Taiwo Olawale
9 October 2007
Lagos — The statistics are so daunting; it is a wonder a state of emergency has not been declared yet by the state and federal governments. One out of every three children in Jigawa State that dies before his or her fifth birthday is killed by malaria. Eleven per cent of the maternal mortality in the state is also due to malaria. And, households spend at least, 25 per cent of their income on malaria treatment. Statistics on the disease show that it kills more people than AIDS/HIV, Tuberculosis, Measles and whooping Cough combined.
Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Symptoms of the disease include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life threatening by disrupting the blood supply to vital organs. It is the leading cause of death in Africa with Nigeria accounting for about 80 per cent of the deaths.
Recent population figures show that there are over 877,000 children under five in Jigawa State. If a third of this figure is likely to die from malaria before their fifth birthday, then, the state's efforts to rebuild its economy and join the elite states of the federation may remain an illusion. Children are always the most vulnerable group in the society and that vulnerability is exploited most mercilessly by malaria.
According to UNICEF statistics, malaria is the leading cause of death in children under five. It accounts for 29 per cent of deaths in the group. Though male adults are not spared by malaria, available data shows that children and pregnant women are most susceptible to the disease. And, the most unfortunate part of this susceptibility is the fact that the future of the state, and indeed, humanity depends on these two all-important groups. The local population is so vulnerable that the attacks have almost become a 'natural' part of life here.
Mallam Adamu Aminu, a farmer in one of the rich wetland areas of the state was in Dutse early last week with his pregnant wife to see the doctor. It was a very sad day for him. He had just learnt that his wife suffered spontaneous abortion. Fati, his wife of about five years had been pregnant with her second baby for about four months before she became ill. She had very intense fever and was weak. But it was a normal thing in his village. Zazabi (fever) was normal and the local remedies were prescribed for her. It was when she started bleeding and could no longer stand on her feet that Aminu accepted the fact that he needed more help.
By the time he got to the city however, it was too late. Maternal malaria had claimed his wife's second pregnancy. He was however lucky he did not lose his wife as well. In Jigawa, just as it is in all of the country, malaria is a major cause of spontaneous abortion. Since the state is an area of epidemic malaria transmission, pregnant women become ill once infected with Plasmodium falciparum, the primary malaria-infecting agent. They are usually at greater risk of developing severe malaria when compared to non-pregnant women living in the same area.
Apart from abortion, a range of adverse pregnancy outcomes including maternal anaemia, which may contribute to intra uterine growth retardation, low birth weight, stillbirth and premature delivery also occur when pregnant women are exposed to malaria attacks. About 200,000 newborn deaths, according to the World Health Organisation (WHO) are due to malaria.
So, malaria is much more than the disease of public health significance; it is public enemy number one in the state. It is an enemy that must be combated with all the recourses within the reach of the respective governments. As deadly as the disease is though, the consensus among many experts in the area of malaria control is that the disease can be controlled effectively through certain proven intervention methods. The methods include Inter-vector management (IVM) activities such as the use of Insecticide Treated Nets (ITNs); and chemoprophylaxis. According to UNICEF, the use of ITNs in high impact districts in Mali, Senegal, Ghana and Benin reduced mortality in children under five by 50 per cent in 2003.
For Jigawa to survive the scourge of the disease, experts say it must not only use proven methods of intervention, it must have a systemic control mechanism that would sustain the fight until the disease is eliminated. The state is not unaware of this. According to Dr. Kabir Ibrahim Aliyu, the state Project Manager of the World Bank Malaria Control Booster Programme, Jigawa State is about the only state in the federation with an indigenous malaria control programme.
He said the state government is fighting the disease with such seriousness that it is expected to be brought under control within the lifespan of the World Bank Booster plan.
Speaking to THISDAY recently on the menace of malaria in the state, Aliyu said the state is already benefiting from the $180 million World Bank grant obtained by the Federal Government to combat the disease across the nation. Praising the Federal Government's commitment to the anti-malaria project, he noted that Jigawa State's indigenous malaria control programme has been in place since 2002. He said the booster programme, which started in May this year is to last five years at the end of which present statistics are expected to change positively.
He noted that the indigenous programme, which started in 2002, has helped the state to lay a solid foundation for the fight against malaria. He expressed optimism that the existing foundation would help the state make the best out of the World Bank programme, which started in May. He then reeled out some of the IVM programmes, which have been carried out by the World Bank project since May.
He explained that the target of the project is that every child under five in the state sleeps under an ITN. This, according to him, would halve the spread of malaria within one year. In addition, the close to 200,000 pregnant women in the state are to receive the Intermittent Preventive Therapy (IPT) twice in the course of each pregnancy. And, to show that he was not just reeling out figures off-hand, he went on to give statistics of some of the IVM programmes already deployed as well as the Chemoprophylaxis activities carried out by the project office.
He expressed confidence that the combination of methods deployed by his office would control the disease in such a way that it would no longer be a menace in a couple of years. "With the appropriate intervention and control programmes, we hope to control malaria so that it would cease to be a disease of public health significance in the state", he declared.
He also declared that, "So far, we have distributed 100,000 insecticide treated nets in five local governments. Before the end of the year, each child under five would have a treated net. In addition, we have distributed 76,000 doses of Artemisinin Combination Therapy (ACT) and 31,000 Fansiders." According to Aliyu, the number of ITNs distributed in the five local governments covers about 80 per cent of the number of children under five in those LGAs. He explained that with such coverage, the children are free from malaria attacks and they also reduce the spread as they stop being carriers.
It is however obvious that the state government has not abandoned the fight against the deadly disease to the World Bank project office. Kabir made this clear when he confirmed that the state is one of the very few in the country with an indigenous malaria control programme. He explained that the World Bank programme is expected to boost the state's efforts. In addition, he explained that it is the state government that provides the logistics for the distribution of the IVM and other intervention materials. Because of this commitment on the part of the state government, he said "with the present commitment, we are confident of success at the end of the project."
Kabir's promise of a society almost completely free of malaria in five years is cheery. If the promise can be kept much earlier than that, it would even be better. But whatever happens, the fight must be fought with all the vigour and resources that can be mustered. It is a fight for the state's future leaders; a fight for the state's tomorrow. With a menace like malaria, the future of the state or any state under its threat is uncertain. It is the people versus malaria; and the people must win if the state's tomorrow must be guaranteed. It is a struggle that involves everybody in the society, they agree.
The efforts of the state government in the past may have halted its continued degeneration. Present efforts must however go beyond that to stop the disease from destroying the very pillars upon which the existence of the society rests: women and children.
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