MALARIA ENIGMA

Nigeria: Confab - Delegate Calls for Measures to Stop Men From Urinating in Open Places 26 May 2014 A delegate representing retired civil servants at the National Conference, Mrs Ebele Okeke, has called for measures to stop men from urinating in the open. Okeke, a former Head of Civil Service of the Federation, made the call on Monday as her contribution to the debate on the report of the Conference Committee on Environment. She said the act of men urinating in public was an eyesore and dangerous to the environment. Okeke also called for measures to stop open defecation as such act contributed to the spread of diseases. She condemned the situation where landlords built houses without making provision for toilets and so encouraged open defecation. "Nigeria is like a big toilet, where people defecate in open places. "This is due largely to the fact that landlords build houses without toilets and even where there are toilets, these toilets are converted to stores. "I, therefore, propose that open defecation be banned and men, particularly, should not come out of their houses to urinate," she said. Okeke called for the provision of potable water for all Nigerians irrespective of location, considering that the right to water was very important. She said Nigeria was one of the countries with the highest rate of infant mortality due to the lack of potable water which caused preventable diseases, such as cholera and diarrhoea ------------------------------------------------------------------------------------------------------------------------- Nigerian Scientists Wary of Anti-Malarial GM Mosquitoes By Adole Abutu, 19 May 2014 Abuja — A vast majority of Nigeria's scientists are sceptical about using genetically modified (GM) mosquitoes to tackle malaria in the country, a study suggests. Nearly 90 per cent of surveyed scientists were concerned that such mosquitoes could spread in an uncontrolled way beyond their release sites, while more than 94 per cent feared they could mate with other mosquito species to produce hybrids with unknown consequences, finds the study published in Malaria Journal last month (23 April). And almost 93 per cent of the scientists said that, before any GM mosquitoes (GMMs) were released in Nigeria, contingency measures must be available to remove them should a hazard become evident, according to the study. The male GM mosquitoes are designed to pass a lethal gene to the offspring of wild female mosquitoes they mate with, killing the progeny before they reach adulthood. The introduction of GM mosquitoes has been suggested by scientists as a way of controlling mosquito-borne diseases in countries such as Nigeria, which has the largest burden of malaria in Africa. Last month, Brazil approved the release of GM mosquitoes to control dengue fever, following trials in various countries. Nigeria's Malaria Eradication Programme encourages innovative ways of supporting current efforts to control malaria-spreading mosquitoes, although there are no clear plans to use GM mosquitoes there yet. The new study surveyed 164 scientists working in various disciplines in two states, Oyo and Kwara. Nigerian scientists want to be involved if GM mosquitoes are released, Patricia N. Okorie, lead author of the study and a researcher at the University of Ibadan, Nigeria, tells SciDev.Net. "The scientists are willing to encourage the use of GMMs if they are carried along during the process and if there are contingency measures to remove GMMs if a hazard becomes evident during the course of the release," she says. "This means that, if all these conditions are met and [so] the scientists are in support, any potential release in Nigeria will be backed with scientific arguments." She adds: "Nigerian scientists are knowledgeable on genetic modification and the applications of biotechnology, and our results show that over 90 per cent had heard or read about genetic modification. They are not ignorant on GMMs and will encourage its use if certain conditions are met." Okechukwu Chukwuekezie, chief medical officer at the National Arbovirus and Vector Research Centre, Nigeria, tells SciDev.Net that the GM mosquito research is worth undertaking, but adds that it is currently impossible to confine the mosquitoes in a particular location or state. Georgina Mwansat, an entomologist at the University of Jos, Nigeria, says that GM mosquitoes are an unsustainable way to cut malaria because Nigeria lacks the resources and facilities to deploy them. "So I am not surprised that most of the scientists interviewed are sceptical," she says. But she is not convinced that the study fairly reflects the views of the country's scientists. "164 scientists from two states out of 36 states is not enough to form an opinion on all of scientists in the country," she says. Link to full study in Malaria Journal References Malaria Journal doi: 10.1186/1475-2875-13-154 (2014) ------------------------------------------------------------------------------------------------------------------------- Nigeria: Malaria - Away From Depressing Statistics 28 April 2014 OUR governments adopt the easiest approaches to the malaria scourge - talk about it, prescribe more use of mosquito nets. Minister of Health, Professor Onyebuchi Chukwu, announced in 2012 that more than 90 per cent of Nigeria's population - about 150.3 million people - is at risk of malaria infection. The Minister summarised the malaria scourge hiding its devastation. "Malaria is a major public problem in Nigeria; Nigeria contributes a quarter of malaria burden in Africa. Over 90 per cent of the country's 167 million people are at risk. It contributes 30 per cent to childhood mortality in the country and contributes 11 per cent of maternal mortality. I must add that it reduces Nigeria's Gross Domestic Product by one per cent annually. It is estimated that malaria-related illnesses and mortality cost Africa's economy about $12 billion annually." How can malaria be this dangerous and we wait for April 26, the annual World Malaria Day, to advertise mosquito nets to Nigerians? The 2010 Malaria Indicator Survey Nigeria showed that about 52 per cent of children aged six months to five years tested positive to malaria. According to experts, if these children survive, their physical and mental growth would be adversely affected. A combination of malaria with poor nutrition ensures many of those children would have stunted growth and poor mental development. The 2013 World Malaria Report rates Nigeria as 100 per cent territory for malaria transmission. "The total private direct cost of treatment is N375.48 billion, total private direct protection cost is N446.07 billion and total private indirect cost is N1.4billion. The total cost of malaria illness in Nigeria was estimated to be about N2.23 trillion representing 7.3 percent of the GDP in 2011," a report in the 2013 Journal of Economics and Sustainable Development, by Nigeria's Olalekan Musa Salihu and Nurudeen Ayodeji Sanni, found. They recommended, "that government should expand the provision of free and highly subsidised insecticide treated mosquito nets." Dependence on foreign initiatives on malaria will not work. The World Health Organisation, WHO, formally proposed malaria eradication in 1955. Malaria is claiming more territories. With climate change, some parts of Europe and North America may breed the harmful mosquitoes. Malaria is not a global challenge. Nigeria bears a huge part of the malaria burden. Nigeria needs to commit resources to researches on malaria vaccine. Our Ministries of Environment should work with health authorities to institute practices that would free the environment of mosquito breeding grounds. The world's interest is more in selling mosquito nets and pharmaceuticals than in fighting malaria. Our governments should be more practically committed to eliminating malaria; reciting statistics, no matter how depressing, is an ineffective step. -------------------------------------------------------------------------------------- Nigeria: African Countries Adopt Controversial Deadly Chemical, DDT, for Malaria Treatment By Tobore Ovuorie, 17 July 2013 Related Topics Nigeria "Exposure to DDT at amounts that would be needed in malaria control might cause preterm birth and early weaning... " Amidst staggering mortality and morbidity rates due to malaria in the African continent, African Heads of State and Government have adopted the use of dichlorodiphenyltrichloroethane (DDT), a controversial chemical, as the means of eradicating malaria in the continent, This came after several debates which commenced Wednesday July 10 at a meeting of Health Ministers of various African countries; and continued at meetings of Ambassadors and members of the Permanent Representative Council of the African Union on July 12. The final decision for DDT adoption was arrived at after another round of debate on Tuesday July 16, during a meeting of the African heads of state and government, which ended same day. However, long before its adoption by African leaders, concerns have been raised about the negative impact of the chemical on the health of humans. DDT is a tasteless, colourless chemical that was successfully used in the second half of World War II to control malaria among civilians and troops. It was then regarded as a contact poison against several arthropods; hence, was also used as an agricultural insecticide, while its production and use skyrocketed. The use of the chemical was first questioned by an American biologist, Rachel Carson, who wrote about the environmental impacts of the indiscriminate spraying of DDT in the United States and questioned the logic of releasing large amounts of chemicals into the environment without fully understanding their effects on ecology or human health. The book, Silent Spring, published in 1962, suggested that DDT and other pesticides may cause cancer and that their agricultural use was a threat to wildlife and plants. Its publication birthed the environmental movement, and resulted in a large public outcry which eventually led to DDT being banned for agricultural use in the U.S. in 1972. More than 600,000 tonnes were applied in the U.S. before the 1972 ban. The chemical was subsequently banned for agricultural use worldwide under the Stockholm Convention, but its limited use in disease vector control continues till date, but remains controversial. Notwithstanding the controversies, 3314 tonnes were produced in 2009 for the control of malaria. In humans, medical researchers say it may affect health through genotoxicity or endocrine disruption. Genotoxicity involves the damage of the genetic information within a cell which then causes mutations, and which could lead to cancer. Further study results say it affects future generations of the primary affected person. Endocrine disruption on the other hand involves negative interference of the hormone system in humans. These disruptions, results of medical researches state, can cause cancerous tumors, birth defects, and other developmental disorders. This specifically, could lead to learning disabilities, severe attention deficit disorder, cognitive and brain development problems; deformations of the body (including limbs); breast cancer, prostate cancer, thyroid and other cancers; sexual development problems. Several African countries including Nigeria, however, argued that there were benefits in the use of the chemical. Nigeria, South Africa others approve Nigeria's Minister of Health, Prof. Onyebuchi Chukwu, during the Abuja meeting, emphasized that the World Health Organization has cleared use of DDT in countries where mosquitoes are resistant to other insecticide, noting that the manner of usage is what matters. "Some countries are using them. In the health sector, it's to be used indoors, not outdoors. It is the Agricultural sector that doesn't need DDT. We are not here for rhetorics but to seek the way forward and the summit and African Union is primarily for that purpose," he stated. Also, the South African representative reiterated that it is important for all African leaders to eliminate malaria in Africa, thus, queried why DDT comes under attack annually whenever it is raised as a means of eradicating malaria. "If we stop using it, we are sentencing our people to death. Every other continent used DDT to eradicate malaria, so why is our turn different in Africa?" He said that within five years, South African had a 600 per cent increase in malaria rate from 1996 when the country stopped using DDT. "We had no choice but revert to it. DDT must remain here until a more effective chemical is discovered. We want to emphasize that it must not be removed from our agreed agenda on how to eradicate malaria in Africa," he said. The Commissioner, Social Affairs of the African Union Commission, Mustapha Kaloko, called for the inclusion of DDT as the means of eradicating malaria in the region. He however noted that it is not to be generally used while food items must be covered and kept away and "only walls and ceilings are to be sprayed". "DDT will remain in the agenda as the major means for the eradication of malaria in the continent," he said. Consequently, all African leaders except Central African Republic which sent no delegate adopted the inclusion of DDT as the chemical to be used in eradicating malaria in the region. Though DDT has been adopted by the African leaders as the key to eradicating malaria in the continent, fear still lingers even in Nigeria as well as other African countries over its usage. Delegates who are against its usage were however scared of having their names in print when PREMIUM TIMES spoke to them. One of the Nigerian delegates, who was against DDT being adopted, told PREMIUM TIMES that "I want malaria eradicated but I am really scared about the negative impact this would have on the health of Africans. DDT is a renowned controversial chemical with grieve impact on health of mammals; and humans are at the worst receiving end." Other delegates from countries like the Republic of Chad and Mozambique equally shared same views as their Nigerian counterpart. Effects of DDT on human health Studies from the United States, Canada, and Sweden link DDT to diabetes; while the U.S. Environmental Protection Agency states that DDT exposure damages the reproductive system and reduces reproductive success in humans. These effects, the agency says, may cause developmental and reproductive toxicity. "Research has shown that exposure to DDT at amounts that would be needed in malaria control might cause preterm birth and early weaning ... toxicological evidence shows endocrine-disrupting properties; human data also indicate possible disruption in semen quality, menstruation, gestational length, and duration of lactation" The Lancet- a science journal also states. According to epidemiological studies on humans, exposure to DDT could also lead to premature birth and low birth weight, and may even harm a mother's ability to breast feed. Recently, other researchers from the United States, Canada, and Australia argued that these effects may increase infant deaths, thus, offsetting any anti-malarial benefits. A study carried out at the University of California, Berkeley, in 2006 indicated that children exposed while in the womb have a greater chance of development problems, while other studies have discovered that even low levels of DDT at birth are associated with decreased attention at infancy as well as decreased cognitive skills. In other related researches from around the globe, it was discovered that daughters of highly exposed women to this chemical may have more difficulty getting pregnant. This is called increased time to pregnancy, TTP, in medical parlance. Similarly, women who are exposed to the chemical in their first trimester of pregnancy (first three months) may have babies with retarded psychomotor development, while those who are unlucky could have a type of miscarriage called early pregnancy loss. Also, occupational exposure in agriculture and malaria control have also has been linked to neurological problems such as Parkinsons and asthma. More recent evidence from epidemiological studies, that is studies in human populations, indicate that DDT causes cancers of the liver, pancreas and breast, while contributing to leukemia, lymphoma and testicular cancer. DDT in the fight against malaria Amidst latest progress reports that malaria incidence has reduced by one-third in Africa, the preventable but killer disease remains a major public health challenge confronting the continent. As a result of this, public health officials rely on DDT to fight the disease due to its 'wonder working power'. In the 1950s and 1960s, WHO's anti-malaria campaign relied heavily on DDT and the results were promising, though temporary. Reviewing what went wrong, experts tied the resurgence of the disease to poor leadership, management and funding of malaria control programs; poverty; civil unrest; and increased irrigation. Like Nigeria's Minister of Health stated, the WHO in 2006, reversed a longstanding policy against DDT by recommending that it be used as an indoor pesticide in regions where malaria is a major problem. As of 2008, only 12 countries used DDT, including India and some Southern African states, as well as Namibia. With the African governments' adoption of the chemical on Tuesday in Abuja, the number is expected to rise. Effectiveness of DDT against malaria When it was first introduced in World War II, DDT was very effective in reducing malaria morbidity and mortality. The WHO's anti-malaria campaign, which consisted mostly of spraying DDT, was initially very successful as well. For example, in Sri Lanka, the program reduced cases from about three million per year before spraying to just 18 in 1963 and 29 in 1964. Thereafter, the program was halted to save money and malaria rebounded to 600,000 cases in 1968 and the first quarter of 1969. The country resumed DDT vector control but the mosquitoes had acquired resistance in the interim, hence, the country switching to malathion, which though more expensive, proved effective. Today, DDT remains on the WHO's list of pesticides. The world health body's policy has shifted from recommending it only in areas of seasonal or episodic transmission of malaria, to also advocating it in areas of continuous, intense transmission. South Africa is one country that continues to use DDT under WHO guidelines. In 1996, the country switched to alternative insecticides and malaria incidence increased dramatically. Returning to DDT and introducing new drugs brought malaria back under control. Making a case for the pesticide, Namibia's Minister of Health, Richard Kamwir, told PREMIUM TIMES that "DDT is effective against resistant mosquitoes. Mosquitoes avoid DDT-sprayed walls and this is what we used in my country. DDT is the best pesticide for malaria control as resistant mosquitoes avoid treated houses". He further argued that for the pesticide to be effective, at least 80 percent of houses in any vicinity must be sprayed if not, its effectiveness would be jeopardized. "People don't like DDT because of the lingering smell and stains on the walls, but I can confidently tell you that it worked for us" he added. When to use DDT Many global research experts however urge that alternatives be used instead of DDT. An epidemiologist, Brenda Eskenazi, said "We know DDT can save lives by repelling and killing disease-spreading mosquitoes. But evidence suggests that people living in areas where DDT is used are exposed to very high levels of the pesticide. The only published studies on health effects conducted in these populations have shown profound effects on male fertility. Clearly, more research is needed on the health of populations where indoor residual spraying is occurring, but in the meantime, DDT should really be the last resort against malaria rather than the first line of defense." Donor agencies against DDT usage At the moment, the African continent is largely dependent on donor agencies for most of her programmes, including malaria control. As a result of this, there are fears that the decision to use DDT may witness some challenges. It has been alleged that donor governments and agencies shy from funding DDT spraying, or make aid contingent upon not using DDT. According to a report in the British Medical Journal, use of DDT in Mozambique "was stopped several decades ago, because 80 percent of the country's health budget came from donor funds, and donors refused to allow the use of DDT." Before now, many countries had been under pressure from international health and environment agencies to give up DDT or face losing aid grants. Belize and Bolivia admitted to have given in to pressure on this issue from United States Agency for International Development, USAID. The USAID has been the focus of much criticism. But the agency is currently funding the use of DDT in some African countries, though it did not in the past. The Agency's website states that "USAID has never had a 'policy' as such either 'for' or 'against' DDT for IRS. The real change in the past two years (2006/07) has been a new interest and emphasis on the use of IRS in general - with DDT or any other insecticide - as an effective malaria prevention strategy in tropical Africa." The website further explains that in many cases, alternative malaria control measures were judged to be more cost-effective that DDT spraying, and so were funded instead. The way forward A WHO study released in January 2008 found that mass distribution of insecticide-treated mosquito nets and artemisinin-based drugs cut malaria deaths in half in Rwanda and Ethiopia- two countries with high malaria burdens. DDT, the study states, did not play an important role in mortality reduction in these countries. Vietnam as well has enjoyed declining malaria cases and a 97 percent mortality reduction after switching in 1991 from a poorly funded DDT-based campaign, to a program based on prompt treatment, bed nets, and pyrethroid group insecticides. A review of 14 studies on the subject in sub-Saharan Africa, covering insecticide-treated nets, residual spraying, chemoprophylaxis for children, chemoprophylaxis or intermittent treatment for pregnant women, a hypothetical vaccine, and changing front-line drug treatment, found decision making limited by the gross lack of information on the costs and effects of many interventions, the very small number of cost-effectiveness analyses available, the lack of evidence on the costs and effects of packages of measures, and the problems in generalizing or comparing studies that relate to specific settings and use different methodologies and outcome measures. The two cost-effectiveness estimates of DDT residual spraying examined were not found to provide an accurate estimate of the cost-effectiveness of DDT spraying; furthermore, the resulting estimates may not be good predictors of cost-effectiveness in current programs. However, a study in Thailand found the cost per malaria case prevented of DDT spraying ($1.87 US) to be 21 per cent greater than the cost per case prevented of lambda-cyhalothrin-treated nets ($1.54 US). Thus, casting some doubt on the unexamined assumption that DDT was the most cost-effective measure to use in all cases. The director of Mexico's malaria control program found similar results, declaring that it is 25 percent cheaper for Mexico to spray a house with synthetic pyrethroids than with DDT. However, another study in South Africa found generally lower costs for DDT spraying than for nets. A comparison of four successful programs against malaria in Brazil, India, Eritrea, and Vietnam does not endorse any single strategy but instead states, "Common success factors included conducive country conditions, a targeted technical approach using a package of effective tools, data-driven decision-making, active leadership at all levels of government, involvement of communities, decentralized implementation and control of finances, skilled technical and managerial capacity at national and sub-national levels, hands-on technical and programmatic support from partner agencies, and sufficient and flexible financing. -------------------------------------------------------------------------------------- Nigeria: Reject Antimalarials, Antibiotics Without MAS Technology - NAFDAC DG By Sola Ogundipe, 10 September 2013 Related Topics Nigeria AS the SEPTEMBER 1, 2013 deadline elapsed for pharmaceutical companies to fully comply with utilisation of the Mobile Authentication Service, MAS, technology on their regulated products, the National Agency for Food and Drug Administration and Control, NAFDAC, has urged Nigerians not to accept antimalarials and antibiotics without the MAS code on their packs. Making the call in Lagos during the official launch of the MAS-embedded Postinor 2 - the foremost brand of Emergency Contraceptives, ECs, in Nigeria, Director General, NAFDAC, Dr. Paul Orhii, said the Agency has commenced enforcement of the mandatory use of the coding technology. He noted that it was in the bid to checkmate the antics of counterfeiters and producers of fake Postinor 2 that NAFDAC, in collaboration with the Society for Family Health, SFH, Nigeria, have embedded the product with the MAS coding. "The health system is compromised by fake drugs with low active ingredients. With this MAS we have put power of detection into the hand of more than 80 million Nigerians who use cell phones. It has been tested and there is proof it works," said Orhii, with a warning there would be no further extension of the deadline in order to effectively counter activities of fakers of regulated drug products in the country. "From this September, we are requiring that every antimalarial and antibiotic drugs that are being used in Nigeria must carry the MAS coding technology. Nigerians must go ahead and reject every antimalarial and antibioltic that does not have this technology on it right now. "We have given enough time. Initially we said the deadline was January 1, 2013, but moved the date because the companies pleaded for more time, but now we cannot move any longer. From now on we will start enforcement activities and wipe out every antimalarial and antibiotic that is not MAS-enabled off the shelves," he asserted. It will be recalled that NAFDAC first introduced the MAS in 2011. It is a technology that enables consumers in Nigeria to confirm the authenticity of a drug through a mobile phone by typing a unique 10-digit number hidden under a scratch off panel that comes with the pack of every MAS-enabled drug product and sending as SMS to 38353. In a few seconds the consumer receives an SMS confirming whether the drug has been approved by NAFDAC. It also confirms the NAFDAC registration number on the product, the manufacturing company and its address, the batch number, date of expiry and a number to call to report any problem. Orhii, who lamented that in recent times, Postinor 2 had fallen victim to the malicious pranks of counterfeiters of pharmaceutical products causing adverse effects, putting lives at risk and discrediting the product, said the UN identifies Emergency Contraceptives as one of the 13 affordable and effective life-saving commodities under reproductive health. They assist women who may have had unprotected sex to prevent unplanned pregnancy. "Soon after the launch of the 'Saving One Million Lives' initiative by President Goodluck Jonathan in Abuja in 2012, there was a surge in the faking of this product, Postinor2. We arrested many of the perpetrators who were trying to manufacture it locally, but they switched to bringing in the packaging materials, knowing that NAFDAC does not regulate packaging materials. This is the new trend." The DG, however, said NAFDAC came up with the MAS as a way of stopping the ugly trend. "If a user scratches and is inable to authenticate the product, immediately we would know something is wrong. Now anyone can report and we would know exactly where the problem is. Lamenting the challenge of tackling the new trend of drug faking and counterfeiting in the country, Orhii said NAFDAC has been continuously looking for ways of stopping the trend. Describing counterfeiting as a global problem, he said globally there are no laws and restrictions to punish offenders. Nigeria is one of the few countries that have secured prosecution. Speaking on introduction of the MAS coding for Postinor 2, Enterprise Funds Manager, SFH, Mr. Obinna Nwogu, said the company has gone ahead to ensure that Postinor II has a MAS code so that end users will scratch the product and send a free SMS to the number, whereupon a response is received to verify whether the product is real or fake. In his view, Managing Director, SFH, Nigeria, Mr Bright Ekweremadu described MAS coding for Postinor 2 as "a giant step in strengthening trust and a great show of positive consideration to all users of the product." Emergency contraceptives assist women who may not have used a contraceptive during sex to prevent unplanned pregnancy. It is also very important in cases of rape and in conflict prone situations where regular contraceptives are unavailable or inaccessible. Nigerian Medical Experts Applaud Investigational Malaria Vaccine By Sola Ogundipe and Chioma Obinna, 13 August 2013 Related Topics Nigeria NIGERIAN medical professionals have applauded the early-stage clinical evaluation of an investigational malaria vaccine known as the PfSPZ Vaccine, conducted by researchers at the National Institute of Allergy and Infectious Diseases, NIAID, part of the National Institutes of Health. In a report published last week in Science - a scientific journal, announcing the phase 1 trial of the vaccine, researchers observed that from preliminary studies, the vaccine had been found to be safe, to generate an immune system response, and to offer protection against malaria infection in healthy adults. An additional tool Reacting to the development, National Coordinator, National Malaria Control Programme, NMCP, Dr Nnenna Ezeigwe, described it as a welcome development. "The news is welcome as are other vaccine projects that are going on at various stages of trial. The process for this one is just starting and if it is to be pursued, will take 8-10 years for it to come to be. "The first in line and closest at hand known as RTS,S is at the final stage of testing and if everything goes right, that one should be able to come into use in 2015. That one is undergoing the last stage of trial which is the phase 3. Nigeria is one of the countries where the final stages of the trial are being carried out. The centres are in Jos and Enugu." She said:"If the results of the trial for RTS,S continue to show green light, if things continue the way we are expecting, by 2015, that vaccine should be recommended for use by the World Health Organization, WHO. "The new product that we are talking about has simply shown some promise worth exploring further and would take a long time to come into fruition if all continue to go well. However when this or other vaccine comes into effect, we are going to use it in addition to what we are already doing in malaria control. Further, she said: "This is just the beginning for the new product as far as the process for a vaccine is concerned. If at the third stage it is proven to be 100 percent protective, other issues may have to be considered such as costs and other things. Based on several considerations a decision has to be made whether we can use the vaccine or stick to other measures. But the important thing is that we have an additional tool to our arsenal. "We would not stop doing what we are doing currently to prevent malaria, including use of long lasting insecticide treated bed nets, prompt diagnosis and appropriate treatment, intermittent prevention in pregnant women, environmental and other measures. "That is the message to take from this. Everyone is excited, I am excited too because there are already 20 vaccines in line, including this one. If the ones we think would be successful prove not to be so, we would be hopeful that the others might be okay, knowing that we have others to assess. It is something to be happy about, I am happy about it but it does not mean we should go to sleep. Invest in indigenous vaccines Applauding the feat with a commendation of the team of researchers from the NIAID, President of the Nigerian Medical Association, NMA, Dr. Osahon Enebulele, called for more research into development of indigenous vaccines. "We strongly call on Nigerian governments at all levels, to invest more in the search for an indigenous malaria vaccine in Nigeria that can protect against other strains of the malaria parasite, besides Plasmodium falciparum. "We also urge scientists and researchers in Africa, and Nigeria in particular to advance the study by replicating it in the various scientific research institutes in Nigeria." Enebulele, who is also Vice President of the Commonwealth Medical Association, observed that the NMA is particularly excited by the outcome of the Phase 1 clinical trial on account of the fact that it offers great hope to the African region where malaria is pre-eminently endemic. "As we await the outcome of further clinical trials of the vaccine candidate, the NMA strongly advises great caution in the interpretation of the research finding as more field studies using a larger number of study subjects need to be conducted in order to validate the effectiveness of the vaccine and the duration of the malaria protective period. "Similarly, we advise that other on-going research efforts to develop other vaccine candidates (about 20 vaccine candidates at various clinical trial stages) should be stepped up. ------------------------------------------------------------------------------------- Africa: President Jonathan Urges Leaders to Find Local Solutions to HIV/Aids By Patrick Ugeh and Muhammad Bello, 16 July 2013 More on This Nigeria Hosts AU Health Summit Stigma remains a major problem President Goodluck Jonathan Monday appealed to his African colleagues to exploit local means of tackling not only HIV but also tuberculosis, malaria and other related infectious diseases. Jonathan made the appeal in Abuja at the opening of the Abuja+12, Special Summit of the African Union (AU) on HIV/AIDS, tuberculosis and malaria. The two-day summit with the theme, "Ownership, Accountability and Sustainability to HIV/AIDS, Tuberculosis and Malaria Response in Africa: Past, Present and Future", is being attended by most African leaders. Also at the occasion, United Nations Secretary-General, Mr. Ban Ki-Moon, stressed the need for Africa to maintain its momentum in the fight against the HIV/AIDS epidemic, saying slowing down of the tempo would reverse the progress already made. Jonathan, in his speech, urged African leaders to de-emphasise reliance on external funding and importation of essential medicines for the treatment of the diseases. "We must stand in solidarity with one another, be proactive to our health challenges and increase inter-continental scientific research partnerships and development efforts to complement the various national and regional plans already underway. "Ownership and sustainability should form the basis of our next plan of actions. Our goal should be to find local solutions to our challenges, translate planning into implementation and develop our continent at the pace we desire," he said. To realise the laudable goals, Jonathan added that the leaders must show commitments by increased funding and synergy between government and other stakeholders. Stressing that the HIV/AIDS and the other infectious diseases remain the major causes of morbidity and mortality in Africa, Jonathan said: "For too long, political instability, insecurity and infectious diseases have beclouded our efforts at rapid development and effective optimisation of the abundant potential of our continent. "However, today there is renewed hope that together and with homegrown initiatives, we can systematically and comprehensively address these tough challenges. "Our people are anxious for tangible results and concrete action to improve the quality of life. As we look forward to a productive summit, meeting the needs of our people by achieving these goals should be our collective resolve." AU Commission Chairperson, Nkosazana Dlamini-Zuma, who spoke in a similar tone, said HIV/AIDS and the other infectious diseases had posed challenges to the socio-economic development of Africa. According to her, the annual rate of infection of HIV/AIDS has fallen by 25 per cent, while death rate has reduced by 32 per cent since the Abuja Declaration of 2011. She added that from 2001 to date, more than 30 million people have received tuberculosis treatment while malaria infection has reduced by one third. In his contribution, Ki-Moon stressed the need for Africa to maintain its momentum in the fight against the dreaded HIV/AIDS epidemic so as not to reverse the progress already made. According to him, despite all efforts, HIV/AIDS, tuberculosis, malaria and other infectious diseases still pose a significant threat to the wellbeing and development of sub-Saharan Africa. Represented by Executive Director of UNFPA, Prof. Babatunde Osotimehin, Ki-Moon said African leaders should show more political commitments to the fight against the diseases. "Every minute, a child dies of malaria, one in 20 adults lives with HIV, TB infection rates are highest in the world, with more than 260 cases per 100,000 people in 2011, while many Africans endure the double burden of HIV and TB. "This summit can provide a tipping point in Africa's progress on health. Let us place AIDS, tuberculosis and malaria at the centre of public health policy," he added. AU Chairman and Ethiopia's Prime Minister, Hailemariam Desalegn, said the main objective of the summit as reflected in the theme, was to allow participants to review achievements and challenges in managing the diseases. Citing a report jointly prepared by AU, UNDP and Africa Development Bank, he said: "For instance, about 22 countries in sub-Saharan Africa have reduced new HIV infections by more than 25 per cent and made considerable reduction in AIDS' mortality. In fact, some African countries, including Ethiopia, have reduced the incidence of HIV/AIDS infection by more than 50 per cent." ------------------------------------------------------------------------------------ Nigeria: New HIV Treatment Format Launched By Tobore Ovuorie, 13 July 2013 More on This Nigeria Hosts AU Health Summit Stigma remains a major problem With about 900 days left to the deadline of the 2015 target on antiretroviral access, the Joint United Nations Programme on HIV/AIDS, UNAIDS, has launched a new framework which seeks to help no fewer than 15 million people living with HIV access antiretroviral treatment by the targeted year. United Nations Member States had in 2011 set a target that by 2015, no fewer than 15million Africans living with the virus would have complete access to antiretroviral drugs. Speaking during the launch of the framework titled 'Treatment 2015', at the ongoing African Union Summit in Abuja, Michel Sidibe, Executive Director, UNAIDS disclosed that it offers countries and partners both practical and innovative ways to increase the number of people accessing antiretroviral medicines. According to him, these medicines will not only enable people living with the virus live longer and healthier lives; they will also help prevent new HIV infections. "Reaching the 2015 target will be a critical milestone. Countries and partners need to urgently and strategically invest resources and efforts to ensure that everyone has access to HIV prevention and treatment services," he said. The new framework, the UNAIDS helmsman disclosed, would encourage countries to enhance public health programmes and leverage services provided by civil society and community based groups. The treatment outlines that community health workers have the capacity to provide almost 40 per cent of HIV service-related tasks; while HIV testing and treatment services should be decentralised to promote easier access. According to Eric Goosby, the United States Global AIDS coordinator, the treatment is coming at a crucial time when scaling up access to antiretroviral treatment is critical to achieving an AIDS-free generation. The new treatment, which has been through several processing by key stakeholders, UNAIDS revealed, was formulated alongside the World Health Organization's, WHO, new consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. The guideline was released on June 30 and recommends that people living with HIV start antiretroviral therapy, ART, when the CD4 Count is still at 500. CD4 count are the cells attacked by the virus. Margaret Chan, Director-General of WHO, had reiterated the importance of the new regimen, stating that "maintaining this momentum will require earlier treatment and innovative ways for enabling more people to take the medicine such as the one-pill daily regimen recommended by the new WHO guideline." "Substantial further scale-up of access to these medicines provides us with a unique opportunity to push this epidemic into irreversible decline," she added. It also underscores the need to ensure that underserved key populations have equitable access to HIV testing and treatment services. The new treatment framework further emphasizes the importance of HIV testing and counselling as a gateway to expanding access to antiretroviral therapy while noting that more efforts are required to normalize HIV testing. "It highlights that community testing campaigns have proven to be particularly effective in Kenya, Malawi, South Africa, Uganda, Tanzania and Zambia. "We have to work hard to defeat HIV and end it as a public health threat and it will require concerted effort from all partners to get there," Mr. Sidibe added. At the moment, 30 countries still account for 9 out of 10people who are supposed to be on antiretroviral therapy but have no access. These countries are Angola, Brazil, China, Cameroon, Central African Republic, Chad, Colombia, Cote d'Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana and India. Others are Indonesia, Kenya, Lesotho, Malawi, Mozambique, Myanmar, Nigeria, Russian Federation, South Africa, South Sudan, Thailand, Togo, Uganda, Ukraine, Tanzania, Viet Nam, Zambia and Zimbabwe. The Treatment 2015, however, stresses that intensive focus on scaling up HIV services in these 30 countries would have significant impact in the world in general. The framework also calls on all countries to use the best available data to identify key geopolitical settings and populations with high HIV prevalence and disproportionate unmet need for antiretroviral therapy. ------------------------------------------------------------------------------------ Nigeria: Special AU Summit On HIV/Aids, Tuberculosis, Malaria Opens in Abuja By Sola Ogundipe, 15 July 2013 Related Topics AIDS The Federal Capital Territory, FCT, Abuja, comes alive today as President Goodluck Jonathan hosts the Special Summit of the African Union on HIV/AIDS, Tuberculosis and Malaria, with the theme: "Ownership, Accountability and Sustainability of HIV/AIDS, Tuberculosis and Malaria Response in Africa: Past, Present and the Future". As early as 6.30am, delegates began trooping into the International Conference Centre (ICC), where the African Union in collaboration with the Nigerian Government is hosting the continent. Among objectives of the Special Summit is leveraging on the opportunity to review and identify factors that underpin the persistent burden of HIV, TB and Malaria on the continent, as well as, the status of health financing on the continent while committing the African leaders to the implementation of innovative and sustainable health financing initiatives. The Summit will among others, articulate Africa's position to project health at the core of development in relevant global forums especially the ongoing dialogue on defining the post 2015 development agenda. Key participants at this important meeting include national delegates from the Presidency, Ministries of Health, Finance and Economic Planning, as well as National AIDS Councils, Malaria and TB Control Programmes and Maternal Newborn and Child Health Programmes. Others are Civil Society Organizations, Regional Health Organisations, Regional Economic Communities, the UN and its Specialised Agencies; Development Partners; the AU Commission and other AU Organs and Programmes; Representative of the Private Sector and representatives of professional bodies among others. ------------------------------------------------------------------------------------ Nigeria: Seeking an End to Malaria Scourge By Steve Dada And Patrick Ugeh, 2 May 2013 Nigeria To mark the World Malaria Day, the United Nations Children Education Fund (UNICEF), Federal Ministry of Health and other stakeholders reiterated commitment to the fight against malaria through public enlightenment, Steve Dada and Patrick Ugeh writes Malaria is still a major problem in Sub-Saharan Africa, where pregnant mothers and children are in the vulnerable group. Globally, UNICEF says no fewer than 600,000 people are killed by malaria every year, which is the reason why all hands must be on deck to ensure that deaths from the disease are reduced to the barest minimum. As part of efforts to contain the increasing scourge of malaria on the populace, the World Health Organization (WHO) set April 25th of every year apart as a day of public awareness. UNICEF's Director of Programmes, Mr. Nicholas Alipui noted that malaria still kills 660,000 people every year, most of whom are children from Africa. He said the universal coverage of insecticide-treated bed nets is key towards making gains against malaria, which remains one of the largest killers of children in the world. He explained that with partners, UNICEF champions and supports governments to undertake the free distribution of insecticide-treated nets, especially long-lasting insecticidal nets. "When universal coverage - one net for every two people - is reached this simple, effective barrier can reduce child mortality by up to 20 per cent," he said. Until recently, limited competition among producers meant that they were too expensive to scale up. However, by 2010, bulk buying, joint procurement, better financing and extending manufacturing capacity into Africa meant that this number had increased to 145 million. A sustained, driven focus on high coverage with this very effective anti-malaria intervention contributed greatly to the 1.1 million lives that have been saved and a one-third decline in African malaria mortality rates that have been recorded since 2000. "It is unacceptable that every day more than 1,500 children still die from a preventable and curable disease. "We must distribute insecticide-treated nets to all who need them, provide timely testing for children and appropriate medicine when they are infected," Alipui said. According to him, a three-day treatment will cure malaria infections, especially if an episode is diagnosed early enough and treated appropriately in particular with artemisinin-based combination therapies (ACTs). "But many children, especially in Africa, still die from malaria as they do not sleep under insecticide-treated bed nets and are unable to access life-saving treatment within 24 hours of the onset of symptoms," he stated. The global agency supports national efforts to train and provide community health workers with simple tools such as malaria rapid diagnostic tests so that children receive medicine quickly when needed. However, in Africa the proportion of treated children who receive a first-line treatment such as an ACT is less than 30 percent in most countries. Alipui added that with governments, donors and other partners, UNICEF also looks for innovative ways to reach the most vulnerable and hardest to reach children in pursuit of universal coverage. For example, in addition to free net distributions during mass campaigns in the poorest and most remote areas, nets are also provided to children during routine immunizations and to pregnant women during ante-natal check-ups. UNICEF is also stepping up its efforts on integrated community case management, which brings a package of life-saving interventions closer to children, families and homes," It is estimated that enough nets were delivered over the last decade to cover 80 per cent of requirements in Sub-Saharan Africa. Many nets however are reaching the end of their useful life and must be replaced. Countries that had already reduced their malaria burdens by up to 50 per cent can quickly detect increased cases and deaths due to malaria if old, worn-out nets are not replaced. From 2000 to 2010, the proportion of children sleeping under an insecticide-treated net in sub-Saharan Africa grew from less than 5 per cent to over a third. But global procurement of long-lasting lasting insecticidal nets has dropped by 52 per cent against an annual target requirement of 150 million. Such a slowdown risks gravely undermining the gains to date. "We have made considerable progress in this fight, but cannot take our eyes off the goal of reducing malaria cases and deaths to zero. We must make sure that countries have the funding they need for malaria control and use it to protect their children and expectant mothers," Mr. Alipui added. Fighting malaria not only saves the lives of children, but also yields many other health and economic benefits for affected communities. For example, reducing malaria improves the health of pregnant mothers and therefore their newborn babies, reduces school and work absenteeism. Eliminating malaria reduces the burden on over-stretched health centres. It is estimated there is a 40-fold return for every US$1 spent controlling malaria in Africa. There have been impressive gains and successes built on strong partnerships and the generous contributions of many donors - but these gains can be quickly lost if sustained focus and investments are not maintained. The health minister Professor Onyebuchi Chukwu has said that the government has distributed over 52 million insecticide-treated nets to all the 36 states of the federation and the Federal Capital Territory (FCT), adding that other methods of malaria control such as indoor residual spraying and larval source management should be supported. The minister said that the federal ministry of health is facing a major challenge with the supply chain management of commodities for the three diseases and called for the inclusion of operational costs in the procurement of the commodities. He said with over 97 per cent of Nigerians at risk of malaria, it remains a major public health problem in Nigeria. Prof. Chukwu said should the decisions reached by African Ministers of Health be fully implemented, malaria could be a thing of the past in the country by next year. In speech to mark the World Malaria Day, Chukwu disclosed that to help Nigeria end malaria, the World Health Organisation had approved the use of insecticide, DDT, which he said was used in America to stop the malaria disease. He however said to achieve the malaria-free environment, citizens must play their part by keeping their surroundings clear of weeds and drains free of stagnant water. A not for profit organisation, Family Care Association has called for continued funding for the eradication of Malaria in the country in order that the objectives behind the Roll Back Malaria initiatives and the Nigerian Malaria Control and Prevention Programme is achieved. The objectives of the twin programme are in line with the Millennium Development Goals 2015 which aim to reduce death via Malaria to near-zero. The National Programme Director of Family Care Association (FCA) Joshua Kempeneer made the statement in Lagos during the flag off of the Lagos leg of the activities to mark the 2013 edition of the World Malaria Day with free screening and free treatment of malaria cases using Artemisinin-based combination therapy (ACT) as part of activities to mark the World Malaria Day. A Seminar for community agents and health workers on the modern treatment and management of malaria as well as free distribution of long lasting insecticidal mosquito net targeted at families, nursing mothers and children under the ages of 5. The World Malaria Day was approved by the World Health Assembly during its 60th session to encourage and recognise the worldwide effort directed at combating malaria as well as to encourage countries in the affected regions to share and learn from each others. ---------------------------------------------------------------------------------- Nigeria: Managing the Malaria Scourge 2 May 2013 Related Topics - The global effort to tackle the spread of malaria again came into focus in this year's World Malaria Day, marked last Thursday. Instituted by the World Health Organization (WHO) member states during the World Health Assembly of 2007, the special day aims to highlight the need for continued investment and sustained political will in the prevention and control of malaria. This preventable disease is however becoming deadlier than other dreaded diseases including tuberculosis. According to the WHO, 219 million cases of malaria occur around the world each year from which 660,000 deaths are recorded annually. In Nigeria, malaria is a leading cause of infant mortality, especially among the rural population. The government spends some N480 billion annually in its anti-malaria campaign;, the jury is out whether this is having appreciable impact on the fight against the scourge. There are many challenges, including the emergency of strains of the disease that are resistant to common treatment regimes. Seven years ago, the WHO approved Artemisinin-Based Combination Therapy (ACT) as the most effective and reliable drug for the treatment of malaria. Nigeria adopted this treatment policy as part of its action plan for the eradication, control and monitoring of the disease, replacing the use of mono-therapy that consisted mainly of chloroquine. The government signed a collaboration pact with Global Fund to subsidize the production of ACT drugs to make them affordable to Nigerians. Despite this, however, chloroquine is still being widely used in the country as is considered by many as the drug of choice in the treatment of malaria. Cost is a major challenge in the use of ACT, the cheapest selling for N950, a price tag this out of the reach for many Nigerians. Other ACT drugs sell for between N2, 500 and N3, 000. Most patients still ask for chloroquine when they have malaria because it is cheaper. The Minister of Health, Professor Onyebuchi Chukwu, in a recent statement attributed the delay in making the ACT drugs and other global health commodities accessible to the high cost of logistics, which according to him are not provided for under the Global Fund. If the cost of ACT drugs is beyond the reach of many Nigerians who reside in malaria-prone environment, this suggests that the pact with Global Fund is either not working or that the proceeds are being misapplied Although Professor Onyebuci said over 52 million insecticide-treated nets have been distributed to states and the Federal Capital Territory, it is not clear all the consignment reached the households they were meant for. It is common to see such nets bieng hawked street in Nigerian cities. The fight against malaria should focus more on preventive mechanism, which is cheaper in the long run than the costly curative effort. No measure can be more effective in combating malaria than keeping the environment clean to make it unsuitable for the survival of mosquito larvae. The government's National Malaria Control Programme (NMCP) needs to do more in sensitizing the public on the need to keep and maintain a clean environment. Bushy surroundings, vehicle tires, bowls and containers which can retain water and bread mosquitoes should be cleared, emptied or upturned. The NMCP should intensify its Integrated Vector Management (IVM) strategies through the indoor residual spray and larval source management homes. There is need also for more public awareness of the ACT policy, which can be translated into local languages and disseminated widely. To take effective control of the fight against malaria, the government should support indigenous research and development and production of the drugs. This would be cheaper to sustain than the donor-based initiatives. ------------------------------------------------------------------------------------ Firm moves to curb malaria among workers . Tuesday, 30 April 2013 00:00 From Collins Olayinka, Abuja Appointments - Appointments RECOGNIZING the massive man-hour loss employers incur as a result of malaria infection of workers, Total Upstream Companies in Nigeria is exploring partnership with relevant private and public sectors on ways of curbing malaria among workers. Speaking recently in Abuja on a general theme titled “Creating value for our stakeholders” at the opening session of the second biennial Corporate Social Responsibility (CSR) of Total Upstream, the Managing Director of the oil multinational firm, Guy Maurice, said the new direction of its CSR has created better planned and communicated CSR initiatives. He explained: “Good health is key to the wellbeing of our staff, their families and to the Nigerian populace. As part of Total’s desire to deepen our collaboration and support for government towards the realisation of the Millennium Development Goals, I am pleased to announce that Total will partner fully with government agencies and other specialist organisations as a partner in the fight against malaria. We shall be involved in the National malaria Control programme with the aim of seeking a comprehensive approach towards the eradication of this pandemic.” Maurice explained that Total takes CSR very seriously and have over the years worked closely with its host communities as well as various local, state and Federal Government institutions and agencies to ensure that its initiatives are spread across the country and impact meaningfully on people. In his presentation at the occasion, Prof. Patrick Utomi urged the Federal Government to empower Nigerian youths and not trivialise its amnesty programme into financial overture. He explained: “Right now, the approach to amnesty has strategic consequences that might make it unsustainable. These consequences include all kinds of people asking for amnesty and that will make mockery of the essence of amnesty. I believe government should engage; it is the duty of government to always engage and should engage with these people. I expect government to go underground and engage with this insurgency organisation just as it was done in Columbia. There is need for government to engage because it’s its obligation and duty. But this advertised amnesty business will become another drain pipe.” Utomi cautioned against introduction of monetary benefits into the polity, saying it is gradually changing the perceptions of Nigerians who have moved from what benefits all to what benefits the individuals. “The main complication in the whole scenario is Nigeria’s policy of sharing the so-called national cake. Once we decided to go down such road, people will be struggling looking for their share. The real thing we should focus on is changing the lives of young people, invest in real development,” he stressed. Delivering a keynote address at the occasion, a former Permanent Secretary in the Ministry of Foreign Affairs, Dr. Hakeem Baba-Ahmed, blamed government corporations for not having effective corporate strategies targeted at the public. “Oil firms paid huge price for being shielded by government corporations and agencies and some may very well have exploited this cover to avoid intense scrutiny,” he said. ----------------------------------------------------------------------------------- World Malaria Day: ” Malaria can be defeated” ON APRIL 25, 2013 • IN HEALTH, NEWS 7:09 pm By Chioma Obinna The Global Fund to Fight AIDS, Tuberculosis and Malaria Thursday, said new advances in science and implementation have given the global community the opportunity to control malaria and remove it as a threat to global health. Executive Director of the Global Fund, Mark Dybul in a statement to mark World Malaria Day stressed the need for partners in the fight against malaria to expand and intensify efforts with a view to transforming the disease from a worldwide killer into a manageable and treatable disease. His words, “We can defeat malaria, if we work together, said Dybul. “We have a chance to control it and sharply reduce the number of children who die from it each year. If we don’t act decisively, we will be counting the cost for generations.” Huge progress has been made against malaria over the past decade, driven by simple scientific advances like mosquito nets treated with insecticide, quicker diagnostic tests and more effective antimalarial drugs. Better implementation, in programs supported by the Global Fund, has led to the distribution of more than 310 million nets, far broader access to rapid diagnostic tests and treatment with artemisinin-based combination therapy. “But these gains could now be in jeopardy. A resurgence of malaria may occur unless increased funding is provided to expand efforts to control the disease. Experts warn that a decline in anti-malarial efforts could quickly allow a return to pre-2000 levels of mortality, when 1.2 million people died from malaria. Today, the total is roughly half that amount. Dybul singled out partners like the Roll Back Malaria Partnership (RBM) and the United Nations Secretary-General’s Special Envoy for Financing Health MDGs and for Malaria, Ray Chambers, for their success in raising awareness of the critical need to increase funding. Earlier this month, the Global Fund announced a target of raising US$15 billion for the 2014-2016 period. When combined with other sources of funding, that will enable global partners to have a transformative effect on AIDS, TB and malaria. For malaria, resources would be targeted to achieve universal coverage of insecticide-treated nets and access to effective treatment in the 18 highest-burden countries, where most malaria deaths occur. An additional 200,000 lives could be saved every year than with the funding that is currently available. The new funding model recently launched by the Global Fund is expected to achieve greater impact by encouraging ambitious programs and by focusing interventions and financing for specific populations and catchment areas. By reaching highly vulnerable, marginalized and stigmatized groups, including women and girls, sex workers, people who inject drugs, men who have sex with men, people in prison and migrants, more programs will maximize impact while advancing human rights. World Malaria Day: UN calls for more efforts to curb deaths ON APRIL 26, 2013 • IN NEWS 1:00 am By Our Reporters The Minister of Health, Professor Onyebuchi Chukwu, yesterday, said about 116 million people from four African countries, including Nigeria and four other countries were currently suffering from malaria. The figure accounted for 47 percent of global burden arising from the disease. Chukwu called for intensified efforts to rid the continent of the disease. The others include the Democratic Republic Congo, DRC, Ethiopia, Tanzania and Kenya. This was even as the United Nations Children’s Fund, UNICEF, has said treated nets were key to the reduction in malaria-induced deaths and illnesses. The Better Society Foundation, TBSF, an international Non-Governmental Organisation said about “$4.4 billion (about N620 billion) has been mobilised from international partners and African governments to make vital interventions in the fight against the eradication of the disease in Africa over the next three years, adding that additional $3.6 billion (about N55.6billion) was needed in funding the project from 2013 to 2015 in Nigeria. At a media parley to commemorate the World Malaria Day, the Executive Director, TBSF, Mr Ade Dare, said,“It is critically important that we stay on course. Malaria resurgence will remain a persistent threat until the disease is eradicated altogether. We need to keep up the momentum but more importantly hold the gains. With sustained funding rapid progress towards ending malaria deaths can continue, but without it, gains could be quickly reversed putting millions of lives at risk”. Speaking to commemorate the World Malaria Day at the African Union Conference of Health Ministers in Addis Ababa, Ethiopia, Chukwu said various strategies were being implemented in the control of the disease, adding that there was need to move on to elimination and ultimately eradication stages. He said the continent needed to adopt several integrated approaches to eliminate malaria, even as Nigeria has distributed 51,703,880 Long Lasting Insecticide Nets, LLINs. His words: “Nets alone cannot lead to the expected outcome. We must diversify into other strategies such as IRS, larviciding and environment management. Awareness creation is being scaled up through the use of NIFAA, Nigeria Inter-Faith Association, as well as the investiture of malaria ambassadors “In the African region, malaria is still of public health importance. Globally, it is estimated that there are about 247 million cases per year and Africa accounts for 86 percent (212million).” Insecticide treated nets key to eradication of malaria UNICEF’s Director of Programmes, Nicholas Alipui noted that malaria still killed 660,000 people every year, adding that most of them were African children. Alipui maintained that universal coverage of insecticide-treated bed nets is key in making gains against malaria. He said: “It is unacceptable that every day more than 1,500 children still die from a preventable and curable disease. We must distribute insecticide-treated nets to all who need them, provide timely testing for children and appropriate medicine when they are infected.” The Ebonyi State government has disclosed that about 96,000 residents across the 13 local government area of the state were affected annually by the malaria scourge. Briefing newsmen, state Commissioner for Health, Dr. Sunday Nwangele, represented by the Director, Hospital Services Management Board in the state Ministry of Health, Dr. Gabriel Onwe stated that the statistics of infected persons were derived from reported cases of the disease in the state. The Kogi State Commissioner for Health, Dr. Idris Omede advocated the use of LLINs, saying the transmission of malaria parasites can best be reduced using the long lasting mosquito nets. The Commissioner noted that N480 billion is spent annually nation wide as a result of the malaria scourge. Nigeria’s Malaria ambassador, Aliko Dangote decried the prevalence of the disease in spite of development of new drugs, saying it remained a major threat to the health of the citizens in the developing countries. Dangote, who spoke in Lagos, said all hands must be on deck to collaborate on how to deal with preventable diseases like malaria, measles, polio etc pointing out that the success achieve in these regards is key to stimulation of the nation’s economy as the potential productive sector of the population are the vulnerable groups. The Nigerian Medical Association, NMA, has called for increased commitment to the malaria campaign by government at all levels. The President of NMA, Dr Osahon Enabulele in statement urged more strategic and robust planning, effective partnership and coordination with investment of more resources into the campaign to eradicate malaria. “We call for greater commitment to research efforts for development of malaria vaccine. We believe that long-term success in the global campaign to defeat malaria will be greatly enhanced with improved investments in on-going research for development of an effective vaccine as well as research into ways of combating emerging threats such as parasite resistance,” he added. Malaria: Nigeria, four others account for 47 per cent World cases ON APRIL 25, 2013 • IN HEALTH 1:25 pm Addis Ababa – The Minister of Health, Prof. Onyebuchi Chuckwu, on Thursday in Addis Ababa said Nigeria and four other African countries accounted for 47 per cent of the global malaria cases. The minister, who stated this at an AU Commission’s breakfast to celebrate the 2013 World Malaria Day in Addis Ababa, said the countries are Nigeria, Congo DR, Ethiopia, Tanzania and Kenya. He said that 47 per cent of the cases amounted to 116 million of the global burden of the Malaria scourge and called for more effort to rid the continent of the disease. He said that recent statistics showed that there were about 247 million World cases per year and that Africa accounted for 86 per cent or 212 million cases. “Various strategies are being implemented in the control, but we need to move on to elimination and ultimately eradication, and for Africa to eliminate Malaria, our approach must be multi-pronged and integrated,’’ he said. According to him, the ECOWAS region is encouraging member countries to ensure vector control through Integrated Vector Management in addition to implementing large scale larviciding. “A ground breaking ceremony for a Larvicidal Factory was done in Nigeria a couple of weeks ago in the presence of the President and Vice President of the ECOWAS commission and the Deputy Prime Minister of Venezuela. “ The region is also focusing on vector resistance and drug surveillance, but Africa must employ Indoor Residual Spraying (IRS) with medical additive (DDT) and also scale up the use of Rapid Diagnostic Test kits (RDTs).“ He said that Nigeria has commenced pre-planning process for the review of the National Malaria Strategic Plan, Malaria Control Policy and other relevant documents to ensure the eradication of the scourge ahead of the 2015 MDGs target. The Minister said Nigeria had distributed 51,703,880 Long Lasting Insecticidal Nets (LLINs) and will continue to distribute nets within the last two years. “ However, nets alone cannot lead to the expected outcome. We must diversify into other strategies such as IRS, Larviciding and environment management. “Awareness creation is being scaled up through the use of NIFAA (Nigeria Inter-Faith Association) as well as the investiture of Malaria Ambassadors,’’ he said. He said Nigeria had successfully implemented the first three phases of the Malaria Programme Review (MPR). “It is presently in the 4th phase that involves the implementation of the recommendations of the MPR. “In 2013, we hope to sustain continuous/routine LLIN distribution, implement a nation-wide Larviciding, IRS as well as establish 18 sentinel sites across the country for malaria vector surveillance. “We will also scale up the use of RDTs as well as ensure the availability of ACTs and SPs for pregnant women, in addition to scaling up behavioural change communication as well as complete the Malaria Programme Review process,’’Chuckwu said. “let me add that the most cost-effective intervention in health are those that are preventive. Education and Environmental Sanitation will not only complement our malaria elimination efforts but will also contribute to the control and elimination of other dieases. Earlier AU’s Commissioner for Social Affairs, Dr Mustapha Sidiki said “ In spite of the success in the fight against Malaria, 85 per cent of the deaths occur in children under five years of age, “The Malaria episodes in pregnant women cause anemia and other complications in the Mother and newborn child.’’ The Commissioner said the worldwide map of Malaria is shrinking, even in African Region, particularly in the E-8 countries. “ Malaria has fallen on the average by more than 33 per cent and in some countries by about 50 per cent since 2000, with more people on combined artemisinin-based therapy and there has been significant Progress in community case management of malaria. In spite of the success in the fight against malaria, Africa continues to account for 85 per cent of malaria cases and 90 per cent of malaria deaths worldwide. “Malaria causes avoidable and often catastrophic out-of-pocket expenditure for households and loss of productivity to the economy resulting in massive losses to economic growth, with an estimated cost of 12 billion dollars each year in lost productivity in Africa alone. “In addition, funding gaps for malaria threaten to reverse the gains already achieved in the past decade. “Indeed, RBM Global Malaria Action Programme (GMAP) estimated a requirement of 26.9 billion dollars between 2012 and 2015, revealing a funding gap estimated at 9.7 billion dollars over the period or 2.4 billion dollars per year. “This is why we need to invest in the future to defeat malaria. Hence the Big Push.’’ Dr Fatoumata Nafo-Traore, the Executive Director of Roll Back Partnership, in her contribution said the effort to eradicate Malaria had saved more than one million lives since 2000 in Africa. Traore said nine African countries are among the 50 countries on track to meet the World Health Assembly and Roll Back target of reducing malaria incidence by 75 per cent by 2015. She, however, said it would cost Africa eight billion dollars to effectively intervene and reduce the menace of the scourge within the three years but lamented that there is about 50 per cent funding gap required to ensure that the effort was sustained to meet the 2015 MDGs target. The News Agency of Nigeria (NAN) reports that Health ministers from over 34 AU member states, WHO, UNFPA and other Health sector Development partners and experts attended the World malaria Day, with the theme “Invest in the future: Defeat malaria’’. “This is to call attention to the big push needed to reach the 2015 Millennium Development Goals and defeat malaria in the future,’’ she said.(NAN) Jonathan to lead fight against AIDS, tuberculosis, malaria worldwide ON APRIL 24, 2013 • IN NEWS 10:18 pm ABUJA –Nigeria’s President, Goodluck Jonathan, has agreed to help lead the Global Fund’s efforts to raise funds to fight AIDS, tuberculosis and malaria all over the world. President Jonathan met with Mark Dybul, Executive Director of the Global Fund, on Monday to discuss joint efforts to control these deadly diseases in Nigeria and globally. Dr. Dybul praised President Jonathan’s effective leadership and personal commitment to expanding health services, embodied by Nigeria’s “Save One Million Lives” initiative that is aiming to dramatically increase access to basic quality health services, particularly for women and children. President Jonathan accepted an invitation to be a Co-Chair in this year’s replenishment efforts by the Global Fund. Other Co-Chairs include UN Secretary-General Ban Ki-moon and heads of states from developed countries, emerging economies and the private sector. “Working together, we can make tremendous gains,” said Dr. Dybul. “With the existing science, our understanding of the epidemiology and our collective experience in combating the diseases, we now have an opportunity to control them. If we do not, the long-term costs will be incalculable.” During his first visit to Nigeria as Executive Director of the Global Fund, Dr. Dybul also met with the Minister of Health, Prof. Chukwu Onyebuchi and Minister of State for Health, Dr. Muhammad Pate, and other key stakeholders, partners and implementers to discuss opportunities to further strengthen collaboration. Mr. Aig-Imoukhuede, Chairman of Friends Africa, said: “The upcoming replenishment of the Global Fund ought to be given the highest levels of support for the fight against these diseases to be won.” World Malaria Day: Lagos identifies challenge, distributes RTD kits ON APRIL 25, 2013 • IN NEWS 12:07 am By Chioma Obinna LAGOS—As Nigeria joins the rest of the world to celebrate this year’s World Malaria Day today, a study by Lagos State Government has identified improper malaria diagnosis before treatment as a major challenge to the fight against the scourge. The state government in collaboration with its partners has, therefore, pushed into the healthcare system microscopes and Rapid Diagnostic Test, RDT, kits to boost diagnosis of the disease and Artemisinin Combination Therapy, ACTs, anti-malarias being provided free for treatment in all the state-owned facilities. At a briefing to mark 2013 world malaria day in Lagos, Commissioner for Health, Dr. Jide Idris, said the study showed that out of all fever cases presented at its health facilities in 2012 only, 26 percent was confirmed malaria case. Emphasising the need for prompt diagnosis and treatment, Idris pledged that the state would continue to sustain and improve upon all activities geared towards malaria control. He said: “We will continue to improve and sustain diagnosis of malaria cases and treatment with effective medicines, distribution of insecticide-treated nets, ITNs. “This is to achieve full coverage of populations at risk of malaria, and the Indoor Residual Spraying, IRS, exercise.” He lamented poor utilisation of ITNs by Lagosians and said the survey showed 17 percent utilisation of ITNs and 88 percent retention rate, noting that the drive to sustain and improve activities on malaria control, especially the distribution of ITNs and IRS exercise, were major means of malaria vector control. ------------------------------------------------------------------------------------ Nigeria: Battling Malaria Without Drugs or Knowledge BY OGECHI EKEANYANWU, PREMIUM TIMES, 26 APRIL 2013 Abuja — The statistics are shocking. Over 300,000 Nigerians die from malaria each year – more than in any other country. An estimated 250,000 are children younger than five. When the disease strikes, most Nigerians visit patent medicine vendors (PMVs) like Bisi (not her real name) for relief. "You will take chloroquine; four today, four tomorrow and two afterwards", says Bisi to a customer, prescribing treatment for a bout of malaria. Bisi operates a small pharmacy in a poor area of Abuja, Nigeria's capital. Many of her patrons buy medicine for their children's malaria, which causes twenty per cent of all deaths of children under five in the country. According to her neighbours, and by her own account, Bisi is a "trained nurse". She administers drugs to the residents of Lugbe, a slum of about 50, 000 people among a metropolitan population thought to number well over three million. "You will take the chloroquine with Panadol", a popular brand of analgesic in Nigeria), Bisi tells her client. The only test Bisi conducts is to ask, "How are you feeling, are you feeling cold, headache?" As soon as she gets an answer in the affirmative, she administers chloroquine and piriton, an anti-allergy drug. Chloroquine was once the most effective treatment for malaria. As early as 2005, however, Nigerian health officials advised against using the drug, because the malaria parasite had become resistant to it. But Bisi is oblivious to that problem. She administers chloroquine in the confidence that her client will be cured of her ailment. The baby killer The death of a child is a sensitive issue to discuss, especially with immediate relatives of the deceased. As reporting for this article unfolded over three weeks, two child deaths from malaria were encountered in one neighborhood. Although traumatised parents refused to speak about it, a relative agreed to talk. "My uncle's daughter was poorly treated for malaria," the source, who wants to remain anonymous, told PREMIUM TIMES. "She was complaining, they gave her medicine, and then she died. It was the only girl. It is too sad." The child was about four years old. "My neighbour's child"- a boy between five and six - "went to the pharmacy," the source continued. "But they gave him adult dosage." He, too, died. The 2010 Malaria Indicator Survey showed that only 11 per cent of Nigerian children treated for malaria were given ACTs. Most took chloroquine. Ineffective but popular Dr. Oladimeji Oladepo, a medical school professor at the University of Ibaden, is working with PMV associations in a program aimed at providing more effective treatments. The Institute of Development Studies has been a partner in the research. Oladepo's unit in the Department of Health Promotion and Education, found that people buy chloroquine, "because it is almost 15-fold cheaper than the ACT" – the 'artemisinin combined therapy' drug cocktail that is effective against most malaria cases. "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 their malaria," he said. A walk into a pharmacy - perhaps better to call it a shop where drugs are sold - reflects chloroquine's continuing dominance. In the Agboju area of Lagos, Nigeria's commercial center and largest city, medicine vendors stock chloroquine because it remains the drug that is most in demand, especially among the older generation. "We sell it because people still buy it, especially the old school people," one of the vendors said. Emmanuel Otolorin, the Country Director of JHPIEGO, a non-profit affiliate of Johns Hopkins University in Baltimore, Maryland, USA, spoke with PREMIUM TIMES on the efficacy of chloroquine. "The malaria parasite became so clever that it started looking for survival," Otolorin said. The spread of chloroquine resistance, first in Latin America and Asia and then across Africa, prompted the development of ACTs. A looming challenge is that resistance to these latest drugs has already been found in four south-east Asian countries. Know your enemy – and how to fight it In addition to treatment with ACTs, the World Health Organisation (WHO) recommends a four-point strategy to combat malaria, Otolorin said. The first is education. "Everyone should know how malaria is transmitted" – by mosquitoes – and "how it breeds in stagnant water," Otolorin said. Armed with that information, communities can reduce the places the insects can breed. A second element of the strategy is sleeping under an insecticide-treated bed net. When a mosquito touches it," Otolorin said, " it dies". But even when bed nets are available, they aren't always used. Nneka Okechukwu knows that sleeping under a net can help protect her. The problem is that the net's small holes, designed to restrict penetration by mosquitoes, also reduce air flow. "The weather is hot," she says, "and there is never light to use the air conditioner or fans at night, so it uncomfortable to use these nets." Nigeria has an erratic supply of electricity, insufficient to power even the homes of the minority of Nigerians who can afford it. South Africa, by comparison, a country of 50 million people, has 10 times the electrical production capacity of Nigeria, with a population of 180 million. "You either die of heat or of malaria," Okechukwu says. "Because malaria is not immediate, I usually consider the heat, so I sleep without the net." Nnenna Ibeh, a journalist, tolerates the nets because she knows they work. "I would sleep under the mosquito nets and when I wake up, I would see dead insects surrounding the nets" she said. "This way I feel safe." Early detection and treatment with effective medicines is the third step in malaria control. A rapid diagnostic test (RTD) to confirm or rule out a malaria infection – is an important step. Limiting treatment to people who have an acute infection is a precaution against the spread of ACT-resistant malaria. The fourth recommended approach is giving malaria-prevention drugs to all pregnant women at least twice in their pregnancies – after the first trimester and at 16 weeks – a practice called intermittent preventive therapy. WHO's 2012 World Malaria Report, released in December, says 10,000 thousand women and 200,000 babies die annually from malaria in expectant mothers. "Pregnancy lowers their immunity; it lowers their ability to fight malaria parasites," Otolorin explains. "The baby will get less oxygen and food during pregnancy; as a result, the baby becomes malnourished inside the womb." Malaria in pregnant women should be treated at any gestational stage, he says, because it is so deadly. A flawed policy Despite the human and economic costs of malaria, most Nigerians remain uninformed about both prevention and treatment. Oladepo says there is a need to translate the government's policy on malaria into the three major Nigerian languages, so that people can understand it. An attempt to speak about government policy to the national coordinator of the Nigerian Malaria Control Programme (NMCP), a division of the Public Health department of the Federal Ministry of Health, is stalled by bureaucracy. "Madam is busy; come back later," a reporter is told. "Madam cannot talk to you just like that. You will have to fill a form; then she will respond to you later," the coordinator's secretary said, in response to a request for an appointment. However, a staff of the NMCP, who spoke on the condition of anonymity because his superiors had not authorised him to speak, acknowledged that there has been no major reduction in malaria deaths. But he insisted that the health ministry is fully involved in campaigns at the grass root level. "Definitely information gets to the rural areas,: he said. "There is a cascade effect from the top to the bottom. ..The national programme coordinates everything about malaria. We also have state offices that coordinate down to the local government level. "Right now as we speak, insecticidal nets are being distributed in the states. This evolves down to the lowest wards in the state," the source said. "There are some gains that have been made. It may not have been exactly drastic as everybody would have been expecting. But we are on the right path," he continued. Asked about the continued popularity of chloroquine, the NMCP source defended health officials. "It is not something we have full control of," he said. "There are no government hospitals where you see chloroquine". But a policy that focuses mainly on hospitals seems flawed, in a country where most people buy medicines from venders in the private market. The PMVs serve rural people and those who have little money – and about 60 per cent of Nigerians live below the poverty line. Venders like Bisi are offered little support to provide effective drugs and no official instruction to help her help her customers. On a recent day, she was sternly warning a pregnant women not to take malaria drugs. "You cannot take malaria medicine for now," she said, offering, instead a mild painkiller and a nutritional supplement. "Take it all this morning", she advised. This article was produced by Premium Times for AllAfrica, in partnership with the Institute of Development Studies. Africa - Malaria - Keeping a Crafty Killer On the Run BY ALLAFRICA, 26 APRIL 2013 ANALYSIS Imagine that snake attacks were killing a person a minute. Or that it was dogs, or foxes or chickens that were killing three-quarters of a million people a year. Envision the non-stop media coverage - and the public outcry to stop the carnage. Instead, the mass killer is the mosquito, weighing in at 2.4 milligrams, about the same as two human eyelashes. Scientists say the mosquito is the most dangerous creature on earth, carrying diseases that have killed more people than all the world's wars combined. Across much of the world, the insect is treated as no more than a nuisance during outdoor activities; mosquitoes in temperate climates rarely carry the parasite that causes malaria. But malaria-transmitting mosquitoes blanket more than 40 percent of the earth, and 90 percent of the deaths they cause are in Africa. Today, on World Malaria Day, as on any given day, an estimated 3,000 children will die of malaria -- most of them before their fifth birthday, according to the United Nations. More than one-quarter of all childhood deaths in Africa are attributed to malaria. But unlike an animal attack, the deaths are rarely dramatic -- a fever, lethargy, crying. The predominant way that children die of malaria is through repeated infection with the Plasmodium falciparum parasite carried by the Anopheles mosquitoes, which are predominant in Africa. When children are bitten over and over again they continually have the parasite in their blood. Even when an acute malaria attack doesn't kill, the cumulative effect can be severe anemia, malnutrition and other complications. "It just sets them up for death, and that death is not a dramatic illness," said Carlos "Kent" Campbell, director of the malaria control program at PATH. "It is a slow, insidious death." In fact, pneumonia or diarrhea may deliver the final blow because the child's weakened system is incapable of fighting off the infections. Malaria can wear children down for a number of reasons. In remote areas, clinics or pharmacies may not be within reach. Even in those facilities, medicines may be out of stock - a "stock-out" in global health parlance. Or a family might be too poor to purchase the first-line artemisinin-combination therapy (ACT) that is most effective. Or they might purchase what they believe to be ACTs, only to discover too late that the drug was fake. Successful Interventions The picture for these children is bleak - but it does not have to remain that way, malaria experts say. In recent years, remarkable progress has been made in the fight against the disease, and if similar progress continues, they say the world may one day see malaria's eradication. A set of interventions - the use of "residual indoor spraying" of interior walls with a low-toxicity insecticide, the distribution of bed nets, the use of rapid diagnostic tests and improved treatment with ACTs - have led to a one-third reduction in malaria deaths in the past decade alone, according to the United Nations. Overall child mortality rates have fallen by about 20 percent in countries where access to malaria control interventions has improved most significantly. That strategy, Scaling Up for Impact (SUFI), has been implemented to scale in 20 of 47 countries in Africa where there is malaria, Campbell said. "In the past five or six years we've proven that once those interventions are deployed in a range of 60 percent of population coverage there's a precipitous fall in terms of malaria transmission and malaria mortality, particularly among children, who suffer the greatest brunt," he said. The World Health Organisation (WHO) in December said in its World Malaria Report 2012 that a "concerted effort by endemic countries, donors and global malaria partners" had led to strengthened malaria control around the world. The scale-up of malaria prevention and control interventions had the greatest impact in countries with high malaria transmission; 58 percent of the 1.1 million lives saved during this period were in the 10 highest burden countries, the report said. "Ten years ago, bed nets were not being used at a wide scale. Indoor residual sprays were not being used at a wide scale," said Alan McGill, who oversees malaria strategy for the Bill and Melinda Gates Foundation. "We were in a transition period between drugs like chloroqine and Fansidar that had lost their efficacy because of resistance and before the scale-up of artemisinin combination treatments." "If you take that as a baseline, over the last 10 years, when those interventions were rolled out at a much wider scale, you have to credit them with being incredibly effective, as well as multilateral initiatives," he said. "We certainly have seen tremendous strides forward." A Race Against Time Maintaining proven interventions is key, malaria experts say, and continued financial support is crucial. The United Nation survey reports an annual shortfall of U.S.$3.6 billion in funding the malaria battle. That concern is reflected in this year's Roll Back Malaria theme -- "Invest in the Future: Defeat Malaria". Administration and managerial problems at the Global Fund to Fight Aids, Tuberculosis and Malaria complicated implementation of anti-malaria strategies, but Campbell said that improvements at the Fund offer hope for growing, consistent support for anti-malaria programs. For that to happen, however, depends on steady financial support from the Fund's global donors. Campbell and others say another big challenge is to sustain the achievements already made: bed nets have to be replenished every three years and treatment drugs have to be available, along with rapid diagnostic testing. The testing is important. Malaria across Africa is now resistant to the former most-common treatment, chloroquine, still widely sold in many countries despite its ineffectiveness. As ACTs become more available, treating every fever as though it were malaria will speed the resistance to those drugs as well - and there are no more drugs in the pipeline. Already, alarmingly, resistance to ACTs has been found in the Mekong region of Asia. "The rapid success in bringing down malaria deaths does not in any way mean that the malaria problem is fixed or there is no malaria problem or investment in malaria control doesn't need to continue," Campbell said. "It is in many respects like immunization programs. You have to continue to immunize and cover the population. Right now that recurrent cost has to be borne, and there have to be programs in place to address clinical illness, even though it may be at a much lower level." Despite progress otherwise in the malaria fight, it is a race against time. A potential slip in funding could be catastrophic, according to scientists. And in addition to the potential of spreading resistance to ACTs, there is the threat of resistance to pyrethroids, which is the insecticide with which many bed nets are impregnated. ?McGill said the current transmission interruption measures -- bed nets, residual indoor spraying and increased testing and treatment with ACTs -- have to be maintained at a certain scale of coverage in order to maintain the benefits. "Historically, going back a hundred years when those control measures are removed, for whatever reason, resurgence is typical," he said. "There would be significant concern about a resurgence in countries that scale back. And one of the goals long term is not only to scale up for impact but to scale up for elimination. That's the only long-term way to deal with this problem." Nigeria: Foundation Distributes Mosquito Nets in Bwari BY HUSSEIN YAHAYA, 26 APRIL 2013 As part of 2013 world Malaria Day celebrations, a charity organisation, Jumai Aduda Foundation yesterday donated about 400 insecticide-treated mosquito nets to three communities in Bwari Area Council. Each households in Yaupe, Zinape and Amoko communities of the council got two of the nets while over 200 locals underwent test conducted by medical personnel to determine if they have malaria or not. Our reporter observed that those with malaria were offered immediate treatment and given some malarial drugs. Speaking at the event, the president of the organisation, Mrs. Hauwa Aduda, wife of the FCT Senator, Philip Aduda, said the gesture is part of the organisation's effort to reach indigent people at the grassroots. She regretted that malaria which is now common in the society can be prevented and reminded them that prevention is always better and cost effective than cure and urged them to make judicious use of the nets. The Bwari council chairman, Peter Yohanna Ushafa, who was full of joy by the gesture, said the organisation's action is in line with the vision of his administration, aimed at providing qualitative health facilities at the rural communities in the area. He said his administration has provided health centres in many communities which include Kogo, Shere, Kuduru, Kawu , Sabo-gari communities in Bwari among others. He commended the organisation for choosing the council and promised his administration's desire to partner with any other body working towards assisting his people at the grassroots. Hundreds of locals in the three communities including some Fulanis trooped out to receive the packages, while some of them commended the Foundation for the gesture. Jumai Aduda Foundation was founded by the late mother of the FCT Senator, Mrs. Jumai Tanimu Aduda as a charity organisation aimed at reaching out to indigents at the various communities in the six area councils of the FCT. Nigeria: NOA, UN Agency Task Nigerians On FOIA...As Osun Spends N200 Million On Malaria in Three Months BY ABDUL-HAMEED OLAWALE, 26 APRIL 2013 Osogbo — The Osun State government yesterday said 41,416 cases of malaria were recorded in the state in the first quarter of this year and that the state government spent over N200 million the control of malaria during the period. Osun State Commissioner for Health, Dr Temitope Ilori, however noted that cases of malaria in the state are on the decline following various intervention measures embarked upon by the state government to improve on the health of the people. She said with the latest survey from the Federal Ministry of Health, Osun is among states with the lowest cases of malaria. According to her, some of the malaria control strategies employed by the state government include; prompt diagnosis and treatment with effective medicine, distribution of insecticide treated nets and indoor residual spraying. Nigeria: WHO Urges More Funding for Malaria BY JUDD-LEONARD OKAFOR, 26 APRIL 2013 The World Health Organisation (WHO) says international funding for malaria programmes have stagnated and slowed down progress against the disease while emerging resistance to drugs and insecticide threatens to reverse recent gains against malaria. In a statement commemorating World Malaria Day, WHO said more funds were urgently needed for the world to maintain and speed up progress against malaria in line with targets set in the Millennium Development Goals. More than 660,000 people still die from the disease, mainly children under five years in sub-Saharan Africa, said WHO. Over 200 million cases of malaria occur each year; most are never tested or registered. In a statement marking April 25, president of Nigerian Medical Association, Dr Osahon Enabulele said, Africa needed to urgently find ways to fill funding shortages that exceed $2.4 billion on the continent alone in order to finance malaria control up till 2015. He commended Nigeria's malaria control programme which has successfully intervened with insecticide-treated nets to households, pregnant woman and children under age five, as well as the integrated prevention treatment programmes which recommends two doses of sulfadoxine-pyrimethamine (SP) during antenatal consultations to pregnant women to prevent malaria. But he also urged for "more strategic and robust planning, effective partnership and coordination with investment of more resources into the campaign to eradicate malaria." Enabulele added improved investment in current research to develop a vaccine against malaria would enhance long-term success against the disease. Nigeria: Niger Spends N155.2 Million On Campaign Against Malaria BY ALIYU M. HAMAGAM, 26 APRIL 2013 Minna — Niger State Commissioner of Health, Dr. Ibrahim Sule, said yesterday that the state government, in the past three years spent N155.2 million on Roll Back Malaria campaign in the state. The commissioner, who spoke yesterday at an event to mark World Malaria Day, said N127.5 million was used as operational cost, while N17,9 million was expended on the training of 1,100 health workers on the use of Rapid Diagnostic Test (RDT) kits and distribution. According to him, 1.3 million doses of anti malaria drugs were distributed to 375 public health facilities for the treatment of malaria for people of all ages. He added that annual statistics indicated that visits to hospitals for malaria treatment are on the increase. Nigeria: World Malaria Day - Malaria Costs Nigeria Billions of Naira Each Year. What Does It Cost a Nigerian? BY RUBY LEO AND JUDD LEONARD OKAFOR, 25 APRIL 2013 Idris Omale makes his living, as a barber at a barbing salon in Mararaba, Nasarawa State. He doesn't own the salon where he's been working since being deported from Libya last year. His income--whatever is left of the proceeds after remitting N400 each daily and N1,000 on weekend to the salon owner--places him in a group loosely categorised as "average Nigerian". Omale last had malaria in February, he remembers. "I took Panadol, but the pains didn't go away. So I took very strong 'hot' [local generic name for bottled gin] and it disappeared." His relief lasted only days before his illness returned full in force and "knocked me down", he says. "I had to see a doctor friend." Treating his condition costs on average N950, according to government surveys, but he would later spend more than N1000 for a complete dose of artemisinin-based anti-malaria his doctor prescribed. He spends much more than money. Millions of Nigerians without health insurance pay out of their pockets for their healthcare, a proportion estimated at more than 75%. On a national scale, malaria costs the country more than N480 billion in lost manpower, treatment and care needs, the national coordinator of National Malaria Control Programme (NMCP), Dr Nnenne Ezeigwe said recently in an interview with Daily Trust. For Omale, the cost is more personal. His family depends on what he makes daily. Each day he stayed home with malaria, he lost daily wage at the barbing salon. He complains about spending more than a day's wage on his medicine because there is "no price control" to keep the cost of anti malaria down. Unfortunately this episode would repeat itself: he doesn't take any medicine to prevent malaria and has not slept under a mosquito net since his children damaged the one the family used. But he is sure where his next bout of malaria might come from. "There's no way it can be eradicated. Look around. Dirt, refuse everywhere--unclean environment, waste, the mosquitoes are all over the country." Everyone has it Malaria is a staple for anyone living in Africa, says Amaka Chukwu. "Every Nigerian treats malaria nearly every other day," she says. "It is only the acute cases that go to hospital." Before going to hospital, most people with malaria try to treat the condition by themselves, using anti malarias bought over the counter at pharmacies, chemists and from informal drug vendors--an open market that ranges from anything from drug sellers on a bus to hawkers peddling drugs in basins gingerly balanced on their heads. Chemists and patent medicine vendors are the first point of treatment for 57% of Nigerians. Dr Nicholas Baamlong, consultant family physician at University of Abuja Teaching Hospital, say, "The tendency is that rather than wasting my time coming to see a doctor and wasting the whole day, let me just go to a chemist and say, 'look I have fever, headache', and the next thing they give you malaria drugs." The lure toward self medication comes from not just cost but the inconveniences of visiting a hospital. On any day, the general outpatient department at University of Abuja Teaching Hospital sees up to 280 patients. Nearly half of all patients coming to hospital daily are suspected cases of malaria, according to doctors. The hours of waiting to see a doctor means many never come to hospital, resorting to self medication for themselves and their loved ones, including children. It cuts waiting time, but not the cost. "Sometimes, you buy these drugs and by the time the child has been absent from school for two, three, four days, before you start coming to hospital. That absenteeism continues and the period it takes to treat before the child resumes. All these are losses," says Dr Baamlong. Difficult battle Anyone self-medicating for malaria is hoping to get rid of the symptoms that come with the disease. Even doctors sometimes rely on treating symptoms. This, according to NMCP coordinator, Dr Ezeigwe is one of the difficult aspect of controlling the disease. She said, "Our greatest worry is that most physicians treat without testing, it is not all fevers that are malaria, and we are very concerned that when all fevers or symptoms are treated with ACT (Artemisinin combination Therapy) we could have started resistance to malaria and right now that is the only approved mode of treatment. This approach of treating without testing would spell disaster for us". Meanwhile Dr Baamlong defending why most physicians treat without bothering to test said, "Most of the time, because of inadequacies in our laboratories, reagents, you might not get an accurate result that will show you this is malaria. You can only get that in a very little percentage. But the presumptive diagnosis, clinical signs and symptoms, points to the fact that a lot of people are coming in with malaria. Surprisingly too when you place them on treatment they get well". Unfortunately, the parasite responsible for malaria--Plasmodium falciparum--has become smart over the years, evolving to become resistant to chloroquine--a strong antimalarial until recently. For ages, malaria was treated with chloroquine. In the last couple of decades, combination therapies based on artemisinin have emerged as more effective, after resistance to chloroquine was discovered. And it has made Nigeria's battle with malaria difficult. More than 30% of the global malaria burden is in Africa, and Nigeria accounts for a quarter. The most recent Malaria Indicator Survey estimates malaria prevalence at 42%, affecting children under age five more than any other population. Ironically, the prevalence increases with age but decreases with wealth. The global scientific community's rule of thumb is straightforward: with diseases caused by viruses, vaccination is the target; but disease caused by organisms other than viruses might potentially be treatable. However, the onslaught of malaria has made it worthwhile to consider a vaccine. The ACT front With the silver bullet promised by a vaccine, national programmes fall back on treatment. In policy, the choice is artemisinin combination therapy but chloroquine, found 15 times cheaper than ACT, is still in wide use, says Prof Oladimeji Oladepo of Health Promotion and Education Department at University of Ibadan. Since its introduction, use of ACT has exceeded use of drugs as quinine and amodiaquine. But it still lags behind sulphadoxine-pyrimethamine combinations and choloroquine. For every case of malaria treated with ACT, two are treated with SP combo and more than four with chloroquine. The pressure is to ensure effective treatment is available. Global health groups are still divided over the issue: whether to put drugs in the hands of individuals, risking misuse and buildup of resistance that's rendered chloroquine suspect or whether to leave drugs in the hands of trained help, risking further distance from women and children who need the drugs. Oladepo, after studies by the African Media and Malaria Research Network, sees disconnect between policy and what happens in the field. He believes Nigeria is better off using its wide network of patent medicine vendors (PMV) at community levels where it could combine treatment and prevention. Patent medicine vendors, with training, could even monitor compliance to standards, he opines. "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. Some 12.5 million doses of artemisinin combination therapy have gone through public health facilities. Another 39.4 million doses have been administered through the Affordable Medicines Facility for Malaria (AMFM), a programme to expand access to antimalarial drugs through public, private and nongovernmental organisations. Nigeria: Most Malaria Programmes Are Donor Funded - NMCP Boss BY RUBY LEO AND JUDD-LEONARD OKAFOR, 25 APRIL 2013 INTERVIEW With malaria costing Nigeria some N480 billion annually in treatment and prevention, the resources that have gone into malaria control will be eroded if Nigeria cannot build local capacity to deal with the disease before donor funding dries up. The Coordinator of the National Malaria Control Programme, Dr Nnenna Ezeigwe, in this interview speaks on the progress and challenges so far. What has the National Malaria Control Programme been up to in the last four years? We have two basic strategies: integrated vector management, IVM--targeting the vector of malaria. The main method is use of long-lasting insecticidal nets of which we operate two methods--the push and the pull. In the pull which started 2009, we have routine distribution during immunisation days. But we are more focused on the push, because we are trying to cover greater portions of our population. Combined, we have distributed 51.7 million nets from 2009 till now. Out of the 36 plus one states, only four were not covered until now but the process of covering them is in progress--including Kogi, Delta, parts of Oyo and Osun. When we are done with the push, we then focus on routine distribution through antenatal care, immunisation services, other community and faith based avenues. There are other IVM interventions like indoor residual spray (IRS). It is not large scale and just being piloted in some states. It is impregnating the walls of living space with chemicals that kill mosquito. Another IVM is focused on mosquito larvae in water bodies. It is less implemented than IRS. In fact, we are just starting; it is also being piloted in states like Lagos, Rivers, Bayelsa. We are looking to scale it up because the ECOWAS sub-region has identified it as a way to eliminate malaria from ECOWAS states. An ECOWAS initiative is building a biolarvicide plant in Port Harcourt to help with the effort. We are also looking at case management--treating people already down with malaria. We recommend and implement diagnosis before treatment--diagnosis with Rapid Diagnostic Test (RDT) or microscopy and then treatment with appropriate medication, in our case, artemisinin-based combination therapy. We strongly encourage diagnosis before treatment. Not every fever is equal to malaria. There are so many other things that can cause fever or even other symptoms that look like malaria. It is very important that we test for malaria before you treat, for many reasons--resistance: if you start abusing medication, resistance will come up and right now there is no other medication. The intermittent preventive treatment in pregnancy using Fansidar is another strategy. It is recommended that a pregnant woman should have three doses of IPT in pregnancy to protect the unborn child and the pregnancy will have a better chance of carrying to term. It is given between the first and second trimester. Physicians say nearly half of all cases in their outpatient units everyday is malaria. Is that practical? When they say 50%, how can they be sure? It is only in testing that you can be sure. Many people treat fever like malaria. Fevers are just being over-treated as malaria. By the time you take tests, you find we don't have up to 50%. What we have is 42% prevalence. So if anyone is treating fever and telling you it is malaria, I wonder how the person is sure that what he is treating is malaria. The target number of nets you want to have distributed is more than 60 million. Do you have a timeline? The process has started. We are looking at the next three weeks or four in the maximum. What yardstick do you use in distributing nets, considering many people still complain of not getting nets? We give two nets per household, and by that not every single person will get the nets. It might not be every household, so if we are able to cover 80% of the households. The federal government launched a programme for Artemisinin Based Combination Therapy (ACT) to be subsidised and distributed. Where is the NMCP on this programme? The AMFM (Affordable Medicines Facility--Malaria) focusing on the private sector is where you get the ACTs at subsidised rates. You have people who bring it in subsidised and give them to the outlets so that anyone who wants it doesn't have to pay more than the equivalent of $1 [about N159]. That is the intention and I suppose it is working. So what exactly is the situation with the ACTs, because people still use chlorophine to treat malaria? They are being procured and sent to facilities but the question is: are people going to the facilities or are they going to the chemist to buy their drugs? There are issues with test kits, aren't there? Doctors routinely treat based on symptoms without resorting to test kits. They say there aren't enough of the kits--an intervention supplied at facilities. Is there a communication breakdown? It is one of the challenges we are having. In some cases, it may not be that the RDTs are not there, but there may be a discordant delivery system--the ACTs are there but the RDTs are not there, so it is a problem of logistic management. There is also the issue of enough not being procured. There are gaps. A lot of resources is required and most of the commodities we have are given by external donors. We as government are not committing enough resources. There are a lot of gaps, there is so much one partner can do. If local resources can be brought on board to be able to get much of the commodities we need, maybe some of these issues will not be coming up. How much exactly is government putting into malaria control? In this year's budget, there is remarkable improvement. In all, between MDG and regular budget, we have about N1.3 billion. What is NMCP's role in the integrated community management of malaria? That is the idea of the primary healthcare centre; it is supposed to be a one-stop centre for testing and treatment. Malaria testing is one of the things you will find on ground--even easier than you find for HIV and TB. Malaria is the number-one problem in the country, and most of these centres have facilities to test for malaria. If you keep up the measures, how much longer before use of ACTs grow appreciably? It is still half as used as chloroquine. Between the last malaria indicator survey in 2010 and now, a lot of efforts have been put in place. It is now outlawed to use monotherapy--chloroquine--even artesunate. These are not supposed to be found in chemists. There is a law against it. Of course there are people who may want to subvert the law, so I am not surprised that you can still find it. If the MIS is done this year, I can tell you there will be a remarkable improvement. What's your take on how local manufacturers are ready or willing to get on board with production of ACTs? That is a concern for us. These commodities are brought from abroad, the price is subsidised, so the local industry that might even want to build their own capacity are not motivated because their own products cannot compete with programme products that are cheaper. We have been talking about it that we want our capacity to be built in-country so that our local industry will be encouraged. I say it every time, that by the time the donors are done with us and gone, we will be back to square one. And you know when a disease is coming back, it comes back in bigger force. A lot of resources and energy have gone into malaria control and it will really be sad if we allow all the gains to be eroded. We don't know when the donors are leaving, but if they leave without local capacity, then we have just wasted all these efforts and resources. Everybody should get onto the fight against malaria. It is costing the country a whopping N480 billion in prevention and treatment costs. We can use that money for something else, to build roads and bridges. Nigeria: The Cost of Malaria I BY JUDD-LEONARD OKAFOR, 25 APRIL 2013 Malaria costs Nigeria billions of naira each year. What does it cost a Nigerian? Idris Omale makes his living cutting hair at a barbing salon in Mararaba, Nasarawa state. He doesn't own the salon where he's been working since being deported from Libya last year. His income--whatever is left of the proceeds after remitting N400 each weekday and N1,000 on weekend day to the salon owner--places him in a group loosely categorised as "average Nigerian". The last time he was taken ill, however, class wasn't a question. Omale last had malaria in February, he remembers. "I took Panadol, but the pains didn't go away. So I took very strong 'hot' [local generic name for bottled gin] and it disappeared." His relief lasted only days before his illness returned full force and "knocked me down", he says. "I had to see a doctor friend." Treating his condition costs on average N950, according to government surveys, but he would later spend more than for complete dose of artemisinin-based antimalarial his doctor prescribed. He spends much more than money. Millions of Nigerians without health insurance pay out of their pockets for their healthcare, a proportion estimated at more than 75%. On a national scale, malaria costs the country more than N480 billion in lost manpower, treatment and care needs, according to estimates. For Omale, the cost is more personal. His family depends on what he makes daily. Each day he stayed home with malaria, he lost daily wage at the barbing salon. He complains about spending more than a day's wage on his medicine because there is "no price control" to keep the cost of antimalarials down. He could be spending that much any time soon: he doesn't take any medicine to prevent malaria and has slept under a mosquito net since his children damaged one the family used. But he is sure where his next bout of malaria might come from. "There's no way it can be eradicated. Look around. Dirt, refuse everywhere--unclean environment, waste, the mosquitoes are all over the country." Everyone has it Malaria is a staple for anyone living in Africa, says Amaka Chukwu. "Every Nigerian treats malaria nearly every other day," she says. "It is only the acute cases that go to hospital." Before going to hospital, most people with malaria try to treat the condition by themselves, using antimalarials bought over the counter at pharmacies, chemists and from informal drug vendors--an open market that ranges from anything from drug sellers on a bus to hawksters peddling drugs in basins gingerly balanced on their heads. Chemists and patent medicine vendors is the first point of treatment for 57% of Nigerians. Says Dr Nicholas Baamlong, consultant family physician at University of Abuja Teaching Hospital: "The tendency is that rather than wasting my time coming to see a doctor and wasting the whole day, let me just go to a chemist and say, 'look I have fever, headache', and the next thing they give you malaria drugs." The lure toward self medication comes from not just cost but the inconveniences of visiting a hospital. On any day, the general outpatient department at University of Abuja Teaching Hospital sees up to 280 patients. Nearly half of all patients coming to hospital daily are suspected cases of malaria, according to doctors. The hours of waiting to see a doctor means many never come to hospital, resorting to self medication for themselves and their loved ones, including children. It cuts waiting time, but not the cost. "Sometimes, you buy these drugs and by the time the child has been absent from school for two, three, four days, before you start coming to hospital. That absenteeism continues and the period it takes to treat before the child resumes. All these are losses," says Dr Baamlong. Difficult battle Anyone self-medicating for malaria is hoping to get rid of the symptoms that come with the disease. Even doctors sometimes rely on treating symptoms. "Most of the time, because of inadequacies in our laboratories, reagents, you might not get an accurate result that will show you this is malaria. You can only get that in a very little percentage. But the presumptive diagnosis, clinical signs and symptoms, points to the fact that a lot of people are coming in with malaria. Surprisingly too when you place them on treatment they get well," he says. Unfortunately, the parasite responsible for malaria--Plasmodium falciparum--has become smart over the years, evolving to become resistant to chloroquine--a strong antimalarial until recently. For ages, malaria was treated with chloroquine. In the last couple of decades, combination therapies based on artemisinin have emerged as more effective, after resistance to chloroquine was discovered. And it has made Nigeria's battle with malaria difficult. More than 30% of the global malaria burden is in Africa, and Nigeria accounts for a quarter. The most recent Malaria Indicator Survey estimates malaria prevalence at 42%, affecting children under age five more than any other population. Ironically, the prevalence increases with age but decreases with wealth. The global scientific community's rule of thumb is straightforward: with diseases caused by viruses, vaccination is the target; but disease caused by organisms other than viruses might potentially be treatable. However, the onslaught of malaria has made it worthwhile to consider a vaccine. Angling for a vaccine One candidate vaccine, RTS,S showed promise in clinical trials when in reduced malaria by approximately one-third in African infants aged 6 to 12 weeks. The study was done in seven African countries. Earlier trials led researchers to believe more reduction was possible, but results from phase-three trials showed lower reductions in older age groups than expected a year ago when trials started. The results also showed there was no overall increase in reporting of serious adverse events in the infants vaccinated with RTS,S, demonstrating an acceptable safety and tolerability profile. However, when administered along with standard childhood vaccines, the efficacy of RTS,S in infants aged 6 to 12 weeks (at first vaccination) against clinical and severe malaria was 31% and 37%,3 respectively, over 12 months of follow-up after the third vaccine dose. The efficacy observed with RTS,S in children aged 5-17 months of age against clinical and severe malaria was 56% and 47%, respectively. One of the researchers, Dr Abdulla, said, "The efficacy is lower than what we saw last year with the older 5-17 month age category, which surprised some of us scientists at the African trial sites." But the enthusiasm for RTS,S didn't cool off. Says Abdulla: "It makes us even more eager to gather and analyze more data from the trial to determine what factors might influence efficacy against malaria and to better understand the potential of RTS,S in our battle against this devastating disease. We were also glad to see that the study indicated that RTS,S could be administered to young infants along with standard childhood vaccines and that side effects were similar to what we would see with those vaccines." The vaccine from pharmaceutical company GSK was pushed by PATH Malaria Vaccine Initiative. Its director, David Kaslow, noted that determining the role of RTS,S in Africa will depend on analyses of additional data. "We are now an important step closer to that day. Success in developing malaria vaccines depends on many factors: at the top of the list are partnerships and robust evidence, coupled with an understanding that different combinations of tools to fight malaria will be appropriate in different settings in malaria-endemic countries." The ACT front With the silver bullet promised by a vaccine, national programmes fall back on treatment. In policy, the choice is artemisinin combination therapy but chloroquine, found 15 times cheaper than ACT, is still in wide use, says Prof Oladimeji Oladepo of health promotion and education department at University of Ibadan. Since its introduction, use of ACT has exceeded use of drugs as quinine and amodiaquine. But it still lags behind sulphadoxine-pyrimethamine combinations and choloroquine. For every case of malaria treated with ACT, two are treated with SP combo and more than four with chloroquine. The pressure is to ensure effective treatment is available. Global health groups are still divided over the issue: whether to put drugs in the hands of individuals, risking misuse and buildup of resistance that's rendered chloroquine suspect or whether to leave drugs in the hands of trained help, risking further distance from women and children who need the drugs. Oladepo, after studies by the African Media and Malaria Research Network, sees disconnect between policy and what happens in the field. He believes Nigeria is better off using its wide network of patent medicine vendors at community levels where it could combine treatment and prevention. Patent medicine vendors, with training, could even monitor compliance to standards, he opines. "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. Some 12.5 million doses of artemisinin combination therapy have gone through public health facilities. Another 39.4 million doses have been administered through the Affordable Medicines Facility for Malaria (AMFM), a programme to expand access to antimalarial drugs through public, private and nongovernmental organisations. The latest grant agreement between Nigeria and Global Funds is to provide a total $225 million to scale up intervention programmes in three diseases--malaria, tuberculosis and HIV/AIDS--for the next two years. In the first grant, valued at $167m, an estimated $68.4m will go to the National Malaria Control Programme and $99.2m to private sector group Society for Family Health. A second extra $50m grant was approved to provide bed nets for malaria control. AMFM enjoys subsidy from Global Funds to keep ACT costs as low as a target N100 for drug with packaging emblazoned with the AMFm logo, but that isn't what Johnson and Omale are seeing, because of loose enforcement and control. "Ideally, no antimalarial should cost more than a hundred naira, but you still see them selling it just the way they are selling others, with the same AMFM logo. It is criminal," says Dr Baamlong. Men and women working for daily wages--and their children--are paying the highest cost, and it isn't in naira.