“What would you say is the most dangerous animal on Earth? Sharks? Snakes? Humans?. If you’re judging by how many people are killed by an animal every year, then the answer isn’t any of the above. It’s mosquitoes. When it comes to killing humans, no other animal even comes close.” ~ Bill Gates
Malaria has remained a significant problem in Nigeria, and with the country accounting for 25% of the global malaria burden, it is no surprise that the presence of the tiny but deadly malaria-bearing mosquito is affecting the country’s health, social and economic progress.
Nigeria’s national strategic plan for malaria control aims to reduce the malaria burden in the country to pre-elimination levels and to bring malaria related deaths to zero by 2020. No doubt this is an ambitious goal. The plan aims to achieve this through vector control (elimination of mosquitoes), malaria case management, prevention of malaria in pregnancy as well as environmental management. Resources have been committed by both the government and donors in the fight to eliminate the disease. However, most malaria interventions tend to focus on the public rather than the private sector, despite the significant proportion of patients that access services from the private sector.
The Society for Family Health (SFH), a principal recipient of the Global Fund Malaria Grant since 2007, at a recent dissemination July event in Abuja, presented the results of an intervention that demonstrated the capacity of the private sector to implement programs that can hasten the achievement of the National Malaria Strategic Plan.
As part of SFH’s intervention, the organisation provided support to 1,920 private hospitals and 3,061 pharmacies and Proprietary Patent Medicine Vendors (PPMVs) across 24 states in Nigeria. They trained health service providers in the private hospitals on malaria case management, health record keeping and reporting. They also trained pharmacies and PPMVs on malaria case management including malaria diagnosis using the Rapid Diagnostic Test (RDT) Kit.
At the dissemination event, themed the Global Fund Malaria New Funding Model Grant (Private Sector), Sir Bright Ekweremadu, Managing Director at SFH said, “Malaria has remained a big burden in Nigeria. We must make malaria OUR fight! The informal private sector which interacts intimately with the community must be empowered capacity-wise to effectively provide required resources and interventions at that level.”
In addition to the support they provided, SFH conducted an exercise to implement and monitor a malaria diagnosis quality assurance program in 12 states in Nigeria. Objectives of the exercise included;
- to assess malaria diagnosis and treatment levels in private health facilities
- to assess infrastructure of private health facilities for malaria diagnosis
- evaluation of health workers’ competency in performing malaria microscopy and RDT
- to build confidence of health workers on the effectiveness of malaria RDTs
RDTs and its use in Nigeria
According to the WHO, Malaria rapid diagnostic tests (RDTs) assist in the diagnosis of malaria by providing evidence of the presence of malaria parasites in human blood in a shorter period of time than a regular lab test.
Despite the increased availability of malaria RDTs to facilitate point-of-care diagnosis elsewhere in sub-Saharan Africa, RDTs are not yet widely available in Nigeria, and presumptive diagnosis continues to be the most common method for determining a patient’s malaria status. Last year at the 2015 Nigeria Malaria Indicator Survey dissemination event, the Minister of Health, Isaac Adewole, said, “It is unethical for any medical professional to treat a malaria case without test and diagnosis.”
If the government aims to test all care-seeking persons with suspected malaria with RDTs by 2020, why are many Nigerians still unaware of the availability and use of these tests in 2017? With nearly 60% of Nigerians seeking treatment for malaria at drug shop outlets in the private healthcare sector, it becomes critically important that pharmacies and Proprietary Patent Medicine Vendors (PPMVs) are trained on Malaria case management. SFH’s intervention is an important step in the right direction.
Although Nigeria is making progress in the fight against malaria, much work is to be done. In a country where malaria is responsible for approximately 60 percent of outpatient visits, we must ensure the timely availability of antimalarial medicines and commodities required for its prevention and treatment.
Director Global Fund Malaria Project for SFH, Dr. Ernest Nwokolo at the dissemination event pointed out that, “Between 2010 & 2015, the malaria prevalence rate in Nigeria has witnessed about 35% drop from 42% to 27%”. This is an encouraging statistic, and it begs the question, “Is it possible that in few years to come, our children will not know what malaria is and would only be able to read its history?”
If Nigeria is to eliminate malaria by 2020, we all have a role to play. As a patient, your role is to request for RDTs at health facilities. As a healthcare worker, your role is to ensure test and diagnosis for every suspected malaria case. We eradicated small pox, we can eliminate malaria.
Nigeria Health Watch is running a poll on RDTs and its use in Nigeria. Please click here to respond.
The use of RDTs should help a lot, but like any programme, there should be (1) effective supervision and monitoring. (2) We have to endeavour to eradicate the supply of FAKE RDTs. and
(3) The sensitivity of the RDTs in use should also be stepped up. Many times, Clinicians still prescribe antimalarials based on clinical diagnosis even when the RDT test is negative because of the perceived sensitivity of the RDTs and they may be wrong. (4) The private sector is usually ignored in planning and implementation of health programmes,and the operators claim to be attending to more patients than the public health facilities. There should be much more engagement of the private health facilities through their organizations to establish stable links that can be followed up. This should include planning. implementation, supervision and monitoring with adequate supply of consumables. (5) Finally, the necessary structures to deliver this programme should be strengthened at State, LGA and facility levels through continuous training and retraining and supervisory visits.
This is my submission.
Good submission. I feel also the most important things to do are ensuring that clinicians at all levels believe RDTs are actually sensitive to malaria by improving knowledge about RDTs and ensuring all RDTs are quality assured before introduction into the Nigerian marketplace, which is a role government, especially NAFDAC must play.
Thanks for sharing the update on malaria
Changing the mindset of Nigerian that not all fever is malaria is the task that at must be achieved. RDT are sensitive and effective, however the issue is when the clinician says to the patient, all you need is rest, this is often not well received by the patient who claim they know their bodies. Considering the clinician is not making monies anyway, if you were in his shoes what will you do?
As Maternal and under-five care is free in most states of Nigeria, can screening for malaria be part of ANC and post natal package using the RDT kit?
Not all RDTs are sensitive and effective! I’ve had to abandon use of them because of many false negative results. I cannot say where the problem lies. How do you explain several examples of a clear clinical diagnosis, with a negative RDT result and clinical improvement after treatment?
Agreed, all fever isn’t malaria, but i ask: what proportion of typical malaria fever pattern points to a different diagnosis in our environment?
Over time there appears to be an increasing focus on Private Health facilities which is mostly the point of care of choice for most. One would wonder how are the Public Health facilities faring? In terms of service provision, quality, health care work force and their capacity, and reach or access particularly for certain population eg the poor and people in the rural setting.
In terms of Malaria testing before treatment with RDTs, awareness still remains an issue ”If the government aims to test all care-seeking persons with suspected malaria with RDTs by 2020, why are many Nigerians still unaware of the availability and use of these tests in 2017?” as noted above.
Questions to be discussed could include; what messages are disseminated and through what channels to what people?
As a Health financing researcher, I would also discuss cost implications (if any) direct and indirect. Looking at causative factors could go a long way to making a difference in testing and treatment of malaria.
I will like to ask if there has been an improvement in the sensitivity and effectiveness of RDTs in recent times. Not all RDTs are sensitive and effective! I’ve had to abandon use of them in the past because of many false negative results. I cannot say where the problem lies.
How does one explain multiple cases of a clear clinical diagnosis, with a negative RDT result and clinical improvement after malaria treatment?
Agreed, all fever isn’t malaria, but i ask: what proportion of typical malaria fever pattern/typical symptoms in adult individuals, point to a different diagnosis in our environment?