Nigeria’s Uncertain Relationship with Malaria: Charting a Course from Past to Future

Malaria in Nigeria rarely announces itself as a crisis. It does not always make headlines or trigger urgency like COVID-19. Instead, it is woven into everyday life, from stagnant water behind homes to the fevers that send families rushing to late-night pharmacies. For many Nigerians, malaria is not perceived as a public health emergency but as a familiar and expected occurrence. This normalization masks an alarming reality that Nigeria bears the highest global burden of malaria, accounting for a significant proportion of cases and deaths worldwide. 

The numbers, when you actually look at them, are staggering. According to the 2025 World Malaria Report, Nigeria accounts for 24.3% of all malaria cases globally and 30.3% of malaria deaths worldwide. And within West Africa, Nigeria alone carries more than half, 54.6%, of the region’s case load.  

To understand Nigeria’s relationship with Malaria today, we must first grasp a sense of the history of this national disease.

Long before these sprawling plains and dense forests came to be known Nigeria, malaria dictated who could live here and on what terms. Indigenous communities had evolved a natural resistance, such as the sickle cell trait, against the disease’s relentless grip. But when British explorers ventured into the West African interior in the 19th century, they encountered an environment that struck them down with merciless precision. The region soon earned a grim epithet among European adventurers:  “the white man’s grave.” 

A third of the people associated with a 1842 British riverine expedition into the Niger died, largely from malaria. It was only in the 1850s, after Scottish physician William Balfour Baikie conducted what amounted to the first clinical trial of prophylactic quinine on a Niger expedition, that meaningful European penetration of the interior became viable. Yet, this hero died at age 39 of tropical fever. Although he was respected in Africa, his contribution to malaria prophylaxis is largely forgotten by the rest of the world.

The colonial administrators who eventually settled in Lagos and later across the amalgamated protectorates managed malaria primarily as a European problem. The strategy was largely one of spatial separation; they kept African quarters at a distance from European residential areas, drained swamps near administrative zones, and ensured quinine was readily available to white officers. The health of the African majority was, by and large, incidental. A common epidemiological view of the era held that Africans, having survived childhood infections, possessed a kind of immunity, making malaria, in the eyes of colonial medicine, essentially a white man’s medical concern. 

After the Second World War, Dichlorodiphenlytrichloroethane (DDT) emerged as a powerful new tool, and the World Health Organization (WHO) launched a series of pilot indoor residual spraying projects across parts of Africa, including northern Nigeria, in the late 1940s and 1950s. Malaria prevalence did decline in target zones. Yet, most of sub-Saharan Africa was excluded from the world’s most ambitious malaria campaign before it even began, on the grounds that the region presented technical challenges that could not yet be overcome. When the Global Malaria Eradication Programme (GMEP) was eventually abandoned in 1969, the main reasons for failure were precisely those technical challenges, especially in Africa, which had been left behind from the start.

Nigeria gained independence in 1960, and the new government that took over inherited a country where malaria was deeply embedded. Our health infrastructure lagged, and malaria, which had never been dealt with at its roots, continued.

To understand the scale of the problem, it helps to sit with a few specific numbers. As of 2024, an estimated 97% of Nigeria’s population lives in malaria transmission zones, meaning that for the overwhelming majority of Nigerians, the risk is not seasonal or occasional but constant and pervasive. The parasite responsible for the vast majority of severe cases and deaths is Plasmodium falciparum, the most lethal of the five malaria species that infect humans.

The people who pay the highest price among the populace are children under five and pregnant women. Children under five accounted for approximately 76% of all malaria deaths in the African region in 2024. In Nigeria specifically, 39.3% of all global malaria deaths in children under five occurred within our borders in 2023 alone. This is not a regional statistic; it is a Nigerian statistic. It simply means that one of every three children who dies of malaria anywhere on earth dies here.

Pregnant women are uniquely vulnerable because malaria during pregnancy increases the risk of low birth weight, maternal anaemia, premature delivery, and death. In 2025, 45% of eligible pregnant women and girls in 34 countries received at least three doses of preventive treatment, which is still far below the global target of 80% coverage. 

Beyond the human cost, there is the economics of it all. Malaria drains productivity, empties household savings, and overwhelms public health facilities. Nigeria’s National Malaria Elimination Programme estimates the annual financial loss due to malaria at approximately 132 billion Naira in treatment costs, prevention, and lost productivity. Similarly, when a parent misses work to take care of a feverish child, when a student misses a week of school, when a farmer cannot tend her crops because she is bedridden, these losses compound invisibly into a national economic wound.

Faced with all this, it was only natural that at some point, the nation with the highest malaria burden worldwide would take concrete steps to mitigate these effects. What does it look like when Africa’s most malaria-burdened nation decides it has had enough? It looks like 28.6 million children protected in a single year. It looks like vaccines reaching remote riverine communities. It looks, slowly but surely, like progress.

The major turning point was 2013, when Nigeria launched the National Malaria Elimination Programme, the NMEP. That programme gave birth to the National Malaria Strategic Plan, a document that laid out exactly how Nigeria intended to eradicate the disease: fewer infections, fewer deaths, and eventually, a country where malaria is a thing of the past.

The goal was ambitious. Reduce malaria deaths to less than 50 per 1,000 by 2025. Cut parasite prevalence to under 10%. These were not small targets for a country of over 200 million people living in one of the most malaria-friendly climates on Earth.

But Nigeria backed the plan with money and went after serious funding. The government secured $364 million from three major international banks: the World Bank, the African Development Bank, and the Islamic Development Bank, to fund malaria interventions across 13 states. That kind of money meant more health workers, more supplies, and more reach into communities that had long been left behind. It was a signal that Nigeria was done treating malaria as a manageable inconvenience.

On the ground, the strategy got practical. Millions of insecticide-treated nets were distributed across the country, especially in rural areas where malaria hits hardest. These nets, simple but effective, kill mosquitoes on contact, cutting the chances of a bite that could turn deadly.

Indoor residual spraying followed, a process where the inner walls of homes are coated with insecticide, turning people’s living spaces into a trap for mosquitoes rather than the other way around.

The government also invested in keeping pregnant women and young children safer through chemoprophylaxis, that is, giving preventive doses of medicine before malaria even strikes. In 2023 alone, 28.6 million children in Nigeria received Seasonal Malaria Chemoprophylactic treatment. 

Perhaps the most exciting development in recent years has been the arrival of the malaria vaccine. Nigeria rolled out the WHO-recommended R21 vaccine, starting in Bayelsa and Kebbi, two states with some of the highest malaria burdens in the country. From the one million doses received, over 140,000 children have already been vaccinated.

For many parents in those communities, it is the first time they have had something beyond a net and a prayer standing between their children and the disease.

One mother in Bayelsa put it simply: even with the vaccine, she still uses her insecticide-treated net and makes sure no water is left standing around the house. “We now spend less on malaria treatment,” she said. That sentence, as quiet and unglamorous as it is, might be the best summary of what progress actually looks like.

None of this means the battle is over. Nigeria still accounts for more than a quarter of the world’s malaria cases, and the disease continues to claim lives every single day. But the country is no longer standing still.

From government policy to community health workers, from international loans to a mother in Bayelsa tucking her vaccinated child under a net, Nigeria is fighting. And for the first time in a long time, the fight is beginning to look like it could be won.

One of the most alarming problems in Nigeria’s malaria fight is one that rarely makes headlines: the testing gap.

Only 13.8% of suspected malaria cases in the country actually go through proper diagnostic testing. The target is 80%. That gap is not just a minor administrative oversight; it means that the majority of malaria cases in Nigeria are being treated, or mistreated, without confirmation. Drugs are being used on the wrong patients, and sick people are being sent home without the right diagnosis. You cannot fight an enemy you are not accurately counting.

Fixing this means getting more Rapid Diagnostic Tests and microscopy equipment into clinics, health posts, and communities, especially in rural areas where the disease hits hardest, and healthcare infrastructure is thinnest.

Now comes the funding problem. Nigeria cannot fight malaria on goodwill alone. Globally, malaria funding in 2024 reached just $3.9 billion, less than half of the $9.3 billion that experts say is needed. Nigeria, as the country with the highest malaria burden in the world, feels every dollar of that shortfall.

The consequences are visible. Insecticide-treated nets go undistributed. Drug supplies run out. Health workers go without training. States that rely heavily on donor funding have gone years without a new net distribution cycle, leaving communities exposed and vulnerable.

Nigeria must increase its own domestic investment in malaria. International support is valuable, but it is unreliable. A country serious about ending malaria must be willing to fund that ambition from within.

Another issue is resistance. Conventional means of managing malaria show reduced efficacy with the passage of time, threatening to jeopardise meaningful progress made over the years. Mosquitoes are developing resistance to the insecticides used in nets and indoor spraying. Some malaria parasites are showing signs of resistance to frontline drugs. This is not a Nigeria-specific problem, but Nigeria, with its enormous population and high transmission rates, is particularly exposed to the consequences. Next-generation nets are already being explored and distributed in parts of the country. That work must be accelerated.

Perhaps the most persistent challenge yet is reach. Rural communities, displaced populations, pregnant women in areas with no nearby clinic, these are the people malaria kills most. And these are precisely the people that current systems struggle most to serve. Poor roads, inadequate storage facilities, and weak supply chains mean that life-saving tools often do not get to the people who need them most.

Community health workers are the bridge between policy and people. Nigeria must train more of them, pay them properly, and trust them with more responsibility.

Nigeria has shown it can fight malaria. The vaccine rollout, the Seasonal Malaria Chemoprevention (SMC) campaigns, and the funding secured. None of that happened by accident. It happened because of political will, international partnership, and community action.

But political will fades. Funding dries up. And malaria does not rest.

The work ahead is harder than the work already done. It requires honest accounting of where the gaps are, adequate investment to close them, and a commitment that does not waver every time a new crisis demands attention.

Malaria ends when Nigeria decides, truly decides, that it will.

Abdulazeez Romlah, Ayomide Bello.