Lagos State government has proclaimed a major paradigm shift in the management of fever as it disclosed that 95 per cent of fever cases in the state are not malaria related and warned health care professionals against treating patients without laboratory proof.
The government said just roughly five percent of fever cases in Lagos are malaria-related, calling the findings a watershed moment for medical practice and public health policy, Sunday Independent reports.
The Commissioner for Health, Prof. Akin Abayomi disclosed the findings at the dissemination of the Immunisation Plus and Malaria Progress by Accelerating Coverage and Transforming Services (IMPACT) Project in Ikeja.
The World Bank-backed project was implemented by the Society for Family Health in collaboration with the Lagos State Ministry of Health.
The evidence, Abayomi added, has transformed the knowledge of fever management in Lagos fundamentally and would be a game changer in clinical practice across Nigeria and West Africa. Geographic Reference
He called the findings the dawn of a new age in which treatment decisions would be based on diagnosis instead than presumption.
He said decades of treating almost every fever as malaria have led to widespread misdiagnosis and many deadly infections being treated too late.
He warned that such beliefs had cost lives and compromised the quality of healthcare delivery.
“Fever has been equated to malaria for too long”, Abayomi remarked.
“Proper clinical practice dictates careful patient evaluation and physical examination and laboratory confirmation before instituting treatment,” he said.
The commissioner said Lagos has ordered all public basic and secondary healthcare facilities to halt treating malaria until patients first test positive through Rapid Diagnostic Tests.
“Inspections after the introduction of the policy showed that there was a significant drop in the number of malaria diagnoses, showing that routine testing is leading to more accurate clinical decisions,” he stated.
Abayomi remembers incidents of patients who kept testing negative to malaria but continued getting antimalarial medications until they finally died.
He warned that making assumptions in the practice of medicine may be fatal.
He argued that evidence-based diagnosis will result in better patient outcomes, less drug overuse and more lives saved.
Abayomi congratulated the Society for Family Health, the World Bank and technical partners for providing evidence that can shape future health policies.
He also commended renowned malaria researcher, Prof. Wellington Oyibo, for supplying scientific facts that clearly demonstrated Lagos’ peculiar malaria status.
Commenting on the research findings, Oyibo said the malaria positivity among patients presenting with fever was just about five per cent.
Laboratory microscopy showed an even lower positive rate, he said, around 2.4 percent.
He said quality certified Rapid Diagnostic Tests had a sensitivity of about 98.5 per cent and were very reliable for routine detection of malaria.
The findings provide a good scientific basis for planning malaria elimination and enhanced disease surveillance, he said.
“It is a huge investment to improve evidence-based healthcare delivery,” said Dr Omokhudu Idogho, Group Chief Executive Officer, Society for Family Health.
He claimed almost two million individuals got access to malaria diagnostic services through 314 public and 289 private health facilities.
The project also provided free treatment for more than 50,000 laboratory-confirmed cases of malaria.
Idogho reported that during implementation, malaria test positivity reduced from 43 per cent to 29.2 per cent.
“The most significant achievement of the project was change of behaviour of healthcare workers from presumptive treatment to laboratory confirmed diagnosis,” he said.
He said categorising all fevers as malaria causes improper use of medicines, missed diagnoses and poor health outcomes.
Represented by the Acting Director, Disease Control, Dr Abosede Wellington, the Permanent Secretary, Ministry of Health, Dr Dayo Lajide, said the initiative increased services for malaria prevention, diagnosis, treatment and immunisation across the state.
She said malaria frequency in Lagos has come down to roughly 2.6 per cent in 2025.
The success, she said, puts Lagos squarely on the path to malaria pre-elimination.
Dr Onoriode Ezire, World Bank Task Team Leader, applauded Lagos for producing scientific evidence that has the potential to influence health policies outside the state.
“The results on non-malaria fevers are a significant contribution to public health in Nigeria,” he said. Geographic Reference
Ezire also praised the project’s robust community involvement strategy, noting community engagement at the grassroots level enhanced accountability and public confidence tremendously.
“The project was not just about diagnosis and treatment,” said Dr Jennifer Anyanti, Managing Director, SFH Advisory Services.
It enabled purchase of antimalarial drugs, Rapid Diagnostic Test kits and materials for healthcare waste management, it said.
The intervention also built the capacity of healthcare personnel, community providers, religious leaders and volunteers advocating for malaria control.
Anyanti said community chemists and Patent and Proprietary Medicine Vendors (PPMVs) were trained to test before treating malaria.
She said the intervention has enhanced access to Rapid Diagnostic Tests in communities in Lagos.
State Malaria Elimination Programme initiative Manager, Dr Abimbola Oshinowo, enumerated some of the accomplishments recorded under the initiative.
The health workers trained in specialised malaria case management at 343 public health facilities were 1,279, she said.
Malaria testing coverage rose to 98.3 per cent during implementation.
“Intermittent preventive treatment for pregnant women has increased dramatically from 25 per cent to 93 per cent,” she noted.
The community mobilising initiatives touched out to almost 1.38 million residents.
Mass media efforts reached more than 10 million individuals in the state with messages on malaria prevention.
“The project has given evidence to health workers that they can use to convince patients that not all fevers are malaria,” Dr Victoria Egunjobi, Executive Secretary, Health Facility Monitoring and Accreditation Agency, stated.
She said the increasing use of Rapid Diagnostic Tests would enhance medical decisions and fortify health care delivery.
Stakeholders believed that the benefits could be sustained by continued investment in healthcare staff, surveillance systems, uninterrupted diagnostic supplies, community participation and strong government leadership.
The meeting closed with a promise to institutionalise evidence-based malaria case management and fast track Lagos State’s progress toward malaria pre-elimination.
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