Nigeria

Malaria facts 

Malaria is transmitted throughout Nigeria, with 97% of the population at risk of malaria. The duration of the transmission season ranges from year-round transmission in the south to three months or less in the north. Plasmodium falciparum is the predominant malaria species. The primary vectors across most of the country are An. coluzzii (59.3 percent) and An. gambiae s.s. (39.0 percent) of all the An. gambiae s.l. collected, with An. funestus as a secondary vector in some areas of Nigeria.[1]

According to the 2022 World Malaria Report, Nigeria accounts for the highest percentage of the global malaria burden compared to any other country, with 27% of the global estimated malaria cases and 31% of the estimated deaths due to malaria. The country accounted for an estimated 55% of malaria cases in West Africa in 2022.[2]

Case numbers remained stable between 2021 and 2022 at 306 per 1000 of the population at risk in 2022 and 305 per 1000 of the population at risk in 2021. Over the same period, deaths decreased by 3.3%, from 0.9 to 0.87 per 1000 of the population at risk.[2]

Microscopy data from the 2018 Nigeria Demographic and Health Survey (NDHS) show that the prevalence of malaria parasitaemia in children under five years of age is 23% (a decrease from 27% in 2015 and 42% in 2010), although there are significant regional, rural-urban, and socioeconomic differences: prevalence ranges from 16% in the South and South East Zones to 34% in the North West Zone.[1]  In rural populations, prevalence is 2.4 times that in urban populations (31% vs. 13%) 

Compared to the highest socioeconomic group, prevalence among children in the lowest socioeconomic group is seven times higher (38% vs. 6%) [1]  

In response to the malaria situation and to guide implementation, the National Malaria Elimination Program (NMEP) initiated the High Burden High Impact (HBHI) approach with technical support from the WHO and technical partners to address the malaria situation in Nigeria.[1] The current 2021–2025 National Malaria Strategic Plan (NMSP) is based on the vision of achieving a malaria-free Nigeria with a goal of reducing malaria morbidity to less than 10 percent parasite prevalence and mortality attributable to malaria to less than 50 deaths per 1,000 by 2025.[1].

The Government of Nigeria has secured credits from three multilateral banks (the World Bank, African Development Bank, and Islamic Development Bank) totalling $364 million to fund health sector interventions in 13 states of the Federation for five years (2020–2024) for malaria [1]. A high level ministerial meeting to end malaria in Nigeria was also held in May 2024 with key thoughts being greater use of new and current tools and increase in resource mobilization for malaria in Nigeria.

Severe malaria case management and control 

In 2012, the NMEP changed the first-line treatment for severe malaria from quinine to injectable artesunate, consistent with WHO treatment guidelines. [1] The recommended pre-referral intervention for severe malaria is intramuscular or rectal artesunate, intravenous quinine, or intravenous artemether.[1] 

Malaria in pregnancy 

Nigeria has adopted the 2016 WHO antenatal care (ANC) model which recommends a minimum of eight contacts during pregnancy. The country has a target of 63 percent of women to receive three or more doses of IPTp (NMSP 2021-2025). The proportion of pregnant women who received at least three doses of sulfadoxine-pyrimethamine (SP) almost doubled between 2018 and 2021 – from 16.6% in 2018 to 31% in 2021. [1]

Factors hindering SP uptake among pregnant women include low antenatal care attendance rates, restrictions that prevent non-pharmacy workers from dispensing SP, missed opportunities during visits, and non-availability.[1]

The National Guidelines specify that pregnant women with severe malaria should be treated with injectable artesunate (or intravenous quinine if injectable artesunate is not available) from the 2nd trimester of pregnancy.[1] Recent guidelines from the WHO now recommend the use of injectable artesunate during the 1st trimester of pregnancy.

Factors hindering SP uptake among pregnant women include low antenatal care attendance rates, restrictions that prevent non-pharmacy workers from dispensing SP, missed opportunities during visits, and non-availability.[1] 

Insecticide-treated nets (ITNs) 

ITN ownership has plateaued and begun to slightly decrease in Nigeria – households with access to an ITN have risen from 47% in 2018 to 56% in 2021 (MIS). Mass ITN campaigns occur every three to four years in only 24 states, and the continuous distribution channels are not sufficient to maintain ITN coverage.[1] However, the proportion of the population that slept under an ITN the previous night decreased from 43% to 36% between 2018 and 2021. In the same period, there were also decreases in the proportion of children under five (from 52% to 41%) and pregnant women (58% to 50%) who slept under a net the previous night.[1]

Seasonal Malaria Chemoprevention 

The NMEP strategy recommends seasonal malaria chemoprevention (SMC) in 21 states in Nigeria that contain local government areas that are eligible for SMC. In all LGAs, in accordance with WHO guidelines, SMC is distributed in 4-5 monthly cycles to eligible children between 3 and 59 months of age. The recommendation is for four doses of SP + amodiaquine [SPAQ] at monthly intervals over the 4-month malaria transmission season).

383 districts and a population of approximately 28.9 million children under the age of five years in these states were reached with SMC in 2023.[5]

SMC programmes are being implemented in the Sokoto, Jigawa, Katsina and Zamfara States by the Malaria Consortium.[1] 

Healthcare tiers 

The public health care system makes up 67% of all healthcare facilities and is divided into three levels: federal, state and local government areas (LGA) or National Primary Health Care Development Agency.[1] 

The federal health budget covers tertiary care and disease control programs (including malaria control).  The state health budget covers secondary care.  The LGA budgets address primary healthcare. 

The Government of Nigeria receives funds for malaria control from the Global Fund, USs President’s Malaria Initiative and others. It has also secured loans from the World Bank, the African Development Bank, the Islamic Development Bank.  The country has similarly been funded by DFID (now called Foreign, Commonwealth & Development Office (FCDO) as well as a number of nongovernmental players. Private sector companies in the extraction industry have also implemented malaria control programmes.[1] 

Populations with low access to treatment  

• North Eastern Nigeria: Due to insurgencies and attacks on health workers, there are operational challenges for delivering malaria intervention services [4] 
• Rural communities: Some hard-to-reach rural communities require special measures (boats or camels) to access. Routine service is difficult. [4] 
• Nomadic population: Population has no fixed location, making them hard to reach. They believe that fever is a Fulani illness that needs no cure; prefer private medicine vendors and avoid health facilities. [4]