FG's Malaria Treatment Setback for Pregnant Women Sparks Concern
In 2005, the national government implemented a policy providing free malaria treatments for pregnant women across the country with the aim of decreasing maternal mortality rates since the illness accounts for 11 percent of such fatalities in Nigeria. However, two decades later, expecting mothers continue to bear the cost of anti-malarial drugs at state-run hospitals. This situation has worsened due to concerns over potential cuts in U.S. financial assistance. Janet Ogunedepo provides this report.
Mrs. Grace Bankola, a fashion designer and mother of two, wished for a daughter whom she could enjoy dressing up with.
Since her two sons were boys, they put an end to the numerous imaginative clothing designs she had envisioned for a daughter.
Popularly known as Mama Boys at her store in the Cardoso district of Mushin, Lagos State, she opted for pregnancy with the hope of conceiving a girl this time around.
Under significant pressure from her husband, who had adamantly opposed having more children because of the financial conditions,Grace became pregnant.
She embarked on her pregnancy journey and enrolled at the antenatal clinic of Lagos University Teaching Hospital, located in Idi-Araba.
Being an informal worker, Grace has no health insurance coverage and pays out of pocket for whatever services she needs at the hospital.
During her second trimester, Mama Boys remembered being advised about the preventative antimalarial medication at her antenatal classes and received a prescription form to buy it alongside her regular prenatal drugs.
"When I reached the pharmacy, they informed me that because I wasn’t enrolled in the NHIA (National Health Insurance Authority) or an HMO (Health Maintenance Organization), I would have to cover the entire cost of the medications," Grace explained to PUNCH Healthwise.
With her funds running low for the day, Grace managed to purchase only her prenatal medicines, having to leave the malaria medication un bought.
The expectant "Mama Boys," who is scheduled for delivery shortly, had access to just one dose of the preventative malaria medication.
Nonetheless, the World Health Organization suggests that all pregnant women should receive at least three doses of intermittent preventive treatment using sulfadoxine-pyrimethamine, known as IPT-SP, particularly those residing in regions where this condition is widespread.
Pregnancy poses significant risks for mothers and fetuses when infected with malaria. To combat this issue, intermittent preventive treatment against malaria in pregnancy has been implemented. This approach involves administering complete dosages of sulfadoxine-pyrimethamine to pregnant women residing in areas affected by malaria, such as Nigeria, regardless of their current infection status. In 2005, the Nigerian government embraced IPTp as an official policy nationwide.
Why do pregnant women require malaria prevention?
In Nigeria, malaria significantly contributes to maternal mortality, accounting for 11 percent of the national maternal mortality rate, which stands at 512 deaths per 100,000 live births.
For expectant mothers, malaria can lead to various complications such as anemia, stillbirths, premature deliveries, lower birth weights, and a higher likelihood of newborn fatalities.
If not treated, it could result in the demise of both the mother and the unborn child.
Doctors specializing in gynecology told PUNCH Healthwise that apart from the dangers associated with abortions, pregnant women suffering from untreated malaria are at risk of slipping into a coma.
The Professor of Obstetrics and Gynaecology at the Lagos State University Teaching Hospital in Ikeja, Oluwarotimi Akinola, stated that the IPT-SP therapy was derived from the rollback malaria initiative, which employed a tripartite strategy encompassing vector management, pharmaceutical intervention, and the enhancement of healthcare infrastructure.
He indicated that malaria was the leading reason for anemia during pregnancy.
The boss pointed out that it might result in premature delivery and intrauterine fetal demise.
Malaria is a hazardous illness. It ranks among the top prevalent diseases due to its ability to induce fever and anemia. In pregnant women, malaria commonly leads to the most frequent occurrence of anemia.
"It may result in premature deliveries, the infant could potentially pass away within, along with various other complications," Akinola stated.
The experienced gynecologist emphasized that the IPT-SP therapy is crucial for expectant mothers because it offers protection against malaria.
He mentioned that the medication is given every month, beginning at the time when the pregnant woman first feels her baby's movements, referred to as quickening.
The ex-President of SOGON highlighted the importance of preventing malaria in expectant mothers, noting that the adverse effects of the illness underscored the necessity for such preventive measures.
He mentioned that although the medication was quite inexpensive, it would be offered at no cost to expectant mothers should the necessity arise.
Neglected policy
Findings by PUNCH Healthwise reveal that in 2005, the Federal Government adopted IPT for malaria in pregnancy.
According to available documents, this policy ensured that free, quality anti-malarial drugs were distributed to pregnant women during antenatal care visits, particularly in public health facilities.
As part of an extensive pledge to combat and manage malaria among expectant mothers in Nigeria, this program sought to alleviate the impact of the illness on both the women and their developing offspring.
Findings reveal that while the IPT-SP continued, its free provision in public facilities stopped due to “unclear policy and guidance and service delivery factors such as frequent stock-out, confusion over the timing of each IPTp dose, and introduction of user fee.”
It suggested that the medication was no longer readily administered to expectant mothers at government-run medical facilities.
Nevertheless, research showed that certain government-run hospitals with free malaria programs offer complimentary diagnostics, treatments, and medications specifically for expectant mothers.
A number of measures were implemented following the unsuccessful 2005 policy.
For instance, the Strategic Plan (2009 – 2013) from the Federal Ministry of Health’s National Malaria Control Programme emphasized "free distribution via public sector facilities during prenatal visits and Expanded Program on Immunization services," targeting "children under five years old and pregnant women."
The overarching aim of the malaria-control strategy was to achieve "a malaria-free Nigeria" and to cut down malaria-related illnesses and deaths by half in Nigeria by 2013, as well as to lessen the socioeconomic burden caused by the disease.
An analysis of NMSP (2021 – 2025) further showed the glaring absence of the provision of free IPT-SP drugs for pregnant women.
In 2023, lawmakers in the House of Representatives called on the FG to urgently provide free malaria treatment and drugs in public-owned hospitals nationwide.
However, in 2025, malaria treatment remains unpaid for in both federal hospitals and numerous state hospitals.
Malaria, amid funding cuts
Experts fear that the pause in malaria funding by the Trump administration could exacerbate Nigeria’s already critical malaria problem.
According to the WHO, Nigeria bears the heaviest load of malaria worldwide, representing approximately 27 percent of global cases. The organization estimates there are about 68 million instances and around 194,000 fatalities resulting from this illness annually.
The international health organization pointed out that the African region carries a concerning share of the worldwide disease load, accounting for approximately 95 percent of annual malaria cases globally.
The WHO expressed concern that even though notable progress had been made, malaria continued to pose a substantial public health issue, resulting in approximately 600,000 fatalities across the continent during 2023.
In a statement for 2025 World Malaria Day, commemorated on April 25, the WHO warned that funding cuts could further derail progress in many endemic countries, putting millions of additional lives at risk.
This year’s theme is “Malaria Stops with Us: Reinvest, Reimagine, Reignite.”
The WHO reports that funding reductions are leading to moderate to severe interruptions of malaria services across more than 30 endemic nations.
In January, a few days after the inauguration of Donald Trump as the 47th President of the United States of America, he signed an executive order to withdraw the country from the WHO and pause overseas funding.
According to PUNCH Healthwise, the financial support formerly supplied via the U.S. Government’s President’s Malaria Initiative has played a crucial role in decreasing malaria-induced fatalities in Nigeria.
According to a 2024 report from PMI, the United States President's funding has provided $914 million for Nigeria’s battle against malaria since 2011. The year 2023 saw an allocation of $73 million as part of this support.
In 2020, even with the limitations imposed by the COVID-19 pandemic, PMI assisted Nigeria in delivering 14.7 million treatment doses across facilities and communities, with 8.2 million of these treatments specifically aimed at pregnant women and children.
PMI disseminated 7.1 million insecticide-coated mosquito nets, supplied 7.2 million rapid diagnostic tests, and educated 9,300 healthcare professionals to accurately identify and manage cases for prompt identification of the illness.
In 2023, the U.S. Agency for International Development provided 13.4 million mosquito nets, six million quick-treatment medications, and 11.8 million malaria rapid diagnostic tests to health facilities and local populations in Nigeria via PMI support and initiatives.
In November 2024, USAID pledged $2.3 million to purchase 4.8 million doses of critical antimalarial medication from Swiss pharmaceutical company Swipha as part of an innovative collaboration aimed at increasing access to vital drugs in Nigeria and across West Africa.
Nonetheless, the halt in this form of funding has sparked concern and anxiety amongst specialists, who have contended that such reductions might exacerbate the nation’s already troubling rates of maternal and infant deaths.
Experts consulting with PUNCH Healthwise cautioned that the reduction in funding could significantly hinder Nigeria’s capacity to manage malaria, especially in remote regions where medical services were hard to come by.
Already, Nigeria has begun to feel the effect of the funding gaps.
Last week, AFP reported that following the withdrawal of funds, clinics that once served 300 people a day in conflict-hit Borno State have been shut down with staff laid off.
A staff of the malaria clinic said, “The clinics have been closed, and there are no more free drugs or mosquito nets.”
Since malaria is endemic in the country and peaks during the rainy season, the sudden dismantling of USAID, the country’s main foreign development arm, implies an end to free malaria interventions, leading to a likely increase in malaria deaths.
The most severely impacted groups would be pregnant women and children below the age of five.
Health professionals are urging the Nigerian government to cease dependence on international donor funds and instead focus on enhancing local financial resources for disease prevention and management.
Out-of-pocket payment
Undeniably, the funding reductions also meant that an increased number of Nigerians would be required to cover costs for medicines that were formerly provided at no charge.
Because numerous Nigerians remain uncovered by both Universal Health Coverage and private insurance initiatives managed by the Health Maintenance Organisation, many individuals still have to bear the costs themselves when seeking diagnosis and treatment for malaria.
Given that malaria is widespread in Nigeria, where approximately 68 million cases and 194,000 fatalities were documented in 2021 as per the World Health Organization, the responsibility for managing these treatments primarily falls upon the populace.
Additional research conducted by PUNCH Healthwise indicates that the cost of antimalarial medications rose from 12 percent in November 2023 to 25 percent in April 2024.
A dispersible oral tablet called Amatem soft gel, priced at N3,000 in April 2024, has increased in price to just under N4,000.
Undeniably, this has resulted in numerous Nigerians turning to traditional remedies and self-treatment when experiencing signs of malaria.
Additionally, PUNCH Healthwise indicates that due to the increase in diagnostic tests, numerous Nigerians experiencing malarial symptoms now opt for antimalarial medications without undergoing lab verification first.
To further prevent the country from reaching drug-resistant antimalaria, health stakeholders in states like Lagos have emphasised the need for undergoing malaria testing before treatment.
However, since rapid diagnostic tests cost ₦3,000, reports indicate that many people avoided the process.
No longer free
PUNCH Healthwise investigated several federal hospitals in the country to check if the free malaria drug was available to prevent women.
At the University of Ilorin Teaching Hospital in Kwara State, a pregnant woman known only as Mrs. Gbadamosi informed PUNCH Healthwise that individuals lacking health insurance had to pay out-of-pocket for standard prenatal medications, including antimalarial prophylaxis.
She mentioned that the payment amounts differed at each prenatal care center, based on the medications provided.
"We purchase the medications, however, the cost is lower than what is charged in private hospitals," Gbadamosi stated.
Inquiries made at the University College Hospital in Ibadan, Oyo State, revealed that a nominal fee was charged for the prenatal vitamins and preventative antimalarial medication.
Nevertheless, expectant mothers enrolled in NHIS and HMOs receive all their medications at no cost.
Inspections at various federal medical facilities nationwide revealed that pregnant women were compensated for taking the preventative antimalarial medication.
States with free malaria treatment
Findings by PUNCH Healthwise reveal that Lagos, Ekiti, Edo, Enugu and Kogi states are the states offering free malaria diagnosis and drugs to pregnant women.
While some of the states have begun the programme under several names such as the Eko free malaria programme, among others.
PUNCH Healthwise verified that expectant mothers enrolled in Lagos general hospitals received the IPT-SP medications at no cost.
Malaria fuelling maternal deaths
Dr Joseph Akinde, an Obstetric Gynecologist, mentioned that one of the reasons some pregnant women do not follow the treatment protocol is due to their lack of knowledge regarding the medication.
He additionally pointed out that some chose to avoid these treatments due to the adverse reactions caused by the medications.
The gynecologist emphasized the significance of IPT-SP therapy, noting that malaria significantly impacted pregnancy results and increased maternal death rates.
In the face of budget reductions, the maternal health specialist urged 'urgent' action to stop additional fatalities from malaria among pregnant women.
Sulfadoxine-pyrimethamine is crucial due to its role in treating malaria in pregnant women, which can otherwise cause severe anemia. This condition significantly contributes to the elevated rates of maternal deaths observed in Nigeria.
"When she experiences a serious episode of malaria, it could impact her pregnancy, potentially resulting in a miscarriage or stillbirth. The disease can have extremely adverse effects on pregnancy outcomes, so it must be treated seriously to enhance the present maternal mortality rates," Akinde stated.
Requirement for robust oversight – Specialists
In response to the issue, Prof Chijioke Nwauche, who holds the position of Professorial Chair for Malaria Elimination and Phytomedicine at the NDDC, verified that the nationwide guidelines for IPT-SP were currently being implemented across the nation.
He pointed out that the program had inadequate funding and poor structure, cautioning that insufficient oversight might lead to the development of malaria drug resistance.
“There is no framework in the country to monitor it. It’s just a haphazard thing and not a well-funded and crafted program. Because if you are doing it, you have to do molecular surveillance to determine the resistance level of the individuals to the drug.
"The program is ongoing, and as far as I know, there have been attempts to enhance it further. However, the IPT-SP program continues to be active. Although the ministry oversees its implementation, I am not content with their oversight since it lacks sufficient funds," explained the researcher focusing on malaria's effects on pregnant women and young children.
Despite the budget reductions, he urged TETFund to allocate specific funds for malaria initiatives. He emphasized the importance of establishing robust oversight processes and developing a systematic approach to implement the IPT-SP program effectively.
Nwauche further promoted comprehensive integrated vector control strategies, an efficient vaccination distribution plan, and better environmental stewardship. This includes establishing reliable drainage infrastructure, removing standing water, and keeping areas tidy to hinder mosquito proliferation and decrease the spread of malaria.
‘Subsidise malaria treatment’
Additionally, Professor Olusegun Ademowo, who specializes in the study of malaria pathogenesis and the molecular mechanisms of drug resistance, pointed out that due to their constant vulnerability to malaria, pregnant women could benefit from using sulfadoxine-pyrimethamine and artemisinin-based treatments as preventive measures against the disease.
He additionally urged expectant mothers to get regular malaria testing besides taking preventive measures, ensuring they remained free from malaria.
The individual additionally verified that the medication was no longer provided indiscriminately in medical facilities.
“Actually, this is not available for free anymore. It might have been in the past, but nowadays you must purchase medications even at the basic health-care level. Therefore, from federal down to primary care facilities, these services are no longer complimentary,” Ademowo explained.
The professor from the Department of Biochemical Pharmacology at the University of Ibadan’s College of Medicine, located in Oyo State, has called upon the government to step up initiatives against malaria. They highlighted the importance of educating the public as well as reducing the cost of antimalarial medications and treatments through subsidies.
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