Bane Of Malaria Treatment In Nigeria

FRSC’s Medical Team carrying out free medical services in Onitsha, recently         Photo: NAN
FRSC’s Medical Team carrying out free medical services in Onitsha, recently Photo: NAN

Damiete Oruwari is a fish
erman from Ido, a community in Asari-Toru Local Government Area of Rivers State. As much as he could remember, fishing had been the key profession of his family. Unfortunately, as unfavourable as the days of his fathers were, the economic hardship never made it impossible for them to get the least net to catch fishes, according to the 45 year old primary four drop out.
Narrating his sordid background, which was further worsened by the biting economic downturn that affected all segments of the Nigerian economy, Mr. Oruwari said what looked like succour came to him when in 2007 the government commenced the distribution of free Long-Lasting Insecticide Nets (LLINs).
According to him, a couple of years before then, he could hardly feed his family of seven, made up of five children, a wife and himself. The major reason was that he could not afford to purchase and maintain a good fishing net from his subsistence fishing.
With the commencement of the distribution of the LLINs, however, his story changed: rather than use the nets for what they were meant, he adapted them as various forms of fishing nets, sometimes combining two or more, as the case may be.
“What I do is to get as many of the nets, even if I have to beg others or pay them small money. I then sew them into various shapes, depending on what type of net I want. When the ones I use get torn, I get new ones.
“They are easier and cheaper to get than the real nets. The only difference is that the real nets last longer because they are made for fishing. But it does not matter to me because it helps me to feed my family.
“At least I know that if my family feed well, our body can withstand some level of malaria. But if we don’t have food, malaria will affect us more. So, I prefer to feed my family than use the net to cover them at night”, he said.
To a large extent, Oruwari’s story is pathetic, and there seem to be sense in his reasoning. But one thing is certain: if he uses the LLINs for the prevention of mosquito bites, which is the sole reason it was made, it will reduce malaria infection on his family. So, the question is, should he forfeit feeding his family and prevent malaria?
This scenario, like several others, constitute the numerous gaps in malaria control, which had made it difficult to attain the Millennium Development Goals (MDGs) 6, which aims to reduce HIV/AIDS, Malaria and others.
One key lesson to be learnt in Oruwari’s scenario is that he is ignorant of the implications of malaria infection. Another one is that not enough measures have been put in place to monitor the extent to which the distributed LLINs are used to prevent mosquito bites.
There is no doubt that so much has been done to either check or eliminate malaria globally, particularly in Africa, which is worst hit in malaria infection, with Nigeria worst off. Such measures include both preventive and curative. In spite of this, however, the existence of various forms of gaps, as shown in the Oruwari’s scenario, has in no small way hampered the achievement of the MDGs 6.
The result is that the global malaria burden does not portray the level of investment aimed at eliminating the ailment. According to World Malaria Record (WMR) in 2013 and 2014, an estimated 3.3 billion people are at risk of contracting malaria, with Nigeria accounting for a quarter of the global malaria burden with 97% of the country’s about 180 million population at risk.
In her presentation in a recent media round table discussion programme on malaria control held in Lagos, the Country Director of “Malaria No More”, Dayo Oluwole, said 25% of the world’s malaria burden is in Nigeria, and that out of 1000 children, 128 die annually, while over 4000 maternal deaths occur within the same period.
She continued that about $1 billion is lost to productivity every year in Nigeria due to malaria, a quarter of the global malaria burden is in Nigeria, and 32% of global deaths as a result of malaria occur in Nigeria.
Beyond these embarrassing figures, which is basically in the health sector,Oluwole further revealed that the malaria burden cuts across other sectors of human endeavour including sports, economy, and education.
Giving an example of what impact malaria could have in sports, Oluwole recalled how Nigeria’s dependable central defender, Kenneth Omeruo, was ruled out of a major warm-up game against Scotland in 2014. The import of this is that malaria is capable of hitting an immeasurable blow on a team if it affects key members of the team in a major championship.
The Country Director said that malaria also takes its bite on the economy of affected countries: in Africa, for instance, she said annually, malaria cost the continent about $12 billion in  productivity. Nigeria, on the other hand, loses N132 billion. This figure is factored in costs of health care, absenteeism, days lost in education decreases productivity due to brain damage from cerebral malaria, and loss of investment and tourism.
“Malaria is bad for business: the disease is responsible for employee absenteeism, increased health care spending, and decreased productivity, all of which can negatively impact a company’s reputation. Malaria can strain national economies, impacting some nation’s Gross Domestic Product (GDP) by as much as an estimated 5-6%”, she said.
As regards education, Oluwole said children miss up 10 million school days per year due to malaria. Also, malaria leads to anaemia, a side-effect of frequent malaria, which interferes with children’s ability to concentrate and learn,and causes chronic fatigue.
In order to control malaria, therefore, so much has not only been invested by countries, governments, organisation, and various stakeholders in terms of funding, but also in strategies, some of which had taken relatively longer time and planning to put the ailment under control thus far.
One of such organisations is Malaria No More (MNM), an international organisation with a focus on creating a world where no one dies from mosquito bites, which has taken up the initiative to involve the media in malaria response and control.
In order to address the issue of ignorance, MNM, in collaboration with Exxon Mobile and other key stakeholders incorporated the media on effective dissemination of information on malaria.  With support from media partners, MNM also bought and distributed 4.9 million LLINs in 16 countries.
In Rivers State, as part of responses aimed at achieving the targets set to control malaria, the State Government has also distributed anti-malaria drugs/commodities and carried out anti-malaria measures such as provision of 7.4 doses of ACT for malaria case management; provided 1.8 million RDT kits for malaria diagnoses; as well as 1.6 doses of SPs for malaria prevention in pregnancy.
The State, according to The Tide’s investigation, also provided 7.6 million LLINs for prevention of malaria transmission through mosquito bites; made available 20, 990 doses of injectable Artesunate; confirmed malaria by laboratory diagnosis using Rapid Diagnostic Test (RDT) kits and microscopy before treatment; training and use of Community Directed Distributors (CDDs) in communities to diagnose and treat malaria in six local government areas (LGAs).
Currently, the Clinton Health Access Initiative (CHAI) is supporting ten states in Nigeria through a UNITAID-funded project to facilitate adoption of injectable artesunate.
The implication of these attention on malaria only goes to re-emphasise the focus on all strategies but that of Monitoring and Evaluation (M&E).At best, this area had always been given lip service by most stakeholders involved in malaria control. At given points, provision had been made by some stakeholders, but there had not been strict monitoring and evaluation mechanism to ascertain the efficacy of such provisions.
This, obviously, gives the likes of Mr. Oruwari, some of who either sell other malaria commodities, or allow same rot away, to have a field day frustrating the efforts to control malaria. It should also amount to an unequivocal declaration on the need to make M&E in malaria control a key strategy, like others.
One way to do this is for countries, states, local government areas, as the case may be, to come up with legislation aimed at checking the rightful use of malaria commodities for purposes they are meant.In the case of Mr. Oruwari, for instance, if there was such a legislation, and an effective monitoring mechanism put in place, he would have been apprehended and made to face the law.
Beyond legislation, however, there is also the need to involve the media more in a two-pronged awareness creation: the first, to create adequate awareness in the use and benefits of malaria commodities, while also making people know the consequences that await defaulters.


Sogbeba Dokubo