For decades, malaria has been a major public health challenge in Nigeria, taking countless lives, draining family incomes, reducing productivity, and hindering national development.
Despite numerous interventions, including widespread distribution of mosquito nets, awareness campaigns, and free malaria treatment in some regions, the disease remains stubbornly persistent.
In recent years, treating malaria has become even tougher, and the rise in treatment failure rates now poses a major threat to public health security.
Understanding the underlying reasons why malaria has become harder to treat is critical to finding lasting solutions.
Nigeria must adopt proactive, scientifically sound, and community-driven measures to reclaim its fight against malaria and protect future generations.
Understanding the Malaria Burden in Nigeria
According to the World Health Organization (WHO) 2023 World Malaria Report, Nigeria accounts for about 27% of the global malaria cases and 31% of global malaria deaths, a staggering statistic that no other country matches.
Children under five years and pregnant women remain the most vulnerable groups. Malaria costs Nigeria an estimated N132 billion ($645 million) annually in treatment, prevention, and loss of productivity.
The disease thrives in tropical climates characterized by abundant rainfall, humidity, and poor drainage—conditions that unfortunately describe much of Nigeria. Despite strong national efforts such as the National Malaria Elimination Programme (NMEP), the disease remains highly endemic, and new barriers have made malaria even tougher to treat today than it was decades ago.
Why Malaria Has Become Harder to Treat in Nigeria
One of the major reasons malaria has become harder to treat is the rising threat of drug resistance. Drug resistance occurs when Plasmodium falciparum, the deadliest malaria parasite species, evolves and survives treatment, making standard drugs less effective. Historically, chloroquine was widely successful against malaria from the 1950s to the 1980s.
However, by the late 1980s, resistance to chloroquine had become rampant in Nigeria, forcing a shift in treatment strategies. Today, Artemisinin-based Combination Therapies (ACTs) are the recommended first-line treatment, but early signs of Artemisinin resistance have already been detected in parts of Africa, such as Rwanda and Uganda, raising alarms for Nigeria.
Parasites mutate when exposed to inadequate drug doses, allowing mutated parasites to survive treatments that once eradicated them.
For example, a patient in Lagos who purchases a fake or incomplete course of ACTs may unknowingly allow resistant parasites to thrive and spread in the community.
Another major barrier is the infiltration of poor-quality, fake, and substandard drugs into Nigerian markets.
According to a United Nations Office on Drugs and Crime (UNODC) report from 2020, over 122,000 children under five die yearly in Africa due to poor-quality antimalarials. Studies specific to Nigeria have found that 20–30% of antimalarial drugs in circulation are substandard, making them ineffective at curing infections.
The consequences are devastating: patients consume these fake medications, resulting in treatment failure, severe complications, and prolonged infections.
In 2022, the National Agency for Food and Drug Administration and Control (NAFDAC) seized thousands of cartons of counterfeit antimalarials in Onitsha, but many such drugs still find their way into the hands of unsuspecting Nigerians.
Climate change and environmental degradation have further exacerbated malaria transmission rates. Higher temperatures accelerate mosquito breeding cycles, leading to faster population growth and more frequent bites. Erratic rainfall patterns, often driven by global warming, create numerous stagnant water bodies that serve as perfect breeding grounds for mosquitoes. Additionally, rapid urbanization without proper planning in cities like Lagos, Port Harcourt, and Abuja has resulted in blocked drainage systems and expanded mosquito-friendly environments. A resident of Ibadan now faces mosquito bites throughout the year instead of just during the rainy season, thus facing an increased risk of malaria exposure year-round.
Misdiagnosis and self-medication also significantly contribute to the malaria crisis. In Nigeria, the culture of self-medication is deeply rooted. Many people assume that any fever or body weakness is malaria and proceed to buy drugs without a proper diagnosis. This behavior leads to wrong drug administration, misuse of effective medications, and delayed treatment of other serious illnesses like typhoid or dengue fever, which can have symptoms similar to malaria. Although Rapid Diagnostic Tests (RDTs) are cheap and effective, their usage remains low, especially among informal drug outlets.
For instance, Mr. Ade from Ogun State, experiencing fever and body aches, might visit a roadside chemist and buy malaria tablets without any diagnostic confirmation, even though his illness might be something entirely different, such as dengue fever.
Weak healthcare infrastructure further compounds the problem. Nigeria’s healthcare system suffers from a chronic shortage of medical professionals, with fewer than four doctors per 10,000 people according to WHO statistics, which is far below the recommended minimum.
Rural communities are particularly affected, as many villages lack functioning health centers, leaving millions dependent on traditional healers or unlicensed patent medicine vendors.
Even in urban areas where hospitals exist, facilities are often overwhelmed and understaffed, leading to delayed or rushed diagnoses. For example, in Kano State, patients often endure hours-long waits at public clinics, which encourages many to opt for self-medication at home instead.
Proactive Measures to Improve Malaria Treatment and Control
A critical first step toward reversing the situation is enhancing drug regulation and market surveillance. Nigeria must strengthen agencies like NAFDAC and the Standards Organisation of Nigeria (SON) by providing better funding, modern forensic laboratories, and advanced technologies to detect counterfeit medicines swiftly. Border controls must be tightened to prevent the importation of fake antimalarial drugs from neighboring countries, and pharmaceutical audits should become regular practices across pharmacies and patent medicine stores. A successful example can be drawn from India, where aggressive crackdowns on counterfeit drugs reduced fake malaria medicines by 50% within five years. Nigeria can replicate this success with determined efforts.
Mandatory testing before treatment should become the new national standard. Encouraging widespread use of RDTs can drastically reduce wrong diagnoses and inappropriate treatment. Policymakers must enforce regulations that require pharmacies, clinics, and hospitals to test patients before selling or administering antimalarials. Furthermore, RDTs should be heavily subsidized to ensure affordability for low-income Nigerians. Ethiopia’s implementation of mandatory RDT policies resulted in a 40% reduction in unnecessary malaria treatments, showcasing the potential impact of such a measure.
Massive public health campaigns must be launched and sustained to educate the population about malaria prevention and treatment.
Key messages should include the importance of getting tested before treatment, completing prescribed medication courses, sleeping under insecticide-treated nets, and draining stagnant water around homes.
Communication channels must be diversified, including radio, television, WhatsApp groups, TikTok influencers, religious gatherings, schools, marketplaces, and transport hubs.
Ghana’s national malaria awareness campaign, which partnered with popular musicians, led to a 60% increase in mosquito net usage among young people, indicating how creative campaigns can effectively reach target audiences.
Investment in research, vaccines, and the development of new treatments must become a priority. Nigeria must focus on developing indigenous treatments using local herbs while expanding into biotechnological research for malaria control.
The country must also expedite the rollout of the RTS, S vaccine for children aged six to twenty-four months, which has shown promising results elsewhere. Kenya’s pilot vaccination program demonstrated a 30% reduction in severe malaria hospitalizations, proving the vaccine’s life-saving potential.
Nigeria must invest in similar initiatives if it is to beat malaria permanently.
Expanding mosquito control efforts and promoting environmental sanitation are equally vital. Community-based efforts should be encouraged, with residents participating in regular environmental clean-up programs.
The government must implement city-wide fumigation projects every quarter and introduce technology-driven solutions like genetically modified mosquitoes that cannot transmit malaria.
Such technology has already been tested successfully in Burkina Faso. Dar es Salaam in Tanzania achieved a 60% reduction in malaria cases through consistent community clean-up efforts, showing that simple strategies can yield enormous results when carried out diligently.
Strengthening healthcare infrastructure remains fundamental. Nigeria must build more rural clinics equipped with the necessary tools to diagnose and treat malaria effectively.
Mobile clinics should be deployed to remote regions where building permanent facilities might take longer, ensuring that no community is left behind.
Additionally, training and deploying more health workers, particularly community health extension workers, will increase access to timely and quality malaria care.
Rwanda’s expansion of community health workers contributed to a 90% healthcare coverage rate and a substantial reduction in malaria deaths, offering Nigeria a strong model to emulate.
Global Comparisons: Lessons Nigeria Can Learn
Nigeria can draw valuable lessons from other countries that have significantly reduced their malaria burden.
Rwanda utilized community health workers and universal healthcare systems to reduce malaria deaths by 80%.
Ethiopia enforced mandatory malaria testing before treatment, which curtailed drug misuse and prevented unnecessary medication administration.
Vietnam successfully combined mosquito control efforts with the provision of free malaria treatment, leading to the near-elimination of malaria. Nigeria must tailor these approaches to its unique context, balancing national policies with grassroots initiatives to maximize success.
Malaria remains one of Nigeria’s greatest public health challenges, and its increasing difficulty to treat today is a serious warning sign. Drug resistance, fake medicines, climate change, self-medication, and weak healthcare infrastructure have all contributed to the growing crisis.
However, with strong government leadership, increased investment in healthcare and research, community-driven initiatives, stricter drug regulations, and aggressive public health education, Nigeria can regain ground in the battle against malaria.
Every Nigerian—from policymakers to parents to young children—has a role to play in combating this disease. Vigilance, collaboration, and sustained efforts are essential.
With the right strategies in place, Nigeria can move malaria from being a persistent health menace to a historical memory and finally deliver a healthier, stronger future for its people.
