Nigeria And The Fiscal Threat Of Malaria

Malaria has infected humans for over 50,000 years and references to the unique periodic fevers of malaria are found throughout recorded history even as far back as 2700 BC in China. The term Malaria probably got its origin from the medieval Italian mala meaning bad and aria meaning air. The combination of the two gives us Malaria which translates to ‘bad air’ in English because by the then it was thought to be as result of bad air. Malaria is also called ague or marsh fever due to its association with swamps and marshland.

It was once common in most of Europe and North America, where it is no longer endemic, though imported cases do occur. Two hundred and twenty five children die every two and half hour in Africa as a result of it. This is not in addition to those infected but eventually killed by something else. The infection is already wrecking a huge havoc in the continent leading the experts to the conclusion that Malaria today poses a greater problem to Africa compared to Acquired Immune Deficiency Syndrome (AIDS).

Malaria causes about 250 million cases of fever and approximately one million deaths annually. The vast majority of cases occur in children under 5 years old. Pregnant women are also especially vulnerable. Despite efforts to reduce transmission and increase treatment, there has been little change. Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years. Precise statistics are unknown because many cases occur in rural areas where people do not have access to hospitals or the means to afford health care. As a consequence, the majority of cases are undocumented.

This situation underscores the place and importance of Roll Back Malaria Campaign undertaken by the World Health Organisation (WHO) and a few other organisations. Designed in 1998 and adopted at the Abuja Summit of 2000, the campaign is embarked upon annually to create further awareness on the need to adopt preventive methods and attitudes towards the disease. On April 25, 2000, heads of state and other senior representatives from 44 countries in Africa came together in Abuja to attend the first ever summit on Malaria.

Out of the world’s 300 million reported cases of Malaria, 255 million are said to be found in Africa. Malaria is more endemic in Nigeria than in any other country in Africa. About 60 million people in Nigeria experience malaria attacks twice a year while over 80 percent of the entire population are exposed to the disease.

Malaria a vector-borne disease is widely spread in tropical and subtropical regions. Each year, there are approximately 350–500 million cases of malaria which kills between one and three million people, the majority of whom are young children in Sub-Saharan Africa where ninety percent of malaria-related deaths occur. Malaria is commonly associated with poverty, but is also a cause of poverty and a major hindrance to economic development.

It is one of the most common infectious diseases and an enormous public health problem. The disease is caused by protozoan parasites of the genus Plasmodium. Five species of the plasmodium parasite can infect humans of which the most serious forms are caused by Plasmodium falciparum. Malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae causes milder disease in humans that is not generally fatal. A fifth species, Plasmodium knowlesi, causes malaria in Macaques but can also infect humans. This group of human-pathogenic Plasmodium species is usually referred to asmalaria parasites.

Usually, people get malaria from female Anopheles mosquito bite. Only female can transmit malaria, and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken, which contains microscopic malaria parasites. About one week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten. The parasites multiply within red blood cells leading to illness.

Today Malaria is a devastating scourge in Africa. According to the report of the Roll Back Malaria Summit, while 225 children in Africa die of Malaria within two and half hours, 100 die of AIDS within the same time frame. Similarly, about 2173 children under the age of five die from Malaria daily in Africa. Medical experts are unanimous that Malaria has been the major cause of death in Africa more than any other single disease, even war and famine. The World Health Organisation recently declared Mosquito as “public health enemy No. 1”. Dr. Kazeem Behbehani, Director of the Division for Control of Tropical Diseases at WHO noted that, “malaria as a single disease has a bigger impact on the world than any other thing”.

According to the African Regional Office of the WHO, in areas of high and moderate malaria transmission, the infections in pregnant women contribute to development of severe anaemia in the mother which results in an increase risk of maternal mortality.

Malaria is a drain on developing economies. Former Nigerian president, Olusegun Obasanjo noted that Africa loses between $7 billion and $12 billion to it yearly. Professor Jeffrey Sachs of the Harvard Institute of International Development seconding Obasanjo observed that the prevalence of the disease has continued to be a major cause of the underdevelopment in Africa and viewed that until Malaria was effectively tackled; macro-economic policies might continue to fail in addressing the African development crisis.

Toeing the same line of argument, the then USAID/Nigeria Acting Mission Director, Natalia Freeman observed that malaria has remained a major barrier to social and economic development. She noted that Malaria is a primary cause of natal miscarriage, stillbirth and low birth weight in most African countries and reiterated that Malaria accounts for 11 percent of all maternal mortality in Africa.

Another expert, Professor Akin Osibogun of Lagos University Teaching Hospital expressed similar view noting that “Africa would have advanced economically by as much as 32 percent over the present state” but for the scourge of Malaria. Dr. Okokon Ekanem, the President of the Malaria Society of Nigeria, concurred with him adding that about 5000 Malaria infections occur weekly in the country and this impedes the socio-economic development and well-being of the citizenry, causing untold discomfort and loss of valuable man hour.

Common symptoms of Malaria include chills and fever accompanied with fatigue, severe headache and nausea. The disease comes in stages. The first stage causes uncontrollable shivering which lasts for about one to two hours. This is followed by the second stage which is rapid spike in temperature and can be as high as 106F and would last for between three and six hours with an intensive sweat. The symptoms maybe repeated daily and could last for one month.

The best way to control Malaria is being aware of the risk of the disease, avoiding Mosquito bites, taking preventive medicine when one is travelling to disease-prone regions and early diagnosis as well as appropriate treatment. Sleeping in rooms with windows and doors properly screened with gauze and fumigating of the rooms are quite important and vital in avoiding Mosquito bites. The use of Mosquito nets treated with insecticide such as Pyrethrum which is a harmless substance manufactured by extracting Chrysanthemum is highly recommended.

Nevertheless, a bleak story from USAID’s Freeman is that despite the awareness of these methods, only about 10 percent of the vulnerable Nigerians use the net. However it is projected that more than that would use it if it becomes widely available. Insecticide Treated Nets (ITN) has been shown to decrease severe Malaria by 45%, reduce premature births by 42% and reduce child mortality and morbidity considerably. By consistently sleeping under an insecticide treated nets, families can protect themselves from Mosquitoes that bite at night.

Eyitayo Lambo, a professor and former Nigerian Minister for Health, noted that the net has been found to be efficacious because “it has been scientifically proven that it is one of the tools needed to roll back this disease”.

The nets reduce transmission and prevent infection and according to an evidence-based research the consistent use of Mosquito nets treated with the appropriate insecticide is effective against Malaria. In the last couple of years Roll Back Malaria partners have made concerted efforts at ensuring that Nigerians especially children under five years have access to effective treatment within 24 hours of infection.

Besides, the use of Mosquito repellent cream containing Diethyltoluamide (DEET) is also recommended as a bite-preventive measure. According to health experts, it has an excellent safety profile in adults, children and pregnant women. However, it is advised that the manufacturers’ warning be followed particularly when it is being applied on infants. Insect repellents containing over 30 percent DEET can effectively repel Mosquitoes when applied to the exposed skin. Refined Lemon Eucalyptus Oil on skin has also been found to be useful since Lemon scent was discovered to protect citrus groves from Mosquitoes.

In Nigeria, at least half the population of adults suffer from at least one episode of Malaria annually while under five years have between three and four relapses yearly. For instance the incidences of Malaria among children under five years across the six geographical zones of the country painted a gloomy picture. In the South-South, it was 32.7% while South-West, South-East, North-Central, North-East and North-West had 36.6%, 30.7%, 58.8%, 55.3% and 33.6% respectively.

Against that background, experts are worried that despite the danger posed by Malaria, it has not been able to receive adequate budgetary allocation of recent to nip it on the bud when compared to other less catastrophic diseases such as HIV and AIDS. About 85 million US dollars is globally spent a year on Malaria research which expert say is just half of the allocation to Asthma research. A recent British study reveals that $3,274 is spent on AIDS research for each fatal case, while only $65 is spent on Malaria for same case.

It was as result of this that the Roll Back Malaria was founded 1998 by the quartet of the World Health Organisation, United Nations Development Programme, United Nations Children’s Fund and the World Bank. The main objective of the programme is aimed at reducing the preponderance of the disease by half of its current statistic in few years. Various governments, civil societies and multi-nationals are in partnership with the programme including the ExxonMobil, Nigerian National Petroleum Corporation (NNPC) and the Mobil Producing Nigeria Limited (MPN). The upstream subsidiary, Mobil Producing Nigeria Limited with its joint venture partner, NNPC, initiated a robust roll back malaria programme which includes support for the allowances of medical personnel to riverside communities to encourage adequate presence of doctors in highly mosquito-infested areas in Nigeria. The NNPC/MPN joint venture has also facilitated the operation of the New Nigerian Foundation, a non-governmental organisation that is promoting community health service programmes in designated communities in Akwa Ibom and River States of Nigeria.

In line with the Roll Back Malaria campaign, the joint venture has erected educational billboards at strategic locations all over the federation to educate people on the dangers of the diseases. MPN over the years has also focused on the provision and upgrading of health facilities in hospitals, polyclinics and healthcare centres to ensure a focused fight against the scourge of Malaria. Between 2004 and 2005, ExxonMobil Corporation committed over $7 million in grants for the fight against Malaria. The grant was provided for programmes promoting research and development of new medicines specific to nine African countries including Nigeria.

In Nigeria, two non-governmental organisations Safe Blood for Africa and Medisend International received grants in support of on-going programmes aimed at ensuring diseases-free blood supply and provision of medical supplies and equipment to hospitals in the country. Part of this support was used in provision of ITNs to 12 boarding schools n Akwa Ibom State.

Lately, the Mobil Oil Nigeria PLC, the downstream subsidiary of ExxonMobil kicked-off a Malaria-prevention programme in Nigeria which is geared towards the distribution of Insecticide Treated Nets. This is in conjunction with USAID NetMark and the Lagos State Ministry of Health. It was aimed at the most vulnerable segments of the society such as pregnant women and children. With this type of response from organisations such as the ExxonMobil subsidiary companies, UN agencies and national governments, the aim of Roll Back Malaria Initiative could be achieved soonest.

However, the good news is that the World Health Organisation and the Nigerian scientists have are already on clinical trial of the new anti-malarial drug, Artemisinin-based Combination Therapy (ACT) in Damboa in Borno State. Then WHO Representative in Nigeria, Dr. Bayo Fatunmbi confirmed this and noted with joy that out of 40 countries that have adopted the ACT, 20 are in Africa and Nigeria is one of them.

Disclosing that health workers and patent medicine dealers have been trained on the management of home-based methods, Professor Lambo quoted earlier, revisited the reasons for the nation’s adoption of the ACT as the new first line drug for Malaria treatment.

“To overcome widespread resistance to Chloroquine and Sulphadoxine/Pyrimethamine, the Malaria Treatment Policy has just been revised to adopt Artemisinin Combination Therapy as the new first line drug. With assistance from the Global Fund, Roll Back Malaria partners have commenced plans to distribute the new therapy in 12 pilot states. This will be expanded to all 36 states once additional funding is received”, said the former health minister.

The workability of this is not known yet but experts are unanimous in their views that community heads and health workers in rural areas should be co-opted for it to be a success and to achieve the Abuja Declaration on Roll Back Malaria.