• Test-before-treatment strategy
By Doris Obinna
Malaria is a disease caused by a parasite that is spread to humans through the bites of infected mosquitoes. People who have malaria usually feel very sick with a high fever and shaking chills. While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries.
According to the latest World malaria report, there were 263 million cases of malaria in 2023 compared to 252 million cases in 2022. The estimated number of malaria deaths stood at 597 000 in 2023 compared to 600 000 in 2022.
The World Health Organisation (WHO) African Region continues to carry a disproportionately high share of the global malaria burden. In 2023 the region was home to about 94 per cent of all malaria cases and 95 per cent of deaths. Children under five years of age accounted for about 76 per cent of all malaria deaths in the Region.
Over half of these deaths occurred in four countries: Nigeria (30.9 per cent), the Democratic Republic of the Congo (11.3 per cent), Niger (5.9 per cent) and the United Republic of Tanzania (4.3 per cent).
In a bold and transformative move, however, the Lagos State Government has announced the launch of the Pathway to Malaria Pre-Elimination & Digitization Programm, an initiative designed to accelerate malaria elimination through digital innovations, strengthened case management, and enhanced public-private partnerships.
Speaking in Lagos, at the unveiling of the ‘Digital Offensive Against Malaria,’ the Governor, Babajide Sanwo-Olu, emphasized the socioeconomic burden malaria imposes on the country and by extension to Lagosians. According to him, the disease hampers productivity, drains household incomes, and disrupts educational pursuits, particularly among modest earners. He stressed that eradicating malaria is not just a health imperative but also an economic necessity that could significantly boost the state’s GDP.
Sanwo-Olu harped on the importance of accurate diagnosis, urging residents to adopt a “test-before-treatment” approach. He cautioned against self-diagnosis and the assumption that all fevers are malaria-related, advocating for transparency and prompt testing to ensure appropriate treatment. The governor also lauded the integration of digital tools in the program, which will enable real-time tracking of malaria cases, thereby enhancing the efficiency of interventions.
Malaria elimination
Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures to prevent re-establishment of transmission are required.
The Commissioner for Health, Prof. Akin Abayomi, emphasized that the Malaria Pre-Elimination and Digitization Programme is a crucial step towards reducing malaria prevalence to below one per cent, marking a significant leap towards disease eradication in Lagos.
According to him, Lagos is already leading the way with a malaria prevalence of under three per cent, far below the national average. “With this initiative, we are taking decisive steps to eliminate malaria altogether and ensure that every fever is properly diagnosed and treated using a scientific and digitalized approach.”
He explained that despite its relatively low malaria prevalence compared to other states in Nigeria, Lagos still records an estimated 900,000 malaria cases annually, with febrile illnesses presumed to be malaria contributing to over 50 per cent of general outpatient visits in public health facilities. He further highlighted the economic toll of malaria, which results in absenteeism from work and school, decreased productivity, and increased household healthcare costs.
“Malaria is not just a health issue; it is a social and economic problem. The cost of treating malaria, combined with the indirect costs of lost productivity, runs into billions of naira annually. A malaria-free Lagos is a stronger, more prosperous Lagos,” he added.
Integrating digital health solutions
The Minister of State for Health and Social Welfare, Dr. Iziaq Salako, expressed delight at Lagos State’s pioneering initiative, recalling the state’s early efforts in malaria case management. He commended the new programme for aligning with the Federal Ministry of Health’s ‘Rethinking Malaria’ concept, launched in April 2024, which aims to fast-track malaria elimination through strategic shifts.
Salako highlighted the program’s focus on integrating digital health solutions for real-time electronic reporting, which is expected to improve malaria diagnosis and case management. He noted that the state consistently records the lowest malaria prevalence in Nigeria, with a 2021 survey indicating a two per cent prevalence rate. The minister expressed confidence that with concerted efforts, the state could achieve pre-elimination status, serving as a model for the rest of the country.
The minister underscored the critical role of the private sector in healthcare delivery, noting that approximately 50-60 per cent of Nigerians seek treatment first in private health facilities. He emphasized that the program’s focus on public-private sector synergy is essential for enhancing diagnostic accuracy and addressing malaria-negative fever protocols.
He also highlighted the discrepancy in malaria positivity rates between private and public sectors, underscoring the need for innovative solutions to improve healthcare outcomes.
He urged all stakeholders to maintain their support for impactful interventions aimed at malaria elimination. He assured Nigerians and international partners that recent changes in global health funding policies would not adversely affect Nigeria’s malaria elimination programs. The minister affirmed the federal government’s commitment to ensuring adequate and cost-effective funding for public health initiatives, urging state governments to collaborate in making Nigeria self-sustaining in public health funding.
Major public health challenge
Abayomi added that malaria remains a major public health challenge, contributing to mortality, economic burden, and reduced human capital development.
In his presentation titled ‘Winning the Fight Against Malaria in Lagos State, he noted that while Nigeria bears the highest malaria burden globally; accounting for 27 per cent of global cases, Lagos State has successfully reduced its prevalence to 2.6 per cent, positioning it in the low transmission category. He credited this progress to sustained interventions, private sector partnerships, and digital health innovations.
He underscored that achieving malaria pre-elimination requires continued efforts in early diagnosis, effective treatment, and vector control measures such as indoor residual spraying and larviciding. He further emphasized the role of community education, digital health tracking, and strengthened health service delivery in sustaining progress.
“Lagos State is on the verge of malaria pre-elimination, and if we align our strategies effectively, we can achieve this goal sooner than expected.
He reiterated a shift in malaria diagnosis and treatment, moving away from presumptive treatment to a ‘test, treat, and track’ approach. “Digital integration in health services would improve accuracy in diagnosis, ensure appropriate use of anti-malarial drugs, and prevent drug resistance.”
He urged healthcare workers to embrace thorough patient evaluations, moving beyond assumptions of malaria as the primary cause of fever-related illnesses.
Economic impact of malaria
Country Director for Nigeria at the World Bank, Dr. Ndiame Diop, emphasized the economic impact of malaria, noting that 30 per cent of under-five deaths and 60 per cent of outpatient visits in Nigeria are linked to malaria. He highlighted the World Bank’s continued commitment to supporting policies and interventions aimed at malaria elimination.
Diop stressed that out-of-pocket malaria treatment costs remain a major barrier to effective disease control, with 95 per cent of treatments paid for directly by affected individuals. He urged for increased funding, public-private partnerships, and community-led interventions to bridge healthcare access gaps.
“Nigeria, as the largest economy in Africa, has the potential to eliminate malaria, and we are confident that with the commitment demonstrated here, we will get there,” he stated.
Managing Director, Society for Family Health (SFH), Dr. Omokhudu Idogho, echoed similar sentiments, emphasizing the need for sustained interventions in malaria prevention, treatment, and community sensitization. He pointed out that leveraging digital technology for case tracking and surveillance will be crucial in accelerating progress towards malaria elimination.
Idogho highlighted SFH’s role in strengthening community engagement and ensuring widespread access to malaria prevention tools. He commended the Lagos State government for integrating digital solutions into healthcare services, noting that this will enhance real-time data collection, improve response strategies, and optimize resource allocation.
Call to action
The governor called for collective action, urging all stakeholders; including government agencies, healthcare providers, community leaders, and citizens to collaborate in the fight against malaria. He acknowledged that while success may not come overnight, sustained efforts and unwavering resolve could lead to a malaria-free Lagos.
While commending the state’s ministry of health and its partners for their transparent presentation of data and ongoing efforts to meet the 2025 targets for malaria elimination, he reiterated the critical role of community engagement in malaria prevention.
He encouraged Lagosians to become advocates for the program, disseminating information about preventive measures and the importance of testing before treatment. The governor expressed optimism that with collective effort, the state could rewrite its malaria narrative and achieve significant public health milestones.