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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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  • Volume 1

Poverty and Malaria : bedfellows?


It was pathetic watching little Kemi writhe in pain. Her body temperature was very high and she had lost her Iappetite for food. The mother, a pepper trader at Oje, a fruit and vegetable market in the centre of Ibadan city, had bought drugs from a patent medicine vendor (PMV) next to her stall to treat her daughter's fever.

Her  mother  could  not  understand  why  she  should  keep complaining of body aches with a temperature after the medicine  seller  had  said  her  ailment  was  malaria  and which she had treated with chloroquine.

It was with this thought that she took Kemi to a primary health  care  centre  where  the   medical  officer  in  charge asked that Kemi should take a different medication that she found too expensive.

“I had bought drugs worth over N200 and this new one you are asking me to buy for her is sold for N1, 500. This is rather too expensive. Are there no alternative medications that will do the same work of healing her? I am a trader and  do  not  even  make  enough  from  my  pepper  trade,” retorted Kemi's mother.

Kemi's mother is not the only one who faces this sought of predicament  by  making  a  choice  between  cheap  and expensive medications for the treatment of malaria. Years before the change in the Federal government's policy on malaria  treatment,  many  people  resorted  to  drugs  like chloroquine for the treatment of malaria. For a drug that is  readily  available  and  cheap,  it  is  the  choice  for  many people in the local communities.

However, it is not without its attendant problems. Unlike when it was initially introduced for malaria treatment, it has lost its potency in curing malaria. Above all, it has also compounded  the  issue  of  preventing  deaths  and disabilities that may arise when malaria becomes severe and deadly.

Ensuring  that  malaria  is  properly  treated  to  prevent  its recurrence  is  one  problem  that  Professor  Oladimeji Oladepo, a Public Health expert and Country Coordinator of  Future  System  (FHS),  an  international  research programme  consortium,  said  is  suggestive  of  a  national malaria  policy  that  was  formulated  by  a  top  to  bottom approach.

“Stakeholders at the Federal Government level, more on less,  dumped  the  policy  at  the  doorstep  of  the  common man.  Though  the  community  people  never  had  any substantial  role  to  play  in  its  formulation,  they  were, however, expected to embrace this policy and run along with it. It does not work,” says Prof. Oladepo, who doubles as Dean of Faculty of Public Health, University of Ibadan.

“The Artemisinin-Combination- Therapy (ACT) which is now the choice drug and is now being promoted is facing challenges  because  the  government  did  not  consider  its economic implications for the poor. They said ACT should be used for malaria treatment in the current policy. It is easy to say that, but if people at the community level had been  involved,  they  would  have  been  told  how  much  it costs to treat one episode of malaria. It is between N1500 and N2000. They would have been told it was not realistic and that would have led to thinking of a mechanism such as  subsiding  the  cost  of  this  medication  to  ensure  it works”, says Prof Oladepo.

According  to  Prof.  Oladepo  the  disconnection  between the  national  malaria  policy  and  what  is  going  on  in  the field, is a big problem.

“Through research we tried to find out what drug people used in malaria treatment. Many still use chloroquine, the same drug found not to be effective in malaria treatment because  it  is  almost  15  fold  cheaper  than  the  ACT, stipulated by the policy. In fact, 70 per cent of people who have fevers, symptomatic of malaria, will visit the patent medicine  vendor  first  and  they  would  want  to  buy chloroquine, the cheapest drug to treat the malaria”.

He  stated  that  people  who  use  chloroquine  are  likely  to have their malaria not cured.

So when they have malaria, it may now progress from the simple  malaria  to  the  severe  form  and  then  to  cerebral malaria.

“In cerebral malaria, seven out of 10, even with the best treatment, are likely to die. What this means is that poor people,  who  are  disproportionately  affected  in  the  first place  with  malaria  infection,  are  also  disappointedly affected  by  the  policy  in  terms  of  getting  effective treatment  because  of  poverty.  So  we  should  bring  out innovative  approaches  to  deal  with  that”.  Professor Oladepo asserts.

But what is the way out? First is the issue of training the patent  medicine  vendors,  the  most  common  and widespread drug suppliers at the community level, about combining  appropriate  malaria  treatment  and  the potential  role  of  insecticide  treated  nets  in  malaria preventions  based  on  the  fact  that  they  have  limited knowledge on malaria treatment.

Though  the  government  is  already  involved  in  the standardisation  of  malaria  medications  and  ensuring provisions  of  quality  anti  malarial  drugs,  Prof.  Oladepo says  another  important  step  would  involve  making  the patient  medicine  vendors  monitor  compliance  to  set standards.

“So part of what we want to do is to combine government regulation with patent medicine vendor's owned- internal regulatory mechanism for drugs. It works better than that of government and with PMV members playing a leading role,  their  members  will  comply  with  agreed  standards. We have actually gone far by actually discussing this with the PMV; in fact they have written letters stating that they want to see this type of regulatory partnership”. Oladepo says.  

Professor  Oladepo  says  that  using  information communication  technology  such  as  mobile  phones  to build  an  information  network  between  the  Ministry  of Health and other drug regulatory bodies can also ensure early notification of fake and substandard medications.

According to Oladepo, there is the need to translate the policy on malaria treatment into the three major Nigerian languages so that people can understand the policy better even if they are not involved in its development as well as to subsidise the cost of ACT to ensure that poor people can have their malaria properly cured.

Third Edition