Nigeria’s Malaria Treatment Policies Still Effective

…But Challenges Threaten Global Eradication Efforts — NIMR Researcher

Despite Nigeria carrying the highest malaria burden in the world, the country’s malaria treatment policies remain effective, according to a senior researcher at NIMR. However, she warned that global malaria eradication will remain unattainable unless Nigeria successfully addresses emerging challenges in malaria control.

Speaking during the institute’s December Media Chat in Lagos, Dr. Adeola Olukosi, a Director of Research, said Nigeria accounts for a significant proportion of global malaria cases and deaths, particularly among children under five, making the country central to worldwide elimination efforts.

“Malaria remains the single most ubiquitous public health problem in Nigeria,” Olukosi said. “Nigeria bears the largest absolute malaria burden globally, and unless malaria is effectively controlled here, global eradication efforts will not succeed.”

Dr. Olukosi however disclosed that ongoing surveillance conducted by NIMR in collaboration with the National Malaria Elimination Programme (NMEP) shows that Nigeria’s current malaria medicines — Artemisinin-based Combination Therapies (ACTs) — are still effective. She explained that NIMR plays a critical technical role in supporting national malaria policies through sentinel surveillance and therapeutic efficacy studies, which monitor the performance of antimalarial drugs across selected sites nationwide. 

“NIMR/NMEP coordinated the surveillance of three of Nigeria’s TES sentinel sites in 2018 which led to the inclusion of dihydroartemisinin-piperaquine as one of the first line antimalarials for treatment of acute uncomplicated malaria, in addition to artemether- lumefantrine and artesunate-amodiaquine that were in use before the 2018 TES”

“There are very few drugs available for malaria treatment globally. Once drug efficacy drops below acceptable thresholds, policies must change. That is why continuous monitoring is essential,” Olukosi noted.

While Nigeria has not yet recorded widespread resistance to ACTs, Olukosi however cautioned that artemisinin resistance, already documented in parts of Southeast Asia, and evidence from molecular surveys suggesting possible resistance or related mutations in countries of East Africa, poses a future risk.

“Historically, resistance often emerges in Southeast Asia and gradually spreads to Africa through East Africa. This is why Nigeria must remain vigilant through regular surveillance,” she said, adding that molecular surveillance, recently assigned to NIMR by NMEP, allows researchers to predict resistance patterns before treatment failure becomes widespread.

Dr. Olukosi said research conducted in collaboration with the Malaria Consortium and the London School of Hygiene and Tropical Medicine found low levels of resistance markers to sulfadoxine-pyrimethamine, a drug still being used for seasonal malaria chemoprevention (SMC) in northern Nigeria.

“The low presence of resistance markers confirms that SMC remains suitable and effective in the states studied,” she said. She explained that while malaria transmission in southern Nigeria is perennial, the northern region experiences seasonal transmission, making preventive drug use during peak periods particularly effective. The researcher also highlighted growing concerns over insecticide resistance in malaria-carrying mosquitoes, noting that resistance to pyrethroids, commonly used in long-lasting insecticide-treated nets, is now widespread across Nigeria.

“As a result, Nigeria has transitioned to deploying nets treated with combinations of insecticides, rather than pyrethroids alone,” she explained.

One of the most significant recent discoveries, she said, was the detection of Anopheles stephensi, an invasive mosquito species originally from Southeast Asia, in parts of northern Nigeria.

“This species thrives in urban environments, breeds in clean water containers, and can survive harsh conditions. It poses a serious threat to malaria control,” Olukosi warned.

She confirmed that NIMR was the first institution in Nigeria to molecularly confirm the presence of Anopheles stephensi, following samples collected from Gombe State.

Dr. Olukosi emphasized that Nigeria’s size and disease burden mean it cannot be sidelined in global malaria strategies. “The global push to eliminate malaria cannot be completed without Nigeria,” she said. “That reality is now well recognised at regional and international levels.”

She noted that NIMR is part of the West African Network for TB, AIDS and Malaria (WANATEM) and other international research collaborations focused on strengthening malaria surveillance and control across the region.

In his remarks, Director-General Prof. Oladapo Obafunwa said Nigeria’s high malaria figures must be interpreted within the context of its population size, noting that countries with larger populations will naturally record higher absolute case numbers.

“Because Nigeria represents a quarter or more of the population of the African continent, it is expected that we will record more malaria cases in absolute terms,” he said. “When figures are viewed as ratios, the picture is often less alarming, but there is no doubt that we still have a major problem on our hands that must be addressed.”

He cautioned against sweeping conclusions based on limited geographic data, explaining that malaria prevalence varies widely even within the same state due to environmental and healthcare-related factors.

“Observations in parts of Lagos State will differ from what we see in riverine or semi-rural communities such as Epe,” the Director-General noted. “A recent study conducted in primary health centres in Epe recorded prevalence rates of between six and eight per cent, showing that internal variations still exist.”

While acknowledging progress in malaria control in some urban settings, he urged sustained effort and realism, stressing that population movement across states continues to influence transmission patterns.

“You may be doing everything right in one location, but people move freely across state boundaries. There are no watertight borders, so malaria control requires continuous, coordinated effort,” he said.

The Director-General commended researchers and partners for their commitment to malaria control and reaffirmed NIMR’s resolve to continue providing scientific leadership and evidence to guide national and sub-national malaria interventions.