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Why Africa’s efforts at tackling malaria are failing

Malaria has proven to be the most horrendous public health challenge confronting countries in sub-Saharan Africa, including Nigeria; despite billions of dollars spent yearly in tackling the scourge on the continent, which still accounts for nearly half of global malaria cases.

In Nigeria, according to the National Malaria Strategic Plan (2014-2020), malaria is responsible for 60 percent of outpatient visits to health facilities, 30 percent of childhood death, 25 percent of death in children below one year of age, and 11 percent of maternal death.

Direct use of Long Lasting Insecticidal Nets (LLIN) and Insecticide Treated Nets (ITNs) has been promoted as control measure to eradicate malaria in Africa has been associated with significant reductions in malaria morbidity and mortality, particularly among pregnant women and children less than 5 years.

Tanzania has been on the fore front in the promotion of the use of Insecticides Treated Nets from research project in the 1980s and 1990s and from validations in large field trials in early 2000 it escalated to a nationwide programme through a discount voucher scheme through a public private partnership approach (WHO, 2005).

Malaria is one of the most severe global public health problems, particularly in Africa, LLIN and ITN are meant to be highly effective means of preventing malaria infection and majority of the burden falls to the poorest and most rural populations which indicate poverty, poor sanitation, significant or decrease the in the distribution of nets coverage.

The National Malaria Control Strategic Plan (NMCSP, 2011) in Nigeria includes universal access to Long Lasting Insecticide Nets, increased indoor residual spraying, and environmental management to decrease mosquito breeding places (The Global Malaria Coordination, 2011).

The Long Lasting Insecticide Nets distribution strategy in Nigeria included a “scale–up phase” (2009-2010) of free Long Lasting Insecticide Nets distributions through mass campaigns (2 LLINs per household ); and “a keep -up phase” of replacing torn or worn nets and providing Long Lasting Insecticide Nets to new households members and new families (National Malarial control programme). Mass distribution of Long Lasting Insecticide Nets started in Kano State in May 2009 (The World Bank, 2009) and more than 24 million Long Lasting Insecticide Nets were distributed in 14 out of the 36 States in Nigeria by August 2010 (The US Global Malaria Coordination, 2011).

The scale up phase Long Lasting Insecticide Nets distribution strategy was through stand-alone mass distribution campaigns led by the state in collaboration with partners, using common methodology and tools (Amajoh, 2011)

However, access does not always result in usage due to sociocultural and logistical reasons. The low rates of ownership and usage exist in Nigeria.

Many Nigerians judge that the treated nets cannot protect mosquito bites, which occasion malaria and the reasons for not using nets include discomfort resulting from heat, smell of the net, and difficulty in hanging the net.

However, there have incidents where mosquito nets have been reported as sub-standard and do not actually, prevent mosquitoes from biting an individual.

The recent rise in malaria incidence has been attributed to the use of substandard bed nets. Millions of ‘insecticide-treated’ bed nets in Africa are less efficient because they do not have enough medicine to kill mosquitoes.

This is a setback to the effort of eliminating malaria; as a result, hundreds of millions of Africans are exposed to malaria, one of the leading killer diseases on the continent.

This is why a recent report from the World Health Organisation (WHO) showed that five countries accounted for nearly half of all the malaria cases worldwide: Nigeria (25%), Democratic Republic of the Congo (11%), Mozambique (5%), India (4%) and Uganda (4%).

The top 10 highest countries with malaria burden in Africa recorded increases in 2017 compared to 2016. Of these, Nigeria, Madagascar and the Democratic Republic of the Congo had the highest estimated increases, all greater than half a million cases.

Recently, Rwandan’s Ministry of Health has blamed the rising rate of malaria incidences in the country on substandard bed nets. The nets were procured in 2013 from Netprotect, a firm based in Denmark.

According to the Minister for Health, Agnes Binagwaho, said three million mosquito nets currently in use in the country are less efficient because they do not have enough chemicals elements to kill mosquitoes explaining that the World Health Organisation (WHO) had certified the bed nets that Netprotect supplied but later due to a high increase of malaria cases, the ministry carried out its own study, which indicated that the bed nets were less efficient.

However, there is a need to scale-up utilisation, accountability and responsibility to achieve the malaria elimination targets; if the targets of the World Health Organisation general assembly target of zero death from malaria and complete eradication of malaria in 2030 have to be achieved.

Effective systems of accountability are powerful tools to improve the prevention, control and awareness of eliminating malaria in Africa. Promoting accountability involves identifying who is to be held accountable for what. In the field of malaria and health generally there are many possible answers to these questions, so accountability must continue to stand for many different things.

 

ANTHONIA OBOKOH

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