Executive Summary
World Malaria Day (WMD) is observed April 25th every year. The day is aimed to spread awareness about malaria disease, take urgent action in the control of the deadly disease, and promote efforts to prevent malaria. In commemoration of World Malaria Day, NOIPolls conducted a new public opinion poll on Malaria disease.
The poll result revealed that slightly more than 9 in 10 Nigerians (91 percent) think that malaria is one of the most worrisome health challenges in the country. This assertion cuts across gender, geographical locations, and age groups with at least 87 percent representation. According to the 2021 World Malaria Report, Nigeria had the highest number of global malaria cases (27% of global malaria cases) and the highest number of deaths (32% of global malaria deaths) in 2020.[1] In addition, Nigeria accounted for an estimated 55.2% of malaria cases in West Africa in 2020.[2]
With regards to the malaria burden in the country, the poll has quantified just how pervasive malaria disease is, with as many as 7 in 10 (71percent) Nigerians revealing they had treated malaria in the past three (3) months. To further corroborate this finding, the World Malaria Report revealed that cases of malaria in Nigeria have increased to 5.3% between 2017 and 2020, from 298 to 314 per 1000 of the population at risk. Deaths increased by 4.7%, from 0.92 to 0.97 per 1000 of the population at risk during that same period.[3]
Furthermore, respondents were asked what they do when they have symptoms of malaria and the poll findings showed that 41 percent of respondents go to the hospital for treatment, 22 percent said they go to a chemist and 21 percent visit a pharmacy when they develop symptoms of malaria. Interestingly, 11 percent of the respondents disclosed that they take herbs to cure themselves of malaria; 7 percent mentioned that they buy malaria drug while 1 percent claimed that they go to meet their Pastors or Imams.
Regarding the most common medications used by the Nigerian populace for the treatment of malaria, the study found that 29 percent of Nigerians use Artemisinin-based combination therapies (ACTs) for the treatment of malaria (e.g., Coartem, Amartem, Lonart and Lumartem). This is followed by 12 percent of Nigerians who use Artemether medication to treat malaria. Additionally, 7 percent of the populace use Paracetamol, while 4 percent use Artesunate for malaria treatment. Alarmingly, the study also found that 1 percent of the Nigerian population uses herbs as medication for the treatment of malaria. Conclusively, Nigerians mostly use medications containing Artemisinin-based combination therapies (ACTs) for the treatment of malaria.
Given the findings from this poll, it is pertinent for the government and other donor agencies to tackle malaria disease swiftly by putting in the needed resources for combatting the scourge. Malaria control in Nigeria will cease to be a mirage and become a reality with a bit more strategic and prioritized effort. For instance, the R21 malaria vaccine was approved domestically, in Nigeria, by the National Agency for Food and Drug Administration and Control (NAFDAC). Mrs. Adeyeye, the Director-General of NAFDAC disclosed that the vaccine is indicated for the prevention of malaria in children from 5-36 months of age and that Nigeria expects to get a minimum of 100,000 doses of the vaccine in donations before market authorization would plan with the National Primary Health Care Development Agency.[4]
2.0 Background and Objectives
Every year, April 25th is observed as World Malaria Day (WMD) a day set aside the world over to commemorate and align with the efforts and commitment of stakeholders and instituted authorities towards the curbing and complete eradication of the malaria malaise which is ravaging lives all over the world. The year 2023 theme is Time to deliver zero malaria, invest, innovate, implement. Interestingly, within the theme of the year, WHO will focus on the third “I” – implement – which is critically important in reaching marginalized populations with tools and strategies that are available today.
In addition, the day is also set aside to highlight the need for continued investment and sustained political commitment to malaria prevention and control for the greater population of the world. More so, the day further intimates the need to invest, innovate and implement eradication strategies to achieve a zero-malaria situation in the world considering the challenges the disease poses on human existence. The WHO statistics show that 619 000 malaria-related deaths were recorded in 2021 alone, also 247 million new cases of malaria were encountered in 2021. The statistics further show that 95 percent of all malaria cases are in the WHO African Region[5].
Nigeria has one of the highest malaria burdens in the world with an estimated 100 million cases, and over 300,000 deaths recorded yearly[6]. According to the 2019 World Malaria Report, Nigeria recorded the largest number of malaria cases, a fourth of the global malaria cases, and the highest number of deaths (24% of global malaria deaths)[7]. An effective vaccine against malaria has been in the offing since the 1960s. Vaccines help prevent the body from diseases by preparing the immune system to detect and fight diseases[8]. They do this by safely exposing the body to pathogens to enable the immune system to make antibodies that can ward off these harmful pathogens.
The World Health Organization recently recommended the use of RTS,S malaria vaccine in children living in areas of high malaria burden, making RTS,S not only the first malaria vaccine, but the first vaccine against any human parasite[9]. However, results thus far show that the efficacy of the RTS,S vaccine (is about 30%, i.e. it prevents about a third of severe disease cases) is poor compared to other vaccines such as COVID-19 (95%), measles (97%), and poliomyelitis (99%). This may not be unconnected with the fact that when the parasite enters the body it goes to the liver first before entering the bloodstream, and there are not many vaccines available that can target the parasite at the bloodstream and the liver, amongst other factors[10].
A second malaria vaccine, the R21, shows greater promise than its predecessor, and is presently showing a higher efficacy of 77% against malaria, which is beyond the World Health Organization (WHO) benchmark of 75%. The R21 malaria vaccine was approved domestically, in Nigeria, by the National Agency for Food and Drug Administration and Control (NAFDAC). Mrs. Adeyeye, the Director-General of NAFDAC disclosed that the vaccine is indicated for the prevention of malaria in children from 5-36 months of age, and that Nigeria expects to get a minimum of 100,000 doses of the vaccine in donations, before market authorization would plan with the National Primary Health Care Development Agency[11]. Against this backdrop, NOIPolls conducted this survey to feel the pulse of Nigerians regarding malaria and hereby presents its findings[12].
3.0 Survey Methodology
The survey was conducted through telephone interviews in the week of April 4th. 2023. A proportionate random nationwide selected sample of 1,000 phone-owning Nigerians, 18 years and above, were interviewed across the six geopolitical zones in the country. This sample size provides a 95% confidence interval that the results obtained are within a range of plus or minus 4.65% of the opinions of the population. The interviews were conducted in English, Pidgin, Hausa, Igbo, or Yoruba. The use of several Nigerian languages reduces the likelihood of a non-response bias.
4.0 Demographic Distribution
A total of 1,090 respondents were randomly selected for this survey. The survey was administered over the telephone in five languages, using a well-structured questionnaire. The demographic distribution of the respondents was analyzed by the following groups: gender, age group, geo-political zones, and occupation as illustrated in Figure 1 below.
Gender: The proportion of male and female respondents was almost equal with 51 percent and 49 percent respectively.
Age Group: The age group with the highest frequency in the survey was 36 – 60 (63 percent) and the lowest age group represented was 60+ (5 percent).
Geo-Political Zone
All geo-political zones were adequately represented in the survey, the highest represented zone is the North-West zone (24 percent) and the lowest is the South-East zone (12 percent).
Occupation: The highest proportion of respondents surveyed were self-employed traders (37 percent); followed by government workers/civil servants (21 percent) and Artisans (9 percent). The lowest-represented occupation in the survey was Youth Corp Members with 1 percent.
Figure 1: Demographic Distribution
5.0 Survey Results
Respondents to the poll were asked fifteen specific questions. This section of the report presents findings from each question.
5.1 Perception of Malaria in Nigeria
The first question gauged the perception of Nigerians nationwide on the malaria disease and the result revealed an overwhelming majority of Nigerians nationwide reported that malaria is one of the most worrisome health challenges in the country. This response cuts across gender, geographical locations, and age groups with a minimum representation of 87 percent.
Figure 2: Perception of Malaria in Nigeria
5.2 Hospital visitation due to illness
One in two (48 percent) of Nigerians disclosed that they had visited the hospital in the last three months because they were sick. Of this population, a larger proportion of males (51 percent) compared to females (45 percent) admitted to having visited the hospital in the last three months because they were sick. However, a slightly larger proportion (52 percent) admitted to not having visited the hospital as a result of being sick in the past three months. A proportion (54 percent) of elderly citizens aged 61 and above revealed they had visited the hospital because of illness, in the past three months. This age demographic visited the hospital the most, compared to the other age demographics.
Figure 3: Hospital visitation due to illness
A trend analysis comparing April 2021 with April 2023 data shows that the difference between the proportions of those who had visited the hospital due to illness and those who hadn’t in 2021 and 2023 is just one percentage point. In other words, the trend remained slightly the same over the period.
Figure 4: Trend on hospital visitation due to illness
5.3 Perception of the diagnosed illness
Furthermore, respondents who disclosed they had been to the hospital in the past three months were subsequently asked what ailment they were diagnosed with. Though more than one response was permitted per respondent, malaria was the most common (88 percent) ailment respondents were diagnosed with, and this was by a margin. The next most prevalent ailment was typhoid (32 percent). This was followed by hypertension (8 percent), and ulcers (5 percent) among others. Malaria was the most diagnosed ailment across gender, geo-political zone, and age groups.
Figure 5: Perceptions of the diagnosed illness
When comparing results from 2023 with 2021, the findings were about the same as Malaria was the most prevalently diagnosed ailment also in 2021 (83 percent). The same was also true for Typhoid (25 percent) in 2021.
Figure 6: Trend on diagnosed illness.
5.4 Proportion of Nigerians who treated Malaria in the past three months.
Survey results show that 1 in 2 respondents, or a member of their household had treated Malaria in the last three (3) months. Interestingly, a larger proportion of females (53 percent) revealed this than males (46 percent). This is poignant keeping in mind that Malaria is a leading cause of miscarriage, low birth weight, maternal anaemia, and maternal death.[13] The numbers were also considerably high given that the survey was conducted in April 2023 which is a few months after the seasonal peak period of malaria in Nigeria. The numbers would be expected to be higher if it were conducted then.
Interestingly, the Northeast posted the lowest proportion (29 percent) of respondents who disclosed they had been treated for malaria in the last 3 months. This may have been attributable to changes in weather conditions. Lastly, a larger proportion of 18–35-year-olds (51 percent) and 36–60-year-olds (51 percent) treated malaria in the past three months compared with 61+-year-olds (37 percent).
Figure 7: Proportion of Nigerians who treated Malaria in the past three months.
Trend analysis shows more people (50 percent) admitted to having treated malaria in the past three months in 2023 than in 2021 (45 percent) hence revealing a growing trend.
Figure 8: Trend on Nigerians who treated malaria in the past three months.
In total, a large proportion of Nigerians (71 percent) disclosed that they have treated malaria within the past three (3) months. However, 28 percent stated otherwise.
Figure 9: Proportion of Nigerian who have treated malaria.
5.5 Actions are taken when having symptoms of Malaria.
Only about 4 in 10 (41 percent) of respondents disclosed that they go to the hospital when they experience symptoms of malaria, which indicates the health-seeking behavior of Nigerians is low, and it underscores the need for the provision of universal health coverage to ensure health care is accessible to everyone. The remainder of the population either visits a chemist (22 percent), or a pharmacy (21 percent), takes herbs (11 percent), buys drugs (7 percent), etc.
Figure 10: Actions are taken when having symptoms of Malaria.
Trend analysis shows that proper health-seeking behavior (i.e. visiting a hospital) declined, rather self-help behavior such as visiting a chemist, or a pharmacy store, or taking herbal remedies which aren’t apportioned in prescribed amounts increased between 2021 and 2023.
Figure 11: Actions are taken when having symptoms of Malaria (Trend)
5.6 Proportion of Nigerians who do a Lab test for Malaria.
Of the proportion who acknowledged visiting a hospital, a chemist, a pharmacy, or buying drugs, were subsequently asked if they ran a lab test to ascertain it was malaria. Most (72 percent) disclosed conducting a diagnostic test, whereas 18 percent reported self-diagnosis. Self-diagnosis seemed to be more prevalent in the southern geo-political zone compared with the northern geo-political zone.
Figure 12: Proportion of Nigerians who do a Lab test for Malaria.
5.7 Drugs commonly used to treat Malaria.
Regarding the most common medications used by the Nigerian populace for the treatment of malaria, the study found that 29 percent of Nigerians use Artemisinin-based combination therapies (ACTs) for the treatment of malaria (e.g., Coartem, Amartem, Lonart and Lumartem). This is followed by 12 percent of Nigerians who use Artemether medication to treat malaria. Additionally, the study revealed that 7 percent of the populace use Paracetamol, while 4 percent use Artesunate for malaria treatment. Alarmingly, the study also found that 1 percent of the Nigerian population uses herbs as medication for the treatment of malaria, a practice that might not be safe. Conclusively, Nigerians mostly use medications containing Artemisinin-based combination therapies (ACTs) for the treatment of malaria.
Figure 13: Drugs commonly used to treat Malaria.
5.8 Frequency in Treating Malaria in Nigeria
Additionally, an assessment on how often Nigerians treat malaria revealed that 34 percent of respondents treat malaria "every two months", 28 percent of the citizenry treat malaria "twice a year”, 17 percent treat malaria "once a year" and 5 percent treat malaria every month.
Figure 14: Frequency of treating Malaria in Nigeria
5.9 Ownership of Insecticides Treated Nets in Nigeria
Insecticide-treated bed nets (ITNs) are a form of personal protection that has been shown to reduce malaria illness, severe disease, and death in an endemic region[14]. The analysis of the survey results showed that 70 percent of Nigerians own and use ITNs in their homes while 30 percent of the population do not own ITNs. Analysis across geopolitical zones in Nigeria shows that the North-West region, at 85 percent, had the highest proportion of Nigerians that own and use ITNs, while the South-West accounted for the region with the lowest percentage at 54 percent.
Figure 15: Ownership of insecticide-treated net in Nigeria.
Analysis of trends on the ownership of ITNs in Nigeria revealed that the percentage of Nigerians that own insecticide-treated nets has decreased from 71 percent in April 2021 to 70 percent in April 2023
Figure 16: Ownership of insecticide-treated net in Nigeria (Trend)
5.10 Reason for not owning an insecticide-treated net.
Subsequently, respondents who do not sleep under the treated net were further probed and findings showed that 26 percent stated that they are not comfortable under the net while 17 percent did not have any reason for not owning a treated net. Interestingly, 6 percent of the respondents disclosed they cannot afford to buy the net.
Figure 17: Reason for not owning an insecticide-treated net.
5.11 Proportion of Nigerians who slept under the net.
Similarly, of the 70 percent of Nigerians who claimed to own an insecticide-treated net, 71 percent stated that they slept inside the net the night before they were interviewed whereas 29 percent did not sleep under the net.
Figure 18: Proportion of Nigerians who slept under the net.
When the result obtained in 2021 is compared to that of 2023, it reveals a 4 percent increase in the number of Nigerians who slept under a treated net the night before they were interviewed.
Figure 19: Proportion of Nigerians who slept under the net.
5.12 Reasons Given for not sleeping under the Net.
For respondents who did not sleep under an insecticide-treated net were further probed findings showed top three reasons given by respondents for not sleeping under an insecticide-treated net include; hot weather (50 percent), having a well-netted house (14 percent) and not feeling comfortable sleep inside the net (13 percent).
Figure 20: Reasons are given for not sleeping under the Net.
5.13 Awareness of the symptoms of malaria
Consequently, Nigerians were asked about the symptoms of malaria and the top four symptoms mentioned were fever with shivering (45 percent), body pain (37 percent), headache (35 percent), and loss of appetite (29 percent) amongst other symptoms.
Figure 21: Awareness of the symptoms of Malaria
5.14 Preventive Measures Taken by Nigerians against Contracting Malaria
The study explored preventive measures taken by Nigerians to prevent contracting malaria, and results showed the top 5 measures were "sleeping inside a mosquito-treated net" (54 percent), "spraying insecticide routinely" (41 percent), "cleaning household surroundings" (28 percent), "drainage of stagnant water" (11 percent), and "clearing bushes and tall grasses near the household" (10 percent).
Figure 22: Preventive Measures Taken by Nigeria against Contracting Malaria
5.15 Awareness Of RTS,S Malaria Vaccine
The study revealed that 23 percent of Nigerians nationwide are aware of the RTS,S malaria vaccines; this indicates that only about 2 in 10 Nigerians are aware of the existence of the RTS,S malaria vaccine. On the contrary, 77 percent of Nigerians are not aware of the vaccine, which implies about 8 in 10 Nigerians nationwide are not aware of the vaccine.
Figure 23: Awareness Of RTS,S Malaria Vaccine
5.16 Willingness to Get Vaccinated
As regards the willingness of Nigerians to get vaccinated with the RTS,S malaria vaccine, analysis shows there is a high likelihood for the uptake of the malaria vaccine as the majority (87 percent) of Nigerians polled nationwide are willing to get vaccinated if the RTS, S vaccines were made available in Nigeria.
Figure 24: Willingness to Get Vaccinated
6.0 Conclusion In conclusion, the survey shows that Malaria disease is pervasive with as many as 7 in 10 (71 percent) treating malaria in the past three months. However, only 41 percent of Nigerians go to the hospital when they experience malaria symptoms, highlighting the need for more widespread, universal health coverage. Nigerians are willing to take action to prevent the spread of malaria as most Nigerians (70 percent) admitted having an insecticide treated net (ITN), and although only about 1 in 5 Nigerians are aware of the vaccine, almost 9 in 10 (87 percent) Nigerians would be willing to get vaccinated against the disease.
[1] World Health Organization (2021). World Malaria Report 2021
[2] World Health Organization (2021). World Malaria Report 2021
[3] World Health Organization (2021). World Malaria Report 2021
[4] Ileyemi, M. 2023. Hope for millions as Nigeria approves malaria vaccine. Premium Times 21st April 2023. https://www.premiumtimesng.com/news/top-news/593845-hope-for-millions-as-nigeria-approves-malaria-vaccine.html
[5] https://www.who.int/campaigns/world-malaria-day/2023
[6] Effiong et al. 2023. Prospects of malaria vaccination in Nigeria: Anticipated challenges and lessons from previous vaccination campaigns. Annals of Medicine & Surgery Published online 2022 Aug 17.
[7] Effiong et al. 2023. Prospects of malaria vaccination in Nigeria: Anticipated challenges and lessons from previous vaccination campaigns. Annals of Medicine & Surgery Published online 2022 Aug 17.
[8] Coelho, S. 2020. What is a vaccine? Types, stages for approval. Medical News Today https://www.medicalnewstoday.com/articles/what-is-a-vaccine#how-do-they-work
[9] Ouattara, A., Cohee, L.M., Lauffer, M.K. 2021. Why Have We Waited So Long for a Malaria Vaccine? Medscape
[10] Ouattara, A., Cohee, L.M., Lauffer, M.K. 2021. Why Have We Waited So Long for a Malaria Vaccine? Medscape
[11] Ileyemi, M. 2023. Hope for millions as Nigeria approves malaria vaccine. Premium Times 21st April, 2023. https://www.premiumtimesng.com/news/top-news/593845-hope-for-millions-as-nigeria-approves-malaria-vaccine.html
[12] https://www.cdc.gov/globalhealth/topics/malaria/index.html
[13] Kidanto H.L., Mogren I., Lindmark G., Massawe S., Nystrom L. Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia. S. Afr. Med. J. 2009 Feb;99(2):98–102.
[14] https://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html#:~:text=Insecticide-treated%20bed%20nets%20(ITNs,to%20malaria%20in%20endemic%20regions.