Nigeria making slow progress in exclusive breastfeeding

Nigeria is making progress in exclusive breastfeeding very slowly. Over 10 years, Nigeria has increased its exclusive breastfeeding rate from 12 per cent to only 25 per cent. By comparison, in 1994, both Ghana and Nigeria had both exclusive breastfeeding rates of 7.4, but by 2013 Ghana had moved up to 63 per cent. 

More than 5 million newborns in Nigeria are deprived of essential nutrients and antibodies that protect them from disease and death as they are not being exclusively breastfed. said UNICEF today, as it marks World Breastfeeding Week. 

Approximately 7 million children are born in Nigeria every year and, according to the 2014 National Nutrition and Health Survey, only 25 per cent are exclusively breastfed from 0-6 months of age.
Research notes that an exclusively breastfed child is 14 times less likely to die in the first six months than a non-breastfed child and that breastfeeding drastically reduces deaths from acute respiratory infection and diarrhoea; two major child killer diseases.
“We know that the pressure to give water to newborns in addition to breast milk is high. But the stomach of a baby is so small it can barely hold 60 millilitres of liquid and when it is filled with water, it leaves no room for breast milk and its life sustaining nutrients,” said Arjan de Wagt, UNICEF Nigeria Chief of Nutrition, on World Breastfeeding Week 2016.
“Babies who are fed nothing but breastmilk from the moment they are born until they are six months old grow and develop better. Breast milk gives a child a head start in life and a chance to fight child malnutrition later in life.”The National Food and Nutrition policy 2014- 2019 has a strong exclusive breastfeeding component and while UNICEF has welcomed the policy it urges the Government of Nigeria to include a budget line for nutrition in the health sector budget and a timely release of budget for immediate programming.
“Lack of exclusive breastfeeding is implicated in the current high rate of child malnutrition in Nigeria,’ noted Jean Gough, UNICEF Representative in Nigeria. “Exclusive breastfeeding is free and breast milk is readily available, so exclusive breastfeeding should be our first strategy in fighting child malnutrition,’ she noted.

‘We are seeing more men with bad, weak or abnormal sperms'

--Dr. Abayomi Ajayi, Medical Director, Nordica Fertility Centre, Lagos, Nigeria

Medical Director, Nordica Fertility Centre, Lagos, Dr. Abayomi Ajayi, speaks to Sola Ogundipe on the challenges of male factor infertility as a result of declining sperm quality. He proffers available solutions and and treatment options. Excerpts:

Dr Ajayi with winners of the maiden Nordica Media Merit Award

Sperm counts have dropped over the years. What is regarded as normal sperm count is going down, even the World Health Organisation, WHO is aware of this. 

We are seeing more men who are having bad sperms, weak sperms and abnormal sperms, and there is a real need to explore a suitable intervention to meet the growing proportion of men that need help in this direction. 

Initially normal sperm count was 40 million per ml. Then it reduced to 20 million per ml, now it is 10 million per ml and still going down. Over the last 10 years, we have seen a 30 percent decline in the sperm parameters of men who presented at Nordica Fertility Clinic, Lagos. That’s an average of 3.3 percent every year and it is as severe all over the world. 

A man can father a child up till age of 70 and for those who are fertile they remain fertile but everybody’s sperm count reduces eventually and there are other reasons especially environmental factors. 

The cells of men divide more than cells of women. That is why we reproduce into older age and people are saying that may actually be where the problem is from because with the division can come mistakes and probably that is why sperm count is getting worse by the day. 

But as bad as things appear, there is hope. The first step of any successful treatment is the proper diagnosis of the male infertility cause. 

Although IVF is taking care  of the problem of low sperm count and poor motility, it can only work when there are some sperm to be got from the man, but even if there is none,we can go to the testes to get it. But there are some cases that even then you are    not going to get anything, so donor sperm may have to be used. 

While there are efforts to develop artificial sperm in the laboratory from stem cells, it is still experimental, but there are so many technologies to manage sperm problems. We know sperms contribute to the quality of the embryo, so if there are poor sperms, the    quality of the embryo will be bad and there may be no pregnancy at all, or the pregnancy will be lost through miscarriage. 

The poorer the quality of the sperm, the higher the number of abnormal embryos from the IVF procedure. Now there is technology to check the DNA of the sperm so we can check the sperms with damaged DNA. 

The only thing the man contributes to fertilization is his DNA and if that code is already damaged, he will not be giving anything viable.”

HIV AND INFANT FEEDING

National (or sub-national) health authorities should decide whether health services will principally counsel and support mothers known to be HIV-infected to: - breastfeed and receive ARV interventions, or, - avoid all breastfeeding, as the strategy that will most likely give infants the greatest chance of HIV-free survival.

9.2m persons now on HIV treatment, says Global Fund

A significant increase in the number of people are now being treated for HIV, according to data from the Global Fund to fight AIDS, TB and Malaria (GFATM), that indicate that the Global Fund partnership provided lifesaving HIV treatment to 9.2 million people by the end of 2015 – an additional 100,000 people each month since mid-2015. 

More than 54 percent of all the people on treatment for the disease around the world are through Global Fund-supported programs. 

Since 2000, There has been a dramatic increase in people on HIV treatment when leaders, activists and scientists first gathered in Durban, South Africa, to demand that world leaders do more to treat people with HIV. 

At the time, only 770,000 of 29 million people living with HIV had access to treatment. The cost of HIV treatment was about US$10,000 per year, per person and was out of reach for most people around the world. 

Today, HIV treatment costs less than $100 per person, per year, and a total of 17 million people are accessing antiretroviral treatment across the world with support from governments, civil society, the private sector and communities affected by the diseases. 

The new results show a rise in all other HIV-related interventions supported by Global Fund partnership in the last six months of 2015: The number of pregnant women receiving antiretroviral medicines to prevent the transmission of HIV to their unborn children grew from 3.3 million to 3.6 million while number of HIV counselling and testing sessions increased from 472 million to 509 million. 

Over the same period, the number of condoms distributed increased from 5.2 billion to 5.3 billion. Chair of the Global Fund Board, Norbert Hauser, said: “In Abidjan in April, the Global Fund Board approved a Strategy that will deliver impact even further by focusing on women and girls, key populations, resilient and sustainable systems for health, and mobilizing resources for prevention, treatment and care. But we need continued political commitment and advocacy to reach our collective goals.” 

Also speaking, Mark Dybul, Executive Director of the Global Fund, noted: “We are tremendously inspired by the many partners who have come together and saved the lives of millions of people. However, we cannot let up. New HIV infections among adults are too high. We must invest more in prevention, including in programs to reduce human rights and gender-related barriers.”

 The results also show significant progress in the fight against tuberculosis, a disease inextricably linked to HIV infection, and malaria. The number of new smear-positive TB cases detected and treated increased from 14.4 million to 15.1 million, and the number of people treated for multidrug-resistant TB (MDR-TB) increased 15 percent from 230,000 to 270,000. 

Over the same period, 59 million new insecticide-treated nets were distributed, taking the total number of nets distributed through Global Fund-supported programs to date to 659 million. The number of malaria cases treated also increased by 22 million from 560 million to 582 million

Global HIV infections on the rise, says Study

An international team of researchers analysed the findings from the Global Burden of Disease 2015 study and found that despite a steady decline in HIV and AIDS-related deaths between 2005 and 2015, the global rate of new infections had dropped by a mere 0.7 per cent per year in the same period.

The study published in The Lancet HIV and its findings were announced at the ongoing AIDS 2016 conference in Durban, South Africa.

Lead author of the study,  Dr Haidong Wang, from the Institute for Health Metrics and Evaluation at the University of Washington, said: “The findings of the Global Burden of Disease Study 2015 on HIV reveal challenges that the global health community faces in the effort to end AIDS by 2030, among other global goals.” 

Wang said the increase in incidence in some countries, both in­ terms of rate and number of new infections, is one of the most significant findings of the study especially given the fast decline in new infections globally between 1997 and 2005 and the tremendous amount efforts and resources global community has committed to in the past decade.

He said the increase in new infections could be due to factors at the nation level, such as “lower than optimum viral load suppression, exaggerated ART coverage and a potential increase in risky sexual behaviour in the presence of ART treatment”, but further analysis would be needed to differentiate between specific countries.

The researchers found that the slow decline of new HIV infections worldwide of 0.7 per cent per year between 2005 and 2015, compared to the annual 2.7 per cent between 1997 and 2005, meant new infections at stagnated at around 2.5 million per year.

While some progress is being made in getting life-saving treatment to people with HIV, the sheer numbers of people getting HIV and dying are devastating.

The number of people living with HIV steadily increased from 27.96 million in 2000 to 38.8 million in 2015, and infection rates increased in 74 countries, mostly in sub-Saharan Africa and south and south-east Asia.

Based on these numbers, most countries would fail to achieve the UNAIDS 90-90-90 target – by 2020, 90 per cent of people living with HIV will know their status, 90 per cent of all people diagnosed with HIV will be on antiretroviral therapy (ART), and 90 per cent of people on ART will have viral suppression.

The researchers also found that annual deaths from HIV/AIDS declined from a peak of 1.8 million in 2005 to 1.2 million in 2015, which they say is partly due to the increased availability of ART. The proportion of people living with HIV that were on ART had greatly increased from 6.4 per cent to 38.6 per cent in men and 3.3 per cent to 42.4 per cent in women.

“While some progress is being made in getting life-saving treatment to people with HIV, the sheer numbers of people getting HIV and dying are devastating.”

Eliminating Neglected Tropical Diseases: A new initiative to finish what we started

Dr. Matshidiso Moeti

By Matshidiso Moeti

When I was a child living in apartheid South Africa, I saw first-hand the pain and suffering experienced by the patients my parents cared for at their medical clinic. Patients came in and out, looking for treatment to their ailments and afflictions. I learned how constant illness and discomfort was an everyday reality for so many of our neighbours.

Now a physician myself, I know that daily sickness and pain is also a reality for a billion people around the world who are affected by neglected tropical diseases (NTDs). NTDs are a group of preventable and treatable diseases that place a constant and heavy burden on the poorest, most marginalized and most isolated communities around the world. Together they cause more than 150,000 deaths every year worldwide, yet even that number vastly understates their impact.

By and large, NTDs are not killer diseases. Instead, over years and decades, they sap people’s strength, destroy their quality of life and eat away their savings. For many people who suffer from them, chronic fatigue, bad vision and persistent discomfort seem to be routine parts of life.

Luckily, treating and preventing many NTDs is medically simple, and the vast majority of the drugs needed to do so are generously donated by pharmaceutical companies – 1.5 billion treatments were donated globally in 2015 alone. But delivering those drugs is harder than it sounds. We need better information on where people are infected or at risk, infrastructure to distribute medicine to remote areas and a system to track progress.

An effort of such scale demands substantial funding and technical capacity, posing a major challenge for many African countries. Designing effective programmes is just half the battle; effective collaboration and sustainable funding for these programmes are crucial ingredients for success.

Over the past few years, we’ve seen increased momentum in the fight against these debilitating diseases. In 2012, a coalition of representatives from various sectors endorsed the London Declaration on Neglected Tropical Diseases, an ambitious plan to control, eliminate or eradicate 10 neglected diseases. In 2014, two dozen African countries pledged to strengthen their commitment to NTDs under the Addis Ababa Commitment on NTDs. And in 2015, the Sustainable Development Goals made clear that tackling NTDs was essential to helping communities break free of poverty.

That’s why the World Health Organization – together with a coalition of multinational organizations – is launching the Expanded Special Project for Elimination of Neglected Tropical Diseases, or ESPEN. ESPEN has a broader mandate than its predecessor, the African Programme for Onchocerciasis (APOC), which closed in December 2015. APOC focused on one disease; ESPEN focuses on five – onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminths and trachoma – that can be controlled and eliminated through mass drug administration, the simple and cheap administration of medicine to all people living in high-risk areas.

To succeed in helping these millions of people, the fight against NTDs must be led by affected countries themselves. Much of that work is already taking place through national NTD programs in partnership with public and private organizations. To help make these programs effective and sustainable, ESPEN will support countries each step of the way: it will support them as they map the burden of these diseases, deliver treatments accurately and efficiently, monitor progress and secure certification when they successfully eliminate diseases from within their borders.

ESPEN will also help countries work better together and work better with their partners. ESPEN will support countries to strengthen their strategic leadership role in convening and coordinating partners support, a must-have for a successful delivery of interventions and progress towards elimination. It will create an online portal so countries can access and share information, and help the range of organizations working on NTDs to coordinate with one another and streamline their efforts. It will also advise governments on how to raise money for NTD efforts, and the best targets for spending it.

This project is building on an existing global and pan-African movement to combat NTDs. APOC helped countries make enormous strides against onchocerciasis (river blindness), achieving a significant reduction in the number of people affected by this debilitating disease.

ESPEN is an essential component of a broader health agenda, and the in-country systems established with its support will outlive NTDs. The recent tragic Ebola outbreak revealed the need for a stronger WHO, and I have initiated a Transformation Agenda for the WHO Secretariat in the African Region to ensure that the Organization evolves to provide quality support to countries to improve and transform their health systems in a manner that is sustainable and accelerates the pace of health development in sub-Saharan Africa.

ESPEN and the elimination of NTDs are both integral components of this Agenda. Arming countries with structures to track disease and deliver services to the most remote corners of society builds stronger health systems. These systems form the basis of the infrastructure needed to respond to emergencies and ensure universal access to the entire menu of primary healthcare services – from childhood immunizations to reproductive healthcare.

The tools and knowledge needed to alleviate the neglected suffering of millions of people are in our hands. I hope countries across Africa and partners will join with ESPEN to treat those afflicted by NTDs, eliminate the devastating diseases of poverty that prey on forgotten communities, and build stronger health systems that deliver for everyone.

Dr Matshidiso Moeti is the World Health Organization’s Regional Director for Africa.

Rapid Results Initiative debuts in Nigeria

The Rapid Result Initiative programme designed to quickly and visibly impact on the health of most Nigerians particularly the most vulnerable and poor, has been introduced by the Federal government.

At the launch to kick start the operationalization of the programme tagged “Better Health for all”, the Minister of Health, Prof. Isaac Adewole, said the programme is expected to achieve results within 100 days.

He said the Rapid Result Initiative would be deployed in seven major areas that would conform with local and international health priorities.

Under the programme, 110 Primary Health Centres would be revamped within 100 days, one in each Senatorial district including a facility in Fuka Local Government in Niger State.

“During my unscheduled visit to Fuka, I noticed there was no functional PHC to offer basic health care and I promised that Federal Government will provide a functional facility, today as we speak the Fuka PHC is ready for commissioning”.

Adewole also said the Ministry would inaugurate Mutual Health Associations at community level to improve access to affordable and qualitative health care.

“Mutual Health Associations are either privately or publicly incorporated body registered by the National Health Insurance Scheme solely to access health care service through health care facilities accredited by the scheme”, he explained.

The Initiative would help treat 200,000 Severely Acute Malnourished children in the North East of the country, while 10,000 surgeries, including hernia, cleft lip, and palate repairs, myomectomy, hysterectomy, Vesico-vaginal Fistula (VVF) amongst others in 46 Federal tertiary institutions.

Other aspects of the initiative include operationalizing the Nigeria Centre for Disease Control, NCDC, which entails having at least one laboratory in each geopolitical region including the Federal Capital Territory.

The designated hospitals as laboratories were University of Port Harcourt Teaching Hospital, Aminu Kano Teaching Hospital, Kano; University Of Maiduguri Teaching Hospital, Borno State, University of Enugu Teaching Hospital, Enugu State; Lagos University Teaching Hospital, Jos University Teaching Hospital and Asokoro/ Gwagwalada Specialist Hospital FCT.

Through partnership with Novo Nordisk, the Ministry plans to screen about 500,000 Nigerians for diabetes free of charge while and they would be appropriately referred to facilities that would cater for their needs if that warranted.

On transparency and accountability, Adewole said the Media and Publicity component of the Initiative would be on ground to engender trust and accountability through media campaigns and close monitoring of the programme to ensure that quality services were provided to the people as promised.