Aisha Abubakar’s world crumbled twice in just two months. First, she buried Hassan and then Hussaini, two months later.
The four-year-old twins died of malaria — one in October 2024, the other in December.
Sitting outside her home in a camp for displaced persons in Nangere, Fika Local Government Area (LGA) of
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Yobe State, Mrs Abubakar’s voice breaks as she recalls the deaths of her boys.
“It started with fever,” she began. “I went to the hospital but wasn’t attended to on time. I went back the second time in the company of my sister, and the doctor said it was malaria.
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“One of my sons wasn’t even admitted. The other suffered until he couldn’t fight anymore,” she narrated.
Mrs Abubakar, who fled from her home in neighbouring Borno in 2019 due to the Boko Haram insurgency, had done everything she could, including sweeping her house in the camp, using mosquito nets, and replacing them when they wore out. But she lived in a town where open gutters brim with stagnant water, breeding swarms of mosquitoes.
Hence, her efforts were not enough.
Malaria prevalence in Kebbi and Yobe states
Malaria remains a global health challenge, particularly in sub-Saharan Africa, with Nigeria accounting for nearly 27 per cent of the global malaria burden. Yobe, in north-east Nigeria, has one of the worst malaria prevalence rates in the country. The state that has the unfortunate distinction of having the worst malaria prevalence in the country is Kebbi, in north-west Nigeria.
Our findings show that Kebbi and Yobe face similar challenges in their fight against the disease.
Kebbi State has the highest malaria prevalence rate in Nigeria among children under 5. In 2021, the World Health Organisation (WHO) estimated malaria prevalence in the state at 75.6 per cent based on rapid diagnostic tests (RDT), while laboratory-confirmed cases through microscopy stood at 49 per cent.
However, the laboratory-confirmed cases in 2021 represent a gradual decline from 63 per cent in 2015 and 52 per cent in 2018. Despite these gains, Kebbi still contributed 3.1 per cent of Nigeria’s estimated 68 million malaria cases in 2021, the highest contribution by a state.
In 2022, the state government distributed four million mosquito nets as part of its malaria prevention efforts, and in 2024, a state-wide fumigation exercise was conducted to reduce mosquito populations. However, limited access to functional health facilities, economic hardship, and environmental factors continue to place a high malaria burden on the state.
Health workers, like Mu’awuya Jega at Birnin Yari Primary Healthcare centre, report about 25 malaria cases daily, with complications such as seizures in children and premature labour in pregnant women being common. Many Kebbi residents, unable to afford proper medical care, turn to unqualified vendors for treatment, further complicating the fight against malaria.
According to the WHO’s 2021 report, the prevalence of malaria in Yobe State stood at 62.5 per cent based on RDT and 20.5 per cent according to microscopy. The state contributed an estimated 1.8 per cent of Nigeria’s 68 million malaria cases in 2021.
In 2022, the state distributed 2.3 million mosquito nets to combat the spread of malaria. Despite these efforts, malaria remains a significant public health threat in the state, with large portions of the population at risk.
Like Kebbi, many Yobe residents rely on informal treatment sources due to financial constraints, often resulting in poor health outcomes and increased malaria-related complications.
Realities from the communities
At Gujba PHC in Yobe State, a one-year-old, Hassan Idris, sits quietly on his mother’s lap with a nasal feeding tube taped to his face. His mother, Aisha Idris, looks on helplessly as health workers check on her son.
According to Emmanuel Nome, the resident doctor at the facility, Hassan was diagnosed with Severe Acute Malnutrition (SAM), a condition that left him too weak to eat on his own. Mr Nome explained that Hassan’s condition was worsened by malaria.
This is a common occurrence in the area where repeated bouts of malaria often push already vulnerable children into life-threatening malnutrition.
With malaria and malnutrition feeding off each other, Hassan’s case is far from unique in Gujba and other parts of Yobe State, where access to healthcare and nutritious food remains a daily struggle for many families.
The stories are not different in Kebbi
In the small, unassuming Kukah village in Birnin Kebbi, the Kebbi State capital, malaria is not just an illness but an unyielding adversary.
Suwaiba Muhammad, a mother of five, is left to bear the burden of care for her malaria-infested children while she battles to stay alive herself. For her, the fight against malaria feels relentless.
When PREMIUM TIMES spoke to her in November 2024, she lamented that all five of her children battled the disease. She herself had been admitted to a clinic; her body was too weak to battle the recurring fever.
According to her, what started as malaria crept into typhoid, compounding her misery.
“The medications are too expensive,” she lamented, her eyes weary from a struggle that feels never-ending.
“I have a shortage of blood due to my body temperature, my child almost collapsed due to high body temperature, and we are struggling to keep up with the cost of medicines. It’s been a while since we received nets from the government,” she added.
Like Suwaiba Muhammad, Jamila Kaura, a mother of four, recounted her daughter’s battle with the deadly disease. “My daughter has been suffering for about seven days, but gradually, she is getting better. Despite sleeping under mosquito nets, my child still has malaria,” she said while calling for more affordable drugs to alleviate the financial burden on families.
Mrs Muhammad’s story is particularly heart-wrenching. Her son’s malaria, lasting three months, caused severe complications. According to her, “Sometimes his body gets so hot, I have to use water and a cloth to press his body,” she recounted.
Poor sanitation worsens malaria cases in Yobe communities
Along New Jerusalem Street in Damaturu, stagnant water sat in open gutters, with mosquitoes buzzing close to people’s heads as they walked past. Children played barefoot beside the murky puddles, their laughter blending with the low hum of mosquitoes. Shopkeepers swatted at flies absentmindedly while chatting with customers.
It is the same story across Gujba, Potiskum, and Guleri LGAs, with blocked drains, pools of dirty water, and waste piling up near homes. Residents did not seem to notice the filth or the mosquitoes. It is just part of life.
Some indigenes told PREMIUM TIMES that the government once made it compulsory to clean gutters and surroundings once a month, but that had stopped for over a decade.
Several officers in charge (OIC) of PHCs in these communities expressed concern. They blamed the poor environmental conditions for the high rate of malaria cases in Yobe State.
Between May and October 2024, Dogon Zare PHC in Potiskum recorded 18 cases of low birth weight, 57 miscarriages, and 78 cases of anaemia caused by malaria in pregnant women.
Fatimah Adamu, the facility’s OIC, said the Yobe State Government has been providing treatment. However, the situation remains critical because the root cause, poor environmental sanitation, has not been addressed.
“To be sincere, the government is trying. They provide malaria treatment kits regularly. We also receive mosquito nets, although they are not enough to go around,” she said.
“But our people need to take environmental cleanliness more seriously. There are too many open gutters and stagnant water everywhere. These are breeding sites for mosquitoes. If environmental sanitation is not addressed, malaria cases will continue to rise in this state.”
At Badejo PHC, 409 malaria cases in pregnant women and 369 in children were treated between May and October 2024. Eight cases of anaemia were also recorded.
The situation is similar in Gujba PHC, where 185 malaria cases were recorded between August and October among children under five, with four of them losing their lives.
Like Ms Adamu, Gujba resident doctor Mr Nome attributed the situation to a lack of urban development and poor environmental practices.
Mr Nome, alongside the facility’s OIC, Mallam Kolo, called for more sensitisation efforts and the introduction of regular environmental sanitation practices among residents.
“The government provides us with 50 mosquito nets, but this is usually not enough for the number of pregnant women we admit each month,” Mallam Kolo said. “If the environment where these people live is clean, they may not even need mosquito nets at all. It is important for the government to address this.”
Like Yobe, like Kebbi…
In Kebbi State, environmental challenges also play a significant role in the high prevalence of malaria. Stagnant water bodies in communities provide ideal breeding grounds for anopheles mosquitoes, the primary carriers of malaria.
“Over 70 per cent of Kebbi’s landmass is intersected by rivers, including the Niger,” explained Nassir Nasir, the state programme manager for the Malaria Prevention Programme.
Mr Nasir said stagnant, clean water from irrigation farming and open water reservoirs provides ideal breeding spaces for mosquitoes.
However, he said public awareness campaigns are ongoing to correct misconceptions, such as the belief that mosquitoes primarily breed in dirty water.
The programme manager hinted at the introduction of new interventions, such as Seasonal Malaria Chemoprevention and a malaria vaccine pilot programme, to curb the disease.
He said the vector control efforts, including a larva source management pilot in Argungu and ongoing vector surveillance, are being put in place.
However, Mr Nasir lamented that challenges such as funding gaps, infrastructure deficiencies, and incomplete coverage of health facilities limit reach.
Government officials speak on sanitation
Mohammed Musa, the director of Environmental Health at the Ministry of Environment, Kebbi State, discussed the state’s monthly environmental sanitation initiative, which is expected to reduce the state’s malaria burden.
Mr Musa said the initiative, launched in June 2024, aims to address sanitation-related diseases across 21 local government areas and prevent sanitation-related diseases through meticulous house-to-house inspections.
He explained that key efforts include malaria prevention strategies that utilise both adulticide and larviciding techniques, with no recorded malaria-related deaths this season.
The initiative involves house-to-house inspections, fumigation, and awareness campaigns. Notably, the programme includes adulticiding (killing adult mosquitoes) and larviciding (targeting mosquito larvae), which have already contributed to a reduction in malaria cases.
“Future projects involve constructing permanent landfill sites and waste recycling villages, accompanied by mobile courts to enforce compliance with sanitation regulations,” Mr Musa said.
“It has been established by the Federal Ministry of Health that 80 per cent of diseases causing the highest morbidity and mortality are sanitation-related.”
Bamai Ali, director of the Malaria Programme in Yobe State, also linked the rise in malaria cases to poor environmental sanitation.
Mr Ali explained that poor environmental practices worsened after the state suspended its monthly environmental sanitation exercises due to insurgency.
He noted that while the state government is considering reviving the sanitation programme, community cooperation and external support are crucial to its success.
He said, “Even if we distribute more mosquito nets, provide more drugs, and carry out other interventions, without proper environmental sanitation, we are just treating the symptoms and not the root cause.”
“Malaria kills more Nigerians than any other disease. If environmental sanitation will come in, malaria can be prevented by over 70 per cent. Of course, the government will do their own,” he added.
Malaria vaccine rollout
The Malaria Prevention Programme Manager, Mr Nasir, highlighted several interventions implemented under the current administration to fight the disease.
These include the Seasonal Malaria Chemoprevention (SMC) programme, introduced in 2020, and the recent piloting of the malaria vaccine in Kebbi and Bayelsa states.
READ ALSO: Nigeria has the highest number of unvaccinated children globally – UNICEF
He said the state government supports 527 health facilities with malaria commodities, distributed bi-monthly.
However, over 400 public health facilities remain unreached due to funding and infrastructural gaps.
He added that the action to distribute malaria vaccines was initially planned for 26 November 2024, with Kebbi and Bayelsa states being the first to receive their share.
Mr Nasir stated that “the flag-off of the distribution was preceded by advocacy efforts, with visits to Emirate Councils in the Gwandu, Argungu, Yauri, and Zuru communities.”
He said the malaria vaccine, donated to the Nigerian government by the GAVI Alliance, WHO and UNICEF, offers hope for reducing the disease burden, particularly during peak transmission seasons.
‘’Ensuring its success will require collaborative efforts from government, donors and community stakeholders,’’ he said.
Welcomed as a ‘’symbol of hope’’ by the Deputy Governor of Kebbi State, Umar Abubakar-Tafida, Kebbi has received 595,980 doses of the malaria vaccine. The state government directed the vaccine’s inclusion in routine immunisation programmes.
The state government has also directed that the malaria vaccine be included in routine immunisation schedules, aiming to reach more children across the state.
Alongside sanitation efforts and vector control programmes, health officials hope these initiatives will finally turn the tide against malaria in Kebbi and Yobe, helping many children avoid the fate of Hassan and Hussaini.
