‘It’s more than nets’ — malaria in Nigeria

Chioma Omenuko is 31 and has four children including daughter Miracle, 20 months. Her husband Godwin died a year ago from malaria. All photos Christian Aid/Sarah Malian

Amy Sheppey, Communications & Information Officer for Christian Aid

These photos tell the story of our malaria response in Nigeria - the issues we face and the impact we’ve made. Nigeria accounts for a quarter of all malaria cases in Africa, which contributes to an estimated 11% of maternal deaths.

In March, I visited families and our projects in both Plateau and Anambra states. 2015 has been a year of change and upheaval for Nigeria. The surge of Boko Haram attacks adversely affected healthcare with many families forced to flee their homes. Mothers, fathers and children continue to live in temporary camps across the country.

The 2015 elections also impacted healthcare delivery. I spoke to people just two weeks before the elections and sensed unease around the potential onset of election violence. I was told ‘People are careful about where they go and what they do. These includes the visiting of health facilities’. Despite this, our staff were on the ground, working alongside communities to tackle a multitude of health issues, never just malaria alone.

Anthony Edozieuno, Malaria Programme Officer, Nigeria
‘It’s the community themselves that are active in solving their own health dilemmas and we are there to support them. We will never tackle malaria just by giving nets, it’s about education, it’s about inclusiveness, it’s about empowerment and it’s about rights. It’s more than nets.’

Through our partners, the Centre for Gospel Health and Development (CeGHaD) and the Aguata Diocesan Community Human Services (AD-CHUS), we are finding creative ways to tackle malaria in the states of Plateau and Anambra that go beyond the distribution of nets. We train government health nurses, recruit community volunteers to demand better health services, and implement an interfaith component to both build peace and tackle malaria in areas where religious tensions run high.

‘It’s one thing to have a net, another thing to sleep under it.’
Ngyuk Ezekiel Gwong, 26, lost two children in late pregnancy from malaria.

Nets are a simple and effective way to save lives but education needs to be a vital part of the distribution. Sometimes nets are sold or misused. The importance of using a mosquito net is often underestimated.

‘The government has distributed over 67 million nets since 2009 but only 30% of those with these nets sleep inside. It’s where the behaviour change comes in. We aren’t about just giving commodities; a big part of the work is to ensure the government is held to account.’

Children under 5 are most at risk

Four-year-old twins Isua and Yakubu were both recovering from malaria when I met them. An estimated 250,000 under-fives die every year in Nigeria.

The nearest health centre is a dilapidated clinic with little facilities. Malaria is prevalent, as are other diseases made worse from the proximity to a stagnant river. Jummai, the twins’ mother, is forced to buy expensive treatment from the pharmacy without a prescription.

‘My twins, especially Yakubu must have had malaria about 18 times. The facilities in the clinic are not adequate. The test kits are often out of stock’.

Our prevention and educational outreach work is vital to protect Jummai and her family. We started working in her community earlier this year

Drug access is a sticking point

The economic impact of malaria is startling. People here choose between food and medicine. Poverty is a huge barrier in tackling malaria and without the free drugs people are entitled to, families can expect to be charged unsolicited amounts, often from vendors who not qualified to test or diagnose.

‘We have no medicines, or malaria rapid diagnostic kits. I have to buy things myself with my own money and then sell it on to patients’, Nurse Lydia.

We support the creation of ‘Community Development Committees’, local residents who act as intermediaries between the community and the state. They identify health priorities and bring issues such as low drug stock and staffing issues for the government to resolve.

Building health leaders

Ezekiel Gwong is married to Ngyuk (26) and father to 4 year old Josiah. The couple lost two children in late pregnancy, attributed to Ngyuk having malaria.

‘My aim is for all the people in my community to use bed nets and know how to prevent malaria’

Ezekiel is a passionate church leader and has recently undertaken training to volunteer as a Community Health Worker. He played an active role during the commemoration of World Malaria Day 2015 and aims to reach 185 families in his community to tackle malaria. He is eager to carry out no less than 3 home visits per day to show people how to use a net.

Training health workers

We train government staff in primary healthcare facilities on malaria preventative measures, the use of long lasting insecticide treated nets and the diagnosis of patients.

Onuchukwu Okoye is 28 years old and recently gave birth to her second child, Israel. I met her the very day her baby was born in Anambra!

We trained staff nurse and midwife Dorothy Ukowfu, through our partner AD-CHUS. Dorothy had prescribed Onuchukwu with preventative medicine so she didn’t get malaria during her pregnancy.

One community member said ‘malaria touches everyone’, but women in particular suffer. Not only as mothers or during pregnancy, but economically, socially and politically. They are often the main carers in Nigeria, sometimes the core breadwinners, the ones who juggle home and work life whilst looking after sick relatives.

Clinic uptake increase

Cyril Ugorji aged 62 is a traditional herbal healer who treats various conditions in the village of Ora-Eri, Anambra.

‘People now go to the clinic. I was seeing more than twenty patients a month but these days I only see three or four’

He is seen here preparing a fever tincture from tree bark surrounded by bottles of his wares. Our community health agents have been encouraging people to visit the clinic instead of self-diagnose. There is an over-reliance on traditional medicine which can be ineffective. Without proper testing and diagnosis, people are in danger of not receiving the care they need.

Tackle health, build peace

Our partner CeGHaD started working with Umar and his team six years ago, in Jos, where religious tensions are high. ‘Umar Farouk Musa is the publicity secretary of Jama’atu Nasril Islam, an umbrella group for the Muslim community in Nigeria.

‘Malaria intervention is a tool for peace. Malaria doesn’t know who is Muslim and who is Christian. Malaria doesn’t discriminate. When sick, you meet in a common place; the hospital. You access the same treatment’.

These two faith groups enter Muslim predominate and Christian predominate communities on the issue of malaria. They believe they can ‘kill two birds with one stone — combat malaria and increase trust between communities’, conducting education in churches and mosques.

Education is key

‘AD-CHUS have taught me a lot about health and many things I had no knowledge of before. My children haven’t had a case of malaria in the past year’

Mary Grace is 38 years old and has four children. Mary Grace had a fifth child who died of malaria. Here, she is visited by Ngozi Richard, an ADCHUS Community Health Agent. Community health agents also run school education programmes, teaching children how to prevent malaria.

For more information on our malaria work, or to donate, visit the Christian Aid Website.