As the world marks World Malaria Day today April 25, 2023, with the theme, “Time to deliver zero malaria: Invest, innovate, implement”, Nigeria has intensified what looks like the last push to eliminate and eradicate malaria in the country.
Malaria is a common illness in Nigeria and, perhaps, Africa. It is usually the first suspect in every bodily disorder that presents fever, headache and pains, before further diagnosis could prove otherwise.
The World Malaria Day has provided an opportunity to highlight the need for continued investment and sustained political commitment for malaria prevention and control, having the knowledge that malaria is endemic in Africa.
Malaria is a life-threatening disease, and it’s primarily found in tropical countries. Nevertheless, it’s both preventable and curable. However, without prompt diagnosis and effective treatment, a case of uncomplicated malaria can progress to a severe form of the disease which is often fatal without treatment.
Malaria, being an acute febrile illness, is caused by plasmodium parasites, which spread through the bites of infected female anopheles mosquitoes. It’s transmitted throughout Nigeria, with 97 per cent of the population at risk. The duration of the transmission season ranges from year-round transmission in the south to three months or less in the north.
Over the last two decades, significant progress has been made towards malaria elimination. The last world malaria report indicated that 27 countries recorded fewer cases of the disease in 2020, up from 6 countries in 2000.
However, the fight against malaria took a much anticipated turn last week when a new malaria vaccine was approved and introduced into Nigeria’s immunization programme.
The National Agency for Food and Drugs Administration and Control (NAFDAC) granted registration approval for R21 malaria vaccine for use in Nigeria, few weeks after Ghana and some other African countries took similar step as recommended by WHO who had certified some of malaria vaccine safe for use in Africa which bear the highest burden of malaria cases in the world.
NAFDAC explained that the R21 malaria vaccine is an adjuvanted protein vaccine presented as a sterile solution, and a dose of it is 0.5ml. The vaccine is composed of R21 malaria antigen 5µg and matrix-M1 50µg as an adjuvant filled in a vial as ready to use liquid formulation for intramuscular injection.
NAFDAC also confirmed that the vaccine has capacity for prevention of clinical malaria in children from five months to 36 months of age, with storage temperature of 2-8 °C.
Its Director General, Prof. Mojisola Adeyeye, confirmed to journalists that the vaccine has passed through rigorous test in line with global standard, and the outcome of the test was satisfactory, hence the approval for use.
Available data from the federal ministry of health confirmed that malaria prevalence in Nigeria is on significant decline, and this was as a result of collective efforts and interventions from the government and international partners.
Several financial and logistics supports have come the way of Nigeria to tackle malaria, notably, from the federal ministry of health through the National Malaria Elimination Programme (NMEP), Global Fund and several others, who have committed huge finances in the fight against malaria.
Undoubtedly, significant successes have been achieved over the years as reflected the malaria prevalence data that indicated downward trend. But in spite of the achievements, Nigeria, according to WHO report, still account for high number of global malaria cases.
The 2021 World Malaria report revealed that Nigeria accounted for 27 per cent of global malaria cases and the highest number of deaths (32 per cent) in 2020. Nigeria also accounted for an estimated 55.2 per cent of malaria cases in West Africa in 2020.
Meanwhile, the outcome of the 2021 Nigeria Malaria Indicator Survey (NMIS) conducted by the federal ministry of health and partners revealed that malaria or malaria-related issues accounted for the death of 9 to 10 persons every hour in Nigeria, and children under five are most hit, with 67 per cent of all malaria deaths.
Obviously, malaria remains a major public health challenge and constitute huge epidemiologic burden in Nigeria, hence the need for collective effort to ensure that further success is recorded in terms of prevalence especially at rural communities.
The 2021 NMIS report further indicated that malaria accounts for 60 per cent of outpatient visits to health facilities, 30 per cent of childhood deaths, 11 per cent of maternal death (4,500 deaths yearly), and 25 per cent of deaths in infants.
But amidst the numbers, malaria prevalence is on decline in Nigeria particularly at national level, 42 per cent in 2010 (NMIS, 2010) to 27 per cent (NMIS, 2015), and 23 per cent in 2018, according to Nigeria Demographic and Health Survey (NDHS 2018). Similarly, significant decline was observed at the zonal and state levels.
“Obviously, gains are being sustained in getting the population to adopt key preventive measures. The report showed us that 56 per cent of households own at least one Insecticide Treated Net (ITN), while 36 per cent of household members, 41 per cent of children under 5, and 50 per cent of pregnant women sleep under an ITN,” Minister of health, Dr. Osagie Ehanire, said.
He, thus, encouraged all partners working in the malaria landscape to utilize the new Advocacy Communication and Social Mobilization (ACSM) strategy and implementation guide to plan, develop, implement, monitor and evaluate a unified and cohesive social behavior change project for malaria control interventions that will, ultimately lead to improvement in the uptake of malaria services by Nigerians.
Despite changes over the years, medical research still maintained that malaria is not contagious and cannot spread from one person to another, but could spread through the bites of female anopheles mosquitoes.
Scientific research further confirmed that five species of parasites can cause malaria in humans and two of the species, plasmodium falciparum and plasmodium vivax, pose the greatest threat. There are over 400 different species of anopheles mosquitoes and around 40, known as vector species, can transmit the disease.
Nevertheless, the risk of infection is higher in some areas than others depending on multiple factors, including the type of local mosquitoes, environment, exposures, and others. It may also vary according to the season, the risk being highest during the rainy season in tropical countries.
Findings indicated that the first symptoms of malaria usually begin within 10–15 days after the bite from an infected anopheles mosquito. Fever and headache are typically experienced, though these symptoms may be mild and difficult to recognize as malaria. In malaria endemic areas, people who have developed partial immunity may become infected but asymptomatic.
WHO, however, recommended prompt diagnosis for anyone with suspected malaria case. It warned that if plasmodium falciparum malaria is not treated within 24 hours, the infection can progress to severe illness and death. Severe malaria can cause multi-organ failure in adults, while children frequently suffer from severe anaemia, respiratory distress or cerebral malaria.
Malaria can be diagnosed using tests that determine the presence of the parasites causing the disease. There are two main types of tests: microscopic examination of blood smears and rapid diagnostic tests. Diagnostic testing enables health providers to distinguish malarial from other causes of febrile illnesses, facilitating appropriate treatment.
Over the years, treatment drugs for malaria cases have evolved. It has continued to change as research on drug-resistant cases advanced. But there’s treat to the fight against malaria due to parasite resistance to antimalarial medicines.
Currently, Artemisinin-based Combination Therapies (ACTs) seems to be most effective antimalarial medicines available for use and recommended treatment for plasmodium falciparum malaria, which is the deadliest malaria parasite globally. Nearly all patients infected with artemisinin-resistant parasites who were treated with an ACT recovered.
ACTs combine two active pharmaceuticals with different mechanisms of action, including derivates of artemisinin extracted from the plant Artemisia annua and a partner drug. The role of the artemisinin compound is to reduce the number of parasites during the first three days of treatment, while the role of the partner drug is to eliminate the remaining parasites.
A health worker, Osingo Akala, said there has been significant improvement in malaria response in Nigeria, attributing the success to magic of ACT which has proven to be largely effective in malaria treatment.
He was optimistic that the introduction of vaccine for children will also go a long way in protecting future generation from coming down with malaria.
He said: “Alternative to artemisinin derivatives may not enter the market soon. So, it’s important that the efficacy of ACTs must be preserved. It has been recommended that treatment should only be administered if a person tests positive to malaria.
National Malaria Elimination Programme (NMEP) said they have intensified campaign on the use of Insecticide Treated Net (ITN) and other measures that have proven to be effective in the fight against malaria in Nigeria.
NMEP National Coordinator, Dr. Perpetua Uhomoibhi, recently said that COVID-19 pandemic, climate change, increased population and dynamics, as well as inadequate resources are some of the key issues affecting the fight against malaria in Nigeria.
She also lamented about the health seeking behavior of the people which, she said, was unimpressive, suggesting that new approach be adopted to achieve more results particularly at grassroot level.
WHO country representative, Dr. Walter Kazadi Mulombo, with reference to world malaria day called on governments to focus on malaria and its devastating impact on families, communities and societal development, insisting that the role of innovation in the fight against malaria had become critical, not only to reduce the disease burden globally but also to save lives.
“There has been a growing political commitment at country, regional and international levels to tackle malaria. We have seen significant breakthroughs in malaria prevention and control, in spite of the COVID-19 pandemic and other challenges,” he said.
