Malaria ravages Nigerians, gulps billions of naira
At the outpatient unit of the Mushin General Hospital in Lagos, Funke Kazeem, 32, tries to console her crying six-month-old baby, Sade, who has been ill with malaria for the past three days. Funke herself is just recovering from a bout of malaria which she says has rendered her too weak for 12 days to […]
At the outpatient unit of the Mushin General Hospital in Lagos, Funke Kazeem, 32, tries to console her crying six-month-old baby, Sade, who has been ill with malaria for the past three days. Funke herself is just recovering from a bout of malaria which she says has rendered her too weak for 12 days to go to the market where she is a food seller. Her four-year-old son, Demola, hovers near the arm of the chair she is sitting on. “He has had a high temperature since last night. I suspect he is also down with malaria,” she says.
Funke is not the only one whose family is ravaged by the malaria scourge. Official estimates from health workers show that 50% of the patients who come to the outpatient unit of the hospitals in Lagos on a daily basis suffer from malaria attacks. The Roll Back Malaria Unit of the Borno Ministry of Health provides that in 2009, a total of 493 cases of deaths caused by malaria were recorded. From the figure, 283 were recorded for children under five, 165 for persons above five and 45 for pregnant women. According to the Manager in-charge of the Unit, Mala Alhaji Waziri, “The statistics are a plus-minus figure because there are local governments whose Disease Surveillance Officers (DSOs) fail to submit collated figures, in addition to the fact that these are just cases brought to the healthcare facilities.”
The figures are almost the same in the 36 states of the federation with only slight variations. Dr. Jide Idris, the Lagos State Commissioner of Health says malaria accounts for 15 percent of admissions and 20-30 percent of deaths in children and pregnant women in the state.
These dire statistics are despite the colossal amount that has been poured into fighting malaria scourge under different health campaigns, the latest being the rollback malaria campaign. In 2007, Nigeria signed an initial World Bank International Association (IDA) loan, worth $180 million for an anti-malaria project. Two years after, in July 2009, the country got a fresh credit of $100 million from World Bank. A key strategy of the campaign is the use of insecticide-treated mosquito nets. It is a donor-funded project from the WHO and other international donors in collaboration with the federal ministry of health. But state health officials and health workers seem to have some reservations about the effectiveness of the campaign and the strategy adopted to contain the spread of the ailment.
Dr. Hadiza Nuhu, a pharmacologist at the Ahmadu Bello University, Zaria criticized the current government’s strategy of fighting malaria, especially the treated nets. “The campaign,” she says, “is at cross purposes with our socio-cultural setting as in Nigeria, most often than not, children sleep on the floor, sometimes in the open, so nets are somewhat useless. In addition, only two nets are given per household and in our society, this is inadequate for even an average family of four. Nigerians should evolve a home-grown strategy in order to curb the menace.”
Another menace that seems to be rendering the strategy of using treated nets void is the diversion of the nets from the hospitals where they are supposed to be distributed freely to the roadside traffic where they are peddled between N500 to N1, 000. “It is true that nets have been diverted and sold to people while they were not meant for sale,” says Baffa Mamuda Kademi, the Project Manager of the Malaria Control Booster Project in Kano. “But the fact is we had a crisis at the initial stage of the nets distribution exercise whereby some thugs vandalized the distribution center and went away with belts of nets and it was from that incidence we decided that no man be given the nets, and we introduced the two-for-one woman method which was successful. So I therefore have the conviction that the nets seen around are the ones stolen away by thugs at the distribution centers while very few people who got the nets decided to sell them out.”
But the fact is not only in Kano alone where health officials explain the anomaly of selling the nets in the streets as the result of the vandalization of the distribution centres in the state, but just in the outskirts of Abuja, the federal capital, similar nets are peddled on the roadside too. In Lagos, officials deny that the nets are sold in the streets even though the contrary applies.
Dr. C.U Undie, a medical consultant at the National Hospital, Abuja says: “I guess people in that area and some health officials will say it is a good thing to do but I do not know the extent to which it has reduced the indices of malaria. Maybe, if the nets were to be put on the doors and windows so that mosquitoes do not come in at all, it will work better than just sleeping in it.” Dr. Zainab Ahmad, a medical doctor at the Aminu Kano Teaching Hospital also agrees in the same vein: “The best measure in dealing with malaria is for people to prevent mosquitoes from biting them so that they wouldn’t even need to be treated.”
Looking beyond mosquito nets
Health workers have stressed often that the poor sanitation and environment prevalent in the urban centres of Nigeria have always provided a ready breeding ground for the mosquitoes that transmit malaria. An effective strategy they say is to control the breeding of mosquitoes by providing better sanitation in the form of drainage facilities and to use chemical sprays at areas where they are known to breed. It is a strategy some state governments are experimenting on but are shy of adopting because of the perceived cost in adopting the project. Most importantly, it has not attracted the support of donor agencies that are usually the source of such funds.
The irony is that yearly, the federal government allocates billions of naira to the 36 states of the federation as ecological funds to fight environmental devastation like erosion by building drainages and other such infrastructures . But such funds are embezzled. In the months between June and August when the raining season is well underway the prevalence of malaria attacks are very high, records from malaria control projects show, because of the accumulation of pools and stagnant waters due to lack of effective drainage systems. Says Dr. Undie: “I do not know if our governments all over Africa are doing enough in anything at all. I will say the government is not doing enough about malaria.”
Looking beyond malaria control
Since the scourge of mosquitoes does not seem likely to be eliminated or minimized drastically anytime soon, health workers are also focusing on administering the treatment that would be most effective in combating the disease. “The best treatment is the WHO approved combined therapy,” says Dr. Ahmed. Dr. Nuhu says, “Right now, the micro organism is drug resistant and in most cases, only a combination therapy can cure the ailment which requires a doctor to administer.”
On the best treatment for the disease, a chief pharmacist with the Aminu Kano Teaching Hospital, Pharm. Riskat Adeola Badamosi said since malaria became resistant to chloroquine, the World Health Organization recommended that a combined therapy be used and therefore certified four brands of the combined therapy antimalarial drugs. She says: “The best treatment is the combination therapy which is athemesiline based combination as recommended by the WHO and they are four which include atemether + Lumenfantrine, Artesunate +Amodiaquine, Artesunate + Meflaquinine and Artesunate + Pymmether/ Sulphadoxine.”
But Pharm. Mohammed Yahaya, who runs a successful pharmacy in Maiduguri, says: “At the moment, there is no single combination therapy drug that could be regarded as the best. None! The ACTs do work, but they only reduce the parasite level, but they do not clear them. If another therapy is taken, it reduces the parasite level again. And that is how it goes on and on until the parasite is no more. There is a serious problem. And I think one factor that could be responsible is that there are lapses because when these drugs were first introduced, they were checked and certified okay. But after a while, the drugs might not possess the same quality as it was when it was introduced. I think NAFDAC should be doing post-market sampling to see if a drug approved three years ago, is still as effective as it was then.”
He warns further: “Another problem is that continuous consumption of these drug combinations is capable of causing damage to internal organs like the kidney, liver, etc because unlike before, when malaria drugs contained single substances, we now take drugs that have two or more combinations, which course are poisonous if not regulated.”
Right now, an issue round the adoption of this treatment is the cost of purchasing such drugs. The generic drugs cost between N1, 200 and N2, 000 and to most Nigerians, this amount is astronomical and consequently, they patronize quack patent medicine dealers who often vend fake drugs. “Even though some of the drugs are expensive, there are those in the generic form that are affordable and equally effective in the treatment,” says Pharm. Badamosi who advised that people buy their drugs at reputable pharmacies in order to be sure that what they are buying is the genuine one and also ensure they take the full dose as prescribed.
Searching for a vaccine
A vaccine that would act as a shield against malaria is sometimes promoted as the best option in controlling the disease by scientists involved in research, but “the development of vaccines for malaria has not being well established,” says Dr. Undie, “because of the frequent change of antigens of the malaria parasite. That is why it difficult to treat malaria, because when you start with a drug by the next day the parasite has changed in antigens and does not respond to that treatment anymore.”
There is some hope that Ghana could have found a malaria vaccine, prompting Dr. Undie to say, “We heard the story but we do not know how far they have gone. We need to see the vaccine and we need to see it work before we can start celebrating, but for now malaria is the dreaded disease we all must be on alert to prevent from affecting us.”