Losses due to malaria in Nigeria are staggering. Whether it is the number of mothers and children that die or the financial and economic costs, malaria’s effect is devastating. What is more worrying is that the human and economic costs that the scourge of malaria unleashes yearly are an avoidable burden.
According to the Ministry of Health, malaria is responsible for 60 percent of out-patient visits to health facilities; 30 percent childhood deaths; 25 percent of deaths in children under one year old and 11 percent of maternal deaths. This excludes patients who self-diagnose and self-medicate and does not capture deaths from misdiagnoses and medication. The financial loss from malaria – in the form of treatment costs, prevention, loss of man hours etc – is said to be about N132 billion ($8345m) a year.
Malaria, associated with poverty, contributes to it and reinforces it. It causes low productivity and reduces school attendance both of which hamper economic development.
According to the World Health Organisation (WHO) malaria thrives where there is “a combination of human population density, high anopheles mosquito population and high rates of transmission from humans to mosquitoes” and vice-versa. The parasite disappears significantly if any of these factors reduce.
All over Africa cities are urbanising rapidly. And Lagos, the largest city on the continent, will no doubt be a hotspot for malaria: open debris cluttered stagnant gutters are a standard feature of streets in densely populated Lagos.
Though the fight against malaria has taken several forms most of the effort has been focused on medication, use of repellents and insecticide-treated nets. Efforts at eliminating the breeding ground of mosquitoes have been at best feeble and it says a whole lot about our sanitary standards.
Surely a concerted effort to make the environment cleaner, to keep gutters free of debris, to ensure drainages are not clogged and that waste water flows in the sewage hold a better promise for improving sanitation and fighting illnesses such as malaria.
The anopheles mosquito, the vector for malaria, is like an insurgent. Denying an adversary refuge, access to ammunition, is a good predictor of victory. Yet we do nothing about our poor sanitation practises. To allow it ample space to proliferate is to accept defeat.
We ignore the environment where mosquitoes breed. We have reeled out various strategies and ignored conquering the territory. We have resorted to preventing it get too close to us. We rely on Artemisin combination therapies (ACTs) after mosquitoes have found their way around treated nets. It’s doubtful if these strategies are an effective option in fighting malaria as long as the environment is accommodative.
Perhaps it is because we don’t have the human and financial capacity to combat malaria. There is a cost-benefit dilemma to eliminating malaria. Though preventing malaria, in the long run, is more cost-effective, few countries can afford the upfront costs. The cost of controlling and eliminating malaria varies depending on the health budget of a country. And Nigeria is infamous for spending less on health (or capital projects) and more on recurrent e.g. salaries.
Ngozi Okonjo-Iweala, the minister of finance, said at the House of Representatives earlier last week that the wage bill for public servants had more than doubled from N857 billion in 2009 to N1.8 trillion a year by 2014.
Better and smarter spending can combat malaria. In Namibia, a study by the University of Southampton and the National Vector-borne Diseases Control Programme (NVDCP) used anonymised mobile phone records combined with diagnosed cases of malaria, topography and climate to identity malaria hotspots. Such information is vital for designing ways to eliminate malaria such as rapid diagnostic tests, distribution of nets but also and more importantly promoting better hygiene.
