Data from a new study reveals that 95 out of every 100 fevers reported in Lagos are not caused by malaria, according to the Lagos State Commissioner for Health, Professor Akin Abayomi.
This finding is at the centre of a new multi-pronged strategy to manage fever cases more accurately and to curb the growing threat of antimicrobial resistance caused by frequent misdiagnosis and inappropriate drug use.
Abayomi made this known during the three-day Study Kick-Off for the Pathway to Pre-Elimination and Digitization Project held in Lagos. The event focused on a comparative study of malaria rapid diagnostic tests (RDTs) and microscopy, and an assessment of patent and proprietary medicine vendors’ (PPMVs) capacity to manage malaria and other febrile illnesses.
“We need to get malaria out of the region,” Abayomi stated. “It is very, very important that we perform a mindset shift among healthcare providers. On average, 95 out of every 100 fevers are not caused by malaria.”
He expressed concern over the long-standing practice of prescribing anti-malarial drugs without proper diagnostic tests. This approach, he warned, is not only ineffective but dangerous, contributing significantly to the global crisis of antimicrobial resistance (AMR), where once-treatable infections become deadly.
“We are really sitting on a very major problem of microbial resistance,” he said. “We have to be careful with how we dispense antimicrobials and antibiotics.”
Abayomi referenced research showing high levels of AMR in animals, with 60 percent of human infections linked to animal sources, highlighting the complex and interconnected nature of the problem.
As part of a new fever management protocol, Lagos State will implement a “test, treat, and track” strategy. Under this system, patients presenting with fever will first undergo a malaria RDT. If the test is negative—as is expected in most cases—healthcare providers will then carry out further investigations to determine the actual cause of the fever, which could range from pneumonia and gastroenteritis to bacterial or viral infections.
Abayomi also announced stricter enforcement of pharmacy regulations. “It is illegal to walk into a pharmacy and request antimalarials or antibiotics without a prescription from a certified healthcare practitioner,” he said, calling on the Pharmacy Council of Nigeria to intensify enforcement efforts.
“If we don’t stop that practice, we are going to be the capital of antimicrobial resistance,” he warned.
The project, supported by a World Bank grant, is being executed in collaboration with Professor Wellington Oyibo’s research team. Oyibo is the Director of the Centre for Transdisciplinary Research for Malaria and Neglected Tropical Diseases and serves as the study coordinator.
He stressed the danger of misdiagnosing febrile illnesses. “If a child has pneumonia, the symptoms may resemble malaria. Administering antimalarial medicine without proper testing could result in that child dying from untreated pneumonia,” he said.
Oyibo also underscored the importance of shifting from traditional microscopy to RDTs, citing their proven accuracy and practicality in low-resource settings. He noted that Lagos is the only state in Nigeria that qualifies for malaria pre-elimination based on current epidemiological parameters.
“This is a significant milestone for Nigeria,” he said. “Yet, fever and other malaria-like symptoms, which are not specific to malaria, are still often misdiagnosed. This misdiagnosis contributes to Nigeria’s high malaria burden reporting.”
According to him, this initiative is a major step toward adopting evidence-based medicine in Nigeria, promoting accurate diagnosis and responsible treatment to prevent the cascading impact of drug resistance.
NAN
