World Malaria Day: Nigeria records 200,000 deaths, loses N646bn yearly to malaria

• Nigeria, DR Congo, Tanzania, Mozambique account for over half of all malaria deaths worldwide
• Country received N176bn worth of aids from development partners to fight malaria, says Adeyanju
• No single tool available today will solve the problem of malaria, say WHO, experts
• Why it is likely current vaccines would eliminate malaria, by Adegboro, Ashiru

Today is World Malaria Day (WMD). WMD is a day set aside by the World Health Organisation (WHO) to raise awareness on the mosquito-borne disease and examine efforts towards prevention, treatment, control and elimination of the illness, which according to the body led to 602,020 reported deaths in Africa last year.

The theme of WMD 2022 is ‘Harness innovation to reduce the malaria disease burden and save lives.’ Experts are, however, worried that despite efforts to contain malaria, Nigeria loses over $1.1 billion (N645.7 billion) yearly to prevention and treatment of the disease as well as other costs.

The experts, yesterday, said malaria killed no fewer than 200,000 Nigerians and afflicted 61 million others in 2021. They also said Nigeria, Democratic Republic of Congo (DR Congo), Tanzania and Mozambique accounted for over half of all malaria deaths.

They, however, said despite the successes recorded with the new malaria vaccine, no single tool is available today that will solve the problem of malaria.

They noted that it would, therefore, take a combination of strategies, including use of existing control and preventive measures, as well as development of new tools, to control and ultimately eliminate malaria.

To this end, the WHO has called for investments and innovation that bring new vector control approaches, diagnostics, anti-malarial medicines and other tools to speed up the pace of progress against malaria.

WHO said despite steady advances in lowering the global burden of malaria between 2000 and 2015, progress has slowed or stalled in recent years, particularly in high burden countries in sub-Saharan Africa, noting that urgent and concerted action is needed to set the world back on a trajectory toward achieving the 2030 targets of the global malaria strategy.

According to WHO, about 95 per cent of the estimated 228 million cases last year occurred in Africa, along with 602,020 reported deaths. It further stated that six African countries, worst impacted by malaria, are reported to have accounted for up to 55 per cent of cases globally and for 50 per cent of these deaths. This is a reduction from the 241 million cases in 2020 and estimated deaths at 627,000.

WHO Regional Director for Africa, Dr. Matshidiso Moeti, in her message to mark this year’s WMD, said the theme aligns with calls to urgently scale up innovation and deployment of new tools in the fight against malaria, while advocating equitable access to malaria prevention and treatment, within the context of building health system resilience.

Moeti further said the past year has seen significant breakthroughs in malaria prevention and control, despite of the COVID-19 pandemic. “Landmark recommendations on the use of the first vaccine against malaria, RTS,S were released by WHO late last year.

This vaccine will be used to prevent malaria among children aged six months to five years, who live in moderate to high transmission settings,” Moeti said.

According to the latest World Malaria Report, “four African countries accounted for just over half of all malaria deaths worldwide: Nigeria (31.9 per cent), Democratic Republic of the Congo (13.2 per cent), United Republic of Tanzania (4.1 per cent) and Mozambique (3.8 per cent). In 2019, there were 303 cases per 1,000 population at risk of malaria.

“Nigeria accounts for about 31.9 per cent of the global malaria deaths; this is approximately 200,000 deaths in 2021. Over 60 million people are infected yearly and an estimated US$1.1 billion is lost yearly due to malaria related absenteeism and productivity losses.”

A TEAM of Nigerian researchers, led by Prof. Boaz Adegboro, Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, and Prof. Oladapo Ashiru of Medical ART Centre, Mayland, Lagos, told The Guardian that the presence of a vaccine may also not be sufficient to eliminate malaria because the vaccine is about 39 per cent effective at first dose and efficacy wanes with time.

Other members of the team of researchers are from the Department of Medical Microbiology and Parasitology, College of Health Sciences, Usman Danfodiyo University, Sokoto and Department of Medical Microbiology, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomosho, Oyo State.

In October 2021, WHO recommended the broad use of the RTS,S malaria vaccine for young children living in areas with moderate and high malaria transmission. The recommendation was informed by results from an ongoing WHO-coordinated pilot programme in Ghana, Kenya and Malawi that has reached more than 900,000 children since 2019.

Evidence and experience from the programme has shown that the vaccine is safe, feasible to deliver and reduces deadly severe malaria. RTS,S is an example of innovation at work and a scientific breakthrough – it is the first vaccine recommended for use against a human parasitic disease of any kind.

On if malaria could be eliminated without a vaccine, Adegboro said: “It is unlikely that malaria will be eliminated without vaccine because in recent years, there has not been a significant reduction in morbidity and mortality, especially in areas where malaria is endemic despite the preventive and treatment measures that have been in place for years. Although people in endemic regions develop immunity to disease in adulthood, they are not immune to infection and therefore the spread of the parasite is inevitable.

“Unless a vaccine that is able to always prevent infection is developed and backed up with 100 per cent uptake, it is most unlikely that the current vaccines would be able to eliminate malaria. Bear in mind that malaria vaccines are developed to reduce disease and death, but not eliminate it completely. It would therefore take a combination of strategies, including use of existing control and preventive measures as well as development of new tools to control and ultimately eliminate malaria.”

Adegboro said this underscores the need for constant analysis and improvements in research and development to ensure that newer, more effective insecticides are developed.

He said unlike in Asia and some other countries around the world where there is high resistance to ACTs, there have not been significant resistance to ACTs in Nigeria. “This is good news but also a reason to be cautious to ensure that ACT use is not abused so as to prevent resistance,” the professor said.

Former Commissioner for Health in Ondo State, Dr. Dayo Adeyanju, told The Guardian: “Malaria accounts for 60 per cent of outpatient visits to hospitals and led to approximately 11 per cent maternal mortality and 23 per cent child mortality, especially among children less than five years. This leads to an estimated monetary loss of approximately N410 billion ($700 million), in treatment costs, prevention, and other indirect costs.”

Adeyanju said the strategy of National Malaria Control Programme (NMCP) in Nigeria is to reduce burden of malaria by 50 per cent through achieving at least 80 per cent coverage of LLINs, together with other measures, such as 20 per cent of houses in targeted areas receiving indoor residual spraying (IRS) and treatment with two doses of intermittent preventative therapy (IPT) for 100 per cent of pregnant women who visit antenatal care clinics.