Malaria has remained a major public health concern in Nigeria, being the leading cause of morbidity and mortality with all Nigerians at risk.
Malaria is also the leading cause of school absenteeism, hospitalisation, and out-of-pocket expenditure.
The acute febrile illness which is spread to people through the bites of infected female anopheles mosquitoes, has attracted so much attention from international donors and the federal government.
However, lack of adequate funding and poor environmental sanitation pose a significant obstacle to the control and prevention of malaria.
The implication is that many families are pushed further into poverty as they spend heavily out-of-pocket on a regular basis to get their loved ones treated for malaria.
Out-of-pocket expenditure for malaria is estimated to be over 70 percent and Nigerians pay as much N3, 500 for each uncomplicated malaria and about N12,000 for severe cases, depending on the facility.
The economic burden of malaria in Nigeria was estimated at $1.6b (N687 billion) in 2022 and may increase to about $2.8b (N2 trillion) in 2030.
Also, it is estimated that approximately 55 million cases of malaria and nearly 90,000 malaria-related deaths occur each year in Nigeria.
A breakdown of these statistics shows that about N1.9 billion is spent on malaria treatment annually for uncomplicated cases and N6.6 billion for severe cases.
Sadly, despite this huge economic burden, many Nigerians remain vulnerable to malaria as the country bears the disproportionate brunt of the malaria toll, accounting for 27 percent and 23 percent of global cases and deaths respectively, according to the World Health Organisation (WHO).
Meanwhile, the minister of Health, Dr Osagie Ehanire, has called for collaborative efforts in the fight to achieve zero malaria by 2030, in line with the WHO’s Global Technical Strategy.
Ehanire, who made the call at a press briefing to commemorate the 2023 World Malaria Day, themed: “Time to deliver zero malaria: invest, innovate, implement and the slogan is “Act now”, noted that successful control of malaria will increase productivity, improve health, reduce school absenteeism, reduce poverty and facilitate the attainment of the Sustainable Development Goals (SDGs).
World Malaria Day is commemorated every April 25th to raise awareness of the global effort to control and ultimately eradicate malaria.
The minister described the theme of this year’s celebration as a clarion call to the populace, particularly those who live in malaria-endemic regions, who account for most of the burden and deaths, to avail ourselves of the available tools and strategies to enable the government to reach those in need.
He said it was a call to “Invest in efforts to defeat malaria. In this regard, we must ensure that funding is prioritised for the most marginalised and hard-to-reach populations who are less able to access services and are hardest hit when they become ill.
“Invest in and step-up innovative strategies and interventions that are impactful. These include innovations that bring new vector control approaches, including the use of new generation insecticidal nets and PBO nets to mitigate the effects of widespread insecticide resistance being observed across Nigeria and other malaria-endemic countries as well as step up surveillance for the recently discovered Anopheles stephensi specie of mosquito in Nigeria.”
Also, in her World Malaria Day message, WHO regional director for Africa, Dr. Matshidiso Moeti, urged that malaria programmes should be decentralized to the district and community levels where health systems are closest to the affected populations.
She said, “We must empower frontline health workers and communities to participate fully in identifying key barriers in accessing services, ensure effective implementation of malaria control strategies and hold their leaders accountable for health outcomes.”
Moeti also called for renewed political commitments and bolster investments in malaria prevention and control, adding that “This can be done by ensuring that everyone, everywhere, has access to the quality and affordable malaria services they need.
“This will require a more granular understanding of who is missing out, why they are vulnerable, and what are their barriers to accessing malaria preventive and treatment services.”
To achieve this, Moeti said governments need to mobilise more resources and technical capacities at domestic and international levels and build effective partnerships and multi-sectoral mechanisms to help strengthen preventive measures and improve coverage of malaria case management.
The National Agency for Food, Drug Administration and Control (NAFDAC) recently granted provisional approval for the second malaria vaccine called R21/Matrix M malaria vaccine by researchers at Oxford University.
According to the minister of health, the provisional approval is premised on the need for the inclusion of Nigeria in the Phase IV clinical trial of the vaccine.
He said it is expected that conducting the trial in Nigeria, will provide evidence for the performance of the vaccine in high malaria transmission settings.
He also said that the country has submitted an application to GAVI for the RTSS malaria vaccine allocation and that the vaccine is expected to be in the country by April 2024.
“The National Programme is working closely with the National Primary Health Care Development Agency (NPHCDA) and other relevant stakeholders in accessing and deploying the new malaria vaccine (RTSS) in a phased fashion subject to availability of needed quantity,” he said.
Medical professionals have described the move by the federal government to provide the vaccine for Nigerian children as a welcomed development.
A medical doctor, Obiora Edward, said hopefully, the rate of malaria-related child mortality will be reduced in the country as well as the economic burden.
WHO report indicates that globally, malaria claims the lives of over 274,000 children under five years every year, with 750 dying daily and one in every two minutes.
It also described malaria as the primary cause of childhood illness and death in sub-Saharan Africa, with more than 260,000 African children under the age of five dying from malaria annually.
Nigeria’s effort towards zero malaria status
The county is witnessing a slow but steady decline in malaria prevalence from 27 percent in 2015 to 23 percent in 2018 and 22 percent in 2021.
According to Ehanire, the country would have done better had the programme accessed early, the loan from the IMPACT project under the World Bank and Islamic Bank funding to close the gaps in malaria programme implementation, particularly in 12 states that had not received any significant donor funding for malaria implementation in recent years.
Also, on vector control for all people at risk of malaria, the country has distributed over 130.42 million LLINS campaigns in 33 states, and over 16.3 million LLINS were distributed through the continuous channels (antenatal and immunization clinics) between 2015 and 2020, while an additional 91,616,860 LLINS were distributed through campaigns between 2021-2022, according to the Federal Ministry of Health.
However, the minister of Environment, Barr. Mohammed Abdullahi, said improved personal hygiene and environmental sanitation remain the best preventive measures of malaria.
He said although control of adult mosquito bites through the use of Insecticide-Treated (Mosquito) Nets is posting some gains, attaining the desired impact is not near and is unfortunately not too reliable.
“Effective mosquito control takes the form of exclusion-removal of suitable vector habitat through sound hygiene and sanitation which stops breeding by preventing egg laying,” said Abdullahi.
According to him, the advantage of mosquito life cycle control through environmental sanitation and physical attack is that in addition to malaria control, it also helps in tackling the menace of diseases such as yellow fever which is caused by Aedes mosquito species, and encephalitis caused by virus-bearing culex species.
“It is therefore incumbent for Nigeria to join the fray in focusing attention on the cause (Mosquito) rather than its effect and/or impact as presented by its bite on the human skin or the development of the plasmodium pathogen it injects inside the human host,” said Abdullahi.
He urged individuals, family, and community members to imbibe preventive measures by keeping waste materials and junks away from village squares, huts, and rooms.