Nigeria’s Poorest Spend N120bn Treating Malaria Annually
Malaria is taking a heavy toll on Nigeria’s economy, not only in terms of the high death rate and the loss of man-hours due to illness, but also the huge
On how to contain the scourge, Oyibo said prevention was still the best option.Of the 857, 899 infant deaths in Nigeria, those between ages 1 and 5, roughly 10 percent (85,000) were caused by malaria, as reported by UNICEF. And according to the World Malaria Report 2020, there were 23, 376, 793 confirmed malaria cases and 95, 418 estimated deaths in Nigeria in 2019, 90 percent being under-5 children.
These are the lives the governments at the federal, state and local levels could potentially save with the introduction of mass vaccination for malaria with the new vaccine recently approved by WHO.Based on the 2020 report, the North West geopolitical zone accounted for a third of all the cases, followed by the south south south/southeast with 16 percent. Meanwhile, malaria patients in the northeast had the least access to treatment and medication because of insecurity.
From investigations conducted by LEADERSHIP Weekend, the most vulnerable Nigerians are paying between N1,000 and N3,000 to test for and treat malaria. On an average, they spend N2,000 to treat each case of malaria.This amounts to N46bn for the confirmed cases and a figure as high as N120bn for the 61 million estimated cases. The recently approved malaria vaccine could however change all that. headtopics.com
Nigeria, however, was not among the three countries – Ghana, Kenya and Malawi – in Sub-Saharan Africa where WHO conducted a pilot programme to establish the effectiveness of the RTS,S/AS01 vaccine.The global health body is planning a phased introduction of the now approved RTS,S vaccine manufactured by GlaxoSmithKline (GSK).
The ministries of health of the three countries of Ghana, Malawi and Kenya had in 2015 agreed to collaborate in the Malaria Vaccine Implementation Programme, while vaccination started in April 2019 in Ghana and Malawi, and in September 2019 in Kenya. The vaccine in the pilot stage, the WHO says, has reached 800,000 children. Based on the trial results, the WHO, on October 6, 2021, announced its approval for the vaccine to be used on children.
While the recent approval of malaria vaccine by WHO raised hope of eliminating malaria among children in Nigeria, some stakeholders in the health sector have faulted the clinical trial carried out on the vaccine since Nigeria was not considered, especially with the country being the most endemic to the disease.
Expressing dissatisfaction at the process, a professor and head of department, Pharmaceutical Technology and Raw Materials Development, National Institute for Pharmaceutical Research and Development (NIPRD), Prof Martins Emeje, told LEADERSHIP Weekend that malaria clinical trials must be conducted in Nigeria. headtopics.com
He said, “Only then should we accept the vaccine. Nigeria is the home of malaria in the world, yet, the country was not part of the clinical trial”.The implication, he said, is that Nigerians may not respond positively to the vaccine.“Though we are all Africans, genetically speaking, we are not the same; our DNA may respond to drugs differently. The way a drug will work with me might not be exactly how it will work with you. In fact, a drug that proved effective in curing a disease in my body might be destructive to your body. However, these things are discovered during clinical trials, hence the reason why I am insisting that the malaria clinical trial must take place in Nigeria because we now have the facilities to conduct clinical trials,” he added.
In the same vein, the president, Nigerian Medical Association (NMA), Prof Innocent Ujah, had told LEADERSHIP Weekend that it is disappointing for Nigeria, being a malaria endemic country, not to be involved in the trials.“I know that Jos University Teaching Hospital was actively involved in the research for the malaria vaccine, but I was shocked that Nigeria was not selected in the trials. Nevertheless, we are grateful for the success of the trials, so we congratulate the world for this great achievement,” he said.
On manufacturing of malaria drugs, Emeje disclosed that Active Pharmaceutical Ingredients (API) used in the local manufacturing of malaria drugs here in Nigeria are mainly sourced from China and India.“Pharmaceutical companies in Nigeria do not produce malaria drugs from scratch to finish. They source raw materials from China and India. Nigeria also imports malaria drugs from these countries,” he added.
Meanwhile, while the federal government has secured some $364 million funding for a five-year malaria intervention programme between 2020 and 2020, it covers only 13 states.The remaining states do not get the free malaria drugs. And where treatment or drugs are subsidized, which is most of the states, patients still pay as much N1,000. headtopics.com
LEADERSHIP Weekend spoke with several health officials in different regions of the country to ascertain those most vulnerable to malaria, those succumbing to the illness, and how much treatment costs in each locality. Most health officials however reported a low mortality rate from malaria, at least in urban areas.
The chief matron of Mulib Hospital in the city of Oyo, Mrs. Olaleye Rasheedat, disclosed that adults are vulnerable to malaria when compared to the younger ones.She said that the government was particular about those between ages 0-5 but those from ages 6 and above were more affected.
According to her, the average treatment of malaria in private hospitals was N3,000, but it costs less at the public health centres.She added that the federal government normally supplied drugs to primary health centres (PHCs), while the government had stopped supplying to the private hospitals, hence the difference in the charges.
Olaleye disclosed that about 200 patients were attended to in a month while the figure was higher at the PHCs.A nurse at one of the PHCs in Ibadan, Oyo State, Mrs. Ogunleye Dorcas, said about 500 malaria patients were treated in a month.On the number of deaths per month, the two medical personnel differ. While Adeleye said it varies at private hospitals and that serious patients were often referred to PHCs for elaborate treatment, Dorcas said the number of deaths had reduced drastically due to government intervention.
In Niger State, those mainly affected by malaria are children of ages 0-5.The hospital officials interviewed said there was no specific fatality rate per hospital but that, generally, malaria is chiefly responsible for infant mortality in the state.It was estimated that for every 10 infant mortality cases in rural areas, six are caused by unattended malaria symptoms.
In Niger State, however, treatment of malaria is subsidized for children and pregnant women, but the average cost in government hospitals for adults is put at N3000 while it varies in private hospitals.Speaking to our correspondent in Jos, Plateau, Rebecca N. Doewuru, the chief nursing officer in charge of Jos North Primary Health Care (PHC) said malaria affects all classes of people but children from the age of 0 to 5 years are mostly affected .
She also disclosed that Jos North Primary Health Centre had not recorded any deaths as a result of malaria attack recently.Nurse Doewuru further said the cost of treating malaria sometimes is less than N1,500 in a severe case because anti-malaria drugs are given out for free or at subsidised rates.
“When the patient is having typhoid fever, it can cost more than that,” she said, even as she advised people to take precautionary measures by sleeping under mosquito nets, clearing their drainages and environment of stagnant water and using mosquito repellents to ward off mosquitoes.
Doewuru also lamented that for 16 years, no single nurse was employed to complement the efforts of the few ones in the hospital or primary health centres.According to her, some of the nurses have died, many others retired and some have gone to seek greener pastures abroad. She appealed to the state government to employ more nurses to serve at the state PHCs.
Similarly, Uwalla Ahmed, a community health extension worker (CHEW) in charge of malaria for Jos South Local Government Primary Health Centre, told our correspondent that children from the age of 0 to 5 years are the worst-hit by malaria. She added that people above 18 years are also prone to malaria.
According to her, Jos South PHC has not recorded any death as a result of malaria. She said malaria can be easily treated, if detected on time, with anti malaria medication.She added that the cost of treating malaria is within the range of N1,000 to N1,500 while advising people to always sleep under mosquito-treated nets to avoid malaria attack.
In Kwara State, the people mainly affected by malaria fall within the 1- 5 years age group.ADVERTISEMENTInvestigation also revealed that a sizable number of people between ages 7- 12 are also vulnerable to malaria infections. The cost of treatment of malaria ranges from N1,000 and N3,000.
A medical personnel at a private hospital in Ilorin put the cost of treatment of a malaria patient at N3,000 while a matron at a public hospital put the cost at N1,000 .The matron clarified that treatment of malaria is free at the primary health centres in Kwara State because the government is providing the centres with anti- malaria drugs.
“We charge N1,000 only on cases of chronic malaria, which requires the patient to take an injection,” she added.On the death rate from malaria, the private medical personnel said, “This depends on the inflow of patients” while the matron said “we don’t keep death records at the primary health centres because we refer patients with chronic cases to secondary and tertiary health institutions after 48 hours.”
Malaria is no respecter of persons and the sickness affects all age groups as nobody is immune to the disease .According to the Public Relations Officer of the Federal Medical Centre (FMC), Owerri, Imo State, Dr. Mrs Jacy Achonu once a parasite-carrying mosquito bites you, you will likely to come down with sickness.
She submitted that once you perceive the symptoms of malaria, the individual is advised to go for the required test and follow up with the treatment.Dr. Mrs Achonu explained that in their facility, people report for treatment and they are treated in accordance with the world best practice and they recover.
She explained that malaria, if discovered and treated on time with the appropriate drugs does not pose any danger and advised the people to report immediately any symptoms of the ailment on time and assured that when this is done they are bound for speedy recovery.
The PRO stressed that the cost of treatment of malaria depends on severity and indicated that ordinarily when the malaria parasite in an individual appears at the stage of uncomplicated, the average cost could be put at between N8,000 to N10,000 .The FMC staff submitted that the treatment of cases not reported on time and had gone into complicated stage cost more as series of tests would be required to determine the underlying factors and this could cost between 15,000 to 12,000 depending on severity.
In Enugu, a staff Nurse at our Saviour Hopital, Miss Uchechi Aneke said adults suffer more from malaria.“From our investigations, adults suffer from malaria more than children and teenagers. I have more than 7 years working experience and we have noticed that more adults suffer from malaria than any other age” she stated.
She further told our correspondent that to treat malaria very well, about N10,000 naira is needed, adding that anything less than that might no treat malaria very well.On the number of deaths so far recorded, she said since seven years, the hospital has not recorded any death caused by malaria.
A medical practitioner with Madonna Catholic Hospital, Umuahia, the Abia State capital, Dr. Chii Linus Ajuzie informed LEADERSHIP Weekend that children from age one to five and pregnant women are mainly affected by malaria in the country due to their low immunity level.
According to him, it is not always easy to pin down the cause of death on malaria alone until a thorough analysis has been conducted because there could be other factors. He noted that this is why it is difficult to have the records of death.He added that even at that, there had been drastic reduction in malaria-related deaths as a result of people having developed some level of immunity against the parasite that causes it, known as Plasmodium Falciparum.
Ajuzie said the cost of treatment of malaria cases depends on the level of the sickness and the medical practioner’s choice of drugs as some of the drugs have become grossly ineffective no sooner than they had been produced.The medical practitioner maintained that, before now, with about N500 a patient could be treated in a matter of days using quinine-based drugs which, he said, were very effective if not for their side-effects,
He noted that with the rising inflation it could take as much as N2,000 to treat a malaria patient with the new set of combined anti-Malaria drugs.He advised against self-medication.Similarly, a health attendant, who spoke on condition of anonymity at one of the health centres in a suburb of the capital, confirmed that with N2,000.00 a malaria patient can be treated to full recovery depending on the level.
She argued that, most often, malaria patients die either as a result of complications arising from combination of othodox and herbal medicine, or the patient and his or her people’s belief that witchcraft was the cause of the illness.A medical expert described malaria as a silent killer that is often underrated by the general public.
Speaking with our correspondent in Osogbo, Mrs Florence Adewale, a retired matron at the Osun State Hospital, Asubiaro, Osogbo, said many people have lost their lives to malaria because, unlike other ailments, patients often handle malaria with levity and resort to self medication, thereby complicating issues.
A serving nurse in the same hospital, who spoke on condition of anonymity, said the major mortalities due to malaria occur at home, adding that unless there are complications before admission, hospitals don’t usually have a high record of death through malaria.
Malaria, she said, is no respecter of persons as it attacks all age grades. She, however, said that it is prevalent among children because they are more exposed to the parasite that causes malaria.She noted that malaria is cheaper to treat compared to other diseases because of the availability of drugs at cheaper rates.
In Rivers State, malaria remains one of the regular infections that residents of the state suffer from.LEADERSHIP Weekend visited some primary health centres in Port Harcourt metropolis, including Model Primary Health Centre, Churchill, Model Primary Health Centre, Elekahia and Model Primary Health Centre, Diobu.
Health officials at the hospitals attributed the high rate of malaria in the state to mosquito bites, due to the presence of stagnant waters in most parts of the state.Speaking with LEADERSHIP Weekend on the condition of anonymity, an official of the Rivers State Primary Health Care Management Agency said deaths are not recorded from malaria because even non-medical personnel know how to treat the infection.
He stated that about 65 percent of the residents of the state suffer from malaria from time to time, adding that those between the ages of 0 to 45 years are mostly affected by the infection.The official further stated that a minimum of N500 was required for the treatment of malaria in the state, without adding the cost of laboratory tests.
The age group of people mainly affected by malaria in Delta State is not restricted. According to experts, it affects all age groups, everybody including old and young.However, pregnant women and children under five years suffer more than others as a result of their lower immunity levels.
According to Dr Aniah Julie, State Malaria Programme Manager, Delta State Health Care Development Agency, (DSHCDA), the average cost of treating malaria patients varies. She disclosed that the preventive drugs (prophylaxis) given to both pregnant women and under 5 children are free of charge.
In Benue State, the state director of public health, Dr. Terna Kur, disclosed that the death toll from malaria complications in a month, especially children, may not be less than 5,000.Dr Kur, who disclosed this in a telephone interview with our correspondent, explained that children who are six months to five years old are mostly hit by the disease.
According to him, “The deaths happen mainly in people who may have not had any proper treatment of malaria and might die from complications.”On the issue of cost of treatment for a malaria infected person, Dr Kur said, “in public hospitals, treatment for malaria is absolutely free.
“In all the public hospitals in Benue, malaria testing and treatment is free for both children and adults. If you walk to any public hospital and make a complaint and if the doctor or nurse in charge suspects malaria, he or she will order for diagnosis – which is free – and if found to be malaria, drugs will also be given to you free of charge.
“We even go as far as giving mosquito nets to pregnant women who attend antenatal to ensure that they sleep inside these nets to avoid being infected by malaria which will be transmitted to the unborn child.“This free testing and drugs is done according to national guidelines for malaria and it is called Rapid Diagnostic Test for Malaria,” he added.
Between 80 and 100 malaria patients are being recorded at the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, COOUTH, Amaku-Awka, Anambra State monthly.Though malaria cases are essentially more prevalent in people aged six months and above, statistics at the Records Department, however, show those who suffered malaria included from 60 years and above.
The findings by LEADERSHIP Weekend showed that malaria treatment cost a patient between N700 and N800 if the treatment was by tablet drugs, while injections cost about N3, 000.The chairman of the Medical Advisory Committee, CMAC, of the teaching hospital, Dr. Emmanuel Azike, however, said that malaria is easily curable, but what compounds the cases of most patients is that they patronised quacks, only to rush to the hospital when their conditions had deteriorated.
“Malaria is treatable, go to our Records Department for them to show you the records of malaria patients”, he told this reporter.Head of the Records Department, Mr Simon Onyido, said deaths related to malaria were low in the hospital.He promised to supply details, but could not, as of the time of filing this report.Read more: LEADERSHIP Newspaper »
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