Recently, health experts converged on Abuja to discuss ways of intensifying efforts to eliminate malaria in Nigeria by 2020.
At the roundtable, the experts agreed that one of such ways was for individuals to undergo laboratory tests to confirm if their ailment was actually malaria fever before commencing treatment.
“Malaria has been with us for a long time; there is the temptation to guess that any fever is malaria and commence treatment with the wrong medicine,’’ they said.
“We need to have a change of attitude; we need to have a complete reorientation in our efforts to treat fever,” they added.
However, Mr Linus Awute, the Permanent Secretary, Federal Ministry of Health, said that government had formulated a policy on malaria.
He said that the policy stipulated that the diagnosis of all suspected cases of malaria should be carried out before treatment, while underscoring the need for individuals to strictly adhere to that policy.
Awute, who was represented by Dr Bridget Okoeguale, the Director of Public Health, said the Federal Government, via the current National Malaria Strategic Plan, was committed to achieving a pre-elimination status and a reduction of malaria-related deaths to zero by 2020.
He, nonetheless, stressed that for Nigeria to eliminate malaria by 2020, the citizens must adopt a culture of testing for malaria before beginning treatment.
“We want to see increased uptake and utilisation of Artemisinin-based Combination Therapies (ACTs).
“We want to see increased attendance of pregnant women at antenatal clinics and improved utilisation of Long Lasting Insecticidal Nets (LLINs).
“We want to see a drastic reduction in malaria-related mortality and morbidity in the country,” he said.
Awute noted that the Federal Government, through the National Malaria Elimination Programme and the Roll Back Malaria partners, had procured LLINs for beneficiaries in states across the country.
“Diagnosis and treatment commodities, including the Rapid Diagnostic Test (RDTs) and ACTs, have also been procured and distributed across the country,” he said.
Sharing similar sentiments, Dr Nnenna Ezeigwe, the National Coordinator of National Malaria Elimination Programme, said: “Malaria is still the foremost public health issue in Nigeria in spite of all the concerted efforts of governments and partners.’’
She said that the 2010 Nigeria Malaria Indicator Survey (MIS) showed that the prevalence rate of malaria in the country was 44 per cent.
“However, at present, this figure has reduced substantially. Malaria is next in line in elimination; we dealt with Ebola Virus Disease, polio, and guinea worm. The focus now is on malaria.
“Nevertheless, the focus has changed from malaria control to elimination. By 2020, we should get to the pre-elimination stage; this is a point where prevalence should be less than 5 per cent and there will be no death from malaria.’’
According to Ezeigwe, virtually all the proven anti-malaria interventions have been introduced in Nigeria and they are actually being scaled up with the support of the Roll Back Malaria partners.
She commended the country’s journalists for being worthy partners in the crusade against malaria.
“We urge the media to take advantage of the National Malaria Advocacy Communication and Social Mobilisation (ACSM) Guideline to improve their coverage and reporting of malaria issues in Nigeria.
“The ACSM Guidelines 2014 was produced to serve as a blueprint to provide the directional thrust for programming of advocacy, communication and social mobilisation for malaria by all partners,” Ezeigwe said.
In the same vein, Dr Godwin Ntadom, the Head of Case Management Branch, National Malaria Elimination Programme, said: “In 1990, 75 per cent of any group of people tested for malaria would definitely turn out having the parasite.
“This is because at that time, Nigeria’s status on malaria was `holoendemic’.
“A holoendemic disease is one for which a high prevalent level of infection begins early in life and it affects most of the child population, leading to a state of equilibrium, such that the adult population shows evidence of the disease much less commonly than children.
“That situation was what made us to advise people that when they present symptoms of fever, they should treat malaria straightaway. Then, every fever was interpreted to mean malaria,” he said.
Ntadom, however, said that the situation changed dramatically in 2005 when the Roll Back Malaria Programme came into existence.
He said that the national policy on malaria, all individuals above the age of five should be tested before treatment of malaria, while for children less than five years, treatment should commence immediately.
“This is because children less than five years are most likely to die as a result of malaria.
“By 2011, the situation changed significantly and Nigeria was rated as mesoendemic (Mesoendemic is a situation where if 100 persons with fever symptoms are tested, about 25 per cent of them are likely to be positive).
“Furthermore, in 2015, the policy was reviewed. In the revised policy, an individual must be tested to confirm if the fever is malaria before any treatment.
“You can either do microscopy through the laboratory or use the Rapid Diagnostic Tests (RDTs) for malaria diagnosis,” he said.
The World Health Organisation (WHO) says Malaria Rapid Diagnostic Tests (RDTs) assist in the diagnosis of malaria by detecting evidence of malaria parasites (antigens) in human blood.
“RDTs are an alternative to diagnosis based on clinical grounds or microscopy, particularly where good quality microscopy services cannot be readily provided,’’ it adds.
All the same, Mr John Ocholi, the Programme Analyst, Society for Family Health, said that the objectives of the National Malaria Strategic Plan included the provision of appropriate preventive measures to cover at least 80 per cent of the target population.
“Besides, all health care seeking persons should be tested to make sure that what we are treating is actually malaria; we should also treat all individuals with confirmed malaria with the right medication” he said.
He listed some of the achievements so far recorded in the malaria elimination project as the distribution of over 58 million LLINs and the improved distribution of ACTs at both private and public health facilities.
“ACTs are widely available and are over-the-counter. That is, you can walk into any pharmacy store and get these commodities at any time.
“Evidence from project implementation shows that about 79 per cent of ACTs distributed in Nigeria are got from private patent medicine vendors.
“That is why we must work with them to achieve results,’’ he added.
Ocholi, however, emphasised that malaria treatment had improved at all levels, adding that the prevalence of malaria was reducing globally and nationally.
Also speaking, Mr Omini Efiong, Senior Technical Advisor, Advocacy of Health Communication Capacity Collaborative (HC3) Nigeria Project, underscored the importance of community mobilisation in the fight against malaria.
Efiong said that community mobilisation would drive a community into taking voluntary action toward achieving sustainable changes in every area of intervention.
“However, community mobilisation is not understood by everyone in the same way; community mobilisation has worked in other public health areas but why has it not worked in malaria?
“Our intervention should be evident and strategic. The National Malaria Elimination Programme has put in place some strategic documents, policies and guidelines, which I urge partners working within the National Malaria Response Plan to use in community mobilisation efforts,” he said.
Efiong also called on the partners to utilise functional systems and structures available in different communities as tools for mobilising those communities.
As regards the media, Rabi Abdallah, Head of the Health Desk in Nigerian Television Authority (NTA), said that the media were an indispensable ally in efforts to promote public health issues.
She said that the media conveniently played the role of a source of “correct information on health matters as well as an advocate for desirable health behaviours.
“When the media reports from the point of knowledge, it makes a lot of impact and brings about the change that we want to bring about.
“As change agents, when we do stories, we are doing the society and ourselves good,” she added.
Abdallah urged the media to adopt and apply a multi-sectoral approach to communications on malaria.
“We can replicate the efforts mobilised to fight Ebola in fighting malaria. Nigerian journalists have the willpower and vibrancy to achieve this,’’ she said.
While describing malaria as a “harbinger of poverty and death”, Abdallah called on individuals to maintain good hygiene by cleaning their environment to keep mosquitoes at bay.
All the same, observers insist that increased public awareness about malaria will facilitate improved commitment and behavioural change toward the elimination of malaria.
“There is more to be done to close knowledge gaps around transmission, prevention and diagnosis of malaria,” they say.
