Meningitis: Death toll rises to 438 in 19 States

*Mass vaccination commences in Zamfara

Even as the Federal Government commenced the Meningitis C Reactive Vaccination exercise in Zamfara State - hard hit by the current outbreak of meningitis in the country, death toll from the disorder has continued to rise in all affected States.

On Friday 7th April, the Nigeria Centre for Disease Control,  NCDC, confirmed a total of 438 deaths out of 3,959 suspected cases  reported in 106 Local Government Areas of 19 States of the Federation.

Giving an update of the situation report of 6th April 2017, NCDC;s Technical Adviser, Communications, Dr Lawal Bakare, said a total of 181 (11 per cent) of the cases have been laboratory-confirmed by Pastorex and Culture, while Neisseria meningitides serotype C is the most common serotype accounting for 83 per cent of cases.

The update revealed that Kogi, Oyo and Delta have joined the list of affected States, however, the North-West zone remains the most affected with Zamfara State topping the list with a total of 262 deaths and 2,332 suspected cases in 12 LGAs,  71 laboratory confirmed.

According to the report, the next most affected is Sokoto State with 61 deaths  and 1,045 cases in 18 LGAs, 47 lab confirmed, while Katsina State is 3^rd with 48 deaths  and 228 cases in12 LGAs.

Children aged 5-14 are the most affected age group accounting for  52 per cent of cases, the report noted.

Meanwhile, the vaccination exercise in Zamfara State witnessed massive turnout in the target Local Government Areas.

Bakare said a public awareness campaign which began on the 6^th of April 2017 in the eight most affected LGAs targets 300,000 persons aged 2 – 29 years is expected to continue until April 9, 2017, even as more campaigns are planned in other States in the near future.

The exercise is being conducted by the National Primary Health Care Development Agency, NPHCDA, in collaboration with the NCDC in support to the Zamfara State Government as part of the on-going response and control activities to curtail the outbreak in the State.

ESGN teams up with physicians to address Endometriosis in adolescents

L-R Dr. Victor Ajayi; Dr. Odunukwe Nkiruka; Dr. Abayomi Ajayi; Mrs Tola Ajayi, Prof Bomi Ogedengbe, Dr. Robert Zurawin, and Monique Bonavita Bueno.

Dr Robert Zurawin

Prof Bomi Ogedengbe

A renowned Paediatric & Adolescent Gynacology Surgeon, and specialist of Minimally Invasive Gynaecology, Dr Robert Zurawin, has called for increased knowledge and awareness of Nigerian doctors about Endometriosis.

Zurawin, who is Associate Professor at the Division of Gynaecology, Baylor College of Medicine, Houston, Texas, and MD, Texas Institute for Gynecologic Research & Education, as well as Specialist in Endometriosis, fibroids, and alternate procedures to hysterectomy and urinary incontinence, said doctors can only think of diagnosing Endometriosis if they are aware of its existence.

Zurawin who shared his experience and expertise on the diagnosis and treatment of endometriosis in adolescents, spoke during the 2017 Physicians’ Roundtable themed  “Endometriosis In Adolescents”, put together by the Endometriosis Support Group, Nigeria (ESGN).

The forum was designed to educate Nigerian medical doctors on the management of the condition because of the difficulty associated with  its diagnosis and treatment.

 “The correct diagnosis is important,” Zurawin stressed. “There was an old saying when I was in medical school that you cannot diagnose Tuberculosis if you do not think that tuberculosis exists. You have to know that it exists, and the same thing goes for Endometriosis.

“Doctors need to think Endometriosis in order to diagnose it. Doctors have to be educated to think of Endometriosis as a diagnosis.”

He urged mothers of young teenagers and other young women to get educated.

“They should be aware of the common signs and symptoms of Endometriosis such as painful periods that do not respond to common relievers, and seek counseling early.  

“Endometriosis is a worldwide condition and it has to do with knowledge and understanding to make positive diagnosis. The awareness of the physician is as important as that of the patient. I have seen patients get over-treated with too much surgery for this condition.”

He said the government has a role to play in providing the right environment for correct diagnosis and treatment of the disorder, noting that government could sponsor healthcare programmes that would provide the right awareness.

In her contribution, Chairman of the forum and the first indigenous female Professor of Obstetrics and Gynaecology in West Africa, Dr. Bomi Ogedengbe, lamented the high incidence of the disorder among adolescents. Ogedengbe who is Professor of Obstetrics and Gynaecology at the College of Medicine, University of Lagos, CMUL, said although endometriosis had existed for many years, it was not until around three or four decades ago before gynaecologists became aware of its existence.

“Now we have come to realize that it exists and we know it causes a lot of distress especially pain and from the issue of pain we are accessing adolescents that are having pain monthly or generally. The pain disrupts their lives, studies and social engagement. 

“The other aspect is that of fertility. As you know in our culture, every woman wants to be a mother. It is very important to be a mother and the fact that endometriosis largely prevents conception is an issue of significance.”

Speaking about making a correct diagnosis of the disorder, Ogedebgbe said the first thing that needs to be done is a laparoscopy.

“In the developed world, having a laparoscopy is like having a routine chest x-ray, but that is not the case here. However, we must have this technology, use it and train the upcoming residents to also recognize and use it.

“Nowadays we produce most of our specialists here in the west Africa sub-region and most of them are Nigerians. They need to have hands-on training in laparoscopy. To do this, we need the theatres, equipment, monitors, staff, etc. It’s the way forward.”

Founder and Spokesperson for the Endometriosis Support Group, Nigeria, Dr. Abayomi Ajayi, said the Physicians Roundtable was an ideal forum to sensitise doctors and draw their attention to the disorder.

Ajayi, who is Medical Director/CEO, Nordica Fertility Centre, Lagos, Abuja and Asaba, noted: “It’s easier when you bring the people who have the same interests so you can communicate with them. We know it is the doctors that see the patient sand unless these doctors are able to think of Endometriosis, the diagnosis will be missed and the patient will continue to suffer.

“We are drawing attention to the fact that endometriosis starts in adolescence and when you begin treating it early, there is possibility of preventing the complications women are subjected to in later life.”

Ajayi said medical doctors in Nigeria are not where they ought to be in terms of endometriosis diagnosis and treatment.

“We know that if a woman has endometriosis, she can store her eggs. This is part of the new discoveries, but what we are trying to push out is that the diagnosis should be made early so that the woman knows what she is up against.

“It is only when the diagnosis is made that the patient can be open to the options. We are taking the campaign to the secondary schools and categorizing each group accordingly.”

Africa unites to immunize 116m children against polio

All children under five years of age in  Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Sierra Leone and Nigeria are to be  simultaneously immunized in a coordinated effort to raise childhood immunity to polio across Africa.

More than 190 000 polio vaccinators are immunizing at least 116 million children across west and central Africa in the synchronized vaccination campaign, one of the largest of its kind ever implemented in Africa, is part of urgent measures to permanently stop polio on the continent.  

In August 2016, four children were paralysed by the disease in security-compromised areas in Borno state, north-eastern Nigeria, widely considered to be the only place on the continent where the virus maintains its grip. 

WHO Regional Director for Africa, Dr Matshidiso Moeti said: “Twenty years ago, Nelson Mandela launched the pan-African ‘Kick Polio Out of Africa’ campaign. At that time, every single country on the continent was endemic to polio, and every year, more than 75 000 children were paralysed for life by this terrible disease.  Thanks to the dedication of governments, communities, parents and health workers, this disease is now beaten back to this final reservoir.”

Moeti cautioned, however, that progress was fragile, given the epidemic-prone nature of the virus.  Although confined to a comparatively small region of the continent, experts warned that the virus could easily spread to under-protected areas of neighbouring countries.

That is why regional public health ministers from five Lake Chad Basin countries - Cameroon, Central African Republic, Chad, Niger and Nigeria – declared the outbreak a regional public health emergency and have committed to multiple synchronized immunization campaigns.

UNICEF Regional Director for West and Central Africa, Ms Marie-Pierre Poirier, stated that with the strong commitment of Africa’s leaders, there was confidence that this last remaining polio reservoir could be wiped out, hereby protecting all future generations of African children from the crippling effects of this disease once and for all. “Polio eradication will be an unparalleled victory, which will not only save all future generations of children from the grip of a disease that is entirely preventable – but will show the world what Africa can do when it unites behind a common goal.”

To stop the potentially dangerous spread of the disease as soon as possible, volunteers will deliver bivalent oral polio vaccine (bOPV) to every house across all cities, towns and villages of the 13 countries. 

To succeed, this army of volunteers and health workers will work up to 12 hours per day, travelling on foot or bicycle, in often stifling humidity and temperatures in excess of 40°C.  Each vaccination team will carry the vaccine in special carrier bags, filled with ice packs to ensure the vaccine remains below the required 8°C.

"This extraordinary coordinated response is precisely what is needed to stop this polio outbreak," said Michael K McGovern, Chair of Rotary’s International PolioPlus Committee. "Every aspect of civil society in these African countries is coming together, every community, every parent and every community leader, to achieve one common goal: to protect their children from life-long paralysis caused by this deadly disease."

The full engagement of political and community leaders at every level – right down to the district – is considered critical to the success of the campaign.  It is only through the full participation of this leadership that all sectors of civil society are mobilized to ensure every child is reached.

PACFaH tasks Nigerian media to report health budget issues

THE Partnership Advocacy for Child and Family Health (PACFaH) wants journalists in Nigeria to actively  report issues  surrounding  the health budget and finance.

Health Reform Foundation  of Nigeria (HERFON), Programme Officer on PACFaH project,  Ms.Aanu’ Rotimi, told members of the Health Writers Association of Nigeria (HEWAN) during a symposium in Lagos recently, that regular reports would ensure that deliberations on the health budget are kept on the front burner, and ensure that  government meets  commitment  towards adequate funding  of  the health sector.

In her presentation  on the  “ Role of Media In Advocating For Increased Health Sector Budget in Nigeria” during  a symposium organised by  HEWAN in Lagos, Rotimi stated that  the media’s  power in  influencing opinions and behavior as well as ability to inspire public interest through creating awareness around respective issues has a great to play  in ensuring that  government  adequately finance  the  healthcare sector.

 “Over the years, evidence has shown that media plays a vital role in mobilising people for national development. It is the connection between the people and government. Advocating for improved health outcomes is a role for all stakeholders in which health journalists are critical stakeholders.

“It is interesting to note the interplay of both intrinsic and extrinsic factors that determines what good health is all about. Appropriate allocation, prompt release  and value for money utilisation  of health funds are important, and not just mere reduction in MMR, U5MR or IMR,  which although are expected ultimate results, but can be transient till  an assured funding, much more transparent utilisation and ownership are available.”

She urged the media to remind government to honor various commitments on health financing, such as the Abuja Declaration  that stated that 15 per cent of  the country’s annual budget  must be allocated to health, Goal 3 of the Sustainable Development Goals (SDGs)’s  Target 3.c ( Increase substantially health financing), National Health Act that says 1 per cent  of the Consolidated Revenue Fund (CRF)   should be allocated   to the health sector, Nigeria’s commit to the Declaration of African Ministers of Health, Finance, Education, Social Affairs, Local Governments attending the Ministerial Conference on Immunization in Africa, Addis Ababa in 2016   and The London 2012 Family  planning (FP) commitment and the costed FP Blueprint.

She noted that health financing issues are not widely covered by the media, adding that health news rarely makes it to the leading headlines or cover page of  media houses.

She argued that challenges of  health finance reporting in Nigeria  include “limited investigation on health sector funding , inadequate reporting on the issue of  health finance,  media owner’s philosophy towards health reportage,limited experts and interest groups to track and report health outcomes on health financing  and limited demand in accountability by the media on health budget” 

Rotimi said health  journalists should ensure   a change on  tracking of health budget  by “following committed organisations/individuals  working on health budget advocacy as partners,  investigate on health allocation, releases and utilization, provide a strong rationale for the need to increase attention to health” sector funding.

The needs to “write or broadcast stories that can enhance funding of the health sector, push for more attention on health funding as it relates to economic development, draw the attention of policy makers and engage constructively and write articles or features that will make health sector funding a priority.”

The PACFaH project is an innovative social accountability project being implemented through the unique strategy of capacity building for civil society organisations (CSOs) on the demand side and government champions on the supply side to build partnerships to advance child and family health through advocacy.

The project's top line objective is to improve the accountability of government at the national and state levels to deliver on commitments by increasing health budget, timely expenditure releases, and  implementation of  policies and guidelines in support of improved child and family health in Nigeria as a result of evidence-based, high-impact advocacy led by coalitions of local CSOs.

                              

Every Nigerian at risk of blindness from Glaucoma

Associate Professor of Ophthalmology, Dr. Adeola Onakoya has called for increased awareness against Glaucoma, the second leading cause of irreversible blindness worldwide. Onakoya, who is the Head, Glaucoma Services and Acting Head of Department of Ophthalmology, College of Medicine/Lagos University Teaching Hospital, said it was necessary to sustain awareness about glaucoma and to encourage all Nigerians above the age of 30 to undergo regular screening for the common cause of blindness.
“It is a public health problem. Currently, 70 million people suffer from Glaucoma worldwide, with 10 million blind. It is anticipated that by 2020, sufferers would increase to 80 million and blindness from the disease will increase as well,” she noted in a statement.
Blindness from Glaucoma is 10 times higher in the developing world, with an aggressive clinical course in blacks, she noted that prevalence increases with age in 0.5-9 per cent of population over 40 years and increases to 15 per cent in population over 65 years.
“With ageing, the population of sufferers will increase. Population studies in Nigeria revealed that 5.02-6.9 per cent(1.8million) of people over 40 years suffer from Glaucoma with almost 360,000(20 per cent) of them blind in both eyes.”
Onakoya said the disease is asymptomatic and progressive with sufferers unaware until at an advanced stage when there is irreversible visual loss.
“Awareness is very poor with only 5 per cent of the Nigerian Glaucoma population being aware. Early detection and appropriate treatment of the disease seem to be the answer to the late presentation of sufferers and reduction of blindness from the disease.
“Education on the natural history of the disease will also improve the compliance and adherence to treatment in the diagnosed patients. Creation of awareness on the disease process and enlightenment programmes, backed up with case detection (through screening) will go a long way in reducing blindness.”
She said special attention should also be given to First Degree Relatives (FDR) of Glaucoma patients because of the heritability nature of the disease with the hope that the news can spread through word-of-mouth through at-risk groups.
“Every Nigerian is at risk of the disease but this is higher in the population over 30 years, so special attention must be paid to include every Nigerian above the age of 30 years as the disease tends to present a decade earlier in Africans.
In recognition of the importance of this common cause of blindness, the World Glaucoma Association (WGA) and World Glaucoma Patient Association (WGPA) declared March 12th of every year as World Glaucoma Day (WGD) 10 years ago.
Two years later, this was extended to a weeklong celebration (WGW). Mass Glaucoma screening and early treatment have been a cardinal aspect of the Rapid Response Initiative (RRI), one of President Mohammed Buhari’s nationwide quick-win thrusts in healthcare.
Onakoya argued that in pursuance of the same vision, the Lagos University Teaching Hospital has outlined a robust programme to educate the public on Glaucoma and also carry out case detection tests for the public.
This was done in conjunction with Glaucoma Patient Care Initiative in Nigeria, a registered glaucoma patients group and the ongoing RRI programme. The screening exercise commenced 14th & 15th March, 2017 at the Guinness Eye Centre, LUTH, in partnership with Pfizer Specialties and Novartis Ophthalmics.
A public lecture to sensitise the populace and impart knowledge held Thursday 16th March 2017 at National Sickle Cell Centre, co-organised with Ophthalmological Society of Nigeria, Mundi Pharma and Novartis Ophthalmics.

Investing in nutrition is an economic necessity in Nigeria

By Senator Lanre Tejuoso

Nigeria is in a state of double emergency. Chronic malnutrition, caused by poor nutrition over a long period of time, plagues one in three children under five. And in recent years, acute malnutrition has skyrocketed—particularly in the northeast—necessitating urgent, life-saving action. This widespread malnutrition crisis threatens the health and development of both individuals and the nation. Policymakers need to establish large-scale programs that treat and prevent malnutrition by funding interventions that target our most vulnerable, save lives and boost Nigeria’s long-term economic development.

Up until now, our response to the malnutrition crisis—both the emergency in the northeast and high rates of chronic malnutrition around the country—has not matched the severity of the problem. Of the 2.5 million children suffering from severe acute malnutrition each year, we only treat about 500,000 with the help of our partners, leaving a huge gap that calls for more commitment.

Chronic malnutrition rates which have remained fairly stagnant for the last 15 years also need to be addressed.  Eleven million children are malnourished in Nigeria. As a result, the lives, development and future productivity of 11 million children are all compromised. Yet to date, nutrition policies and programs have been chronically underfunded. The disconnect between what is urgently needed and current funding levels is deeply concerning.

Nigeria’s economic situation makes investments in nutrition all the more crucial. Even in the midst of a recession, nutrition needs to be prioritized. The toll that malnutrition takes on the economy cannot be ignored. Poor nutrition impedes cognitive and physical development, which translates to decreased learning ability, reduced productivity in adult years and increased healthcare costs. African countries lose an average of 8 percent of their annual GDP due to malnutrition. Micronutrient deficiencies alone result in a USD 1.5 billion loss in Nigeria each year. On the flipside, every dollar invested in nutrition in Nigeria has an average return of nearly USD 17. These figures leave little doubt of the economic potential of nutrition.  If Nigeria is to compete in the global economy—and supercharge the potential demographic dividend—, it will need to ensure its children are well nourished.

Progress is possible, and we now know what works. Targeting women and children—especially during the first 1,000 days of life—with interventions like food fortification and breastfeeding promotion, has proven to yield significant results and end the corrosive cycle of multi-generational malnutrition. Conversely inaction in those first 1,000 days likely means that any later interventions will be too little, too late, and too costly. Policymakers structured the National Food and Nutrition Policy on this knowledge—selecting and costing nutrition programs to maximize impact, all but guaranteeing a strong return on investment and improving the health of Nigerian’s population.

But investments in these interventions in Nigeria remain much too low and significantly lower than neighboring countries. Scaling up such proven interventions could help Nigeria reach the World Health Assembly (WHA) target of reducing stunting by 40 percent by 2025 and add USD 29 billion to our economy.  It is encouraging to note that rates of chronic malnutrition vary considerably between states in Nigeria, with some stunting rates among children at more than 50 percent and with several others with rates around 20 percent. This indicates that it is possible to address malnutrition even in the complex Nigerian environment.

Policymakers now need to marry the political will that gave rise to the National Food and Nutrition Policy with the actions needed to achieve impact. The recent high-level policy dialogue, “Nigeria’s Nutrition Crisis,” which I chaired, hosted by the Nigerian Senate Committee on Health and Federal Ministry of Health, resulted in a call for a USD 305 million (N1 billion) investment in nutrition in the 2017 budget at the very least, which closely aligns with the government’s costed plan to scale-up a set of effective nutrition programs across the country. The Senate Committee on Health will be on the lookout for this as we deliberate on the 2017 budget proposals. 

We can no longer afford to let policies gather dust on a shelf; government leaders must invest in and implement strong nutrition policies. Nigeria has an ambitious vision of becoming one of the largest economies in the world and establishing itself as a significant player in the global economic and political arena. This vision will not be realized unless we follow through on our commitments to improve nutrition. With increased leadership and action, Nigeria has the potential to make unprecedented progress that will be evident for generations to come – that is the change we promised. There is no time like the present.

Senator Lanre Tejuoso of the Federal Republic of Nigeria represents the Ogun Central Senatorial District which comprises of Abeokuta North, Abeokuta South, Obafemi/Owode, Odeda, Ewekoro and Ifo Local Governments. He also serves as Chairman Senate Committee on Health, Nigeria.

Lagos Community Health Insurance Scheme takes off June 2017

A specially designed Community Based Health Insurance Scheme of the Lagos State government is coming on stream in June this year.
State Commissioner for Health, Dr Jide Idris, who disclosed this on during the 2017 Eko Health Mission conference in Alausa, Lagos, said efforts are on to ensure smooth take off of the scheme in the State.
His words: “Come June we will start the soft launch of the health insurance scheme. We planned to start sometime last year but certain things stopped us.
"We are using both private and public facilitites, that is why the modalities is taking quite a while because we have to get the technical aspect right."
Idris explained that participation in the scheme must conform to certain requirements.
" They have to be accredited. when accredited, we have to go and observe their facilities. The insurance agencies also have their own modalities.  
"Let me say again, if anybody has a problem with the facilities, they should let us know so we can shut it down immediately. From now we have to start publicizing it, telling people what to do, how to go about it”, he said.
Scarce economic resources, low or modest economic growth, constraints in the public sector and low organisational capacity have created the need for adequate health financing systems for low income groups and individuals.