It did not begin with madness.
It began with fever.
In many Nigerian homes, long before words like mental health entered public conversation, malaria was already a familiar visitor. It arrived with the rains, with the buzzing of mosquitoes at night, with chills that rattled the bones and heat that burned the skin. For most families, malaria was expected—almost ordinary. You treated it, rested, and moved on.
But for some, the fever did not leave quietly.
In rural villages and crowded urban settlements alike, people began to notice changes that went beyond physical illness. A child who survived repeated bouts of malaria stopped concentrating in school. A young man became withdrawn, confused, and restless after severe fever episodes. A mother who suffered malaria during pregnancy gave birth to a child who struggled with learning, emotions, or behavior.
No one called it mental illness then.
They called it spiritual attack, stubbornness, weakness, or destiny.
As the years passed, malaria continued its silent work—not only attacking blood cells, but sometimes the brain. Severe malaria, cerebral malaria, repeated untreated infections, and malaria in early childhood left marks that were invisible but lasting: memory problems, mood changes, seizures, anxiety, depression, and psychosis-like symptoms.
Yet Nigeria’s health system, like many others, treated malaria and mental health as separate worlds.
One belonged to the clinic.
The other was pushed to the prayer house, the street, or the shadows.
People living with mental health conditions were often among the poorest—those sleeping in overcrowded rooms, lacking mosquito nets, unable to complete malaria treatment, or delayed in seeking care. This made them more vulnerable to malaria, and malaria, in turn, worsened their mental health. A cycle quietly formed:
Poverty bred malaria.
Malaria worsened mental health.
Mental illness deepened poverty.
Families noticed that during malaria episodes, symptoms became worse: agitation increased, hallucinations intensified, confusion deepened. Some patients relapsed after years of stability. Others were labeled “mad” for life after a single severe illness.
Still, the story remained untold.
Malaria was discussed in terms of fever, anemia, and mortality. Mental health was discussed in terms of stigma, morality, or spirituality. The connection between the two lived only in people’s homes, not in policy papers.
Today, Nigeria stands at a point of remembering.
Researchers now acknowledge that malaria—especially in childhood and during pregnancy—can shape cognitive and emotional outcomes. Mental health advocates are beginning to ask harder questions:
How many mental health stories began with a mosquito bite?
How many lives could have been different with early treatment, prevention, and understanding?
This storyline is not about blaming malaria alone.
It is about recognizing that physical illness and mental health are not separate stories in Nigeria—they are chapters of the same book.
And until we tell that story fully, many will continue to suffer in silence, misnamed, misunderstood, and untreated.
Dr Owoeye Oluwatobi Ajibola
Psychiatrist
08131860275
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