Lagos State Commissioner for Health, Professor Akin Abayomi has revealed that only five percent of fevers in Lagos were caused by malaria.
The statistics upends long-held assumptions about fever treatment and highlights the dangers of misdiagnosis and drug misuse in the state’s healthcare system.
Abayomi, who disclosed this at the three-day “Study Kick-Off of the Pathway to Pre-Elimination and Digitisation Project,” disclosed that recent data from the state’s health monitoring programme shows that 95 out of every 100 fever cases in Lagos have no link to malaria.
This underscores the urgent need to shift away from the routine prescription of anti-malarial drugs without proper diagnostic testing.
“We need to get malaria out of the region. It is very, very important that we perform the mind shift in our healthcare providers that on average, 95 out of every 100 fevers that you may see are not caused by malaria,” Abayomi said.
According to him, the persistent assumption that fever equals malaria has led to widespread overuse of anti-malarials and antibiotics, a trend he warned is driving a growing crisis of antimicrobial resistance (AMR).
“We are really sitting on a very major problem of microbial resistance. And we have to be careful how we dispense antimicrobials and antibiotics,” he cautioned.
The Commissioner said new research indicates that 60 percent of human infections now originate from animals, highlighting the growing complexity and interconnectivity of microbial threats.
He stressed that the misuse of medication in both human and veterinary settings contributes significantly to the antimicrobial resistance crisis.
“If the test result is negative, which we anticipate in over 90 percent of the cases, the healthcare provider must then investigate other possible causes, such as pneumonia, typhoid, dengue, or gastroenteritis,” Abayomi explained.
The Commissioner further disclosed that the state is stepping up regulations on pharmacies, insisting that anti-malarials and antibiotics should no longer be issued without a valid prescription.
“It is illegal to walk into a pharmacy and say, ‘Give me an antimalarial’ or ‘Give me an antibiotic’ without a certified healthcare practitioner’s prescription,” he said.
He called on the Pharmacy Council of Nigeria to intensify enforcement, warning that without immediate action, “we are going to be the capital of antimicrobial resistance.”
As part of the measure to address this challenge of misdiagnosis, Abayomi said the Lagos State Ministry of Health, with support from a World Bank grant and in collaboration with the research team led by Prof. Wellington Oyibo, is instituting a “Test, Treat, and Track” fever management strategy.
Under this protocol, any patient presenting with fever first undergo a Rapid Diagnostic Test (RDT) for malaria.
The new fever management strategy, built on data-driven diagnostics, marks a critical shift towards evidence-based medicine in Lagos State.
Health officials said it is the only sustainable path to accurate treatment, disease control, and ultimately, the elimination of malaria.
Coordinator of the study, Prof. Oyibo, reinforced the dangers of misdiagnosis, stating that, “If it is a child that has pneumonia, pneumonia will present just the way you see some symptoms of malaria presenting. And you now give anti-malaria medicine without a test. What will happen to that child? That child will die quickly of pneumonia,” he warned.
Oyibo also noted that Lagos is the only state in Nigeria currently qualified epidemiologically as being at the “pre-elimination” stage of malaria, meaning the disease isnow relatively rare, yet symptoms such as fever are still too often wron gly treated as malaria.
“This misdiagnosis not only endangers patients but also inflates malaria case data, misguiding national health interventions,” he said.
He explained that a crucial element in Lagos State’s drive to eliminate malaria is a policy shift that prioritises Rapid Diagnostic Tests (RDTs) over traditional microscopy.
He said this approach is backed by evidence, with RDTs proving to be more accurate and better suited for use in low-resource environments.
Oyibo also highlighted that Lagos is currently the only state in Nigeria that meets the epidemiological criteria for malaria pre-elimination, a notable public health achievement.
“It is a remarkable milestone for the country. However, many cases of fever and malaria-like symptoms, which are not exclusive to malaria, continue to be misclassified as malaria. This misdiagnosis inflates reported malaria cases and undermines actual progress,” Oyibo said.
He added that the new strategy represents a bold step towards evidence-based healthcare, where clinical expertise and proper diagnosis help safeguard the public from the severe consequences of misdiagnosis, unnecessary treatment, and the growing threat of drug resistance.
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