Malaria: Local data strategy boosts efforts to reduce prevalence in Nigeria

By Ojoma Akor

Nigeria has reduced malaria parasite prevalence from 27 percent in 2015 to 15 percent in 2025, emerging as an exemplar of how countries can use local data to target malaria interventions despite persistent high disease burden and shrinking international health financing.

Experts disclosed this at a virtual briefing organized by Nigeria Health Watch ahead of World Mosquito Day, with the theme, “Learning from Nigeria’s Exemplary Progress in Malaria Subnational Tailoring (SNT).”

Despite the progress, Nigeria remains the country with the highest malaria burden globally, accounting for about a quarter of all malaria cases and approximately 30 percent of malaria deaths worldwide.

Vivianne Ihekweazu, Managing Director of Nigeria Health Watch, a health communication and advocacy organization based in Nigeria, said the figures underscored the urgency of accelerating malaria elimination efforts, particularly as Nigeria has a high birth cohort of about seven million children annually.

She said the changing global health financing environment made it increasingly important for Nigeria to ensure that limited resources were directed to interventions capable of producing the greatest impact.

She said, “Development assistance is becoming even more constrained, which makes it even more important that the very limited resources that we do have available are used efficiently.”

She explained that subnational tailoring involves using local data to determine which combination of malaria interventions is most appropriate for specific geographical areas.

Rather than applying a uniform package across the country, the approach considers differences in malaria transmission, geography, seasonality, mosquito behavior, population characteristics and health-system capacity.

Dr. Adachi Ekeh, Director of Strategy and New Business at Nigeria Health Watch, said Nigeria’s experience was examined alongside Burkina Faso, Mozambique, Tanzania and Laos as part of research into countries that had made effective use of subnational tailoring.

The research involved quantitative analysis, process mapping, and interviews with stakeholders at national and subnational levels, including government officials, donors, technical partners, and malaria program implementers.

In Nigeria, researchers examined six states representing the country’s geopolitical zones — Borno, Katsina, Kwara, Akwa Ibom, Imo and Ekiti.

Ekeh said Nigeria began its subnational tailoring journey in 2019 after years of implementing a largely “one-size-fits-all” approach to malaria control.

The first cycle enabled the country to use evidence to reassess where interventions were most needed and how to prioritize available resources.

One example was seasonal malaria chemoprevention, an intervention that involves administering antimalarial medicines to children in areas with seasonal transmission.

Ekeh said analysis showed that the intervention could be appropriate in 21 states, compared with the 12 states where it had previously been implemented.

The data-driven approach also influenced decisions around insecticide-treated nets, indoor residual spraying and other malaria-control interventions.

“Subnational tailoring is not just saying this is what is best for this area, but what should you prioritize also in terms of how much money you have,” Ekeh said.

Data strengthens decision-making

Ekeh said the first SNT cycle was followed by a reduction in malaria parasite prevalence from 27 percent to 22 percent.

The second cycle, which began in 2021, sought to strengthen the country’s ability to generate and use evidence.

Nigeria launched an Integrated Malaria Data Repository and introduced data “deep dives”, bringing stakeholders together to analyze available information. Federal, state and local government personnel were also trained to use the data system.

The process helped improve data quality and informed changes in the mix of malaria interventions deployed across different parts of the country.

The third cycle began in 2024, ahead of the development of the latest malaria strategic plan in 2025.

According to Ekeh, stronger political leadership, improved data systems, continued evidence generation, collaboration with partners and the use of geospatial and mathematical modeling helped inform decisions during the latest cycle.

By the end of the second cycle, malaria parasite prevalence had fallen to 15 percent.

‘Funding remains a major threat’

The speakers, however, warned that sustaining the gains could prove difficult amid declining external financing for malaria and other health programs.

Ihekweazu cited changes in the global development assistance landscape, including the shutdown of USAID and the outcome of the Global Fund’s eighth replenishment, which secured about $12.64 billion against a target of at least $18 billion.

She said Nigeria’s experience offered an important lesson beyond the country’s high malaria burden: evidence could help governments make better choices when resources were limited.

“The value of this work lies in how better evidence can lead to better choices and better decision-making,” she stated.

She added that ultimately, reducing malaria infections would mean fewer deaths and less loss of productivity for Nigerian families and the wider economy.

The research identified challenges including bureaucratic bottlenecks, fragmented governance, insecurity, workforce shortages, gaps in surveillance and data quality, and incomplete integration of private health facilities into malaria reporting.

Ekeh called for greater investment in the capacity of states and local governments to interpret and use malaria data.

“The National Malaria Elimination Program is doing very well, but we also need to build the capacity of the subnational at the state level even more,” she added.

Ekeh also urged Nigeria to build stronger domestic capacity for mathematical and geospatial modeling, noting that partners had previously done much of the technical work.

She said that community engagement and communication were also important to ensure that interventions such as insecticide-treated nets were properly used.