Punch Editorial

After over three years without recording a single case of malaria, the Central American nation, El Salvador, was declared free of the killer disease by the World Health Organisation. Two South American countries – Paraguay and Argentina – had been similarly declared malaria-free in 2018 and 2019 respectively. Currently, about 100 countries and territories no longer witness malaria, a disease that kills at least one child every two minutes.

Sadly, only four out of the 47 countries that make up the WHO Africa region no longer witness malaria. The countries are Algeria, Mauritius, Lesotho and Seychelles, while the disease continues to ravage mostly poor African nations, killing 403,000 people yearly. According to the World Malaria Report, Nigeria currently has the highest malaria burden in the world, recording 23 per cent of the total malaria cases. Others with high incidence of malaria include the Democratic Republic of the Congo (11 per cent), Tanzania (5.0 per cent), Niger (4.0 per cent), Mozambique (4.0 per cent) and Burkina Faso (4.0 per cent). It adds that 10 nations in sub-Saharan Africa alone account for approximately 70 per cent of the world’s malaria burden, which is 200 million per year. This means Nigeria records approximately 46 million malaria cases yearly.

Malaria is transmitted through the bites of female anopheles mosquitoes, which lay their eggs mostly in stagnant water. Scientists say the strong human-biting habit of the African vector species is the main reason why Africa accounts for the highest malaria burden. While it is true that environmental factors make African nations more susceptible to malaria, several man-made factors also make sub-Saharan Africa a breeding ground for the disease.

Research shows a nexus between poverty and malaria. The economic effect of malaria yearly is estimated at $12 billion. Indeed, while malaria deepens it, poverty also helps spread malaria. It is therefore not surprising that sub-Saharan Africa, which accounts for 70 per cent of all cases, is the poorest region in the world, while Nigeria, which has the highest burden of malaria, is also the world’s poverty capital. Nigeria has open gutters filled with stagnant water. It also witnesses frequent flooding, especially during the rainy season, due in part to clogged drainage caused by poor waste disposal practices and weak enforcement of town planning and sanitation laws. The poor cannot afford tools for malaria prevention such as treated nets, insecticide and drugs making them more susceptible to the disease.

But how did El Salvador, a nation with a GDP of just $27 billion, eliminate malaria? According to health officials, the country achieved the milestone by consistently budgeting huge sums of money for malaria treatment and elimination programmes for 50 consecutive years. Despite reporting its last malaria-related death in 1984, El Salvador maintained its domestic investments for malaria and continued to put foreign aid to good use. The funding continued even during the COVID-19 pandemic while the small nation mobilised thousands of health workers to battle malaria in strategic areas. It ensured the mechanical control of mosquitoes through construction of permanent drains in swamps, followed by indoor spraying with pesticides.

Sadly, however, Nigeria’s health sector investments have been abysmal. The woeful budgetary allocation to health by the three tiers of government calls for a complete rethink of health-care financing. The health budget, which stands at seven per cent in the 2021 budget, is in clear violation of the African Union Abuja Accord of 2001 that mandates all signatories to set aside 15 per cent of national budgets for health care. Rather, Nigeria relies largely on foreign aid to fund its health sector. With Universal Health Coverage at a paltry five per cent, most Nigerians have to pay for medication out-of-pocket. No wonder Nigeria has a high malaria casualty figure and one of the highest neonatal death rates.

But it is not too late for Nigeria to put its house in order. Government at the national and sub-national levels must invest more in the health sector while the private sector should be given incentives such as tax exemptions or reductions to encourage investments.

According to the WHO, eliminating malaria in countries like Nigeria would require some tools that are not yet available hence the charge by the Director-General, Tedros Ghebreyesus, for the global health community to increase investment in the research and development of new malaria-fighting tools and approaches. Nigeria must also invest more in research and education. The academia must therefore be alive to its responsibilities by putting in extra effort to finding a viable malaria vaccine.

In the interim, however, Nigeria can use a combination of several modern methods to bring down its rate of malaria infections. Such methods as prescribed by the US Centers for Disease Control include: Genetic modification of malaria vectors, introducing sterile male mosquitoes into strategic areas and the removal or permanent destruction of mosquito breeding sites which could be done by filling depressions that collect water, by draining swamps or by ditching marshy areas to remove stagnant water. Other effective methods of prevention are: use of insecticide-treated nets, intermittent preventive treatment of malaria in pregnant women and infants as well as indoor residual spraying. Recent research showed that through an optimised mix of some of these interventions, Nigeria could avert tens of millions of additional cases and thousands of additional deaths by 2023.

The Sustainable Development Goal III regarding good health and well-being, which is one of the 17 Sustainable Development Goals established by the United Nations in 2015, seeks an end to the preventable death of new-borns and children under-five and to end epidemics such as AIDS, tuberculosis, malaria. Nigeria must therefore not be left behind in the race to ensure malaria reduces by 90 per cent by 2030.

Originally published at Punch