The Persistent Burden of Malaria in Nigeria
Recurring malaria infections are significantly impacting the lives of Nigerians, both financially and in terms of productivity. Households find themselves repeatedly spending on treatment as illness keeps individuals away from work. Despite being preventable, the disease continues to claim nine lives every hour, with misdiagnosis, self-medication, poor sanitation, and weak health systems hindering efforts to eliminate it.
For Chidinma Onyenucheya, a teacher in Ikotun, Lagos, malaria is not an occasional inconvenience but a relentless visitor that has shaped her life, drained her finances, and disrupted her career. She falls ill with malaria at least five times a year, each episode costing her close to N50,000 on drugs, tests, and hospital treatment. This means she spends about N250,000 annually, an amount more than three times the N70,000 monthly minimum wage, battling a disease that has been declared preventable.
Beyond the financial toll, the preventable and treatable disease, transmitted through the bites of infected female Anopheles mosquitoes, also disrupts her productivity at home and at work. “Once I come down with malaria, it weakens me; I cannot do anything,” she told PUNCH Healthwise. “Before I got married, my mother and siblings would do the chores I was supposed to do. It also affected me academically. Now that I am married, my husband does all the chores. But once the malaria is severe, I have to move to my parents’ house for proper care.”
Onyenucheya initially visits a nearby pharmacy to purchase Artemisinin-based Combination Therapy whenever she notices symptoms, but turns to the hospital for proper testing, diagnosis, and treatment when self-medication fails. “The hospital is the last resort because drugs from the pharmacy don’t always work. I end up going there for complete treatment,” she said.
Environmental Factors and Government Negligence
The area where Onyenucheya lives is a major source of her constant exposure to mosquitoes. However, adopting preventive measures such as sleeping under Long-Lasting Insecticide-Treated Nets and using mosquito repellents has not been feasible for her due to poor power supply and adverse reactions to the products. “We know how dirty Lagos is. Residents do not dispose of their waste properly, and the drainages are not cleared, making mosquitoes breed there. At night, there is no light, and you have to open your windows for air. This is how mosquitoes enter the rooms,” she said.
Onyenucheya reserved particular frustration for waste management operators and government at all levels, arguing that the persistence of malaria in a city like Lagos is less a medical failure than that of governance. “The government needs to ensure the environment is clean. The PSP operators are not helping because they continue to dispose of waste improperly. You see their dirty trucks, which they do not clean, parked in residential areas, and this is very bad because of the horrible smell,” she said.
Economic Impact and Productivity Losses
Mariam Durojaye, an entrepreneur in Ogba, faces an even heavier burden, with malaria occurring several times a year. “Around five times or more in a year,” she said, adding that each episode costs her about N30,000. The repeated illness affects both her strength and ability to work. “It makes me feel very weak and restless, which affects my ability to work and carry out daily activities effectively,” she lamented.
When malaria strikes, Mariam Adegbite’s sewing machine goes silent. For the Surulere-based fashion designer, the illness does not just bring fever and body pain; it brings her work to a halt. “Malaria affects my productivity a lot. I feel weak, have body pains and headaches, and I won’t be able to stand or sit for long. It slows down my business and daily activities,” she told PUNCH Healthwise.
The Global and Local Context
Malaria, according to the World Health Organisation, is a life-threatening but preventable and curable disease caused by Plasmodium parasites, transmitted through the bites of infected female Anopheles mosquitoes. Symptoms include high fever, chills, and flu-like illness. Prevention involves avoiding mosquito bites by sleeping under long-lasting insecticide-treated nets, applying repellents, and maintaining a clean environment to eliminate breeding sites. Treatment is primarily through Artemisinin-based Combination Therapy.
Africa, especially Sub-Saharan Africa, bears a high burden of the global malaria epidemic due to climatic and environmental conditions that favor mosquito breeding, resulting in year-round transmission. Other factors include weak health infrastructure, limited access to treatment, and insecticide resistance. The region accounts for 95 per cent of the global 265 million malaria cases and 95 per cent of malaria-related deaths in 2024.
Nigeria alone accounts for 27 per cent of global malaria cases and 31 per cent of deaths, according to the World Malaria Report 2024 by the WHO. A report by the Society for Family Health further revealed that malaria kills nine Nigerians every hour and accounts for 30 per cent of child deaths and 11 per cent of maternal deaths annually.
The Cost of Malaria
Despite interventions, malaria still kills nine Nigerians every hour, with households spending an estimated N1.7tn annually on treatment. The cost of treatment, lost productivity, and reduced economic output remains significant. In 2024, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, described malaria as a pressing economic and developmental emergency. He said the disease costs Nigeria over $1.1bn in annual losses to its Gross Domestic Product.
Three out of 10 staff affected
To assess productivity losses, PUNCH Healthwise spoke with human resources managers. A HR professional, Stephen Bello, said it is common to have at least one staff member down with malaria at any given time, often requiring three to five days off to recover. He noted that recurring illness disrupts workflow, especially in small and medium-sized organizations where limited staff strength means others must take on additional responsibilities, leading to slower output.
Another HR professional, Aderonke Agunbiade, said malaria remains a recurring challenge, affecting attendance and workplace efficiency. Drawing from her experience managing about 40 staff, she noted that cases are frequent, with several employees falling ill monthly.
Misdiagnosis and Self-Medication
A Professor of Biochemical Pharmacology at the College of Medicine, University of Ibadan, Oyo State, Olusegun Ademowo, has said many Nigerians who frequently treat malaria may not actually be suffering from the disease, warning that misdiagnosis and self-medication are fueling unnecessary treatment and costs. The don noted that while malaria remains endemic in Nigeria, not every fever or illness should be attributed to it, stressing the need for proper diagnosis before treatment.
Ademowo explained that a major issue contributing to frequent malaria treatment is the misconception that all fevers are malaria. “People say they have malaria all the time when they have all kinds of fever and symptoms that overlap with malaria. However, malaria is a disease caused by the presence of Plasmodium. If there is no Plasmodium, it is not malaria. Not all fevers are malaria, but because of our environment, where malaria is common, everything is attributed to it,” he said.
The Role of Sanitation and Environmental Control
Poor sanitation fuels malaria. A family physician with a special interest in primary care paediatrics and public health, Dr Rotimi Adesanya, said malaria remains largely driven by environmental conditions and poor health-seeking behavior, stressing that the disease pattern has not significantly changed over time. According to him, “There has been a lot of research and evidence-based studies over the years, but the causes of malaria have not really changed. What has improved is in the area of diagnosis and treatment.”
Adesanya emphasized that malaria is still caused by the female Anopheles mosquito, noting that prevention must begin with eliminating breeding sites. “Mosquitoes still breed in stagnant water, which is everywhere around us. If we remove these breeding sites, we reduce transmission significantly,” he added.
The Path Forward
Ademowo emphasized the need to break the cycle of transmission by reducing contact between humans and mosquitoes. “Malaria does not have legs or wings. It is the mosquito that carries it. So, we need to reduce or eliminate contact between mosquitoes and humans. That is key to preventing malaria,” he said. Ademowo also stressed the importance of proper diagnosis and rational drug use. “If you have taken antimalarial drugs and you are not getting better, go for proper testing to know exactly what is wrong. You should not keep treating malaria when the illness may be bacterial, viral, or even stress-related. There must be rational use of drugs,” he said.
