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    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.


    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.


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ACT:Still a bitter pill to swallow

In Nigeria, the story of malaria is a mixture of misery and mystery. Every narration is a lamentation of woe, a recitation of grave repercussions and a distress call to action.

Nine in 10 persons are at risk in Nigeria which accounts for 25 percent of malaria cases in Africa.

Various interventions, including the WHO-recommended malaria treatment, artemisinin-based combination therapies (ACTs), being sold at affordable prices, are barely ameliorating the situation.

“I almost died of malaria,” recounts Oluwadamilola Agbajo, Miss Nigeria 2010. “I was in school that time, and I was so ill for a long time. I missed writing a very important examination due to that bout of malaria.”

This experience forever changed Oluwadamilola’s perspective about malaria. Today, she is Queen Ambassador of the Affordable Medicines Facility for malaria (AMFm) in Nigeria.

She recounts that her encounter with malaria was more as a result of late diagnosis than lack of access to efficacious drugs.

“My illness opened my eyes and I became really interested in treatment, prevention and management of this disease. I have been going to the internet to find out more on available research of a lasting malaria cure. I believe in the AMFm programme because it is appropriate.”

The Queen Ambassador expresses total willingness to support the Federal Ministry of Health of Nigeria in the AMFm initiative which debuted in Nigeria in November 2010.  It is directed at developing a major policy that would put in place a sustainable malaria treatment, control and prevention programme.

Oluwadamilola’s rendition echoes the typical Nigerian attitude to malaria infection, and even though not everyone is privileged to be appointed ambassador, it’s a safe bet every Nigerian knows malaria as much as malaria knows every Nigerian. Virtually everyone has a story to tell about this “ordinary” disease with extraordinary consequences.

Every 30 seconds, a Nigerian child dies from malaria; 30 per cent of childhood mortality and 11 per cent of maternal mortality in Nigeria are attributable to malaria. Just about every other person on the street has had at least one malaria attack at some point in the last six months.

The World Health organization (WHO) estimates that 50 percent of the adult population in Nigeria experiences at least one episode of malaria yearly while infants and small children have up to two to four attacks annually.

Many persons actually suffer multiple attacks in the same year. Infants, young children and pregnant women are particularly vulnerable to the malaria menace. The multiple indicator cluster survey (MICS) Nigeria conducted in 2010 showed that about 52 per cent of children aged six months to five years tested positive to malaria.

Despite significant progress in increasing awareness, malaria remains one of the greatest public health burdens in Nigeria. Every year the nation loses about N132 billion ($868.42 million) to malaria in man hours while the disease drops the nation’s annual Gross Domestic Product by one per cent.

Long ago, medical experts realized that the malaria parasite will continue to debilitate its victims due to increasing resistance to oldertreatments like chloroquine.

Currently, the WHO specifically recommends ACTs as the best treatment for uncomplicated malaria. ACTs have remained the gold standard in malaria treatment, and, essentially, their use at the community level has been vigorously promoted over the years since the emergence of chloroquine-resistant strains of the malaria parasite.

“AMFm will further accelerate our drive to ensure we have 50 per cent reduction in malaria by 2013,” Nigerian Minister of Health Prof Onyebuchi Chukwu, announced during the official kick-off in November 2010.

Eight countries - Tanzania, Kenya, Niger, Ghana, Madagascar, Uganda, Cambodia and Nigeria were selected to pilot the initiative. In Nigeria, as in the other countries, the AMFm is at the transition stage. Come 2014 the new model will commence but will not be limited to the eight countries which ran the pilot.

It is being implemented by the National Malaria Control Programme (NMCP), the Society for Family Health and the Yakubu Gowon Center with support from Clinton Health Access Initiative (CHAI).

Dr. Olusoji Adeyi, Director, AMFm Nigeria, explained that under Phase1 implemented over 24 months, eligible first line buyers placed orders for AMFm subsidised ACTs after completing the necessary Global Fund documentation.

The goal of the AMFm initiative is to increase the availability and affordability of ACTs through a subsidy of up to 95 percent of the manufacturer’s cost. It also seeks to promote the increased use of ACTs with price levels of about N75.00 ($0.49) for an adult dose.

The AMFm also intends to reduce the cost of ACTs to a level that is comparable with other anti-malarials.

There is also the objective to increase the market share of ACTs among antimalarials and also to increase its use among vulnerable groups such as poor people, rural communities and children.

While the AMFm remains an interesting model, so far, it appears effective only on paper. How much of its objectives have

been achieved is debatable. Some Nigerians do not naturally seek a clinician’s assistance at the onset of symptoms. They rather prefer self-medication.

People complain of the side effects of orthodox drugs and would rather settle for herbal remedy in malaria treatment.

Sometimes there is the problem of misdiagnosis and some cases of malaria are treated as typhoid.  

Argument has been that low cost ACTs would only be a reality if the public is fully aware of the programme, the effectiveness of ACTs and the fact that they are to be made affordable by retailers.  

The current picture is that Artesunate-Amodiaquine (AS/AQ) combinations and Artemether-Lumefantrine (AL) are still not widely available. Patients with uncomplicated malaria still do not have enough access to ACTs.

From this perspective, the goal of AMFm to eventually crowd out the ineffective medicines cannot be said to have materialized.  

Lillian Oguguo of the NMCP argues that for eligibility to supply ACTs under the AMFm, a manufacturer must meet criteria set out in the Global Fund’s Quality Assurance Policy. “In keeping with the AMFm objective of countering resistance to artemisinin, manufacturers committed to not marketing oral artemisinin monotherapies.

Under the signed agreement, the Global Fund mandates manufacturers to brand all AMFm ACT packages with a special logo of a green leaf with “ACTm” underneath.

Leslie Emegbuonye, Senior Malaria Analyst with CHAI describes the logo as a symbol of high quality and affordability.

However, in practice, it is a challenge obtaining the highly subsidized medicines at health facilities, pharmacies and chemist stores at the advertised shelf price of about N30.00 ($0.12) per dose for children and N75.00 ($0.49) for an adult dose.

A search at drug stores for ACT packs with the green leaf logo yielded little success.
Worse still, random sampling among buyers of malaria medicines showed there is limited public awareness about this requirement.

This is regardless of a nationwide awareness campaign for the AMFm brand by the implementers.

At inception in 2011, 43 importers were signed up to participate in making ACTs affordable and available across Nigeria. More than 20 million doses of ACTs were brought in for distribution through first line buyers in the public, private and not-for-profit institutions. Questions arise about what has become of the 43 importers as their drugs are hard to come by.

The cost of ACTs continues to escalate and there are questions about adherence to the aims and objectives of the AMFm initiative to increase provision of affordable ACTs through the public, private not-for-profit and private for-profit sectors.

There are questions about government really subsidizing the manufacturing cost of the drugs by facilitating increased use of ACTs.

Although ACTs account for some significant numbers of anti-malarial treatments, cost is still a major hindrance. On the average, ACTs cost N700- N1, 800 ($4.60 - $11.84), depending on the combination therapy and place of purchase. The patient also has other costs (laboratory test, consultation, hospital admission, etc.) to contend with.

The misconceptions about malaria do not help because required confirmatory laboratory tests are often ignored. Complaints of headache, weakness, fever, aches and pains, high body temperature and bitterness in the mouth are presumed to be malaria.

A simple loss of appetite, change in sleep pattern, nausea and vomiting are wrongly attributed to malaria and presumptive treatment commences, usually at home.

The truth is that in these parts, malaria treatment is quite expensive. For most Nigerians, this is a bitter pill to swallow.

More than two years after the introduction of AMFm, the bulk of Nigerians do not have access to cheap, effective ACTs. Access to cheap malaria drugs is still not a reality.

But all this is expected to change as the AMFM exits the pilot stage into the transition stage. However, expectations are high that, things will generally pick up after the transition stage, when the new AMFm model takes off with country specific grants to address their malaria problems using stakeholders of their choice.

- By Sola Ogundipe -Nigeria

Tenth Edition