On April 25, the ‘World Malaria Day’, was commemorated by countries across the world, including Nigeria.
Despite being a major public health challenge in Nigeria, Reportr Door Healthwise discovered that the simplest and cheapest proactive measure against this deadly disease – the use of insecticide-treated nets, was extremely low among residents in areas toured.
In this report, Angela Onwuzoo highlighted reasons why most shun using ITNs, despite the glaring, danger posed by such an act, and how it can impact negatively on the nation’s drive towards recoding zero malaria.
As awareness of malaria heightened over the past week, beginning with the commemoration of the 2023 World Malaria Day, Lagos residents lament that they are constrained by several factors from sleeping under insecticide-treated nets, which prevents them from being bitten by mosquito.
The reasons they gave ranged from heat occasioned by epileptic power supply, to having many people crammed into small rooms with little or no ventilation, and lack of beds to hang the nets.
Our correspondent gathered that even some pregnant women in the commercial city of Lagos, who are at greater risk of coming down with malaria, refused to sleep under ITNs, and cited extreme heat as a reason.
Residents that spoke with Reportr Door Healthwise said they have at least two-bed nets in their homes but prefer to use other malaria-preventive strategies such as mosquito repellents, wearing of protective clothing and keeping their environment clean and free of dirt as well as bush and water puddles.
Troubling statistics
World Malaria Day is celebrated annually on April 25 by countries and organisations globally.
This year’s theme, ‘Time to deliver zero malaria: invest, innovate, implement’, focused on the implementation of strategies to reach marginalised communities.
Data from the Federal Ministry of Health, Abuja, showed that malaria accounts for 60 per cent of outpatient visits to hospitals and led to approximately 11 per cent of maternal mortality and 30 per cent of child mortality, especially among children less than five years.
The Minister of Health, Dr. Osagie Ehanire, recently disclosed that an estimated 55 million cases of malaria and nearly 90,000 malaria deaths occur each year in Nigeria.
He also said despite efforts by the government and its partners to combat the effects of malaria, the country still accounts for 27 per cent of global malaria cases and 32 per cent of global malaria deaths.
Ehanire also said that the disease has an adverse effect on the economy of Nigeria.
He said, “It is the major cause of absenteeism in schools, offices, businesses, markets and thereby reducing the income of families, including the hardship of out-of-pocket expenses borne by Nigerians yearly for diagnosis and treatment. The out-of-pocket expenditure for malaria is estimated to be 70 per cent and Nigerians pay as much as N2,280 for each malaria drug.
“The economic burden of malaria in Nigeria was estimated at $1.6b (N687bn) in 2022 and may increase to about $2.8bn (N2tn) in 2030. It is important to note that successful control of malaria will increase productivity, improve health, reduce school absenteeism, reduce poverty and facilitate the attainment of the Sustainable Development Goals.”
Malaria is caused by Plasmodium falciparum, and the mosquitoes Anopheles gambiae, Anopheles funestus, Anopheles arabiensis, and Anopheles machete are the major vectors that cause year-round transmission.
Artemether-lumefantrine or artesunate + amodiaquine is the treatment regime adopted in 2004.
However, recently, there was a provisional approval for R21/Matrix Malaria Vaccine in the country by the National Agency for Food and Drug Administration and Control.
NAFDAC had last week, announced it had granted provisional approval for R21 Malaria Vaccine, which experts affirmed was 75 per cent effective in preventing malaria in children, aged five to 36 months.
Ghana, and now Nigeria, are the two African countries to approve the new malaria vaccine for use in children between the ages of five months to three years old.
The World Health Organisation in 2021, approved RTS,S – or Mosquirix, a malaria vaccine for use in children for the first time, after a successful pilot scheme in three African countries – Ghana, Kenya and Malawi.
ITN in Nigeria
Experts say insecticide-treated net use is crucial for preventing malaria infection as they are meant to prevent mosquito bites.
According to the experts, there is an urgent need for all stakeholders to intensify behaviour change communication interventions to facilitate the adoption of ITN use in the state, especially by pregnant women.
As a way to checkmate malaria parasites and ensure that people live healthily, as of 2021, the federal government was noted to have distributed 193.5 million insecticide-treated nets since the commencement of free distribution of mosquito nets in 2009.
But it was observed that public acceptance and usage of the nets have been on the decline.
Heat from ITN can suffocate
A resident of Oyingbo, a densely populated area of Lagos, Mrs. Ruth Balogun, told our correspondent that she was given ITNs during one of her antenatal care visits years back but never used any of them.
The 43-year-old foodstuff seller said, “I have four children and they are all grown now. During my antenatal care for each of them, I was given ITN in a particular private health facility where I registered.
“We live in a one-room apartment and power supply is not regular at night, which was why I didn’t bother to use any of them. Before I got married, an organisation distributed ITNs to traders at the Oyingbo market where I trade and gave me one.
“When I got home and slept inside it that night, it wasn’t a palatable experience. Thank God I did not suffocate. I was sweating profusely because of the heat. Initially, I thought the heat would stop and then I could sleep well. But this never happened. I just assumed that with time, I would get used to it but the sleepless nights continued.
“After enduring the discomfort and sleepless nights for five days, I went to share my experience with other traders that were also given the net to know if they were having a similar experience, and they said yes. They told me that I even tried to have slept under it for five days.
“They told me they managed to sleep under the net for just one day and had to stop due to excessive heat. Since then, I vowed never to use it again.”
A nursing mother and teacher, who simply identified herself as Tope, also told Reportr Door HealthWise that she finds it very difficult to sleep under an insecticide-treated net, especially when the room is not well-ventilated.
The mother of two added, “The size of our room is very small and can’t accommodate the space required to hang a net.”
Meanwhile, a 28-year-old banker, James Johnson, said he placed his form on the floor and has no bed to hang an insecticide-treated net.
He said,”It is not that I can’t afford to buy a bed but it will take up more space in my room. You know that rooms in Lagos are very small, which explains why I prefer to place my mattress on the floor so that I can easily stand it against the wall in the morning. I have an ITN. It was given to me during a kick against malaria campaign in my area.”
Also, a commercial bus driver, Ola Lateef, said not having a bed discouraged him from making use of an insecticide-treated net. He, however, sees malaria as no big deal, stressing that it can easily be treated.
“I don’t have a bed. I sleep on a mat. I know a lot of my colleagues and other people that sleep on mats in the state because they have no bed. So, where are we going to hang the nets,” he asked.
He further said, “Many people have the nets. But the problem is that there is no light. And sometimes there is not space in the room to hang them because the rooms are small.”
Other residents who spoke with Reportr Door Healthwise shared similar experiences.
Habit fuelled by epileptic power supply – Expert
Meanwhile, a Consultant Paediatric Haematologist and Oncologist at the Lagos University Teaching Hospital, Idi-Araba, Prof. Edamisan Temiye told our correspondent that the reasons given by the residents for not using ITNs were genuine.
While validating their reasons, he said it can be quite uncomfortable to sleep inside the net without good ventilation.
Prof. Temiye said, “Else they won’t sleep. The government should do what is right. Let there be constant electricity supply that will allow people to use fans or cooling units, and feel comfortable sleeping under the net.
“Sleeping under ITN causes heat and at the end of the day, you won’t have a good sleep. That is the problem with it – heat. Sleeping inside net could be very hot without electricity and that is what discourages people from using it.
“If there is electricity and air blows properly, people would sleep under nets, which protects them from mosquito bites. But if you are inside it and the heat does not allow you to sleep, you will wake up feeling sick. So, why would you still want to sleep inside it?”
He urged the government to do the right thing by providing electricity and by building appropriate housing where there would be adequate airflow.
A medical researcher, Dr. Dan Onwujekwe, who also acknowledged the frustrations of the residents, said a lot of ITNs in many households go unused owing to the heat, which he likewise blamed on inadequate power supply.
According to him, the use of insecticide-treated nets during pregnancy is one of the proven interventions noted to reduce the malaria burden.
Dr. Onwujekwe, a retired Chief Research Fellow at the Nigerian Institute of Medical Research, Yaba, Lagos, said malaria in pregnancy could lead to low birth weight, premature birth, anaemia, and maternal and neonatal mortality.
“If you give people ITNs, they will rather keep them in their homes. They don’t use them. Some people will go to the extent of selling them. This issue of electricity supply is a big problem. People feel hot when they sleep inside them and some don’t have beds where they can hang them. All these are some of the problems that are hindering people from using ITNs”, he said.
The researcher said the government should find out reasons why people are not using the nets after collecting them, and address the challenges highlighted, adding, “It is not enough to give people ITNs that they won’t use.
According to the 2021 World Malaria Report from the World Health Organisation, Nigeria contributes 27 per cent to the global malaria burden (one out of every four persons having malaria) and 32 per cent to malaria deaths globally, which is about one out of every three deaths.
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Image Source 1: UNICEF Uganda
Image Source 2: UNICEF
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