Towards eradicating malaria in Nigeria

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Malaria is one of the deadliest childhood under five diseases that has claimed the lives of so many infanta. It has also been claiming the lives of many adults despite several calls and advocacy messages on malaria preventive measures.

According to the WHO 2021 World Malaria Report, there were 247 million cases of malaria in 2021 compared to 245 million cases in 2020. The Report added that the estimated num- ber of malaria deaths stood at 619 000 in 2021 compared to 625 000 in 2020. The WHO African Region is recorded in the report as having a disproportionately high share of the global malaria burden.

In 2021 the region was home to about 95 per cent of all malaria cases and 96 per cent of deaths. Children under five years of age accounted for about 80 per cent of all malaria deaths in the Region. Four African countries accounted for just over half of all malaria deaths worldwide: Nigeria (31.3 per cent), the Democratic Republic of the Congo (12.6 per cent), United Republic of Tanzania (4.1 per cent) and Niger (3.9 per cent). Nigeria reportedly had the highest number of global malaria cases (27 per cent) of global malaria cases) and the highest number of deaths (32 per cent) of global malaria deaths) in 2020, and accounted for an estimated 55.2 per cent) of malaria cases in West Africa in 2020. Case increased by 5.3 per cent between 2017 and 2020 and from 298 to 314 per 1000 of the population at risk. Deaths in- creased 4.7 per cent, from 0.92 to 0.97 per 1000 of the population at risk during that same period.

Although over the two peak years of the pandemic (2020– 2021), COVID-related disruptions led to about 13 million more malaria cases and 63 000 more malaria deaths, the minister of Health, Dr. Osagie Ehanire had noted that within the period, Nigeria experienced a decline in the prevalence rate of malaria, as recorded in 2015 and 2018 respectively; the prevalence rate had dropped from 42 per cent in 2010 to 27 per cent in 2015 and 23 per cent in 2018. The minister averred that decline cannot be disassociated from the increase in the uptake of treated insecticide mosquito nets, testing and access to malaria care. With this, he was was optimistic Nigeria would be able to further crash the mortality rate to 50 per 1000 live births and the prevalence rate of malaria to less than 10 percent in the next three years. However, two years after this beautiful narrative by the minister Nigeria is still struggling with the burden of malaria.

The disease is transmitted throughout Nigeria, with 97% of the population at risk of malaria despite reaching 27 mil- lion children across 21 states with Seasonal Malaria Chemoprevention (SMC) medicines and distributing 42, 910,303 insecticide treated nets (ITNs) to beneficiaries in 11 states. SMC is one of the interventions recommended by the WHO to prevent malaria in children. It involves intermittent administration of full treatment courses of anti-malarial medicines to children in areas of high seasonal transmission during the malaria season. According to the Director, Public Health of the ministry, Dr Morenike Alex-Okoh, the SMC and ITN programmes were strategically undertaken to accelerate malaria elimination in Nigeria.

This had become necessary if Nigeria must join other countries in eradicating the disease, as the 2021 Malaria Indicator Survey (NMIS) shows that malaria prevalence in the country was highest amongst children between the of 48 to 59 months. National Coordinator, Nigeria Malaria Elimination Programme (NMEP), Dr Perpetua Uhomoibhi, National Coordinator, NMEP, said there was need for Nigeria to do things differently to improve acceptability and uptake of malaria interventions. One of such different ways to address this situation is embarking on a community led monitoring of the implementation of national malaria programs, following reports that mist if the ITN were not given freely to the citizens especially pregnant women, but sold o those willing to make use of the nets. Also, there a lots of myths and misconceptions around the use of nets, while others run away from using it due to the extreme and harsh weather conditions which leave many Nigerians in need of air while they sleep.

According to the Ogun State Coordinator of Civil Society in Malaria Immunisation and Nutrition (ACOMIN), adoption of community-led monitoring of the implementation of malaria programmes is imperative to addressing the various challenges militating against the prevention and elimination of the disease in Nigeria. She raised alarm that Nigeria might not attain full elimination of malaria by 2030 if the government continued to ignore the people while formulating policies on its eradication, and called for the involvement of members of the community, Civil Society Organisations (CSOs), religious organisations, Non-Governmental Organisations (NGOs), among others, to ensure accountability and sustainability of malaria programmes.

But with the recent provisional approval for the use of R21 malaria vaccine for prevention of clinical malaria in children from 5 to 36 months of age by the National Agency for Food and Drug Administration and Control (NAF- DAC), there is hope Nigeria might just be able to join league if other countries who have succeeded in eradicating malaria fro that country in the next seven years. Note that Since the world’s first malaria vaccine was introduced in 2019, African communities fully accepted it after a relatively short period of time with over 1.3 millions n children as beneficiaries in three African countries.

According to NAFDAC’s Direictor General of NAFDAC, Prof Christianah Adeleye, Nige- ria expects to get at least 100,000 doses of the vaccine in donations soon before the market authorisation would start making other arrangements with the National Primary Health Care Development Agency (NPHCDA), NAF- DAC. According to her, the review committee recognised that the vaccine was 75 per cent effective in protecting against malaria and that it’s potential benefits outweigh its known and poten- tial risks, added that the storage temperature of the vaccine was 2-8 °C.

This comes as a welcome development as many countries round the globe are adopting measures tht would help them achieve a malaria free country by 2025. For example, in January this year, the 4th Annual Global Forum of Malaria-Eliminating Countries was held convened by the WHO Headquarters and South Africa Country Office, where countries close to eradicating malaria took time to share their success sto- ries and challenges. Speaking at the forum, Dr. Sibongiseni Dhlomo, Deputy Min- ister of South Africa’s National Department of Health noted that “The malaria map is gradually, if not rapidly, shrinking. At the turn of the 20th century, endemic malaria was present in almost ev-ery country. During the years 1955 to 2018 the disease was eliminated in 111 countries and 34 countries are advancing towards elimina-tion. We understand elimination as the absence of transmission in a defined geography – typically a country.” Nigeria, once fully acknowl-edged as the giant of Africa without brows being raised, must stand up t the occasion and continue to chart the cause that will have a country free from the burden of malaria.

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