Ahead of World Malaria Day coming up on Tuesday, April 25 2017, the long lasting insecticide treated mosquito net has been described as an effective way of preventing malaria cases. But interestingly, only one in four children in Nigeria sleeps under the mosquito net.
One of the major challenges confronting international malaria prevention agencies is the cultural resistance to using bed nets in communities, where people view nets as intrusive. There is also evidence that in some countries, more bed nets go to the rich than the poor. Health groups are devising strategies to encourage use of bed nets and ensuring they are distributed more equitably.
Treated mosquito net forms a protective barrier around people sleeping under it. The insecticide in it not only kills mosquitoes, which carry the malaria parasites and other insects, but also repels mosquitoes. With treated mosquito nets, the number of mosquitoes, as well as their life span, is reduced.
Malaria, the leading cause of death among children in Africa, could be eliminated, if the population used insecticide treated bed nets. According to experts, if 75 percent of the population in Nigeria were to use treated mosquito nets, malaria could be eliminated. Therefore, it is clear that educational campaigns around the use of bed nets must continue.
Dr. Sam Awolola, Head, Malaria Research Programme Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, said fight against malaria has been in existence over the years until year 2000, when Abuja declaration came in and malaria has been viewed from the economic angle, which has helped in reducing malaria infections in the country.
Awolola stated that children under five years and pregnant women are vulnerable to malaria infections; so, they should sleep under long-lasting treated mosquito nets and always try to buy nets at primary healthcare and pharmacy to avoid adulterated ones.
He said malaria has been over diagnosed over the years because every case of fever was taken as malaria, but malaria researchers now know better that not all cases of fever are malaria.
He said: “We have scaled up our interventions, which include distributing treated mosquito nets, which has been very wonderful. Over 70 million treated mosquito nets have distributed to Nigerians, but have they been used? And have they reduced the number of malaria cases in Nigeria? The answer is no, because people do not use the nets. We have distributed many rapid diagnoses test kits for malaria to enable us respond to treatment quickly. But will that alone lead us to reduction in malaria? The answer is no, because there are critical areas that need to be looked at holistically. So, government needs to encourage malaria researchers in term, of funding.
“Many people think eliminating mosquitoes would lead to reduction of malaria cases, but that is a wrong approach, as we do not need to eliminate all mosquitoes in the country. In most countries, where malaria has been eradicated as public health disease, mosquitoes are not eliminated totally. They only reduce the number of mosquitoes. These countries include Brazil, Europe, Italy and America, among others.
“Mosquitoes are very difficult to eliminate, because they have been in existence before human beings. So, it is not possible to eliminate mosquito totally, but we can only reduce them to the barest minimum.
“Government must encourage strategy together with milestone to measure success in the fight against malaria. For us to achieve success in fight against malaria there must be a robust plan and execution of the plan is also very important. When you have a plan, you have a team that is determined to support the plan; there must be financial support, including measures to determine if you have achieved the plan.
“Indoor insecticide spread is a key prevention method to countries that have eradicated malaria. Why is our government not investing in indoor insecticide spread? Today, we have a lot of unemployed youths. Government needs to invest in the youths for them to take the indoor spread exercise to the communities in the country on regular basis, maybe at every six month interval, as it would go a long way in reducing malaria.”
Awolola explained that NIMR is the only malaria research institute in Nigeria, adding that their finds show that if government wants to eradicate malaria, there must be serious investment in infrastructure and the people who will execute project trainings, capacity buildings and provision of medical facilities.
“There are local basic things needed to be done, apart from other preventive methods,” he explained. “Environmental sanitation is very important, because mosquitoes breed well in the environment, especially when the environment is dirty. Mosquito does not transmit only malaria infection, but there are other such infections as Zika virus, chikungunya virus, yellow fever and dengue fever, among others. All these are mosquito-transmitted diseases and we can avoid them, if our environment is clean.
“There is no country that could survive malaria without research to compare with other countries in Africa that put in more money into research, such as South Africa, Gambia, Kenya, Uganda and Malawi, among others. So, if there were a political will in Nigeria to fight malaria by year 2020, the country would be where it ought to be in terms of malaria elimination.
“People complain of hot weather because there is no electricity, which is the reason they do not use bed nets. So, government should encourage people by providing electricity. Again, some people believe that mosquito net does not conform to their tradition. For instance, some feel that after building a beautiful house, there is no need to put net on it.
“Again, there are lots of misconceptions and myths in the use of misquote nets. Some people believe the chemical on the net would affect their health. But I believe with more education, people may change, but electricity problem has not been solved, which is a major challenge.
“Most treated mosquito nets do not just go into the market; they must have been tested by World Health Organisation (WHO), before sending them into the market. So, the chemical has been tested for human use and it is very safe. This is not a guarantee that there would be no fake mosquito nets in the market because you see people selling nets on the street, which source we don’t know.
“This is a major challenge for most of us who are researchers in malaria treatment. Most of the fake mosquito nets do not have labels to show the company that manufactured them. So, people should go to primary healthcare and pharmacy close to them, whenever they want to buy genuine mosquitoes nets. But if you buy your mosquito net on the street, there is no doubt that it is fake one. I can assure you that genuine treated mosquito net can kill mosquitoes, cockroaches, scorpions, spiders and snakes, among others.”
Prof. Wellington Oyibo, Consultant Medical Parasitologist, and Director Research and Innovation Office, University of Lagos (UNILAG), Akoka, Lagos, noted that pregnant women should sleep under treated mosquito nets to avoid malaria infections, as well as go for antenatal care during pregnancy.
Oyibo said children can have pneumonia and other life-threatening diseases, that have the same symptoms with malaria, which is why people must conduct medical test before treatment of malaria, with micro scoping or rapid diagnosis test.
He said: “There is need for enlightenments because other things can cause fevers. If we continue to assume all fevers are malaria, it would cause a lot of harm. The same thing applies to heath workers, who treat and manage people with malaria down to all levels of health care. The same thing applies to the people on the street.
“Why do people assume all fever symptoms must be malaria? Now, things are beginning to change. Several years ago, when malaria was endemic, Nigeria was first among other endemic countries, which means 75 percent of children aged under five would have malaria. It was over 20 years ago, when we did not need laboratory tests, and one must be sure of every fever symptoms caused by malaria.
“During that period, Chloroquine was still efficacious, as one of the most affordable medicine ever seen in management of malaria. So, at that time, there was no need for laboratory tests because we were on the street. We had presumable treatments based on clinical symptoms of malaria, which was the norm, and it was simple to say all fevers were malaria.