Archives for 2018

You are browsing the site archives by date.

REPORT ON THE 2018 WORLD HEART DAY CELEBRATION

REPORT ON THE 2018 WORLD HEART DAY CELEBRATION

PRESENTED AT THE MEETING OF THE FEDERATION OF AFRICAN MEDICAL STUDENTS’ ASSOCIATIONS’ (FAMSA) HEADQUARTERS’ BOARD

VENUE: FAMEWO COMMON ROOM, ALEXANDER BROWN HALL, UNIVERSITY COLLEGE HOSPITAL, IBADAN

DATE: 1ST OCTOBER, 2018

BY
Mr. Ifeoluwa ODUGUWA

INTRODUCTION
Cardiovascular diseases (CVDs) are the leading cause of death globally. An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. Over three quarters of CVD deaths occurred in middle- and low-income countries many of which are in Africa.
The 29th of September every year is set aside to raise awareness about the scourge of heart disease and to encourage people all over the world to look after their hearts.
The theme of this year’s campaign was “My Heart, Your Heart.” It involved creating a sense of responsibility and commitment towards the cause of heart health. It represented a challenge to make personal decisions that would benefit every heart “because every heart beat matters.”
The committee therefore set out with the clear vision of inspiring our audience to make personal and impactful promises for the sake of themselves and their loved ones.

MEMBERS
The committee comprised the following board members:
• Mr. Ifeoluwa ODUGUWA – Chairman.
• Miss Wuraola RAHMAN – Secretary.
• Miss Roseben ANYANWU
• Miss Frances CHUKWU
• Mr. Abdulbasit FEHINTOLA – Supervisor

APPROACH
• Outreach to the International School Ibadan
• Social media campaign

OUTREACH TO THE INTERNATIONAL SCHOOL IBADAN
The venue was The International School Ibadan (ISI), University of Ibadan. The program held on Saturday 29th September 2018. It started few minutes past 11am and lasted about 2 hours.
150 students from JSS3-SS2 were in attendance together with a female teacher and two male teachers.
The outreach entailed:
• Writing competition on cardiovascular health
• research to assess the knowledge, attitude and perception of Cardiopulmonary Resuscitation (CPR) pre- and post-CPR training among secondary school students and teachers
• health talk on cardiovascular health and diseases
• cardiopulmonary resuscitation training

WRITING COMPETITION ON CARDIOVASCULAR HEALTH
As a means of generating awareness of cardiovascular health and diseases among the students a writing competition was organised by the committee. The management of the school were given the topic “Write a letter to the minister of health asking him to commit to the cause of heart health and improve access to prevention and treatment options for heart disease.” However only one entry was received. The sole letter will be published on the FAMSA website and the author will be rewarded with a gift.

RESEARCH ON CARDIOPULMONARY RESUSCITATION
Questionnaires were administered to the students to assess their knowledge and attitude towards CPR. Pre-test questionnaires were distributed before the CPR training and post-test questionnaires were administered after the students had been trained. The students were encouraged to attempt all the questions.

HEALTH TALK ON CARDIOVASCULAR HEALTH AND DISEASES
The talk was delivered by Dr. Okengwu, a Senior Registrar from the Department of Cardiology, University College Hospital (UCH), Ibadan. It featured a brief introduction on cardiovascular diseases and practical ways by which the students could improve their heart health. The students also had the opportunity of asking questions after the talk and their questions were duly attended to by the doctor.

CARDIOPULMONARY RESUSCITATION (BASIC LIFE SUPPORT) TRAINING
We requested for four mannequins from the College of Medicine, University of Ibadan through the Coordinator of the International Training Center. We were given the Mannequins together with four adult face shields and four adult Ambulatory Manual Bagging Units.
A training was organised for Board members courtesy of the Department of Anaesthesia, UCH in preparation for the outreach. However only four board members were present due to the fact that most of us had tests on that day. Those present were trained on Basic Life Support by Dr. Owoade and were therefore adequately equipped for the outreach.
A brief introduction to CPR was done by Dr. Owoade after which the students were divided into four groups. Training within the groups was facilitated by Board members. Students took turns to demonstrate the technique while their colleagues and facilitators watched.
Leaflets containing information on cardiovascular health were distributed to the students with the hope that they would go on to share the leaflets with their family and friends thereby increasing the impact of the campaign.

SOCIAL MEDIA CAMPAIGN
We printed campaign posters from the World Heart Federation website which were distributed to various classes. Board members were tasked with ensuring that the posters were used.
Participation in the campaign was impressive as medical students from different classes assembled in small units to take pictures with the symbol posters and promise cards. The pictures were put up on various social media handles of FAMSA on the world heart day.
An activity guide containing information on how to make use of the social media campaign resources on the World Heart Federation website was created and sent by the administrator to the chairman of the FAMSA Standing Committee on Health and Environment (SCOHE). However no positive outcome was recorded as a result.
In Ibadan, online campaign resources were not used as effectively as the printed posters probably due to the fact that all the clinical classes had tests during the week of the celebration.

CHALLENGES
The challenges we faced are as follows:
• Lack of funds: Most of the expenditure had to be financed by myself and other board members. This was due to the fact that we did not have sponsors for the project.

• The committee was not large enough: The committee was made up of only three members and a supervisor initially. The fact that Miss Roseben Anyanwu left the board meant most of the burden of the late running around fell on myself and Miss Wuraola Rahman. Although Miss Frances Chukwu was later asked to join the committee there was not much she could do to reduce this burden.

• Slow progress of plans because of distance barrier: Due to the fact that I do not stay on campus, we were not able to meet regularly and this slowed the progress of the project and communication with the supervisor and other directors was also limited.

• The World Heart Day was a Saturday: As a result of this, we were only able to get boarders to attend the event. More students would have been reached if the outreach had held on a weekday.

• Few personnel for the training: This is understandable as most board members had tests on the day of the training.

RECOMMENDATIONS
• Early preparation by future committees is encouraged: This would ensure that future committees are not overwhelmed as the date for the event draws close.

• The committee should include more board members: This would ensure that the work is shared among a larger group of people and this would reduce the burden on each individual.

FINANCIAL REPORT

EXPENDITURE

Items                                 Quantity.               Unit Price (₦) Total Cost (₦)
Symbol posters printing 30                          100                   3000
Promise cards design      1 graphic design 2000 2000
Promise cards printing.  24                          120 2880
Leaflets printing               100                        90 9000
Transportation                  3900
Refreshment                      3 facilitators        400 1200
TOTAL 21,980,
INCOME
This was gotten from the donation of five hundred naira (₦500) each by members of the headquarters’ board. 13 board members have paid as at the time of preparing this report and this amounts to six thousand five hundred naira only (₦6500).

APPRECIATION

I would like to appreciate the immediate past administrator of the board, Mr. Joshua Egbedimame for the opportunity to serve as chairman of the 2018 World Heart Day Planning Committee. I would also like to thank the present administrator for his support and guidance throughout the period of the project.
My sincere appreciation also goes to the Department of Anaesthesia, UCH for providing a facilitator for the CPR training of board members and the secondary school students.
I would also like to thank the Coordinator of the International Training Center, College of Medicine, University of Ibadan, Professor Ikeoluwa Lagunju for facilitating the release of the training materials to us at no cost.
I would also like to thank the management of the International School Ibadan for granting us the permission to hold the event in their school and going out of their way to ensure that the programme went smoothly.
I would like to sincerely thank all the members of the committee, Miss Wuraola Rahman especially, for her invaluable contributions towards ensuring the success of the event. I would like to specially thank Miss Roseben Anyanwu who continued to work with the committee despite the fact that she was no longer on the board. I would like to thank my supervisor for his support during the planning and execution of the project.
Finally I would like to appreciate all the board members who contributed in one way or the other to the success of the project. Together we were able to impact the lives of these students and as a result edge closer toward our goal of improving health in Africa. Thank you very much.

Ifeoluwa ODUGUWA,
World heart Day Planning Committee Chairman

Read More

DEATH IN THE WATERS: MENACE AND PANACEA OF INADEQUATE WATER SUPPLY AND POOR ENVIRONMENTAL SANITATION IN AFRICA

FEDERATION OF AFRICAN MEDICAL STUDENTS’ ASSOCIATIONS (FAMSA) HEADQUARTERS’ BOARD

]
DEATH IN THE WATERS: MENACE AND PANACEA OF INADEQUATE WATER SUPPLY AND POOR ENVIRONMENTAL SANITATION IN AFRICA

PRESENTED AT THE FAMSA HEADQUARTERS’ MEETING WHICH HELD ON THE 1ST OF OCTOBER, 2018 AT FAMEWO COMMON ROOM, ALEXANDER BROWN HALL, UNIVERSITY COLLEGE HOSPITAL, IBADAN.

BY

OGUNFOLU AMINAT AFOLAKEMI (MISS)

 

OUTLINE

  • Introduction
  • Menace of inadequate water supply and poor environmental sanitation in Africa
  • The causes of inadequate water supply and poor environmental sanitation in Africa
  • Existing policies on provision of portable waters and existing help from international bodies
  • Shortcomings of the policies
  • Panacea – Solutions to the problem of inadequate water supply and poor environmental sanitation in Africa
  • Conclusion

INTRODUCTION
Access to water has been broadly defined as the availability of at least 20 liters per person per day from a source within one kilometer of the user’s dwelling (WHO 2000).
Sanitation is defined as access to, and use of, excreta and wastewater facilities and services that ensure privacy and dignity, ensuring a clean and healthy living environment for all (WHO 2000).
A safe, reliable, affordable and easily accessible water supply as well as good environmental sanitation is essential for good health. Yet, for several decades, about a billion people in developing countries, particularly in Africa have not had safe and sustainable water supply neither can they boast of good environmental sanitation. This is a growing nuisance for heavily populated areas, carrying the risk of infectious disease, particularly to vulnerable groups such as very young, elderly and immunocompromised individuals.
It has been estimated that an average home requires at least 50 liters of water per day for drinking, food preparation, personal hygiene and domestic needs. Adequate water supply helps to maintain proper environmental sanitation. Thus, the availability of adequate water supply equals good environmental sanitation in an ideal environment.
In Africa, 16% of urban communities and 55% of rural communities have poor environmental sanitation (WHO, 2000). About 36% of the African population lack access to pipe-borne water and a large percentage lack access to proper sewage infrastructure. Even for those with proper sewage infrastructure, about 51% have to leave their compounds to access water and about 1 in 5 have to leave their houses to access water and to use a latrine.

MENACE OF INADEQUATE WATER SUPPLY AND POOR ENVIRONMENTAL SANITATION IN AFRICA

  • Yearly, more than 315,000 African children die from diarrheal diseases caused by unsafe water and poor sanitation (WHO 2000).
  • Environmental damage
    Inadequate water supply and poor environmental sanitation have discouraged tourist trade, reduced overseas markets and fish production. This is due to water pollution by industrial and domestic waste which have polluted the living conditions of the aquatic environment and lead to increased death rate of fishes, thereby, reducing sales and overseas trade.
  •  Nutritional stunting
    Poor environmental sanitation leads to decline in agricultural production or production of foods with inadequate nutrients which causes decline in nutritional intake. This coupled with intake of water from unhealthy sources eventually lead to nutritional stunting.
  • Poor health status
    Increased incidence of infections e.g. cholera, typhoid, dysentery, worm infections, eye infections, skin disease etc.
  •  Environmental pollution
    Waste products especially from industries pollute the environment can cause depletion of the ozone layer thereby causing global warming. Also, exposure to fumes and hydrocarbons are dangerous and this is a risk factor for some cancers e.g. laryngeal carcinoma.
  • Reduced economic returns
    Reduced agricultural production leaves a big gap in the economy by reducing exchange trades and reducing the income of the economy.
  • Increased morbidity and mortality rates
    A combination of the above factors especially exposure to pollutants and consumption can lead to reduction in life expectancy in the society. Also, infections and diseases which occur as a result of inadequate water supply and poor environmental sanitation will eventually lead to death in most cases.

THE CAUSES OF INADEQUATE WATER SUPPLY AND POOR ENVIRONMENTAL SANITATION IN AFRICA

  • Increasing population demand for portable water and waste disposal
    There is low contraceptive use in Africa and the population increase is not fully under control. Thus, there is increasing need for portable water and waste disposal. The demand cannot the met by the current facilities in place for portable water and waste disposal.
  •  Increasing urban slums (illegal settlements)
    Over the years, there has been a rapid increase in immigrants from rural settlements into the urban areas. Due to insufficient funds to settle in the urban areas, the immigrants tend to create illegal settlements for themselves and usually, they do not have a proper facility to get water and dispose waste. Instead they source for water through illegal means e.g. by breaking through pipes that supply the legal settlements and dispose their wastes on the road sides.
  •  Environmental pollution by industrial and domestic waste
    Most industries and homes in Africa do not have controlled means of disposing waste. Especially industries, fumes are released into the atmosphere which pollute the air and deplete the ozone layer thereby causing global warming. Also, waste products are disposed into water bodies thereby reducing the quality of water supply.
  • Ineffective long term health care policies
    Most health care policies in Africa do not last for long as they do not address the major issues affecting inadequate water supply and poor environmental sanitation, Also, there is an issue with compliance with these policies in most African nations.
  •  Poor economy and inadequate budget in developing countries
    Most African countries usually have a low percentage of their budgets allocated to adequate water supply and waste disposal. This does not allow adequate provision of these needs.
  • Corruption
    This is a major problem affecting most African nations. Even with the low budget for water supply and waste disposal, the corrupt practices of most government officers restricts provision of these needs.
  •  Inadequacies of existing policies on water supply and environmental sanitation
    Most of the existing policies on water supply and environmental sanitation in Africa do not specifically address how to tackle the problem of inadequate water supply and poor environmental sanitation.
  • Poor supervision of environmental sanitation in communities
    Most communities do not have adequate supervision for sanitation practices and this has increased the problem of poor environmental sanitation,
  • Poor health practices due to little knowledge on health education
    Due to high rate of illiteracy in Africa, most people do not know the right health practices and they dispose waste inadequately and use poor water sources.
  • Lack of collaboration between health and environmental agencies
    More often than not, health agencies work in isolation from the environmental agencies to adequately inform people on the right health practices especially those involving sanitation.
  • Water wastage
    This is a major problem affecting water. Burst pipes and leaking pipes are left unattended to till the water source gets exhausted.EXISTING POLICIES ON PROVISION OF ADEQUATE WATER SUPPLY AND GOOD ENVIRONMENTAL SANITATION

    A lot of policies have been introduced to help with adequate water supply and good environmental sanitation. Few amongst them include:

  • Millennium Development Goals (MDGs)
    The MDGs are 8 goals which were signed in September 2000 by the United Nations Millennium Declaration to commit world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women. Particularly relating to inadequate water supply and poor environmental sanitation is MDG 7 which aims at maintaining environmental sustainability.
    However, these goals were not attained at the stated deadline in 2015 and this lead to the introduction of the sustainable development goals.

  • Sustainable Development Goals (SDGs)
    On the 19th of September, 2015, the 193 countries of the UN General Assembly adopted the 2030 Agenda titled “Transforming our world: the 2030 Agenda for Sustainable Development”. There are 17 SDGs and the increase in number was to correct the gaps and shortcomings of the MDGs which were described to be not specific by many countries.
    The SDGs cover social and economic issues including poverty, hunger, health, education, global warming, gender equality, water, sanitation, energy, urbanization, environment and social justice. SDG 6 particularly focuses on clean water and sanitation.
    Many nations including African nations are focused and working towards these SDGs.

  • Water, Sanitation and Hygiene (WASH) ProgrammeThis programme is a UNICEF initiative that aims at creating safe water sources and sanitary facilities in communities and schools and also, provides hygiene education.
  • National Environmental Sanitation Policy (NESP)

This is specific to Nigeria and it was introduced in January 2005. It covers solid waste, medical waste management, excreta and sewage management, food sanitation, sanitary inspection, adequate portable water supply, pest and vector control and urban drainage management. Targets have been set but these targets have been extended four times to increase the coverage of this policy. The latest target aims to achieve and sustain 100% sanitation coverage of the population.


Source: Nigeria’s Sanitation Targets (2007-2025)

SHORTCOMINGS OF THE POLICIES

  •  The MDGs were perceived as being ‘too ambiguous’ by most UN member nations especially the African nations as it was not very specific in stating the aims that were meant to be achieved. Due to this reason, most African nations could not successfully carry out the MDGs.
  • Even though the SDGs were introduced as a modification to the MDGs, a major problem is the fact that government challenges towards implementing these goals have not been addressed. This could lead to failure in achieving these goals.
  • The WASH programme had issues with some communities and religious groups who refused to accept the programme and did not volunteer. There were also issues with lack of motivation and the training was not sufficient.
  • The NESP policy did not address how it would impact on water and sanitation supply through additional yield especially in local communities. Also, issues of acceptability to local communities and long-term applicability were not addressed. Till now, the shortcomings of NESP have not been fully addressed and this might just mean that the aims of the policy might not be eventually achieved at the new deadline.

PANACEA – SOLUTIONS TO THE PROBLEM OF INADEQUATE WATER SUPPLY AND POOR ENVIRONMENTAL SANITATION IN AFRICA

  • Dry or low water sanitation techniques in which waste can be processed directly on-site or collected and transported to the processing site to obtain products like water, compost, fertilizers, soil conditioners, biofuel and biogas should be used instead.
  •  For low-cost options, clean pit latrine systems, urine diversion dry toilets and pour flush toilets (requires just 0.5-2 liters) of water
  • New policies that will address the problem and factors surrounding the problem in a holistic should be introduced.
  •  Private institutions could also go into providing sewage disposal facilities.
  • Collaboration between health and environmental agencies
  •  Strict sanctions on industrial and domestic environmental pollution
  • War against corruption
  • Water conservation

New-ground breaking initiatives which are still getting processed include:

  • A dehydration auesterisation machine which would enable faecal sludge from ventilated improved pits to be processed by drying off and pasteurizing the sludge using infrared radiation. The product can be safely used in agriculture.
  • Another promising project is use of the larvae of black soldier flies for faecal material degradation. After which, the larvae, which are rich in fattys acids and proteins, can be used for poultry feed or biodiesel production.
  •  There’s also another project that focuses on the treatment of urine to obtain reused water and fertilizer.

CONCLUSION
Inadequate water supply and poor environmental sanitation in Africa have to a large extent affected growth and progress in the continent. Also, various infections and disease conditions have occurred due to these problems leading to increase in mortality and morbidity rates in Africa.
Although some policies have been put in place to address these problems, they have their shortcomings which have to be addressed to provide long lasting solutions.
Also, strict measures should be put in place to ensure that the solution-providing policies are adhered to.

REFERENCES
Adeleye B, Medayese S, Okelola O. [2014] Problem of Water Supply and Sanitation in Kpakungu Area of Minna (Nigeria). Glocalism. Available at:
www.glocalismjournal.net/issues/feeding-the-planet-energy-for-life/articles/assessing-the-problems-of-water-supply-and-sanitation-in-kpakungu-area-of-minna-niger-state-nigeria-using-gis.kl [Accessed 29th September, 2018]
Adeoti, O. [2007] “Challenges to Managing Water Resources along the Hydrological Boundaries in Nigeria”. Water policy 9, 105-118
Gibbs D [2015]. MDG Failures: The Borgen Project. Available at:
https://borgenproject.org/mdg-failures/ [Accessed 1st October, 2018]
Hunter PR, MacDonald AM and Carter RC [2010].Water Supply and Health. PLos Medicine. Available at:
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000361 [Accessed 29th September, 2018].
Patterson J [4th August, 2015] 3 Challenges facing the UN Sustainable Development Goals. World Economic Forum. Available at:
https://www.weforum.org/agenda/2015/08/3-challenges-facing-the-uns-sustainable-development-goals/ [Accessed 1st October, 2018]
Smith, R. [May 2002] World Water Day 2001: Sanitation; Controlling Problem at Source. Available at:
www.who.int/water_sanitation_health/en/sanitation.html [Accessed 29th September, 2018].
WaterAid [2007]. Sanitation and Economic Development: Making a case for the MDG Orphan. Available at:
http://www.wateraid.org/documents/sanitation_and _economic_development.pdf [Accessed 29th September, 2018]

Read More

UNIVERSAL HEALTH COVERAGE IN NIGERIA: A MEDICAL STUDENTS’ PERSPECTIVE

INTRODUCTION

Health as defined by the World Health Organization is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Everyone has the right to be in good health and good medical services irrespective of their class in the economy. The aim of the universal health coverage is to secure access to adequate healthcare for all at an affordable price. What is Universal Health Coverage?

Universal Health Coverage is a health care system that provides health care and financial protection to all citizens of a country. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.

 

Universal health coverage is one of the set goals for Sustainable Development Goals (SDGs) that Africa and other countries pledged to achieve by 2030.To monitor the progress of Universal Health Coverage, the focus should be on

  1. The proportion of a population that can access essential quality health services.
  2. The proportion of the population that spends a large amount of household income on health.

World Health Organisation uses 16 essential health services in 4 categories as indicators of the level of achievement of coverage in countries. The 4 categories have different services under them. These include

CATEGORY I: Reproductive, maternal, new born and child health:

  1. Family planning
  2. Antenatal and delivery care
  3. Full child immunization
  4. Health-seeking behaviour for pneumonia.

CATEGORY II: Infectious diseases:

  1. Tuberculosis treatment
  2. HIV antiretroviral treatment
  3. Hepatitis treatment
  4. Use of insecticide-treated bed nets for malaria prevention

CATEGORY III: Non-communicable diseases:

  1. Prevention and treatment of raised blood pressure
  2. Prevention and treatment of raised blood glucose
  3. Cervical cancer screening
  4. Tobacco (non-)smoking.

CATEGORY IV: Service capacity and access:

  1. Basic hospital access
  2. Health worker density
  3. Access to essential medicines
  4. Health security: compliance with the International Health Regulations.

Universal Health Coverage is Sustainable Development Goal 3 and it should not be achieved alone. It must be achieved with other Sustainable Development Goals.

UNIVERSAL HEALTH COVERAGE AS AN SDG

Sustainable Development Goals(SDGs) or Global Goals for Sustainable Development are a collection of 17 global goals set by the United Nations(UN) in 2015. The 17 goals are further broken down into 169 targets. Accomplishing these targets means achieving the 17 goals. The SDGs covers social and economic development issues including poverty, education, gender equity, urbanisation, health, hunger, climate change, environment and social justice.

The SDGs was developed to replace the Millennium Development Goals (MDGs). The MDGs had 8 goals, and it categorised the countries into developed and developing countries. The reason for introducing the SDGs is that countries would use it as a template or a road map for development. The SDGs do not categorise the countries, as all countries are undergoing different degrees of transformation. Thus, even the developed is still developing.

Universal Health Coverage as an SDG focuses on the good health and well-being of citizens of a country.  Progress has been made in the last 25 years before the commencement of SDGs, as preventable child death reduced by almost more than half.

 

UNIVERSAL HEALTH COVERAGE IN THE WORLD

Some countries in the world have started providing health services for their citizens even before the World Health Organisation was established. One of the ways these countries achieved this by providing health insurance schemes for their citizens. For example, Luxemburg in 1901 established compulsory health insurance for manufacturing and industrial workers. Universal Health Coverage does not involve health insurance alone. Germany has a good healthcare system and Nigeria can learn a lot from their success

GERMANY: The German health care system is divided into three major areas. These include the outpatient care, the inpatient care and rehabilitation facilities. The health care system in Germany are based on four basic principles which are

  1. Compulsory insurance: Every citizen must have a statutory health insurance provided that their gross earning is within a fixed limit. Anyone who earns more than the fixed limit can choose to be on private insurance.
  2. Funding through insurance premium: Insured employers and employees pay insurance premium. This premium is also supported by tax revenue surplus.
  • Principle of solidarity: In statutory insurance, citizens pay according to their income. According to the principle of solidarity, the rich that pay more support the poor that pay less so that at the end of the day, everyone receives the same quality of health care service.
  1. Principle of self-governance: The German government set rules and standard for medical care, but further organisation and financing of individual medical services is the responsibility of self-governing bodies which are composed of physicians, nurses, pharmacist and physiotherapist within the health care system

 

UNIVERSAL HEALTH COVERAGE IN AFRICA

Africa is developing and has a lot of problems. Africa has 12 years to achieve these goals and the current look of things, a lot still must be done. Some countries in Africa have recorded improvement, for example, Kenya ministry of health claimed to have recorded a decline in the death of children below five years from 74 per 1000 live births to 52 per 1000 live births and decline in infant death from 52 per 1000 live birth to 39 per 1000 live births since 2013. This is just the result of one of the indicators to measure progress of universal health coverage.

Rwanda has moved ahead as the country allotted 13.1% of her annual national budget to health in 2015. This is close to the prescribed 15% by the AU. Since 2015, there have been a decline in the percentage allotted to health in Rwanda, but it is still greater than that allotted to health in Nigeria.

Figure shows percentage of annual budget allocated to health in Rwanda

 

UNIVERSAL HEALTH COVERAGE IN NIGERIA

Nigeria, with a population of over 170 million needs strategic plans to achieve universal health coverage. To provide affordable health service for everyone in Nigeria, there is need to have at least a standard primary health care facility in every ward in Nigeria. According to the minister of health, this would sum up to about 10,000 primary health care facilities in the country within 12 years. There would also be needing to revitalise the secondary and tertiary healthcare facilities. These are nice mouth-watering feats to achieve. Every patriotic Nigerian would love to live to see the day all these would be achieved.

There is no hard and fast rule on how to achieve these goals, but it must be systematically broken down to achievable goals to encourage and facilitate their actualization. Attaining universal health coverage would involve identifying the problems that have plagued the healthcare system, providing a solution to those problems and improving on the achieved feats.

Figure showing the 2017 WHO summary of the Nigerian health system

 

PROBLEMS OF THE NIGERIA HEATHCARE SYSTEM

Some of the problems facing the healthcare systems are highlighted below

1. INADEQUATE FUNDING

The Nigerian health care system is poorly funded. The funds that are allocated favour the secondary and tertiary healthcare facility more than the primary health care facility. Though the secondary and tertiary healthcare facility provide relatively cheap health services compared to the private health facilities scattered around the country, the capacity of these healthcare facilities is small and must be augmented by adequate primary healthcare facility to cater for the population. Heads of state of members of the African Union (AU) agreed to AU health funding commitment which requires member countries to assign 15% of their annual budget to improving the health sector. This agreement was reached in 2001 at Abuja, but till date the highest Nigeria have ever allocated to health was 5.95% in 2012. The percentage allotted to health in the 2018 annual national budget is 3.9%; this is lower than that assigned in 2016 and 2017 which are 4.23% and 4.16% respectively

2. INADEQUATE STAFFING

Health facilities would not just be provided without having adequate workforce in the facilities. It is not news that even the tertiary health facilities are short staffed, not to mention the primary healthcare facility.According to the Medical and Dental Consultant Association of Nigeria (MDCAN), the current ratio of doctors to patient is 1:6000, that is to every 6000 patients, there is only one doctor. The MDCAN recommended that the acceptable ratio of doctor to patient should be 1:600.

3. INADEQUATE INSURANCE SCHEMES

The high rate of poverty in the country has only added to the problem of the country. The desire of a man that lives less than a dollar per day would be that he would be able to confidently walk into any healthcare facility and receive adequate healthcare services without having to pay too much out of pocket. Health insurance should be made compulsory for every citizen of the country. The health insurance scheme isineffective, and a lot of changes still must be made. Using university of Ibadan as an example, a matriculated student of university of Ibadan have access to affordable health service at the university clinic but medical student that cross to the university teaching hospital to continue their training usually must run down to the university clinic to access medical services when there is a teaching hospital in their immediate environment. If health coverage organised by a university in inadequate, what would we say of the country. Moreover, health insurance usually covers more of the formal populace that is the civil servants and other educated people that work for good private companies. The informal populace which forms majority of the Nigerian population know little or nothing about insurance scheme.

4. INADEQUATE KNOWLEDGE OF THE HEALTH SCHEME: Most people in Nigeria do not know about universal health coverage. A survey was carried out among the medical students in the University ofIbadan to verify this assumption. It is surprising that most of them do not know about the Universal Health Coverage. The statistics are thus

 

 

If medical students are not on health insurance and do not know much about health insurance, it can be inferred that a large percentage of the Nigerian population do not know about it.

 

PROPOSED SOLUTION TO THE PROBLEMS IN NIGERIAN HEALTHCARE SYSTEM

The problems of the Nigerian healthcare system have so far been identified, providing adequate and long-lasting solutions to them should be the focus. Some of the proposed solutions are

1. CAMPAIGN AND GRASSROOT ENLIGHTENMENT: Medical students have a big role to play in enlightening the people in the immediate environment about the universal health coverage but from the data gathered, medical students needs to be educated and enlightened first before they can enlighten others. Community funded health insurance could be adopted wherein members of the community pool resources to support their primary health care facility. For example, if the members of the university college hospital Ibadan community can have access to health insurance, it would be easier to communicate it to other people. Rwanda for example has used this method successfully. In Rwanda, every leader in each community is responsible for enrolling members of the community. He is also responsible for collecting or pooling funds within the community and allotting them to the primary healthcare facility in the community. This has resulted in 75% health coverage for people in Rwanda. This method of pooling resources is called Community Based Health Insurances (CBHI). Nigeria can adopt this method too. Imagine if every community in Nigeria could adopt this; sit would take little time to increase the percentage of people that are reached by the Universal Health Coverage.

2. REGULAR FUNDING: Government should be committed to funding the available healthcare facilities in the country. There should be increase in funds allotted to the secondary and tertiary healthcare facilities though the primary healthcare facilities should be the major focus as this would provide immediate easy accessibility to health service in every community. Funds would be primarily provided by government and should be augmented by funds from international donors and innovative financing schemes. Much of funds should go more to primary healthcare unit. Plans should be made on how the funding would be regular and consistent. There are different methods through which the government can use to make funds available for the health system. For example, Earmarking taxes on some goods: Taxes on goods like tobacco and alcohol should be set aside to fund the health system. Philippines for examples earmark 85% of the taxes on tobacco and alcohol to their healthcare system. These funds are used to enrol the poor into insurance scheme and to improve their primary health facilities.

Nigeria can also adopt this method to generate regular supply of funds to the primary healthcare facilities.

3. ADEQUATE STAFFFING OF HEALTHCARE FACILITIES

This should be addressed adequately especially in the primary healthcare facilities. There should be massive recruitment, training and support of rural-based health workers. There should be incentives and special benefits to encourage workers to stay in primary healthcare facilities in rural areas. Workshops could be provided to educate health assistance workers so that people in the rural areas can be informed. There could also be a law that mandates it for medical student to have their elective postings in primary healthcare centres in the country to augment the manpower available in the primary healthcare facilities.

4. AMENDMENT OF HEALTH INSURANCE SCHEME

Health insurance should be made compulsory for everyone in the country. There should be intensified campaigns to create awareness on the importance of insurance. Only a few numbers of people are currently on insurance schemes in Nigeria. Nigeria can learn and adopt Germany’s method where there is statutory insurance by being a citizen of the country. This will make it easy for those in the informal setting that is those that are not civil servants to benefit from the insurance scheme. Insurance should also be made compulsory. If insurance were to be voluntary, people with low health risk and people that can pay out of pocket without adverse effect on their standard of living would have no reason to reason to register. Those that would register would be people with high health risk and the effect would be that there would be insufficient funds to cover their health management thus making it ineffective.

5. INCREASED PUBLIC-PRIVATE PARTNERSHIP

Government should encourage partnership with private investors. Private investors would want to make gain and as such make health services more effective. Partnership encourages effective management of scarce resources. This would strengthen the health system and bring about cost effectiveness in the health sector. Government should make private partners invest more in primary healthcare as much more people can be reached though improvement of the primary healthcare services.

 

CONCLUSION

The aim of Universal Health Coverage is to provide good affordable healthcare services for every citizen of a country. Africa as well as Nigeria still has a long way to go in achieving and fulfilling the aims of Universal Health Coverage. Everyone deserves access to good health services without much financial hardship, but someone must pay for these services. This then calls for the active involvement of the Government, non-governmental organisations, private companies and individuals in promoting and sponsoring quality health services.

 

REFERENCES

  1. Oreh, A. (2017). Universal Health Coverage – Is Leaving No One Behind in Nigeria a Pipe Dream? [online] Pubs.sciepub.com. Available at: http://pubs.sciepub.com/ajphr/5/5/4/ [Accessed 22 July. 2018].
  2. Seye, A. and Arnold, I. (2015). Operationalizing universal health coverage in Nigeria through social health insurance. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698843/ [Accessed 20 July. 2018].
  3. (2017). Adewole: Nigeria is committed to Universal Health Coverage – THISDAYLIVE. [online] Available at: https://www.thisdaylive.com/index.php/2017/12/13/adewole-nigeria-is-committed-to-universal-health-coverage-2/[Accessed 25 July. 2018].
  4. org. (2017). [online] Available at: https://www.unicef.org/esaro/UNICEF_Rwanda_–_2017_–_Health_Budget_Brief.pdf [Accessed 23 July. 2018].
  5. World Health organization. (2018). Frequently asked questions. [online] Available at: who.int\suggestions\faq\en  [Accessed  27 July. 2018]
  6. World Health Organisation. (2017). Universal health coverage (UHC).[online] Available at: http://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(uhc)  [Accessed 26 July.2018]

 

Author: Moses Bamigboye

Read More

WORLD HEART DAY: THE IMPORTANCE, CARDIOVASCULAR DISEASE BURDEN, FAMSA’S ROLE AND THE ROLE OF THE GOVERNMENT.

THE HEART

The heart has been described over the years as the engine of life. From the moment it is created in a foetus, it continues to beat till the last moment of life. The heart being a muscular chamber, supplies blood and is the pump which controls the circulatory system. It is estimated that every day, the heart pumps blood through 90,000 kilometres of blood vessels.

 

WORLD HEART DAY

World Heart Day is a World Health Organization (WHO) recognized day that has been set aside to inform people around the globe about Cardiovascular Disease, the world’s leading cause of death which claims about 17.5million lives each year. World Heart Day is celebrated on 29 September each year.

 

WHY MARK WORLD HEART DAY?

 

World Heart Day being an initiative of the World Heart Federation aims at

  • Creating awareness about Cardiovascular Disease (CVD) which include stroke, heart failure, coronary heart disease and hypertensive heart disease.
  • Educating people on the need for controlling risk factors such as tobacco use, unhealthy diet, excessive alcohol intake, physical inactivity and obesity which help in preventing at least 80% of premature deaths from CVD.

It is estimated that 90% of CVD is preventable. Risk factor such as tobacco has been identified. Approximately 10% of CVD is attributed to tobacco smoking. Within two years of stopping smoking, the risk of coronary heart disease being a form of CVD has been found out to be significantly reduced. However, people who quit smoking by age 30 have almost as low a risk of death as never smokers.

High dietary intake of saturated fat, trans-fats and salt, and low intake of fruits and vegetables have been found out to be associated with increased risk of CVD. The World Health Organization attributes approximately 1.7million premature deaths from CVD to low fruit and vegetable consumption. Reducing intake of saturated fat has been found out to reduce the risk of CVD by 17%.

 

BURDEN OF CARDIOVASCULAR DISEASE

Cardiovascular disease remains the leading cause of death and disability worldwide accounting for about 17.5million deaths every year. CVD resulted in about 17.9 million deaths (32.1%) in 2015, up from 12.3 million (25.8%) in 1990. Of the 57 million global deaths in 2008, 36 million (63%) were due to Non Communicable Diseases (NCDs) and 17.3 million (30%) were due to CVDs. Nearly 80% of NCD deaths occur in Low – and middle – income countries (LMICs). Coronary artery disease and stroke account for 80% of CVD deaths in males and 75% of CVD death in females. Most CVD affects older adults. In the United States, 11% of people between 20 and 40 have CVD, while 37% between 40 and 60, 71% of people between 60 and 80, and 85% of people over 80 have CVD.

Cardiovascular is among the top three causes of death in Sub-Saharan Africa with about 210 daily deaths from CVD in South Africa. The challenge is that the prevalence of major risk factors has increased in the last 10 years.  Hypertension has been identified as the biggest single risk factor in Sub-Saharan Africa. The African region has the highest prevalence rate, 46% of adults aged 25 and above. The prevalence has been suggested to be increasing rapidly. The number of adults with hypertension in 2025 is predicted to increase by about 60% to a total of 1.56billion, with a disproportionate prevalence developing countries including Sub-Saharan Africa. 1 in 3 South African adults have hypertension and about 10% of the population over 15 years of age are pre-hypertensive. In the Sub-Saharan African region, 30% of adults over the age of 18 suffer from hypertension. In contrast with other CVD risks such as high BMI, the burden of hypertension is greater in lower income countries than higher income settings. Multiple risk factors positively interact to exacerbate CVD risks. Hypertension, for example, combined with unhealthy diets (high sodium and excessive alcohol intake) and lack of physical activity has a multiplicative negative effect on CVD mortality and disability-adjusted life-years (DALYs). In Sub-Saharan Africa, the prevention, detection, management and control of hypertension should now be regarded as a high priority. It is estimated that if the 10 – 20 million people who are believed to have hypertension in Sub-Saharan Africa were treated effectively, about 250,000 deaths would be prevented annually.

 

FAMSA’S OBJECTIVES

Federation of African Medical Students’ Associations (FAMSA) is a Non Governmental Body which has contributing towards the improvement of health in Africa as one of her objectives.

Having identified the rise in incidence of CVD in Africa, in marking this year’s World Heart Day, FAMSA aims at

  • Creating an awareness about CVD related deaths via various media platforms

The social media being a vital tool in disseminating information is being employed by FAMSA in staging a world class online campaign on the need to have a healthy heart. In line with this year’s theme of “My Heart, Your Heart”, the social media messages will preach sharing power via various ways. Other plans include gathering medical students together to display the need for a healthy heart by snapping with campaign posters and also forming a heart shape.

  • Educating the African populace about the possibility of reducing the risk of CVD

Studies have proven that about 80% of CVD risk can be reduced by lifestyle changes. FAMSA hopes to use the various campaign media to educate the African man on the need to engage in daily exercise, stop tobacco smoking, promote healthy diet and check his blood pressure regularly.

  • Identifying the risk factors of CVD and how they can be prevented

This campaign will aim at identifying risk factors with high prevalence in our community. In so doing, people who are at high risk are identified and educated about the need to put a stop to the identified risk factors or ensure adequate control as seen in diabetes mellitus.

 

ROLE OF GOVERNMENT IN REDUCING THE RISK OF CVD

The burden of CVD in Africa can be reduced if the African Government rises up to the increasing rate of CVD related deaths. Various measures that should be put in place include:

  • Creating a surveillance system to monitor CVD deaths and identifying those at risk of having CVD
  • Implementation of stringent tobacco control policy
  • The prevention, early detection, management and control of hypertension should be regarded as high priority.
  • Ensuring availability of diets that promote healthy heart and putting in place measures that limit the availability of diet high in fat, sugar and salt.
  • Putting in place strategies that control excessive consumption of alcohol
  • Promoting physical activity among the populace by creating an awareness on the need for it
  • Equipping the healthcare services available and provision of new and effective ones.
  • Making available healthy diet for school children.

 

CONCLUSION

Healthy heart is essential for healthy living. Ensuring a healthy heart begins with you as an individual. The risk of CVD related death can be reduced and it begins with you. The African government should rise up to the increasing rate of CVD related death. The message of ensuring a healthy heart should be preached to every individual. You and I should make a promise towards a healthy heart!

 

REFERENCES

Cooper RS, Rotimi C, Kaufman JS, et al.(1998) “Hypertension treatment and control in Sub-Saharan Africa: the epidemiological basis for policy. Br med J. ; 312:614-617. doi: 10.1136/bmj.316.7131.614 (Accessed 28th September, 2018)

Francesco PC, Michelle AM. (2016) “Cardiovascular disease and hypertension in Sub-Saharan Africa: burden, risk and interventions”. Intern Emerg Med.; 11: 299 – 305. doi: 10.1007/s11739-016-1423-9 (Accessed 28th September, 2018)

GBD 2013 Mortality and Causes of Death, Collaborators (2014). “Global, regional, national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990 – 2013: a systemic analysis for the Global Burden of Disease Study 2013”. Lancet. 385 (9963): 117 – 71. PMC 4340604. PMID 25530442. doi:10.1016/S0140-6736(14)61682-2. (Accessed 28th September, 2018)

Ibrahim MM, Damasceno A. (2012) “Hypertension in developing countries”. Lancet; 380:611 – 619. doi: 10.1016/S0140 – 6736 (12) 60861 – 7 (Accessed 28th September, 2018)

Kearney PM, Whelton M, Reynolds K, et al (2005). “Global burden of hypertension: analysis of worldwide data”. Lancet ; 365:217 – 223.doi:10.1016/S0140 -6736(05)70151-3 (Accessed 28th September, 2018)

Liesl Zuhlke (2016). “Why heart disease is on the rise in South Africa”. The Conversation Africa (Accessed 28th September, 2018)

Lim SS, Vos T, Flaxman AD, et al.(2010) “A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990 – 2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet. 2012;380:2224 – 2260. doi: 10.1016/S0140-6736(12)61766-8. (Accessed 28th September, 2018)

McGill HC, McMahan CA, Gidding SS (2008) “Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study”. Circulation. 117 (9): 1216 – 27. PMID 18316498. doi:10.1161/CIRCULATIONAHA.107.717033 (Accessed 28th September, 2018)

Seedat YK (2004). “Recommendations for hypertension in Sub-Saharan Africa”. Cardiovasc J S Afr. 15:157 – 158. (Accessed 28th September, 2018)

 

Authors: Odedara A. M. and Ogunfolu A. A.

Read More

PRESS RELEASE ON THE DEATH OF FORMER UNITED NATION SECRETARY-GENERAL AND NOBEL PEACE PRIZE LAUREATE – KOFI ANNAN

 

The Federation of African Medical Students’ Associations (FAMSA) is profoundly disheartened by the passing of former United Nations Secretary-General and Nobel Peace Prize Laureate Mr. Kofi Annan.

Kofi Annan, in full Kofi Atta Annan was born April 8, 1938, in Kumasi, Gold Coast (now Ghana); died August 18, 2018.

He served as the seventh Secretary General of the United Nations from January 1997 to December 2006. Annan and the UN were the co-recipient of the 2001 Noble Peace Prize. He was the founder and chairman of the Kofi Annan Foundation as well as chairman of the Elders, an international organization founded by Nelson Mandela.

Mr. Annan was the first black African to head the United Nations, was deeply respected by all who knew and worked with him. He left an unforgettable legacy through his work at the United Nations.

Of his numerous mind blowing works, it is worth noting that Mr. Kofi Annan worked on ending human rights abuses and also to combat HIV/AIDS virus especially in Africa. He began his new term as the UN secretary general in 1997; the outlook from the AIDS epidemic was bleak. Some 23 million people were living with HIV there were 3.2 million new HIV infections and access to life saving treatment was only available to a privileged few. Under his leadership in 2000, the UN Security Council adopted resolution 1308, identifying AIDS as a threat to global security.

Also, in 2000, at a time, when less than one billion dollars was invested in the AIDS response, he called for a war chest of at least 7-10 billion dollars for AIDS tuberculosis and malaria.

As UN secretary general, he spoke glowingly on gender equality including its role in development. According to him, no other policy is as likely to raise economic productivity or reduce infant and maternal mortality as well as improve nutrition including the prevention of HIV/AIDS. These were directed towards the improvement of health in Africa and the world as whole.

A highlight of Annan’s strides in office was his issuance of a five-point Call to Action in April 2001 to address the HIV/AIDS pandemic and his proposal to create a Global AIDS and Health Fund. He and the United Nations were jointly awarded the Nobel Peace Prize in December of 2001 “for their work for a better organized and more peaceful world”. A few of his strides in office include:

• Adoption of the UN’s first-ever counter-terrorism strategy,

• Involvement in the transition to civil rule in Nigeria in 1998,

• Launch of the “Global Impact” initiative in 1999 which has become the world’s largest effort to promote corporate social responsibility,

• Being responsible for certifying Israel’s withdrawal from Lebanon in 2000 and in 2006, his efforts contributed to securing a cessation of hostilities between Israel and Hezbollah.

• Also in 2006, he mediated a settlement of the dispute between Cameroon and Nigeria over the Bakassi peninsula.

While Under-Secretary-General for Peacekeeping in 1990, Kofi Annan facilitated the repatriation from Iraq of more than 900 international staff and other non-Iraqi nationals and also served as Special Representative of the Secretary-General to the former Yugoslavia and Special Envoy to NATO (1995-1996).

“Mr. Annan devoted his life to making the world a more peaceful place through his compassion and dedication to service. He worked tirelessly to unite us and never stopped fighting for the dignity of every person” (Nikki Haley).

Mr. Kofi Annan will be greatly remembered as a colossus of peace and justice

The Federation of African Medical Students’ Associations join the international community in remembering and acknowledging his remarkable service to the world.

May his soul rest in peace

 

 

Read More

ELIMINATING MALARIA IN NIGERIA BY 2030: A POSSIBILITY OR A MIRAGE?

INTRODUCTION

Malaria is a disease spread by the female Anopheles mosquito and is caused by a parasite known as Plasmodium. The mosquito carries the parasite and is where the parasite starts its life cycle. Once the parasites get into the human body, they travel to the liver where they mature. After several days, the mature parasites enter the blood stream and begin to infect the red blood cells. Within 48-72 hours, the parasites inside the red blood cell multiply causing the infected cells to burst open usually resulting in development of symptoms like chills, headache, vomiting, fever and so on. Malaria is not a communicable disease but can be spread without a mosquito example, through blood transfusions. The subspecies of Plasmodium include Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, and Plasmodium knowlesi.

Malaria remains the most important public health parasitic disease and a major global health problem with the greatest burden in Sub-Saharan Africa. Nigeria accounts for 25% of the world’s malaria burden. Apart from the health burden, the socio economic consequences are enormous such that it was part of the Millennium Development Goals and Goal 6C was to halt and reverse the incidence of malaria by 2015. Following the end of the Millennium Development Goals, the WHO member states, Nigeria inclusive, on 20th May, 2015 agreed to a new global malaria strategy for 2016-2030. The strategy aims to reduce the global disease burden by 40% by 2020 and by at least 90% by 2030.

 

 

STATISTICS

Nigeria is reported to have the enviable record of contributing about 25% of the world’s malaria burden, with approximately 51 million cases and 207,000 deaths reported annually while 97% of the total population is at risk of infection. In Nigeria, the disease is responsible for 60% of outpatient visits to health facilities, 30% of childhood deaths and 11% of maternal death. The financial loss due to Malaria annually is estimated to be 132 billion Naira in form of treatment costs, prevention and loss of man hours among other expenses, however it is a treatable and completely evitable disease.

 

 

 

 

 

 

 

THE JOURNEY SO FAR

In 2000, Nigeria joined other African nations, to initiate a more focused and calculated effort to reduce the burden of malaria. They agreed to set aside the 25th of April of every year to draw attention to the menace of Malaria and to drum up support for its elimination.

Consequently, the day was tagged “World Malaria Day”. The National Malaria Elimination Programme (NMEP) has implemented about three strategic plans. The first plan covered the period 2001-2005 and was developed after the African Summit on Roll Back Malaria to build partnership and garner political will. The second plan covered 2006-2010 and focused on vulnerable populations as the primary target groups for intervention that is, pregnant women, children less than five years and people living with HIV/AIDS. The third plan provided a road map for Malaria control in Nigeria. The current plan covers 2014-2020 and it aims to achieve pre-elimination and reduce Malaria related deaths to zero by 2020.

 

 

CHALLENGES

 

DRUG RESISTANCE AND TREATMENT FAILURE

Malaria drugs are meant to clear malaria parasites from the blood of an infected person and in the process diminish sources of infection in the community. Drug resistance, the ability of a parasite strain to survive and/or multiply despite the administration and absorption of drug given in doses equal to or higher than those usually recommended but within the tolerance of the subject, is a major challenge in the fight against malaria. Chloroquine used to be the drug of choice against malaria but chloroquine resistance which swept across endemic countries in the 1980s was the reason for treatment policy change that gave rise to the use of Artemisinin-based Combination Therapy (ACT) as the current drug of choice. ACT has played a major part in reducing the number of deaths due to Malaria over the past decade. However, Artemisinin-resistant Plasmodium falciparum has recently spread across large parts of Southeast Asia, and now threatens to destabilise Malaria control worldwide. Related to drug resistance is treatment failure. A failure to clear Malaria parasites or resolve clinical disease following drug treatment could be a function of non-patency and not necessarily drug resistance as not all cases of treatment failure is a function of drug resistance. Many factors can contribute to malaria treatment failure including incorrect dosing, non-compliance with the duration of dosing regimen, poor drug quality, drug interaction or misdiagnosis. The role of each of these in malaria treatment failures in Nigeria is not known and there is a need for a study in the effort to eliminate the disease.

 

 

 INSECTICIDE RESISTANCE

Anopheles mosquitoes are vectors of malaria parasites.Control of Anopheles mosquitoes relies on the use of Long-Lasting Insecticide Nets (LLINs) and Indoor Residual Spraying (IRS). This method has been implemented successfully in many countries. However, success is being impeded by the development and spread of insecticide resistant malaria vectors in Africa, which may compromise the use of these vector control strategies. Only 4 classes of insecticide (carbamates, organophosphates, organochlorines and pyrethroids) are available for IRS, whereas the use of LLINs depends exclusively on pyrethroids. In Nigeria, Anopheline vector resistance to DDT andpyrethroids have been reported. The emergence of pyrethroid and DDT resistance in the major Afro-tropical malaria vectors would haveconsiderable implications for the success of vector intervention and the monitoring of ongoing control programmes. Hence, there is a strong need for the development of appropriate tools to monitor resistance in field populations of Anopheline mosquitoes in order to benefit from the contributions of the appropriate use ofchemical insecticides in Malaria elimination in Nigeria.

 

 

GLOBAL WARMING AND CLIMATE CHANGE

Available data suggest that the temperature of the world is increasing, with the last decade recorded as having the highest temperature. This increase in global temperature mainly as a result of human activity, is known as global warming. Global warming changes the climate, and climatic factors play important roles in the spatial and temporal distribution of malaria. The relationship between climatic variables and malaria transmission has been reported in many countries. Malaria has been identified as one of the most climate sensitive diseases,with studies suggesting significant associations between temperature and malaria incidence. Relative humidity and rainfall have also been associated with malaria transmission. Climate change expressed through changes in temperature and precipitation influences habitat suitability and can potentially shift the geographical range of Malaria. Warmer temperatures accelerate physiological processes of the mosquito vector, leading to increased activity such as biting rate, growth, development and reproduction. Extreme temperatures may also decrease survivorship of vectors, leading to a convex relationship between temperature and mosquito performance. In particular, temperature plays a key limiting role on malaria at the edge of the altitudinal distribution of the disease in highland regions, where the parasite is not likely to complete development during the lifetime of its vector. Drivers of malaria control and elimination need information to guide vector control challenges in an era of climate changes. Therefore, there is work to be done in this regard.

 

 

 CONFLICTS, TERRORISM, INSURGENCY, INTERNALLY DISPLACED PERSONS AND MIGRATION.

Nigeria today is plagued by conflicts, terrorism, insurgency, migration and internally displaced persons. Virtually all regions ofthe country are affected with the northeast bearing the highest burden. The massive movement of non-immune people across areas infested with the malaria vector is one of the consequences of civil unrest. The malaria control situation is threatened by the impact of refugees, returnees, internally displaced populations, and natural disasters, i.e. flooding, that put added strain on an already weakened system from years of conflict and that may destabilize whatever gains that have been made. The situation is aggravated by an increase in population due to refugees, returnees and internally displaced persons. Accordingly, the country experiences exceedingly high malaria transmission intensities with inherent high morbidity and mortality rates. Every effort is needed to understand the dynamics of this issue in the effort to control and eliminate malaria.

 

 

POLITICAL WILL, LEADERSHIP AND FUNDING

An important action for mobilizing and encouraging governments to continue to support malaria programmes is to generate political will. Since 2000, there has been an increasing political drive to eliminate malaria. The transition from sustained control, once achieved, to elimination demands a shift in focus. It requires significant national commitment, and sustained investment and financial support. To maintain a malaria-free status, a country must show that it has the necessary political will and vision, has created the required legislative and regulatory framework and has adequate financial and administrative resources, personnel and technological capacity.Effective and sustained control is an important prerequisite for elimination. The most important challenge in battle against malaria in Nigeria is the lack of political will. Until this is overcome, achieving elimination may be a mirage. When there is the desired political will, effective leadership will emerge to coordinate elimination efforts. Political leaders should muster the political will to create an enabling environment within which strategies to support elimination would operate: appropriate research, a well-functioning health system, community participation, sustainable financing, a national and regional legal framework, and political stability are all crucial.A certain level of financial support is also required to achieve elimination, prevent resurgence and support larger goals of regional elimination and global eradication.

 

 

SUCCESSES

Nigeria has recorded a 35% decline in malaria cases in five years with only 25% of children under the age of 5 testing positive for the disease in 2015 compared to 40% in 2010. The result of the 2015 Nigeria Malaria Indicator Survey (NMIS) released by the National Malaria Elimination Programme (NMEP), National Populations Commission and National Bureau of statistics show a marked decrease in prevalence of the disease among children under five, and major improvements in prevention and treatment. The decrease corresponds with expanded malaria prevention interventions. There has been considerable progress in the control of malaria over the years. A 61% increase in the ownership of insecticide treated nets among households was observed from 2008-2015. The percentage of children who slept under a mosquito net increased from 2008-2015by 38%

In 2010, only 12% of children took ACT. However, over five years, this percentage increased to 38%.

There has also been reasonable progress in the percentage of pregnant women who sleep under an insecticide treated net, with a 44% increase in percentage from 2008-2015. Furthermore, there was a 32% increase in the percentage of pregnant women who took anti-malarial medication during their first pregnancy from 2008-2015.

 

 

THE WAY FORWARD

 

The past decade has seen considerable progress in reducing preventable mortality in low- and

Middle-income countries (LMICs), as evidenced by the 50% reduction in childhood deaths,

25% reduction in malaria cases, and the World Health Organization (WHO) certification of

four countries as malaria-free. Nigeria can be one of the malaria free countries as well.The Lancet Commission on Investing for Health determined that if the right investments are made in scaling up existing health interventions and in developing new prevention, treatment, and surveillance tools, the world could achieve a “grand convergence” by 2035, with preventable deaths reaching universally low levels and economic benefits exceeding cost by a factor of 9–20. Historically, LMICs that have aggressively adopted new tools have seen an additional 2%-per-year decline in child mortality rates compared with non-adopters. However, adoption alone of new and existing tools with poor implementation will have little impact on disease transmission in the long term. Malaria control and elimination demand new tools and technologies as well as better mechanisms for maintaining detailed surveillance and spatial decision support systems (SDSS) that improve reporting and timeliness of activities. The majority of new products currently under development are in partnership with Product Development Partnerships (PDPs) such as the Program for Appropriate Technology in Health (PATH); Malaria Vaccine Initiative (MVI), Medicines for Malaria Venture (MMV), the Innovative Vector Control Consortium (IVCC), the Foundation for Innovative New Diagnostics (FIND), Novartis Institute for Tropical Diseases (NITD), Drugs for Neglected Diseases Initiatives (DNDi), and the European Vaccines Initiative (EVI). There are over 100 products in the research and development pipeline that will benefit regional elimination and global eradication goals. These range from innovative diagnostics, medicines, vaccines, and vector control products to improved mechanisms for surveillance and targeted responses.

 

Seasonal Malaria Chemoprevention (SMC)

SMC involves administration of treatment on a monthly basis to coincide with the annual peak in malaria transmission. This intervention is highly effective in reducing the incidence of clinical malaria and anemia in young children, and, in 2012, WHO recommended implementation of SMC for children under the age of five in areas of the Sahel sub region of Africa with highly seasonal transmission. This recommendation is now being implemented increasingly in countries of the Sahel. Although less extensively researched, and not yet recommended by WHO, evidence suggests that SMC is as effective in older children.

 

Vaccines

Vaccines are generally classified into three approaches: Pre-erythrocytic vaccines aim to prevent blood-stage infection; blood-stage vaccines aim to clear parasitaemia and prevent clinical disease; and transmission-blocking vaccines aim to prevent infection of mosquitoes and interrupt malaria transmission in populations. There is a growing appreciation that vaccines combining multiple targets and stages will be required for achieving and sustaining elimination.

The development of effective malaria vaccines has been a major goal of the malaria research community for many decades. In 2006, the global Malaria Vaccine Technology Roadmap established the goal of developing an 80%-effective vaccine against P. falciparum malaria by 2025 that would provide protection for longer than four years, with an interim landmark of a 50%-effective vaccine of one-year duration by 2015. The new Technology Roadmap updated in 2012 outlines that by 2030, vaccines should be developed that provide at least 75% protective efficacy against clinical malaria, reduce transmission of the parasite, and can be deployed in mass campaigns. Because of the complex life cycle of the Plasmodium parasite, host immune response efforts have been focused most recently on the pre-erythrocytic stage of infection to protect against the early stage of malaria infection and thereby block disease progression to red blood cells and clinical malaria. RTS,S, a pre-erythrocytic vaccine for the prevention of clinical P. falciparum malaria in children, is the first vaccine to successfully complete a Phase III clinical trial. The vaccine has recently been approved by the European Medicines Agency, and WHO was imminently expected to make the first malaria vaccine policy recommendations. The trials, conducted in African children, demonstrated a vaccine efficacy for clinical malaria of 50% in children aged 5–17 months old but only 30% in infants, the target population. While RTS,S demonstrates that a malaria vaccine is possible, an ideal candidate to support global eradication efforts would need to have a higher efficacy .

Paraguay was recently declared malaria free by WHO. From 1950 to 2011, Paraguay systematically developed policies to control and eliminate malaria. A five year plan to consolidate the gains, prevent re-establishment of transmission and prepare for elimination certification was launched in 2011. Activities focused on robust case management, engagement with communities, and education to make people aware of ways to prevent malaria transmission. Dr Risintha Premaratne of Sri Lanka also said “Sri Lanka became a malaria free country by eliminating the Parasite and not the vector” He also said the principle strategy used as keys to Sri Lanka’s success are vector control, access, surveillance and treatment.

 

 

CONCLUSION

Like every other issue plaguing Nigeria, it is not impossible to completely eliminate Malaria by 2030. However, lack of political will, poor leadership, corruption, poor sanitation practices in Nigeria using Irefin as a case study and many other challenges to malaria elimination, it is safe to say that except drastic measures are put in place to tackle these challenges, malaria elimination by 2030 remains a mirage.

 

REFERENCES

 

  1. Aribodor D. N., Ugwuanyi I. K., and Aribodor O. B., “Challenges to Achieving Malaria Elimination in Nigeria.” American Journal of Public Health Research, vol. 4, no. 1 (2016): 38-41. doi
  2. Chukwuocha UM (2012) Malaria control in Nigeria. Primary Health Care2:118.doi: 10.4172/2167-1079.1000118
  3. Dawaki, S, Al-mekhalfi Ibrahim, Atroosh, Abdulsalam (2016) Is Nigeria winning the battle against malaria?. Prevalence, riskfactors and KAP assessment among hausa communities in Kano state. Malaria journal, 15,351
  4. Health think team, malaria status in Nigeria. Available at https://Healththink.org/malaria-in-nigeria-where are we now/ Accessed 14th July 2018
  5. Hemingway J, Shretta R, Wells TNC, Bell D, Djimdé AA, Achee N, et al. (2016) Tools and Strategies for Malaria Control and Elimination: What Do We Need to Achieve a Grand Convergence in Malaria? PLoSBiol 14(3): e1002380. doi:10.1371/ journal.pbio.1002380s
  6. The Guardian News – Nigeria records 35% decline in malaria cases. Available at https://guardian.ng/news/nigeria-records-35-per-cent-decline-in-malaria-cases/ Accessed 14th July 2018

 

 

FRANCES CHUKWU

4th year medical student,
University of Ibadan,
Nigeria.

Read More

32nd FAMSA General Assembly and Scientific Conference

FAMSA GA is the annual general assembly of member medical student associations of FAMSA from all around Africa. This year’s edition is the 32nd of its kind and will mark the 50th anniversary of the association. To celebrate FAMSA’s historic anniversary, University of Ibadan Medical Students’ Association (UIMSA) http://uimsa.org.ng will be hosting other medical students from all over Africa and the world as this edition will also feature a scientific conference themed “Repositioning healthcare in Africa for Sustainable Development”.

The 32nd FAMSA General Assembly and Scientific Conference will bring together young vibrant minds as well as professionals and relevant stakeholders in both the public and private sectors from across Africa and beyond to discuss ideas and initiate steps to position Africa on the path to sustainable development in health and by extension in every other sphere of human development. The conference will feature keynote addresses, plenary sessions, workshops, trainings, hackathon sessions, and scientific presentations on carefully selected subthemes all related and contributory to our goal of repositioning healthcare in Africa for Sustainable Development.

For more information about the general assembly, kindly visit http://famsaga2018.com

Read More

A BRIEF INTROSPECTION INTO THE RELEVANCE OF MENTAL HEALTH IN TOTAL HEALTH

The mind is the embodiment of mental health. It houses, controls and refines the faculties of thoughts and memories in a finite balance so that to the outside world, everything would put on a normal, conforming and orderly outlook. More so, the mind’s conduct is the weighing scale for gauging the extremes and normality of mental health which is part and parcel of total health as rightly exemplified and postulated by the World Health Organization (W.H.O) in 1948.

However, it is worth remembering that right from the time of wearing figs and hides to the inception of concrete scientific philosophies, art, industry and innovation; the perception of mental health has been muddled up in myths and obscurity.

Why? We simply have discredited the sovereignty of the mind over the body; that there is an insoluble alignment between the physical body and the mind. A healthy mind represents a healthy body and vice versa. The realms are inseparably interwoven. It’s the subliminal reason behind why some corporeal disease elicit co-morbid mental illnesses too e.g. HIV and Dementia.

Thus, we cannot sit back to keep reciting endless details and facts. The way forward is to know, examine and accept that Health in its entirety is incomplete, bland and vulnerable to implications without a sound and bright mental stand.

This is the truth, the whole truth and nothing but the truth.

Pat Ashinze.
College of Health Sciences,
University of Ilorin, Nigeria

Read More

NO HEALTH WITHOUT MENTAL HEALTH

‘Mental illness is nothing to be ashamed of but stigma and bias shame us all’- Bill Clinton

Individuals with good mental health are described as being in a state of well- being. Positive mental health includes emotion, cognition, and social functioning and coherence. (WHO: 2009). Mental illnesses present themselves in varies forms from anxiety to suicidal thought, affecting other aspects of life such as health, social life and work.

A psychiatrist is a doctor, as much as an endocrinologist is and their services are as accessible too. However, for a diabetic patient, it’s much easier to seek help compared to a mental illness patient. When we think about health we tend to separate mental and physical health, forgetting that mental health controls our physical health and vice versa. Anxiety is one well known mental illness. Innumerable people have been anxious for a few seconds at least once in their lives. It is associated with, increased heart rate, chest pain and restlessness. A continuous state of anxiety can lead to increased chances of acquiring various chronic physical illnesses such as heart attacks, diabetes and a weakened immune system; illnesses that can be prevented if the core, the mental illness is treated. Furthermore, according to data from the World Health Organization (WHO), depression is the leading cause of disability worldwide. Not only does a mental illness affect body but also affects various aspects of life such as the quality of work leading to economic losses.

For many years, people focused on genetics and neurotransmitters as being the major cause of mental illnesses, where this is true, recent studies have identified that the environment has a great impact on mental health. The general breakdown of causes of mental disorders is;

  • Biological; genetically inherited, brain defects or infection by certain bacteria or viruses
  • Psychological; emotional/ physical/ sexual abuse, trauma, family violence
  • Environmental; death of a loved one, substance abuse, romantic failures

Everyone experiences days where they are low or upset but a few surpass the fine line and develop a more serious mental illness. The normalization of some mental health disorders has desensitized us from it severity. ’I feel depressed’, ‘I just want to kill myself’- these are phrases we say or hear often when people are low or stressed. It has become so common that we can’t identify when people are actually suffering from the condition. Depression isn’t merely a feeling; it is a struggle. A fight every day to try and find reason for existence.

For several years there has been a negative attitude towards mental illnesses in some cultures and societies encouraging stigma towards those who are courageous enough to admit they have a mental illness. Despite one out of four people suffering from a mental illness, many remain undiagnosed due to the fear of discrimination and are unable to seek assistance despite there being many several professionals present. Sadly, it is still associated mental illness with curses, evil spirits and witchcraft in some societies. The ‘taboo’ is more prominent in African cultures. For so long mental health disorders such as anxiety and depression have been considered ‘white man’ diseases.

Patients who resist seeking attention from professionals tend to ‘self-medicate’ using other methods such as substance abuse and self-mutualisation. These mechanisms provide temporary relief from the uncomfortable symptoms but eventually place the user at risk of mental health illness. An area of the brain known as the hippocampus that is associated with emotion, stress control and long term memory gets impaired, making it that much harder for a patient to recover during treatment. On one hand people take drugs to escape depression, anxiety while on the other hand there are those taking drugs just for recreational purposes, therein resulting in self-inflicted mental health conditions. Patients with both a substance abuse problem and mental illness are said to have a co-occurring disorder.

In some cases, patients from low-middle income countries and regions, willing to seek assistance are unable to do so due to the lack of resources such as mental health services and human resources (psychiatrists, psychiatric nurses, psychologists, etc.). 800,000! That is the estimated number of people that commit suicide annually between the ages of 15-29 globally according to the WHO, rate being higher in men more than women. This is because women are more open to seeking help or discussing their issues with others compared to the men. Furthermore, having a combination of mental illnesses increases the likelihood of suicide attempts.

Mental health is the fundamental basis of a good healthy community and therefore deserves a significant amount of attention rather than prejudice. Everyone has a part to play in the mental health of family members, friends and communities health by being more mindful and attentive to them. As a society we should create an environment where an individual is comfortable enough to express their feelings preventing progression of their condition.

‘We need to be allowed to fall apart’ – Selena Gomez

Wanjiru Ndumu
Sunaina Bains

 

Read More

AN AFRICAN CHILD’S VIEW OF MALARIA

The average African child has heard of malaria countless times. It probably comes to mind when a friend in school runs a temperature,  a sibling vomits or when a relative complains of stomach pain.

For *Fred, he did not consider malaria as a life threatening disease. It is only when his primary six teacher told him that their relative died of malaria that he saw the gravity of the disease.

He didn’t understand why someone would die of malaria because back at home, mum had a drawer full of drugs that was given to everyone every year’s quarter as treatment for malaria. At the time, Malaria never meant anything more than vomiting and fever.

Years ago, grandma had warned him to stop taking oil, papaya, orange, tomatoes and basically every other fruit that even had a splash of orange, yellow or red colors as they caused Malaria. At home, he would have sleepless nights due to the buzzing of mosquitoes and the painful stings they’d give.

When He got into Secondary school, the Nigerian Government gave out mosquito nets to all students in Federal Unity Colleges as part of their programs to free the country from the bondage of Malaria. After using the net, he noticed that he could sleep peacefully most nights without the buzzing or biting of the mosquitoes. His friend would cover himself with his mosquito net like a blanket. He got a high fever a few days later and was diagnosed with Malaria.

Later on, they had a class on Malaria. They learnt that its method of transmission is through a mosquito called the female Anopheles mosquito. They were also taught that mosquitoes have various species such as Anopheles, Aedes and Culex. Their teacher added that the causative agent, the plasmodium, has different species too; falciparum, vivax, malariae and knowlesi. The teacher had also mentioned passively that the name Malaria was adopted from Latin, meaning ‘bad air’.

On his return home for the Christmas holidays, he couldn’t help but notice that all the windows and doors in the house had mesh on them. In the house, all beds had nets dangling from the ceiling and were all well tucked in. The next morning, he noticed that the compound looked different and that the place where the weeds had grown wild looked almost as flat as the grass he played on in school.

Even the little body of water that was usually left stagnant days after heavy rains was nowhere in sight. Mum said that she had made dad do the clearing after they had been given a talk in church on Malaria prevention. They had been taught that stagnant water and long grass are breeding grounds for mosquito larvae.

That evening as he went to buy groundnuts for his mum, he noticed that some women had used the mosquito net as fences for their farms. When he asked his mum about this. She told him that the nets were being used improperly. She then said that Malaria could be defeated by using the mosquito nets in houses and not in farms and carefully discarding empty containers. She also insisted on the importance of the community adhering to the Saturday morning cleanup of bushes and surroundings.

Fred understood Malaria and worked to have his community educated on how Malaria is transmitted and how it can be treated. He now wishes for a world free of Malaria and always sleeps under his mosquito net.

(*: not the real name).

By Archibong, Abasi-Ifreke Aniefiok (400 level)
University of Uyo Teaching Hospital, Uyo.
Nigeria.

 

Read More