Mrs. Grace Ameh lives in Eyyan, a community in the Kwali area council of the Federal Capital Territory. Each time her five-year-old daughter develops a fever, her first assumption is malaria. This assumption stems from limited access to diagnostic facilities within her community.
Ameh explained that the nearby patent medicine vendor often prescribes antimalarials and antibiotics for her child without conducting any tests, relying only on the symptoms she describes.
“But weeks ago, my daughter’s condition worsened after multiple treatments. We kept giving her malaria drugs and antibiotics, but nothing worked.
“Eventually, we rushed her to a teaching hospital, where they told us it was typhoid,” she said.
Ameh’s experience mirrors the harsh reality faced by millions of Nigerians, where fever is often misdiagnosed as malaria. The consequences of such misdiagnoses are dangerous and exacerbate the country’s growing antimicrobial resistance (AMR) crisis.
According to the 2024 World Malaria Report, Nigeria accounted for 40 per cent of malaria cases and 46 per cent of malaria deaths among the 10 High Burden to High Impact (HBHI) countries in the previous year.
While global interventions have prevented over 2.2 billion cases and 12.7 million deaths since 2000, malaria remains a significant threat, particularly in sub-Saharan Africa, which bears 95 per cent of global malaria deaths.
Data from the Primary Healthcare Performance Initiative, funded by the Bill & Melinda Gates Foundation, reveals a troubling statistic: diagnostic accuracy in Nigeria stands at just 36.4 per cent. This means fewer than four in ten patients are correctly diagnosed when they visit healthcare providers.
Considering that 70 per cent of clinical decisions rely on laboratory tests, the majority of Nigerians are being treated without proper lab confirmation, especially in primary healthcare settings.
Experts say malaria is the most commonly mistreated illness in Nigeria. Community health centres, pharmacies and clinics frequently treat patients based on symptoms alone, often resulting in poor health outcomes and avoidable fatalities.
Akindele Opeyemi, a pharmacist and health systems consultant, explained that the malaria rapid diagnostic test (MRDT) was designed to be affordable, quick and easy to administer. Yet, many frontline health workers no longer use them consistently, despite policy support.
“Community pharmacists, nurses and even some physicians have stopped using MRDTs. They either don’t trust the results, lack access, or face logistical challenges,” Opeyemi said.
“In some cases, prior antibiotic use can hide the malaria parasite, producing false-negative MRDT results. Some MRDT kits are also too weak to detect low-level infections, which further erodes trust in their reliability,” he added.
According to Opeyemi, when those responsible for treating over 70 per cent of malaria cases do not use diagnostic tools, the rise in malaria-related deaths should not be surprising.
Nutrition policy advisor at Resolve to Save Lives, Batet Musa pointed out that even when antimalarials are correctly prescribed, malnutrition can render the treatment ineffective.
“Artemether/lumefantrine, a widely used malaria drug, requires fatty foods for proper absorption – something many families can’t afford.
“A child who only eats pap won’t absorb the medication effectively. Sometimes, it’s not about fake drugs or misdiagnosis – it’s about hunger,” Musa said.
He noted that suboptimal dosing, especially among children due to poor knowledge or financial constraints, often results in treatment failure and severe complications.
Dr. Ridwan Yahaya, Antimicrobial Stewardship Manager at the Nigeria Centre for Disease Control and Prevention (NCDC), emphasised that antibiotics are frequently prescribed alongside antimalarials. Over time, this indiscriminate use has contributed to the rise of drug-resistant bacteria, now recognised as a major global health threat.
“Misdiagnosis fuels antibiotic overuse. We’re breeding resistant organisms – and that’s deadly,” he said.
Despite more than 70 years of interventions, Nigeria still accounts for 30 per cent of global malaria cases – about 68 million annually – and 23 per cent of global malaria deaths, which amount to roughly 194,000 each year.
To reverse this trend, stakeholders are urging a comprehensive re-evaluation of malaria strategies.
According to the Minister of Health and Social Welfare, Prof. Muhammad Pate, 60 per cent of hospital visits in Nigeria are attributed to malaria, including at tertiary facilities.
Pate said this points to a critical failure at the primary healthcare level.
One initiative seeking to shift this narrative is the African Leadership and Management Training for Impact in Malaria Eradication (ALAMIME), coordinated by Makerere University’s School of Public Health and funded by the Gates Foundation.
ALAMIME is building leadership capacity for malaria programmes across nine African countries, including Nigeria.
ALAMIME Nigeria lead, Prof. Olufunmilayo Fawole stressed the importance of developing malaria solutions based on local realities rather than imported models.
In a related development, the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) recently signed a memorandum of understanding with the National Malaria Elimination Programme (NMEP). The agreement aims to support local manufacturing and strengthen Nigeria’s pharmaceutical supply chain, particularly for malaria diagnostics and treatment tools.
This collaboration, part of the World Bank’s IMPACT project, seeks to address longstanding challenges such as frequent stockouts, expired testing kits and the high cost of essential medications.
To tackle the diagnostic gap and slow the rise of antimalarial resistance, Dr. Salman Polycarp, an epidemiologist, called for stronger regulatory oversight.
He said such oversight would ensure that only reliable, internationally certified RDT kits are distributed and routinely evaluated.
“Regular training and re-training of healthcare workers, especially at the primary level, are crucial to improve their ability to properly administer and interpret RDTs.
“In areas with high disease burden, RDTs should be combined with microscopy to improve diagnostic precision, especially in drug-resistant or complex cases,” he said.
Polycarp also advocated for public awareness campaigns to encourage proper diagnosis before treatment, reduce self-medication, and curb reliance on symptom-based care.
“Region-specific, large-scale studies on RDT performance are vital. Nigeria’s diverse ecological zones affect disease patterns, so it’s important to deploy diagnostic kits in areas where they are most effective,” he added.
Head of disease prevention and control at the NCDC, Dr. Tochi Okwor reiterated the importance of strict adherence to treatment guidelines. She said antimalarials should only be prescribed following confirmed diagnostic results and also called for the regulation of over-the-counter access to these medications.
“Investing in research on different Plasmodium species and tracking emerging resistance patterns through genomic surveillance is critical, especially in high-transmission areas,” she said.
Okwor also recommended embracing new diagnostic technologies, including molecular testing and AI-powered tools, to identify infections that standard RDTs might miss.
She said Nigeria must strengthen its international partnerships to access more advanced tools, technical knowledge, and innovations.
“Upgrading our health information systems to monitor malaria cases, track RDT performance, and assess treatment outcomes is essential. This will support data-driven policymaking and improve healthcare delivery,” she added.
For mothers like Ameh and thousands of children across Nigeria, the difference between life and death can rest on timely and accurate diagnosis.
Only locally informed, practical solutions can bring the country closer to malaria elimination and halt the advance of antimicrobial resistance.
