NIGERIA remains world’s malaria capital, despite making significant strides in reducing cases and deaths from the disease over the past two decades, according to the World Health Organisation’s (WHO) data.
As the country joins the rest of the world to commemorate this year World Malaria Day, today, April 25, The ICIR presents how the country has fared with the scourge.
Public health experts who spoke with The ICIR urged Nigerians to utilise available services and support the government’s efforts to combat the disease.
They called on government at all levels to be more committed to tackling the menace.
They also solicited sustained commitment to the fight against the scourge.
Caused by parasites transmitted to people through the bites of infected female Anopheles mosquitoes, malaria is a preventable and curable major public health issue affecting millions of Nigerians.
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The disease, mostly found in tropical countries, can be life-threatening, with nearly half of the world and 97 per cent of Nigeria’s population at risk of the disease.
For instance, in 2021, there were approximately 249 million reported cases of malaria, leading to about 608,000 deaths.
Nigeria (26.6 per cent), the Democratic Republic of the Congo (12.3 per cent), Uganda (5.1 per cent), Mozambique (4.1 per cent) and Angola (3.4 per cent) collectively represented half of the total malaria cases worldwide.
Also, Nigeria (31.3 per cent), the Democratic Republic of the Congo (12.6 per cent), Tanzania (4.1 per cent), and Niger (3.9 per cent) together accounted for slightly more than half of all malaria-related deaths worldwide.
While individuals of all ages are susceptible to the disease, children and pregnant women are particularly vulnerable and prone to experiencing complications. This heightened susceptibility puts them at a higher risk of severe illness and increases the likelihood of mortality, especially among children under five.
Experts who spoke with The ICIR disclosed that a higher prevalence is generally observed in the northern states compared to the southern states.
They also noted that the Nigerian government has taken proactive measures over the years to reduce the spread and prevalence of the disease, focusing on reducing it to at least 10 per cent by 2025, but minimal successes have been recorded.
Why Nigeria continues to grapple with malaria
Despite concerted efforts and interventions, Nigeria continues to face significant challenges in its fight against malaria, said Adewale Adeleye Samuel, medical doctor and a senior registrar at the Department of Public Medicine, University of Abuja Teaching Hospital.
Samuel said it was important to look into the factors contributing to this persistent struggle, noting that the government had implemented several strategies to reduce the prevalence of the disease over the years.
He also noted that while the government needed to do more to sensitise and distribute insecticide-treated nets (ITNs) to people in marginalised communities, citizens should also use ITNs instead of selling them.
“Before now, we had ITN in circulation. But then we had incidents of people storing them in their houses, and at the end of the day, they started selling them. There are two issues here: One is there’s a difference between you giving them and them using them. So that is the place where I think the government should come in,” he said.
Also, according to the 2022 WHO report on malaria in Nigeria, the disease continues to take a toll on people’s health, especially young children. The WHO estimates that malaria accounted for 20 per cent of all deaths in children under five in 2021.
Compared with other countries with high malaria prevalence in the WHO African region, Nigeria, despite its efforts, experienced disruptions to essential malaria services.
These disruptions are estimated by WHO to have resulted in an additional 480,000 malaria cases and 10,000 malaria-related deaths.
WHO also states that in 2021, about 37 per cent of children under five did not receive care within two weeks when they had a fever, and only a quarter of all children with fever got tested. Among those who sought care, only 39 per cent were tested.
Despite recent improvements, malaria parasitological diagnosis remains low in Nigeria, leading to inappropriate treatment of patients and irrational use of malaria drugs.
The global health body also cites lack of state ownership, poor budgetary allocations, and high out-of-pocket expenditures as contributing factors.
Strides in malaria intervention
The 2021 Nigeria Malaria Indicator Survey (NMIS) revealed that malaria prevalence in Nigeria fell from 42 per cent in 2010 to 27 per cent in 2015, then to 23 per cent in 2018 and 22 per cent in 2021.
WHO also observes that despite the significant burden and the hurdles posed by the COVID-19 pandemic, malaria incidence has decreased by 26 per cent since 2000, noting that the decline is evidenced by a decrease from 413 cases per 1000 population in 2000 to 306 cases per 1000 in 2021.
Before the pandemic in 2019, WHO says malaria incidence stood at 302 cases per 1000 population.
In the same period, the malaria mortality rate (i.e. deaths per 1000 population at risk) fell by 55 per cent from 2.1 per 1000 population in 2000 to 0.9 per 1000 population in 2021. Malaria mortality rate in 2019 was 1.2 per 1000 population.
“Between 2009 and 2021, about 220 million insecticide-treated nets (ITNs) were distributed in 37 States. The proportion of the population who slept under ITNs the night before the survey increased from 22.9 per cent in 2010 to 36.4 per cent in 2021. The percentage of children under the age of five who slept under an ITN the night before the survey increased from 28.9 per cent in 2010 to 41.2 per cent in 2021.
“The coverage for the intermittent preventive treatment of malaria in pregnancy – receiving two or more doses of sulfadoxine-pyrimethamine (SP) – rose from 22 per cent in 2015 to 26 per cent in 2020, it declined to 23 per cent in 2021,” the report added.
The public health expert, Adewale Adeleye Samuel, explained that the government had tried to control malaria through several intervention programmes.
“A lot of programmes have come over the years. Roll Back Malaria; a lot of them just want to see that malaria is being controlled. The last strategic plan, the National Malaria Strategic Plan that we were looking at the end of 2025, aimed at reducing the prevalence of malaria to less than 10 per cent and then looking at mortality, especially among children now, to be less than 50 per 1000 births.
“So, all these efforts, put together, are the efforts by the government, through the Federal Ministry of Health, to ensure that malaria is under control.”
Looking forward
Proferring solutions to the prevalence of malaria in Nigeria, a public health practitioner, Michael Olarewaju, emphasised the need for the government to expand ITN distribution and ensure proper use across the country.
He also highlighted the need to improve access to rapid diagnostic tests and effective antimalarial treatments, invest in research for new prevention and control strategies, including vaccines, and promote community awareness about malaria prevention measures.
On his part, Samuel called for improved budgetary allocations and investment in research for medical practitioners.
