Only 5% of fever cases in Lagos are malaria - Commissioner

Lagos State Commissioner for Health, Prof. Akin Abayomi, has stated that a mere five percent of individuals presenting with fever in Lagos actually have malaria. This revelation challenges the long-standing practice of equating every fever with malaria, a habit Abayomi warns is fueling misdiagnosis, excessive medication use, and the rise of antimicrobial resistance.

These findings stem from the Lagos State World Bank-supported IMPACT Project, which tested nearly 78,000 patients with fever across 392 health facilities. The project, described as the largest field evaluation of malaria diagnosis in Nigeria, found that while malaria was historically diagnosed in about 70% of fever cases, laboratory tests confirmed a true prevalence of only five percent.

"For decades, fever has become synonymous with malaria in our communities," Abayomi noted. "Patients often present convinced they have malaria, while healthcare providers have historically treated fever as malaria until proven otherwise. That approach served us during an era of high malaria transmission. Today, the evidence tells a different story."

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For decades, fever has become synonymous with malaria in our communities. Patients often present convinced they have malaria, while healthcare providers have historically treated fever as malaria until proven otherwise. That approach served us during an era of high malaria transmission. Today, the evidence tells a different story.

The diagnostic accuracy was confirmed using World Health Organization-accredited malaria Antigen Rapid Diagnostic Tests (RDTs), validated by expert microscopy and Polymerase Chain Reaction (PCR). Based on this evidence, Lagos State is now implementing quality-assured RDTs as the primary diagnostic tool for suspected malaria cases. The state is also collaborating with the Pharmacy Council of Nigeria to ensure accredited RDTs are widely available in community pharmacies and vendor outlets, where many residents first seek treatment.

This shift signifies a fundamental change in how patients are diagnosed and treated, how medicines are prescribed, how healthcare professionals are trained, and how public resources are allocated. Lagos has adopted a new fever management strategy centered on the principle of "Test. Treat. Track." This approach mandates proper diagnostic evaluation for every fever case before treatment begins. Confirmed malaria cases will receive prompt treatment, triggering surveillance and environmental measures to prevent further transmission. Abayomi stressed that fever is a symptom, not a disease, and patients testing negative for malaria require investigation for other underlying conditions.

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This changes everything. It changes how we diagnose patients. It changes how we prescribe medicines. It changes how we train healthcare professionals. It changes how we allocate public resources. And ultimately, it changes how we protect our communities.