Nigeria: Malaria Prevention Initiative Delivers Positive Results for Infants and Children in Katsina

Zulaihatu Musa, a 28-year-old mother of two, noticed that prior to 2021, she had witnessed fewer cases of malaria among her children and other babies in the compound where she lives with her family in the Rafindadi community of Katsina State, northwest Nigeria.

Hafsatu Ibrahim, another resident of the community, corroborates Zulaihat's account, stating that contrary to previous rainy seasons, there has been a decline in the number of reported malaria cases in the community.

Malaria is a significant health issue in Nigeria with 97% of the population at risk. The country also accounts for 27% of global malaria cases and 31% of malaria deaths, contributing to child morbidity and mortality with 95,000 children dying annually from the disease. Malaria-related deaths are further compounded as most families rely on out-of-pocket expenses for healthcare. Families with low income do not always have the money to purchase antimalarial drugs.

A 2021 study revealed the prevalence of malaria in children across Nigeria, with Katsina State recording 55.5% of children aged 6 to 59 months who tested positive for malaria through rapid diagnostic tests (RDTs).

To this effect, Management Sciences for Health (MSH), an international non-governmental organisation (NGO), began administering Sulfadoxine-Pyrimethamine with Amodiaquine (SPAQ), to children between 3 and 59 months across the 34 Local Government Areas (LGAs) of the state through the Seasonal Malaria Chemoprevention (SMC) campaign.

While there is an approved vaccine for malaria prevention in children living in endemic areas, a World Health Organization (WHO) expert committee recommends adding co-packaged amodiaquine with sulfadoxine + pyrimethamine to the Essential Medicine List for Children (EMLc). The recommendation aims to facilitate seasonal malaria chemoprevention in children, ensuring its safety and demonstrating its effectiveness in reducing clinical malaria episodes, severe malaria episodes, and mortality and anaemia rates while adhering to WHO malaria guidelines.

Zulaihat and Hafsatu are just two of many who have experienced the impact of the SMC campaign. "All my grandchildren and almost all the babies in the community have taken the malaria drug," Hafsatu said. "In the past, when it begins to rain, their bodies become hot with constant cries, and when they are taken to the hospital, healthcare personnel will say it is malaria. With this malaria drug that is given to babies in each household, our grandchildren rarely show those signs."

Reducing the burden

According to Isaac Adejo, the Project Director for the Global Malaria Fund at MSH, the target population is 2.5 million children every year since the commencement of the programme in 2021.

"Each year, MSH administers four cycles, each lasting a month," he noted. "Normally, it starts at the onset of rainy season, which in Katsina is usually around July."

According to Adejo, MSH uses metrological data to understand the right time to start administering the SPAQ medication and in Katsina, it usually begins in late June and sometimes early July. "There are four cycles in each month. What MSH does is ensure that the children's systems are saturated with SPAQ to prevent them from contracting malaria during the [rainy] period."

This is the fourth year of the intervention in Katsina, and health facilities have reported a reduction in the number of babies brought in with fever and malaria since the programme began.

Dr Emenyi Bassey, the Technical Officer of MSH in Katsina, noted that the non-profit has been in the state since 2018 implementing the Global Fund Malaria grant. He added that MSH has supported 1,028 health facilities in the state with malaria commodities that include insecticide-treated nets, and Artemisinin-based Combination Therapies (ACTs) in secondary health facilities. It also supports malaria prevention campaigns that happen every year.

Dr Bassey disclosed that they work with volunteers who distribute the SPAQ drugs to their communities. These volunteers are residents of the community who are paid a token by MSH to provide the malaria medications to households in their respective communities.

Reaching hard-to-reach areas in Katsina

The insecurity in Katsina has severely affected healthcare delivery, with many communities impacted by the activities of bandits. Adejo noted that MSH draws on existing structures, such as members of the communities who still reside there despite security concerns.

Labaran Muhammad, a leader in Rafindadi community, noted that "as community leaders, we understand how influential we are. Each year, when the distribution of the malaria drug for babies commences, we go from one house to another to inform community members that they should give it to their children. If we don't do that, there will be hesitancy. They trust us. They know that we will not promote what will harm them because we are also part of the community."

Muhammad pointed out that community gatherings and community mosques advocate for and encourage people to understand that the medicine is harmless and is meant to protect their children.

Some barriers

According to Adejo, their initiative is not without challenges. He observed that the level of education of some of the community volunteers is sometimes a problem. A volunteer is required to obtain at least a secondary school certificate, but they often struggle to find those whose educational qualifications satisfy the requirements.

There are cases where volunteers are unable to operate smartphones -- a major tool being used for data collection in the programme.

Adejo further explained that the funding is meant to complement government efforts by covering the operational costs of MSH. However, inflation and fluctuating prices are a significant challenge, as the budget allocated in one year may not be sufficient for the next, hampering long-term planning and implementation.

MSH is a grantee of Global Fund Malaria grant alongside Catholic Relief Service (CRS), Malaria Consortium, Society for Family Health (SFH), and the National Malaria Elimination Programme (NMEP).

Innovation and improvement

Since the successes of the initiative outweigh the challenges, other non-profits can learn from what MSH is doing such as its transparency. According to Adejo, when MSH started the programme, their data collection was paper based but has since been digitised.

Working with 18,000 volunteers every year in 34 LGAs of the state, Adejo stated that the data collection app is downloaded on their phones. "We teach them how to use [it] and we see [data added] in the backend even if there is a foul play."

The app uses geo-coordinates, "you enter the number of children you have given [the drug to], and it will take the geocoordinate of [the children's] house. If you stay under a tree, it will show that you are in one place putting 17 to 20 children, which cannot be in one house."

He added that they also use Google Earth to check where volunteers are working from. "This is an innovation that people who want to implement community-level interventions that involve a lot of personnel can borrow from," Adejo said.

He also advised others who intend to carry out such programmes to make it community-centred, because community members are more familiar with their communities which reduces hesitancy in accepting the SPAQ.

MSH's interventions extend to other states including Taraba, Delta, Adamawa, Ogun, Osun, Jigawa, Kaduna, Kano, Niger and Yobe State.

The original article appeared on Nigeria Health Watch.