The international society is aware of the necessity to dedicate itself to eradicating a long-standing illness that predates malaria. It is no secret that Nigeria has the highest percentage of malaria infections and fatalities among the 87 endemic nations, particularly among children under the age of five.
Nigeria accounted for over 27% of all malaria cases worldwide, according to the WHO data from 2022, making it the country with the most instances worldwide.
Approximately 31% of all malaria deaths globally in 2022 occurred in Nigeria, which also had the highest global mortality rate.
Additionally, the nation loses an estimated $1.1 billion (N645.7 billion equivalent) annually as a result of absenteeism and medical expenses associated to malaria. It’s important to note, though, that malaria incidence and prevalence have changed over time in Nigeria.
The most recent malaria indicator survey (year) revealed that the prevalence, or the percentage of children under 5 who had malaria, gradually decreased from 27% in 2015 to 22% in 2021.
Given that malaria is mostly a rural illness and that Nigeria has experienced significant urbanization, one could ascribe the fall in malaria cases and deaths’ reduction and advancement to the natural decline brought on by urbanization. A natural drop in the number of cases seen occurs as a result of internal migration to metropolitan areas. However, research has revealed that the advancements we have seen have been made possible by purposeful and persistent efforts to manage and eradicate malaria in Nigeria.
The National Programme has supported interventions and programs to increase access to malaria prevention and control measures, especially mosquito nets, improve malaria diagnosis and treatment at hospitals and within communities. These partners include, but are not limited to, the Global Fund, the World Bank, the United States President’s Malaria Initiative (PMI), Bill and Melinda Gates Funding, the Islamic Development Bank, and the UK Department for International Development (DFID).
But will this be enough to eradicate malaria in Nigeria? Should the resources allocated to combating and preventing disease be increased in light of the expanding population?
Let’s look to other nations for inspiration and take note of their achievements before tackling these pressing issues. Only five of the 40 nations that the WHO has designated as malaria-free are African nations.
More recently, in 2019, Algeria received the certification that it had successfully eradicated malaria.
How did Algeria accomplish this improbable task? Strong levels of political commitment (a measure of investment in healthcare or malaria) in Algeria, including ongoing financial support from the national government, while implementing the standard WHO recommended interventions; robust integrated surveillance systems; and efficient vector control measures, such as insecticide-treated bed nets, have all been credited with the country’s success.
The nation has made great steps to improve its healthcare systems, ensuring that all people, including migrants, have access to free and affordable healthcare services delivered by a skilled health staff.
This dedication is essential for quickly identifying and treating malaria cases. The nation also had a strong political commitment at the national level and fervently committed resources, including financial support for the malaria program through domestic financing. Understanding the main source of transmission—the open and wide borders—was also a critical step toward elimination. Algeria recorded imported cases and carried out appropriate interventions using an integrated surveillance system. Looking outside Africa, nations free of malaria such as Uzbekistan, Paraguay, and Argentina have succeeded using various strategies.
Through a results-based strategy, the Global Fund consistently supported Uzbekistan. Paraguay used community health workers to treat and eradicate malaria, and Argentina promoted cross-border cooperation.
This dedication is essential for quickly identifying and treating malaria cases. The nation also had a strong political commitment at the national level and fervently committed resources, including financial support for the malaria program through domestic financing. Understanding the main source of transmission—the open and wide borders—was also a critical step toward elimination. Algeria recorded imported cases and carried out appropriate interventions using an integrated surveillance system. Looking outside Africa, nations free of malaria such as Uzbekistan, Paraguay, and Argentina have succeeded using various strategies.
Through a results-based strategy, the Global Fund consistently supported Uzbekistan. Paraguay used community health workers to treat and eradicate malaria, and Argentina promoted cross-border cooperation.
In terms of domestic finance for malaria, bringing these lessons back to Nigeria is difficult.
In Nigeria, government spending on malaria in 2017 accounted for 8% of overall spending, with the remaining 86% coming primarily from households’ own pockets. But there is still hope. Nigeria’s establishment of the End Malaria Council in 2022 demonstrates a certain level of political commitment.
This partnership between the public and private sectors is focused on boosting the fight against this fatal illness. Gathering service and money pledges to help close the budget gap for the National Malaria Strategic Plan and other malaria elimination programs is one of the council’s most crucial responsibilities.
The End Malaria Fund was formed to supplement and stretch Nigeria’s meager resources in order to meet these goals. More than $23 million has been put into national malaria programs in other nations where this council has been established.
A number of issues, including a weak primary healthcare system due to deteriorated health structures, a scarcity of healthcare staff, and inadequate referral mechanisms, often known as the “Japa syndrome,” make it difficult to provide universal healthcare, which is essential for Nigeria to eradicate malaria.
However, Nigeria can save lives from malaria and develop healthcare systems at the same time by addressing the disease, as Algeria has done with great success.
Malaria eradication in Nigeria would remain a pipe dream without robust and integrated healthcare systems.
In addition to what has already been described, Nigeria offers a number of additional prospects for the eradication of malaria. This entails looking into the role played by the private sector, raising funding for further interventions and innovations, mobilizing the community to support testing and treatment, and using a multiministerial approach to elimination.
Nigeria has a thriving private sector, which could be used to raise money for the malaria eradication effort and assist better case management at the community level. This sector includes private philanthropy, civil society organizations, and the formal and informal private sectors.
The fight against malaria at the community level could benefit greatly from the private informal sector, which includes Patent and Proprietary Medicine Vendors (PPMVs) and Community Pharmacists, collectively also known as drugstores or chemists.
According to the 2021 malaria study, more than 56% of fever cases seek treatment in the private unregulated sector. This indicates that the majority of people in the neighborhood will go to a pharmacy first if they have a fever.
Here is a chance to make sure that customers of these pharmacies receive the proper screening and care.
Despite the fact that the legal framework has been established to let drug shop proprietors to do easy, quick testing and administer combination therapies based on artemisinin.Due to behavioural attitudes toward testing, also known as “I know na malaria dey worry me, I no need testing,” incorrect malaria messaging/advertising, limited availability of malaria commodities, and insufficient coordination of drug stores to ensure that all suspected fever cases are treated, testing remains remarkably low at these stores. Furthermore, the nation has robust community institutions, initiatives, and programs that can be leveraged and reinforced to promote early detection, testing for suspected cases, and treatment for instances of malaria that have been confirmed. However, many of these community structures and activities need to be formalized, and resources and capacity need to be increased.
The World Health Organization has proposed two important strategies to control the malaria vector, including the usage of nets and indoor residual spraying. Nigeria could potentially investigate further interventions and innovations.
Insecticide-treated net distribution and purchase have received significant funding from Nigeria and its development partners, but usage rates are still low.
People indicate that they do not routinely use their nets because of the rising temperatures in the nation, which is one of the factors contributing to this poor utilization.
In order to manage the malaria vector, it is necessary to investigate additional interventions, such as indoor residual spraying (a technique in which a unique insecticide rather than the typical “fleet or insecticide” is sprayed inside homes on the walls to kill mosquitoes). Indoor residual spraying, albeit it is capital demanding, does not require family involvement, which lessens the problems associated with internet use and has been a significant role in the removal of some countries.
The R21 Malaria Vaccine (Recombinant, Adjuvanted), a recently developed malaria vaccine, is a positive innovation. Nigeria has made a significant advancement by authorizing the vaccination through NAFDAC. This is a chance to address malaria cases and fatalities among the group most susceptible to malaria mortality (children under 5).
Last but not least, there is a huge and urgent need to switch from the one-ministry approach to eliminating malaria to a multi-ministries approach. Different factors drive malaria transmission, such as environmental and behavioral factors, which require different ministries to work together. An integrated approach will mean different ministries, such as Environment and Education, working with the Health Ministry to address factors that drive the infection beyond the health sytem.