Malaria burden in
Nigeria: Analysis of Essential Facts and Interventions towards its
Prevention/Elimination in Anambra State
Background
The 2014 World Malaria Report indicates that Africa still
bears over 80 percent of the global malaria burden, and Nigeria accounts for
about 29 percent of this burden. Similarly, the report also states that in
combination with the Democratic Republic of Congo, Nigeria contributes up to 40
percent of the global burden. The Nigeria Malaria Indicator Survey (NMIS 2015)
further indicates that malaria contributes up to 11 percent of maternal
mortality, 25 percent of infant mortality, and 30 percent of under-5 mortality.
The National Demographic and Health Survey (NDHS 2013) similarly reports that
an estimated 97 percent of the country’s approximate population of 160 million
residents are at risk of malaria.
The economic burden of malaria on Nigerian households is
huge, as revealed by a study on the Economic Burden of Malaria on Households
and the Health System in Enugu State Southeast, Nigeria. The study further
shows that the average household expenditure per case was NGN3935 equivalent to
12.57US$ and NGN7772 equivalent to 23.20US$ for outpatient department visits
and inpatient days respectively.
The Nigeria Malaria Indicator Survey (NMIS 2015) in its
summary report showed that malaria prevalence was still lowest in South East
Zone with 14% as compared to 28%, the lowest also in 2014. On Insecticide-
Treated Nets Ownership, almost 70% of households in Nigeria and 75% of the
households in Anambra State own at least one insecticide-treated net (ITN). On
the Use of Insecticide-Treated Nets by Household Members more than one-third
(37%) of Nigerians and 24% in Anambra State slept under an ITN the night before
the survey. On Intermittent preventive treatment during pregnancy (IPTp) - 3 or
More Doses of SP, the survey also showed that nationally only 19% of women and
20% of women in Anambra State with a live birth in the two years before the
survey received three or more doses of SP during antenatal care visits while
nationally, only 37% and 43% in Anambra State with a live birth in the two
years before the survey received two or more doses of SP during antenatal care
visits.
The National Malaria Elimination Programme (NMEP) developed
a new National Strategic Plan (NSP) (2014-2020) to facilitate the elimination
of malaria in Nigeria by 2020. The goal of the NMSP is to reduce malaria burden
to pre-elimination levels and bring
malaria-related mortality to zero. In October 2015, the Sub-recipient to NMEP,
Christian Aid(CAID)UK commenced support to the Anambra State Malaria
Elimination Programme following the close out of the World Bank Malaria Booster
Project and the Support to the National Malaria Programme (SuNMaP).
The suite
of support from CAID cuts across major malaria intervention activities
including Malaria Case Management (Diagnosis and Treatment) and Programme Management. Consequently, the Global Fund through
Christian Aid, UK has committed funds to support Anambra State to apply the
strategies embedded in the plan as a means to contributing to the achievement
of the NMSP 2014-2020 objectives.
The 2017 AOP for Malaria Elimination of the Anambra State
Malaria Elimination Programme has stated specific objectives and targets which
align with the NMSP 2014-2020 goal and objectives. One of the key output areas
is in strengthening malaria programme management through the development and
reviews of Annual Operational Plans (AOPs). The AOPs serves as a widely
acceptable resource mobilization tool for malaria programme implementation.
Situational Analysis
This section provides a concise analysis of the current situation
of each of the seven (7) NMSP 2014-2020 objective areas within the Anambra
State Health System. The content serves as the framework for the derivation of
the objectives and the performance targets of the Anambra State Malaria
Elimination Programme AOP 2017.
* Malaria Prevention
Data from the
Malaria Commodity Logistics System (MCLS) indicates that the state received a
total of 173,500 LLINs and 74,900 doses of Sulfadoxine Pyrimethamine (SP) in
the first quarter of 2016. A total of 250,700 LLINs and 80,120 doses of SP were
also distributed during that period.
Furthermore in
2016, a pilot programme on Indoor Residual Spraying (IRS), funded by the
Federal Ministry of Health (FMOH), was conducted in Mgbakwu community in Awka
North LGA of Anambra State. A total of 6,000 structures were sprayed using
Delthametrin. The spraying exercise was a follow-up to a baseline entomological
survey done in which the most effective insecticide was found to be
Delthametrin. A total of 6 supervisors and 44 spray men were trained and
deployed by NMEP through the FMOH to conduct the exercise.
Focused Antenatal
Care (FANC) has commenced in all the health facilities in the State. In FANC,
the administration of a minimum of 3 doses and maximum of 4 doses of
SP(Sulphadoxine/Pyrimethamine) during pregnancy is emphasized, as opposed to 2
doses in the past.
Training activities
carried out under Malaria Prevention in 2016 include the following:
Residential
training of 71 participants which comprised 2 Doctors from selected secondary
health facilities; 1 LGA Malaria focal person from each of the 21 LGAs and 10
SMEP staff of the State grouped in 2 clusters of 30 participants on Prevention
of Malaria in Pregnancy.
Non-residential
step-down training of 756 health facility workers which comprised of (2 Health
Workers per 15 Health Facilities, 1 Programme Officer- SMoH, 1 LGA Malaria
Focal Person, 1 SMEP Programme Officer from each of the 21 LGA in the state) on
Prevention of Malaria in Pregnancy.
Programme achievement in the Prevention Objective Area significantly improved to 75% in 2016 from 17.10% in 2015 due to the availability of training materials, facilitators and training venues to conduct trainings on LLIN continuous distribution.
* Malaria Diagnosis
All categories of health facilities (HFs) in the State
(Primary, Secondary and Tertiary) offer mRDT services, particularly at the primary
level. In addition, all Secondary HFs comprising the 36 General Hospitals and
the 10 Mission Hospitals are offering malaria microscopy services. The tertiary
facility in the State-
Chukwuemeka Odumegwu Ojukwu Teaching Hospital is also
providing microscopy services.
Towards improving the quality of malaria diagnostic tests,
trainings on mRDT were conducted for 785 health workers of different categories
drawn from the 21 LGAs of the State. The sessions on mRDT were part of the
Global Fund/Christian Aid UK supported trainings on case management of severe
and uncomplicated malaria.
Majority of the HFs comply with the national guidelines for
parasitological confirmation of malaria. External Quality Assurance (EQA) for
malaria diagnosis has been established and is conducted quarterly in Anambra
State. In 2015, the Support to National Malaria Programme (SUNMAP) project
collaborated with the State to establish and inaugurate an eight-man External
Quality Assurance team.
The review of the 2016 AOP showed that the Programme
achievement in the Diagnosis Objective Area was 100% across the four quarters
of the year and this was enhanced by the availability of state-based training
facilitators, manuals and supportive supervisory tools.S
