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Nigeria and the challenge of eliminating malaria

By Paul Okolo
The good news that came out of this year’s World Malaria Day on April 25 is that mankind is winning the war against the disease which for hundreds of years has killed millions. The World Health Organisation disclosed that countries in its European Region comprising Europe, the Caucasus and Central Asia have already eliminated malaria from their territories. In addition, it said that eight other countries elsewhere didn’t record any cases of the disease in 2014, a feat that puts them out of the danger zone if they keep the clean sheet in subsequent years. The countries are Argentina, Costa Rica, Iraq, Oman, Paraguay, Sri Lanka, United Arab Emirates and Morocco.
A sustained global effort in the past 15 years is responsible for some of the modest gains achieved. The period saw a massive deployment of insecticide-treated mosquito nets in Africa, Asia and South America, mostly distributed free of charge to pregnant women and children under five, the group most at risk. Equally impactful has been the use of very effective anti-malarial drugs and indoor insecticide spraying.
Malaria is caused by parasites that are transmitted to people through the bites of infected female mosquitoes, according to health experts. The first symptoms – fever, headache, chills and vomiting – usually appear between 10 and 15 days after the mosquito bite. Without prompt treatment, it can cause severe illness and eventually death. Malaria is responsible for more than 100,000 deaths in Nigeria annually. This is approximately one out of every four deaths credited to the disease worldwide. Most of the mortality is in Africa. Nigeria’s Health Minister, Prof. Isaac Adewole, says the country also has set a target of eliminating the disease by 2025, five years ahead of the global deadline contained in the Sustainable Development Goals.
While there are reasons to believe it’s possible, it won’t be easy. Since 2011, an aggressive programme against malaria in Nigeria has cut mortality rates among children under five years of age by 18 percent. There was also a 15 percent drop in malaria attacks among this same group. At a time of economic crisis caused by the slump in the price of crude oil, the country’s major revenue earner, the cost of fighting this global problem is enormous, estimated at around $600 million yearly, according to U.S. Ambassador to Nigeria, James Entwistle. This is besides the man-hours lost by people who fall sick as a result of malaria — time that could have been best used on the farm or in the office or factory. Yet, the world’s economy will gain if malaria is truly arrested, says Mr. Entwistle in a statement. “Leading economists have identified the fight against malaria as one of the ‘best buys’ in global development, estimating that a 50 percent reduction in global malaria incidence could produce over 7,000 naira ($36) in economic benefits for every 200 naira ($1) invested.” In addition, “Malaria eradication could deliver more than four hundred trillion naira ($2 trillion) in economic benefits and, more importantly, save an estimated 11 million lives,” he says.
I find the perspective of a Kaduna-based commentator quite interesting. Nigeria can end malaria if it can make focus its attention mainly on women, Dr. Nana Sa’id said in a newspaper article this week. Her views are worth repeating here: “Women are at highest risk during pregnancy, which can lead to severe complications for mothers and their babies. In Nigeria, the impact is devastating: malaria is responsible for 11 percent of all maternal deaths, in part because less than one in five pregnant women receive the recommended dose of life-saving preventative treatment. Our social structures exacerbate the challenges women face in protecting themselves from malaria. Women often lack access to the same resources as men, making it harder to afford preventative measures or malaria treatment. Many women do not have the education they need to fully understand malaria’s risks. As a result, too many women are not in the position to seek appropriate care when they or their children get sick.
“All of these factors contribute to a vicious cycle that holds women back and allows malaria to persist. When women spend their income on malaria treatments, or miss work to care for themselves or a sick child, they have fewer resources to provide other necessities for their families – especially if they are the sole source of income. As women’s financial security falters, they have a harder time keeping their families healthy, making them more susceptible to infectious diseases like malaria.” I agree with Dr. Sa’id. Unless Nigeria deals with the problem of malaria as it affects women, eradicating it in 2025 will be a mirage.
Still, behavioural change among the people will be unavoidable going forward. Nigerians have to reduce breeding grounds for mosquitoes by keeping their environment clean. Refuse dumps are ubiquitous, including in rural areas that used to be green a few decades back. Unsanitary conditions in the urban centres equally compound the problem. There exists yet a growing hazardous trend in big cities that must be stopped. Whenever it rains, people empty bags of rubbish inside gutters and drains in the hope that the flood water will wash it downstream. Sadly, the rubbish doesn’t travel far. It blocks drains and creates stagnant waters that serve as massive breeding grounds. Health authorities should consider re-introducing sanitary inspectors to check this practice. Failure to act could prolong the war against malaria unnecessarily. It could take the focus away from finding solutions to the emergence of mosquitoes that are resistant to anti-malaria drugs and insecticide-treated nets. Also, many people are now unwilling to use the nets during the hot season when the persistent power cuts make the heat most severe and nights very uncomfortable. So until efforts to develop a vaccine cure yield the desired result, stakeholders should know that the battle’s far from over.
*Paul Okolo is an Abuja-based public affairs analyst.
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