Highpoint of the Africa Union Abuja +12 Special Summit on HIV/AIDS, Tuberculosis and Malaria, ATM, held recently at the International conference Centre, ICC, Abuja, was the launch of the "The Malaria Situation Room" - an intelligence gathering focusing on Nigeria and nine other African countries accounting for 70 per cent of the malaria burden in Africa and 50 per cent of that burden worldwide.

On the heels of this revelation, National Coordinator, National Malaria Control Programme, NMCP, of the Federal Ministry of Health, Dr. Nnenna Macelina Ezeigwe, a public health physician and Fellow of the College of Public Health,in this interview with Sola Ogundipe, argues for more investment and compliance with approved malaria prevention and control policies in the country. Excerpts:

Prevalence

The average prevalence of malaria is now 42 percent, by rapid diagnostic test,RDT, but when you use the microscope which is more sensitive to check, the prevalence rate is 35 percent. This is a very good improvement from where we were in 2000, when the prevalence rate was more than 50 percent. The point is that malaria is the No.1 public health problem in Nigeria.

It is a high burden and when you look at the fact that Nigeria is more than 160 million people where 90 percent is at risk of the disease, then you begin to appreciate. When you look at the prevalence against the population, it is quite high and you'll see where the problem is. Apart from that it is responsible for 30 percent under-5 mortality and 11 percent maternal death, malaria causes a lot of man hours to be lost from school and other areas of social endeavour. It has been calculated to cause a loss of about N480 billon every year,

The Malaria Situation Room says Nigeria is one of the worst hit, if fact we are the worst in Africa because we contribute a quarter of the burden. We are ranked close to Democratic Republic of Congo in terms of the burden. The report is a good initiative for us in Nigeria. What it means is that Africa is now going to focus on Nigeria and other high burden countries to track progress so that as soon as any bottleneck is identified in the implementation strategy, it can be easily addressed - whether it is technical, or financial. Then it will be identified on time and solution proffered so we can make progress.

Investment

There are many factors contributing to the high malaria burden, I do not even think as a country we are investing enough in malaria control. Actually we are not investing enough. Most of the finances used so far are donor-supported and that is one of the issues. True, a lot of resources have been committed. Nigeria is making a big investment in malaria, but it could be better. Let it be on record that I said we are not investing enough in malaria treatment. We should do better.

Compliance

Compliance is one of the issues. There is something in the policy that indicates people are not following the laid down principles for malaria control. The policy says every suspected case of malaria should be tested before treatment so that you are sure. But from every indication, malaria is coming down and it is like everybody is over-treating malaria and buying drugs.

The major interventions such as the Long-lasting Insecticide-treated Nets, LLINs, are not being properly utilised. People have these nets but are not using them. And one begins to wonder if they do not understand that the nets prevents them from malaria. People are not complying. It is a rule that pregnant women that when register early for antenatal care should get what we call Intermittent Preventive Therapy, IPT. But it is either people are not aware or do not demand for this service. Some people do not want to discharge their responsibility and need to be checked. We can't catalogue all the problems.

Counterfeits

The issue of counterfeits is also worrisome. You hear people saying they are taking drugs which are not working. It is likely what they are taking is not the right one, and this discourages them from taking the right drug when they are given. Just a few moments ago, somebody told me he is taking choloroquine and I asked why he is still taking chloroquine in this day and age? But people keep saying when they take the other drug it is not working. It is one of two things - either they didn't have malaria in the first place, or even if they had malaria they are using fake drugs. As government we will continue to try.

Mobil Authenticatication Service

The Mobile Authentication Service, MAS, is being coordinated by NAFDAC. Our donors are helping us place orders that couldn't arrive before the waiver, all the consignments didn't come so we dialogued with NAFDAC and we are going to suspend implementation of enforcement till September.

Awareness

In the areas with awareness, we are stepping up to make people see why they need to obtain the interventions then we are looking at counterfeit collaborating with NAFDAC because at NMC we cannot enfoirce.

Enforcement is with NAFDAC we are collaborating in the area of pharmacovigilance and basically worknig in collaboration at state level so that they can take the message further to the grassroots and trying to build their capacity.

AMFm initiative

I can't say categorically that the Affordable Medicined for Malaria Inititiative has failed because it has been documented through operations research that there has been a reduction in prices of ACTs.

Granted, there was a time there were challenges in the programme which might have probably delayed the supply of the drugs and disrupted the supply chain a little bit. But it has worked. If it didn't work, the Global Fund would not be interested in it any longer. That programme is on ground. One of the first line buyers recently told me he has placed an order for the drugs, and these drugs should be in the public domain. Give it another two months and do your research again.