Why The Fight To Beat Malaria Is Still A Mirage In Some Communities

Malaria is one of the deadliest diseases in Africa. It is caused by a blood parasite -Plasmodium parasites – which spread the disease to people through bites of an infected Anopheles mosquito otherwise known as “Malaria vectors.”

According to World Health Organisation, most malaria deaths and cases occur in Sub Saharan Africa. The most vulnerable people to this disease are the mother and child as well as people living with HIV/AIDs.

The good news is that the fight against malaria is being won gradually in Africa given the preventive measures and work of health providers, most especially in local communities where the condition is much deadlier due the social conditions there.

In this interview, Dr Laz Ude Eze talks about his work as a social health provider working to beat malaria in rural Nigeria communities and the preventive measures that can help communities gain victory on malaria.

Laz as is a public health physician, global health ambassador, health policy advocate and development consultant. A University of Ibadan and the University of Kentucky alumni; he prides himself as an avid fan of Enyimba FC, Manchester United and Kentucky Wildcats with passion for health and development of Africa.

He is also one of the advocates of the trending hashtag on twitter, #Beatmalaria, an advocacy programme that uses the social media to educate and enlighten people on how they can combat malaria. 

How did the fight to beat malaria start for you? And how are you doing it at the moment?

Malaria is a preventable and curable disease but kills so many children and harmful to pregnant women. As a medical student, we had a 2 year old patient who was treated for cerebral malaria (case severe malaria where malaria parasites enter the brain). It was later observed that the child has gone blind. There were too many parasites that possibly obstructed the tiny blood vessels supplying the occipital region of the brain that controls sight. That was one of the reasons that influenced my choice to major in preventive and social medicine. The popular use of #BeatMalaria hashtag in Nigeria started in September 2013 as an outcome of Abuja Social Good Summit where I spoke on how young people can help to beat malaria using mobile devices. I’ve been using my social media platforms to educate friends and followers on malaria. Some friends do make fun of me whenever they see mosquito, they would ask me to come and #BeatMalaria.

From what I gathered, most of your works are in small communities. What will you say are the factors affecting/challenging beating malaria in such communities and how can locals help in the fight against malaria?

You are very correct, I work with the Association for Reproductive and Family Health (ARFH) and most of our interventions are largely in small rural communities and hard-to-reach areas. We are currently supporting 1,684 health facilities in more than 1000 communities across the country to eliminate malaria. The challenges affecting the efforts to beat malaria are multiple but let me summarize it with a phrase – weak public health system. It is largely due to lack of political will to eliminate malaria among many of our policymakers. As a people, we don’t usually take preventive measures very serious. A key objective of the #Beatmalaria effort is vector control to prevent mosquitoes from biting people in the first place. To achieve this, long lasting insecticide treated nets (LLIN) are being distributed free of charge especially to pregnant women and children under five years of age. Unfortunately, we observed that the utilization of the nets is poor in some communities. Some people even use it for fishing; others use it as sponge or even on goal posts as football nets. In-door Residual Spray (IRS) of insecticides and Seasonal Malaria Chemoprophylaxis (SMC) are also other vector control measures.

Locals can help in the fight by applying preventive measures. The environment should be kept clean. Everyone especially children and pregnant women should sleep inside LLIN. The locals should also demand greater commitment of political office holders on public health.

From your work so far, will you say there has been a big improvements in the fight against malaria?

Absolutely, there has been significant improvement in the efforts to #BeatMalaria in Nigeria. Many studies show significant drop in the incidence and malaria-related deaths over the past 10 years. However, there is a whole lot more to do to stop malaria from killing people in Nigeria.

When you work in communities, how do you or your organisation carry out evaluation on the progress made towards the fight against malaria?

We collect data on all aspects of our intervention using the national data collection tools. As the Monitoring and Evaluation Officer on the Global Fund-supported intervention, I lead the technical support in this regard in five states. We analyze the data and provide feedback to the states. We have also built the capacity of the state officers to be able to do same.

More so, national surveys are carried out periodically by the National Malaria Elimination Program (NMEP) to evaluate the progress being made. One of such known as Malaria Indicators Survey (MIS) is currently being planned.

Can you share one of the practical experiences you had in the local communities you have worked in which the people helped your fight against malaria.

In all the communities we work, the people are involved in the intervention and many are doing amazingly well. With the support of ARFH through the Global Fund Malaria grant, these communities carry out community dialogue and compound meetings where they discuss issues affecting malaria elimination efforts in their area who also develop strategies to tackle those challenges. They also nominate volunteers from areas far from health facilities and serve as Role Model Caregivers. We trained and provided 1,365 of them with antimalarial medications to ensure commencement of treatment for suspected malaria cases within 24 hours to prevent progression to severe malaria. From Adamawa to Niger and Osun to Bayelsa, communities are very much involved.

Please talk about some of the communities and the projects you are currently working on to fight against malaria?

Our projects are largely similar in most of the communities we work in but the implementation strategy may differ from place to place. Meanwhile, note that we don’t implement directly, we provide support – both technical and financial to the State Malaria Elimination Programs to do so. We also carry out supportive supervision of the project activities.

Let me share with you a success story in one of the communities we support. In Shatta Community,Bosso Local Government Area of Niger State, we have an exceptional Role Model Caregiver (RMC) known as HajaraSule. She lives and works in the community. Hajara, like other RMCs, provides services around her home and community and serves as a liaison between her community and the primary health facility (PHC) to which she is attached. She providesprompt treatment and care for children under-five years with fever and has provided services to over 300 children in her community. She refers adults, especially pregnant women to health facilities to receive appropriate Ante Natal Care (ANC) services and engages in community mobilization and sensitization on malaria prevention activities.

What will you say is best and simplest way to fight malaria in local communities?

There is no one best way to fight malaria in all communities. What is best in riverine community in Bayelsa State may be not be the best in a desert community in Sokoto State. However, I consider use of long lasting insecticide treated nets as one of the cheapest and simplest ways but it may not be convenient to use in places without cooling devices during hot weather periods.

How best do you think the fight against malaria can be won?

Nigeria will win the fight against malaria when federal, state and local governments demonstrate strong political will to make it happen. It is very depressing to know that some states in Nigeria and many LGAs do nothing to control malaria.

If you are to proffer a permanent and sustainable solution to eradicate malaria totally, what will it be?

I will recommend In-door Residual Spray. It is very expensive but no amount is too much to save the lives of Nigerian children and pregnant women we lose to malaria. Eradication of malaria will also save the country at least N480 billion every year – a whooping sum of money being consumed by malaria. Spraying of households has worked in some countries. The United States commenced malaria eradication operations in 1947. By the end of 1949, over 4,650,000 housespray applications had been made. In 1947, 15,000 malaria cases were reported. By 1950, only 2,000 cases were reported. By 1951, malaria was considered eliminated from the United States.

Recently, a Greek friend asked me why Nigeria doesn’t want to eliminate malaria as his country did 40 years ago. I couldn’t provide an acceptable answer. Greece eliminated malaria in 1974 using similar method as the United States.

Thank you for your time, Dr Laz.

Many thanks for having me.