Malaria

Malaria is a life-threatening infectious disease caused by Plasmodium parasites transmitted through the bites of infected female Anopheles mosquitoes. Nigeria carries one of the highest malaria burdens in the world, with tens of millions of cases recorded annually. The disease disproportionately affects children under five and pregnant women, though it can strike anyone. Malaria is both preventable and curable — early diagnosis and prompt treatment are critical to a full recovery.

Symptoms typically appear 7 to 15 days after an infectious mosquito bite: • Sudden high fever (38°C / 100.4°F or above) with shaking chills • Profuse sweating as the fever breaks • Severe headache • Muscle aches and joint pains • Nausea, vomiting, and diarrhoea • Fatigue and weakness • Abdominal pain Signs of severe malaria (emergency — seek care immediately): • Confusion, altered consciousness, or coma • Repeated seizures or convulsions • Inability to stand, sit, or feed • Rapid or difficult breathing • Dark or cola-coloured urine • Extreme pallor (severe anaemia) • Yellowing of the skin and eyes (jaundice)

Malaria is caused by Plasmodium parasites. The four species that most commonly infect humans in Nigeria are: • Plasmodium falciparum: the most dangerous species, responsible for the majority of severe cases and deaths in sub-Saharan Africa • Plasmodium vivax: less lethal but capable of causing relapses months or years after the initial infection • Plasmodium malariae: causes a milder, chronic form of the disease • Plasmodium ovale: rare in Nigeria Transmission occurs when an infected female Anopheles mosquito bites a person and injects parasites into the bloodstream. The parasites travel to the liver to mature, then re-enter the blood to invade red blood cells. As infected cells burst, more parasites are released, causing the characteristic cycles of fever and chills. Malaria can also spread rarely through blood transfusion, sharing of needles, or from mother to unborn baby during pregnancy.

Everyone living in or travelling to malaria-endemic areas (all of Nigeria) is at risk. The following groups face the greatest risk of severe disease: • Children under five years of age • Pregnant women and their unborn babies • People living with HIV/AIDS or other causes of weakened immunity • Travellers from malaria-free countries who have no acquired immunity • People with sickle cell disease • Elderly individuals Environmental factors that raise risk: • Living near stagnant water, wetlands, or rice fields where mosquitoes breed • Sleeping without an insecticide-treated net • Rainy season (April–October in southern Nigeria; June–September in the north)

Without prompt treatment, malaria — especially P. falciparum malaria — can rapidly progress to severe, life-threatening conditions: • Cerebral malaria: parasites block blood vessels supplying the brain, causing coma, seizures, and permanent neurological damage • Severe anaemia: massive destruction of red blood cells leading to dangerously low haemoglobin • Acute respiratory distress syndrome (ARDS): fluid accumulation in the lungs • Acute kidney failure • Hypoglycaemia (dangerously low blood sugar), particularly in pregnant women and young children • Blackwater fever: rapid breakdown of red blood cells causing dark-coloured urine and kidney failure • Multi-organ failure • Pregnancy complications: miscarriage, preterm birth, very low birth weight • Death

Malaria is largely preventable through consistent protective measures: Mosquito bite prevention: • Sleep every night under a long-lasting insecticide-treated mosquito net (LLIN) • Apply DEET-containing insect repellent to exposed skin • Wear long-sleeved clothing and trousers at dawn and dusk • Install window and door screens Environmental control: • Eliminate standing water around the home (old tyres, containers, blocked drains) • Support community indoor residual spraying (IRS) programmes Preventive treatment: • Pregnant women should receive intermittent preventive treatment (IPTp-SP) at each antenatal visit • Children under five should receive seasonal malaria chemoprevention (SMC) where available • Travellers from abroad should take antimalarial prophylaxis as prescribed Early diagnosis and treatment: • Test with a rapid diagnostic test (RDT) or blood microscopy at the first sign of fever • Treat confirmed cases promptly with an artemisinin-based combination therapy (ACT)