Malaria’s Unfinished Battle: Why Nigeria Must Clean Up To Win

Nigeria has remained at the epicentre of the global malaria crisis for decades, accounting for more cases and deaths than any other country. Despite sustained government and international interventions, malaria continues to erode household incomes and claim thousands of lives each year. PATIENCE IVIE IHEJIRIKA writes.

When 10-year-old Ibrahim developed another fever barely three weeks after recovering from malaria, his mother, Mrs Aisha Adamu, refused to believe the malaria had returned.

Mrs Adamu, a petty trader living in Kurudu, a suburb of Abuja, believed it was typhoid or another infection. Having just completed a full course of malaria treatment, she saw no reason her son should be battling malaria again.

To be certain, she took him to a nearby laboratory, and to her surprise, it was malaria again.

Mrs Adamu said that while the diagnosis was distressing, the financial consequences proved even more devastating. The money she had painstakingly saved to restock her small business disappeared on laboratory tests and medicines.

“I used all the money I had intended to spend on my business to treat him twice within three weeks,” she recalled.

Mrs Adamu’s experience is far from unique. Across Nigeria, millions of families continue to battle not only the health effects of malaria but also its crippling economic consequences. Each recurrent infection means another round of hospital visits, medication, laboratory tests, transport costs and lost income. For households already living from one day to the next, malaria can wipe out business capital, disrupt children’s education and deepen poverty.

Ironically, this burden persists even as malaria prevalence has declined dramatically, from 42 per cent in 2010 to 15 per cent in 2025, reflecting years of sustained government commitment and support from international partners.

Yet behind these encouraging statistics lies the reality that mosquitoes continue to thrive because the environments that breed them remain largely unchanged.

From overflowing gutters in Lagos to blocked drainage channels in Abuja and stagnant pools in Port Harcourt, poor environmental sanitation continues to undermine decades of investment in malaria control.

Phillip Osakwue, a public health expert, said that indiscriminate refuse disposal, clogged drains, stagnant water, bushy surroundings and poor waste management have turned countless communities into ideal breeding grounds for the female Anopheles mosquito, the vector responsible for transmitting malaria.

During the rainy season, these conditions worsen. Pools of stagnant water accumulate around homes, in abandoned containers and in blocked drainage systems, creating millions of mosquito breeding sites.

Environmental health expert Juliet Ajawura said Nigeria cannot defeat malaria without addressing these environmental conditions.

“The truth is simple: you cannot spray your way out of malaria when the environment keeps producing mosquitoes faster than we can eliminate them,” she said.

According to her, environmental neglect is steadily eroding the gains achieved through insecticide-treated mosquito nets, seasonal malaria chemoprevention and the ongoing malaria vaccine rollout.

Despite the enormous burden, the Minister of State for Health and Social Welfare, Dr. Iziaq Salako, acknowledged that Nigeria has made measurable progress, noting that the country’s malaria prevalence has fallen from 42 per cent in 2010 to 15 per cent in 2025, and that no state is currently classified as having high malaria transmission.

According to him, the country has adopted a new National Malaria Strategic Plan (2026–2030), which uses state-specific interventions to accelerate malaria elimination.

“The progress we have made shows that when Nigeria commits and partners align, results are possible. However, progress is not victory, and we must sustain the momentum,” Salako said.

Between 2021 and 2023, more than 63 million insecticide-treated mosquito nets were distributed nationwide, and about 70 per cent of households now own at least one net. About 51 per cent of pregnant women receive intermittent preventive treatment for malaria. In contrast, approximately 18 million malaria cases are now prevented annually through interventions under the National Malaria Elimination Programme, the minister explained.

He also said that the malaria vaccine has moved beyond pilot implementation in Bayelsa and Kebbi to Bauchi and Ondo States, with nearly 1.3 million children receiving at least one dose.

Despite these achievements, Nigeria remains the country with the highest global malaria burden.

The World Health Organisation estimates that Nigeria accounts for roughly one-quarter of global malaria cases and nearly one-third of malaria deaths. Children under five and pregnant women remain the most vulnerable groups.

Beyond the human suffering lies an equally devastating economic crisis, as a single uncomplicated malaria episode can cost about N17,000 in consultation, diagnosis and treatment in public hospitals. Severe malaria may cost several times more.

For petty traders such as Mrs. Adamu, farmers, artisans and other low-income earners, repeated infections often mean choosing between buying medicine and feeding their families.

The Group Managing Director of the Society for Family Health, Dr. Omokhudu Idogho, said the country cannot eliminate malaria without addressing its environmental roots.

“Some of our states need serious environmental rework. You see drains blocked everywhere, with larvae worming in stagnant water. It is not just about giving people nets; we must clear the places where mosquitoes can breed. If we do that, we can rapidly achieve what we want,” he said.

Also, Prof. Francis Faduyile, former President of the Nigerian Medical Association (NMA), said that reducing malaria deaths requires more than medicines, adding that education, affordable healthcare, functional primary healthcare centres, universal health coverage and environmental sanitation must work together.

“Mosquitoes thrive in dirty environments with stagnant water. Until we address environmental cleanliness and involve everyone in preventive measures, we cannot truly aim for zero malaria deaths,” he said.

Medical microbiologist Dr Mary Alex-Wele shares this view, insisting that mosquito nets alone cannot defeat malaria. “We live in a malaria-endemic environment. If we take care of bushy areas, stagnant water and dirty surroundings, we will reduce the mosquito burden around us,” she said.

The recurring malaria infection that drained Aisha Adamu’s business savings illustrates a painful reality faced by millions of Nigerian families.

While vaccines, medicines, mosquito nets and seasonal chemoprevention have undoubtedly saved millions of lives, experts insist that these interventions will continue to yield only partial results unless communities become cleaner and environmental sanitation is treated with the same urgency as medical treatment.

For Nigeria to achieve its target of reducing malaria prevalence and deaths by 50 per cent by 2030, the fight must move beyond hospitals and clinics to the streets, drainage channels, refuse dumps, and neighbourhoods where mosquitoes breed daily.