By Sola Ojo
In Sub-Saharan Africa, and Nigeria to be specific, malaria is still a significant public health issue that is of great concern to local and foreign interests. It is said that every two minutes, malaria kills a Nigerian child under five years old. It is so significant that SDGs have it as one of the diseases that should be addressed by 2030.
Findings have shown that there has been limited dedicated malaria eradication support for Nigerians on the move – especially for those that have been displaced from their ancestral homes, either by Boko Haram terrorists in the North-east or bandits in the North-west until recently when the Global Fund saw malaria information, diagnosis, treatment and care as human right issues.
As a country, Nigeria’s strategic plan to end the malaria scourge by 2020 was not hitherto feasible and coming of the COVID-19 global emergency further threatened the zeal of concerned government agencies, civil society groups and development partners to eradicate the disease in the most populous black country in the world with a population of about 200 million (2006 National Population Census projection).
Unarguably in Nigeria, coupled with sharp cultural practices, malaria is more serious than COVID-19 in terms of its effects , especially on the vulnerable, the women and children who live in low-income settings when compared to their fellows in elevated reserved areas with netted windows and proper water channels.
In northern Nigeria for example, as in some other countries, some women cannot seek malaria information, diagnosis, treatment or care in the hospital without the approval of either their husband or mother-in-law. This is also a human rights issue which UNICEF is helping to solve through volunteer community mobilisers in selected local government areas in Kaduna State (UNICEF Kaduna Field Office 2021).
Commissioner, National Refugees for National Commission for Refugees, Migrants and Internally Displaced Persons, Imaan Sulaiman-Ibrahim, while defending the commission’s 2022 budget at the national assembly recently, puts the figure of displaced persons at 3 million.
With the approval of the malaria vaccine by the WHO, it is not clear if this key population (IDPs) would be holistically included in this intervention.
Voices of displaced persons:
Secretary in one of the Internally Displaced Person camps, in North-west, Nigeria, Emmanuel Yari, lamented that they have been living in their own world since bandits chased them away from their homes.
“We have been facing malaria disease here in the camp. Most of our children here have been treated at one point in time or the other. We don’t have any hospitals close to us here.
“The only primary health care facility around is far from here that you have to spend between N400-N500 to and from that facility which is not easy for us, considering our current economic situation as displaced persons fighting for survival.
“We are pleading with the government and others to check on us and come to our rescue, by developing a dedicated malaria programme for us, the displaced persons.
“In this particular camp, we have a total of 868 persons comprising 278 men, 342 women and 248 children. These are the names on the list, but we are now more than a thousand here due to the continuous activities of these bandits.
“It is shocking that some of our fellow displaced persons that we came to seek shelter here last year decided to return home a few months ago due to economic and shelter harsh conditions.
“The news we are hearing from them is sad. Some of them have been attacked again and lost their lives while some women have been kidnapped and yet to secure their release as we speak.
“To me, malaria can be eliminated because we are aware of countries that had it before but due to aggressive engagements without leaving anyone behind irrespective of the social status and geographical locations”, he said.
Another displaced person, who is a young mother, Cecelia Josiah, said she and her children lack access to malaria information or kit, including insecticide-treated mosquito nets.
“I’m calling on the government to come to our aid. We know we are supposed to be sleeping under mosquito nets but we sleep outside with our little ones.
“If someone is sick and we manage to take the person to the hospital and it is confirmed the person is suffering from malaria, we will go and buy the prescribed drugs but after a few days, malaria will come back and that is how we have been managing it.
“We don’t know of any malaria programme for people like us. Government don’t even know we are here. We have been left behind. We have been forgotten. They don’t even hear our cry. We don’t hear anything from them.
“We don’t know when we are going back to our homes because bandits have taken over our homes and use them as enclaves where they keep their victims for ransom.
“We are calling on the government and others who can help to come here and help us because we cannot help ourselves”, she pleaded.
Christiana Danjuma is a displaced woman with two children aged between two and five. Her position is of displaced persons understanding of the symptoms of malaria.
“If malaria holds you, you will be feeling very weak and you will not be able to eat or do anything and, in most cases, when we go for a test, it is usually positive.
“Since we came here, no help from our government. No insecticide-treated mosquito nets. We and our children sleep outside without mosquito nets. We do go to primary healthcare centres to get some malaria drugs at a price. Nothing is free.
“Sometimes, we look for menial jobs to do so we can get some money to buy malaria drugs. We need mosquito nets and drugs for our children, pregnant women and old people among us”, she said.
Civil society speak:
Malaria Matchbox Equity Assessment report in selected states in North-eastern Nigeria 2020 by ACOMIN (a network of civil society organizations working on the prevention, treatment and mitigation of the impact of malaria in Nigeria) further buttressed that, no holistic malaria programme specifically meant for internally displaced persons in the Northwest Nigeria even as it engages communities in its malaria eradication campaigns in the area.
Program Officer of ACOMIN in Kaduna State, Mr Ogidi Nicodemus, identified the diversion and sale of free malaria commodities by unscrupulous health facilities as top setbacks facing the disease elimination efforts among the regular populace.
To him, before the coming of ACOMIN on the Global Fund Malaria Commodity Monitoring project in Kaduna, North-west Nigeria, malaria commodities have been going to the public health facilities in Kaduna and 13 other States without many people knowing. So, ACOMIN is enlightening communities on the availability of free malaria commodities in their communities.
“ACOMIN took it upon itself to engage the communities in our day-to-day activities and made them know that there’s a free malaria commodity, which includes test kits for malaria, Artemissinin-based combination therapies (ACT) and lasting insecticide-treated mosquito nets amongst other commodities are available in PHCs in their locality”, he said.
He said as part of national efforts to address the challenges of Malaria in Nigeria, ACOMIN has been re-engaged by Catholic Relief Services (CRS) under the ongoing Global Fund malaria grant to continue implementing the civil society component, having successfully done it from 2019 to 2020.
The programme officer’s position was echoed by representatives of other partners including Malaria Consortium Global Fund, who attended the ACOMIN media brief.
World Health Organisation and other reports on malaria:
World malaria report 2021 by WHO (Geneva 2021) Globally, there were an estimated 241 million malaria cases in 2020 in 85 malaria-endemic countries (including the territory of French Guiana), increasing from 227 million in 2019 with most of this increase coming from countries in the WHO African region. Some 29 countries accounted for 96% of malaria cases globally, and six countries – Nigeria (27%), the Democratic Republic of Congo (12%), Uganda (5%), Mozambique (4%), Angola (3.4%) and Burkina Faso (3.4%) – accounted for all cases globally.
To the Breakthrough ACTION -Nigeria, COVID-19 wreaked havoc on malaria control and elimination efforts, quoting the World Health Organization (WHO) as urging countries not to scale back their planned malaria prevention, diagnostic, and treatment activities during the COVID-19 pandemic or the gains made in saving lives from malaria and other diseases over the past 20 years may be lost.
Also, microscopy data from the 2018 Nigeria Demographic and Health Survey (NDHS) show that the prevalence of malaria parasite in the blood in children under five years of age is 23 % (a decrease from 27% in 2015 and 42% in 2010), although there are significant regional, rural-urban, and socioeconomic differences.
Nigerian Government speaks:
In a telephone interview with this correspondent, National Coordinator, National Malaria Elimination Programme (NMEP), Dr Perpetua Uhomoibi, hinted that with the support of the Global Fund, displaced persons and their host communities are being targeted in malaria programmes in four Nigerian states which are Yobe, Adamawa, Taraba and Gombe.
NMEP, which domiciles in the National Malaria and Vector Control Division, Department of Public Health of the Federal Ministry of Health, Nigeria, was tasked to formulate, facilitate policy and guidelines, coordinate the activities of partners and other stakeholders on malaria control activities.
The Director said specifically that, “for the Global Fund grant, there is an emphasis that we add IDP population in the North-east to ensure that both the IDPs and their host communities have access to free malaria diagnosis, prevention and treatment services. That is being done and it is WHO that is implementing that on behalf of the national programme. They make sure that they have nets, they can go and get diagnosis and treatment for malaria.
“We also have SDG messaging to make sure that when they are sick, they come to facilities to get treatment and prevention services. We call it malaria IDP intervention. Also, when we have commodities as NMEP respond to the NEMA as it provides for areas affected by flood and other emergencies. But mostly, we have continuous intervention in those four North-eastern states.
“The NMEP and partners have developed a new malaria strategic plan that will take us from 2021-2025. The goal of that strategic plan is to achieve a further reduction in malaria burden to less than 10 percent treatment in children under five by 2025 and to achieve malaria-related deaths to less than 50 deaths per 100,000 livebirths by 2021”, she said.
Call for action:
The Nigerian government needs to increase its efforts at fighting the epidemic in terms of allocating more resources, working on behavioural changes towards best environmental practices among its citizens and reducing its dependency on development partners.
If the government at all levels, civil society groups and development partners failed to develop an all-encompassing malaria package for internally displaced persons across the country, the 2030 SDGs goal of eradicating the epidemic in affected parts of the world may be another effort in futility. The time to act is now.
This story was produced as part of the ‘Breaking Down Barriers to Health Services’ journalism programme, run by the Thomson Reuters Foundation and the Global Fund.