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Eradicating malaria from Nigeria: Myth or Reality?

Eradicating malaria from Nigeria: Myth or Reality?

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Bello Sebutu

The World Malaria Day on April 25, 2018 was marked in Nigeria. While the people of Sri Lanka, a middle-income country like Nigeria, will be rejoicing over the successful elimination of malaria from their country, Nigerians are still preoccupied with procuring drugs for treatment as the disease is still endemic in the country.

The nauseating prospects of possible resistance to common antimalarial medicine, the need to battle fake antimalarial preparations, and the development of resistance to chemical agents impregnated into the insecticide-treated bed nets all remain puzzles that are yet to be resolved. As of today, 10 countries have eliminated malaria since 2010. In addition, three countries in Sub-Saharan Africa including South Africa, Namibia and Botswana are on the verge of eliminating malaria following nationally coordinated efforts, increased funding for malaria research and the consistent implementation of evidenced-based guidelines. The success story from countries far and near that have eliminated malaria raises the hope of a possibility of beating malaria. Nigeria can indeed join the league of successful nations that have triumphed over the deadliest disease that has ravaged Sub-Saharan Africa for centuries.

Nigeria, the most populous country in Africa with a population of 182 million and the richest in terms of GDP in the continent, is burdened with the highest morbidity and mortality from malaria. According to the World Health Organisation, Nigeria’s share of the global burden of malaria stood at 27 per cent with 24 per cent of global malaria deaths. Malaria accounted for 11 per cent of all pregnancies and birth-related deaths in Nigeria. Even though no one is spared of being infected in Sub-Saharan Africa, yet, 80 per cent of those who die from the disease are children under the age of five from mostly poor families. Poverty remains a major contributing factor to the disease, and malaria, in turn, is a major promoter of endemic poverty, hence the nickname ‘the disease of poverty.’

According to a release by the Federal Ministry of Health in 2017, the average life expectancy in Nigeria is 54 years, compared to 79 years in the United Kingdom and over 80 years in Japan. This is far below the expected life expectancy from middle-income countries with similar or lower GDPs. Infectious diseases continue to take the promising lives of children while making life uncomfortable for the older adults despite the fact that they can be controlled or wiped off completely through multiple interventions. The major causes of morbidity and mortality in Nigeria are communicable diseases with malaria, HIV, and tuberculosis being significant contributors. Nigeria’s under-five mortality rate is 128 per 1000 live births, with malaria contributing 24 per cent.

Even neighbouring countries such as Ghana has witnessed a sharp reduction in under-five mortality, from 193 per 1,000 live births in 1966 to 63 in 2015. According to the malaria indicator survey of 2015, the prevalence of malaria parasites in children under the age of five is 27 per cent, which further corroborates the fact that malaria continues to pose a serious health challenge to children, affecting their growth and overall development.

Most of the efforts made in the past by governmental and non-governmental agencies such as the Global Fund, the WHO, United Kingdom-DFID, Presidents Malaria Initiative, Canadian government, UNICEF, Bill and Melinda Gates Foundation, Faith-based organisations and other stakeholders with genuine interests in eliminating the scourge have created pockets of scattered programmes across the country, lacking necessary nationwide coordination with a unified goal. Though the prevalence rate of malaria has reduced from 42 per cent recorded in 2010 to 27 per cent in 2015 which in itself is a significant gain, the death from malaria continues to soar according to WHO putting Nigeria as the country with the highest deaths from malaria in the world.

This situation calls for a draconian measure to halt the dreadful menace. Such effort like the Rapid Access Expansion of Integrated Community Case Management of Malaria, Pneumonia and Diarrhoea (RAcE2015 project) funded by the Canadian/American governments that targeted only two states of the federation; Niger and Abia states, helped in early detection and treatment of acute cases of malaria, while strengthening manpower needed in primary care. Such programmes where community health workers were appropriately trained, supervised and supported with an uninterrupted supply of antimalarial and diagnostic kits should be integrated into the national malaria control programme.

The WHO in a release in 2018 noted that the World Global funding for malaria has reached a plateau since 2010 and the present funding with 2.7 billion dollars only represent 41 per cent of the estimated 6.5 billion dollars needed annually by 2020 in order to reach the 2030 target. The insufficient funding has resulted in major gaps in coverage of ITNs, antimalarial medicine and other required tools for control.

Nigeria is estimated to require N504 billion ($1.4 billion) over the next three years in order to realise the objective of the national malaria strategic plan. Although a lot is expected from the international community in terms of funding, accessing domestic funds will require considerable political will. This is however imperative to combat the disease. The money expended on malaria control is an investment that will translate to great gain in terms of considerable savings on drugs and wasted useful time and resources.

Efforts at moving Nigeria from a currently designated region of high transmission to a zone of lower transmission and subsequently to pre-elimination stage can only be successful through a reduction in transmission. This can only be achieved through adequate treatment of all infected children and adults using recommended drugs taken in the right dosage and at the right time for the expected duration.

The WHO’s recommendations of test, treat and track needs to be instituted in the case management of malaria by strengthening primary care health facilities and a complete elimination of out-of-pocket funding of malaria treatment by individuals and families. Early presentation of under-five children in primary care by their mothers/parents or guardians will meet with great success where they don’t have to think of the cost implication of the treatment. Coordinated control measures with all stakeholders at federal, state and local government levels will lead to great gain from the widespread use of indoor residual spray.

Focusing on the potential gains from eliminating malaria from Nigeria is enough to spur our leaders and civil societies to heavily invest in prevention rather than sinking all available health funds into the treatment of the disease. The by-products of a successful elimination of malaria in Nigeria will include a drastic reduction in poverty, a healthier and more equitable society and indirect benefits to agriculture, education and businesses, with a consequential evolution of healthy cities and happy families.

Dr. Sebutu is a consultant family physician at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State.

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