By Abujah Racheal
Malaria continues to be a significant public health challenge in Nigeria, with millions of cases reported annually.
Malaria is an acute fever illness caused by Plasmodium parasites, which are spread to people through the bites of infected female Anopheles mosquitoes. Though it can be a cause of death, it is preventable and curable.
In spite various efforts to combat the disease, including the distribution of insecticide-treated bed nets and the administration of antimalarial drugs, Nigeria still grapples with high morbidity and mortality rates related to malaria.
One critical factor in effectively tackling this disease is the presence of strong political will and sustained commitment from government authorities, policymakers, and stakeholders.
However, the decline in cases and fatalities falls short of meeting the benchmarks outlined in the World Health Organisation (WHO) Global Technical Strategy for Malaria 2016–2030.
This strategy serves as a technical guide for achieving the corresponding Sustainable Development Goals (SDGs).
Alarmingly, the deceleration in the reduction of malaria incidence and mortality has been evident since 2015, with numerous countries worldwide reporting spikes in cases.
Notably, between 2016 and 2017, all 10 African countries, including Nigeria with the highest malaria burden experienced an increase in cases.
This trend raises significant concerns, necessitating immediate action to realign the response efforts.
However, on Friday, January 12, 2024, the World Health Organisation (WHO) certified Cape Verde as being malaria-free, hailing it as a significant milestone in the fight against the disease.
Cape Verde, an archipelago of 10 islands in the central Atlantic Ocean, faced severe epidemics in densely populated areas before it implemented targeted interventions.
“It gives us hope that with existing tools, as well as new ones including vaccines, we can dare to dream of a malaria-free world,” WHO Director-General Tedros Adhanom Ghebreyesus had said in a statement.
Worldwide, some 43 countries have been certified malaria-free by the WHO, which requires showing that the domestic chain of transmission has been broken for at least three consecutive years.
According to Severe Malaria Observatory, Statistics and Facts of Malaria in Nigeria, malaria is a pervasive health issue in the country, affecting 97 per cent of the population.
It says the predominant malaria species was Plasmodium falciparum, transmitted by Anopheles mosquitoes. In 2021, the country reported the highest global malaria cases and deaths.
It says efforts to combat malaria include the High Burden High Impact approach, the 2021–2025 National Malaria Strategic Plan, and securing $364 million from multilateral banks. Severe malaria treatment shifted to injectable artesunate.
It also notes that malaria in pregnancy faces challenges in sulfadoxine-pyrimethamine uptake, slightly decreased insecticide-treated net ownership , as well as seasonal malaria chemoprevention in the Sahel region aimed to cover 35 million children.
It highlights the healthcare sector and efforts on malaria control, elimination and prevention.
“Healthcare tiers range from federal to local levels. The public health care system covers tertiary, secondary, and primary care. Nigeria receives funding from various sources for malaria control, with Seasonal malaria chemoprevention (SMC), programmes implemented in specific states.
“Populations with low access to treatment include those in North Eastern Nigeria due to insurgencies, rural communities, and nomadic populations”.
Meanwhile, the WHO regional director for Africa, Dr Moeti Moshido, commends Nigeria at the launch of the 2022 Nigeria Malaria Report in Abuja for a significant 55 per cent reduction in malaria deaths, from 2.1 to 0.9 per 1000 population.
Moshido says despite the country contributing 27 per cent of global malaria cases, progress has been made, with a 26 per cent decline in malaria incidence since 2000.
“The Report on Malaria in Nigeria 2022 is an excellent model from which to use data to prioritise health interventions.
“Using data, we can prioritise and target interventions, optimise the allocation of resources and facilitate the monitoring of performance at federal and state levels.
“This report is a result of the collaboration between the Nigeria Malaria Elimination Programme, the WHO Regional Office for Africa, and the Global Malaria Programme,” she said.
She emphasises the importance of maintaining essential health services, particularly in populations affected by humanitarian emergencies. Environmental factors like climate change and certain practices may increase transmission.
To also show the will to eliminate malaria, efforts by the federal government to eliminate malaria are emphasised in the 2024 budget where there is an allocation of N57.392 billion without details.
This sum of money is for a new project titled “Immunisation plus and malaria progress by accelerating coverage and transforming services (impact)–immunisation (multilateral/bilateral project tied loan).”
Considering the huge sum of N57.392 billion, experts say a breakdown of the amount should have been provided.
“It would have been better if a little more detail were provided.
“There is a need for the country to foster a multi-sectoral approach, to build and sustain the political will to eliminate malaria within its borders,” they said.
Proffering some ways forward, Mr Odinaka Kingsley Obeta, a Biomedical Scientist and Executive Director of Block Malaria Africa, stresses the need for sustained political commitment in the country’s fight against malaria, citing Algeria’s success after over 20 years of dedication.
He also emphasises the need for increased youth engagement in the fight against malaria considering that youths makeup over 60-70 per cent of the Nigerian population.
According to him, this strategy has already been adopted in Kenya, Zambia, Eswatini and a number of countries in Africa with outstanding contributions already being made by young people in these countries towards achieving zero malaria.
Obeta says some factors impede efforts at eliminating malaria of which some are the evolving challenges, including antimalarial drug resistance, fake antimalarials, and new threats such as climate change and the emergence and spread of Anopheles stephensi across Africa.
He criticises the country’s inconsistency in commitment, noting a decline in external funding due to insufficient domestic support.
He highlights the country’s limited involvement in the clinical trials and production process of the recently approved malaria vaccines, expressing concern about the nation’s seriousness in tackling the global burden of the disease despite being a high burden country.
“The low funding support for the Nigeria National Malaria Elimination Programme raises questions about the government’s commitment to malaria eradication,” he says.
Prof. Oyewale Tomori, a Virologist, advocates that the country studies the successful malaria eradication strategies of countries like Cape Verde.
Tomori says the need for a multifaceted approach involving reliable laboratory diagnosis, street-wise diagnosis, therapeutics, mosquito control, environmental sanitation, and vaccination.
He underscores the importance of coordinated efforts from individuals and governments, stating that both play crucial roles in ending malaria.
He calls for proper education to define specific responsibilities for all stakeholders, rejecting the idea that the government alone can achieve sustained malaria eradication.
Instead, he emphasises collective responsibility to address the malaria challenge.
Prof. Olugbenga Mokuolu, a Professor of Paediatrics at the University of Ilorin and Ilorin Teaching Hospital, Kwara, also says multifaceted approaches are need to achieve the fight to end malaria.
“Nigeria is progressing steadily, but the malaria situation varies among countries, making comparisons challenging.
“To strengthen our gains, we must enhance intervention coverage, target them effectively, and pursue malaria vaccine access.
“Insecticide resistance prompts the procurement of costlier nets, while deploying additional strategies like Indoor Residual Spray and Larva source management is crucial, especially in high-burden states,” he said.
Mokuolu, who is also the former National Malaria Technical Director, says uptake of the malaria vaccine and ensuring continuous improvement in data quality are essential measures the country could use.
Meanwhile, Dr Charles Ugwuanyi, a Consultant Neurosurgeon and NMA-FCT, emphasises the importance of developing and executing comprehensive public awareness campaigns in the country to educate citizens on malaria’s devastating effects.
Ugwuanyi urges political leaders to publicly commit to ending malaria, allocating resources to maintain momentum and political will.
“Collaborating with civil society organisations, advocacy groups, and international partners can mobilise support and resources for malaria control.
“Establishing transparent monitoring and evaluation systems ensures accountability and effective resource utilisation in the fight against malaria.
“Engaging local communities is crucial for grassroots support, sustaining political will through collective action, and advocating for improved access to prevention and treatment services.
“Supporting research and innovation in malaria control demonstrates the value of ongoing investment, providing evidence for policymakers to prioritise these efforts,” he said.
He also recommends that the government establishes dedicated funds and sustainable financing mechanisms for malaria control programs to ensure continuous support and resources.