Eden Kanowitz
Malaria in Nigeria
From: Secretary of Health, Nigeria
To: Minister of Finance, Nigeria
Introduction
With over 300,000 deaths occurring annually, Nigeria currently holds the largest share of the world’s burden of malaria..[i], [ii]While malaria regularly impacts the lives of all Nigerians, mortality rates are especially high among pregnant women, infants under one year of age, and those of low socioeconomic status.[iii] Risk factors contributing to higher malaria-associated morbidity and mortality include: age, pregnancy, HIV/AIDS infection, migration and socioeconomic status.[iv] High rates of malaria-associated illness and death throughout our population greatly detract from our overall economic growth and productivity as a nation. To decrease the rates of malaria we must provide citizens with long lasting insecticidal nets, provide all pregnant women with preventive therapy, and increase our healthcare capacity and expand services to underserved regions.
Nature and Magnitude of the Problem
Nigeria currently holds the largest share of the world’s burden of malaria, with an estimated 300,000 deathsannually.[v]With a population of over 160 million people, Nigeria has both the largest population in Africa and the most individuals susceptible to malaria.[vi]In 2007, there were2,969,950 reported cases and 10,289 reported mortalities due to malaria in Nigeria.[vii]While the majority of the global burden of malaria lies within 30 countries of sub-Saharan Africa, only four countries—including Nigeria—account for 50% of all malaria-related mortality.[viii] Within Nigeria, malaria cases account for about 66% of all visits to health care clinics and 30% of hospitalizations.[ix],[x]
Most malaria in Nigeria is spread during the nighttime through the bite of an infected Anopheles gambiaemosquito; however there are other species of mosquito that may carry the vector. Transmission in Nigeria is high throughout the entire year, but specifically high during the wet season.[xi]
Affected Populations
While morbidity related to malaria is found among most geographic and socioeconomic groups within Nigeria, the majority of malaria-related mortality is found among children less than one year of age, pregnant women, and individuals of low socioeconomic status,who cannot afford appropriate treatment. Malaria among infants accounts for 25% of all deaths of those under the age of one, and 11% of all maternal deaths. These instances are further exacerbated within families suffering from extreme poverty that cannot afford proper treatment and prevention.[xii]
Risk Factors
A Nigerian citizen’s risk of suffering from malaria is greatly increased by his or her: age, pregnancy status, co-infection with HIV/AIDS, migration habits,and socioeconomic and educational status. Since malaria is transmitted through the bites of the female Anopheles mosquito and is endemic in Nigeria, built immunity plays a significant role in limiting morbidity and mortality due to malarial infection. Children below the age of five—specifically infants one year and below— are likely to have not yet built up significant immunity to the most virulent forms of malaria. Pregnant women with limited or completely absent immunity are much more likely to give birth to a child of low birth weight with higher risk for anemia, and they themselves are at great risk of dying from malaria-related anemia. Individuals with HIV/AIDS are also at higher risk, as they already have compromised immune systems and can suffer from symptoms greater in severity.[xiii]
Frequent immigration to and from endemic areas increase one’s risk of suffering from malaria-related morbidity and mortality. Individuals of low socioeconomic status will often move many times in search of work and better living conditions. This means, however, that they are also moving between malaria-endemic and non-endemic areas. Previously acquired immunity will wane once the individual leaves the endemic area, but the risk of malaria will return if he or she returns to the endemic region.[xiv]
Finally, a lack of proper education and low socioeconomic status can also increase one’s chances of malarial infection. If communities are unaware of the signs, symptoms, and risk factors for malaria, they cannot protect against or treat its symptoms. However, even when communities are educated in malarial symptoms and treatment, extreme poverty will prevent the populace from seeking proper health care.[xv]
Economic and SocialConsequences
The high rates of morbidity and mortality due to malaria that currently afflict Nigeria are not only matters of human health, but are issues detrimental to our economic growth and overall productivity as a nation, as well.Currently, our country spends $906 million (USD) annuallyon the treatment, prevention, and opportunity costs associated with malaria, such as years of productive life lost to morbidity and mortality. In a nation that already suffers from diminishing economic growth and widespread financial corruption, we cannot afford such an immense financial loss. Those suffering from the debilitating symptoms of malaria are less productive and therefore less likely to pull themselves out of crippling poverty, as this implies more days of work missed and more expenses incurred due to treatment costs.[xvi]
Our current health care system is over-taxed and insufficient. Access to hospitals and clinics for malaria treatment is difficult and nearly impossible to utilize by those who need it most; and those that do seek formal treatment will wait hours to see an overworked healthcare provider. These inadequate resources specifically prevent children from receiving the care they need to begin a healthy life.[xvii] If children are suffering from malaria, they cannot receive an education and will suffer physical and cognitive developmental delays, if they even make it past their first birthdays. These children will never become productive members of our society and will only tax our system further. To improve our nation’s economic growth and productivity, we must reduce infant mortality due to malaria.[xviii]
Priority Action Steps
We can decrease the rates of malaria and associated morbidity and mortality in populations throughout Nigeria through three main steps: (1) provide all citizens with long lasting insecticidal nets (LLINs), with a specific prioritization of pregnant women and children under five; (2) improve child and maternal mortality rates by providing all pregnant women with preventive therapy; and (3) expand our healthcare infrastructure and capacity by hiring new workers from communities and create incentives for workers to enter the field, stay in the field, and relocate to underserved areas.
In order to contain and eventually reduce the spread of transmission of malaria, we must employ the widespread nighttime use of insecticide treated bed nets to serve as a barrier method for preventing mosquito bites. We want to prioritize bed net allocation to pregnant women and children under five, as they are particularly susceptible and must be targeted to ultimately improve the productivity of our nation’s workforce in the long run. The same can be said of providing all pregnant women with preventive malarial therapy; by keeping our young mothers safe and starting our neonates off on a healthy trajectory, we can minimize their morbidity and loss of productivity throughout later life. Finally, through job benefits and government provided education subsidies, we must incentivize new workers to enter the healthcare force. This is feasible, as we have the support of many global initiatives, such as “Roll Back Malaria” due to our serious share of the world’s global burden of malaria.[xix]
Bibliography
[i]“Key Malaria Facts.” Roll Back Malaria, 2008,
[ii] “Malaria Prevention Program in Nigeria Aims at Universal Bed Net Coverage.” The World Bank,
[iii] Ibid.
[iv] “Malaria: Fact Sheet Nº94.” World Health Organization, last modified October 2011.
[v]“Key Malaria Facts.”
[vi] “Malaria Prevention Program in Nigeria Aims at Universal Bed Net Coverage.”
[vii] “Nigeria.” Malaria Consortium,
[viii] “Global Malaria Action Plan for a malaria-free world.” Roll Back Malaria,
[ix]“Partnering to roll back malaria in Nigeria’s Bauchi State.” UNICEF, last modified 22 April 2009,
[x] “Malaria Prevention Program in Nigeria Aims at Universal Bed Net Coverage.”
[xi] “Roll Back Malaria Initiative.” Operation Peace of Mind, Nigerian-American Center for Peace and Development, last modified January 2009,
[xii] “Malaria Prevention Program in Nigeria Aims at Universal Bed Net Coverage.”
[xiii]“Malaria: Fact Sheet Nº94.”
[xiv]Ibid.
[xv]“Partnering to roll back malaria in Nigeria’s Bauchi State.”
[xvi]“Malaria Prevention Program in Nigeria Aims at Universal Bed Net Coverage.”
[xvii]“Partnering to roll back malaria in Nigeria’s Bauchi State.”
[xviii]“Malaria Prevention Program in Nigeria Aims at Universal Bed Net Coverage.”
[xix] “Global Malaria Action Plan for a malaria-free world.”