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ACT cocktails have halved malaria deaths ever since. While all public hospitals in Nigeria are supposed to provide antimalarial medication for free, many people prefer—or feel their only affordable option is—to go to the local markets and self medicate. They often choose monotherapies over ACTs. Even Ismail, who only gives his patients government-approved ACTs, often self-medicates with chloroquine, despite knowing that the drug has a high rate of resistance and is no longer a recommended treatment in Nigeria.
Having grown up exposed to malaria, he feels that even resistant malaria is likely not a huge risk to him. But if resistant parasites linger in his bloodstream, just one mosquito bite could put his more vulnerable patients—especially young children and pregnant women—at risk.
When Rafiat developed severe malaria just before falling pregnant, she came to the hospital and received an injection of artemisinin, which should have then been followed with the recommended dosage of ACT. Since she had felt better right away, she kept the medicine for another time. Here and elsewhere in Nigeria, researchers like Christian Happi are studying how to prevent antimalarial resistance. Using samples collected from patients infected with malaria, Happi is identifying and geographically mapping where genetic indicators of resistance appear so that he can create an early warning system for the country.
While resistance to artemisinin, either as a monotherapy or combination therapy, has yet to appear in Nigerian patients, it is already lurking in the genes of Plasmodium falciparum , the most deadly malaria species.
For Happi and his team, their work is personal. While growing up in Cameroon, he suffered malaria so many times that he promised his mother that, when he grew up, he would find a cure. His colleague, Onikepe Folarin, knows too many people who have lost loved ones to malaria. It was here, last year, that he diagnosed the first case of Ebola in Nigeria. The peeling yellow exterior of the lab building belies the clinically clean research facility within. Equipped with the latest in genomic sequencing equipment, it may be the most advanced lab of its kind in the country and possibly, on the continent.
His team is working with more than 2, blood samples collected from all over Nigeria. Their lab is littered with brown envelopes full of thin tabs of paper, each with a round spot of malaria-infected blood from a pricked thumb. Worldwide, the World Health Organization WHO has identified dozens of mutations of the K13 gene, now the marker for tracking artemisinin resistance, but no one knows which of them represents the biggest threat.
When I ask if they have found K13 mutations in many of the clinical samples from Nigeria, he almost laughs. Now Happi and his research team are focusing on how to prevent resistance from spreading to patients. As a transit hub for the region, resistant parasites could be transported into the country by infected travellers and spread out to the region.
There is little in the way of cross border surveillance for resistance, which would be costly and require greater collaboration. But as Happi has been learning, it seems inevitable that artemisinin resistance will spread. Antimalarial drugs are available without a prescription in Nigeria—part of the effort to make genuine, high-quality treatments more accessible to the entire population.
But even if quality drugs are available for a mother to treat her sick child, she may not give him the entire course. Other Nigerians may not be able to afford the whole pack so they buy half the pack or just a few tablets. When only part of the dosage is taken, not all of the parasites are killed off. The survivors are more likely to contain mutations for resistance. I show Happi a photo of four different types of antimalarial medication I found for sale in an upscale neighborhood pharmacy on Victoria Island.
The streets are lined with bustling stalls, piles of colorful bras, and mountains of sandals. Today, a woman in a bright yellow print dress is weaving her way through the crowd, deftly balancing a flat screen TV on her head.
On the side, a man is selling bibles from a wheelbarrow. The sweet smell of dough balls frying in hot oil hangs thickly in the air. Down a cramped passageway, just over a rivulet of greyish water, a busy pharmacy sells a plethora of mainly imported medicines.
A 25 year-old trader named Chidieberre, a member of the Igbo ethnic group, stands behind a desk in his neatly stocked stall, serving customers as cartoons buzz on a small television screen hanging in the corner. In one corner of his stall, the walls are stacked with antimalarial drugs. Those visible are ACTs, but he can quickly produce boxes of different types and brands of monotherapies, including older drugs such as a chloroquine syrup for children and artesunate, a form of artemisinin that the WHO strongly advises against selling on its own.
Chidieberre tells me this is one of the fastest selling drugs he has. He estimates that he moves one to two boxes of it on a good day. The rapid sales of Vietnamese artesunate in Idumota is emblematic of how globalized pharmaceutical markets have become. We cannot play policemen. But while the biggest manufacturers of monotherapies, such as pharmaceutical giant Sanofi-Aventis and the Shanghai-based Guilin Pharmaceuticals, agreed to cease production, smaller companies have filled the gap.
Substandard medications also fuel drug resistance by providing only a tiny amount of the active ingredient. Outright fakes are exacerbating the problem, too. Residents of the slum, mainly fishermen from the linguistic minority, the Egun, filmed the fires on their mobile phones and said police had used tear gas to drive them toward the water.
Many jumped into canoes on the lake in panic as police fired shots into the air. A dozen people, including women and children, drowned, said community youth leader Celestine Ahisu. Can you imagine that? Despite their pleas, and opposition from rights groups, the state has adopted a hard line stance towards slum dwellers.
Yet the demolition of Otodo Gbame follows years of development in the area by investors who have built apartments and shopping centers, pushing out fishing communities, said local legal campaign group Justice and Empowerment Initiatives. While the authorities and residents point the blame at each other over the clearing of the slum, it was destroyed just days after slum communities, including Otodo Gbame, secured a High Court order to stop the state pushing ahead with evictions.
Lagos state government said the razing was a result of clashes between the Egun and Yorubas, the major ethnic groups in the community, while police denied destroying homes and said they had arrested several people for setting fire to them. The U.
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