Data now shows an astounding 95 out of every 100 fevers experienced in Lagos are not caused by malaria, the Lagos State Commissioner for Health, Prof. Akin Abayomi has said.

The critical finding is at the heart of a new, multi-pronged approach to fever management, designed to combat misdiagnosis and, crucially, to avert a looming crisis of antimicrobial resistance.

Abayomi said this at a three-day Study Kick-Off of the Pathway to Pre-Elimination and Digitisation Project in Lagos State.

The focus was Malaria Rapid Diagnostic Test and Microscopy Comparative Study & Assessment of PPMVS’ Capacity to Manage Malaria and Febrile Illnesses.

Abayomi said: “We need to get malaria out of the region.

“It is very, very important that we do that once and for all, perform the mind shift in our healthcare providers that on average, 95 out of every 100 fevers that you may see are not caused by malaria.”

“For too long, the default response to fever in Lagos, and indeed nationwide, had been to administer anti-malarial drugs, often without proper diagnostic testing.

This practice, the commissioner warned, was not only wasteful but dangerous.

According to him, the widespread, often unnecessary use of anti-malarial and antibiotics is accelerating Antimicrobial Resistance (AMR), a global threat where common infections become untreatable.

“We are sitting on a very major problem of microbial resistance. And we have to be careful how we dispense antimicrobials and how we dispense antibiotics.”

He cited recent research indicating significant AMR in animals, with 60 per cent of human infections originating from them, stressing the interconnectedness of the problem.

Under the new “test, treat, and track” pathway/strategy, he said that Lagos residents presenting with fever will first undergo a Rapid Diagnostic Test for malaria.

“ If the result is negative, which is anticipated for the vast majority, healthcare providers will then conduct thorough examinations and investigations to pinpoint the true cause of the fever, be it pneumonia, gastroenteritis, or other infections.’

“The ministry is also tightening regulations on pharmacies.

 “It is illegal to walk into a pharmacy and say, give me an antimalarial, or give me an antibiotic without a doctor’s, or healthcare practitioner’s, accredited healthcare practitioner’s certificate.”

Underscoring the urgency of the situation, he urged the Pharmacy Council of Nigeria to enforce this, stressing, “If we don’t stop that practice, we are going to be the capital of antimicrobial resistance”.

To combat this, the ministry, with support from a World Bank grant, and in collaboration with Prof. Wellington Oyibo’s Research Team, is instituting an evidence-based “test, treat, and track” pathway for fever management.

“The cornerstone of this approach is rigorous testing for malaria first.

“If negative—which is expected for over 90 per cent of cases in Lagos—healthcare providers are then mandated to investigate other potential causes of the fever, ranging from common colds to more serious bacterial or viral infections like E. coli, salmonella, or dengue.”

Oyibo, Director of the Centre for Transdisciplinary Research for Malaria and Neglected Tropical Diseases, who explained to the News Agency of Nigeria the grave consequences of not testing, also underscored the severity of misdiagnosis.

Oyibo, the study Coordinator, said: “If it’s a child that has pneumonia, pneumonia will present just the way you see some symptoms of malaria presenting.

“And you now give anti-malaria medicine without a test. What will happen to that child? That child will die quickly of pneumonia.”

According to Oyibo, the key strategy to eliminating malaria in the state also includes a policy shift toward Rapid Diagnostic Tests over traditional microscopy due to RDTs’ proven accuracy and operational feasibility in low-resource settings.

He noted that Lagos state was the only state that epidemiological parameters qualified as a state at pre-elimination.

“This is a significant milestone in the history of Nigeria but fever and other malaria-like symptoms, which are non-specific to malaria, are still diagnosed as malaria. This forms a significant contribution to high malaria burden reporting.

“This bold initiative aims to usher in an era of evidence-based medicine, where intellectual capacity and accurate diagnosis protect society from the cascading harms of incorrect treatment and drug resistance.

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