Malaria kills 300,000, afflicts 100m yearly in Nigeria

*Disease-related absenteeism, production losses cost nation N482bn yearly
*AHAPN alerts to rising resistance of malaria parasite to ACTs, mosquitoes to insecticides
*Urges institutes to intensify research into discovery, production of new medicines

Pharmacists under the aegis of the National Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) have warned that rising resistance of mosquitoes to available insecticides and the malaria parasite to the drug of choice, Artemisinin-based Combination Therapy (ACT), are threatening efforts to ensure that the country eliminates malaria by 2025.

They said malaria-related absenteeism and production losses cost Nigeria close to an estimated $1 billion (N482 billion) loss yearly.

Chairman, AHPN, Dr. Kingsley Chiedu Amibor, in his welcome remarks during an online meeting organised by the association to mark the 2021 World Malaria Day: Zero Malaria – Draw The Line Against Malaria, said: “There are an estimated 100 million malaria cases with over 300,000 deaths per year in Nigeria. This compares with 215,000 deaths per year in Nigeria from Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS). Malaria contributes to an estimated 11 per cent of maternal mortality.”

Amibor said the theme of this year’s celebration is “Zero Malaria- Draw a line against Malaria” and it was chosen because every malaria case is preventable and every malaria death is unacceptable. “In 2019, Africa accounted for 94 per cent of the 229 million cases of malaria and 409,000 deaths reported globally. Children aged under-five years are the most vulnerable group affected by malaria; in 2019, they accounted for 67 per cent (274,000) of all malaria deaths worldwide. Between 2000 and 2019, malaria incidence declined by 29 per cent and deaths by 60 per cent. More than 1.2 billion cases and 7.1 million deaths were averted in Africa. In 2019, six countries accounted for approximately half of all malaria deaths worldwide, with Nigeria accounting for a whopping 23 per cent,” the pharmacist said.

Is zero malaria really attainable? Amibor said: “Yes, some parts of Africa have. Algeria has been certified malaria free, while Ghana, Namibia and South Africa achieved the 2020 milestones of reducing malaria incidence and deaths by 40 per cent, compared to 2015. Unfortunately, Nigeria is one of the malaria-endemic countries in the WHO African Region that did not achieve these milestones.
Every year that malaria spreads, health and developments bear the brunt. On the average, malaria is responsible for an annual reduction of 1.3 per cent of Africa’s economic growth. Malaria related absenteeism and production losses cost Nigeria close to an estimated $1 billion (N482 billion) loss yearly.”

Amibor said the massive reductions in malaria-related morbidity and mortality in regions of high endemicity in the last decade has been in part due to the effectiveness of the ACT regimen. He, however, said the emergence of artemisinin-resistant strains of Plasmodium falciparum (malaria parasite) from some parts of Asia has threatened these successes.

Amibor said Artemisinin resistance is a major threat to global health, particularly in low- and middle-income countries in which the disease burden is highest, substandard or counterfeit ACT compounds are widely available, and systems for the monitoring and containment of resistance are inadequate. “Unfortunately, Nigeria is not exempted,” he said.

The pharmacist said there is little existing knowledge regarding ACT-resistant malaria in many countries, including Nigeria, and the most recent reports of ACT treatment failures were in travellers who had recently visited African countries. “Cases of early treatment failure due to possible artemisinin-based combination therapy-resistant Plasmodium falciparum malaria have been reported. All cases showed adequate clinical and parasitological responses to quinine. This is one of the reasons AHAPN chose to observe this year’s World Malaria Day, to draw the attention of Nigerians and the global community to the possibility of the gradual emergence of resistance to ACTs, and the need to re-evaluate the quality and efficacy of artemisinin-based combination therapy agents in Nigeria and other parts of Africa,” he said.

Amibor added: “We at AHAPN are advocating for increased monitoring and surveillance to identify and contain artemisinin resistance especially in Nigeria. We are calling on research agencies such as National Institute for Pharmaceutical Research and Development (NIPRD), as well as pharmaceutical companies especially those that manufacture ACTs to intensify research into possible resistance of Plasmodium falciparum to ACTs in our locality, and the mechanisms for such resistance. This is very important when we remember that ACTS for now remain the mainstay of treatment of malaria and we cannot afford to have the plasmodium parasites develop resistance to this group of antimalarial. In the same vein, AHAPN is hereby calling upon the various research institutes to intensify research into the discovery and production of new antimalarial medicines that could serve as reservoirs in the event of ACT resistance being confirmed. We call upon governments to assist such institutions (including our universities), with the needed grants to facilitate production of new antimalarial moieties.”

He said towards achieving zero malaria status in Nigeria and elsewhere in the world, AHAPN fully endorses the WHO Global Strategy for malaria 2016-2030, which aims at: reducing malaria case incidence by at least 90 per cent by 2030; reducing malaria mortality rates by at least 90 per cent; and eliminating malaria in at least 35 countries by 2030.

Amibor said AHAPN is emphasising the need for all to continue to adopt measures aimed at prevention of the spread of the disease, which is caused by Plasmodium species, with Plasmodium falciparum being the most dangerous.
He said Nigeria has been identified as one of the 11 counties that carry a high burden of the disease; as such, an aggressive new approach to jump-start progress against malaria has become inevitable.

The pharmacist said a high burden to high impact response model is advocated. The features, he said, include: a call upon the government to demonstrate the political will to reduce the toll of malaria; need for strategic information to drive impact; better guidance, policies and strategies; and coordinated national malaria response.

Amibor said one very important reason for AHAPN marking the 2021 World Malaria Day is to draw national and global attention to the fact that as the global community battles the second wave of COVID-19 and possibly the third wave.

He said there is urgent need to aggressively tackle the virus, while ensuring that other killer diseases such as malaria are not neglected.

The pharmacist said the need to maintain core malaria services cannot be overemphasised, while protecting healthcare workers and the community against COVID-19 transmission. He said there is a report that some countries in Africa had suspended mass insecticide net-treated campaigns in the wake of the coronavirus pandemic and AHAPN is encouraging Nigerians to continue with use of insecticide treated nets and indoor residual spraying campaigns, which have remained the mainstay of malaria prevention efforts in Sub Sahara Africa including Nigeria for years now.

Keynote Speaker and professor of pharmacy at the Faculty of Pharmacy, University of Benin, Prof. Ehijie Enato, said: “In the face of COVID-19 pandemic, we must do more to protect everyone at risk of malaria. Elimination is possible, despite the challenges posed by COVID-19. Investments to end malaria are useful to other current and future diseases. Ending malaria strengthens our fragile health system and reduces the burden on it. Today’s youths are the generation that can play a key role in ending malaria (YPG).

“Getting rid of malaria in the world will lead to healthier, more resilient communities that are better able to thrive, prosper and confront new health challenges as they arise.”