Years after war declared on malaria, mosquitoes still biting at Nigeria’s population

After decades dealing with bloodsucking mosquitoes and the death toll they bring, where is Nigeria on malaria elimination? Six African countries have the potential, according to analysis by the World Health Organisation, to eliminate local transmission of malaria by 2020-and Nigeria is not among them. Algeria, Botswana, Cabo Verde, Comoros, South Africa and Swaziland made […]

After decades dealing with bloodsucking mosquitoes and the death toll they bring, where is Nigeria on malaria elimination?

Six African countries have the potential, according to analysis by the World Health Organisation, to eliminate local transmission of malaria by 2020-and Nigeria is not among them.
Algeria, Botswana, Cabo Verde, Comoros, South Africa and Swaziland made the list of six in a WHO “Eliminating Malaria” report out last week. The analysis comes a year after the World Health Assembly resolved to eliminate malaria from at least 35 countries by 2030.
Lately Nigeria’s battle against malaria has shifted from control to elimination but that is not enough to place it among countries where transmission could end by 2020.
Nigeria has a huge malaria burden. Last year alone saw an estimated 214 million new cases of malaria and 438,000 deaths, according to WHO.
One out of every four cases and deaths was in Nigeria. It is the second leading cause of death from infectious diseases in Africa, after HIV/AIDS.
And it sets the country back billions of naira in lost man hours-economic time lost because a parent had to stay off work or business to care for a child or relative ill with malaria. The disease, borne by blood-sucking mosquitoes, is so common, authorities are having a battle convincing the public that not every fever is necessarily malaria.
The shift from control hasn’t quite got to elimination mode yet. It is stuck on pre-elimination. Latest findings have indicated seropositivity and endemicity are falling off across the country.
Out of 100 cases tested, less than half will test positive for malaria. Large swathes of regions of the country with high red-alert endemicity are sinking in amber and green levels of endemicity, according to the National Malaria Elimination Programme, NMEP, which coordinates the country’s malaria response.
But malaria cases still pop up, which is why elimination cannot take off at full throttle.
Nigeria’s own Malaria Strategic Plan Goal is to reduce malaria burden to “pre-elimination” levels and bring malaria-related deaths to zero by 2020, said Dr Godwin Ntadom, of NMEP.
To meet this target, it must ensure:
•    80% of targeted population get access to appropriate preventive measures
•    anyone with suspected malaria undergoes a rapid diagnostic test or microscopy
•    any confirmed malaria case seen in public or private facility is treated with effective antimalarial drug-translated mostly as artemisinin-combination therapy, ACTs.
ACTs are still expensive, and an intervention under the Affordable Medicines for Malaria provides subsidised packages for as low as N100.
But the subsidised packages are yet to saturate markets and the price difference-meant to make the drug affordable-has even bred suspicion in some instances.
According to Ntadom, the face of malaria in Nigeria has altered: ACTs are widely available over the counter; malaria treatment has improved at all levels even within communities, rapid diagnostic test (RDT) kits are becoming increasingly available; malaria prevalence is dropping nationally; most fevers experience are not malaria; and presumptive treatment of malaria is still prevalent.
The final couple of points he makes sharpens attention on the risk of getting complacent about malaria, and in particular the ACTs. Presuming every fever to be malaria is a waste of ACTs-and misuse is simple room for malaria parasites to develop resistance against the drug. ACTs are considered the last line of defence, and its failure against malaria could roll back decades of work against malaria.
International donors funding much of the malaria programmes aren’t smiling. Last week, US ambassador to Nigeria James Entwistle said malaria elimination in Nigeria costs the US N132 billion (around $660 million) a year. He spoke of “tremendous progress” in the wake of spending, but said, “We must remain committed to our fight against malaria.”
NMEP has an idea where Nigeria wants to be on malaria elimination. It needs to scale up diagnosis before treatment.
It also needs to increase “informed demand for diagnosis of malaria within the general population,” according to Ntadom. In addition, it will need make available and accessible RDT, ACTs and mosquito nets treated with long-lasting insecticides through any means necessary.
They are targets, ambitious as they are. The hope is a time when malaria transmission stops within the country, and a possible sight on eliminating the disease.