Nigeria was excluded from the malaria vaccine study because we lacked the necessary health infrastructure – Prof. Oyibo, director of the Malaria Research Center

Prof. Wellington Oyibo is Consultant Medical Parasitologist and Director of the Center for Malaria Diagnosis, Research, Capacity Building and Policy at Lagos University. In an interview with DAYO OJERINDE he talks about the fight against malaria in the country and the consequences of
newly approved malaria vaccine from the World Health Organization

why Is malaria so common in Nigeria?

In Nigeria, as in most parts of Africa, malaria has a long history. Remember that it was not easy for British colonial rulers before and after the merger of Nigeria. The country has the appropriate breeding conditions for the female Anopheles mosquitoes – the main vector of the disease. There are different species of the Anopheles mosquito in the different ecological zones of the country. It is important to note that these conditions are common in African countries and in other endemic countries outside of Africa. In particular, the temperature requirements for the development of the malaria parasites in mosquitoes determine the type of Plasmodium species occurring in countries. For example, the most feared form of the malaria parasite, Plasmodium falciparum, requires a relatively higher temperature to develop in the mosquito vector. To answer your question simply, I would say that our tropical environment is the main reason and is not common in Nigeria.

Where is malaria most common in Nigeria?

A few decades ago, the entire country had high levels of malaria, but over the past decade, based on population-based surveys of children under 59 months, we have seen a decrease in the prevalence of malaria in 2010, 2015 and 2018, with a prevalence of 42 per. record percent, 27 percent and 23 percent, respectively. The data also showed that the distribution of malaria varies from place to place, and you can have low exposure in one place and high exposure in the next, even in a state with generally low prevalence. Currently, the malaria burden in the state of Kebbi is the highest of any state in the country. Interestingly, in 1946, malaria in the Kebbi Axis was 93 percent. A similar burden was recorded in Ogun state, but a more drastic reduction was observed in Ogun state than in Kebbi state as of 2018. The National Malaria Elimination Program of the Federal Ministry of Health and Partners is currently conducting the Malaria Indicator Survey (MIS) 2021, from which new data on malaria will emerge by the end of the year or the beginning of next year.

Which organ is most affected by malaria?

Malaria can affect several organs in the body such as the brain and kidney, especially in severe cases in children, and these organs can shut down quickly and lead to death. Just the presence of the parasites in the blood cells triggers several symptoms and signs that can also trigger acute uncomplicated malaria and these can cause diseases in several dimensions. In pregnant women, malaria may not be symptomatic as the parasites prefer the placenta where it could affect the growing fetus and mother with serious health problems and this could be dangerous as the pregnant woman may not be sick but has the infection. The malaria pathogens can lead to spontaneous abortions, stillbirths, reduced fetal growth, low birth weight and severe anemia in the mother.

What happens if malaria is left untreated?

Untreated malaria can lead to death, but we have to distinguish between the infection and malaria as a disease. You can have an infection with no symptoms, but those with the disease need to be taken care of. Malaria can be straightforward or serious. Children with malaria who were not treated early could die. In children, malaria is treatable and it is recommended to have early diagnosis and prompt treatment.

How do you assess the fight against malaria in Nigeria?

I can say that we are making progress. However, the country is still in the control phase and a concerted effort is needed to reduce malaria transmission to pre-eradication levels and cooperation between all is essential to achieve this.

What are the current malaria statistics in Nigeria?

Lagos State currently has the lowest prevalence while Kebbi State has the highest.

The north-central zone of the country has the highest malaria prevalence in Nigeria and these also vary within states and local government areas and communities.

How can Nigeria win the war on malaria?

All should be involved in the application of the interventions through partnerships, because malaria is actually preventable. The government’s political will is also crucial. The commitment to use and invest in these interventions is vital as the government, especially the state government, should devote more resources to malaria control and eradication in their states. This is important because poor engagement can be frustrating and may not produce the results you want.

What do you think of the WHO’s newly approved malaria vaccine?

This is historic for malaria as it is the first malaria vaccine to be so approved. It is a step in the right direction so that we have an additional tool that can save lives and reduce morbidity and mortality in children. It is important to note that the WHO recommends a comprehensive package that includes vaccine, effective case management, the use of long-lasting insecticide nets (LLINs), indoor residue spraying, seasonal malaria chemoprevention in children especially in the north Using Preventive Therapy in Pregnant Women, Keeping the Environment Clean and Others. A strategic implementation of this comprehensive package in the country, in which all parties involved use social innovation, will have an impact.

Do you think the vaccine will help eradicate malaria?

The vaccine must be used as a complete package as described.

Aren’t you concerned that there weren’t any clinical trials conducted in Nigeria before the vaccine was approved?

Of course I was, regardless of the criteria used to select the countries. Nonetheless, I was delighted with the commitment of the founder of the Prince Ned Nwoko Foundation, Prince Ned Nwoko, who applied for and received government approval to coordinate the introduction of the malaria vaccine in Nigeria long before the current WHO recommendation. It is an exciting development that appropriate resources are being mobilized to expand interventions against malaria.

How long does the immunity that the malaria vaccine gives people last?

Remember that this vaccine is intended for children five months and older and there are four doses to continually boost immunity to the malaria parasite.

How effective are malaria tests in Nigeria? What are the gaps in the tests and what needs to be done to close these gaps?

Pre-treatment testing is the best method for effective malaria case management. However, many people still believe that all malaria-related symptoms should be treated for malaria. As a result, malaria is overdiagnosed and over-treated in the country. The diagnosis-to-treatment ratio is around 1: 3 or even 1: 4, with less than 40% of tests currently being done in Nigeria. Early diagnosis and prompt treatment are the current recommendation. Treatment based on symptoms and signs alone is not recommended.

Is It True That Malaria Cannot Be Treated?

Malaria is treatable and treatment should be based on a simple test that is now available.

Why wasn’t the clinical trial for the vaccine conducted in Nigeria? What does it say about our health system?

There are important health systems and infrastructures that should be in place but weren’t there. However, nothing prevents the country from negotiating these options. We have learned our lessons and I am confident that the country will do better.

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