Nigerians are increasingly getting worried over the risk of exposure to malaria parasites when seeking care within hospitals wards that have literally turned into hotbeds of mosquitoes.
The unfettered freedom for mosquitoes to breed around healthcare facilities and feast on already sick patients is complicating the disease burden and altering health outcomes for many.
In spite of decorating their lobbies and receptions with wall posts raising awareness of the danger of malaria and the benefits of early treatment, hospitals are still out of the loop on effective actions to prevent and control a disease that accounts for 60 percent of all hospital visits in Nigeria, according to the World Health Organisation (WHO).
Patients and the caregivers who work within most hospital settings are largely unprotected in open wards that have their windows damaged; surrounding drainages filled with stagnant water, and open dumpsites.
Doofan Lordyeh, an optometrist and expert in digital healthcare marketing went to the hospital a few years ago for appendectomy, a surgery to remove an infected appendix. But she ended up treating severe malaria which was never part of her initial prognosis, she said in a tweet sharing her experience.
“I had my baby at a general hospital. Nets are torn and I and my newborn had to spend the night like that. I spent most part of the night keeping vigil to ward off mosquitoes from my newborn,” Bunmi Essien said, reliving her experience in a tweet too.
In a tweet urging the government to fix healthcare in Nigeria, Chioma Nwakanma, a medical doctor said “in Nigeria, you go to most government hospitals to treat malaria and you are discharged to return soon with the “mother of malaria”. According to her, hospitals are a breeding ground for mosquitoes, with bad drainages, overgrown bushes, and torn or lack of window nets.
A hospital official who didn’t want to be mentioned told BusinessDay that the lack of mosquito control in hospitals has been a challenge since 1986 when she started her nursing career. As a matron in her ward at the Lagos University Teaching Hospital (LUTH), she often advise patients to get individual bed nets due to the level of exposure to mosquitoes.
“LUTH for instance is practically in the middle of a water zone and there is no way it will rain that the grasses won’t sprout. I use mosquito cream on all exposed areas of my body, including my face. I’ve been doing this since I was a student. There is a pregnant lady in my ward right now. I’ve told her to use insecticide at bedtime because mosquitoes are too much,” she said.
Mercy Iwok, a young nurse experienced working in both private and public hospitals said the risk of exposure is higher in public hospitals than in private hospitals due to proper sanitation and regular fumigation.
A difference she noticed was that beds in some private hospitals have mosquito-treated nets attached to them for patient protection.
“But in the general hospital where I work now, the nets in some units are overdue for change. They are old and torn. Patients are left to fend for themselves. But private hospitals change more often, making the protection effective,” she said.
Mosquitoes are vectors of numerous diseases, including malaria and yellow fever. Nigeria shoulders the largest burden of malaria in the world, accounting for 27 percent of global cases in 2020.
The disease tops the causes of mortality with 23 percent of global malaria deaths domiciled in Nigeria, according to the World Malaria Report 2020.
The government aims to reduce malaria prevalence to a parasite prevalence of fewer than 10 people and mortality attributable to malaria to less than 50 deaths per 1,000 live births by 2025 as reflected in the new malaria strategic plan 2021 to 2025.
But that effort is not well reflected in hospitals management.
For instance, a 2021 study on mosquito control at a tertiary teaching hospital in Abakaliki that covers 517 hospital staff and 302 patients shows that people experience higher mosquito exposure in hospitals than at home or anywhere else. 72 percent of staff and 86 percent of patients reported more mosquito bites at the hospital than at home or elsewhere.
The study found that patients were significantly more likely than staff to have experienced more bites at the hospital and less likely to have face bites at home. A few recorded no difference between home and hospital.
Complaints from patients about mosquitoes were reported by over 90 percent of staff, and over 50 percent of staff respondents were aware of patients discharged against medical advice due to mosquitoes.
The most common control method was killing mosquitoes by hand. The authors concluded that measures against mosquitoes in the hospital appeared inadequate, and healthcare staff and hospital patients could be at increased risk of mosquito-borne infections.
“We observed a lack of door screens in all wards, window screens were absent or torn, and most beds did not have nets. In the children’s wards none of the beds had nets,” the authors note.
“Mosquito control in the hospital requires attention, and the need for improvement in mosquito control in the healthcare setting more widely should be evaluated and addressed.”
The World Malaria Day 2022 marked under the theme “Harness innovation to reduce the malaria disease burden and save lives,” has the WHO calling for investments and innovation that bring new vector control approaches, diagnostics, antimalarial medicines, and other tools to speed the pace of progress against malaria.
Despite steady advances in lowering the global burden of malaria between 2000 and 2015, progress has slowed or stalled in recent years, particularly in high burden countries in sub-Saharan Africa.
The organisation is seeking urgent and concerted action to set the world back on a trajectory toward achieving the 2030 targets of the WHO global malaria strategy.