By Oluwatomisin Ogundipe
Nigeria accounted for more than 20 percent of the world’s 438,000 malaria deaths last year, according the World Health Organization’s 2015 World Malaria Report. And while the Nigerian government has demonstrated a renewed commitment to reducing the incidence of malaria, its current plan—the Saving One Million Lives initiative—is insufficient. Nigeria needs to focus on environmental management, not just bed nets, to save tens of thousands of lives every year.
A water-related disease, malaria is widespread in the world’s tropical and subtropical regions near the equator. Nigeria’s high temperatures and rainfall levels create breeding grounds for mosquitos. In turn, the parasite Plasmodium falciparum develops within mosquitoes, which is then transmitted to humans.
Apart from a suitable climate for malaria, poor standards of sanitation and access to quality health care services increase the risk of disease. According to WHO, about 2.4 billion people globally live in highly unsanitary conditions. But it’s not just sanitation: Studies show that in Africa both the prevalence and development of malaria are higher in houses made of wooden planks than in one made of cement. Additionally, houses that are surrounded by bushes, garbage heaps, swamps, and stagnant water are also more likely to host infected mosquitoes. In parts of Nigeria, living in proximity to waste has become a way of life, which increases the risk of malaria.
Yet, Nigeria’s Saving One Million Lives initiative, known as SOML, is prioritizing the use of insecticide-treated bed nets and anti-malarial drugs. Both methods are proven to reduce infection rates and are cost-effective, but by itself this strategy has a limited impact. Over time, malaria parasites can develop resistance to insecticides, drugs, and insecticide-treated bed nets. To eliminate malaria in the country, the Nigerian government needs to include environmental management and sanitation control measures in its SOML initiative. If breeding sites are not eliminated, conditions will be conducive for drug-resistant malaria, which will reduce the effectiveness of antimalarial drugs and bed nets.
What Nigeria is doing right now to reduce malaria is clearly not enough. Between 2000 and 2015, Nigeria was among the countries with the slowest declines in case incidence and mortality.
In contrast, Eritrea, a country with whose GDP per capita is a one-sixth of Nigeria’s, has seen more than an 80 percent reduction in malaria mortality in recent years. Its success lies in the use of indoor residual spraying, distribution of bed nets, expansion of diagnostic and treatment services, as well as dealing with malaria-infected mosquitos breeding sites. Because Eritrea has prioritized environmental management in addition to its other initiatives, the country has been able to drastically reduce its malaria deaths. The Nigerian government should follow suit.
The Nigerian government should increase its investment in the SOML initiative with the specific aim to improve environmental hygiene. The findings of Amoran and his colleagues in the Nigerian Journal of Medicine show that regularly cleaning house surroundings is associated with decreased levels of malaria infection in rural areas in Nigeria. The country cannot sustainably control and eliminate malaria by funding only a few isolated initiatives. The sources of disease must also be removed.
Through the SOML initiative, the Nigerian government should create awareness of the link between malaria and improper personal and community disposal methods, uncleared bushes, and stagnant water sites. The government has the capacity to do so—this was recently demonstrated by its successful hand sanitizer and hand-washing campaign to control Ebola. A campaign to raise awareness should be coupled with improvements to environmental sanitation methods. Additionally, the existing rules are regularly violated and unobserved, so proper monitoring and strict punishments are necessary. If Nigeria wants to decrease its number of cases and deaths from malaria, environmental management is non-negotiable.
Oluwatomisin Ogundipe is a Ph.D. candidate at the Department of Economics and Development Studies, Covenant University, Nigeria. She received her Master of Arts in economics at Virginia State University in 2011. Her research interests are cost and benefit analysis, health care quality improvements, and health outcomes. In addition to pursuing her Ph.D., she is a homemaker and wife with two kids.
[Photo courtesy of Ixtla Malaria Control Zambia]