uhomoibhi, national coordinator of NMEP, said in line with the theme of this year’s World Malaria Day adopted by Nigeria, her message to Nigerians was that every effort counted (the slogan chosen for the country for this year’s commemoration).
She said, “So every hand should be on deck to end malaria. Advancing equity means that we have to ensure that every Nigerian has access to malaria prevention and treatment services, and that means that government cannot do it alone. So we need the private sector in particular to come on board. We need non-governmental organisations, CBOs, government agencies, policy makers and the legislature and everyone to be on board so that we can invest more in Nigeria to provide that equity, to ensure that all population in the country; whether in remote communities, have access to full malaria prevention treatment and diagnostic services so that we can all come together to end malaria in Nigeria.”
Situation across states
The Lagos State commissioner for health, Professor Akin Abayomi, last year, disclosed that malaria accounted for more than 70 per cent of outpatients in the public health facilities in the state.
He added that more than 700,000 malaria cases were reported annually, while 657,154 patients with malaria were seen in both private and public health facilities in 2020.
He noted that the topography and ecological features of Lagos State; the vast coastal terrain, rapid urbanisation and poor drainage were major predisposing factors that contributed to the transmission of malaria all year round.
A public health physician, Dr Ogunyemi Riyike, pointed out that in Lagos State there had been continued commitment to the control of malaria with the Eko free malaria programme where malaria diagnosis with rapid diagnostic tests and treatment were provided free for all ages in the state.
Despite all the effort of the government to fight the scourge of malaria, she noted that the disease still ravaged and claimed the lives of many children annually.
A common factor that besets the progress of all these interventions, according to her, is lack of commitment and follow-through with all the laudable initiatives and programmes.
She, therefore, stressed the need to come up with new ideas to overcome the scourge of malaria, and to also maximise current strategies; adding that an increase in the uptake of the malaria vaccine would help to minimise the burden as vaccines were known to be a cost-effective means of preventing diseases.
Also, she pointed out that existing programmes in the state such as Eko free malaria should be revitalised and sustained to meet the needs of Lagosians, especially those under the age of five.
She also called on all families to spearhead the course and protect their immediate families against mosquito bites, ensure clean environments which would curb the breeding of mosquitoes and endeavour to have prompt and adequate medication once malaria was diagnosed.
“Nigeria needs sustained, interdisciplinary and multifaceted research into malaria elimination, and hopefully eradication,” Dr Riyike said.
Malaria major disease in Edo
Dr Uwa Ukhuarobo, an Edo State-based epidemiologist, noted that malaria was the number one disease in the state and Nigeria.
He said, “For every 10 persons that come to hospital for treatment, I can tell you that between six and seven are positive to malaria, and those who do not have are carrying the parasite.”
He said addressing malaria started from the contribution of everybody because it was the single most endemic disease that affected everybody: in the middle, lower or upper classes.
“This starts from what individuals are doing to eliminate malaria in our environment; whether we are keeping our environment clean, how we disposing waste around our environment or whether we are leaving things that can breed the vectors that carry malaria parasite”.
He noted that environmental cleanliness was key in preventing and eradicating malaria in Nigeria.
He, therefore, advised the public to get insecticides to kill the vector and get treated if affected by the disease.
He further said, “The other scientific way is to fumigate the environment and the rain forests and also bring up organisms that can control vectors so as to reduce female anopheles mosquitoes that transmit the malaria parasite.
612,340 cases recorded in Nasarawa
Dr Adamu Ibrahim, the Nasarawa State director of public health, said 612,340 malaria cases were recorded in 2021.
Dr Ibrahim said, “No deaths were recorded among pregnant women across the state. Death among children aged less than five was 409.”
He said malaria prevalence had dropped to 13.6 per cent in the state.
He further said an innovation in the state for reducing the malaria burden included new chemicals that could be put on the insecticide treated nets that killed mosquitoes instantly.
He added that, “We also have rapid test kits in the state now that will detect malaria in 10 to 15 minutes.”
Also, a pharmacist, Ahmed Yahaya, Nasarawa State commissioner for health, during a news briefing, called on residents of the state to do malaria test to enable them know their status before treatment to avert complications.
He said test was important because not all fevers were malaria, as according to him, malaria is capable of causing intrauterine growth retardation of the unborn child, abortion, pre-termed labour, renal failure and death.
He further said the fact that malaria was dangerous and responsible for many deaths made the state government, in conjunction with partners, to invest a lot in its elimination.
He warned against self-medication and advised residents to visit health facilities for test and subsequent treatment, noting that the state government, in conjunction with partners, had done a lot towards eradicating malaria across the 13 LGAs of the state, which he said would go a long way in reducing the burden to less than 14 per cent.
On his part, Mr Ohobo Thomas, Nasarawa State programme manager of Break Through Action Nigeria, said winning the fight against malaria was possible if everyone slept inside treated nets.
He added that those diagnosed with malaria should ensure that they took all their prescribed drugs to complete treatment.
He said, “It is not good for one to stop taking malaria drugs half way into the treatment. Therefore, everyone diagnosed must complete their treatment in order to avoid complications.”
The WHO regional boss, Dr Matshidiso Moeti, said the ultimate goal was to reduce the number of people catching and dying from malaria.
She said this required a focus on research and on leveraging available evidence to ensure that targeted interventions were on efficient use of resources which produced measurable results.
She further said, “We also need to work on drug and insecticide resistance, as well as focus on new strains of malaria arising in the region which are more difficult to detect and treat.
“Malaria is, however, about much more than medical and technological interventions. Malaria affects households and communities, and these communities need to be empowered to play an active role in the fight against this disease. As WHO in Africa, we recognise that a whole-of-society approach requires us to listen to and learn from those who are worst impacted.”
She, therefore, called on countries and communities affected by malaria to work closely with development partners to advance their societies along the road to elimination, while contributing to the achievement of other Sustainable Development Goals (SDGs).
By Ojoma Akor (Abuja), Umar Muhammed (Lafia), Christiana T. Alabi (Lagos) and Usman A. Bello (Benin)