Malaria has remained a cause of significant morbidity and mortality in Nigeria. According to the WHO World Malaria Report 2021, the number of confirmed cases of malaria in Nigeria increased five-fold between 2011 and 2020, with more than 21 million Nigerians having confirmed diagnoses of malaria in 2020.
The national policy on malaria treatment traditionally encouraged home management and treatment based on clinical diagnosis for all ages. However, due to a lack of testing capabilities in some communities, some patients in Nigeria are being treated without a confirmed positive test. The misuse of artemisinin-based combination therapy (ACT) in negative cases contributes to a host of issues, including low supplies of ACT and potential drug resistance.
Access to malaria testing and diagnosis is critical to malaria elimination. Currently, the Nigerian national guidelines recommend a prompt parasitological diagnosis of all febrile-suspected malaria cases and administration of ACT only to those cases testing positive. The mainstay of malaria case management is the identification of the parasite in blood films, which is not always available or feasible at peripheral health facilities in resource-limited settings.
As part of efforts to bridge this gap, a Nigeria-U.S. collaboration was launched to develop Nigeria’s first-ever Malaria Slide Bank with funding from the U.S. President’s Malaria Initiative (PMI). This resource provides standard, validated slide sets for use in malaria trainings and in healthcare facilities. The partners participating in the slide bank project are the Walter Reed Army Institute of Research (WRAIR) and the U.S. Army Medical Research Directorate-Africa in Nigeria (USAMRD-A/N), partnered with the National Malaria Elimination Programme (NMEP), the Nigerian Ministry of Defence, and the State Ministries of Health in Benue and Akwa Ibom, supported by HJFMRI.
The National Malaria Slide Bank (NMSB) will provide sets of known replicate slides for training, external and internal assessments of malaria microscopists, and for proficiency testing schemes. Over the course of one year, the project is expected to generate at least 55,000 quality assured blood films that will be centrally stored. These blood films will be available for training malaria microscopists in facilities across Nigeria.
Having this type of resource in Nigeria expands capability to adequately train medical laboratory scientists in quality-assured malaria diagnosis in accordance with the World Health Organization’s strategic framework to move countries towards malaria elimination. Additionally, having access to its own slide bank will enhance Nigeria’s malaria diagnostic capacity and is a sustainable program that frees Nigeria from dependence on procurement of training materials from other countries.
WRAIR worked with the Ministries of Health in both Akwa Ibom and Benue States and successfully established the NMSB in three sites in these states. The NSMB Project was activated in Akwa Ibom at the General Hospital, Ikot-Ekpene between April 25 and 29, with General Hospital, Ikpe Annang scheduled for activation in July 2022. In Benue State, the activation took place from May 9 to 13 at the Benue State University Teaching Hospital, Makurdi, and General Hospital, Wanune.
The NMSB will develop blood smears containing all species of Plasmodium, the parasite responsible for malaria, as well as smears from malaria-negative patients. In addition, the NMSB will have slides of other parasites such as trypanosomes and microfilariae, as well as red blood cell abnormalities such as macrocytosis and reticulocytosis.
HJFMRI LTD/GTE provides key support to the WRAIR and USAMRD-A in Nigeria, where, together with the Nigerian Armed Forces, they have collaborated to provide PEPFAR-funded services since 2005 with the U.S. Military HIV Research Program. The program also advances high quality clinical research for the development of prevention and control countermeasures against HIV and emerging infectious diseases of public health importance, such as Lassa fever, Ebola and monkeypox.
Written by Ndukwe Ukoha and Naomi Oboyi, Walter Reed Program-Nigeria