Malaria: Nigeria’s Annual Pandemic

26^th April, 2020

By: Amir Abdulazeez

W

hen the decision was reached to spare a date for the observance of ‘World Malaria Day’ in May 2007 by the 60^th session of the World Health Assembly, which is the World Health Organization's decision-making body, there were about 100 countries and territories that have eradicated Malaria, set the path for eradicating it or have reduced the disease to the barest or negligible level. In spite of this, Malaria was still regarded as a global disease, perhaps not for its spatial coverage, but for its high prevalence among a significant number of the global population mostly domiciled in Africa.

The World Malaria Day itself was an offshoot from the Africa Malaria Day, an event that had been observed since 2001 by African governments. The first World Malaria Day was held on 25^th April, 2008 with the theme ‘Malaria: a disease without borders’. The day was established to provide education and understanding of malaria and spread information on annual implementation of national malaria-control strategies, including community-based activities for malaria prevention and treatment in endemic areas. Its observance served as a time to assess progress toward goals aimed at controlling malaria and reducing its mortality in affected countries.

A review of different reports suggests that globally, 3.3 billion people in 106 countries are at risk of malaria. In 2012, malaria caused an estimated 627,000 deaths, mostly among African children. Asia, Latin America, and to a lesser extent the Middle East and parts of Europe were also affected. According to the most recent World Malaria Report, the global tally of malaria reached 212 million new cases and 429,000 deaths in 2015. The rate of new malaria cases fell by 21% and death rates fell by 29% globally between 2010 and 2015. Children under 5 years of age are the most vulnerable group affected by malaria; in 2018, they accounted for 67% (272,000) of all malaria deaths worldwide. Malaria is the 3^rd leading cause of death for children under five years worldwide, after pneumonia and diarrheal disease.

According to the latest World malaria report, released in December 2019, there were 228 million cases of malaria in 2018 compared to 231 million cases in 2017. The estimated number of malaria deaths stood at 405,000 in 2018, compared with 416,000 deaths in 2017. African continues to carry a disproportionately high share of the global malaria burden. In 2018, the region was home to 93% of all malaria cases and 94% of all malaria deaths. Malaria transmission is more intense in places where the mosquito lifespan is longer with the parasite getting adequate time to complete its development and having preference to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world's malaria cases are in Africa. Thirty countries in Sub-Saharan Africa account for 90% of global malaria deaths.

How has Malaria been faring in Nigeria? In 2018, six countries accounted for more than half of all malaria cases worldwide: Nigeria (25%), the Democratic Republic of the Congo (12%), Uganda (5%), and Côte d’Ivoire, Mozambique and Niger (4% each). With this, Nigeria is the World Malaria Capital constituting a risk for 97% of Nigeria's population. The remaining 3% of the population are reported to only be relatively safe because they live on the highlands. According to the United States Embassy in Nigeria, there are an estimated 100 million malaria cases with over 300,000 deaths per year in Nigeria. This compares with 215,000 deaths per year in Nigeria from HIV/AIDS. Malaria is a major public health problem in Nigeria where it accounts for more cases and deaths than any other country in the world. This explains why the World Malaria Day is an important event in Nigeria.

Malaria is not the only deadly health challenge in Nigeria. According to various reports, the top causes of death in Nigeria are; malaria, lower respiratory infections, HIV/AIDS, diarrheal diseases, road injuries, protein-energy malnutrition, cancer, meningitis, stroke and tuberculosis. The Nigerian office of the International Center for Disease Control and Prevention listed the top 10 Causes of Death in Nigeria as at 2018 to be lower respiratory infections, neonatal disorders, HIV/AIDS, Malaria, diarrheal diseases, Tuberculosis, Meningitis, lschemic heart disease, Stroke and Cirrhosis. Researches have suggested that Malaria accelerates other diseases, including some of the ones mentioned above.

In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. According to WHO, there are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species bite between dusk and dawn. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment. Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of fresh water, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

No matter how severe Malaria has become, it is time to eradicate it in Nigeria and all other places. Doing it is not rocket science provided sustainable and dedicated efforts are put in place. Globally, the elimination net is widening, with more countries moving towards the goal of zero malaria. In 2018, 27 countries reported fewer than 100 indigenous cases of the disease, up from 17 countries in 2010. The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination. From 1999 to 2019, if Nigeria had a solid and implementable vision against Malaria, the disease may have been history by now. This would have eased the pressure on our health facilities and saved billions of Naira spent on drugs.

Countries that have achieved at least 3 consecutive years of 0 indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Over the last decade, 10 countries have been certified by the WHO Director-General as malaria-free: Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019) and Argentina (2018). Some of these countries do not have half the resources that Nigeria commands.

Fighting and defeating Malaria even in advanced countries has not come without challenges. But the key issue is that prevention is always better than cure. Over the years, hundreds of millions of Insecticides Treated Nets have been distributed and used in most parts of Nigeria, yet the problem still persists. Sometimes, mosquitoes that transmit Malaria bite their victims before the bed time in which they might have been inside the nets. Therefore, they major way out is comprehensive town and environmental planning which will rehabilitate slums, poor unplanned settlements and stop the emergence of new ones. Government must rise up against the disease-breeding shanties we call settlements. Drainage network planning and rehabilitation is also essential.

One key control measure is vaccination. RTS,S/AS01 is the first and, to date, the only promising vaccine against severe malaria, in young African children. It acts against P.falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria over a 4-year period. This shows, even the vaccine is not a permanent ultimate solution. The WHO’s top advisory bodies for malaria and immunization have jointly recommended phased introduction of the vaccine in selected areas of sub-Saharan Africa. Three countries – Ghana, Kenya and Malawi – began introducing the vaccine in selected areas of moderate and high malaria transmission in 2019.

Eradicating Malaria can best be achieved first by individual and then community efforts. It is not a coincidence that the themes for the 2019 and 2020 World Malaria Days have been "Zero malaria starts with me". If we all make a resolve to take good care of our environment and personal hygiene, we stand a chance to defeat Malaria. Community efforts towards regularly sanitizing the environment and getting rid of stagnant waters through clearing of drainages and water ways is equally important. Community contributions for the periodic spray of insecticides will be far be better than sticking to the individual mosquito coils that drain our micro-economy. It is also far better than waiting to be infected and then spend hundreds or thousands on treatment.

The current efforts to defeat Malaria and other diseases by various stakeholders, even if inadequate yet, must be commended. Alongside the World Malaria Day, the WHO has dedicated days for seven other global public health campaigns; World Health Day, World Blood Donor Day, World Immunization Week, World Tuberculosis Day, World No Tobacco Day, World Hepatitis Day and World AIDS Day. With current developments, we may soon have World Coronavirus Day.

Twitter: @AmirAbdulazeez

Conditional Cash Transfer

17^th April, 2020

By: Amir Abdulazeez

I

n 2001, the Nigerian Government created the ambitious National Poverty Eradication Programme (NAPEP). The population then was estimated to be well above 120 million with over 63% of it living below one dollar per day which as at then exchanged for between 99 to 105 naira. NAPEP may not be declared a major success even if it fairly represented an improvement over previous attempts. A 2008 analysis on African Poverty reported that the programme was able to train about 130,000 youths while engaging 216,000 beneficiaries.

There were three main problems with NAPEP; its impact was too minimal considering the large population, there were widespread allegations that many of the beneficiaries were politically selected and hence not poor and thirdly, the programme was not organized to be sustainable. Since NAPEP, the Federal Government had initiated other cosmetic initiatives like YOUWIN, SURE-P empowerments, N-Power, etc directly and indirectly aimed at reducing poverty and unemployment. Equally, many state governments have invested heavily in vocational programmes. Since the APC government came in 2015, it has also introduced Conditional Cash Transfer where vulnerable Nigerians are paid N5,000 monthly.

Will this kind of initiatives end poverty in Nigeria? I believe, the major question we should be asking as Nigerians is not about the need to fight poverty, it should be about why do we have growing poverty? Should Nigeria have any significant business with poverty? Do the current and past leaders actually understand the level of poverty in the land as well as the right strategies to fight and defeat it? Are we fighting poverty from its roots or are we only selectively relieving its symptoms? Will conditional and even unconditional cash transfer reduce poverty significantly? What is the sustainable way of defeating poverty?

Times like this pandemic are the trying periods when all that have been said about Nigeria’s poverty which hitherto appear theoretical is now experienced in real and practical terms. The main clog in the wheel regarding fighting coronavirus in Nigeria is poverty. Locking down 200 million people, out of which about 50% or more are very poor can come with dire consequences. While many modestly developed and truly developing countries are concerned mainly with the micro-economic dimensions of this crisis, Nigeria is dealing with both the micro and the macro. In fact, the micro is more critical as this is the main reason why the government appear to be giving much priority to conditional cash transfer which it apparently lacks the capacity to execute intensively and extensively without macroeconomic consequences.

In 2017, Nigeria with 94.5 million extremely poor people representing 47.2% of the population, was declared the world’s poverty capital overtaking India with 70 million poor people or 5.1% of their population. Carried away with its ‘largest African economy’ status, the government instead of reflecting and getting back to work immediately, rather went on denial. Today, what the authorities denied verbally, they have been forced to accept practically as it is obvious that the government is facing more headache from the consequences of measures taken to fight Covid 19 than the actual disease itself.

For example, how do you ask a people you have deprived clean drinking water to wash their hands with running water frequently or a population in which a significant percentage are either homeless or semi-homeless to practice social distancing? It is evident therefore, ever since majority of Nigerians have been fighting with a bigger virus, much bigger than corona. How did we get here?

Just yesterday, the Daily Trust reported that the Nassarawa State Government spent over 500 million naira to procure ‘official’ vehicles for the state law makers. According to the paper, the 24 vehicles cost about 21 million naira each. This is happening amidst the coronavirus pandemic in which the state is reported to have no single government-owned ventilator which cost between 9 to 18 million. The picture on the paper’s story showed the Speaker of the State House Assembly and his crew shamelessly and satisfactorily inspecting the vehicles as they wore face masks that give the false impression of their concern towards the current predicament.

The Nassarawa story is a summary of how governments at all levels had been behaving towards poor Nigerians since 1999. The trillions of naira wasted on irrelevant priorities while peanuts are budgeted for the so-called poverty alleviation initiatives over the past 20 years is the major reason why majority of ordinary Nigerians are becoming poorer and poorer everyday.

Before 2017, I was of the habit of reviewing federal and state government yearly budgets; I even volunteered to translate some of them into local languages for the benefit of other readers. One general conclusion I reached was that majority of these budgets are mere recycled documents that will probably change nothing positively as far as development is concerned. As the representatives of the people, the legislature which supposed to vet these budgets and make them pro-poor end up making them more anti-people by manipulation, rubber stamping the corruption-motivated projects proposed by the executives and insertion of self-servicing fraudulent constituency projects.

If Nigeria is truly serious about alleviating poverty, it must take some solid, sincere and long-lasting measures against the cosmetic and rhetorical ones it keeps packaging regime after regime. First, it has to guarantee its citizens security at all cost. Insecurity is perhaps one of the biggest sources of poverty. Only God knows the amount of monies and sources of livelihood lost by poor and ordinary Nigerians to terrorism, armed robbery, political thuggery, kidnapping, farmers-herders’ conflicts, religious riots and ethnic unrests over the last 20 years. Many have had permanent disabilities and lost the very health they can otherwise use to stay out of poverty.

Government must provide power at all as it is the most critical sector that has the potential of automatically creating and consolidating direct and indirect jobs. For example, if there is adequate security and power supply, industries will be revamped and businesses will run for 24 hours. When some people who conduct businesses during the day are asleep, some others who were resting during the day will conduct businesses during the night. Nigerian businesses will work for 24 hours with no valuable time to waste thereby hugely increasing productivity. When power is available, thousands of jobs would be created both directly and indirectly. The idea of banning the import generators is just a laughable way of diverting attention from government failures.

Massive and not cosmetic investment in agriculture is required. As at 2016, I counted about 109 major dams and reservoirs that can support irrigation but largely underutilized across the country. I want to believe they are much more than that.  A particular state with about 26 major and minor dams that cut across almost each Local Government are among those complaining of poverty. The governors have vandalized the state resources on white elephant projects that are not only useless in terms of revenue generation, but adds burden to state finances for their maintenance. A survey conducted revealed that a 4-billion-naira investment in the irrigation scheme will generate over 2 million jobs for poor people, but no, the governors prefer straight-forward projects in urban centres that come with high returns on kickbacks. Shameless and wicked.   

Government must re-establish peoples’ trust by ensuring equity and transparency. Over the years, virtually only rich sons and daughters can secure white collar jobs while the poor are left with crumbs or nothing. While lucrative opportunities are reserved for the rich to make them richer, palliatives like Npower are established for the poor to save face. With this, national resources are channelled towards making others richer, while the poor remain poorer. A poor university graduate that can secure a job with NCC, NNPC, CBN or FIRS can gradually pull the whole of his family out of poverty. But he can’t dare get such opportunities unless on rare occasions.

The Local Governments are major shock absorbers in terms of poverty reduction. For the past 10 years, everyone concerned had folded their arms and watched while the state governments have massacred them and rendered them useless through hijacking their responsibilities as well as withholding and siphoning their funds. Many of the states consume their resources and expend them on political projects that yield no financial dividend for the future. We hardly hear states investing in agriculture, industrialization and tourism.

The absence of a national development plan has given way to the politicization and inconsistencies of government activities at the federal and state levels. Government projects are not initiated along any short or long-term development plan but rather based on political sentiments. At the states, hardly, can you find a state with any long-term development plan which is continuous and consistent; even states that have been governed by one party since 1999 experience planning inconsistencies and policy summersaults. Right from 1999, if the states had made it an objective to truly eradicate poverty, many would’ve achieved significant progress by now.

Right now, Nigerians are part of the global community being held hostage by this pandemic. Many poor people are likely to be affected in high proportions. The post-pandemic period will likely come with additional economic challenges. After all these, we must return to fighting against our main virus which is the poverty that was artificially imposed on us by people who called themselves our leaders.

It is unfortunate that we have reached a level where we cannot get the most basic things right in this country and nobody is held responsible. At different levels, we are governed by heartless leaders who can maim and kill their own people with impunity to stay in power while the constitution grants them immunity. In our country, truth has been reduced to a mere opinion. Under these conditions, it is only a matter of time that every Nigerian become vulnerable and then eligible for conditional cash transfer.

Twitter: @AmirAbdulazeez