Beyond the breakthrough vaccine
The Malaria vaccine is considered to be one of the greatest breakthroughs in medical history. However, in spite of this breakthrough, the battle against malaria is far from over. In the 2021 World Malaria report, Nigeria is still considered one of the 11 highest-burden countries. About 96% of malaria deaths globally were in 29 countries. The 11 highest-burden countries account for 70% of the global estimated case burden and 71% of global estimated deaths. Nigeria accounts for the highest malaria deaths at 27%.
A section of the World Malaria Report is dedicated to self-evaluation by high burden to high impact (HBHI) countries. In this section, Nigeria-specific data outlined ongoing steps to address the malaria situation in-country. There are four pillars and the third response pillar stated that the development of a national social behavioural change communications strategy is in progress. For effective dissemination and use of such strategy documents, a multi-stakeholder approach will be useful. By engaging in coordinated community outreaches and health promotion interventions to prevent malaria, Nigerian Medical Students’ Association (NiMSA) may have just positioned itself as an unexpected channel for its dissemination.
The Report suggests that to ensure continued progress against malaria, any response must be anchored in strong health systems, funded and equipped to deliver quality health care for all. Nigeria’s health system is weak and as was made clear at the recently concluded Primary Health Care Summit, any efforts to strengthen health systems must begin at primary health care level. In the words of His Excellency, The Vice President of the Federal Republic of Nigeria, Professor Yemi Osibanjo, “a health system is only as strong as its primary health system”. Therefore, Nigeria’s hope for any significant progress against malaria might very well depend on how swiftly and effectively key actors in healthcare in Nigeria implement the 10-year strategy for re-imagining Primary Health Care in Nigeria.
From class to action
When Professor Olugbenga Ayodeji Mokuolu, Malaria Technical Director at the Federal Ministry of Health (FMoH) and Founding Director, Center for Malaria, and other Tropical Disease Care (CEMTROD) lectured medical students at the University of Ilorin (UNILORIN), he never imagined it would go beyond the classroom.
In 2017, the UNILORIN chapter of NiMSA led by the then president, Wesley Yesufu approached him about their desire to institute the Olugbenga Mokuolu Annual ILUMSA Malaria Lecture (OMAIML). Despite his concerns, they successfully delivered the lecture. Professor Mokuolu said he was initially concerned about their ability to sustain the idea. “I thought it was a flash in the pan idea among students, and they are unlikely to sustain it. But I was mistaken”. Following the end of Yesufu’s tenure, the new executives brought it up again and the second OMAIML took place. “From then on, I knew a baby had been born, and it has survived the period of infancy. We have since been conducting the OMAIML annually except in 2020 when there was an interruption due to the Covid-19 pandemic”, he added.
From small steps to giant strides
Although the pandemic disrupted their plans to have the lecture in 2020, it provided an opportunity to expand it in 2021 and involve other NiMSA chapters. This time, under the leadership of Danbuba Umar Muhammed, as National President. Capitalising on the popularity of virtual meetings, NiMSA mobilised their members across 47 universities to join the malaria lecture virtually. They also conceived the National Malaria Elimination and Sensitisation Project (NMESP) to observe World Malaria Day on April 25, 2021. The project ran from April 25 to June 10, 2021, across 14 chapters.
They recruited 433 members as volunteers to implement the project. But to ensure that they were equipped with the right information, the volunteers received virtual training on “Essential skills for engagement in crucial areas of malaria intervention” with support from Mr. Phillip Okoko-Oyale, the Head of Integrated Vector Management Unit, National Malaria Elimination Programme (NMEP). Among other things, the training provided them with useful insights on how to carry out education and awareness in remote communities, malaria testing, and case management, especially on the proper use of Rapid Diagnostic Kits (RDTs) and administration of medications.
In addition, they visited the selected communities ahead of the project start date, to inform community leaders and gatekeepers of their intentions to carry out a community outreach.
Temitayo Femi Matthew, NiMSA’s National Technical Officer on Infectious and Communicable Diseases said they gained valuable “knowledge on the efficacy and relevance of Seasonal Malaria Chemoprevention (SMC) and Insecticide Treated Net (ITNs) for malaria prophylaxis”. Even though they received some support from other organisations, Professor Mokuolu was certain that without the Zoom meeting platform, it would have been a logistical nightmare as it would have been impossible to assemble all the volunteers in one place for the training.
Easier said than done
Having the support of Professor Mokuolu as well as some State Malaria Elimination Programme Managers was key to the success of the project, Mathew said. But it wasn’t all smooth as some chapters couldn’t go on their outreaches due to insufficient funds for transportation and procuring supplies, such as RDTs.
Some communities were not as welcoming as expected. This highlighted the importance of community engagement and for local partners to create enough awareness about the programme. Turnout was little to nothing, while those who came out wanted other things. “In some of our chapters, the people weren’t ready to listen to our awareness messages because we didn’t go with mosquito nets and other consumables. The people believed they only needed us to give them mosquito nets, even though their environment showed they needed the sensitisation message,” Mathew said.
In Sokoto State where volunteers from Usmanu Danfodiyo University supported the activity, it appeared that information sent out by the Ministry of Health might not have been widely disseminated. When the team arrived at Minnata Primary Health Care Center, they met a handful of people waiting and were only able to reach seven persons at this centre. However, they reached 40 others in the two communities they visited in Sokoto South LGA.
Worth the effort
In 46 days, NiMSA volunteers reached 38 communities in 14 states across the six geopolitical zones of Nigeria. During this time, they spread awareness about malaria, used RDT kits to test 523 symptomatic people, and prescribed around 147 ACT medications to those with positive results. They also distributed 280 insecticide-treated mosquito nets and about 170 mosquito repellants, for free. To ensure ease of communication, they made sure to use the local languages of the communities they visited.
Their awareness campaigns reached a combined 8,816 people with information on malaria infection, prevention, and treatment, including ensuring proper usage of mosquito nets in the homes of those who already had it. They also inspected the communities’ surroundings while assisting in destroying possible breeding grounds for mosquitoes.
Even though it wasn’t her first-time volunteering in community outreach, Princess Olubukola Alabi, who is now the local chapter president in UNILORIN enjoyed the opportunity to impact the community. “I believe that we left the community in a better state than we met it,” she said. This year, they are planning a weeklong activity involving online and radio campaigns, essay competitions, and community outreach.
Taking the driving seat
NiMSA has shown that students can also take the driver’s seat in health advocacy, especially at the grassroot level. As advocates and civil society organisations continue advocating for better health outcomes for Nigerians, active citizenship for health — everyone knowing their rights, privileges and responsibilities and using such knowledge to demand accountability from those responsible — will make significant difference.
However, without further action from government agencies who have the reach and resources to drive progress against malaria, they can only do so much. Dr Perpetua Uhomoibhi, Director/National Coordinator, NMEP, Federal Ministry of Health, said, “NiMSA’s significant contributions to awareness creation, community outreaches is very commendable”. She added that they can support the new Malaria Strategic Plan 2021–2025 which seeks to achieve a parasite prevalence of less than 10% and reduce mortality attributable to malaria to less than 50 deaths per 1,000 live births by 2025. “The successful implementation of the plan requires robust multi-stakeholder, multisectoral and appropriate strategy mixes based on the stratification of Nigeria into low, high, and very high epidemiological areas. NiMSA has a role to play”.