MALARIA CONTROL PROGRAM
Lagos State Malaria Control Program
Introduction -Malaria is endemic in Nigeria and in Lagos State. It is both a cause and consequence of underdevelopment and remains one of the leading causes of morbidity and mortality in the State. Hospital reviews show that it accounts for over 60% of outpatient visits and equally responsible for 30% and 11% mortality in children under five and pregnant women respectively.
Nigeria’s contribution to Global Malaria Burden:Over ¼ of the estimated global malaria deaths occur in Nigeria (Malaria Deaths in ten highest burden African Countries (Thousands)
The goal of the Lagos State Malaria Elimination Program is to significantly reduce the burden of disease consequent upon malaria. The activities of the Malaria Control Unit are carried out in collaboration with the Lagos State Malaria Research, Technical and Advisory Committee which is chaired by the Honourable Commissioner and includes all partners including donors, researches and NGOs in the State.
Key Malaria Indicators: 2014 Jan- Jun NHMIS data
Strategic Objective Area Proxy indicator Proxy Indicator Value
1 Prevention Proportion of pregnant women who received at least two doses of SP for intermittent preventive treatment during antenatal care visits 47%
Proportion of pregnant women who receive LLIN during antenatal care visits 113%
2 Diagnosis Proportion of persons presenting at health facility with fever who received a diagnostic test (RDT or microscopy) for malaria 67%
3 Treatment Proportion of persons that tested positive for malaria at health facility (uncomplicated or severe) that received antimalarial treatment according to national treatment guidelines 107%
4 ACSM Proportion of wards in which Community-based organizations (CBOs), Civil society organizations or implementing partners are involved in malaria ACSM activities 93%
5 Procurement & Supply Chain Management Proportion of health facilities with stock out of ACTs lasting more than one week at any time during the past one month. 44.6%
Proportion of primary health facilities with stock out of RDTs lasting more than one week at any time during the past one month. 49.8%
Proportion of health facilities with stock out of LLINs lasting more than one week at any time during the past one month 42.2%
6 M&E Proportion of health facilities reporting through the DHIS tool/database 83.5%
Proportion of health facilities reporting data in a timely manner 70.3%
7 Programme Management Proportion of AOP cost released by the state out of total expected to be funded by the state during the period under review 63.7%
The Government of Lagos State has demonstrated continued commitment to the control of Malaria. The Eko free Malaria is a programme where malaria diagnosis using Rapid diagnostic Tests (RTDs) and treatment is provided free for all ages; children, pregnant women, adult men, women and the elderly.
The present Roll Back Malaria (RBM) strategies are a multi-pronged approach including appropriate diagnosis and treatment of malaria cases, prevention of malaria in pregnancy, environmental management and integrated vector control with emphasis on operational research and using its results for evidenced based programming.
Prevention–This strategy aims to rapidly reduce transmission of malaria to the lowest possible level in the state by reducing vector-human contact, the abundance of adult vector populations and suitable breeding sites for mosquitoes.Integrated Vector Management –The components include use of Long Lasting Insecticide Nets (LLINs), Indoor Residual Spraying (IRS) and larviciding. LLINs and IRS primarily attack indoor-biting vectors and may do little to reduce outdoor biting and therefore larviciding as an alternative option or combination intervention is recommended.
• In Lagos State, LLINs are being deployed to the communities through integration into existing services with the distribution of nets in health facilities to children who have completed their immunization schedule and pregnant women who booked for antenatal care in public health facilities in the State.
• Indoor Residual Spraying (IRS) is the application of long-acting chemical insecticides on the walls and roofs of houses for the effect of curtailing malaria transmission.
IRS activities are currently being implemented in six LGAs namely Ojo, Ikorodu, Badagry, Amuwo-Odofin, Kosofe and Ibeju-Lekki LGAs with each LGA benefitting from 2rounds of spraying. A total of 45,814; 105,737; 45,011; 53,405; 43,013 and 41,789 rooms have been sprayed respectively in these LGAs. Estimated population protected is 3,570,113.
• Larviciding is the application of larvicides to bodies of water to attack mosquito larvae and prevent the development of the larvae to adult mosquitoes. Larviciding activities commenced in Kosofe LGA in Ikosi Isheri and Agboyi Ketu LCDAs in October 2011 and 5 rounds of spraying were carried out over 544 hectares of land and 934,614 estimated numbers of people have been protected.
Malaria in Pregnancy – The broad objective is to protect all pregnant women, their newborn and children under five from the ill-effects of malaria and thereby contribute to reductions in maternal and infant mortality in Lagos State.
The pregnant women are freely and routinely given Sulphadoxine Pyrimethamine (SP) for Intermittent Preventive Treatment -IPT 1, IPT 2 &IPT3 of malaria and provided with LLINs. In addition, appropriate treatment is given for pregnant women with malaria at no cost to the patient
Malaria Case Diagnosis and treatment – Malaria is not the only cause of fever in these regions and therefore, there is the need for quality diagnosis and this is an important step in confirming patients with malaria that should be given antimalarial medicines. The broad objective is to achieve timely and equitable access to malaria diagnosis and treatment by all sections of the population and as close to the home as possible.
Rapid Diagnostic Test (RDTs) kits and Artemisinin Combination Therapies (ACTs) antimalarials are distributed free to all public health facilities in the State for malaria case management for all patients.
Advocacy, Communication and Social Mobilization – The target is to reach 90% of people in Lagos State through relevant BCC approaches for appropriate actions on malaria control activities. Activities are implemented through:
• Road shows through all the major streets of all 20 LGAs.
• Jingles on various strategies to combat malaria are aired on radio.
• Advocacy visits, community sensitization and mobilizations to increase community awareness, participation and ownership.
• IEC materials distributed as dissemination material
Monitoring and Evaluation/ Operational Research–The broad objective is to establish a sound and continuously updated system that monitors progress towards agreed targets and is used to effectively manage and adjust interventions based on evidence.
There exists a vibrant research practice through the Lagos State Malaria Research, Technical & Advisory Committee and many research works have been done to provide local evidence for planning purposes. Some of the research activities conducted by the committee include:
1. Baseline Malaria Household survey in five (5) LGAs (4 urban and 1 rural).  2. Health Facility assessment of institutional based policy and practices on Malaria Case Management.  3. Baseline and Longitudinal entomological studies. [2009 – 2010] 4. Malaria Prevalence Study in 16 LGAs.  5. Pharmacovigilance of ACTs in General Hospital Ijede.  6. Post LLIN campaign survey on ownership, retention and utilization of LLINs  7. Environmental Impact Assessment of the IRS program  8. Rapid Impact Assessment of the Malaria Control Program  9. Economic evaluation of malaria control interventions  10. Insecticide resistance testing in Epe  11. Institutional based capacity of health facilities to manage malaria 
The Malaria Elimination Unit also conducts monitoring visits to the health facilities.
Health System Strengthening- To support the strengthening and expansion of the health system through staff training, integrated supervision, effective management, efficient planning and coordination of activities in all public and private facilities.
The strengthening and expansion of the health system through staff training, supervision, effective management, efficient planning and coordination of activities is essential for overall performance of the program.
The Unit in collaboration with our partners carries out trainings and workshops on malaria case management and core program management modules.
Malaria case management 1,091
Use of Rapid Diagnostic Test kits 536
Malaria microscopy 71
Program management 62
Community care givers
Patent medicine vendors 200
In addition the unit holds coordination meetings on a monthly basis with the LGA RBM Managers, donors and other stakeholders.
The State Ministry of Health provides leadership, coordinate and harmonizes the efforts of all players and stakeholders in order to achieve the desired results for malaria control. Structural arrangements that ensure this are as follows:
– Lagos State Malaria Control Technical Research and Advisory Committee (LASMATRAC) chaired by the Honourable Commissioner for Health
– The Permanent Secretary, Lagos State Ministry of Health
– The Director, Disease Control, Lagos State Ministry of Health
– Lagos State Malaria Control Program consisting of the following key officers at the minimum:
• State Program Manager
• Deputy Program Manager/Case Management Officer
• M&E /Data Management Officer
• Procurement and Logistics Officer
• Integrated Vector Management Officer
• ACSM Officer
– State Forum for Partners Supporting Malaria Control in Lagos State
– State forum for Civil Society and Professional Organizations involved in Malaria Control in Lagos State