THE GLOBAL community has been making frantic effort towards eradicating mosquitoes and  malaria, the common enemy of man, but the more they try, the harder it seems difficult to defeat the scourge. Mosquitoes have caused the deaths of over one million people around the world. There is no over stating the fact that malaria has dealt a hard blow on mankind in the form of out-of-pocket spending, man lost hours, effect on families and development. According to WHO reports in 1900, malaria was endemic in almost every country in the world and throughout the first halve of the 20th century, it killed about 2 million people yearly. Mosquitoes have kill not less than one million people yearly, but now the World Health Organisation, WHO, statistics shows that the number of caseloads are beginning to dwindle globally because in hitherto countries with high burdens have successfully eradicated the fever from their lands. In Nigeria, malaria still accounts for almost half of hospital visits to primary, secondary and tertiary health facilities. The worst hit are pregnant women and children under age five. The Nigerian National Malaria Strategic Plan 2014- 2020, report  shows that malaria is responsible for 60 percent of outpatient visits to health facilities, 30 percent of childhood deaths, 25 percent of deaths in children under one year, and 11 percent of maternal deaths,” he said. With these figures, Nigeria still has the highest burden of malaria in sub-Saharan Africa and even the world due to ignorance and lack of proper procedures in controlling the mosquito spread in neighbourhoods. Ahead of this year’s celebration in Nigeria, the United States Ambassador to Nigeria, Mr James Entwistle, said that with about 300,000 deaths out of 100 million cases of Malaria, Nigeria has the highest number of malaria causalities globally, largely due to the widespread of fake and substandard
medicines in the country. Entwistle noted that despite so many gains in malaria prevention and treatment, the widespread prevalence of counterfeit, substandard medicines is contributing to the alarmingly high number of malaria deaths and costs of health care in Nigeria. During last year’s celebration of World Malaria Day with the theme “End Malaria for Good” and a slogan, “Yes it is achievable’’, the National Coordinator of National Malaria Elimination Programme, NMEP, Dr. Nnenna Ezeigwe, in an exclusive interview with Nigerian Pilot in Abuja debunked the belief that malaria is still a high burden in Nigeria. She said that it was not true that most people who have fever have malaria. “I want to correct the impression about malaria”, she said. “When people have fever and they go to the hospitals, the first thing that comes to their minds is that it is malaria, but I want to say that all is not malaria because other things can cause fever. There are viral infections, common cold, Ebola, Lassa fever and  all these can cause fever. “The ones that are confirmed to be malaria is through tests and are not as many in Nigeria of today. We are raising awareness for people to get tested before treatment in line with the malaria policy and when they do test positive, we are also raising awareness about how to be treated with the correct medicine which is the Artesimin Based Combination therapy, ACT”, he said. According to Ezeigwe, when people are sick with fever and they visit hospitals, they should do malaria test by Rapid Diagnostic Test, RDT, which is not expensive as microscopy test. She advised that people including pregnant women and children should access the RDTs for free at most Primary Health Care facilities supported by Global Fund. “In these facilities, especially in the 24 high burden states where malaria is high we have made available the Rapid Diagnostic Tests and the ACTs so you get tested for free and treated for free’’she explained. The 24 Global Fund supports states including Akwa Ibom, Anambra, Bauchi, Benue, Cross River, Edo, Ekiti, Imo, Jigawa, Kaduna, Kano,  Katsina, Kebbi, Kogi, Kwara, Lagos, Niger, Ogun, Ondo, Osun, Oyo, Rivers, Sokoto and Zamfara. The NMEP coordinator said that Nigeria is fastening its process of ending malaria through training to empower patent medicine sellers to be able to test people using RDTs and sell ACTs correctly because a lot of people just walk into chemists and ask to buy but ACTs without testing, so we are able to empower them to do the tests and to sell the medicines now to people. Eziegwu assured that the ACTs with the green leaf logo which is supported by the Global Fund are available at patent medicines stores at subsidized rate not costing more than N200. But bringing malaria to its heels has not just required money but also imagination, persistence and political will because elimination would save millions of lives and trillions of dollars in lost productivity and health costs, mostly in low income economies like Nigeria. According to her, controlling malariain the country depends on budgetary allocation and help from partners because Global Fund has contribute a lot in the fight against malaria but in the 10 years over 1 billion dollars cumulative of government and all partners have been spent on the chase of malaria in Nigeria. The Bill and Melinda Gates Foundation, a fervent source of funds for anti-malarial research and control efforts believes that malaria can be eradicated completely by 2040. “Yes it is possible to eliminate malaria from Nigeria because it has actually been eradicated in some countries so why can’t it happen in Nigeria?” Ezeigwe concorded. According to Ezeigwe, “This is because we know the cause of malaria; it is caused by plasmodium parasite and it gets from one person to the other when the female anopheles mosquito takes it from one person and takes it to another person. We also know that mosquitoes breeds in bodies of water, in unhygienic environments, and we also know that if one comes down with malaria, that there is treatment that is capable of curing. If we know all these things, then why can’t we eliminate malaria?” she asked. Also you can remove the reservoir where mosquitoes can breed and if you can make your environment clean, sleep under a mosquito net so mosquito would not touch you then if it bits someone with malaria it cannot touch you because you are running away from it. But unlike in countries where this feat has happened, in Nigeria, the challenge is that people don’t believe that malaria can be eliminated from Nigeria, Ezeigwu observed. ‘’Nigerians are sceptical of the fact that malaria can be eliminated here and because of this they are not prompted to do what they ought to do. ‘’We make people to know that we have commodities in facilities and also available. They should go to hospitals and access these drugs. They should keep their environments clean and sleep under mosquito treatment nets. By registering for ante-natal when women are pregnant and in hospitals, theyshould ask their healthcare providers for Intermittent Preventive Treatment in Pregnancy, IPTP, drugs and they would be given free.’’ The actual problem, she said, is that some healthcare providers do not know how to read the microscopic which is the ultimate in malaria testing so they just put ++ and tell people that they have malaria while in actual sense they do not have malaria. ‘’We are also teaching the mocroscopics how to trust the RDTs because malaria cases are coming down in Nigeria because a lot of them don’t want to agree maybe because the person still has the symptoms of fever. So it is important that you diagnose and treat properly, she advised Nigerians. “We also do seasonal malaria chemo prevention in the northern part for children under the age of  five because the malaria season in this part of the country is about three to four months so within that period, we give children a particular medicine to cover them at that time. There is indoor residual spraying whereby you spray the walls of your homes with the correct insecticide so you won’t have malaria.’’ In the last three years, government has distributed 51 million mosquito treated nets to Nigerians to replace old ones.  From 2009 till now over 100 million nets has been given to Nigerians, Eziegwu told Nigerian Pilot. Another milestone discovery in malaria elimination from the world is the recent world’s first malaria vaccine, which represents a major foothold towards prevention of the singular disease that kills more than half as million people globally, most of whom are children in Africa. According to experts, roughly 40 species of Anopheles mosquito which acts as hosts for the types of malaria that affects humans are found all over the world. Five types of malaria that cause illnesses in humans are the plasmodium falciparum, which is responsible for majority of malaria- related deaths which killed 528,000 people in sub-Saharan Africa in 2013. Plasmodium vivax is most found everywhere and it is responsible for most cases of malaria outside sub- Saharan Africa, it is less lethal than P falciparum but can remain domant in the liver and cause illness to recur when it emerges into the blood; frequent relapses weaken its victims, making them more susceptible to other diseases. Up to 85% of malaria victims do not show symptoms and the parasite can lay dormant for months or years after an initial infection before emerging, so this makes it tricky to fight. According to WHO key facts, malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female mosquitoes. About 3.2 billion people – almost half of the world’s population – are at risk of malaria. Young children, pregnant women and non-immune travellers from malaria-free areas are particularly vulnerable to the disease when they become infected. Malaria is preventable and curable, and increased efforts are dramatically reducing the malaria burden in many places. Between 2000 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by 37% globally. In that same period, malaria death rates among populations at risk fell by 60% globally among all age groups and by 65% among children under 5. Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 88% of malaria cases and 90% of malaria deaths. Nigeria can actually eradicate malaria if the right steps are taken to testing and drug administration.

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