DUE largely to her lethargic attitude towards public health matters, Nigeria has fallen behind in the global drive to curtail malaria morbidity and mortality. Apparently, the same lackadaisical attitude that has seen the country holding back the rest of the world from eradicating polio or substantially containing other life-threatening infectious diseases such as tuberculosis, HIV, diarrhoea and cholera, has been brought into the malaria eradication bid.
A recent report by the World Health Organisation shows that, following a sustained period of decline, incidence of global malaria witnessed an upsurge last year, jumping from 217 million cases in 2016 to 219 million cases in 2017. While this setback has been rightly contextualised as global, available evidence shows that it is Africa-driven, with Nigeria as the biggest culprit.
WHO’s 2018 World Malaria Report shows that 92 per cent of global malaria cases last year occurred in sub-Saharan Africa, just as the continent was responsible for 93 per cent of mortality cases. Among the trio of Nigeria, Madagascar and the Democratic Republic of Congo, there was a marked rise in malaria cases in 2017, with each country accounting for additional half a million over the previous year’s figures, the report said. Besides, in countries such as Mali, Tanzania, Burkina Faso, Cameroun, Ghana, Uganda and Niger, about 3.5 million extra cases of malaria were diagnosed.
Malaria, an acute febrile and life-threatening illness, is caused by the plasmodium parasite. It is transmitted through the bite of the female anopheles mosquito, also the vector. When it bites an infected person, it carries the parasite, which is later transmitted to a healthy person, also through a bite. The parasites grow in the liver, after which they enter the blood stream and attack the red blood cells. Particularly vulnerable are children under the age of five and pregnant women. Among these groups, if not treated promptly, malaria can be very fatal as it is said to claim the life of a child every two minutes.
Out of the 435,000 malaria deaths recorded across the world last year, according to the report, 93 per cent (407,000) took place in Africa. This is unacceptable for a disease that can both be treated and prevented. Given the efforts and resources by donor agencies targeting the elimination of malaria, Nigeria has no reason to carry a disproportionately high malaria burden. The situation therefore calls for a renewal of efforts and a change of strategy to stem the tide of the ailment, especially in Nigeria, which carries 25 per cent of the global malaria burden.
Although worrisome, Nigeria’s situation should not be totally surprising, given the fact that the country has an abysmal record of health funding and in cases where there has been international support, questions have arisen over transparency in the disbursement of funds. For instance, insecticide-treated nets provided by foreign partners are being sold in the open market, instead of being distributed free as intended by the donors.
This is one reason why Global Fund, a Geneva-based financial institution, threatened to withdraw support for the country’s response to tuberculosis, HIV/AIDS and malaria in 2016. “Despite the efforts made by the secretariat, and with $800 million disbursed to the country in the last four years, major deficiencies in the internal control environment persist in the portfolio,” the fund lamented then, alluding to the lack of accountability in the disbursement.
Also, a concrete evidence of the dismal state of health funding in the country is the four per cent allocated to that sector in the current budget, when the United States, for instance, set aside 17.2 per cent of its Gross Domestic Product for health funding. For Switzerland and Germany, it is about 11 per cent.
This poor funding in Nigeria, understandably, is at the root of the perennial friction between the government and the health workers. Hospitals are poorly equipped, while the health workers resort to strike over perceived poor remuneration. It is little wonder that many Nigerians who can afford it seek medical care abroad, citing decayed health infrastructure at home.
While sub-Saharan African countries continue to lag behind, others such as the United Arab Emirates (2007); Morocco (2010); Turkmenistan (2010); Armenia (2011); Maldives (2015); Sri Lanka (2016) and Paraguay (2016) have been certified by WHO as having successfully eliminated malaria from their shores.
Unfortunately, Nigeria has a mountain to climb as even those who should assist consider her unserious. Despite leading the rest of the world in the number of malaria cases, Nigeria was overlooked by WHO when it was carrying out a pilot programme for a new malaria vaccine two years ago. Ghana, Kenya and Malawi were the preferred choices.
As part of WHO’s Global Technical Strategy for Malaria 2016-2030 – adopted by the World Health Assembly in 2015 – the global health agency provides a framework for malaria-endemic countries towards the control and elimination of the disease. The Director-General, WHO, Tedros Adhanom Ghebreyesus, also vowed to intensify support for countries that carry the highest burden of the disease. The target is to reduce malaria-related child mortality by at least 90 per cent by 2030. Nigeria has to embrace this goal with greater commitment.
Although a lot of investment can go into the provision of drugs for treatment, the key strategy is to control the vector. Government should invest in the provision of insecticide-treated mosquito nets, described by WHO as the most effective way of protecting people from mosquito bites, while also pursuing an aggressive outdoor spraying to kill mosquitoes. There should be adequate enlightenment by the government about the need to make the environment unfriendly for mosquitoes to breed freely. Since mosquitoes breed in stagnant water, cans, used tyres and other materials where water could collect should be destroyed or properly disposed of.
Ghebreyesus’ call for a high impact approach to tackling malaria should be embraced. Launched in Mozambique last month, the “High burden on high impact” demands the government to show the political will to reduce malaria toll and to also come up with adequate information to drive the impact. Above all, Nigeria should initiate a national response involving government at all levels and the people. There is no doubt that, with a little more commitment from everybody, the malaria burden in the country will be drastically reduced.
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