Eguarding Against Malaria - Using Insecticide Treated Nets

from All Africa

By Florence Udoh
Lagos

Scientifically it has been proven that prevention of malaria or any other disease is a cost effective way of combating any disease condition. In the treatment of malaria which has continued to claim many lives, particularly women and children, it is canvassed that all Nigerians should sleep under mosquito treated bed nets.

Indeed even as African continet gears up to celebrate this year's African Malaria Day on April 26th, it is good news to note that recently, the World Bank gave a credit facility worth 180 million dollars to Nigeria for control of malaria.

With the release of about $22 million US dollars from that grant for mitigation of the disease in seven states of the federation, the need to allow for more states to benefit from such long term grant is evident if the control programme is to achieve full success.

Recent statistics from the Federal Ministry of Health reveal that about 60 per cent of all outpatient attendances in hospitals across the country are as a result of malaria. Another 30% of all hospital admissions are said to be as a result of malaria disease.

Prevention rather than treatment of malaria, studies show is a more secure way of staving off the deadly disease. One of such preventive approach under international guidelines is sleeping under insecticide treated nets at all times.

In Nigeria, malaria disease is known to affect a high population of people. Women, particularly pregnant women, and children aged 0-5 are among the worst hit by the mosquito- borne ailment.

What is more disturbing about malaria scourge is that it affects in a major way, women, particularly pregnant women, and children aged 0-5 years.More than half of the total percentage of mortality among these vulnerable groups have been traced to malaria, over the years.

Malaria is said to be caused by a parasite called plasmodium falciparum. This parasite is transmitted by a particular specie of mosquito known as Anopheles, when it bites and secretes this germ into the blood stream of an exposed person. The Anopheles mosquito is easily distinguished from other breeds in many ways. For instance,they prefer to breed in stagnant water or generally moist and unclean environment which is why they thrive in many parts of the country where public hygiene is low.

The Anopheles mosquitoes have unique postures for which they are identified by. Unlike most other species of mosquitoes that rest in a flat posture on any object , the Anopheles mosquitoes rest on surfaces with their heads slanting down and their bodies raised at a steep angle upward.

A single bite of a mosquito like the Anopheles can introduce the life threatening plasmodium, which if not promptly treated can lead to death or cerebral disorder due to the complex make up of these germs that tend to quickly attack the human brain.So far, sleeping under Long Lasting Treated Nets are about the easiest options for preventing the common and preventable environmental disease.But the question is, how many Nigerians comply with this advice of sleeping under Insecticide Treated Nets.For many flimsy excuses, many avoid this alternative to the detriment of their lives or even that of children.

But determined to rid Nigeria of malaria burden at all cost, particularly in keeping with the Millennium Development Goal(MDG) on health, the Federal Government recently appointed key health officials from across various states of the federation to become members of a newly constituted National Project Steering Committee (NPSC) on the Nigerian Malaria Control Booster Project.This is an initiative of the health minister, Professor Eyitayo Lambo.

Speaking in Abuja at the inauguration ceremony of NPSC members Minister of State for Health, Halima Tayo Alao who chaired the occasion on behalf of the health minister, observed that Nigeria for far too long has been an endemic site for malaria disease. She said more hands must now be on deck to comprehensively rid the country of the avoidable menace in a pro-active system. She pointed out that with the conclusion of a grant offer from the World Bank,totalling 180 million US dollars, the fight against the disease should naturally should be unrellenting in the seven states penciled down to receive funding to curb the disease.The states include, Akwa Ibom, Anambra, Bauchi, Gombe, Jigawa, Kano, and Rivers State. The selection of the seven states she explained, was based on a survey carried out to identify states with extremely high burden of malaria, as well as those with high level of commitment to eliminating the environmental disease in their various domains.She explained that efforts so far in combating malaria in Nigeria has been slow due to a number of reasons. These include lack of effective legislation on sanitation and control, illiteracy, poverty, poor environmental health, failure to sleep under Insecticide Treated Nets(ITNs) among other causes.

"Progress to date in combating malaria has been slow. And the coverage of prevention measures and effective treatment is below target. Only 34 percent of febrile children received anti-malaria treatment (chloroquine) and 17 percent of pregnant women received Intermittent Preventive Therapy(IPT) with Sulphadoxine- Pyrimethamine. Despite being a country where malaria is endemic, the use of long lasting insecticide- treated bed nets(LLINs), which is one of the main preventive interventions against malaria, remains below target.Only 6.8 percent of children under five and pregnant women sleep under insecticide treated nets," she said.

The minister disclosed that the primary goal of the National Malaria Control Program is to reduce the burden of malaria by half come the year 2010.According to her, this level of progress is expected to have a spiral effect on as well as reduce child mortality by 20 percent across the country. She explained that the National Malaria Control Program has been put in place to ensure massive scale up of vector control interventions for all at-risk population with a strong focus on preventive approach against the disease.

"Through the National Malaria Control Program, we expect to reduce all-cause child mortality by 2010, which is in turn expected to reduce all-cause child mortality by 20 percent .To attain this goal, the program envisages a massive scale up of vector control interventions for all- at risk population and a strong focus on preventive measures, coupled with the introduction of more effective case management and this includes the use of artemisinin-based combination therapies(ACTs) for treatment of uncomplicated malaria cases, with an initial focus on children under five,"she said.

The minister described malaria as a major public health problem which must be done away with at all cost. She said that studies have shown that malaria is a cause and consequence of poverty in Nigeria. She attributed majority of cases of malaria in the country to a parasite called plasmodium falciparum.The life-threatening parasite is transmitted by the Anopheles mosquito.According to the minister, malaria accounts for about 110 million clinical cases annually, including 60% of all out patient attendances and 30% of all hospital admissions across the various health care facilities in the country.

Alao, also explained that a program known as Country Strategic Plan is to used to improve access of Nigerians to treatment on a broad intervention scale. One of the key strategy of this program is the Case Management strategy. This the minister said entails diagnosis to ensure that at least 80% of people at risk of malaria take prompt and effective treatment within 24 hours of start of illness due to malaria.

Under this scheme, children under five will receive free Artmether- Lumefantrine(AL) through public sector and faith based health facilities.

"Under the case management treatment program, a home based management of malaria strategy will be developed to increase access to effective treatment for children under five years of age. This strategy will utilize patent medicine vendors as well as expand the role model mother system", she said.

Another strategy is the Integrated Vector Management system.This process is designed to ensure that at least 80% of the population at risk of malaria sleeps under insecticide treated nets. Under this scheme, the country coordinator of Roll Back Malaria Project in Nigeria(RBM), Dr. Yemi Sofola said that already, about 700,000 units of insecticide Treated Nets(ITNs) have been disbursed to children aged 0-5 in about 18 states across the various geo-political zones .

According to the minister, many more Nigerian children would be reached during the Immunization Plus Days (IPDs) and Measles campaigns. She said children under the age of five who have commenced Dipthera 3 vaccination would be given Long Lasting Insecticide Nets(LLINs) as soon as they are brought forward for immunization. "The nets are to be handed over to mothers when they present their children for immunisation activities. Also under the scheme, free LLINs will be given to pregnant women attending first ante natal care(ANC)", she said.

Yet another national program for malaria control is Malaria Prevention during Pregnancy. The minister of state for health noted that this initiative is put in place to increase access of at least 80% of pregnant women to direct Intermittent Prevention Therapy(IPT) and Sulphadoxine-Pyrimethamine(SP), both of which are drugs specifically designed to fight malaria in pregnant women. This is key, because many otherwise young and healthy pregnant women have in the past died needlessly from a single malaria attack. This is because pregnant women very easily are susceptible to death when exposed to malaria infection.This again is because their immune system is put under severe strain when a malaria causing plasmodium enters into their blood stream after just one mosquito bite .

The process of administering IPTs require expertise and competence on the part of medical personnel.This is because the procedure requires close monitoring of both mother and child on rather very regular basis to ensure effectiveness of the drugs as well as safety and tolerance level of mother and child.

In compliance with the Africa Region charter on Integrated Vector Management(IVM) on malaria, Nigeria, a signatory country to the resolution recently conducted a pilot Indoor Residual Spraying(IRS) in Barki Ladi area of Plateau state, north central of Nigeria.This area is known to be susceptible to malaria nearly through out the entire year.

According to Dr Yemi Sofola ,the Country Coordinator of Roll Back Malaria Project in Nigeria, the indoor residual exercise was done through collaboration with departments of parasitology and entomology, department of zoology, faculty of natural sciences of the University of Jos and the Roll Back Malaria Project.

"The implementation of Indoor Residual Spraying (IRS) against malaria conducted in Barki Ladi was a pilot work.It is a part of Integrated Vector Management(IVM) procedure.This is because vector population control or suppression is crucial to effective malaria control program anywhere in the world.And Nigeria is a signatory to the IVM resolution adopted by Africa Region resolution AFR/RC50/R6," she said.

According to her, the Integrated Vector Management(IVM) processes include chemical control(adulticides and larvicides), biological control(predators, parasites, and pathogens), and environmental management.Indoor Residual Spraying and larviciding are done using chemical control.

Results of the preliminary malaria study in Plateau has shown tremendous improvement in the process of building data for understanding molecular details of mosquitoes.It has also been proven that the exercise has gone a long way to provide up to date parasitology and entomological data among other vital body of knowledge directly linked to disease control in the state.During the study, malaria infection was found to be highest(98%) at the start of December of every year. Infection with malaria was observed to have been due to infestation with Plasmodium Falciparum(83.8%) more than any other parasite.Different species of mosquitoes were found to exist heterogeneously.These include the Culex mosquitoes, Anopheles Gambiae, Anopheles Funestus, and other species of Culex breed.The study also revealed in specific ways that there is a relationship between mosquito prevalence and poor environmental health and home based hygiene.

Further research into malaria has revealed that the proportion or frequency of attack is linked to certain blood groups. For instance, 33 year -old Dr Ken Eguda, a General Practitioner (GP) at the Wuse General Hospital confirmed that cases of malaria are common with specific blood groups, even as he said that a good percentage of his income is most often sunk into various treatment procedures, using ACTs. He said that blood groups that carry high oxygen levels naturally help malaria parasites in regenerating quickly. According to Dr. Ken whose blood group is O-positive, malaria is common with such general donor blood group.He said that sometimes he gets a malaria attack without even a mosquito bite.The attack is rather triggered from residue of malaria parasites already inside his system, which he said naturally reproduce themselves.He said that one of the biggest challenge to malaria cure is the fact that most drugs used in treating malaria do not reach the liver, an organ that is usually attacked by the parasites in the body. He said that single dose of Coartem, or other use of artesunate combination are usually handy in subduing the malaria parasites.

But another volunteer, Sunday Taiwo, aged 29 said that he rarely experiences malaria attack. Sunday whose blood group is AB, however said that he could have a spell of malaria may be just once in a year, but with very severe symptoms like head aches, fever, lack of appetite, vomiting which cost him a lot of out of pocket expenses to treat. He admits also that a drug called Coartem have been found to effectively deal with the disease whenever it surfaces.

According to Roll Back Malaria boss, Dr Sofola ,Nigeria is committed to drastically reducing the social and economic burden of malaria by half come 2010 This ambitious target she says forms part of the objective of Nigeria Malaria Control Booster Project is to improve access of pregnant women and children aged 0-5 to comprehensive malaria plus interventions in focal states. She said that the Malaria Control Booster scheme expected to commence March 2007 to February 2010 would go a long way in significantly improving level of utilization of malaria booster interventions but would also help to check maternal and child morbidity and mortality as a result of malaria.

"This is why the Federal Government recently obtained a World Bank credit, totalling $180 million dollars to push for elimination of the disease in Nigeria. But out of the amount, the World Bank has only approved the release of $20 million dollars to support Nigeria's malaria control program. This credit facility would be used to implement the Malaria Control Booster Project in seven states to start with," she said.

The major challenge however facing this giant leap is the sustainability of the program.Already, there appears to be an uneven spread of the funds appropriated for implementation of the program in seven states.For better results, more states should be incorporated into the otherwise laudable program. This no doubt means that more funds have to be sourced to be able to cover more states. Although the $20 million released for management of drugs procurement, preventive campaigns and treatment of malaria in all seven states appears to be insufficient, however close supervision of implementation process of the scheme is needful to make sure that the core values of the program are not jeopardised by scarce funds. Also, all participating states must play their roles in such a way that they are in consonance with the country's strategic plan for Roll Back Malaria, which is to give priority to pregnant women and children under five years.

Malaria is caused by a parasite called plasmodium falciparum. This parasite is transmitted by a specie of mosquito known as Anopheles mosquito when it bites and secretes this germ in the blood of a victim. One of the commonest characteristics of the Anopheles mosquito is that they prefer to breed in stagnant water or generally moist and unclean environment.

The Anopheles mosquitoes are easily identifiable because of their peculiar posture. Unlike most other species of mosquitoes that rest in a flat posture on any object , the Anopheles mosquitoes rest on surfaces with their heads slanting down and their bodies raised at a steep angle upward.Apparently determined to rid Nigeria of malaria burden, the Federal Government recently constituted a National Project Steering Committee (NPSC) of the Nigerian Malaria Control Booster Project.

Speaking in Abuja at the inauguration ceremony of NPSC members recently, minister of state for Health, Halima Tayo Alao who chaired the occasion , observed that it was high time Nigeria took steps to effectively check the malaria menace in a pro-active method. She pointed out that Nigeria is currently to benefit from a loan facility of 180 million US Dollars which would be used to tackle malaria in seven states.The states include, Akwa Ibom, Anambra, Bauchi, Gombe, Jigawa, Kano, and River state. The selection of the seven states she explained was based on a survey carried out to identify states with extremely high burden of malaria, as well as those with high level of commitment to eliminating the environmental disease in their various domains.She explained that efforts so far in combating malaria in Nigeria has been slow, due to a number of reasons. These include lack of effective legislation on sanitation laws and control, illiteracy, poverty, poor environmental health, failure to sleep under Insecticide Treated Nets(ITNs) among other causes.

"Progress to date in combating malaria has been slow. And the coverage of prevention measures and effective treatment is below target. Only 34 percent of febrile children received anti-malaria treatment (chloroquine) and 17 percent of pregnant women received Intermittent Preventive Therapy(IPT) with Sulphadoxine- Pyrimethamine. Despite being a country where malaria is endemic, the use of long lasting insecticide- treated bed nets(LLINs), which is one of the main preventive interventions against malaria, remains below target.Only 6.8 percent of children under five and pregnant women sleep under insecticide treated nets," she said.

The minister disclosed that the primary goal of the National Malaria Control Program is to reduce the burden of malaria by half come the year 2010.According to her, this level of progress is expected to have a spiral effect on as well as reduce child mortality by 20 percent across the country. She explained that the National Malaria Control Program has been put in place to ensure massive scale up of vector control interventions for all at-risk population with a strong focus on preventive approach against the disease.

"Through the National Malaria Control Program, we expect to reduce all-cause child mortality by 2010, which is in turn expected to reduce all-cause child mortality by 20 percent .To attain this goal, the program envisages a massive scale up of vector control interventions for all- at risk population and a strong focus on preventive measures, coupled with the introduction of more effective case management and this includes the use of artemisinin-based combination therapies(ACTs) for treatment of uncomplicated malaria cases, with an initial focus on children under five,"she said.

The minister described malaria as a major public health problem which must be done away with at all cost. She said that studies have shown that malaria is a cause and consequence of poverty in Nigeria. She attributed majority of cases of malaria in the country to a parasite called plasmodium falciparum.The life-threatening parasite is transmitted by the Anopheles mosquito.According to the minister, malaria accounts for about 110 million clinical cases annually, including 60% of all out patient attendances and 30% of all hospital admissions across the various health care facilities in the country.

Alao, also explained that a program known as Country Strategic Plan is to used to improve access of Nigerians to treatment on a broad intervention scale. One of the key strategy of this program is the Case Management strategy. This the minister said entails diagnosis to ensure that at least 80% of people at risk of malaria take prompt and effective treatment within 24 hours of start of illness due to malaria.

Under this scheme, children under five will receive free Artmether- Lumefantrine(AL) through public sector and faith based health facilities.

"Under the case management treatment program, a home based management of malaria strategy will be developed to increase access to effective treatment for children under five years of age. This strategy will utilize patent medicine vendors as well as expand the role model mother system", she said.

Another strategy is the Integrated Vector Management system.This process is designed to ensure that at least 80% of the population at risk of malaria sleeps under insecticide treated nets. Under this scheme, the country coordinator of Roll Back Malaria Project in Nigeria(RBM), Dr. Yemi Sofola said that already, about 700,000 units of insecticide Treated Nets(ITNs) have been disbursed to children aged 0-5 in about 18 states across the various geo-political zones .

According to the minister, many more Nigerian children would be reached during the Immunization Plus Days (IPDs) and Measles campaigns. She said children under the age of five who have commenced Dipthera 3 vaccination would be given Long Lasting Insecticide Nets(LLINs) as soon as they are brought forward for immunization. "The nets are to be handed over to mothers when they present their children for immunisation activities. Also under the scheme, free LLINs will be given to pregnant women attending first ante natal care(ANC)", she said.

Yet another national program for malaria control is Malaria Prevention during Pregnancy. The minister of state for health noted that this initiative is put in place to increase access of at least 80% of pregnant women to direct Intermittent Prevention Therapy(IPT) and Sulphadoxine-Pyrimethamine(SP), both of which are drugs specifically designed to fight malaria in pregnant women. This is key, because many otherwise young and healthy pregnant women have in the past died needlessly from a single malaria attack. This is because pregnant women very easily are susceptible to death when exposed to malaria infection.This again is because their immune system is put under severe strain when a malaria causing plasmodium enters into their blood stream after just one mosquito bite .

The process of administering IPTs require expertise and competence on the part of medical personnel.This is because the procedure requires close monitoring of both mother and child on rather very regular basis to ensure effectiveness of the drugs as well as safety and tolerance level of mother and child.

In compliance with the Africa Region charter on Integrated Vector Management(IVM) on malaria, Nigeria, a signatory country to the resolution recently conducted a pilot Indoor Residual Spraying(IRS) in Barki Ladi area of Plateau state, north central of Nigeria.This area is known to be susceptible to malaria nearly through out the entire year.

According to Dr Yemi Sofola ,the Country Coordinator of Roll Back Malaria Project in Nigeria, the indoor residual exercise was done through collaboration with departments of parasitology and entomology, department of zoology, faculty of natural sciences of the University of Jos and the Roll Back Malaria Project.

"The implementation of Indoor Residual Spraying (IRS) against malaria conducted in Barki Ladi was a pilot work.It is a part of Integrated Vector Management(IVM) procedure.This is because vector population control or suppression is crucial to effective malaria control program anywhere in the world.And Nigeria is a signatory to the IVM resolution adopted by Africa Region resolution AFR/RC50/R6," she said.

According to her, the Integrated Vector Management(IVM) processes include chemical control(adulticides and larvicides), biological control(predators, parasites, and pathogens), and environmental management.Indoor Residual Spraying and larviciding are done using chemical control.

Results of the preliminary malaria study in Plateau has shown tremendous improvement in the process of building data for understanding molecular details of mosquitoes.It has also been proven that the exercise has gone a long way to provide up to date parasitology and entomological data among other vital body of knowledge directly linked to disease control in the state.During the study, malaria infection was found to be highest(98%) at the start of December of every year. Infection with malaria was observed to have been due to infestation with Plasmodium Falciparum(83.8%) more than any other parasite.Different species of mosquitoes were found to exist heterogeneously.These include the Culex mosquitoes, Anopheles Gambiae, Anopheles Funestus, and other species of Culex breed.The study also revealed in specific ways that there is a relationship between mosquito prevalence and poor environmental health and home based hygiene.

Further research into malaria has revealed that the proportion or frequency of attack is linked to certain blood groups. For instance, 33 year -old Dr Ken Eguda, a General Practitioner (GP) at the Wuse General Hospital confirmed that cases of malaria are common with specific blood groups, even as he said that a good percentage of his income is most often sunk into various treatment procedures, using ACTs. He said that blood groups that carry high oxygen levels naturally help malaria parasites in regenerating quickly. According to Dr. Ken whose blood group is O-positive, malaria is common with such general donor blood group.He said that sometimes he gets a malaria attack without even a mosquito bite.The attack is rather triggered from residue of malaria parasites already inside his system, which he said naturally reproduce themselves.He said that one of the biggest challenge to malaria cure is the fact that most drugs used in treating malaria do not reach the liver, an organ that is usually attacked by the parasites in the body. He said that single dose of Coartem, or other use of artesunate combination are usually handy in subduing the malaria parasites.

But another volunteer, Sunday Taiwo, aged 29 said that he rarely experiences malaria attack. Sunday whose blood group is AB, however said that he could have a spell of malaria may be just once in a year, but with very severe symptoms like head aches, fever, lack of appetite, vomiting which cost him a lot of out of pocket expenses to treat. He admits also that a drug called Coartem have been found to effectively deal with the disease whenever it surfaces.

According to Roll Back Malaria boss, Dr Sofola ,Nigeria is committed to drastically reducing the social and economic burden of malaria by half come 2010 This ambitious target she says forms part of the objective of Nigeria Malaria Control Booster Project is to improve access of pregnant women and children aged 0-5 to comprehensive malaria plus interventions in focal states. She said that the Malaria Control Booster scheme expected to commence March 2007 to February 2010 would go a long way in significantly improving level of utilization of malaria booster interventions but would also help to check maternal and child morbidity and mortality as a result of malaria.

"This is why the Federal Government recently obtained a World Bank credit, totalling $180 million dollars to push for elimination of the disease in Nigeria. But out of the amount, the World Bank has only approved the release of $20 million dollars to support Nigeria's malaria control program. This credit facility would be used to implement the Malaria Control Booster Project in seven states to start with," she said.

The major challenge however facing this giant leap is the sustainability of the program.Already, there appears to be an uneven spread of the funds appropriated for implementation of the program in seven states.For better results, more states should be incorporated into the otherwise laudable program. This no doubt means that more funds have to be sourced to be able to cover more states. Although the $20 million released for management of drugs procurement, preventive campaigns and treatment of malaria in all seven states appears to be insufficient, however close supervision of implementation process of the scheme is needful to make sure that the core values of the program are not jeopardised by scarce funds. Also, all participating states must play their roles in such a way that they are in consonance with the country's strategic plan for Roll Back Malaria, which is to give priority to pregnant women and children under five years.

Malaria is caused by a parasite called plasmodium falciparum. This parasite is transmitted by a specie of mosquito known as Anopheles mosquito when it bites and secretes this germ in the blood of a victim. One of the commonest characteristics of the Anopheles mosquito is that they prefer to breed in stagnant water or generally moist and unclean environment.

The Anopheles mosquitoes are easily identifiable because of their peculiar posture. Unlike most other species of mosquitoes that rest in a flat posture on any object , the Anopheles mosquitoes rest on surfaces with their heads slanting down and their bodies raised at a steep angle upward.Apparently determined to rid Nigeria of malaria burden, the Federal Government recently constituted a National Project Steering Committee (NPSC) of the Nigerian Malaria Control Booster Project.

Speaking in Abuja at the inauguration ceremony of NPSC members recently, minister of state for Health, Halima Tayo Alao who chaired the occasion , observed that it was high time Nigeria took steps to effectively check the malaria menace in a pro-active method. She pointed out that Nigeria is currently to benefit from a loan facility of 180 million US Dollars which would be used to tackle malaria in seven states.The states include, Akwa Ibom, Anambra, Bauchi, Gombe, Jigawa, Kano, and River state. The selection of the seven states she explained was based on a survey carried out to identify states with extremely high burden of malaria, as well as those with high level of commitment to eliminating the environmental disease in their various domains.She explained that efforts so far in combating malaria in Nigeria has been slow, due to a number of reasons. These include lack of effective legislation on sanitation laws and control, illiteracy, poverty, poor environmental health, failure to sleep under Insecticide Treated Nets(ITNs) among other causes.

"Progress to date in combating malaria has been slow. And the coverage of prevention measures and effective treatment is below target. Only 34 percent of febrile children received anti-malaria treatment (chloroquine) and 17 percent of pregnant women received Intermittent Preventive Therapy(IPT) with Sulphadoxine- Pyrimethamine. Despite being a country where malaria is endemic, the use of long lasting insecticide- treated bed nets(LLINs), which is one of the main preventive interventions against malaria, remains below target.Only 6.8 percent of children under five and pregnant women sleep under insecticide treated nets," she said.

The minister disclosed that the primary goal of the National Malaria Control Program is to reduce the burden of malaria by half come the year 2010.According to her, this level of progress is expected to have a spiral effect on as well as reduce child mortality by 20 percent across the country. She explained that the National Malaria Control Program has been put in place to ensure massive scale up of vector control interventions for all at-risk population with a strong focus on preventive approach against the disease.

"Through the National Malaria Control Program, we expect to reduce all-cause child mortality by 2010, which is in turn expected to reduce all-cause child mortality by 20 percent .To attain this goal, the program envisages a massive scale up of vector control interventions for all- at risk population and a strong focus on preventive measures, coupled with the introduction of more effective case management and this includes the use of artemisinin-based combination therapies(ACTs) for treatment of uncomplicated malaria cases, with an initial focus on children under five,"she said.

The minister described malaria as a major public health problem which must be done away with at all cost. She said that studies have shown that malaria is a cause and consequence of poverty in Nigeria. She attributed majority of cases of malaria in the country to a parasite called plasmodium falciparum.The life-threatening parasite is transmitted by the Anopheles mosquito.According to the minister, malaria accounts for about 110 million clinical cases annually, including 60% of all out patient attendances and 30% of all hospital admissions across the various health care facilities in the country.

Alao, also explained that a program known as Country Strategic Plan is to used to improve access of Nigerians to treatment on a broad intervention scale. One of the key strategy of this program is the Case Management strategy. This the minister said entails diagnosis to ensure that at least 80% of people at risk of malaria take prompt and effective treatment within 24 hours of start of illness due to malaria.

Under this scheme, children under five will receive free Artmether- Lumefantrine(AL) through public sector and faith based health facilities.

"Under the case management treatment program, a home based management of malaria strategy will be developed to increase access to effective treatment for children under five years of age. This strategy will utilize patent medicine vendors as well as expand the role model mother system", she said.

Another strategy is the Integrated Vector Management system.This process is designed to ensure that at least 80% of the population at risk of malaria sleeps under insecticide treated nets. Under this scheme, the country coordinator of Roll Back Malaria Project in Nigeria(RBM), Dr. Yemi Sofola said that already, about 700,000 units of insecticide Treated Nets(ITNs) have been disbursed to children aged 0-5 in about 18 states across the various geo-political zones .

According to the minister, many more Nigerian children would be reached during the Immunization Plus Days (IPDs) and Measles campaigns. She said children under the age of five who have commenced Dipthera 3 vaccination would be given Long Lasting Insecticide Nets(LLINs) as soon as they are brought forward for immunization. "The nets are to be handed over to mothers when they present their children for immunisation activities. Also under the scheme, free LLINs will be given to pregnant women attending first ante natal care(ANC)", she said.

Yet another national program for malaria control is Malaria Prevention during Pregnancy. The minister of state for health noted that this initiative is put in place to increase access of at least 80% of pregnant women to direct Intermittent Prevention Therapy(IPT) and Sulphadoxine-Pyrimethamine(SP), both of which are drugs specifically designed to fight malaria in pregnant women. This is key, because many otherwise young and healthy pregnant women have in the past died needlessly from a single malaria attack. This is because pregnant women very easily are susceptible to death when exposed to malaria infection.This again is because their immune system is put under severe strain when a malaria causing plasmodium enters into their blood stream after just one mosquito bite .

The process of administering IPTs require expertise and competence on the part of medical personnel.This is because the procedure requires close monitoring of both mother and child on rather very regular basis to ensure effectiveness of the drugs as well as safety and tolerance level of mother and child.

In compliance with the Africa Region charter on Integrated Vector Management(IVM) on malaria, Nigeria, a signatory country to the resolution recently conducted a pilot Indoor Residual Spraying(IRS) in Barki Ladi area of Plateau state, north central of Nigeria.This area is known to be susceptible to malaria nearly through out the entire year.

According to Dr Yemi Sofola ,the Country Coordinator of Roll Back Malaria Project in Nigeria, the indoor residual exercise was done through collaboration with departments of parasitology and entomology, department of zoology, faculty of natural sciences of the University of Jos and the Roll Back Malaria Project.

"The implementation of Indoor Residual Spraying (IRS) against malaria conducted in Barki Ladi was a pilot work.It is a part of Integrated Vector Management(IVM) procedure.This is because vector population control or suppression is crucial to effective malaria control program anywhere in the world.And Nigeria is a signatory to the IVM resolution adopted by Africa Region resolution AFR/RC50/R6," she said.

According to her, the Integrated Vector Management(IVM) processes include chemical control(adulticides and larvicides), biological control(predators, parasites, and pathogens), and environmental management.Indoor Residual Spraying and larviciding are done using chemical control.

Results of the preliminary malaria study in Plateau has shown tremendous improvement in the process of building data for understanding molecular details of mosquitoes.It has also been proven that the exercise has gone a long way to provide up to date parasitology and entomological data among other vital body of knowledge directly linked to disease control in the state.During the study, malaria infection was found to be highest(98%) at the start of December of every year. Infection with malaria was observed to have been due to infestation with Plasmodium Falciparum(83.8%) more than any other parasite.Different species of mosquitoes were found to exist heterogeneously.These include the Culex mosquitoes, Anopheles Gambiae, Anopheles Funestus, and other species of Culex breed.The study also revealed in specific ways that there is a relationship between mosquito prevalence and poor environmental health and home based hygiene.

Further research into malaria has revealed that the proportion or frequency of attack is linked to certain blood groups. For instance, 33 year -old Dr Ken Eguda, a General Practitioner (GP) at the Wuse General Hospital confirmed that cases of malaria are common with specific blood groups, even as he said that a good percentage of his income is most often sunk into various treatment procedures, using ACTs. He said that blood groups that carry high oxygen levels naturally help malaria parasites in regenerating quickly. According to Dr. Ken whose blood group is O-positive, malaria is common with such general donor blood group.He said that sometimes he gets a malaria attack without even a mosquito bite.The attack is rather triggered from residue of malaria parasites already inside his system, which he said naturally reproduce themselves.He said that one of the biggest challenge to malaria cure is the fact that most drugs used in treating malaria do not reach the liver, an organ that is usually attacked by the parasites in the body. He said that single dose of Coartem, or other use of artesunate combination are usually handy in subduing the malaria parasites.

But another volunteer, Sunday Taiwo, aged 29 said that he rarely experiences malaria attack. Sunday whose blood group is AB, however said that he could have a spell of malaria may be just once in a year, but with very severe symptoms like head aches, fever, lack of appetite, vomiting which cost him a lot of out of pocket expenses to treat. He admits also that a drug called Coartem have been found to effectively deal with the disease whenever it surfaces.

According to Roll Back Malaria boss, Dr Sofola ,Nigeria is committed to drastically reducing the social and economic burden of malaria by half come 2010 This ambitious target she says forms part of the objective of Nigeria Malaria Control Booster Project is to improve access of pregnant women and children aged 0-5 to comprehensive malaria plus interventions in focal states. She said that the Malaria Control Booster scheme expected to commence March 2007 to February 2010 would go a long way in significantly improving level of utilization of malaria booster interventions but would also help to check maternal and child morbidity and mortality as a result of malaria.

"This is why the Federal Government recently obtained a World Bank credit, totalling $180 million dollars to push for elimination of the disease in Nigeria. But out of the amount, the World Bank has only approved the release of $20 million dollars to support Nigeria's malaria control program. This credit facility would be used to implement the Malaria Control Booster Project in seven states to start with," she said.

The major challenge however facing this giant leap is the sustainability of the program.Already, there appears to be an uneven spread of the funds appropriated for implementation of the program in seven states.For better results, more states should be incorporated into the otherwise laudable program. This no doubt means that more funds have to be sourced to be able to cover more states. Although the $20 million released for management of drugs procurement, preventive campaigns and treatment of malaria in all seven states appears to be insufficient, however close supervision of implementation process of the scheme is needful to make sure that the core values of the program are not jeopardised by scarce funds. Also, all participating states must play their roles in such a way that they are in consonance with the country's strategic plan for Roll Back Malaria, which is to give priority to pregnant women and children under five years.