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USAMRD-A/N Partners NMEP to Develop Nigeria’s First-Ever Malaria Slide Bank
NSMB activation at the BSU Teaching Hospital, Makurdi[/caption]
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 on the basis of clinical diagnosis for all ages. However, since the introduction of artemisinin-based combination therapy (ACT), Nigeria has been faced with issues of diagnosis without testing and treatment without a confirmed positive test – with undesirable outcomes.
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 recommended 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, the Walter Reed Army Institute of Research (WRAIR) partnered with the National Malaria Elimination Programme (NMEP), the Nigerian Ministry of Defence, and the State Ministries of Health in Benue and Akwa Ibom to develop Nigeria’s first-ever Malaria Slide Bank with funding from the U.S. President’s Malaria Initiative (PMI). This will provide standard, validated slide sets for use in malaria trainings and in healthcare facilities. Having this type of resource in Nigeria expands the capability to adequately train medical laboratory scientists on quality-assured malaria diagnosis, in line with the World Health Organization’s strategic framework to move countries towards malaria elimination.
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.
WRAIR worked with the Ministries of Health in both Akwa Ibom and Benue States and successfully established the NMSB in three out of four 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 including non-malaria parasites such as trypanosomes and microfilariae, as well as red blood cell abnormalities such as macrocytosis and reticulocytosis.
The development of the NMSB is important, as 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.