Why malaria is still killing Nigerians

Victor TalksHealth

Nigeria accounts for 30.3 percent of every malaria death on earth. Treatments exist. Bed nets have been distributed by the hundreds of millions. A new strategic plan for 2026–2030 has just been launched. So why are more Nigerians still dying from malaria than from anywhere else in the world? The answers involve counterfeit drugs, emerging resistance, broken supply chains, and a disease that has quietly been learning how to survive the medicines we throw at it.

In June 2024, in the dense market of Bariga, Lagos, a hawker was advertising “baba wonder super balm” through a horn speaker, claiming it could cure malaria, skin infections, and sickle cell disease — all for 500 naira. No branded label. No regulatory number. And people were buying it. This scene, ordinary by Nigerian market standards, captures one dimension of a crisis that kills more people in Nigeria than anywhere else on the planet.

According to the World Health Organization (WHO) global malaria report 2025, Nigeria accounts for 24.3 percent of all global malaria cases and 30.3 percent of all malaria deaths — meaning nearly one in three people who die of malaria anywhere in the world dies in Nigeria. In absolute numbers, this represents hundreds of thousands of Nigerians every year, the majority of them children under the age of five. Despite significant progress — malaria parasite prevalence falling from 42 percent in 2010 to 15 percent in 2025 — Nigeria remains the world’s single heaviest malaria burden country, and the disease is actively evolving new ways to resist the drugs used to treat it.

Why Malaria Is Still Killing Nigerians
The persistence of malaria in Nigeria is not the result of any single failure. It is the product of several interlocking problems that reinforce each other in ways that are difficult to untangle.
The most fundamental challenge is structural. Nigeria’s health system lacks the infrastructure to sustain comprehensive malaria control across 36 states and the FCT, a territory the size of France and Germany combined, with a population of over 200 million. Access to rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs) remains inconsistent across primary health care centres, particularly in rural and northern states. Many patients, particularly in poor communities, never reach a facility with reliable supplies and instead self-medicate with whatever is available in the market.

Self-medication with over-the-counter antimalarials is almost universal in Nigeria. A study assessing treatment failure in Ebonyi State found that most malaria patients source their drugs from open markets and patent medicine stores rather than health facilities — a pattern repeated across the country. This creates conditions under which drug quality cannot be assured, doses are frequently incorrect, and treatment courses are abandoned partway through when symptoms temporarily improve.

Nigeria’s tropical climate, combined with inadequate drainage systems in urban areas, poor refuse management, and widespread informal settlements, creates near-ideal conditions for year-round Anopheles mosquito breeding. Over 97 percent of Nigeria’s population lives in areas classified as at risk of malaria transmission. Unlike countries that can push transmission into a seasonal window, Nigeria is fighting malaria twelve months a year, everywhere.

Nigeria’s Malaria Burden By The Numbers (WHO world malaria report 2025)
Nigeria accounts for 24.3% of all global malaria cases and 30.3% of all global malaria deaths in 2024
610,000 people died of malaria globally in 2024 — nearly 185,000 of them in Nigeria
75% of malaria deaths in Africa are in children under 5 years old
Malaria parasite prevalence has fallen from 42% (2010) to 15% (2025) — real progress, but still far too high
Nigeria accounts for 54.6% of all malaria cases in West Africa
Case incidence decreased by only 1.5% between 2023 and 2024 — progress is slowing

How Counterfeit Antimalarials Are Fuelling Deaths and Resistance
In September 2025, the National Agency for Food and Drug Administration and Control (NAFDAC) intercepted 277 cartons of counterfeit and unregistered malaria drugs valued at over ₦1.2 billion in a warehouse in the Ilasa-Oshodi area of Lagos. The drugs, branded as “Malamal Forte,” were concealed in cartons labelled as Diclofenac Potassium 50mg and had been illegally imported from a pharmaceutical company in China. They were falsely declared as spare parts to evade customs detection.

This interception was not an isolated incident. In 2024, NAFDAC destroyed smuggled, expired, and fake drugs estimated at ₦11 billion in Ibadan, Oyo State alone. The scale of the counterfeit drug market in Nigeria reflects a convergence of factors: high demand for cheap antimalarials in a population where over 133 million people are multidimensionally poor, weak supply chain oversight at the last mile, and a thriving informal drug market that operates beyond regulatory reach.

The consequences are two-fold and deadly. A person who takes a counterfeit antimalarial that contains no active ingredient, or an insufficient quantity of it, receives no therapeutic benefit and dies of untreated malaria. But the second consequence is arguably worse at a population level: sub-therapeutic drug doses — doses too low to kill the parasite but high enough to expose it to the drug — create precisely the selection pressure that drives drug resistance. The parasite is trained by repeated low-level exposure to survive the medicine. Fake drugs do not just kill individual patients.

They are actively eroding the effectiveness of the drugs that protect everyone.

How To Spot Fake Antimalarial Drugs
1) Always buy antimalarials from a registered pharmacy, government health facility, or NAFDAC-approved outlet — never from open markets or roadside hawkers
2) Check for the NAFDAC registration number on the packaging. Verify it on the NAFDAC website (www.nafdac.gov.ng ) or by texting the number to the NAFDAC verification line
3) Inspect the packaging carefully: genuine drugs have consistent print quality, proper seals, and clear expiry dates. Poor printing, misspellings, or broken seals are warning signs
4) Be suspicious of unusually cheap antimalarials — if the price seems too good to be true, the drug likely is too
5) Do not buy loose tablets from unlabelled containers or market hawkers — regardless of the price or the seller’s claims
Report suspected fake drugs to NAFDAC: 0800-162-3322 (toll-free)

Drug-Resistant Malaria in Africa
Malaria parasites have a long history of developing resistance to the drugs used against them. Chloroquine became largely ineffective in sub-Saharan Africa by the 1990s due to widespread resistance. Sulfadoxine-pyrimethamine (SP) followed a similar trajectory. Both drugs were replaced by artemisinin-based combination therapies (ACTs), which became the global standard treatment and have saved millions of lives.

Now, the WHO World Malaria Report 2025 has delivered an alarming warning: partial resistance to artemisinin derivatives — the backbone of modern malaria treatment — has been confirmed or suspected in at least 8 countries in Africa. A systematic review of molecular surveillance in Nigeria published in 2025 found a high prevalence of mutations associated with resistance to chloroquine and sulfadoxine-pyrimethamine, particularly in specific genetic markers (Pfcrt and Pfdhfr genes).

While the review found a low frequency of artemisinin-specific resistance markers (Pfk13 mutations) in Nigeria to date, a separate 2026 molecular surveillance study found evidence of clonal expansion of infections with characteristics that require continued close monitoring.

The epicentre of artemisinin partial resistance in Africa is currently East Africa — particularly Uganda, Rwanda, and Tanzania. In Uganda, more than half of malaria parasites in some districts now carry validated resistance markers. The concern for West Africa, including Nigeria, is that this resistance does not remain geographically contained.

Resistance mutations spread through human movement, through the circulation of parasites across borders, and through the continued selection pressure created by sub-therapeutic drug exposure — including, critically, through counterfeit drugs.

The clinical consequence of partial artemisinin resistance is slower parasite clearance — the drug takes longer to kill the parasite. In a patient being treated with a combination therapy, this means the parasite survives long enough to be exposed to the partner drug alone, creating the conditions for resistance to that drug as well.

This is exactly how ACT resistance unfolded catastrophically in Southeast Asia, where it spread from Cambodia to multiple countries and produced a severe treatment crisis. African health authorities and the WHO are working urgently to prevent a repeat of that scenario on this continent.

Understanding drug-resistant Malaria
Drug resistance develops when malaria parasites change genetically (mutate) in ways that allow them to survive drug treatment.
Resistance is driven by incomplete treatment courses, sub-therapeutic doses (including from fake drugs), and overuse of drugs without proper diagnosis.
Chloroquine resistance is now widespread across Nigeria — do not use chloroquine as a malaria treatment unless specifically advised by a doctor
Artemisinin partial resistance has emerged in East Africa (Uganda, Rwanda) and is being closely monitored across the continent.
Nigeria’s molecular surveillance (2025) shows low but present chloroquine and SP resistance markers; artemisinin-specific resistance remains low but requires ongoing monitoring.
If your malaria symptoms persist or return within 28 days of completing ACT treatment, see a doctor — do not simply buy more drugs. This could indicate treatment failure.

Nigeria’s New Malaria Strategic Plan 2026–2030
On World Malaria Day 2026, the Federal Government launched the new National Malaria Strategic Plan (NMSP) 2026–2030 — the country’s most ambitious malaria roadmap to date. The plan was unveiled by the Honourable Minister of State for Health and Social Welfare, Dr Iziaq Adekunle Salako, and represents a significant evolution from the preceding 2021–2025 plan.

The 2026–2030 NMSP has a core numerical target: reduce malaria parasite prevalence and mortality by 50 percent from 2025 levels by 2030. It is grounded in what the Ministry describes as “subnational tailoring” — the recognition that malaria transmission, health system capacity, and community behaviours differ dramatically between states and local government areas, and that a one-size-fits-all national programme has limits. Interventions under the new plan are designed to reflect the specific realities of different communities.

The plan is aligned with three global frameworks: Nigeria’s own National Health Sector Strategic Blueprint, the Sector-Wide Approach (SWAp), and the WHO Global Technical Strategy for Malaria (GTS). It is backed by the Advisory on Malaria Elimination in Nigeria (AMEN), a council of international experts providing technical direction. The government has pointed to the distribution of over 500 million insecticide-treated nets since 2015 and the expansion of seasonal malaria chemoprevention (SMC) as evidence of the programme’s momentum.

Nigeria also receives the largest share of global SMC — preventive antimalarial medicines given to young children during peak transmission season — of any country in the world, reaching tens of millions of children annually. The 2025 WHO report credited this intervention as one of the genuine success stories in Nigeria’s malaria response.

Key Pillars Of Nigeria’s National Malaria Strategic Plan 2026–2030
Target: reduce malaria prevalence and mortality by 50% from 2025 levels by 2030.
Subnational tailoring: interventions designed for the specific epidemiological and health system realities of each state and LGA.
Vector control: continued scale-up of insecticide-treated nets (ITNs), indoor residual spraying, and larval source management.
Chemoprevention: expansion of seasonal malaria chemoprevention (SMC) for children and intermittent preventive treatment in pregnancy (IPTp)
Diagnosis and treatment: improving access to rapid diagnostic tests (RDTs) and quality-assured ACTs at primary health care level.
Drug resistance surveillance: strengthened molecular monitoring of antimalarial resistance markers across all geopolitical zones.
Counterfeit drug control: enhanced NAFDAC enforcement and supply chain verification for antimalarial medicines.
The R21/Matrix-M malaria vaccine: Nigeria is among countries rolling out the WHO-approved vaccine for children, with potential to significantly reduce childhood malaria deaths.

What Every Nigerian Household Should Do Right Now
The malaria battle cannot be won by government and health agencies alone. Every household is a frontline. Here is what the evidence recommends for Nigerian families:
Use insecticide-treated nets every night, every person, every night of the year — not just during rainy season. Ensure that free nets distributed through government programmes are used and not sold. When a household member has a fever, go for a rapid diagnostic test before taking antimalarials — not every fever is malaria, and treating non-malaria fever with antimalarials wastes drugs and accelerates resistance. When malaria is confirmed, complete the full ACT course as prescribed, even when you feel better after two days.

Buy antimalarials only from registered pharmacies or health facilities. And report suspected fake drugs to NAFDAC immediately.

Victor Aniogbu (Victor TalksHealth) is a Human Anatomist and Wellness Advocate.
He wrote in from Owerri.
For feedback, email– vi*****************@***il.com

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