The Lagos State Government on Friday announced a major overhaul of fever management across its health facilities, declaring that malaria is responsible for only about five per cent of fever cases in the state and directing healthcare providers to stop treating patients for malaria without laboratory confirmation.

The directive marks a significant shift from the long-standing practice of presumptive malaria treatment and is expected to reshape clinical practice in Lagos as the state intensifies efforts towards malaria pre-elimination.

Commissioner for Health, Prof. Akin Abayomi, announced the policy at the dissemination meeting of the Immunization 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 (SFH) in collaboration with the Lagos State Ministry of Health.

Abayomi said evidence generated through the project had fundamentally changed the understanding of fever management in Lagos, stressing that healthcare providers must now rely on diagnostic evidence rather than assumptions before prescribing malaria treatment.

According to him, the findings show that while fever remains one of the most common reasons for hospital visits, only a small fraction of patients actually have malaria, making routine treatment without testing both ineffective and potentially dangerous.

He said: “For far too long, fever has automatically been equated with malaria. Good clinical practice begins with listening carefully to the patient’s history, conducting a thorough examination and using appropriate diagnostic tools before reaching a conclusion.”

He warned that treating every fever as malaria had contributed to widespread misdiagnosis, delayed identification of other serious illnesses and avoidable deaths.

Recounting cases encountered during the implementation of the project, Abayomi said some patients repeatedly received antimalarial drugs despite consistently testing negative, only to die later from other undiagnosed conditions.

“Today, I believe we are ushering in a new era in Lagos State, and indeed in Nigeria, where fever management will be guided by evidence rather than assumptions, where diagnosis will precede treatment, and where better clinical practice will ultimately save more lives,” he said.

He described the dissemination meeting as the beginning of a new phase in healthcare delivery rather than the conclusion of a donor-supported intervention, noting that the evidence generated would guide future health policies in Lagos and potentially across Nigeria and West Africa.

Presenting findings from the project, renowned malaria researcher, Prof. Wellington Oyibo, said the study confirmed that malaria test positivity among patients presenting with fever in Lagos was only about five per cent, while microscopy results recorded an even lower positivity rate of approximately 2.4 per cent. Demographics

Oyibo said quality-assured Rapid Diagnostic Tests demonstrated about 98.5 per cent sensitivity, making them highly reliable for routine malaria diagnosis.

He explained that the findings provide a strong scientific basis for malaria elimination planning while underscoring the need for stronger disease surveillance, research and multidisciplinary collaboration.

The Group Chief Executive Officer of the Society for Family Health Group, Dr. Omokhudu Idogho, said the IMPACT Project had significantly strengthened malaria diagnosis and transformed clinical practice across Lagos.

Idogho said the greatest achievement of the intervention was changing the behaviour of healthcare workers by promoting laboratory confirmation before treatment.

“Not every fever is malaria. Treating every fever as malaria can lead to missed diagnoses, inappropriate use of medicines and poor patient outcomes,” he said.

He urged governments and development partners to sustain investments in malaria diagnostics, surveillance systems, healthcare worker training and public-private partnerships to consolidate the gains achieved.

Earlier, Permanent Secretary of the Lagos State 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 across all 20 Local Government Areas and the 37 Local Council Development Areas.

She said Lagos had reduced malaria prevalence to about 2.6 per cent in 2025 through sustained investments in surveillance, diagnostics and healthcare worker capacity development, positioning the state firmly on the path to malaria pre-elimination. Demographics

World Bank Task Team Leader and Senior Health Specialist, Dr. Onoriode Ezire, commended Lagos for producing evidence capable of influencing health policy beyond the state, describing the findings on non-malaria fevers as a significant contribution to public health.

He also praised the project’s community engagement strategy, saying grassroots health education and the establishment of a Grievance Redress Mechanism had improved accountability and strengthened public confidence in healthcare programmes.

Managing Director of SFH Advisory Services, Dr. Jennifer Anyanti, said the project extended beyond malaria diagnosis and treatment to include procurement of antimalarial medicines, Rapid Diagnostic Test kits, healthcare waste management commodities and the establishment of grievance redress structures across all wards in Lagos.

She said the intervention also trained community pharmacists, Patent and Proprietary Medicine Vendors, healthcare workers, traditional rulers, religious leaders and Mothers Against Malaria Agents to promote evidence-based malaria management and expand access to malaria testing at the community level.

State Malaria Elimination Programme Project Manager, Dr. Abimbola Oshinowo, highlighted additional achievements under the project, including the training of 1,279 healthcare workers in malaria case management across 343 public health facilities.

She disclosed that malaria testing coverage increased to 98.3 per cent during implementation, while uptake of Intermittent Preventive Treatment in Pregnancy rose from 25 per cent to 93 per cent.

According to her, community mobilisation campaigns reached more than 1.38 million residents, while mass media awareness campaigns delivered malaria prevention messages to over 10 million people across the state.

Oshinowo also said the project established Grievance Redress Mechanism committees in all 20 local government areas, resolved 362 complaints without escalation and significantly improved malaria reporting from both public and private health facilities.

Executive Secretary of the Health Facility Monitoring and Accreditation Agency, Dr. Victoria Egunjobi, said the evidence generated through the project had empowered healthcare workers to confidently explain to patients that fever does not necessarily indicate malaria.

She expressed confidence that the widespread use of Rapid Diagnostic Tests would improve clinical decision-making, reduce unnecessary use of antimalarial medicines and strengthen healthcare delivery across Lagos.

Stakeholders at the meeting unanimously called for sustained government investment in surveillance systems, healthcare worker capacity building, uninterrupted supply of malaria commodities, environmental sanitation and community engagement to preserve the gains recorded under the project. (The Nation)