Katsina — Although malaria remains the highest killer disease in Africa, far more devastating than HIV/AIDS, the scourge, perhaps, has never been deadlier in the northern part of Nigeria than in the last 60 days.

In Katsina, Kano and Jigawa states over 800 people were reported killed by the disease while over half a million victims were diagnosed and treated within the period.

Sunday Trust investigations in these states revealed a barely concealed level of desperation on the part of government officials who seemed to have been caught un-prepared and therefore overwhelmed by the huge number of patients who turned up for treatment. The picture of over-stretched facilities and personnel poignantly exposed the zero level of our emergency preparedness.

When Sunday Trust visited Katsina in the aftermath of the outbreak, many hospitals were desperately battling with the army of patients trouping for medical care. In some places evidence of over stretched facilities became apparent when patients were forced to return home after preliminary attention was given to them.

The outbreak according to reports saw over 400 people killed in Katsina alone from October19 and now, with over 50.000 patients diagnosed as having mild or severe malaria attack in most of the local government areas of the state.

An official at the Katsina General Hospital had informed our reporters that the situation reached its peak in the seven days between October19 and 25 were thousands of patients were brought, most of them with anemia cases only to face delay in consultations and diagnoses.

The Medical Director of the hospital, Dr Sabiu Liadi told Sunday Trust that what was witnessed was increased incidences of malaria but that it had since been brought under control through sustained efforts towards providing drugs and treatment of those affected.

However, an official who spoke on condition of anonymity said the situation nearly got out of hand in the first week of the outbreak when over 12.000 patients were turned back due to unavailability of space in the General Hospital.

"We had to turn back many patients because ward one and two were filled up and we could not do anything as we resorted to treating people under the trees, while others were referred to the Federal Medical Centre for immediate treatment to prevent them from dying.

A check at the children's ward shows scores of patients still battling to survive, with their parents praying fervently to God and hoping that their children would escape the fate of hundreds who died before.

Malama Rabi Kabir told our reporters that she has been in the hospital with her child for two weeks now. She said when they came to the hospital, there were so many patients that she was afraid she might lose her only child, 'but luckily he survived'

The story was not the same with Kabiru Nuhu Yashe who lost his three year old boy to the outbreak. He told Sunday Trust that on the fateful day that Nuhu fell sick, they had rushed him to the General Hospital for treatment hoping that he would be okay.'

"Few days after he was taken there, we were discharged due largely to over crowding, and we returned home. Although he was getting better then, he died two days after,' he said.

The story is the same in Malumfashi, Funtua, Daura, Dutsinma and many parts of the state with high number of casualties. But Katsina State government officials denied that 400 people died as a result of the outbreak, according to Alhaji Nasiru Abdul who was officially designated to speak to the media on the outbreak.

He told Sunday Trust the reports that a number of people died as a result of malaria in Katsina state were over blown. 'One can not just rule out the possibility of it in respect of any illness or outbreak of any disease. But I still challenge the figures that were quoted in those reports because Katsina, like any other state, does not have the standardized method of recording casualties or victims of such outbreaks, as you put it.

"But this malaria outbreak is not only peculiar to Katsina State - but all over the northern states." Abdul said. Immediately after reports indicated increase in malaria cases and even before then, the state government had taken many measures to combat the situation and prevent any casualties.

The government, Abdul further said, introduced a Mobile Ambulance Scheme and that the ambulances visit remote areas where there are no health facilities to provide medical attention to the people for various diseases, including malaria.

'The mobile ambulances also give routine immunization and offer public enlightenment on hygiene and sanitation. Of course, we are also emphatic on antenatal care which government gives to the people of the state free of charge. And if any case goes beyond their capability to handle at that level, they will refer them to other clinics or health centres.

He said within the last few months, the ambulances have been able to carter for substantial number of patients and that prevented lots of malaria incidences reaching serious levels. "Between February and August this year these ambulances have been able to attend to 177,880 patients, he added.

"The number of people given health education is 253,341, while the number of children immunized is 89,886. Also, there are 46,972 women attending antenatal care, while the number of patients referred to health facilities is 3,149. There is also a number of delivery supports, which is 485, while the number of villages visited is 850.

Aside this, we also have free medical care scheme in Katsina, a scheme introduced by the previous administration,' He said. The adviser disclosed that although the outbreak was not preventable, the government has taken enough measures before and during the period to ensure control of the menace. Though I am not a medical doctor, but an epidemic is something that occurs at any given time. Based on our religious inclination, this is what we call 'annoba' in Hausa.

"It can happen at any time, and when it comes, it means that God has ordained that it will come. The only thing we can do at most is to do something that is humanly possible to mitigate its impact. Like I said earlier, this year we have had heavy downpours in the northern states," he said.

The story of those who lost their loved ones to the deadly outbreak did not, however, end in Katsina, Malama Hausatu Gwale lost her only son Auwalu to Malaria at the infectious disease hospital in Sabon Gari Kano. She narrated her story to our reporter when he visited the hospital on Wednesday to ascertain the present situation of the outbreak in Kano state.

Hausatu who was in the hospital with her grand daughter Jummai said late Auwalu was her only son who died as a result of malaria. The story is almost the same in every community in the state, and most of the causalities are children below the age of five.

A statistic from the IDH made available to Sunday Trust showed an astonishing figure of casualties within the last 60 days in Kano state. According to the figures, over 241 died of malaria between July and September this year alone, the number from January to date has gone well over 600 deaths.

Dr Dayyabu Muhammed said there are no reports of any outbreak in Kano state, although cases of malaria are known to be on the high always. He said knowing the situation regarding malaria even before the current situation forced the Kano state government to introduce several measures aimed at tackling malaria disease in the early stage. "We are doing a lot in trying to control malaria in the state through several efforts that include partnering with the World Bank and the Federal Ministry of Health to tackle the problem.

So far he said the state government has received about $17 million to control malaria, and 'we have also received several other donations from other organizations, all towards combating the malaria scourge." "As I am talking to you the state government has distributed over 600.000 treated nets free of charge to the people.'

He said there also have been efforts that saw the distribution of 603,000 doses of new effective malaria drugs to various clinics in the state, as well as free treatment of pregnant women so as to protect their unborn children and themselves.

In Jigawa state communities in the Hadejia valley are most affected with Birniwa Local Government area as well as Malam Madori. Investigations showed that thousands of people were hospitalized between July to September this year, and although hospital records were not available to ascertain the number of those who died, unconfirmed reports showed that over 100 people died of malaria within the two months.

The state commissioner of health, Dr Tafida Abubakar who said he could not confirm any number as a committee is right now working in Birniwa to ascertain the level of malaria cases in the area, said "I can not say how many people are affected right now but I think by next week we will be able to know exactly the level of affected persons; he said.

He also said the rise in malaria cases in this season is normal because of the increase in breeding sites due to rainy season and especially in Jigawa state, 'We have witnessed high rainy season and this led to bodies of water that serves as breeding grounds for mosquito. Dr Tafida said poor sanitation habit of the people is another problem militating against adequate malaria control, adding that until increase awareness is created among communities, the problem will persist.

This assertion was supported by Dr Abdulrazak Habib, an associate professor of infectious and tropical diseases at the Department of Medicine. Bayero University Kano when he told Sunday Trust that unless adequate measures are taken towards improving the environment and facilitating the components that support malaria control, the problem will persist. He said from the point of view of environmental control, what needs to be done is to introduce a method of improving sewage and drainages before the next raining season and to ensure pools and ponds of water do not provide habitation for mosquitoes.'

He also frowns at the poor sanitary habit of the people which he said enhances breeding capacities of the mosquitoes. "We have to ensure long grasses are cut around human abodes, containers where mosquitoes breed are cleared, refuse dumps must also be cleared, as well as dirt must be cleared from human abodes.

"All these must be taken into consideration. We must also have improved reach of the insecticide treated nets; they must be distributed widely especially to people like children, pregnant women and other members of the households' He added.

He called on state governments to improve health care delivery through early detection mechanisms and through sensitization, education and community participation in tackling the menace of malaria and other diseases.

Another expert, Dr Kabir Dara told Sunday Trust that the high number of casualties recorded in recent malaria incidences in some northern states is even more damaging to women, especially pregnant ones.

He said because malaria parasite attack red blood cells and breaks into the cells easily, and that leads to anemia in most victims and subsequent death, 'this is why we witnessed death of children easily' .He added that Nigeria losses over N130bn annually to malaria scourge and that unless concerted efforts are made to combat the disease, then the nation has not seen the last of such incidences.