A comprehensive study of Nigeria’s malaria treatment market has uncovered a troubling trend: while antimalarial drugs are widely available in private pharmacies and drug shops, most patients are not being tested before receiving treatment.
According to the ACTwatch Lite Nigeria 2024 study, conducted by Population Services International (PSI) through its ACTwatch project, examined how malaria medicines are sold and distributed across Lagos, Abia, and Kano states. The findings paint a complex picture of Nigeria’s fight against malaria, particularly in the private sector where most Nigerians seek treatment.
The testing gap
The research found that Patent and Proprietary Medicine Vendors (PPMVs); the small drug shops found in nearly every Nigerian neighbourhood, remain the primary source of malaria treatment across all three states. While this is not necessarily bad news, there is a critical problem: these outlets rarely offer diagnostic testing in Abia and Lagos. Only in Kano state do PPMVs commonly provide testing services alongside medicines.
This gap matters because taking malaria drugs without confirming the infection can lead to overtreatment, mask other illnesses with similar symptoms, and potentially contribute to drug resistance over time.
The price factor
The study revealed why testing remains uncommon in some states, especially in Abia and Lagos where the study is covered. It said a malaria rapid diagnostic test (RDT) costs about the same as or even more than the actual treatment. For patients already convinced they have malaria based on symptoms, paying extra for a test seems pointless. But Kano tells a different story. There, diagnostic tests cost less than half the price of antimalarial medicines, which helps explain why testing is more common in that state.
Market diversity and drug quality
On the positive side, the antimalarial market shows healthy competition with no single manufacturer or brand dominating across the three states. ACTs (Artemisinin-based Combination Therapies), which the World Health Organization recommends as the most effective malaria treatment, are increasingly available compared to previous surveys.
However, the study found that WHO-prequalified ACTs and non-prequalified versions were priced similarly, raising questions about quality assurance and patient choice.
Perhaps the most concerning finding involves data collection. Very few private sector outlets report malaria cases to health authorities, even among licensed pharmacies and PPMVs. Without this data, government health officials cannot accurately track malaria trends or allocate resources effectively.
Reporting of malaria cases remains extremely low in the private sector, even within formal outlets, while supervision of those who do report is minimal – the researchers stated
Behind the scenes challenges
Through interviews with pharmaceutical industry stakeholders, the study identified several systemic problems affecting the malaria treatment market. Regulatory delays and high fees make it difficult for companies to bring products to market. Nigeria’s currency volatility and high import duties drive up costs. Counterfeit drugs remain a persistent threat, and supply chain inefficiencies create shortages in some areas while others have oversupply.
What needs to change
Second, PPMVs and pharmacists need better training on proper malaria case management guidelines. Many drug sellers may not fully understand when testing is necessary or how to counsel patients about appropriate treatment.
Third, public education campaigns should teach Nigerians why testing before treatment matters. Many people assume fever means malaria, but other illnesses like typhoid can present similar symptoms.
The study also recommended continuing the ban on oral artemisinin monotherapies (single-drug treatments that can lead to resistance) and reducing the use of injectable artemisinins for non-severe cases.
Different states, different solutions
One crucial insight from the research is that Lagos, Abia, and Kano each face unique challenges requiring tailored solutions. What works in Kano may not work in Lagos, and vice versa. This variability also raises questions about other Nigerian states not included in the study.
Conclusion
The ACTwatch Lite approach offers a replicable model that other Nigerian states can use to assess their own malaria treatment markets. As Nigeria works toward eliminating malaria, understanding how the private sector operates becomes increasingly important.
The study also briefly examined e-pharmacies, finding that while online drug sales exist in Nigeria, this sector remains relatively new and small. However, it may grow significantly in the coming years as more Nigerians become comfortable with online shopping.
Nigeria has made progress in ensuring antimalarial drugs reach communities through private outlets. The next challenge is ensuring those drugs are used appropriately, starting with affordable and accessible testing that gives patients and provides the information they need to make the right treatment decisions.
The ACTwatch project is PSI’s global initiative that monitors antimalarial markets to provide evidence for malaria control programmes. This Nigeria study contributes to a growing database that helps policymakers, donors, and health programmes make informed decisions about malaria interventions
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