Nigeria is the most populous country in Africa and the hardest hit by malaria globally [Onwuka., 2012]. In 2012, the Minister of Health in Nigeria claimed that malaria reduced the nations Gross Domestic Product by 1% [Nigerian Vanguard, 2012]. The World Malaria report 2019 has stated that Africa accounts for approximately 94% of the global malaria cases and this was about 215 million cases recorded with six African countries contributing half of all deaths associated with malaria worldwide with Nigeria accounting for twenty-five percent [Garner et al., 2009]. According to the WHO it accounts for a total cost of 12 billion United states dollars thus imposing a significant economic burden [Okorosobo et al., 2011].

Onwujekwe et al [2000] in a study assessing the economic burden of malaria versus the combination of other illness showed that malaria accounted for 40% of total monthly curative healthcare costs incurred by household compared to a combination of other illnesses depleting 7.03% of the monthly average income while treatment of malaria cases alone was 2.91%

In Sub-saharan Africa, malaria is the leading cause of death for children under 5 years with infections during pregnancy increasing the risk for maternal mortality and neonatal death [Ryan et al., 2020]. About 50% of the population suffers from at least one episode of malaria annually while children under 5 have an average of 2-4 attacks of malaria [ Adedotun et al., 2010]. An estimated 300,000 people die from disease accounting for 60% outpatient visits to health facilities, 30% childhood deaths, 25% of death in children under one year, 11% maternal deaths[ Jimoh et al., 2007].

In a bid to combat the malaria scourge governmental, non-governmental and organizations and strategic partners have raised concerns, organized advocacy campaigns and implemented strategies through partnerships at various levels of policy making with considerable progress [APET, 2023].However, there are still some gaps that need immediate attention such as increasing drug resistance, limited access to efficacious intervention, stumbling health service systems[APET, 2023]. An innovation to address the gap is the knowledge hub developed by the WHO called MAGICapp which aims to give living evidence and resources for tackling malaria interventions which contains all official WHO recommendations for malaria prevention and case management[Chibi et al., 2023].

CURRENT TRENDS IN MALARIA PREVENTION

The current trends in the prevention of malaria in Nigeria involves the use of Health education, Insecticide treated nets, Indoor Residual spraying and Artemisinin Combination Therapies[Omolade., 2013].

Insecticide Treated Nets:

Bhatt et al., [2015] described insecticide treated nets as a widespread, cost effective, impactful method of malaria elimination in Africa,averting an estimated 450million cases from 2000-2015.

In Africa, mosquitoes typically bite between dusk and dawn thus a net hung over the sleeping area prevents mosquito bites especially the insecticide treated nets which provides greater protection by repelling and killing mosquitoes that land on it, providing a physical and chemical barrier to mosquitoes [Omolade., 2013].Insecticide Treated Nets have been shown to reduce all cause all-cause mortality in children under 5 and pregnant women up to 50%.The use of treated nets reduced the childhood mortality by 18% in Sub-Saharan Africa[WHO,2007]. A study by Oyedeji et al [2009] in south-western Nigeria showed the use of treated nets to be 1% a major reason being ignorance, unavailability and alternatives such as insect sprays, mosquito repellant coils and topical creams.

Insecticide Treated Nets are considered the most efficacious for malaria control in Africa due to its incomparable cost effectiveness in preventing malaria associated morbidity and mortality and better acceptability by the local communities than most other control measures[Ordinioha,2012].

Indoor Residual Spraying: This is basically the co-ordinated,timely spraying of the interior walls of homes with insecticides. It has proven to be highly effective method of malaria control recommended by the World Health Organization. Unfortunately, it remains underutilized in sub-saharan Africa [WHO Global Malaria Program[2010]. The underutilization can be attributed to the expense of operations compared to insecticide treated nets distribution and the uncertainty around the effectiveness of combining Indoor Residual spraying with Insecticide Treated Nets [Corbel et al., 2012]

Health Education:Health Education as defined by the Joint Committee on Health Education and Promotion 2001 is “any combination of planned learning experiences based on sound theories that provide individuals,groups,and communities the opportunity to acquire information and the skills needed to make quality health decisions[WHO,2001]. This is an effective tool that helps improve health in developing nations as it not only teaches prevention and basic health knowledge but also conditions ideas that reshape everyday habits of people with unhealthy lifestyle in developing countries[Omolade., 2013].

Knowledge, Attitude and Practice studies is the educational diagnosis of a community which is essential for control programs. The knowledge of malaria is the understanding which affects the attitude which is a preconceived idea which culminates in practices,the way they demonstrate knowledge and attitude by actions. In summary this is just awareness tailored to the need of the society [Omolade., 2013]. In a study by Lasisi[2012], on Knowledge, awareness and practice[KAP] among secondary school students in Lagos, there was adequate KAP about malaria although few[1%] attributed it to the sun.

Use of Artemisinin Derivatives: Artemsinin and its derivatives are a group of drugs that possess the most rapid action of all current drugs against Plasmodium falciparum malaria.The Drug enhances efficacy and has the potential of lowering the rate resistance emergence and spread[Mutabingwa., 2005] Despite been recommended by the WHO since 2001 its overall deployment has been very slow due to high cost, limited knowledge and public awareness on the concept of combination therapies, limited knowledge on safety during pregnancy, inappropriate drug use, lack of suitable drug formulations, lack of post-marketing surveillance systems and the imbalance between demand and supply [Mutabingwa,2005].

INNOVATIONS IN MALARIA PREVENTION, DIAGNOSIS AND TREATMENT

In a bid to combat malaria epidemic, several technological innovations have been developed all over the world that have contributed significantly to surveillance, micro-planning, prevention, diagnosis and management.

Diagnosis: Improved diagnostics are needed to monitor and measure changes in infection rates, assure quality of medicines and insecticides and measure characteristics that drive treatment choice.

Next Generation Rapid Diagnostic such as the Infection Detection Test which has the potential to detect infections hidden from current case management tests and plays a major role in elimination settings. The development of serological tests that can identify hot spots and enable more effective mass screening and drug administration especially at residual foci of administration[Hemingway,2016].

Insecticide Quantification kits allow quality assurance of insecticide formulations. This needs to replace insecticide bioassay methods which are impossible to use in operational programs despite been recommended as the gold standard[Hemingway,2016].

Prevention:

Vaccines are generally classified into three based on their mechanism of action: pre-erythrocytic, erythrocytic and transmission blocking which aim to prevent blood stage infections, clear parasitemia and interrupt malaria transmission in population [Hemingway,2016].

In 2006, the goal of developing an 80% effective vaccine against P.falciparum malaria by 2025 was developed by the global Malaria Vaccine Technology Roadmap with the aim of providing protection for longer than four years with an short-term landmark of 50% effectivity of one year duration by 2015[Malaria Vaccine Founders Group, 2006]. RTS,S, a pre-erythrocytic vaccine for the prevention of malaria in children is the first vaccine to successfully complete a phase III clinical trial and has demonstrated a vaccine efficacy of 50% for clinical malaria in children aged 5-17months old but only 30% in the target infant population[RTS,S Clinical Trials Partnership, 2015]. A highly effective transmission blocking vaccine with the ability to disrupt the transmission of the parasite from humans to naïve mosquitoes would be a key tool for malaria elimination [Nikolaeva et al., 2015].

Seasonal Malaria Chemoprevention a protocol that involves administration of treatment on a monthly basis to coincide with the annual peak in malaria transmission. In 2012 the World Health Organization recommended implementation of this protocol for children under 5 years with increasing acceptance worldwide. Although less extensively research evidence suggest it is effective in older Children [ WHO,2013].

Treatment: This is important due to the emergence of resistant strains of the parasite. In the last few years Artemisinin Combination Therapies were launched of which only one was pediatric friendly and more pediatric therapies developed as cohort drug resistance is increasingly becoming common[Burrows et al.,2013 ].

Currently only four new medicines have reached clinical phase II trials where they have been shown to be active in curing malaria: OZ439,a third generation endoperoxide,KAE609 an inhibitor of parasite sodium channel PFATP4, KAF156 whose mechanism of resistance includes previously un annotated cyclic amine resistance locus and DSM265 an inhibitor of the parasite dihydroxyorotate dehydrogenase [DHODH]. All four products are active against primary quantifiable isolates including artemiinin resistant strains [Charman et al., 2011]

Surveillance:

In the context of elimination surveillance strives to identify and respond promptly to every malaria case, ideally within 24hours [Moody, 2002]. Reporting and case investigation must be rapid and complete to identify symptomatic and asymptomatic cases and prevent additional malaria infection usually achieved by either active or passive approach. Active approach is used for hard to reach populations who do not attend health facilities as well as asymptomatic cases that spread the parasite in the absence of symptoms however the passive approach is adequate in areas with a history of low transmission and good access to health facilities [Hemingway.,2016].

The most widely accepted advancement in surveillance is the reactive case detection [RACD] whereby household members, neighbours, and other contacts of passively detected cases are screened for infection and treated with anti-malarials[Smith et al., 2013].

CONCLUSION

The emergence of resistance has created the urgent need for better diagnostic tools and new methods for detecting and preventing importation of malaria parasites into low endemic areas cost effectively, quickly and accurately.Newer strategies are important to identify the most efficient ways to deploy interventions thus significantly enhancing the prospects of malaria elimination in Nigeria

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