•Governor Babajide Sanwo-Olu of Lagos State
The Lagos State government has announced a major shift in fever management after revealing that 95 percent of fever cases in the state are not caused by malaria, warning healthcare providers against treating patients without laboratory confirmation.
The government declared that only about five per cent of fever cases in Lagos are linked to malaria, describing the findings as a turning point for medical practice and public health policy, reports Sunday Independent.
Commissioner for Health, Prof. Akin Abayomi, unveiled the findings during the dissemination of the Immunisation Plus and Malaria Progress by Accelerating Coverage and Transforming Services (IMPACT) Project in Ikeja.
The World Bank-supported initiative was implemented by the Society for Family Health in partnership with the Lagos State Ministry of Health.
Abayomi said the evidence had fundamentally changed the understanding of fever management in Lagos and would influence clinical practice across Nigeria and West Africa.
He described the findings as the beginning of a new era where diagnosis, rather than assumption, would determine treatment decisions.
According to him, decades of treating virtually every fever as malaria have fuelled widespread misdiagnosis and delayed the treatment of many serious illnesses.
He warned that such assumptions have cost lives and undermined the quality of healthcare delivery.
“For far too long, fever has automatically been equated with malaria,” Abayomi said.
He stressed that proper clinical practice requires careful patient assessment, physical examination and laboratory confirmation before treatment begins.
The commissioner disclosed that Lagos has directed all public primary and secondary healthcare facilities to stop treating malaria unless patients first test positive through Rapid Diagnostic Tests.
He said inspections conducted after the policy took effect recorded a significant decline in malaria diagnoses, confirming that routine testing is producing more accurate clinical decisions.
Abayomi recalled cases of patients who repeatedly tested negative for malaria but continued receiving antimalarial drugs until they eventually died.
He warned that assumptions in clinical practice could prove fatal.
He insisted that evidence-based diagnosis would improve patient outcomes, reduce unnecessary drug use and save more lives.
Abayomi commended the Society for Family Health, the World Bank and technical partners for generating evidence capable of shaping future health policies.
He also praised renowned malaria researcher, Prof. Wellington Oyibo, for providing scientific data that clearly explained Lagos’ unique malaria situation.
Presenting the research findings, Oyibo said malaria positivity among patients presenting with fever was only about five per cent.
He added that laboratory microscopy showed an even lower positivity rate of approximately 2.4 per cent.
According to him, quality-assured Rapid Diagnostic Tests demonstrated about 98.5 per cent sensitivity, making them highly reliable for routine malaria diagnosis.
He said the findings provide a strong scientific foundation for malaria elimination planning and stronger disease surveillance.
Group Chief Executive Officer of the Society for Family Health, Dr Omokhudu Idogho, described the project as a major investment in strengthening evidence-based healthcare delivery.
He said more than two million patients received malaria diagnostic services through 314 public and 289 private health facilities.
The project also provided free treatment for over 50,000 laboratory-confirmed malaria cases.
Idogho disclosed that malaria test positivity declined from 43 per cent to 29.2 per cent during implementation.
He described the project’s biggest achievement as changing the behaviour of healthcare workers from presumptive treatment to laboratory-confirmed diagnosis.
He warned that treating every fever as malaria encourages inappropriate medicine use, missed diagnoses and poor health outcomes.
Permanent Secretary of the Ministry of Health, Dr Dayo Lajide, represented by Acting Director of Disease Control, Dr Abosede Wellington, said the project strengthened malaria prevention, diagnosis, treatment and immunisation services statewide.
She disclosed that malaria prevalence in Lagos had fallen to about 2.6 per cent in 2025.
According to her, the achievement places Lagos firmly on the path to malaria pre-elimination.
World Bank Task Team Leader, Dr Onoriode Ezire, praised Lagos for generating scientific evidence capable of influencing health policies beyond the state.
He described the findings on non-malaria fevers as a major contribution to public health in Nigeria.
Ezire also commended the project’s strong community engagement strategy, saying grassroots participation significantly improved accountability and public confidence.
Managing Director of SFH Advisory Services, Dr Jennifer Anyanti, said the project extended beyond diagnosis and treatment.
She said it supported the procurement of antimalarial medicines, Rapid Diagnostic Test kits and healthcare waste management materials.
The intervention also strengthened the capacity of healthcare workers, community providers, religious leaders and volunteers promoting malaria prevention.
Anyanti added that community pharmacists and Patent and Proprietary Medicine Vendors were trained to test before treating malaria.
She said this intervention has improved access to Rapid Diagnostic Tests across Lagos communities.
State Malaria Elimination Programme Project Manager, Dr Abimbola Oshinowo, highlighted several milestones achieved under the project.
She disclosed that 1,279 healthcare workers received specialised malaria case management training across 343 public health facilities.
Malaria testing coverage increased to 98.3 per cent during implementation.
She added that intermittent preventive treatment for pregnant women rose dramatically from 25 per cent to 93 per cent.
Community mobilisation activities reached more than 1.38 million residents.
Mass media campaigns delivered malaria prevention messages to over 10 million people across the state.
Executive Secretary of the Health Facility Monitoring and Accreditation Agency, Dr Victoria Egunjobi, said the project has empowered health workers with evidence to reassure patients that not every fever is malaria.
She maintained that wider adoption of Rapid Diagnostic Tests would improve medical decisions and strengthen healthcare delivery.
Stakeholders agreed that sustaining the gains would require continuous investment in healthcare workers, surveillance systems, uninterrupted diagnostic supplies, community participation and strong government leadership.
The meeting ended with a renewed commitment to institutionalise evidence-based malaria case management and accelerate Lagos State’s journey towards malaria pre-elimination.
