World Malaria Day is celebrated every April globally. This year, great speeches were made and articles written in Nigeria. But not much has changed, medical experts say, as more people are affected by the scourge.
The vice president of the Commonwealth Medical Association, Osahon Enabulele, says the government is not doing enough to eliminate the top killer. Mr. Enabulele, a family health consultant and former president of the Nigerian Medical Association, advises women must be given top platforms in the country’s malaria project.
PREMIUM TIMES: Do you think Nigeria is doing enough to stop malaria?
ENABULELE: Until Nigeria and other African countries understand that they cannot but take their destinies in their own hands by being in the forefront of the push for the allocation of malaria, they will continue to move in circles. And will continue to record alarming deaths due to malaria. As I speak to you, African countries are still waiting upon the Western world to discover a vaccine for prevention of malaria. We should be in the forefront of research and whatever mechanisms are needed to stop malaria in this continent because it is largely an African malaise; an African problem.
PREMIUM TIMES: But there are many medications out there used in managing malaria. Are they not enough?
ENABULELE: Yes, there are so many medications now, but again, they are just palliatives for managing the condition when it comes. But we are talking about eliminating it from the African continent and that takes into perspectives, the research abilities, capacities and commitments of our government in Africa, including Nigeria. But as long as we are not ready to devote that huge investments in the search for permanent solutions to the malaria scourge, we would continue to throw about figures and statistics about the malaria affectation in the African continent and within Nigeria.
PREMIUM TIMES: Are you saying the government is not making efforts in eliminating this killer disease?
ENABULELE: I appreciate that efforts have been made in the past and are still being made, but those efforts are not huge enough to bring about the end date, in terms of the end date for malaria. In terms of the eradication of the malaria scourge, that is, saying goodbye to malaria in Nigeria and the African continent.
PREMIUM TIMES: So, where is the government getting it wrong?
ENABULELE: It has to do with the political commitments to the whole malaria campaign, and the whole malaria ending project, and also involving huge investments in malaria. Just as I speak to you, the budget for health in Nigeria is an abysmal 3.65 percent and that cannot take us anywhere.
PREMIUM TIMES: But, there is a global economic crisis while Nigeria is swimming in hers. Is that not a contributing factor to the 3.65 percent awarded health in the 2016 budget?
ENABULELE: Irrespective of what anyone will say, that it is as a result of the global economic crisis or it is a Nigerian economic crisis, but nations that have made progress in health and their prosperity have always prioritized health interventions. So, even in budgeting, you prioritize it. It should be prioritized. It shows that perhaps we are still in the era of being literary to fundamental health interventions in our country.
As much as I appreciate efforts that have been made in the past, those efforts are just like a drop in the ocean. For as long as we are not in the front seats in terms of driving real research interventions, into possible permanent solutions to the malaria scourge, we would just be scratching the surface.
PREMIUM TIMES: I was managed for malaria in the United States two years ago, since then, I have never come down with it. Before then, every time, I would treat malaria in Nigeria and would have another bout in less than a month. Are our medications or medical management style faulty in Nigeria?
ENABULELE: Certainly malaria management is not a one directional management pathway. In managing malaria, a lot of social issues and determinants of health come into play. Basic education is key.
PREMIUM TIMES: Such as…?
ENABULELE: For instance, the preventive approaches to malaria management. So, if we have an uneducated man who does not understand or appreciate the simple fact that malaria is all about transmitting the plasmodium into the bloodstream of the host (individual) and from where the whole business of infection takes place, there is therefore the need to ensure that even your environmental issues, such as sanitation is taken care of to reduce the level of exposure. For as long as that sensitization, education, and of course, enlightenment is not at optimal level, then we will continue to have individuals who will be subjected to wild level of exposures. Even if they take the medications, they will only work for a while, they can’t prevent the plasmodium being inoculated into the individual.
PREMIUM TIMES: So, what should such individuals do to prevent inoculation of the plasmodium into them?
ENABULELE: The only thing that can be done is to adopt individual and community approaches in terms of sanitation, hygiene, and of course, preventive measures. The basic issues of ensuring that there are no stagnant forms of water, clear your surroundings so that you have environmental friendly infrastructures, the fact that people know where to seek help when they notice a rise in temperature are all issues in malaria management. It is a broad spectrum which plays in keying into the overall management all forms of determinants of health in terms of the issues of education and poverty.
PREMIUM TIMES: You are saying poverty contributes to the malaria malaise. How?
ENABULELE: Poverty will limit people from even embracing or investing in those issues of determinants of health. For instance, if somebody has to get a mosquito net, and does not have the opportunity of having free access, then the person will have to look into his own internal resources to get that. So, how many Nigerians can afford to have those resources to get some of those needed ingredients that will help to prevent exposure to malaria?
PREMIUM TIMES: But, the Nigerian government has been distributing millions of treated mosquito nets for several years and hospitals, like the government say, give them out for free. Is the government lying?
ENABULELE: Inspite of the so-called distribution of free mosquito nets all over the place, there are still people who do not have access to it. What I am saying in essence is that, it is not all about taking a western medication, there are a lot of issues that go into it because if you take a drug now and you get exposed to the plasmodium, or mosquito bites you, preeminently the anopheles mosquito, irrespective of whatever drug you have taken, if you are very susceptible to malaria, you are likely to come down with malaria in the next 10 to 14 days. And you will begin to wonder why are you coming down with malaria, is it that you took a fake drug? No, you exposed yourself. So, that is where the preventive strategies are very important in managing malaria, for as long as we are yet to get appropriate vaccines to inoculate individuals to prevent them from coming down with it in the first instance.
PREMIUM TIMES: Statistics indicate there is a disproportionate malaria burden more on women and children, particularly, those of reproductive age. So, what about women being at the centre of malaria programmmes in the country?
ENABULELE: Absolutely, I buy into that.
PREMIUM TIMES: Will that really help in stopping the killer?
ENABULELE: Absolutely, we have no choice but to use the platform for women involvement in the whole malaria management. Like you said, the statistics are overwhelming in terms of the affectation of women in the reproductive age group and children, especially the under-five. So, any interventionist policy, must key into it, these two groups: women and under-five children.
PREMIUM TIMES: So, how can interventionist policies key into these two groups: women and under-five children?
ENABULELE: In terms of women empowerment and ensuring they are well educated, enlightened, all those preventive approaches, must involve them and integrate them. We have to make them the centre place for all the approaches and management strategies that need to be involved. Women need to be empowered so they can have financial empowerment and all sorts of environmental empowerment. They need to be able to have that level of decision making, to know that when their child is having fever, they can run to the nearest health facility without any obstacle or obstruction either at the home front or whatever. So, they have to access health facilities to ensure their children are treated quickly.
PREMIUM TIMES: So, what you are saying is that, if not treated quickly, that means there are consequences. What are they?
ENABULELE: Delay in treatment can result to what we call cerebral malaria and all sorts of severe malaria which increase the mortality profile. Once they are able to promptly respond, that means, some level of empowerment given to the women, to be able to take decisions on time and access both physically and financially health facilities within her locality, then we would be making a headway.
PREMIUM TIMES: I feel health facilities within many localities I have been to, are rather too far from the people, so women travel to access treatments. Like developed countries, isn’t there a standard measurement for the location of health facilities in Nigeria?
ENABULELE: There is in Nigeria. Health facilities must be at least not more than five kilometer radius. It contributes in reducing the whole burden, disability and mortality associated with malaria and other health conditions both with the woman and the child; particularly women of reproductive age group because malaria can be transmitted from the mother to the child.
PREMIUM TIMES: So, are you saying it is a must that women be given preeminent platforms in the malaria ending project?
PREMIUM TIMES: Why?
ENABULELE: Women of reproductive age group are very critical in the whole reduction of morbidity and mortality. Because a woman that is pregnant and has malaria has chances of affecting the child and it is always very overwhelming even before the child is born. So, a lot of challenges can occur in terms of pregnancy complications among others. There is no emphasizing the fact that women need to be preeminently given a platform in the whole preventive and eradication approaches in the malaria ending project.
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