Health
Abujah Racheal
FOR many Nigerians, malaria is not just a health challenge. It is an ever-present part of life. In many instances, barely weeks after treatment, many Nigerians see themselves battling with malaria again.
This cycle of recurring malaria begs the question: Why does it keep coming back?
“I can’t count how many times I have treated malaria this year,
“Sometimes, I don’t even bother going to the hospital. I just buy drugs and treat myself at home,” says Ms. Funmi Adekunle, an Abuja-based 35 year-old businesswoman.
Adekunle’s experience is far from unique. Malaria remains one of the most common ailments in Nigeria.
Nigeria accounts for 27 per cent of global malaria cases and 32 per cent of deaths, according to the World Malaria Report of 2023.
While treatment is readily available, the recurrence of the illness has led to questions about the efficacy of interventions and the behaviour of the parasite itself.
Dr Solomon Chollom, a public health expert, explained that recurring malaria was often misunderstood.
“What many Nigerians think is malaria `coming back’ is often a combination of factors.
“Sometimes, it is reinfection due to continued exposure to mosquitoes that carry the parasites but other times, it is as a result of incomplete treatment or drug resistance by the parasites,“ he said.
Chollom, however, is more inclined to incomplete treatment as the major cause.
“Many Nigerians stop taking antimalarial drugs once they feel better; failing to complete the prescribed regimen. This allows some parasites to survive and become more rugged when they re-emerge.
“The issue of drug resistance is another major factor behind the recurrence of malaria in Nigeria.
“Years of overuse and misuse of antimalarials have led to resistance. Some of the commonly available drugs are losing their effectiveness because the parasite has adapted and tolerated their once poisonous effects,” Chollom said.
This problem is exacerbated by self-medication practices, where individuals skip medical consultations and buy over-the-counter antimalarials.
This behaviour fosters a cycle of misuse, further encouraging the development of drug resistance in the malaria-causing parasites.
Environmental and behaviour factors also contribute to malaria recurrence, according to Ms Eunice Ali, an Environmental Health Specialist.
“Nigeria’s tropical climate, poor drainage and improper waste disposal create ideal breeding grounds for mosquitoes,”
“Furthermore, limited use of preventive measures like mosquito bed-nets and insecticides leaves individuals vulnerable to reinfection,’’ she said.
Ali also highlighted the critical role of healthcare providers in ensuring proper treatment adherence.
Studies have shown that adherence to malaria treatment guidelines among healthcare workers is suboptimal, which can contribute to treatment failures and recurrence.
“For instance, adherence to guidelines was significantly higher among public healthcare workers (60.6%) compared to those in private facilities (27.3%),”say Oluyomi Bamiselu and a team of scholars in a study published in BMC Public Health.
The study is entitled: “Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria“.
Cultural perceptions about malaria, traditional healing practices and community beliefs can impact on malaria eradication efforts, treatment-seeking behaviour and adherence to medical advice.
In some rural areas, people prefer traditional remedies over modern antimalarial drugs due to cultural beliefs.
This undermines the effectiveness of malaria control strategies.
Dr Tochi Okwor, Antimicrobial Resistance & Infection Prevention Control Coordinator, Nigeria Center for Disease Control (NCDC), says in Nigeria: “Patients are often treated for malaria without proper diagnostic confirmation.
“This practice can lead to drug resistance and a false sense of security among patients.
“Adherence to malaria rapid diagnostic test results among healthcare workers is essential to prevent misdiagnosis,” she said.
According to her, recurring malaria disrupts lives in profound ways, especially for children and pregnant women.
“For children under five, repeated infections weaken their immune systems, making them more susceptible to severe illness.
“For pregnant women, malaria contributes to maternal mortality, low birth weights, and other complications,” Okwor said.
For many Nigerians, the financial burden of malaria is equally devastating.
Malaria treatment costs may seem small in isolation, but for families living below the poverty line, repeated expenses add up.
“Every time my son gets sick, we have to spend lot of money have. We try to protect him but the mosquitoes are everywhere,” said Mallam Musa Ibrahim, whose 10 year-old child frequently suffers from malaria.
In rural areas, limited access to healthcare facilities further compounds the problem.
Many individuals rely on local chemists who may dispense substandard or counterfeit drugs. This aggravates malaria recurrence.
The Nigerian government, along with international partners, has ramped up efforts to combat malaria. Initiatives like Seasonal Malaria Chemoprevention (SMC) for children under five and the distribution of insecticide-treated nets (ITNs) have shown promise in reducing malaria transmission.
However, experts such as Chollom believe that community engagement is critical.
“People need to understand the importance of completing treatment and using preventive measures consistently.
“We also need more investment in environmental sanitation to reduce mosquito breeding,” he said.
Nigeria has recently rolled out the new Oxford R21 malaria vaccine, which is administered for free. The initiative is expected to mark a significant step in combating the disease.
It aims at significantly reducing severe malaria cases and deaths among children, with early trials showing promising results.
Experts hope the vaccine would provide a breakthrough in the fight against malaria.
Mr Odinaka Obeta, a biomedical scientist and Executive Director at Block Malaria Africa, says continuous education about malaria prevention, proper drug use and environmental sanitation are essential.
According to him, ensuring that rural and underserved areas have access to effective treatment and preventive tools is crucial in the malaria eradication efforts.
“Investments in malaria vaccine development and alternative treatments are needed to reduce dependence on antimalarials,” he also said.
According to him, grassroots movements can also play a significant role in reducing malaria transmission.
He said that community-driven initiatives to improve drainage, clear stagnant water and promote the use of insecticide treated bednets can have measurable impact on controlling the disease.
Obeta said that these efforts were particularly important in rural areas, where local involvement can make a significant difference.
“Strengthening adherence to malaria treatment guidelines among healthcare workers, especially in private facilities, is essential to ensure effective treatment.
“Tailoring interventions to address socioeconomic determinants can help reduce malaria recurrence among vulnerable populations,” he added.
Obeta also underlined the importance of incorporating cultural beliefs and practices into malaria control strategies.
“Engaging communities in malaria prevention campaigns and tailoring messages to local customs can enhance community acceptance and effectiveness,” he said.
Experts say that addressing malaria recurrence in Nigeria requires a multi-faceted approach that combines treatment, prevention, education, and community involvement.
“It’s a reflection of systemic gaps in Nigeria’s healthcare system and public health infrastructure,” Chollom said.
Recurring malaria is more than a health challenge—it is a reflection of broader systemic issues that require urgent attention.
Ending the cycle of recurring malaria will take collective effort—but it is a fight that must be won.
The battle against malaria is not just a public health challenge but an economic and social one.
For Nigeria to succeed, it must strengthen its healthcare system, engage communities and implement long-term and sustainable malaria control strategies. (NAFeatures)
6th January, 2025.
C.E.
Tags:
