Funding freeze, high treatment cost, heighten Nigeria’s malaria burden

As Nigeria joins the rest of the world today to mark this year’s World Malaria Day, citizens say the disease has continued to take a huge toll on them. Some of them, who spoke to Daily Trust, complained about spending large chunks of their incomes on malaria treatment. The theme of this year’s World Malaria […]

As Nigeria joins the rest of the world today to mark this year’s World Malaria Day, citizens say the disease has continued to take a huge toll on them.

Some of them, who spoke to Daily Trust, complained about spending large chunks of their incomes on malaria treatment.

The theme of this year’s World Malaria Day is ‘Malaria ends with us: Reinvest, Reimagine, Reignite’

Malaria, according to experts, is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female anopheles mosquitoes. The symptoms include fever, headache, vomiting, diarrhea, profuse sweating and anaemia.

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Health believe that the United States Agency for International Development (USAID) funding freeze, the exit of pharmaceutical companies, inadequate domestic funding for malaria, high cost of treatment,  poor adherence to preventive measures, and limited access to prevention and treatment  have further  exacerbated the malaria scourge in Nigeria.

They noted that the cost of treatment is higher if malaria is severe and the patient has to be admitted.

According to the National Malaria Elimination Programme (NMEP), Nigeria accounts for 27 percent of global malaria cases and 32 percent of global malaria deaths. 

This translates into 22 persons dying every hour due to malaria in Nigeria; and according to the 2018 National Demographic and Health Survey (NDHS), children are the worst affected.

A 2022 World Health Organisation (WHO) World Malaria report indicates that over 66 million cases of malaria occur annually in Nigeria.

Over 90 percent of the population is estimated to be at risk of malaria.

‘Kebbi, Zamfara, Sokoto most affected’

The  NMEP said  Kebbi, Zamfara, and Sokoto states top the chart of malaria prevalence in Nigeria.

This is happening even as some countries in the region have achieved elimination of the disease or are near elimination. 

‘Treatment costing us fortunes’

Some residents of Birnin Kebbi, Kebbi State capital, have expressed frustration over the frequency at which they treat malaria and the money they spend on treating it. 

Some of them, who decried the scourge of malaria among their children and pregnant wives, said treatment is costing them a fortune at the various hospitals as they don’t usually get the prescribed drugs at the primary healthcare centres.

A civil servant, Adamu Augie, said he treated malaria for five of his children almost every month.

“The painful thing is that we don’t get malaria drugs at the primary healthcare centres. Most times, we have to get them at a high cost from pharmacies. It is a serious issue for me anytime my children fall ill with malaria”, he said.

Another resident, a teacher in one of the state’s secondary schools, Saadatu Aliyu, a mother of three said:  “I suffer malaria almost every month. Sometimes, I’m down with malaria twice in a month. The challenge I face is the cost of the medicines. No malaria treatment is less than N25,000 in the private hospitals. Sometimes, if we have to treat it along with typhoid, it cost over N50,000. I’m a teacher, married to a civil servant and i have three children. We really can’t afford the cost of malaria treatment. We most times have to add herbal concoction with some drugs we can afford to buy.”

Mr Dayo Agbaje, an engineer with a construction company, called on government to equip hospitals and primary healthcare centres with malaria drugs.

He said, “Not many people can go to the private hospitals to pay over N35,000 for the treatment of malaria. Just last week, my pregnant wife was admitted at a private hospital at the GRA in Birnin Kebbi, I spent over N68,000 for her treatment.”

‘Why malaria is endemic in Kano’

Professor Isa Abubakar, an expert on infectious diseases at the Aminu Kano Teaching Hospital (AKTH), said malaria is endemic in Kano State because of environmental factors and population size, making malaria burden higher than in other states.

He said governments at all levels must step up to narrow the funding gaps to help prevent its spread.

“Before now, one can treat malaria with as low as N500, but today, a minimum of N5,000 is needed because the prices of essential drugs have also gone up.

“People without health insurance cover really suffer treating common illness like malaria,” the don said.

Bashir Muhammad, a resident of Kano, said malaria is prevalent in the state during the raining season.

“Last year, no one was spared from malaria in my family. I personally treated malaria twice because the parasite sometime develops resistance and doctors give double dosage of treatment,” he said.

Malaria vaccines

A major health event in 2024 was the roll out of malaria vaccine in the country. The rollout of the vaccine was a highly anticipated event, having been piloted in some other African countries.

There is currently a malaria vaccine for children, not adults. The vaccine offers protection to millions of children and moves the country closer to a malaria-free future.

The federal government, in collaboration with other partners such as the World Health Organisation (WHO), UNICEF, among others, commenced the first phase of the roll out in Kebbi and Bayelsa States on December 2, 2024.

Earlier in October, the federal government received one million doses of the R21/Matrix-M malaria vaccine donated by Gavi, the Vaccine Alliance.

The National Primary Health Care Development Agency (NPHCDA) said this would be expanded to other states and integrated into the country’s national routine immunisation schedule as it receives additional doses.

“The second phase targets 19 states and the Federal Capital Territory (FCT), while the third phase will target the remaining 15 states. Both phases are scheduled for 2025,” the Executive Director of NPHCDA, Muyi Aina said.

Although the vaccination is ongoing  in the two states, there are expectations that it would be scaled up to other states.

Bayelsa residents speak

Residents of Bayelsa State said malaria treatment takes more than half of their monthly incomes.

They blamed malaria on “stagnant waters” blocked gutters and creeks as well as the drinking of untreated water.

Daily Trust gathered that most residents of riverine communities in the state drink from Rivers sources, while many others in Yenagoa, the state capital, drink from borehole.

Mr Ebiewe Japheth, a resident of Amarata community and father of five, said the challenge of malaria has become worrisome to most of the people in the state, lamenting he spent almost half of his meager monthly income for treatment of malaria for himself and the family.

“As a father of five, with myself and my wife, you could imagine how much I spend on the treatment of malaria for seven people every month, especially now that the drugs are very expensive. Before now, you could buy malaria drugs for N1,500 or N2,000, but now, you are talking about N5,000 to treat one person of malaria and typhoid fever,” he said.

A resident of Odi community in Kolokuma/Opokuma, Mrs Felicia Henshaw, said her family spent huge some of money to treat malaria on a monthly basis.

She pleaded with the state government to provide mosquito treated nets for citizens free of charge, while tasking residents on sanitisation.

Why malaria remains endemic – Experts

Experts identified factors that are making it difficult to eliminate malaria in Nigeria as including poor utilization of insecticide treated nets and other prevention tools; poor funding for malaria; traditional beliefs and norms; dearth of medicines across facilities, especially at the grassroots level; poor health-seeking behavior; poor hygiene and environmental cleanliness, among others.

The Director of Public Health, Bayelsa State Ministry of Health, Dr Jones Stow, said: “I think the issues around traditional beliefs, norms still pull a challenge because a lot of people will ask: is it not malaria? Then, there is a delay in going to the hospital and most times, they go to the hospital very late. So, when you do that, the prognosis is always very poor, especially when children and pregnant women are involved.”

Dr Dele Balogun, a public health physician and Country Lead for Rotary Community Health Challenge Programme on the Eradication of Malaria,  said Nigeria has the worst cases of severe malaria, particularly in children under five and its prevalence case is higher in children an women especially pregnant women in Kebbi State.

“There are many challenges on the eradication and control of Malaria because of the structures that are on ground. For instance, there are many primary healthcare centres that are not functioning at their best.

“They don’t have commodities, they don’t have drugs and their well trained staff are not enough. If we are strengthening the primary healthcare centres, it means we are ready to eradicate malaria. 

“The PHCs have many community volunteers that have been trained over the years but are not empowered to do the work. They need to be retrained and given the commodities and also ensure they have enough data to access and see what they are doing. 

“Beyond this, we need the people to buy in on the malaria project. It is very important that they believe in what the public health workers are doing.

“We need to let them know we are here to let their children survive, their pregnant women deliver safely and they don’t die from preventable disease such as malaria. When we have a healthier community it will be easy for us to do other things”. 

Impact of USAID funding freeze on malaria

Some of the free insecticide treated nets distributed to many households as a result of support from partners like the USAID may no longer be available this year because of the funding freeze policy of American President Donald Trump’s administration. 

Muhammad Inuwa Shuaib, Executive Director, Centre for Good Governance and  Development (CAGDev), said the fight against malaria scourge might suffer from several fronts including technical and material support because of the disruption of USAID activities in Nigeria and other countries.

“Financing of health programs is a critical aspect that provides meaningful changes in promoting the health sector.

“The current development about USAID funding cuts would affect health interventions including the malaria program for the fact that some technical assistance and logistics support rely on the funding from the USAID.

“Unless the government can fast track the system of domestic resources mobilization for sustainable health financing which would not be unconnected with significantly improving budget allocation, prompt releases and utilization of resources like that of the malaria program,” he said.

But Dele Balogun said the USAID is not the only international agency interested in the prevention, control and eradication of malaria. 

He said, “Now that we know that we don’t have a lot of aide coming from USAID, we can put our acts together and work on our own on ending malaria in the country.”

How to end malaria – Experts

Stakeholders on malaria said increased domestic funding for malaria by governments at all levels, clean environment, utilization of malaria prevention tools, among others can help end the disease in the country.

Dele Balogun said  malaria can be completely eradicated in the country if “the environment is healthy, if mosquitoes cannot breed, if children can sleep under insecticide treated net and if mothers know that if the child has high temperature and he is not playing, he needs to be tested and if it shows that he has malaria, there is drug to use and malaria will not kill the child.

“When this happens, we can get rid of malaria in the country just like countries with zero Malaria”.

Prince Cletus Ilobanafor, Managing Director of CEOAFRICA, which advocates against malaria, said it could be ended through collaboration with all stakeholders. 

He said: “You do not need to be in the health sector to know that malaria is a silent killer; children, adults, the aged, pregnant women, are all victims of malaria. This is the time that every stakeholders in Nigeria must rise up to address the silent killer.”

He said it is critical for the country to adopt the CACOVID model used in addressing COVID-19 to tackle malaria.

Professor Wilfred Mbacham, the chairman of the Board of Trustees of Malaria Consortium, an international non-governmental organisation, advised Nigeria to increase domestic funding for malaria to effectively tackle the disease.

FG’s response to malaria burden

The Coordinating Minister for Health and Social Welfare, Prof. Muhammad Ali Pate, has expressed a concern that malaria continues to exert an unacceptable toll on Nigeria. 

Speaking during an inaugural meeting of the Advisory on Malaria Elimination in Nigeria (AMEN) in Abuja, he said, “In 2022, over 180,000 Nigerian children under the age of five lost their lives to malaria – a tragedy we have the tools to prevent.” 

The minister added that malaria reduces productivity, increases out-of-pocket health expenditures and compounds the challenges of poverty.

He said: “The annual loss to Nigeria’s Gross Domestic Product (GDP) from malaria exceeds $1.1 billion, a stark reminder of the economic imperative of elimination.” 

Pate said the federal government was resolute in its commitment to eliminating malaria.

The minister noted that the National Malaria Strategic Plan 2021-2025 targets to, among other things, reduce malaria prevalence to below 10 per cent and halve malaria-related mortality by 50 deaths per 1,000 live births.

‘Test before you treat malaria’

Dr Stow advised people to get tested for malaria, and get a treatment only if they test positive.

He said: “It is not only malaria that causes a fever, part of the protocol of treating malaria now is that you must run a malaria parasite test. But our people most times will just go to the chemist and they will just mix several medications and give to them. They may feel temporary well, and before they know it, their situation gets worse overnight and becomes an emergency.

“So, I will use this opportunity to advise Bayelsans that not every fever is malaria, when you feel unwell, there must be proper test so that if it has to do with some other thing, it can be handled properly. But most important thing is that user friendly nature to our health facilities,” he added.

The National Malaria Elimination Programme (NMEP) advised Nigerians to get tested before treating malaria as some  had been found to incur expenses on malaria drugs and treatment when they did not have malaria in the first place.

“Test before you treat malaria. Not every fever is malaria. Malaria ends with us and your life is precious. Do not be your own doctor. Confirm if your fever is due to malaria. Get tested and treat with Artemisinin-Based Combination Therapy (ACT) if positive for malaria test,” it said.

The NMEP also advised the public to only go for recommended anti-malaria medicines as some, such as mono-therapies, are ineffective.

The programme officer of NMEP, Wudi Natasha, said malaria could not be diagnosed based on clinical (signs and symptoms) assessment alone, adding that diagnosis requires testing confirmation of a clinical suspicion.

Wudi said: “Case management intervention through prompt diagnosis and treatment with recommended anti-malarial is pivotal for reduction of malaria burden.”