Malaria is a major public health problem and can be life-threatening. The disease, found mainly in tropical countries, is transmitted to humans by the female Anopheles mosquitoes. Almost half of the world’s population was at risk of contracting the disease. In 2021, for example, around 247 million cases of malaria were reported and some 619,000 people died. Four African countries accounted for just over half of all malaria deaths globally: Nigeria (31.3%), the Democratic Republic of the Congo (12.6%), Tanzania (4.1%) and Niger ( 3.9%).
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Prof. Dr. Olugbenga A. Mokuolu currently oversees all malaria work in Nigeria for Management Sciences for Health, a global health advisory organization. He is also the former Technical Director of the National Malaria Elimination Program in Nigeria. Professor of molecular parasitology, Segun Isaac Oyedeji, spoke with him about the burden of malaria in Nigeria.
According to Oyedeji: Nigeria has a high malaria burden. How did this get here?
Olugbenga Mokuolu: It is a combination of many things.
The existence of malaria anywhere is an interaction between the environment and the organism responsible for the disease. Mosquitoes breed by laying their eggs in standing water. When you look at an environment, you are looking at natural factors like temperature and humidity. It also includes man-made factors, such as blocked drainage systems.
mosquitoes with malaria
Regarding humidity, Nigeria has a vegetation that favors the reproductive stages of the parasite in the mosquito that serves as a vector. Altitude also plays a role. In most of Nigeria, the altitude allows the mosquito to fly without much difficulty. Only the Mambilla Plateau, in the state of Taraba, northeast Nigeria, is considered relatively malaria-free in Nigeria. It has an altitude that is above 5000 feet. This makes it difficult for mosquitoes to inhabit.
In terms of environmental management, Nigeria leaves a lot to be desired. The country has open garbage cans, blocked drainage systems and various containers at home that people use to store water because they do not have a guaranteed working piped water system. All of these provide ideal sites for mosquitoes to breed.
When you combine all of this, you have a favorable environment for the malaria vector to thrive.
Unfortunately, Nigeria also has a large population. Transmission is much easier with a large population.
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That is not to say that progress has not been made. The country’s interventions have not been a total failure. My organization is supporting Nigeria to provide preventive chemotherapy against malaria. We have reached more than 25 million children under the age of five in our intervention cycles. This has been shown to make a significant contribution to mortality reduction. But we’re still not where we’re supposed to be.
Government
According to Oyedeji: Children are disproportionately affected. What can be done?
Olugbenga Mokuolu: The Nigerian government and its partners have singled out children as the focus of most interventions. Additionally, we need to strengthen the health system to address gaps in access, particularly in communities.
The Nigerian National Agency for Food and Drug Administration and Control recently approved the use of the R21 malaria vaccine.
Hopefully, when the R21 vaccine becomes available, it will reduce new cases or the impact of cases. It is unclear when the vaccine will be rolled out in Nigeria.
A recent study shows that the R21 vaccine has some efficacy. This vaccine has been shown to be most effective when given to children from five to 36 months of age. It is 77% effective in preventing infection and reducing the occurrence of severe malaria. Reducing the frequency of severe malaria reduces the malaria mortality burden by extension.
Vaccines will not be used alone. They will be used as complements to existing tools to combat malaria, such as preventive treatment and the distribution of bed nets.
According to Oyedeji: How can Nigeria reduce its malaria burden?
Olugbenga Mokuolu: New cases of malaria can only be stopped by environmental measures, including the use of insecticidal bed nets and personal protection. I know that vaccines are not 100% effective, but they will surely offer additional prevention.
But Nigeria needs to step up their game. The current National Malaria Strategic Plan 2021 to 2025 is based on a well-researched model. It is no longer business as usual. The plan clearly shows that if we don’t do more, malaria will continue to rise.
But we are actually doing a lot.
mosquito nets to prevent malaria
Take the mosquito nets. These are distributed on an almost regular basis to eligible states. Even COVID-19 did not stop the distribution. Now, due to the size of the Nigerian population, bed nets are distributed in what we call mass deployment campaigns where each state runs its own campaign. The improvement in malaria control that we have seen in the last five to seven years is based on the intensity of interventions in two-thirds of our states.
But Nigeria has gone further to be almost a world example in how to implement preventive chemotherapy. We have 21 states out of 36 states where we reach more than 25 million children under the age of five each cycle of intervention. We have four cycles in the year and this has contributed to the reduction of mortality.
But we could do more.
Malaria will not be significantly reduced unless Nigeria intensifies its development. Development plays an important role in reducing the burden.
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Also, infusion of funds and not just from the government. There is also a public-private partnership for drug manufacturers. The government should give them a protected market and negotiate good prices. Let the manufacturers take over the distribution using their own marketing principles in a way that is affordable to many people.
We need to look at new initiatives and also position ourselves in the vaccine game with respect to malaria.
According to Oyedeji: How can the international community (donors and aid agencies) better support Nigeria?
Support
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Olugbenga Mokuolu: International partners are supporting the country in many ways. To a large extent, the support is in the technical and financing areas. In the future, countries like Nigeria will need more support to consolidate current gains, new tools, strengthen the health system, expand access to vaccine, and local manufacturing or production of malaria intervention products.
Article of: According to Isaac Oyedeji. Professor of Molecular Parasitology and Genetics, Federal University, Oye Ekiti
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