Thoughts On World Malaria Day By Rasak Musbau

Perhaps more than any other disease, malaria stays in the developing world and continues to spread because of poverty. It keeps on infecting and weakening people because of poor sanitation, poor health practices, poor environmental practices and poor housing.

In Nigeria, in spite of the huge amount that governments both at the federal and the states levels spend in the provision of curative malaria drugs with the support received from the Global Fund, malaria has remained endemic. Indeed, it is impossible to calculate the actual harm malaria has done to us. The malaria parasite has been sapping the strength of the whole populations. It impairs the health of our people and consequently restraints economic development. It leads to loss of productive hours, productivity, money, persistent absenteeism and maternal and child mortality among others.

Meanwhile, for Nigeria to move forward, we really have to get rid of malaria just as we need to do with similar preventable diseases such as measles, diarrhea and tuberculoses. The question here is: Since malaria is a preventable disease, why is it so endemic to the extent that our country alone bears about 25 per cent of Africa’s malaria burden? The answers are simple and straightforward.

In Nigeria, one of the essential family practices that are found wanting is sufficient protection from mosquito bites. Two, most illnesses, including malaria, are treated at home or in the community before or without seeking care at a formal health facility. Added to these are our coastal environment, poor environmental sanitation and improper diagnoses. In many places, hospitals don’t do a proper check. Anyone with the minutest symptoms of malaria is often offered treatment without proper diagnosis. The consequence is that while a growing number of countries have recorded decrease in the number of confirmed cases of malaria, the disease remains a scourge here.

As such, it is crucial for everyone to be aware of and adhere to essential family practices to promote mosquito control and prevention. You can’t contract malaria if you aren’t bitten by mosquitoes, and the type of mosquitoes that transmit malaria usually bite at night. For this reason, it is important to sleep every night inside a long-lasting insecticide-treated bed net. Long-lasting bed net is a tool that is most associated with the recent progress against malaria. Another way out is to always ensure that all windows and doors are properly screened to prevent mosquitoes from coming in.

Many people also perform what is called indoor residual spraying where they spray insecticide on likely mosquito hideouts in the house. It is equally advisable for those that frequently have malaria attack to wear long-sleeved clothing in the evenings and at night to prevent being bitten by mosquitoes. Furthermore, proper diagnosis is of utmost importance as people need to be aware that having symptoms of fatigue, weakness, nausea and cold, which are very typical of malaria, is not enough to conclude it is malaria, thereby resorting to self-medication without visiting a health facility for proper diagnosis and treatment.

The World Health Organisation (WHO) recommends that anyone suspected of having malaria should receive diagnosis and treatment with an effective drug within 24 hours of the onset of symptoms. It is only when a sick person cannot have access to a health care provider within that timeframe that home treatment is acceptable as first aid. Moreover, it is important to stress that you should not be given chloroquine to treat malaria, unless your case is confirmed as not being caused by plasmodium falciparum. Virtually all the plasmodium falciparum in Africa are resistant to chloroquine, and so it is no longer an effective treatment. Instead, first-line treatment for malaria is recommended as an artemisinin-based combination therapy.

However, the truth is that whether the malaria map will keep shrinking, as it has in the past decade, or be reclaimed by the malaria parasites depends, to a great extent, on the resources that will be invested in control efforts over the next few years. Thanks to malaria elimination efforts in United States in the 1940s, most people in the U.S. today have never had any direct contact with the disease, and most doctors have never seen a case. That success means other nations including Nigeria can also achieve reduction or complete elimination with right investment and positive attitude.

Over the last couple of years, UNICEF’s support has been focused on several different states where the agency distributes and promotes the use of insecticide-treated bed nets. UNICEF also supports health facilities and community-based health workers with diagnosis and treatment of malaria, and it support preventive treatment for pregnant women.

In this direction, Lagos State government’s investment in malaria control has progressed appreciably with lots of steps being taken to clinically stamp out the prevalence of malaria and its parasites. The topography and ecological features of the state, the abundant coastal features, rapid urbanization and inadequate drainage systems are some of the major factors that contribute to all year transmission of malaria in the state. But the state, through its Directorate of Disease Control, is doing all it could to invest heavily toward reducing the burden of the disease. Investments in malaria control in the state have created unprecedented momentum and yielded remarkable returns in the past years, particularly in the scale-up of insecticide treated nets (ITNs), indoor residual spraying (IRS) of insecticides, and prevention of malaria during pregnancy. The goal of the Lagos State Malaria Elimination Program is to significantly reduce the burden of disease consequent upon malaria. The activities of the Malaria Control Unit are carried out in collaboration with the Lagos State Malaria Research, Technical and Advisory Committee which is chaired by the Honourable Commissioner and includes all partners including donors, researchers and NGOs in the State.

Take away from all-aforementioned is that the war against malaria is easier fought and won if taken more seriously by all of us. Just as governments at all levels have the responsibility to strengthen the health system, the citizens, individually and as a group, also have a big stake. We have the responsibility of protecting our children and family from malaria by using insecticide-treated nets (ITNs), draining of stagnant water or water collection points, and keeping our environment clean. Positive attitudes towards environmental sanitation are very germane. We do all know that mosquitoes and pests are frequently attracted towards heaps of garbage and wastes. They are the main transmitters of diseases like chicken pox, malaria and jaundice.

As medical research and behavioural change communication continue, it is hope that, there will be a day when malaria and most all major deadly diseases are eliminated in Nigeria. Complete elimination of the malaria parasite (and thus the disease) would constitute eradication. While eradication is more desirable, it may not currently be a realistic goal yet, but we can all play a role in reducing it.