Malaria on the Offensive

In spite of efforts to roll it back, malaria appears to be claiming more mortality and morbidity due to a combination of a number of factors

Sixteen-year-old Chinedu Ilechi, a Senior Secondary School class two student of Government Secondary School, Nyanya, Abuja, for the umpteenth time visited the Wuse General hospital, Abuja recently. The symptoms were unmistakable but to be sure, the young doctor recommended a laboratory test. A few hours later, it was confirmed she had come down with malaria again. It was barely two weeks after she completed treatment for malaria in the same hospital, which had cost her one-week absence from school.


That too was not the first time Ilechi had missed classes due to malaria. “I treat malaria every month, and my mother already knows my common illness is malaria,” she lamented. Usually she engages in self-medication whenever she feels symptoms of malaria, but sometimes when it becomes severe, she ends up in the hospital. She wished there was a vaccine that could immunise one against malaria.


She was not alone. On an average day, over two-third of the outpatients at Wuse General Hospital were because of malaria. Similar visits to Garki, Maitama, Asokoro and Kubwa general hospitals in Abuja also showed that half of the outpatients were there due to malaria. One of such patients is Abdullahi Aminu, 37, who said, “I have malaria regularly, may be because my genotype is AA. I heard people with AA are at high risk of malaria.”


Every year, malaria kills nearly two million people globally, according to the World Health Organisation, WHO. The National Malaria Control Programme, in the first quarter of 2010, maintains Nigeria recorded over two million (2,083,367) cases of malaria; in the first quarter of 2011 it rose to nearly 3.5 million (3,428, 897), about 75 per cent increase. And in the first quarter of 2012 it ballooned to nearly 6.5 million (6,490,843), over 200 per cent increase in persons who have various cases of malaria, including pregnant women.


According to the Federal Ministry of Health, some states are more endemic to malaria than others. In 2010, Jigawa State had 466,723 cases, which was the highest occurrence in the country. It was followed by Lagos and Gombe states with 244,080 and 210,241 respectively. In 2011, Kano had the highest occurrence of 968,303, followed by Bauchi with 279,194; Niger State followed closely with 271,539 and Lagos had 229,556 cases. In 2012, Kaduna State recorded the highest with 1,272,131 cases. It was followed closely by Osun State with 1,113,000 cases; Zamfara had 822,830 malaria cases; Kano 585,280; Bauchi 230,898, and Jigawa, 208,381 respectively.


Globally, Africa is the most affected continent due to the existence of the malaria carrying Anopheles gambiae, which is mostly found in Africa. According to the WHO, about 3.3 billion people, almost half of the world population lives in areas at risk of malaria, affecting 106 countries and territories. Malaria has complex lifecycles and different stages occurring between two living beings, the vector mosquitoes and the vertebrate hosts. The survival of both is made possible by 5,000 genes and their specific protein that helps a parasite to attack and develop within multiple cell types and to attack host’s immune responses. The stages the parasites pass through in order to develop are the sporozites, merozoites, trophozoites and gametocytes. The sporozites stage is when the sporos (seeds) infectious form is injected by the mosquito. The merozites stage is when the meros (piece) attacks the red blood cell. In the trophozoites stage, the trophes (nourishment) form multiply in the red blood cells. And the gametocytes are the sexual stage. The stages have their unique structures, shapes and protein complements. The external proteins and metabolic pathways changes during the various stages, and helps the parasite to evade the immune clearance, while also causing problems for the development of drugs and vaccines.


People more vulnerable to malaria are children under the age of five because they have not yet developed partial immunity to malaria, the pregnant women whose immunity is decreased by pregnancy, especially during the first and second pregnancies, HIV patients are also vulnerable because of their low immune system, as well as travellers or migrants coming from areas with little or no malaria transmission and therefore lack immunity.


Rilwanu Mohammed, executive secretary, Federal Capital Territory, Primary Health Care Board, a medical doctor who is an expert on malaria, advised that once a child has these symptoms, the mother of the child should bath her child with lukewarm water, give the child paracetamol, then lastly give the child anti-malaria tablets. And it should be done within 28 hours or the malaria gets severe and then penetrates the brain. When treating malaria it is expected the drugs are taken appropriately in order to avoid resistance to drugs.


For Mohammed, one of the causes of malaria drug resistance is lack of compliance to malaria drugs, like “when you did not take appropriate malaria drug dosage; for example, you are supposed to take Artemisinin-based Combination Therapy, ACT, but you bought chloroquine.” Above all, he said, patients are expected to visit the hospital to confirm how severe the malaria attack is by going for a laboratory test. That way, he said, it would also be possible to detect the type of parasite that attacked the body.


There are specific treatments for different individuals and body system. If the malaria parasite is severe, patients are to use an ACT like Coartem, while the approach is different in the case of a pregnant woman. A pregnant woman is not allowed to use the ACT but could use a mono-therapy like Artesunate.


The challenge however, may lie in ensuring that the right diagnoses are made and the right course of treatment is pursued. Jesse Kalu, a private medical practitioner, says there are lots of quacks that cannot diagnose malaria. To check such persons, the Council of Laboratory Scientists has started clamping down on quacks just to ensure that every diagnosis made is authentic and handled by professionals.


Asked how to prevent malaria, Kalu said, “it is by taking note of the swamps around the house. Government needs to pay more attention to malaria because when we were much younger, living at Ajaokuta, government used to employ people and you will see helicopter come and spray chemicals in the city against yellow fever, against viral infections, against malaria. Then also sanitary workers went round to each compound, fumigating everywhere, the inspectors ensured that the environment was clean. So we need to bring back that culture of environmental cleanliness with personal hygiene.”


Agreeing with Kalu, Moses Haggai, a pharmacist working with the Garki Hospital Abuja, said malaria will continue to be endemic in Nigeria because of certain factors like habit, mode of approach taken by the government towards eradicating malaria and the issue of self-medication.  Haggai said, “Habit has to do with things that concern our environment and our sanitary condition, the way we keep our homes, the nettings and so many others factors. The surrounding particularly during the rainy season, different water come to gather from different places, lots of grasses grow and are left unkempt, they serve as breeding grounds for mosquitoes.” Talking about the mode of approach in eradicating malaria, he is of the opinion that ACT drugs are sold at expensive rate to the hospitals and therefore unaffordable to the common man. More so, he said, the drugs are not readily available in hospitals.


Haggai says self-medication goes a long way in causing resistance to malaria drugs. Some malaria attacks require light medication while some require severe medication. Wrong drugs for a different diagnosis, he says, leads to resistance and could also lead to miscarriages for pregnant mothers.


Looking at mortality and morbidity rates attributable to malaria, a preventable disease, Mohammed says that government is trying but needs to do more concerning health care. He regrets that government has abandoned the national health bill. “One of the things that will take off the problem of malaria is the passage of the national health bill; the national health bill is to strengthen the policy of government on health that depends on primary health care. We want the National Assembly to take up that matter because they are almost abandoning the national health care,” he said.

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