New Telegraph

Fighting malaria with innovations

About 460 species of the Anopheles mosquitoes are recognised, according to the Wikipaedia. While over 100 can transmit human malaria, only 30 to 40 commonly transmit parasites of the genus Plasmodium, which causes malaria in humans. Experts say inventive measures must be adopted to distribute long-lasting insecticide-treated nets (LLINs) and implement malaria activities during COVID-19 pandemic, reports APPOLONIA ADEYEMI

It was 10.30 p.m when the Alabra Family retired to bed. As Mr and Mrs Alabra moved into their bedroom, their four children similarly went into their separate bedrooms and at that point they began discussion on whether or not to put up the long-lasting insecticide-treated nets (LLINs). Notwithstanding that it has become a daily routine to argue back and forth on the benefits of sleeping under the net to prevent mosquito bites, the number of persons in Alabra Family who choose to sleep without the net was always more. While one of the Alabra’s four children usually slept under the net, the other three always shunned the measure, which the World Health Organisation (WHO) advocates could prevent mosquito bites, reduce malaria incidence and save lives.

Even when their mother criticised their move, the first child, Jenny Alabra, 17 years justified her decision. She said, “Sleeping under the net was not a pleasant experience. It was always hot under the net, she had insisted, and claimed that without the net, she would get a sound sleep.

Jenny always had her way, sleeping without the net, but she is not alone. Some Nigerians who are beneficiaries of free nets, which were delivered courtesy of donor international and local agencies, either don’t use the nets or misuse them to achieve other personal purpose. Some people who get the nets divert them for fishing activities, bungling the purpose it was intended to achieve. Nearly 58 million free LLINs have been handed out across several states of Nigeria between 2009 and 2013.

Among international donors playing a significant role in scaling up malaria prevention in Nigeria are Global Fund to Fight Aids, Tuberculosis (TB), and Malaria, the World Bank, the UK’s Department For International Development (DFID) and the United States (US) President’s Malaria Initiative, the Bill & Melinda Gates Foundation, among others; they all play significant roles in scaling up malaria preventions in the country.

According to the 2010 Malaria Indicator Survey (MIS), the most common reason why no one slept under the net was that it was too hot. A smaller percentage of households said the net was too difficult to hang, the net was not needed or there were no mosquitoes.

Against the background of this negative attitude to own and use LLINs, medical experts are explicit about the impact of the Anopheles mosquito bite on human health. About 460 species of the Anopheles mosquitoes are recognised, according to the Wikipaedia; while over 100 can transmit human malaria, only 30 to 40 commonly transmit parasites of the genus Plasmodium, which causes malaria in humans in areas where the disease is endemic. Based on this background, it is clear and certain that the presence of the Anopheles mosquitoes abound in Nigeria, being one of the malaria endemic countries. Hence, conversation about non availability of mosquitoes in Nigeria is untrue.

According to the World Health Organisation (WHO) Fact Sheet, malaria is a risk for 97 per cent of Nigeria’s population. There are an estimated 100 million malaria cases in the country with over 300,000 deaths per year: the burden is huge and there is no doubt that this situation has now been compounded by the impact of the coronavirus pandemic, which has currently over-burdened global health systems including that of Nigeria.

Even before the outbreak of the pandemic, the country was able to implement malaria intervention activities to cover two-thirds of the country instead of the entire country. For instance, it could cost approximately about $400 to $450 million US dollars to implement most of the interventions that are needed in the country annually, said Olugbenga Mokuolu, a Professor of paeditrics and technical adviser, National Malaria Control Programme (NMCP).

He disclosed that the Federal Government contributions were all within these funding envelopes, but not in a quantity or volume by which a heavy commodity like LLINs could be procured.

“The government makes contribution; it provides counterpart funding but the entire resources available when compared with what we get from global fund, PMI and the Federal Government little contribution, all of that covers implementing activities in just about two-thirds of the country and the way it is arranged , it covers 13 states that were the highest malaria burden states.

“Then we have 13 other states including the Federal Capital Territories (FCT) that does not have immediate support. It is for that reason that the government has to approach the World Bank in order to source resource for these 13 states so that they, also will be covered and considering that if they are not covered the efforts going on in the other states can be reversed.”

Going by the data from the National Demographic Health Survey (NDHS) 2018, the prevalence of malaria in the country reduced by 42 per cent in 2010. By 2015, it was 27 per cent and in 2018 it was 23 per cent. Similarly, number of death from malaria is much less because when we talk about death averted, Mokuolu said, “We could say that more than 150,000 deaths were averted with current malaria interventions that were carried out for which if nothing was done, all those people would have died.

Although, the progress recorded is cheering news, with the impact of the pandemic, there is fear the progress could be reversed. For instance, it is known that many Nigerians with various ailments including malaria seeking care at public facilities do not get needed attention and care and based on fear of contracting COVID-19 from facilities, many sick people including those with severe malaria deliberately avoid going to hospitals during the pandemic.

On the way forward, Mokuolu stressed the need to stick to WHO recommendations to always test and diagnose malaria before treatment and the use of artemisinin combination therapy (ACT) as the prescribed medicine for malaria. He said, “We acknowledge that there’s is more use of ACTs now than monotherapies. We are discouraging monotherapy use, but we still underscore that there’s still pockets of persons using monotherapies.”

Mokuolu who is also the director, Centre For Malaria & Other Tropical Diseases at the University of Ilorin Teaching Hospital (UITH), said the NMCP together with its partners, the Nigeria Centre for Disease Control (NCDC), have analysed the effect of COVID-19 on the implementation of malaria services.

He said, “Luckily, During the lockdown some form of corridors were created for people carrying malaria commodities to get them to where they were intended and some that were expected in terms of importation had already berthed at our ports.”

He said preceding activities of planning, training, behavior change education encouraging more usage of LLINs and a few other things for net distribution campaigns activities during this period of lockdown have adopted other strategies such as virtual meetings to carry out a lot of the planning activities that were necessary.

He said areas of challenge has been areas like training for some field workers, but “we felt that once we buy time properly by carrying out the planning activities then as soon as the lockdown is relaxed we can take the training in small batches.

“About the LLINs distribution, when we get to that it may this time around be connected to house to house rather than the previous strategy of having a fixed location where people come to.”
When these are achieved now and even beyond the pandemic, Nigerians in the category of Jenny Alabra who despise sleeping under nets, could be convinced to use LLINs, at some points to prevent mosquito bites and thereby reduce the incidence of malaria.

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