Lagos State is one of the highest-burden malaria transmission zones in Nigeria — and by extension, in the world. Unlike northern Nigeria where malaria transmission is seasonal, Lagos transmits malaria year-round. The humid coastal climate, urban density, standing water from inadequate drainage, and high mobility of the population create conditions for sustained, high-intensity transmission.
In 2024, the Lagos State Ministry of Health reported over 978,000 confirmed malaria cases treated through its facilities — and this almost certainly underestimates the true burden, as the majority of Lagos residents self-treat through pharmacies without ever visiting a health facility.
Over 95% of malaria in Lagos is caused by Plasmodium falciparum — the most dangerous of the five malaria species. P. falciparum can progress to severe and cerebral malaria within 24–48 hours, particularly in young children, pregnant women, and immunocompromised individuals. The remaining cases are predominantly P. malariae and P. vivax, with P. ovale occurring rarely.
The WHO and Federal Ministry of Health of Nigeria recommend artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated P. falciparum malaria. The most widely available and recommended regimens in Nigeria are:
Despite clear FMOH guidelines, chloroquine — resistant and no longer effective — continues to be dispensed at Lagos pharmacies. Fansidar (sulfadoxine-pyrimethamine) monotherapy, which has significant resistance rates in Nigeria, remains in circulation. Quinine is occasionally prescribed as monotherapy for uncomplicated malaria (appropriate only for severe disease or in pregnancy in the first trimester).
The reason for this disconnect is partly cost (ACTs are more expensive than chloroquine), partly habit, and partly the absence of testing — when malaria is assumed rather than confirmed, the treatment decision is equally imprecise.
In Lagos, the most dangerous habit is treating assumed malaria without testing. A patient presents with fever, chills, and headache — they receive antimalarials and often antibiotics simultaneously, without a malaria RDT or blood film. The consequences:
A malaria rapid diagnostic test (RDT) costs less than ₦3,000 and produces a result in 20 minutes. At Mascot Healthcare, Akoka, every febrile patient receives a malaria RDT before any antimalarial is prescribed. This is the standard of care — not a luxury.
Children under 5 years have not yet developed partial immunity to malaria and are at the highest risk of severe disease and death. In Nigeria, malaria remains the leading cause of under-5 mortality. Any febrile child under 5 in Lagos should have a malaria RDT as the first investigation.
Malaria in pregnancy causes severe maternal anaemia, low birth weight, preterm labour, and placental malaria — a condition that impairs fetal growth by sequestering P. falciparum in the placenta. The WHO recommends intermittent preventive therapy in pregnancy (IPTp) with sulfadoxine-pyrimethamine — at least 3 doses during pregnancy. Treatment of malaria in pregnancy requires careful antimalarial selection based on trimester (artemether-lumefantrine is safe from the second trimester; quinine preferred in first trimester).
HIV infection significantly increases the risk of severe malaria and malaria-related mortality. HIV-positive patients in Lagos have particularly high malaria burden, and co-treatment of both conditions requires attention to drug interactions.
The most effective malaria prevention measures available in Lagos:
About the author: Dr. Adebayo Okonkwo is a General Practitioner at Mascot Healthcare, Akoka, Lagos with 8 years of experience in primary care and infectious disease management. This article is reviewed annually and updated to reflect current FMOH Nigeria guidelines and Lagos disease burden data.
By appointment malaria RDT at Mascot Healthcare, Akoka, Lagos. From ₦3,000. Treatment prescribed same visit.