Not Every Fever Is Malaria: Lagos Flips the Script on Fever Treatment

Lagos has just changed the way fever is managed across its hospitals, and the data behind the decision is making doctors rethink a practice that has held for decades.

The state government announced on Friday that only about 5% of fever cases in Lagos are actually malaria. That one finding is now driving a new statewide rule: no one will be treated for malaria in public facilities without first testing positive.

Speaking at the dissemination meeting for the World Bank-backed IMPACT Project, Health Commissioner Prof. Akin Abayomi said the old assumption is officially over. “For far too long, fever has automatically been equated with malaria,” he said. “Good clinical practice begins with listening to the patient, examining them properly, and using diagnostics before we treat.”

The directive is already in effect. All public primary and secondary health facilities have been instructed to withhold malaria drugs unless a Rapid Diagnostic Test confirms the infection. According to Abayomi, follow-up inspections have shown a sharp drop in malaria diagnoses since the order began, which he described as proof that the policy is working.

He called the moment a turning point for Lagos and for West Africa, pointing to tragic cases of patients who died after being treated repeatedly for malaria even when their tests were negative. “Assumptions in medicine can kill,” he warned. “We are ushering in a new era where diagnosis comes before treatment.”

The evidence came from the Immunisation Plus and Malaria Progress by Accelerating Coverage and Transforming Services Project, or IMPACT, implemented by the Society for Family Health in partnership with the Lagos Ministry of Health. Malaria expert Prof. Wellington Oyibo presented the findings, noting that malaria positivity among fever patients in Lagos was approximately 5%, microscopy positivity was about 2.4%, and quality-assured Rapid Diagnostic Tests showed 98.5% sensitivity, making them reliable for routine use.

Dr. Omokhudu Idogho, Group CEO of the Society for Family Health, said the project supported testing for more than 2 million patients across 314 public and 289 private facilities, and provided free treatment to over 50,000 confirmed cases. During the project, test positivity fell from 43% to 29.2%. For Idogho, the biggest gain was not just in numbers but in behavior. “Treating every fever as malaria leads to missed diagnoses, drug misuse, and poor outcomes. Testing first saves lives.”

Dr. Abimbola Oshinowo of the State Malaria Elimination Programme outlined other achievements recorded under IMPACT. She said 1,279 health workers were trained on malaria case management in 343 public facilities, malaria testing coverage reached 98.3%, and uptake of Intermittent Preventive Treatment in Pregnancy rose from 25% to 93%. Community mobilization reached more than 1.38 million residents, while mass media campaigns delivered prevention messages to over 10 million people. Grievance redress committees were also established in all 20 LGAs and resolved 362 complaints without escalation.

Permanent Secretary of the Ministry of Health Dr. Dayo Lajide said these efforts have helped reduce malaria prevalence in Lagos to about 2.6% in 2025, placing the state on the path to pre-elimination. The project also worked with the Pharmacy Council of Nigeria to make Rapid Diagnostic Tests available in community pharmacies and Patent Medicine Vendors, bringing testing closer to where residents first seek care.

World Bank Senior Health Specialist Dr. Onoriode Ezire praised Lagos for producing evidence that will influence national policy, and highlighted community engagement as one of the project’s strongest elements. Dr. Victoria Egunjobi of HEFAMAA said the new approach gives clinicians the confidence to be direct with patients. “Not every fever is malaria.”

For years malaria has been the default explanation for any fever in Nigeria, which meant other causes such as typhoid, bacterial infections, and viral illnesses were often missed. With this test-before-treatment policy, Lagos is betting that evidence-driven care will reduce drug resistance, cut unnecessary spending, and save more lives.

As Abayomi put it, “This is the beginning of a new chapter. Diagnosis first. Treatment second. Better outcomes for all.” The Society for Family Health said it will continue supporting pharmacies and community providers even as the project formally transitions to state ownership.