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Nigeria and her fight against malaria



MALARIA is a disease caused by parasites called Plasmodium. The most dangerous of the malaria parasites is called Plasmodium falciparum and is the most prevalent malaria parasite in African, accounting for 99.7% of estimated malaria cases.
Malaria parasite is transmitted by infected female Anopheles mosquitoes. Nigeria as a country is highly endemic for malaria with 97% of the population living in malaria transmision areas. According to 2018 World Malaria Report published by the World Health Organization (WHO), the global burden of malaria cases stood at 219 cases with 435, 000 deaths.
Children under five years of age and pregnant women especially those in their first pregnancy remain the most vulnerable groups for the disease. The burden of malaria during pregnancy include abortion, stillbirth, low birth weight for newborns and maternal mortality. Ninety two percent (92%) of malaria cases in the world occur in subSaharan African and Nigeria unfortunately has the unenviable record of having the highest malaria burden in the world. Nigeria accounts for 25% of the global burden of malarial disease.
Nigeria and development partners have been collaborating in the effort to fight malaria especially over the last eight years. However, huge gap still exist in the battle against the disease. The fight against malaria is still within the domain of control even though the country has the ambition of elimination. Any country with malaria prevalence of more than 5% is considered to be within the range of malaria control. The average prevalence of malaria in Nigeria currently is above 20%.
Malaria is a disease that is not only preventable and treatable, but can be eliminated. Many countries including Lesotho, Mauritius, Seychelles, Morocco, Libya, and Tunisia with determined political will has eliminated the disease from their territories using available intervention tools.
Many intervention tools including sleeping under long lasting insecticidal nets, use of malaria rapid dignostic tests and microscopy for diagnosis , use of intermittent preventive treatment for pregnant women, seasonal malaria chemoprevention for children aged 3-59 months in some parts of northern Nigeria where malaria transmission lasts less than 4 months, indoor residual spraying (IRS), artemisinin-based combination therapy (ACT) for treatment as well as sanitation and changes in human behaviour using behaviour change communications are available for the fight against malaria.
These weapons against malaria notwithstanding, there is still a very huge gap in the fight against malaria in Nigeria. The most important of the gaps is the lack of political will by the political actors especially particularly the executive and legislative arms of various levels of governments to provide adequate domestic funding for malaria control and subsequent elimination.
Local Government Chairmen and Councillors, State Governors and State Assembly members, President and the National Assembly members hold the magic wand in the fight against malaria in Nigerain. Governments in Nigeria need to own the malaria fight by appropriating and spending more in the fight against this ancient scourge. Malaria is not only a health problem; it is also a socioeconomic problem which if defeated will unleach resources for the development of other sectors of the economy. There is every need to increase the domestic funding for the fight against malaria.
Even the National Malaria Elimination Programme (NMEP) has called for increased domestic funding inthe fight against malaria in Nigeria.Speaking at the NMEP 4th quarter media chat 2018 in Abuja, the National Coordinator of the programme, Audu Mohammed, said government at all levels needs to give more resources for malaria control activities in the country. He said and I quote,“We need the government to give more resources for malaria control activities in the country. This is not limited to the federal government but also state and local governments. Even the private sectors can also be a major contributor to malaria fight. The private sector does not need to give money to States or National Malaria Elimination Programmess but they can just to do something within their environment. There is the need for a major subsidy on malaria commodities so as to ensure easy access to them. Commodities in the private sector are hardly accessed because they are too expensive.
These commodities are already subsidised at the government health facilities because donors are bringing them in at subsidised rates. That also has to happen for all health facilities, whether government or private for there to be a significant difference in the Nigerian fight against malaria. Beyond the issues of domestic funding for malaria control activities and subsidy for antimalarial commodities, there is the urgent need to accelerate the efforts to make government-owned health facilities funtional.
Most primary and secondary health care facilities across the states of the federation are in a terrible bad state. There is the lack the adequate human resources and infrastructure in these health centres and these have grossily undermined their capacities to effectively deliver on their mandate of providing good service delivery.
There is therefore the need for massive recruitment of health personnel local, states and federal governments. This will reduce workload of available staff and boost confidence of Nigerians in patronising government health facilities mostly accessed by the poor.
There is also the need for government to fund local research activities on malaria to provide needed evidence to guide decision making in malaria control programmes. Such research may produce local commodities including environmentally-friendly insectcidal products including repellents for mosquito contol and even create job opportunities for teeming Nigerian youths. Time has come for Nigeria to depend less on donor-funded research and intervention programmes in order to protect national interest. As countries in the African continent are transiting from malaria-endemic to malaria-free status, governments in Nigeria should own the fight against malaria by increasing domestic funding for malaria control activities and indeed take effective leadership of the fight against malaria. Nigeria as a country has all it takes to ensure malaria disease is not only controlled but indeed eliminated within the shortest time period. The time to act is now.
*Prof. Aribodor, a malariologist and professor of Public Health Parasitology works in Nnamdi Azikiwe University, Awka



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