Towards zero malaria in Nigeria: Challenges and opportunities –

May 30, 2023 Mary

Malaria remains a major public health problem, with nearly half of the world’s population at risk of the disease. Malaria is life-threatening and one of the deadliest childhood diseases, claiming the lives of so many infants each year. In 2021, the African region was home to about 95 percent of all malaria cases and 96 percent of deaths. According to the World Health Organization’s (WHO) World Malaria Report 2022, Nigeria accounted for the highest number of global malaria cases (27 percent) and malaria deaths (31 percent) in 2021.

With 97 percent of the population at risk of malaria, several factors contribute to making Nigeria conducive for the transmission of the disease and the prevalence of malaria across the nation. A variety of natural factors such as temperature, humidity, altitude, and rainfall, allow the malaria vectors—mosquitoes—to thrive in Nigeria.

For example, Nigeria’s vegetation favours the reproductive stages of the parasite in the mosquito. In addition to this, Nigeria’s large population makes malaria transmission much easier, as the mosquito vector can quickly find a contact for transmission of the malaria parasite.

There is also the challenge of the growing rate of mosquitoes’ resistance to older insecticides and parasites’ resistance to antimalarials. These factors, compounded by inadequate health systems, result in difficulty curbing malaria in Nigeria and on the African continent.

Nigeria’s efforts towards a zero malaria target

Despite these challenges, the last few years in Nigeria have seen increased access to malaria prevention tools, including effective vector control and the use of preventive antimalarial drugs. At least 27 million children across 21 states have been reached with seasonal malaria chemoprevention (SMC) medicines, and about 42,910,303 insecticide- treated nets (ITNs) have been distributed to beneficiaries in 11 states. SMC is one of the interventions recommended by the WHO to prevent malaria in children.

It involves the intermittent administration of full treatment courses of antimalarial medicines to children in areas of high seasonal transmission during the malaria season. Both the SMC and ITN programmes are being strategically undertaken to accelerate malaria elimination in Nigeria.

Moreover, the recent provisional approval for the use of the R21 malaria vaccine for the prevention of clinical malaria in children from 5 to 36 months of age by the National Agency for Food and Drug Administration and Control (NAFDAC) also provides hope for the eradication of malaria in Nigeria sooner rather than later. Nigeria expects to get at least 100,000 doses of the vaccine in donations soon. A few other African countries have also approved this vaccine.

However, despite these achievements, more work still needs to be done. The Nigerian government needs to intensify efforts towards meeting WHO deadlines for reducing and ending the transmission of malaria globally, including reducing malaria case incidence and mortality rates by at least 90 percent by 2030.

Opportunities and strategies towards achieving zero malaria in Nigeria Going forward, Nigeria needs stronger support for consolidating current gains, developing new tools, strengthening the health system, scaling up access to vaccines, and strengthening local manufacturing and production of malaria intervention commodities.

In view of this, Bloom Public Health recommends the following strategies towards achieving zero malaria in Nigeria:

1. Strengthening local pharmaceutical manufacturing of malaria products: A critical component in the elimination of malaria in Nigeria is ensuring the availability of quality, efficacious, and safe malaria products and reducing reliance on imports for malaria intervention programmes. This requires building capacity for local manufacturing in Nigeria’s pharmaceutical industry.

To achieve this, Bloom Public Health has partnered with Nigeria’s National Institute for Pharmaceutical Research and Development (NIPRD) in a World Bank-funded initiative to support selected Nigerian pharmaceutical manufacturing companies that produce antimalarial medicines and insecticide-treated nets (ITNs) in the attainment of Good Manufacturing Practices (GMP) and also support them through the process of WHO prequalification.

Through this project, selected Nigerian pharmaceutical manufacturers will establish their capability to produce malaria medicines that consistently meet stringent standards of quality in line with WHO specifications and global standards, thus ensuring increased availability and equitable access to quality malaria prevention and treatment medications in Nigeria.

2. Adoption of community-led monitoring for the implementation of national malaria programmes: This is imperative for addressing the various challenges militating against the prevention and elimination of malaria in Nigeria. For Nigeria to attain full elimination of malaria by 2030, the government needs to involve the people while formulating policies on its eradication, as this will significantly improve the acceptability and uptake of malaria interventions.

The involvement of members of the community, civil society organisations (CSOs), religious organisations, and non- governmental organisations (NGOs), among others, will ensure accountability and sustainability of malaria programmes.

3. Increasing funding for research and product development: In Nigeria, a significant funding gap exists for basic research and malaria product development. There is therefore an urgent need to ramp up investment in new malaria tools to address emerging threats such as urban malaria and the spread of antimalarial drug resistance.

In conclusion,the malaria burden in Nigeria, although enormous, can be tackled through concerted efforts to scale up innovation and the deployment of new tools in the fight against malaria, while advocating for equitable access to malaria prevention and treatment and building resilient health systems.

Professor Anyakora is the CEO of Bloom Public Health and a public health expert.

Odibeli is a pharmacist and the regional communications manager at Bloom Public Health.