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Issue

Nigeria has been severely affected by Malaria and reports have estimated that 97% of the population is at risk of getting transmitted by the malarial parasite Plasmodium falciparum (PMI, 2021 reported in Severe Malaria Observatory, 2022). The predominant vector, in this case, is Anopheles (An.) gambiae (around 67%). Statistics by WHO (2021) have analyzed that Nigeria has the highest number of Malarial cases at the global level (approximately 27% of global malarial cases) which is concerning and has even been increasing with a 5.8% jump from 2017 to 2020. The situation of Malaria is more severe considering 32% of global malarial deaths which is the highest is alarming for the policy makers not only in the African subcontinent but at the Global level (Igwe, 2022).

The Nigerian health ministries have responded with the support of WHO with the development of the NMEP or National Malaria Elimination Program that was implemented with HBHI or the High Burden High Impact approach. Another federal program of five-year planning aka National Malaria Strategic Plan (NMSP) has major agenda of curbing malaria deaths by 50% and malaria parasite mobility by 90% before 2025 to get Nigeria free from malarial severity.

Synopsis of the Causes

Nigeria has reported more than 27% of 241 million cases of malaria in 2020 and 200,000 deaths in the same year which is one-third of the global deaths of malarial cases. Pregnant women and children below the age of 5 are at risk of contracting the disease.

Poor & Unhygienic Living Conditions

Nigeria is home to more than 200 million people which is largest in the Africa, and Bloomberg (2021) reports that more than 40% of the population do not earn more than $2 that showcase the poor living standard and conditions of the majority of the people (Olurounbi, 2022). Malaria which is infectious and treatable in the majority of the country is endemic and life-threatening in Nigeria (Sokunbi et al., 2022). This vividly describes the poor and unhygienic conditions of the communities and the habitat of human dwellings.

Tropical & Rainy Climate

Over the above, malarial parasites and vectors have high chances of transmission in the rainy season and this has been globally as well as in Nigeria (Ande et al., 2011). Nigeria experiences tropical rains and high amounts of rain during the June and September season, where the severity of malarial cases increases. The rural settings of North Nigeria are most affected during this season (Weli and Efe, 2015).

Poor Sanitary Infrastructure

Reports by Zhongming et al. (2021) have estimated that more than 60 million Nigerians have no access to clean drinking water and proper water disposal. In rural, the conditions are worsened due to improper discharge of drainage and become a breeding ground for malarial parasites.

Improper Health System

The existing system of healthcare within the country is poor and inaccessible to the majority of the population. It has been reported that nearly half of the Nigerian population estimated at around 83 million are not able to access any form of healthcare support and this becomes more severe in the case of rural areas. OOPE or out-of-pocket expenses is the main source (approximately 70%) of bearing the healthcare issues and when the majority of the population is poor, it becomes difficult to curb endemic (World Bank, 2022). Secondly, the feasibility of the health insurance sector is also at risk at less existing in such situations.

Existing Interventions

Dosage Manipulation (Recommendations of WHO)

Injectable artesunate is primarily the first line of treatment after it changed in 2012 from quinine. WHO has recommended the use of intravenous artemether, rectal or intramuscular artesunate, or quinine (Ababa, 2018). This has recorded slow transmission and better control of the disease. Similarly, there has been dose change and three prescriptions of sulfadoxine-pyrimethamine (SP), and even mandating a minimum of eight contacts during pregnancy for antenatal care or ANC (World Health Organization, 2020).

Healthcare layering

Nigeria is dependent upon a governmental or public healthcare system that accounts for more than 70% of the total healthcare infrastructure (Innocent et al., 2014). This has been consisting of three tiers that are local government areas (LGA) or health agencies at the lowest level and state government at the mid-level and national or federal authority at the top (Scott-Emuakpor, 2010). There are approximately 80+ facilities of hospitals or agencies that cater to tertiary healthcare demands. This is completely taken care of by the federal government. Nearly 4000 healthcare facilities are governed by the state level agencies and at the lowest level, LGA accounts for more than 30,000 units of primary healthcare facilities (Welcome, 2011).

Low Access

Several regions have minor to extreme operational challenges for healthcare workers due to insurgent attacks. Several areas in the rural setting are hard to reach due to poor access to roads or transport. A nomadic population usually considers Malaria as Fulani disease and avoids taking medicines that often become fatal (The Global Fund, n.d.).

Funding Status

Several agencies such as the US's Malarial Fund and Global Fund provide financial support to the Government of Nigeria (The Global Funds, 2022; PMI, n.d.) apart from financial loans from the Islamic Development Banks, the African Development Bank and World Bank (Severe Malaria Observatory, 2022). On the other hand, FCDO, or Foreign Commonwealth and Development Office has also pooled funds for the Malarial causes in Nigeria

Way Ahead

  • Proper mobilization of National and Global funds for developing the infrastructure of the healthcare system is necessary.
  • Systematic development of the healthcare system that includes diagnosis, prevention, and awareness should be focused on by the Government
  • Awareness and community reach-out programs should be extensively carried out to prevent and develop hygienic living conditions for the people.
  • Spraying insecticides during rainy and tropical seasons can also reduce the number of cases.
  • Malarial drugs should be mass available and intervened up to every 6 months for children under the age of 5.
  • Monitoring the outbreaks and controlling methodology should be harnessed at even the tertiary level of the health care system.

References

Ababa, A. (2018) National malaria guidelines.

Ande, A. T., Ayanwale, A. V., Mohammed, A. Z., Bello, I. M., Idris, B., Isah, B., ... & Ukubuiwe, A. C. (2011) Seasonal trends in epidemiological and entomological profiles of malaria transmission in North Central Nigeria.

Igwe, I. (2022) Nigeria, DRC Top Global Malaria Deaths – WHO. Retrieved from https://www.channelstv.com/2022/12/09/nigeria-drc-top-global-malaria-deaths-who/#:~:text=“About%2096%25%20of%20malaria%20deaths,of%20Tanzania%20(4%25).”

Innocent, E. O., Uche, O. A., & Uche, I. B. (2014) Building a solid health care system in Nigeria: challenges and prospects.Academic Journal of Interdisciplinary Studies,3(6), 501-501.

Olurounbi, R. (2022) Nearly Two-Thirds of Nigerians Live on Less Than $2 a Day. Bloomberg. Retrieved from https://www.bloomberg.com/news/articles/2022-11-18/nearly-two-thirds-of-nigerians-live-on-less-than-2-a-day#:~:text=Nearly%20two-thirds%20of%20Nigeria's,the%20National%20Bureau%20of%20Statistics.

PMI (n.d.) USAID to spend N15bn on malaria prevention in Nigeria. Accessed from https://www.pmi.gov/usaid-to-spend-n15bn-on-malaria-prevention-in-nigeria/

PMI. (2021) U.S. PRESIDENT’S MALARIA INITIATIVE Niger Malaria Operational Plan FY 2022. Retrieved from https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2022/01/FY-2022-Niger-MOP.pdf

Scott-Emuakpor, A. (2010) The evolution of health care systems in Nigeria: Which way forward in the twenty-first century.Nigerian Medical Journal,51(2), 53.

Severe Malaria Observatory. (2022) Nigeria. Retrieved from https://www.severemalaria.org/countries/nigeria

Sokunbi, T. O., Omojuyigbe, J. O., Bakenne, H. A., & Adebisi, Y. A. (2022) Nigeria End Malaria Council: What to expect.Annals of Medicine and Surgery,82, 104690.

The Global Fund (n.d.). Malaria. Accessed from https://www.theglobalfund.org/en/malaria/

The Global Funds (2022) Nigeria. Accessed from https://www.theglobalfund.org/en/government/profiles/nigeria/

Welcome, M. O. (2011) The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems.Journal of pharmacy & bioallied sciences,3(4), 470.

Weli, V. E., & Efe, S. I. (2015) Climate and epidemiology of malaria in Port Harcourt Region, Nigeria.American Journal of Climate Change,4(01), 40.

WHO. (2021) World Malaria Report 2021. Retrieved from https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2021

World Bank (2022) Out-of-pocket expenditure (% of current health expenditure) - Nigeria. Retrieved from https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=NG

World Health Organization (2020) WHO technical brief for countries preparing malaria funding requests for the Global Fund (2020–2022).

Zhongming, Z., Linong, L., Xiaona, Y., Wangqiang, Z., & Wei, L. (2021) Nigeria: Ensuring Water, Sanitation and Hygiene for All.

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