Malaria is a major public health concern in Nigeria. Statistics released by the United States Embassy in Nigeria show that malaria affects approximately 100 million people in the country each year, and almost the entire population is thought to be at risk of catching the disease.
In fact, Nigeria shares approximately 30% of the African continent’s total Malaria burden, and almost 800,000 Nigerians are understood to have died from the disease in 2017.
Despite this high mortality rate, malaria is preventable and, once diagnosed, relatively easy to treat. A study published in the Malaria Journal shows that the standard, artemisinin-based combination therapies are 90% effective if delivered correctly, and there are a number of secondary options to help tackle the infection should these treatments fail.
Unfortunately, it’s often challenging to get antimalarial drugs to the people who need them the most. Many Nigerians still struggle with access to testing facilities, and treatment is often unavailable in many parts of the country.
We asked Dr. Ikpeme Neto—CEO and Founder of Wella Health—why malaria is so challenging to treat in Africa: “A lot of Africans are complacent ... [malaria is] quite common, so they don’t respect it.” It seems, therefore, that tackling the disease is as much about education as it is about the availability of tests and proper treatment.
The dangers of complacency
With 97% of people in Nigeria at risk of contracting malaria, and 30% of all outpatient appointments relating to the diagnosis or treatment of the disease, ignoring the guidelines set out by the Nigeria Centre for Disease Control has become commonplace.
Often, people will assume that any flu-like symptoms—from a fever, to muscle weakness, nausea, or muscle pain—are being caused by the disease, and begin taking antimalarial medications right away.
Those who start antimalarials but do not have malaria will then see no improvement in their symptoms. Due to a perception that the medication is ineffective, they are less likely to take antimalarials in the future—when they might actually be required.
Many pharmacies and clinics treat the disease as commonplace too - handing out malaria medication without a formal diagnosis or, in some cases, before they’ve even run a test.
According to Dr. Neto, only 45% of Nigerians who take malaria medication have actually received a test beforehand confirming they have the disease. His goal is to increase this figure to 100% by 2020.
This trend towards complacency and the inappropriate use of antimalarial medications reduces the effectiveness of cheaper treatment options, and increases the diseases’ mortality rate. It’s one of the principal reasons that older malaria medications like Chloroquine are no longer effective.
Talking with Dr. Neto, it becomes clear how the lack of respect for the condition, and the guidelines for diagnosis and treatment, result in so many cases of malaria lasting long enough to become life threatening.
Over the past 10 years, a widespread effort has been made to try and reduce the incidence of malaria. The World Health Organisation (WHO) has called for all suspected cases to be confirmed with a reliable diagnostic test to cut down on the mismanagement of the disease.
Unfortunately, recent reports from both the World Health Organisation and the Lancet show that the response to the overall problem has plateaued, and there are statistics from the WHO to show that the situation is now worsening in Nigeria.
Wella Health are one of a handful of organisations actively trying to reverse this trend. Since launching in 2015, they’ve made it their mission to reinvigorate the diagnosis and treatment of malaria by working with pharmacies across Nigeria to offer safe, reliable and affordable access to Malaria testing.
According to Dr. Neto, Wella Health “have introduced rapid diagnostic testing to over 1,000 Nigerian pharmacies” and are actively helping to build the infrastructure needed to ensure that every Nigerian can access some sort of testing facility.
Neto and the rest of Wella Health’s staff are also helping to train local pharmacies in the use of the rapid diagnostic testing kits, which cut down on the need to make repeat trips to a clinic, —allowing people to receive a reliable diagnosis in a matter of minutes.
Who are Wella Health?
Wella Health are a health technology startup borne out of Dr. Neto’s desire to provide Nigerians with better access to healthcare.
In the beginning, they focused on helping pharmacies and clinics make the most of modern medical technology by building customer management (CRM) systems capable of tracking patient notes, retaining histories and recording prescribed medications.
Once Wella Health realised they could help solve the malaria problem, Dr. Neto recalls, they quickly switched course, and started looking at opportunities to help pharmacies offer better testing and treatment options.
According to Dr. Neto, previous efforts to test for malaria involved long wait times, with blood samples being sent off for testing at remote laboratories, where they would be examined by hand using a microscope.
People who thought they might be suffering from the disease would have to make several long trips to a facility many miles from their primary residence, assuming, of course, that they were able to do so.
Wella Health started connecting pharmacies to the companies that provide rapid testing kits: modern alternatives that use reactive chemicals to provide a reliable diagnosis in just 10 minutes.
A holistic approach
Wella Health’s approach is revolutionising the administration of malaria testing, and making it much easier for people to confirm whether or not they are actually suffering from the disease —reducing the burden on pharmacies, and improving outcomes for patients.
Dr. Neto is quick to point out that Wella Health don’t just provide access to the testing kits themselves though; they’ve also devised an onboarding process to help train pharmacists providing them with the knowledge they need to use the equipment properly, and teaching them to comply with the government guidelines surrounding the treatment of Malaria.
Using their knowledge and understanding of the underlying issues, Wella Health have worked hard to ensure there’s a robust testing process in place for all of the pharmacies they’re partnered with —including aftercare via text, and patient education on the use of antimalarial drugs.
If you’re in Nigeria, you can now use the Wella Health portal to book a malaria test in seconds. Pharmacies can also use the company’s infrastructure to store patient information, or send texts containing information about follow-up appointments.
“No one in Nigeria is more than 30 minutes away from one of our [Wella Health’s] pharmacies”. That’s a huge step in the right direction, but there’s still work to do.
More education is required, and changing behaviours takes time. There is also a pressing need to correct the trend for bypassing testing services completely, but Dr. Neto’s team are working hard to educate the public wherever they can.
Through partnerships with health insurers, ensuring that information about pharmacy-based testing becomes more widespread. Wella Health have also started helping their partners to organise community-based events designed to further spread awareness.
What does the future hold?
When asked about the future, Dr. Neto is optimistic. It’s clear that Wella Health have ambitions beyond the scope of their testing initiative as well. They are currently working to bring a unique urine testing kit to market, which would allow people to test for malaria at home, and remove the need to travel from remote parts of Nigeria.
The company are also hoping to move onto other preventable diseases in the future too: Dr. Neto reminds me that they’re in a good place to “promote awareness about other common diseases, like diabetes or heart disease”, particularly now that they’ve developed all of the relevant infrastructure, and have built relationships with a large network of pharmacies.
If you’d like to learn more about the incredible work that Wella Health are doing, you might be interested in visiting their website, which contains a wealth of information about their projects and technologies.
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