Lagos State Commissioner for Health, Prof. Akin Abayomi, has disclosed that an overwhelming 95 per cent of fever cases in Lagos are not caused by malaria, urging an urgent shift in clinical diagnosis and treatment patterns across the state.
The revelation came during the three-day kick-off of the Pathway to Pre-Elimination and Digitization Project, where Abayomi addressed stakeholders on the need for a new evidence-based “test, treat, and track” strategy to tackle misdiagnosis and its dangerous consequences, particularly antimicrobial resistance (AMR).
“For too long, the default response to fever in Lagos has been to administer anti-malarial drugs—often without any diagnostic test,” Abayomi said. “But evidence now shows that on average, 95 out of every 100 fevers are not caused by malaria.”
According to him, this outdated approach has led to widespread misuse of anti-malarial and antibiotic medications, which fuels AMR—an escalating public health crisis where infections become increasingly resistant to treatment.
“We are really sitting on a major problem of microbial resistance,” he warned. “We must be careful how we dispense antimicrobials and antibiotics.”
The commissioner stressed that Lagos is moving to a more scientific model for fever management. Under the new approach, any patient presenting with fever must first undergo a Rapid Diagnostic Test (RDT) for malaria. If the test returns negative, healthcare providers are mandated to conduct further investigation to identify the actual cause of illness—ranging from pneumonia and gastroenteritis to dengue or bacterial infections like E. coli and salmonella.
Abayomi also criticised the casual access to medications in pharmacies, declaring it illegal to obtain antimalarials or antibiotics without a certified prescription. “If we don’t stop that practice, Lagos will become the capital of antimicrobial resistance,” he said, calling on the Pharmacy Council of Nigeria to enforce regulations.
The new strategy is being implemented in collaboration with Prof. Wellington Oyibo and his research team at the Centre for Transdisciplinary Research for Malaria and Neglected Tropical Diseases, with support from a World Bank grant.
Speaking at the event, Oyibo explained the risks of misdiagnosing febrile illnesses. “If a child has pneumonia, which mimics malaria symptoms, and is given anti-malarials without proper testing, that child could die from untreated pneumonia,” he warned.
Oyibo also advocated for a policy shift towards broader use of RDTs over traditional microscopy, citing their operational feasibility and accuracy, especially in low-resource settings.
He added that Lagos is currently the only Nigerian state that meets the epidemiological parameters for malaria pre-elimination status—making accurate diagnosis even more crucial.
The “test, treat, and track” initiative marks a significant shift in public health strategy, aimed not just at improving malaria diagnosis, but at safeguarding the population against the growing global threat of drug-resistant infections.