CHAPTER ONE

1.0                                             INTRODUCTION

1.1     Background of the Study

Despite various declarations by African governments in the 1990s and complementary effort promised in the main content of the Roll back Malaria Declaration in Abuja in 2000, malaria remains a major health challenge. About 107 countries and territories involving about 3.2 billion people are still at risk of malaria attack as at 2004 (World Health Organisation [WHO], 2005). Present estimates suggest that around 350–500 million clinical disease episodes occur annually (Bawah and Binka, 2005). Around 60% of clinical cases and over 80% of the deaths due to malaria occur in Africa south of the Sahara (Alaba, 2005). The above has serious implication for economic growth and welfare. Malaria is responsible for an estimated average annual reduction of 1.3% in economic growth for those countries with the highest burden, Nigeria inclusive. The seemingly intractable trend of this ancient scourge has compounded the national and household poverty due to intensive loss of productive time to attack and death. A cause for worry at the moment is the growing resistance of the disease to cheap first line drugs and the need for the more expensive ACT combination therapy. Given that malaria is endemic throughout Nigeria, and that more than half the country’s population are living below poverty line. Malaria incidence may increase significantly in Nigeria because many may not be able to afford the newly introduced drugs due to poverty.

Success in malaria control using these existing tools has led to renewed interest in the possibility of malaria elimination in some countries or regions. Although the Global Malaria Eradication Program of the mid-20th century was ultimately abandoned, current calls for elimination stress the need for new technologies (insecticide delivery systems, new drugs and insecticides, and candidate vaccines) and the revitalization of older strategies (IRS and larviciding). Mass drug administration (MDA) was a component of many malaria elimination programs during the eradication era, but it is not currently recommended due to concerns about efficacy, logistical feasibility, sustainability and the risk of accelerating drug resistance (WHO 2010). However, these concerns are not supported by firm evidence, particularly in light of the development of new antimalarial drugs (WHO 2007).

Mass drug administration (MDA) refers to mass treatment of all, or a section of, the population, whether or not symptoms are present. MDA has been implemented by national malaria control programs (NMCPs) in the past as a way to control epidemics, or to reduce or interrupt transmission, and has generally been used in conjunction with indoor residual spraying (IRS). Based on a review of the results of 19 MDA projects during the period 1932–1999, and a technical consultation held in 2003, WHO concluded that there was little evidence that MDA is effective in reducing transmission, although in some cases a reduction in parasite prevalence and a transient reduction in mortality and morbidity were documented. Therefore, WHO recommended mass treatment of symptomatic patients for epidemic and complex emergency situations, combined with an active search for febrile patients, to ensure that as many cases as possible are treated. Over the past decade, MDA has received renewed interest, both in the context of malaria elimination initiatives, and as part of efforts to contain multidrug resistance. In 2010, a WHO consultation reviewed the potential role of MDA to eliminate multidrug resistance in the Greater Mekong sub region (GMS), based on evidence of the impact of existing interventions, and operational and modelling considerations. The consultation recommended immediate planning of a pilot MDA operation in western Cambodia or eastern Thailand, and the collection of essential information on the safety and efficacy of candidate drugs for MDA. The 2010 consultation also reviewed the potential role of mass screening and treatment (MSAT), in which all the people in a broad geographical area are screened, regardless of whether they have symptoms of malaria. MSAT generates important information on the epidemiology of malaria, which can be useful for further containment efforts. However, this approach is resource intensive and logistically challenging, especially in view of the lack of field ready, high-throughput, diagnostic tests that are sensitive enough to detect submicroscopic parasites. When applied in a defined geographical area (sometimes households), the strategy is defined as focal screening and treatment (FSAT), in which everyone is screened, and treatment is provided for those who test positive. FSAT is operationally more feasible than MSAT, but is not delivered simultaneously in the whole of an area sustaining malaria transmission; hence, it is unlikely to contribute significantly to elimination efforts.

1.2     Statement of the Problem

Malaria causes an estimated 219 million clinical episodes and 660,000 deaths annually, primarily among young children in subSaharan Africa (WHO 2012). Four main species of the malaria parasite infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. P. falciparum and P. vivax cause the majority of infections, with P. falciparum responsible for most cases of severe and potentially fatal malaria. Malaria is both preventable and treatable. Prevention efforts have focused on vector control strategies to reduce adult mosquito populations and human-mosquito contact, and to eradicate mosquito breeding grounds. These strategies include the use of insecticide treated nets (ITNs), indoor residual spraying (IRS), larviciding, and environmental management. In addition, treatment strategies in endemic areas frequently combine case management, and the diagnosis and treatment of clinically ill malaria patients, with disease prevention. This involves administering antimalarial drugs to particularly vulnerable population groups, such as pregnant women, infants and non-immune travelers to endemic areas, to prevent clinical disease.

1.3     Objective of the study

The main objective of this study is to find out the influence of mass administration of malaria drugs on the fight against malaria in Nigeria; specifically the study intends to;

1. Find out the effects of malaria on Nigeria
2. Find out the effects of mass administration of malaria drugs on fighting malaria in Nigeria
3. Investigate the challenges of mass administration of malaria drugs in Nigeria

1.4     Research Questions

The following questions are formulated to guide the study

1. What are the effects of malaria on Nigeria
2. What is the effects of mass administration of malaria drugs on fighting malaria in Nigeria
3. What are the challenges of mass administration of malaria drugs in Nigeria

1.5     Significance of the study

1.6     Scope of the study

This study will cover the problems of malaria in Nigeria, proffering solution to those problems, the challenges of mass administration of drugs and the effects and proffering solutions to the challenges of mass administration in Nigeria.

1.7     Limitation of the Study

The challenge of finance for the general research work will be a challenge during the course of study.  However, it is believed that these constraints will be worked on by making the best use of the available materials and spending more than the necessary time in the research work. Therefore, it is strongly believed that despite these constraint, its effect on this research report will be minimal, thus, making the objective and significance of the study achievable.

1.9       Definition of Terms

Malaria: A disease caused by a plasmodium parasite, transmitted by the bite of infected mosquitoes.

Mass Administration: The administration of drugs to whole populations irrespective of disease status is referred to as mass drug administration (MDA)

Drug: a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body