Malaria is present in Lagos all year round and worst in the rainy season, when standing water breeds mosquitoes. Nigeria carries more of the world’s malaria than any other country. Almost everybody who lives here gets it sooner or later; the aim is to get it rarely, recognise it early and treat it properly.
How you get it
Malaria is a parasite carried by Anopheles mosquitoes, which bite mostly between dusk and dawn. It does not pass from person to person in ordinary contact.
Prevention
- Sleep under a treated net if your bedroom is not sealed and air-conditioned. Long-lasting insecticide-treated nets are sold in pharmacies and markets, and handed out free in public campaigns.
- Screen the windows and doors, and keep the screens mended.
- Use repellent in the evening, and cover your arms and legs outdoors after dark.
- Get rid of standing water around the house: blocked drains, buckets, old tyres, flower-pot saucers, the uncovered water drum.
- If you are visiting, see a travel clinic before you arrive about preventive tablets. People who live here long-term usually rely on prevention and quick testing rather than years of tablets, but that is a decision to make with a doctor.
Symptoms
Fever, chills and sweats, headache, aching joints and muscles, tiredness, nausea and vomiting. It can feel like flu. Symptoms usually start a week or two after the bite, but can appear months later - so if you get a fever after leaving Nigeria, tell the doctor where you have been.
Test before you treat
Many people in Lagos treat every fever as malaria. Do not. Get a rapid diagnostic test at a pharmacy or clinic, or a blood film at a laboratory, first. If it is negative, the fever is something else - and something else needs finding.
Be sceptical of a diagnosis of typhoid made from a Widal test alone. The test is unreliable and over-diagnoses typhoid badly; a blood culture is the proper test, and a doctor should decide whether you need antibiotics.
Treatment
Uncomplicated malaria is treated with an artemisinin-based combination therapy (ACT), such as artemether-lumefantrine, which Nigeria’s national treatment guidelines recommend. Finish the full course even when you feel better on the second day.
- Do not treat with chloroquine. The parasite here is resistant to it.
- Buy from a registered pharmacy and check for the NAFDAC number. Counterfeit antimalarials are common, and a fake one is worse than none because you believe you are treated.
- If you are not better within a couple of days, go back.
Danger signs: go to hospital now
Severe malaria is an emergency and is treated in hospital with injections. Go straight to a hospital with an emergency unit for any of these:
- Confusion, drowsiness or unusual behaviour
- Fits
- Repeated vomiting, or unable to drink or keep medicine down
- Difficulty breathing
- Very dark urine, or very little of it
- Yellow eyes or skin
- Unusual bleeding
Young children and pregnant women become seriously ill fastest. A child with a fever needs testing the same day, and a pregnant woman should ask her antenatal clinic about preventive treatment.