·As WHO certifies Cabo Verde 3rd malaria-free African country
In 1973, when the World Health Organisation, WHO, certified Mauritius as the first African country to eliminate malaria, Nigeria was not in contention for certification.
That year, the first single comprehensive blueprint for global malaria control and elimination, the Global Malaria Eradication Programme, GMEP, was already at its peak.
The programme outlines a global strategy for malaria control to reduce the current burden sustain control as long as necessary, eliminate malaria over time country by country and develop research new tools and approaches to support global control and elimination efforts.
Although Nigeria was participating fully in the GMEP with the ambitious goal of complete eradication of malaria, the country's malaria parasite rate load (the number of people infected with malaria parasites) was high, exceeding 60 percent in some parts of the country.
Coupled with the challenges of insecticide resistance, logistical difficulties, and limited funding, among others, the effectiveness of the elimination programme was ultimately hampered.
The primary control measures utilised at that time for malaria included a combination of indoor residual spraying, IRS, with DDT and chloroquine prophylaxis, which ultimately proved inadequate to achieve sustained eradication goals set by GMEP.
Forty-six years later in 2019 when Algeria attained the same milestone, again Nigeria was not in contention. The malaria burden had decreased considerably but the country was still battling it as a significant public health concern.
The malaria parasite rate dropped to an estimated 27 percent, and mortality rates also declined, thanks to several factors, including increased funding and investment; expanded use of insecticide-treated bed nets (ITNs); the availability of artemisinin-based combination therapies (ACTs), etc.
In January 2024, Cabo Verde (The Republic of Cabo Verde) was certified by WHO as having eliminated malaria, and Nigeria is still off track. According to WHO, the Cabo Verde certification is a historic milestone for the fight against malaria in Africa and the world.
Cabo Verde successfully eliminated malaria after implementing a strategic malaria plan from 2009 to 2013, centered around expanded diagnosis, early and effective treatment plans, and increased surveillance and reporting of all malaria cases.
Certification by the WHO is attained only when a country has interrupted the local transmission of all human malaria parasites nationwide for at least three consecutive years, even as measures are in place to prevent a recurrence.
Worldwide 43 countries have been certified as malaria-free by the WHO. The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, "WHO's certification of Cabo Verde being malaria-free is testament to the power of strategic public health planning, collaboration, and sustained effort to protect and promote health."
The WHO Regional Director for Africa, Dr Matshidiso Moeti, noted, "Cabo Verde's achievement is a beacon of hope for the African Region and beyond. It demonstrates that with strong political will, effective policies, community engagement and multi-sectoral collaboration, malaria elimination is an achievable goal."
Despite committed elimination efforts, malaria has remained a major public health threat in Nigeria. As of January 2024, Nigeria recorded significant progress from previous years.
The malaria parasite rate further declined to an estimated 23 percent, with improved access to Insecticide-treated bed nets, ITNs, even as artemisinin-based combination therapies, ACTs, remain the cornerstone of malaria control.
Coupled with community engagement, there is increased local community involvement in malaria control and prevention efforts. However, challenges remain in the form of funding gaps, drug and insecticide resistance, as well as socioeconomic and environmental factors.
Despite increased investment in malaria control, resource limitation remains a significant obstacle. The emergence of resistance to antimalarial drugs and insecticides continues to pose a major threat.
Malaria remains a major public health concern. But there is hope. While complete eradication remains a long-term goal, the country's progress in recent years offers a glimmer of hope for a future with significantly reduced malaria cases and improved health outcomes.
Nigeria's fight against malaria requires continued commitment from the government, healthcare professionals, communities, and international partners.
It is believed that by emulating Cabo Verde's malaria elimination journey, Nigeria can accelerate its progress towards malaria elimination and contribute to the global vision of a malaria-free world.
Among the key lessons for Nigeria include the need for a strong political will and leadership. According to WHO, Cabo Verde demonstrated a high level of commitment and ownership of the malaria elimination agenda, allocating adequate resources and engaging with partners and stakeholders.
Nigeria must adopt effective policies and strategies like Cabo Verde did, in the form of a comprehensive and evidence-based national strategic plan for malaria elimination. This included clear goals, objectives, indicators, and targets. It also implemented effective interventions, such as vector control, case management, surveillance, and response.
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Just as Cabo Verde involved communities and civil society in the malaria elimination efforts, raising awareness, promoting behavior change, and mobilizing social support, Nigeria must initiate and sustain similar programmes. The role of the media, religious leaders, and local champions to advocate for malaria elimination, cannot be overstated.
Cabo Verde showed that multisectoral collaboration and coordination play a major role, hence fostering a strong partnership and coordination among various sectors, and partners is crucial.
Nigeria must also emulate the way Cabo Verde adapted its plans and strategies according to the changing epidemiological and operational context.
The place of innovation, such as using drones for vector surveillance and control, and the introduction of new tools, such as malaria vaccines, cannot be left out.
Research is essential for malaria elimination, as it can provide evidence and guidance for effective policies, strategies, and interventions to reduce malaria transmission and prevent its resurgence.
Research can also help to address the challenges and gaps in malaria elimination, such as developing and evaluating new tools and approaches, such as vaccines, drugs, diagnostics, vector control methods, and digital technologies.
