APPOLONIA ADEYEMI 
Algeria is the second country in the World Health Organisation’s (WHO) African Region to be officially recognised as malaria-free, after Mauritius, which was certified in 1973. In Nigeria, achieving same feat appears to be an arduous task. Adapting to new malaria treatment guidelines, anticipating artemisinin drug resistance with a view to averting the trend, among others, could set the country on the path of freedom from malaria, writes APPOLONIA ADEYEMI
The last three months were traumatic for 14-year-old Tade Malaika, who had been severely ill. Two weeks before his death, the once vibrant Junior Secondary School (JSS) 3 student had developed a gaunt frame and sunken eyes. He became a shadow of his former self.
Going by his physical features days before his demise, news of his death was not surprising. What was, however, shocking was that his death was attributed to malaria. His body had hardly been deposited in a morgue in Abeokuta, the capital of Ogun State, when the news about the cause of his death spread like bush fire in the harmattan. “It is a lie! Don’t say it again.
Do you mean that ordinary malaria killed Tade?” a close friend of his mother asked. “The doctors that cared for him for two days before he passed on confirmed that his health challenges emanated from malaria,” replied Tade’s bereaved mother, Mrs. Aina Malaika. Another sympathiser, who was in the late Tade’s home to pay condolences to Mr and Mrs Malaika, said: “If this is true, it is time one took malaria and how to prevent the disease seriously.” “Wonders shall never end,” she added as she joined other mourners in the home of the late Tade.
What is malaria?
Malaria is a life-threatening disease caused by a parasite transmitted to humans by the female anopheles mosquito. Although malaria is a preventable and treatable disease, if diagnosed and treated early, the duration of malaria infection can be considerably reduced which, in turn, could lower the risk of complications and sometimes death.
Incidence of malaria in Nigeria
In Nigeria, data from the Federal Ministry of Health (FMOH) shows that malaria accounts for 60 per cent of outpatient visits and 30 per cent of hospitalisations among children under-five years. Deaths from malaria occur mostly from those with severe malaria, which contributes to between 10 to 25 per cent of the burden of death in children that are admitted in most emergency paediatric units, said Olugbenga Mokuolu, a professor of paediatrics at the University of Ilorin (UNILORIN). According to Mokuolu who is the Malaria Technical Director, National Malaria Elimination Programme (NMEP) at the FMoH, about four per cent of malaria cases have the tendency to become severe and severe malaria carries approximately 10 per cent mortality; the reason is that by the time it is severe the patient is not contending with only malaria but with complications that have risen, all of which can kill the person. “By the time the malaria is severe it is most likely that the affected patient does not have adequate blood.
“The person can die either because of inadequate blood or because of the severity of the malaria itself. So, there are many complications that are associated with severity. “That is why our key strategy is to prevent people with malaria infection from becoming severe because at that stage, you are really running against the clock.”
The case of Tade, undoubtedly transited into severe malaria. Actually, Tade’s diagnosis, which tested positive for malaria, was conducted two days before his death. That was when he presented at the private hospital in Akute where he was rushed to in an emergency. Three months earlier, the infec-tion had manifested as flu-like symptoms, associated with high fever, headache, fatigue, among others but Tade’s mother, a trader selling cooked groundnuts to make a living, said she couldn’t afford to pay for a microscopy test to determine the presence of malaria parasite in the blood samples taken from her son.
Impact of drugs from unskilled providers
Worse still, while Tade’s ailment lasted, she had relied on medicines sourced from local drug sellers, many of whom were merchants without needed training on drugs. Sadly, instead of getting better, the condition of her son had deteriorated badly, rendering him incapacitated.
This drew the sympathy of neighbours who not only rushed him to the private facility but contributed the initial fees deposited on demand. However, the onset of treatment prompted a quick diagnosis by the caregivers, which showed the presence of plasmodium parasite, which causes malaria, in Tade’s blood sample. Although this detection was to pave the way for appropriate treatment, it was too late as his condition had already transited to severe malaria, resulting in anaemia. He was promptly referred to a tertiary facility in Abeokuta, but Tade breathed his last while on the way to that hospital.
Following his unexpected death, the concerns of Tade’s friends and relations prompted questions: what exactly happened? How could this young lad have succumbed to a common malaria infection? Mrs. Malaika disclosed that throughout the months that her son was ill, she couldn’t afford to take him to either a public or private hospital for proper care.
According to her, Tade relied more on self-medication sourced from roadside drug sellers. Besides, much of the interventions he received were from several unorthodox places, the majority of which were not licensed. This is a major factor inhibiting the fight against malaria in Nigeria, according to Mokuolu.
There is no doubt that when people without training on drugs prescribe and dispense medicines, it could negatively impact treatment outcomes. Tade may have been a victim of this particular challenge. Explaining the impact of the wrong prescription/inappropriate malaria medicine dosage on treatment, a former National Chairman of the Association of Community Pharmacists of Nigeria (ACPN), Dr. Albert Alkali, said in treatment, if a patient does not take the right dosage, the malaria parasite could develop resistance and such resistant strain could become very difficult to clear. “With that, we could have a lot of multiplication of resistant strains,” added Alkali, who is a pharmacist.
Wrong prescription
He stressed that malaria is a dangerous and killer disease especially in children. “The malaria parasite could multiply and break the whole cell within thousands of seconds and before you knew it, the affected child has become anaemic if not properly managed,” the pharmacist added. Alkali, however, lamented that Nigerians are spending too much on malaria because of the use of wrong medicines, counterfeit drugs, and poor drug dosage, among others. Artemisinin drug resistance typically refers to a delay in the clearance of malaria parasites from the bloodstream following treatment with an artemisinin combination therapy (ACT).
As a result, the artemisin in compound is less effective in clearing all parasites within a three-day period among patients who are infected with artemisinin-resistant strains of malaria. The Malaria Technical Director at NMEP, Mokuolu, said there has been resistance to many antimalarial drugs globally over time until the global community got into the artemisinin group of compound and “they offered us a significant respite especially when later on we also discovered the concept of combination treatment which is why we call it the Artemisinin-based combination therapy.”
He noted that the driver of that combination is the artemisinin compound because it is fast acting; it is very efficacious and for a long time there was no resistance reported against it. However, there has been observed resistance to artemisinin in the Great Mekong Region of Southeast Asia, which has potential to spread to other parts of the world.
