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Malaria burden is falling but never gone

Bukola Afeni
Deaths from malaria fell around the world—from 655,000 in 2010 to 445,000 in 2016, data show.
But fresh data compiled by the World Health Organization (WHO) shows that while malaria is present in 91 countries, at least 80 percent of malaria infections and deaths are now concentrated in just 18 of them.
And researchers presented WHO data showing that over this same six-year period, many of these countries—including Nigeria, Ivory Coast, South Sudan, the Central African Republic and other regions experiencing armed conflict—saw infections and deaths surge.
The WHO Director General Tedros Adhanom recently warned: “If we continue with a business as usual approach, these malaria hot zones could reverse hard-fought progress against the disease. He therefore called for an all encompassing approach to tackle malaria.”
Several individuals in Nigeria are faced with malaria attack on a daily basis, despite government’s effort at tackling the disease.
A visit to the Dutse Primary Health Care Centre shows that the pregnant women were given long lasting Insecticide treated net in the course of attending antenatal classes.
In the course of the report, we spoke to 10 women about the nets. Only two of them use the nets.
Businesswoman Aminat Shehu was given the net during her antenatal visit at the centre. She used it only after giving birth, and just a few times.
“I never like using the mosquito net because it is always causing heat for me on many occasions,” she says.
“While pregnant with my baby, my husband always query me to use the long-lasting nets, but I told him that if I stay too long under the net I will suffocate.
“Tried making use of the net my the first day, I was given, but it is saddening that the choking that I witnessed is too much, so we decided to call carpenter to fix our own net for us.”
Tolari Dada also used the net only after the birth of her baby.
“I will advise health officials to ensure minimal adherence to the use of the net, especially pregnant mothers,” she says.
Kogo is a small settlement in Bwari Council Area. It is frequently waterlogged. And with water come mosquitoes.
Hannatu has lived in Kogo for four years, and seen neighbours frequently down with malaria.
“I have five children. Since this year began, I have been to the primary health care centres in Dutse more than five different times to treat members of my immediate family,” she recalls.
A doctor with the Bwari General Hospital, Dr Benedict Olise, called on all Nigerians to practise healthy living at all times, and noted that malaria is attributed to poor living conditions and encouraged all and sundry to maintain clean environment.
“We normally counsel our nursing mothers who normally come for the ante natal activities to always use long lasting insecticidal treated nets,” he says.
The World health organisation has set a target to reduce malaria-related deaths among children by at least 90% by 2030.
Innovations are on to prevent and treat malaria using artemisinin-combination therapy.
The pharmaceutical firm Novartis wants to expand access to paediatric anti-malaria mediation and help strengthen health system in four sub-Saharan countries.
“Resistance to treatment presents the biggest threat to the incredible progress that has been made in the fight against malaria in the past 20 years,” says Novartis chief executive officer Vas Narasimhan.
“We cannot afford to wait; we are committing to advance the research and development of next generation treatments.”
The efforts to combat malaria
Nigeria has spent N198 billion in the fight against malaria in the past 10 years.
But the disease still remains a major public-health problem: it is a major barrier to social and economic development, says the Minister of health, Professor Isaac Adewole.
“We are encouraging Nigerians to contribute resources to the fight against malaria in Nigeria. It is only then that the desired impact can be guaranteed,” he says.
“The government is working hard to improve the quality of care and increase access to anti-malaria commodities particularly amongst the poor. “We are also working towards securing additional funding to close the existing commodity gap and move Nigeria towards elimination of malaria.”
The fight is still on to get individuals to test before treating a fever. Even more effort is needed to maintain the use of artemisinin-combination therapy as treatment for uncomplicated malaria. That is a matter of policy.
Self prescription
Research for this report shows what’s been common for long: many Nigerians self medicate once they feel feverish. They don’t test; they buy drugs from chemists rather than go to a primary health centre or a certified private or public hospital.
Nigeria has recently developed and published its National Insecticide Resistance Management (IRM) Plan to provide guidance and ensure effective monitoring, management of vector resistance and monitoring of quality vector control interventions.
“The surveillance activities are currently going on in six sites across the country, one in each geo-political zone,” says Adewole.
“We are on the verge of establishing another 3 sentinel sites in Kano, Niger and Osun States to increase in coverage in terms of insecticide resistance monitoring and vector management.”
Use of LLIN
An official of the National Malaria Elimination Programme says the federal government and the partners have been very supportive with the distribution of the long lasting insecticidal nets.
He said the nets are meant to be free of charge and called on any citizen to report any health officials that sells the LLIN to them in the facilities.
It is however worrisome that out of the total 10 respondents that the reporters spoke to, it was discovered that only two use the net routinely daily.
While speaking to Blessing Onuh, she noted that even though she has been given the net in the primary health care in Dutse, she explainedthat on the first day that she tried using the net at home, she and her children sweated all thorough the night, they almost suffocated because there was no power through the night.
“Since the incident happened, I have been very discouraged from using long lasting insecticidal nets. Maybe during the rainy season, I will be able to use the treated net, but right away I can’t compromise,” she says.
It is a problem officials and authorities admit.
“Most Nigerians do not use the Long lasting insecticides treated nets,” according to health minister Adewole.
“In 2017 about 16,199,953 Long Lasting Insecticidal Nets (LLINs) were distributed in seven states comprising of Sokoto, Edo, Kwara, Osun, Imo, Ondo and Adamawa”
“We plan to distribute about 18.4million nets in six States this year, the states include Nassarawa, Ogun, Jigawa, Katsina, Gombe and Kebbi States. Nets are also being distributed through antenatal clinics for pregnant women and routine immunization of children. It is common knowledge that a lot of the LLINs distributed are not used.
The National Programme Officer for malaria at WHO in Nigeria, DrLinda Uzor,reiterates the needfor strong coordination and determined efforts from all Nigerians and stakeholders towards eliminating malaria in Nigeria .
She also advised the citizens to be wary of emerging insecticides that have adverse effects on the health of individuals.
“We are calling for more interventions towards beating malaria, as Nigeria still represent 30% of the case burden in African region .We need to put in more effort to achieve a malaria free country”
A nurse at the Bwari General Hospital, Ifeoma Odili, called on all Nigerians to put in preventive measures towards combating malaria.
According to her, 69% of malaria deaths around the world in 2015 were in children under five years of age.
“As a preventive measure, it is recommended that children under age five sleep under long lasting insecticide-treated net
“Despite the series of ongoing effort at combating malaria, the disease is still ravaging the community around us.
“On a daily basis we keep treating the children, but sometimes we found out that the mothers engage in all sort of self medication. They assume that when their children are ill, they are suffering from malaria
“We keep carrying out awareness and sensitization activities to all the patients, especially against self medication, we hope they will listen in this regard, and do the right thing.”
According to Ozor, “At policy level, Nigeria has put together a strategy to guide efforts in controlling malaria; the national strategic plan, which is aligned to global malaria technical strategy”
“The key strategies under this plan are prevention through Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spraying (IRS) and chemo prevention for children and pregnant women; diagnosis with malaria microscopy and rapid diagnostic test kits and prompt treatment Artemisinin Combination Therapy (ACTs).
“These interventions are proven and remain effective for the control and elimination of malaria. It is important to note that these interventions need to be implemented at scale or universal coverage to achieve optimum effect and results.
According to her, the cost of delivering one LLIN is a minimum of $3.50, diagnostics and treatment staggering around $1 each.
“These costs do not include cost of training of health care providers, community mobilisation, maintenance of the supply chain system and other system costs including surveillance,” she says.
“But it is rather saddening that only a small percentage of Nigerians like using the long lasting insecticidal nets.”

This research was made possible with support from Code for Nigeria via The Wanadata Program

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