NAFDAC suspends use of Nigerian government’s ‘substandard’ HIV drug

The drug was deemed substandard by persons living with HIV.
The National Agency for Food and Drug Administration and Control, NAFDAC, has suspended the use of Tryonex, a brand of Antiretroviral, ARVs, medicines in the country. This was due to concerns expressed by Treatment Action Movement, TAM, a coalition of HIV activists in Nigeria and other similar organisations.
Distributed under the Federal Government’s National HIV/AIDS program, Tryonex is a local brand of ARV medicine produced byTryonex Nigeria Limited, a Lagos-based company, with funding from the Millennium Development Goals, MDGs, funds through the Federal Ministry of Health. It contains Zidovudine, Lamivudine and Nevirapine. The latter of the three is no longer accepted for use by the World Health Organisation but is still in circulation in Nigerian hospitals.
In July 2013, the Director General of the National Agency for the Control of AIDS, NACA, John Idoko, confirmed in an interview with PREMIUM TIMES that Nevirapine was still in circulation in Nigerian hospitals but would be gradually phased out.

Doctor’s Recommendation: 11 tips for healthy 2014

The President of the Nigerian Medical Association (NMA), Osahon Enabulele, has said Nigerians can live better and healthier lives in 2014 if basic principles are adhered to.
Speaking in an interview with PREMIUM TIMES, Monday, Mr. Enabulele suggested 11 healthy lifestyles Nigerians should adopt in the New Year. Below are his recommendations.

1. Visiting their licensed Medical/Dental practitioner for medical check up, at least once in six months.Many Nigerians are known not undergoing medical checkups. Many have blamed the habit of not seeing the doctor except when critically ill on financial constraint. Mr. Enabulele, however, says it cost very little in government hospitals and is more cost effective compared to when one completely breaks down.  “Visiting their licensed Medical/Dental practitioner for medical check up, at least once in six months will do them greater good”, he said.
2. Eating healthy balanced diets at least thrice a day.Again, many Nigerians eat mostly carbohydrates, with rice and garri being the main dishes in a lot of homes cutting across social strata.This explains the prevalent stunted growth in many children and teenagers which they carry over into adulthood, resulting in less productive lives. The NMA President says eating healthy balanced diets at least thrice a day will bring about better health. Balanced diets contain carbohydrates, protein, minerals, vitamins and oil. They can be found in many of our food produce yet they are often overlooked.
3. Eating fresh fruits and leafy vegetables.Fruits and fresh leafy vegetables are quite inexpensive and readily available. Yet, the Nutrition Society of Nigeria says this is not a habit that Nigerians have imbibed. When taken regularly, they will keep the doctor’s needles away all through 2014!
4. Having regular exercises at least 15 – 30 minutes twice a day or a minimum of 3 – 4 days in a week.This is yet another lifestyle that is uncommon among Nigerians as confirmed by the Nutrition Society of Nigeria. Sedentary lifestyle is rife and is responsible for many ailments such as cardiovascular diseases that are ravaging the country. Mr. Enabulele says having regular exercises at least 15-30 minutes twice a day or a minimum of three to four days in a week will keep Nigerians fit, healthier, and more productive in the New Year.
5. Avoiding risky social habits like smoking, heavy drinking and drunk driving.Social habits such as smoking and heavy drinking, researchers note, are veritable sources of untimely death and poor health. Avoiding such risky habits particularly smoking, heavy drinking and drunk driving, Mr. Enabulele said will keep the body in one piece all year long.
6. Allotting time for relaxation.Nigerians don’t rest especially those in commercial hubs such as Lagos! Lack of relaxation is one of the major causes of the high rate of hypertension in the country. Thus, creating time to rest will prevent the body from breaking down and wearing out fast. Rest can come in the form of good sleep.
7. Avoid quacks who impersonate licensed medical/dental practitioners.In recent times, in order to cut cost, many Nigerians visit ‘special nurses’ and quack doctors who play the roles of medical doctors when ill. Many of these quacks have been discovered to be dropouts of nursing or medical schools. Staying away from these quacks who impersonate licensed medical/dental practitioners will help you stay alive in 2014.
8. Verify the status of any doctor before consulting with him/her for treatment.The emerging threat of fake doctors in the country is real. While the government, Nigerian Medical and Dental Council of Nigeria (MDCN) and NMA aim to fish out these fakes doctors, you should verify the status of any doctor before consulting with him/her for treatment.
9. Get prescriptions of medicines from licensed pharmacists, doctors, or dentists.Self medication is fast becoming a norm among Nigerians. Many Nigerians buy these drugs from hawkers in buses and along the roadside. To stay alive in 2014 and be more productive, get prescriptions of medicines from only licensed medical/dental practitioners so as to avoid complications.
10. Promptly visit a licensed medical/dental practitioner when ill.Studies so far in the country indicate that when ill, many Nigerians visit traditional healers first. They only go to hospitals when their condition deteriorates. The NMA President warns Nigerians should desist from this habit.He says “by promptly visiting a licensed medical/dental practitioner when they fall ill, Nigerians will fare even better in the new year”.
11. Appreciating stress limits and avoiding situations that push beyond the limits.Everyone has different stress threshold but many people are yet to discover theirs, hence, don’t know when to stop or rest. But knowing and appreciating your stress limits through accepting it and avoiding situations that push you beyond your stress limits can help you live a healthier life in 2014.

INVESTIGATION: How Nigerian health officials connive with hawkers to steal, counterfeit mosquito nets

Even as malaria remains prevalent in Nigeria, the counterfeiting of anti-mosquito nets remain on the increase, exposing more citizens to the deadly effects of malaria.
Despite repeatedly receiving anti-mosquito nets, Remi Olatunde knew next to nothing about deploying or maintaining the malaria-preventive covers. When she got new ones from the hospital or shops, the nurses or sellers had no useful information to help her. Each night, she set the nets up her way, and not being able to write or read instructions, she ended up exposing herself and her children to deadly mosquito stings.
So when she gave birth this year, and was given another net at the Mascara Primary Health Centre, Ketu, Lagos, Mrs Olatunde pressed a nurse for clear instructions on how to use it.
The nurse asked her to leave the net outside for an hour before setting it up.
“All I was told is hang it on the ceiling and enter under it in the night, she didn’t tell me how to set it up” she recalled recently, speaking in Yoruba. On how to clean the net when soiled, the nurse advised her to wash it the way she washed her baby’s clothes.
That night, her toddler nearly died, gasping for hours to breath inside the net that appeared over-treated. Mrs Olatunde managed to pull the kid to safety in time, ripped off the net and ended with terrible skin rashes that lasted over a week.
The net that almost landed the Olatundes in trouble may have been one of the millions counterfeited by crooked dealers, who, in connivance with dubious government officials, steal government-treated nets and replace them with fake stocks to avoid detection.
Months of investigation by PREMIUM TIMES has shown the risk faced by millions of Nigerians in using covers that should protect them from malaria, but that are increasingly hazardous as many are counterfeited by hawkers in a large-scale illicit trade.
Without adequate control and monitoring by the authorities, more and more vendors have joined the trade, buying the free products cheaply from government storekeepers and selling them to millions of unsuspecting Nigerians, our investigations show.
When the government occasionally clamps down on the network, like a recent jailing of two health workers, sellers not wanting to allow the illicit markets die, resorted to importation and purchase of fake mosquito nets which they pass off as treated and approved.
The nets get to the public more than those provided by the government, as not only are the counterfeiters more accessible to Nigerians than health officials, they also produce what passes as “exact” same nets distributed by the federal government. The difference between the genuine and the fake nets can hardly be detected on the package as the counterfeiters produce nets with NAFDAC registration numbers got from original treated mosquito nets.
Crooked and hazardous market
There are two types in this category of counterfeited products: those bearing the FG’s nets with the embargo “not to be sold” and those without it, but having original NAFDAC registration numbers.
“We produce these two types because some people prefer buying the ones with ‘not to be sold’. They feel that is the original one from government,” one dealer, Chibuzor Chimaroke, told a PREMIUM TIMES reporter who posed as a prospective partner.
“Other people especially the educated people will not buy any net with ‘not to be sold’, so the other type is meant for those kind of people. We make sure it has NAFDAC numbers and our own manufacturers use authentic NAFDAC numbers so you don’t need to be afraid if you buy from us,” Mr Chimaroke said.
A 35-year-old single father to five children from different mothers, Mr. Chimaroke is a secondary school dropout that has made good money running illegal businesses. He imports most of his own fake nets from China and gets a few from Upper-Iweka road, Onitsha. He is popularly known as “Chi Square” around Alaba International Market, a commercial hub in Lagos state, renowned for counterfeited products in Nigeria.
Indeed, samples of the nets which Mr. Chimaroke showed PREMIUM TIMES bore “genuine” National Agency for Food Drug Administration and Control (NAFDAC) registration numbers when the numbers were sent to the agency for confirmation. Not only that, when compared with some of the government’s original nets, officially called Long Lasting Treated Insecticide Nets, LLINs, there was no obvious difference when the packages were compared.
Some of the mosquito nets we sampled in markets within Lagos, Kaduna, Abuja and Kogi states, tallied with the NAFDAC numbers Mr. Chimaroke’s products carries.
In a booming trade that involves a network of dealers, unlike Chimaroke, who produces fake nets with “original” registration numbers, Nnamdi, popularly known as Fine Boy- still in Alaba market, until recently, got his supplies from government officials and even health workers from different parts of the country.
This partly explains why many of the government designated hospitals are frequently out of stock of the live-saving nets.
Nnamdi said he re-strategized after some of his suppliers were nabbed. Trusting he was opening up to a co-dealer, he recounted how one of his government suppliers, who was caught in June 2011 in Asaba Delta state, was charged to court and sentenced in July this year.
“This has affected my business as my other government suppliers are recoiling. I have no choice now but order from Onitsha,” he said.
The two suppliers he was referring to are Mike Okonkwo and Tracy Finecountry, who were sentenced in July to 24 years imprisonment. Mr Okonkwo was head storekeeper while Ms Finecountry was his assistant. They had stolen 100 balls of treated mosquito nets valued at six million naira under the custody of Millennium Development Goals office Delta state, an offence punishable under section 390 (9) of the criminal code.
Among the products sold by Fine Boy, which he buys from Onitsha, include Dolphin Net, PermaNet 2.0 and Long Lasting Insecticide Nets. The Dolphin Net comes in a blue nylon pack and has no name, no NAFDAC registration number, no manufacturing date, expiration date or batch numbers which all original and certified nets ought to have.

Real PowerNet
In the case of PermaNet 2.0, which bears A5-0415 as its registration number, NAFDAC records indicate the number belongs to PermaNet 3.0 treated bed net and not PermaNet 2.0.
The fact that even government-distributed nets do not have registration numbers complicate the situation. That was confirmed by Adeline Osakwe, Director, Pharmacovigilante at NAFDAC.
Fine Boy, and the likes, have since cashed in on that too. “Except you tell anyone or the nets are taken to a laboratory for testing, nobody can ever know they are fake,” he confided, seeking to convince the reporter to do business.
The widening network
The counterfeiters are spread across the country, but some of the most brazen dealers were found to be in Onitsha, Anambra state and Port-Harcourt, Rivers state. There, even inquiries as a prospective marketer, must go with a deposit fee.
“This way, we are certain you want to buy from us and not waste our time” one dealer, Ufuoma Odogu, in Port Harcourt, said.
Mr. Odogu is one of the major suppliers to other dealers in Port-Harcourt, Aba, Onitsha and Owerri. His operations are in two categories: purchase and resale of original nets stolen from government stores, and importation and sales of fake nets.
“We have our people who work in hospitals and other government offices who get us the real product but at cheaper rate. In order not to be caught, we give them exactly the same number of nets (fake products) more like an exchange which they keep with the original in their stores,” he disclosed.
With such an exchange, dealers pay far less, Mr Odogu said.
Nets distributed by the government should go for N6 million for 100 balls were they to be sold. Depending on the brand, one ball can contain from 30 to 100 nets.
“When we buy the real and replace with fake, we don’t pay up to N1.5million for those 100 balls. This type is more convenient. But if you buy without restocking (with fake products), it is at least N3 million,” Mr. Odogu said.
Depending on the brand quality -government supplied or fake – marketers can net between N3 and N6 million for a ball of net they retail.
Like other racketeers in the fake net business, Mr. Odogu gets his products from China and supplies unsuspecting chemists and pharmaceutical stores as well as dealers who in turn resell to retailers.
“When you come on board fully, you will be able to tell the difference between the real one and the other type” he assured the reporter, who again, posed as a prospective partner.
But one of the many signs between the two types, Mr. Odogu’s assistant, who gave his name as Kenny, said, was with the washing and skin reaction on the user.
“Even if you dry it (the fake) for 24 hours under a cool shade the way it ought to be done, it will still itch you and give you skin and other health reactions,” Kenny said.
The net will also not last four years as expected. “This way, people will have to buy more nets and you will remain in business”.
The skin reaction is what the Olatundes and their toddler experienced that night.
The explanation by Mr Odogu’s assistant about skin effect somewhat confirmed explanations by experts on widespread complaints about skin reaction.
The Director, Global Malaria Programme, of the WHO, Roberts Newman, had told PREMIUM TIMES that such prolonged reaction could only occur if something was wrong with the specific brand of nets.
He called the trade of counterfeited nets a “crime against humanity”. “The skin rashes ought not to last long except there is something actually wrong with the net,” he said.
Many brands, many names
Other brands of nets in the market include Shielded Mosquito Net and So Fine Treated Net. NAFDAC however confirmed both nets to be fake.

Fake So Fine net
The shielded Mosquito Net with a brand payoff: “…durable lasting net even after twenty washes” bears the NAFDAC registration number 01-0877 and has the manufacturing address Wits 2050, Johannesburg, South Africa.
When the Pharmacovigilante Unit of NAFDAC was contacted with the details, the registration number 01-0877 was said to belong to Indomie Instant Noodles, while the name Shielded Mosquito Net doesn’t exist in NAFDAC’s records. The other net, So Fine treated net’s registration number 01-0878 actually belongs to Tehado Table Water while the name So Fine treated net doesn’t exist in NAFDAC’s records as well.
Also, all efforts by PREMIUM TIMES to locate the address of Shielded Mosquito Net was futile as the address very close to it is that of Witwaterstand University, South Africa which is: Private Bag 3, Wits 2050, South Africa. The net’s address in essence is non-existent.
One of the most counterfeited nets our findings indicate is the PermaNet with NAFDAC number 04-7508. While both the original and fake have 16458 as their batch numbers, the genuine was produced on 03/2013 and would expire on 03/2017, the fake on the other hand was supposedly produced on 10/2008 with its expiration date indicating 10/20.
Every net lasts for a maximum of four years before it expires or a maximum of 20 washes.
Malaria still a burden in Nigeria
Notwithstanding the Roll Back Malaria’s latest report published in July this year that malaria is down by one-third in Africa, it remains Nigeria’s number one, and one of the world’s most prevalent sources of illness.
Caused by protozoan parasites of the genus plasmodium, the most serious forms of the disease are caused by plasmodium falciparum and Plasmodium vivax-both transmitted by female anopheles mosquitoes.
Nigeria is well known for a high prevalence of malaria, which is also a leading cause of morbidity and mortality among its citizenry.
Latest scorecard released by NOI Polls- a leading opinion polling and research organization which works in partnership with the Gallup organization (USA) to develop opinion research in Nigeria, on April 16th this year, showed that almost seven in 10 Nigerians (66%) had malaria at least once in 2012, and about 13% treat the ailment with the use of local herbs such as Agbo, Dogonyaro, Neem leaves and lemon grass.
The former, accounts for over 45 percent of all outpatient visits in hospitals.
On geo-political zones, malaria is more prevalent in the South than in the North. Again, the malaria scorecard indicated that majority of the residents in the northern regions; North-Central (43%) North-East (38%) and North-West (38%)) have not had malaria over the past 12 months while the southern regions; South-South (77%), South-East (75%) and South-West (64%) have the largest percentage of people who have had malaria more than once over the last 12 months.
Also, statistics by the National Malaria Control Programme (NMCP) indicate that in 2010 the disease accounted for 25 per cent of infant mortality and 30 per cent of childhood mortality in Nigeria.
One of the government’s response to malaria is the use of Long Lasting Insecticide treated Nets (LLIN), which protects users from mosquito bites.

Original LLIN with NAFDAC number
As at 2012, the the Nigerian government distributed no fewer than 51, 703,880 free insecticide nets worth over N30billion. As part of the strategic intervention, N1.8billion was equally earmarked this year for the purchase of 36million nets.
Nigeria also got two grants from Global Funds valued at $225m as part of her Phase-2 grant in boosting malaria prevention and treatment in the country in 2013. This project is geared at reaching at least 80 percent of pregnant women and children below five years in the country.
Unfortunately, with nefarious activities of touts and counterfeiters, much of the expenses might end up in the wrong hands as officials sell what should be free. With the counterfeiting, Nigeria also risks not meeting its MDG target 6 which has to do with the reduction of malaria.
Children at risk
As a way of monitoring LLINs supply in the country, only certain insecticide treated nets and re-treatments kits were approved for use in Nigeria and these include: K.O net, K-O tab; Solfac net; Solfac treatment kit all supplied by CHI limited, Nigeria.
Others are Iconet; Iconet treatment kit supplied by Sygenta Nigeria Ltd; Al-Cypernet; Al-Cypernet treatment kit supplied by Harvestfield Industries Ltd, Nigeria; PowerNet and PowerNet treatment kit supplied by Sunflag Ltd, Nigeria and PermaNet with Dangote Holdings Ltd, Nigeria as the supplier.
Notwithstanding these efforts, our market surveys and monitoring since September 9th, 2013 when most schools resumed across the country, revealed that many parents bought fake nets for their children returning to boarding schools.
Many schools operating boarding facilities across the country have made it mandatory for every returning student to resume with at least an LLINs, while parents have been purchasing PowerNet with NAFDAC registration number 14722753 and which was supposedly manufactured on 19/02/2012 but has no stated expiration date as well as batch number as the most purchased.
But when NAFDAC was contacted with these details, the response was “PowerNet….does not exist”.
Further investigations reveal that the original PowerNET has the NAFDAC registration number A5-0256 and not 14722753. The real product bearing the name PowerNet has 4722-3 as its batch number and was manufactured on 19/02/12 and last for only four years but like other nets would lose its efficacy before 2016 if washed more than 20 times.
Another fake net being bought en mass is the PermaNet with NAFDAC number 04-7508 which was supposedly produced on 10/2008 with its expiration date indicating 10/20. This particular brand has a wide patronage in Kaduna state, especially at the central market.
When confronted with the findings, Health Minister, Onyebuchi Chukwu, initially expressed shock and said it wasn’t possible. When however presented with the experiences of this reporter, he promised investigations.
“There is going to be zero tolerance; ….it’s not an easy thing anywhere in the world to fight a fake product whether it is fake currency or fake commodities, it is not an easy thing. We are determined and NAFDAC is introducing a lot of innovative ways to monitor it,” he said.
The Director, Global Malaria Programme, of the WHO, Mr Newman, said the WHO will be focusing more on net counterfeiting.
“It is a crime against humanity and I hope every African leader note this and gear up to this potential challenge that could slow or stop us from even meeting the MDG target on malaria. The counterfeiters must be stopped before they get out of hands,” he said.
Namibia’s Minister of Health, Richard Kamwi, said his country had similar experience.
“One of the way to win the war against these counterfeiters is to push for good quality control check before shipping and after shipping,” he stated.
Fatoumata Nafo-Traore, Executive Director, Roll Back Malaria, said the operational capacity, financial resources and delivery systems of commodities are crucial and need to be re-strategized if the war against the counterfeiters must be won.
“We must do all these without relenting,” she said. “If we relax, we would lose this war and there would be a rebound on the progress made so far, thus, we would have time, resources wastage and of course, unnecessary deaths.”

another fake new looking real

2014: What Nigerian government must do to improve health sector

Otuoke General Hospital. What should be the responsibility of the Bayelsa state government was built by the federal government

Premium Times takes a look at the challenges ahead.
Despite all odds, reports so far in the course of 2013 indicate that Nigeria fared slightly better in the health sector when compared with its abysmal and gloomy ratings in past years.
However, the sector was besieged by several industrial actions culminating in a warning strike by the Nigerian Medical Association just before Christmas. The doctors, on December 23, while suspending their five-day old strike, promised a graver showdown in 2014 if the government continued with what was described as ‘its insincerity’.
The year in polio and cholera
With health practitioners, who should help salvage the health sector, more out of hospitals over disagreements with the government, among other developmental drawbacks in the sector, 2014 seems already filled with various challenges.
The nation’s polio eradication programme, for instance, did not fare well as expected this year; it should be the government’s top priorities for next year. This year’s eradication efforts were further hampered by the insecurity caused by the Boko Haram insurgents. The National Primary Health Care Development Agency, NPHCDA, acknowledged that the gains earlier made by the country in the eradication programme, especially in some Northern states where the virus is endemic – Borno, Yobe, Bauchi, Plateau, Kano, Jigawa and Kaduna, were gradually being lost on account of the insecurity. Health officials rejected postings to the states troubled by Boko Haram following the killing of some of their colleagues in June.
Nigeria remains one of the most entrenched reservoirs of wild polio virus in the world. It is the only country with ongoing transmission of all three serotypes: wild poliovirus type 1, wild poliovirus type 3, and circulating vaccine-derived poliovirus type 2. As a result of the nation’s continued failure to eradicate the disease, India and Saudi-Arabia have now introduced a new policy targeting Nigeria. It would now be mandatory for all Nigerians, irrespective of age, coming into their country for whatever purpose to show evidence of having received the polio vaccine. And when in doubt, Nigerians would receive the vaccines at the customs/immigration screening point of these two countries before being granted entrance into their domains.
Attention would also have to be given to cholera as several parts of the country, towards the end of the year, were besieged by the disease primarily caused by poor hygiene. States such as Lagos were not spared. Meanwhile, Oyo which in 2008, 2009 and 2010 was well known for cholera outbreaks, did not report any incident in 2013.
The lows and highs
For sure, the Federal Government must work towards achieving the Millennium Development Goals, MDGs, in the health sector. 2015 is meant to be the deadline, hence, would want to ensure it is met.
The nation’s health indices, according to statistics from the Federal Ministry of Health seem to have indicated that maternal mortality ratio has also continued to reduce over the years; from 800 per 100,000 live births in 2003 to 545 per 100,000 live births in 2008. However, Nigeria still remains one of the countries with the highest maternal mortality in the world, contributing at least 10 per cent of the world’s maternal deaths.
Efforts still need to be deployed at reducing the mother/child mortality rates though the nation’s infant mortality rate has remained on the downward trend at 99 per 1000 live births, under-five mortality rate at 157 per 1000.
The abysmal cancer incidence in Nigeria took a sudden u-turn this year. Before now, there had been several challenges within the Nigerian health sector in the fight against cancer; insufficient medical personnel being one of them. As at September 8, 2011, there were only 15 Oncologists in the country but after the embarrassing discovery, contentious efforts were made to make the specialty attractive in the country. Subsequently, the next head count of Oncologists in the country this year showed that the number had increased to about 40.
Although still far from what it ought to be when compared with the rate at which the dreaded disease is spreading, it is still a source of hope that healthier days in the fight against cancer are ahead.
Notwithstanding the setbacks, the nation’s immunisation programme was however strengthened with the use of the MenAfric meningitis vaccine which replaced the now rested scarce polysaccharide vaccine. The MenAfric meningitis vaccine according to a pharmacist with the NPHCDA, Muhammad Adamu, is a more efficacious vaccine used for prevention of huge meningitis epidemics unlike the polysaccharide.
In 2013, no fewer than 79.5 million Nigerians between the ages of one and 29 years were innoculated with the MenaAfricVacine across 26 states which include the Federal Capital Territory.
Fleeing doctors
With Nigerian doctors fleeing the country for greener pastures abroad, even to neighbouring African countries, the government has much work to do to wedge this tide.
Presently, the country has only 27,000 doctors (both general practitioners and specialists) to care for over 160 million Nigerians. Out of these, there are only 600 paediatricians to care for the nation’s 40 million children under age six; 120 urologists to manage reproductive health issues in over 50 million Nigerian men and not a single podiatrist to care for the feet of the nation’s growing diabetics.
No doubt, 2014 will be a very busy phase in the history of the nation’s health care delivery system. Nigerians do have every cause to anticipate healthier days next year if the ship is properly captained and in the right direction.

INVESTIGATION: Gravely ill patients die queuing to see Nigeria’s few specialist doctors

English: Map locator of Nigeria. (Photo credit: Wikipedia)

TOBORE OVUORIE
In March 2013, when the pains in Ogaga Akpojaro’s breast, ankles and wrist became unbearable, she rushed to a private hospital in Ozoro, Isoko North local government area of Delta state where she lived.
A doctor, whose name she recalled only as Dr. Ben, treated her with antibiotics and a painkiller, and explained that the pains were symptoms of fatigue.
That made sense since Mrs. Akpojaro spent all her days, except Sundays, on the farm and sold garri during evenings in the local market. So she took the drugs as directed, stayed away from work for weeks, but her condition worsened. By early May, her breast had become swollen and rigid. Her ankles became taut. She rapidly lost weight and could barely walk.
“When all the pain killers Dr. Ben prescribed refused to work, he said we should take her to Ughelli General Hospital,” her only daughter, Ifoghale, recalled recently.
At the new hospital where they travelled to same night, no doctor attended to her, so they returned to Dr. Ben who referred them to Federal Medical Centre, Warri. There, a doctor explained that she needed to see an Oncologist – a cancer specialist. Delta state, one of Nigeria’s richest states, had none. So she got another referral to the Lagos University Teaching Hospital, LUTH, Idi-Araba, Lagos.
It was at LUTH, where they had borrowed money to travel to, that the family got a startling response. Without examining the gravely sick woman, a doctor minuted on the referral letter and asked her to return in two weeks.
“I was shocked and said it was not possible. I cried with no one able to console me and I created a scene,” Ifoghale, a 17-year-old student of the Delta State Polytechnic told PREMIUM TIMES.
“I had borrowed money to bring my mum to Lagos and returning in two weeks meant more expenses.”
While she waited, sobbing, the doctor emerged in the door way, and she accosted her, and pleaded that she help save her mother’s life. But the doctor calmly explained to her the hospital’s burden, and indeed Nigeria’s, one that portends great danger to public health if a response is not quick: there were just too many patients queuing for the same attention.
“He said ours was a new case and the queue is quite long and may not get to our turn even in the next two months as oncologists are so few compared with the number of cancer patients in the country. But to assist us, she phoned another oncologist in LASUTH and sent us to him,” she recalled.
With Nigeria taking the bottom lead on several global health indicators, nothing threatens to keep those woeful numbers unchanged as the dearth of qualified health personnel in key sectors of health care.
Despite the rising cases of cancer, there are only a little above 15 Oncologists in the country, experts told PREMIUM TIMES. Besides Delta state, 28 other states have no Oncologist. Only seven states in the entire country have specialist care for cancer. These include: Lagos – 7, Oyo – 7, Kaduna – 5, Edo – 1, Ondo – 1, Sokoto – 1, and Abuja – 3.
Patients like Mrs. Akpojaro travel long distances, through states, to get attention. Many don’t live to narrate their experiences. Those unable to travel for lack of money settle for non-specialists, while well-to-do families go abroad for treatment.
In Nigeria, the Lagos hospital, LUTH, is one of the most visited.
With no Paediatric Oncologist in Adamawa state and environs, Benjamin Enema, shuttles his son, Monday, who was diagnosed with leukaemia, between Adamawa and Lagos seeking the resources to keep the five-year-old alive.
“It was one of the most hectic moments of my life. Shuttling Lagos and Adamawa every now and then was not funny,” Mr. Enema said.
As the family struggled to keep up with the rigorous routine, his wife gave up her petty trading, relocated to Lagos to be with Monday while the father hunted for more cash. Their other three children lived with relatives while the ordeal lasted.
With much debt incurred, and no one willing to loan the family more money, Mr. Enema sold his inherited home and pleaded that the boy be transferred to a hospital close to Adamawa state. When that failed, he asked the doctor to discharge Monday who was still unwell. He wanted to take him to a traditional healer, where according to him, treatment would be cheaper.
“The doctors didn’t. Rather, to my surprise, some of them contributed money for my son’s hospital bills. They were even rallying to help raise the money with which to send him abroad for treatment after they learnt I had sold everything and now homeless to keep him alive. They said they would have referred him to a hospital closer home but there was no specialist to care for him in our region. Can you imagine that?” he asked.
On April 1, 2013, Monday died. “I know it’s not the doctors’ fault, they tried for my family,” the father said. “If we had the needed number of specialists in Nigeria my Monday would be alive.”
No Podiatrists, few Geriatricians
Nigeria has the highest number of diabetics in sub-Saharan Africa with no fewer than 1.5million Nigerians living with the condition, according to the World Health Organization.
Sufferers of diabetes are prone to injuries, especially on their feet and legs, requiring a specialist caregiver-a podiatrist. Currently, such patients would either have to go abroad or be managed by an orthopaedic surgeon as Nigeria has no podiatrist. Orthopaedic surgeons often recommend immediate amputation.
“Orthopaedic surgeons have been standing in as substitutes over the years since we do not have podiatrists nor podiatrics in Nigeria,” said Nnaemeka Nwakanma, Head of Medical Education, Nigerian Medical Dental Council of Nigeria, MDCN.
Also, while Nigeria is projected to rank 11 globally by 2015, as the country with the highest population of elderly persons–age 65 and above, the country has only one geriatric centre where the elderly receives specialist attention.
Located in the University College Hospital, Ibadan, the Chief Tony Anenih Geriatric centre was built and commissioned in November 2012.
Minister of health, Onyebuchi Chukwu, blamed what he called lack of “positive selfishness” as the major reason why Nigeria has many elderly persons but no geriatrics to care for them. He said it was the reason public office holders engage in excessive accumulation of wealth which at the end of the day becomes meaningless to them.
The chairman, Peoples Democratic Party Board of Trustees, Tony Anenih, whom the centre in UCH is named after and who himself, is over 80 years, said it was clear Nigeria has had no plans for its elderly.
“Nobody seems to be thinking about the aged in Nigeria because those who make policies, do so in their primes and are often too caught up in the present to know that sooner or later, old age with all its complications will creep in on everyone,” he said.
Few Urologists, Neurosurgeons and Cardio Therapeutic Surgeons Statistics show that men are as likely to have fertility problems as women with rising cases of impotency, erection or ejaculation problems. A recent study at the University of Nigeria, Nsukka, as well as Ebonyi State University, Abakaliki, showed that 25.35 percent of the studied population had symptoms suggestive of Benigh Prostate Hyperplasia, BPH.
PREMIUM TIMES findings show that Nigeria has only 120 Urologists to manage millions of conditions related to male urinary tract and reproductive organs, such as BPH or enlarged prostate; cancers of the urinary tract such as kidney cancer, bladder cancer, prostate cancer, testicular cancers; infertility in men; sexual dysfunction such as erectile dysfunction; urinary tract infections.
Majority of those specialists work in government hospitals located in Lagos, Abuja and Port-Harcourt, with some of them, such as the Lagos State University Teaching Hospital, LASUTH, having just a urologist. The finding was confirmed by the Nigerian Association of Urological Surgeons.
Nigeria has few neurosurgeons and cardio-therapeutic surgeons. According to Francis Faduyile, the chairman, Lagos state chapter of the Nigerian Medical Association, they are no longer up to 10 in the country. Another source said the number of neurosurgeons may be up to 40, but not more.
“Right now, neurosurgeons and cardio therapeutic surgeons are so few in the country. The available ones are close to retirement while some governments, like the Lagos state government, have refused to employ resident doctors who can learn and take over from them,” he said.
Psychiatrists, Paediatricians, Forensic Pathologists
Mental ill health, especially depression, is a leading cause of death in Nigeria. But according to Joseph Adeyemi, a professor and Head of psychiatry department, College of Medicine, Lagos University Teaching Hospital, LUTH, Idia-Araba, psychosis is a worse phenomenon.
“People who suffer from psychosis have more inpatient care than even those receiving care for cancer,” he said.
Psychosis is characterized by derangement of personality and loss of contact with reality, while causing deterioration of normal social functioning. It is characterized by defects in judgment and other cognitive processes.
It can be caused by depression, drugs, liver or kidney failure, endocrine disorders, metabolic disorders, Alzheimer disease, epilepsy and other neurological functions. There are only about 200 practicing psychiatrists in Nigeria, our investigations show.
If all the affected mentally ill person were in hospital, one doctor would be having to attend to 167, 000 patients while psychiatry nurses will each attend to 25,000 patients.
Abolore Lawal, the Chief Medical Director, Neuro-Psychiatry Hospital, Yaba, Lagos, said the poor ratio was the result of the poor rewards for doctors in the country.
“Nigerian doctors do not want to specialize in psychiatry; rather, they prefer popular areas such as obstetrics and gynaecology, as well as surgery. The general believe is that there is more money in these specialties when compared with psychiatry. Really, it takes a calling to want to go for psychiatry,” Mr. Lawal said.
For paediatricians, the World Health Organization says no fewer than 11 percent of children who die yearly are from Nigeria. About 13 children under the age of five die every minute in the country due to lack of immediate care and basic medical interventions.
Acute shortage of trained paediatricians, is found as a major contributing factor to Nigeria’s high numbers. Our findings reveal that Nigeria has only 600 consultant paediatricians to manage and care for the nation’s 70 million children, out of which over 40 million are under the age of five. Majority of paediatricians are in Lagos and Abuja.
The situation is quite different in other climes. For instance, the UK has 3,084 trained consultant paediatricians and 1,184 associate paediatric specialists for her 20million children. This does not include the 3,174 paediatricians currently undergoing training.
For Forensic Pathologists who investigate causes of death, there are only four in the entire country. Albert Anjorin, an eminent professor of pathology with the University of Ilorin confirmed our findings, and attributed Nigeria’s failure in resolving crime to factors such as the dearth of forensic pathologists.
“A forensic investigation would help classify such deaths into either natural, suicidal, homicidal, accidental, misadventure or be consigned as ‘open verdict’” he said.
William Odesanmi, a foremost professor of Forensic Pathology of the department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, said he would have loved to boast of at least 20 forensic pathologists in the country, but the present situation is a far cry.
As cases of cancer increases, help fades away
Annual estimates of the incidence of this killer disease which often gives no symptoms at its early stage is put at no fewer than 7,000 in Nigeria. But experts refute this figure describing it as a gross underestimation.
Moji Animashaun, Administrative Director at the Lagos State University Teaching Hospital LASUTH, said cancer treatment accessibility in Nigeria is virtually non-existent. She noted that the dearth in the availability of oncology specialists ranging from MDs to medical physicists to radiologists and even to oncology nurses makes the situation really discouraging.
The situation is worsened by the fact that the actual number of oncologist specialists available in the country remains unknown. For instance, during the West African Health summit, which held in September 2011, Nigeria was said to have just 15 Oncologists.
But Clement Adebamowo, a renowned Nigerian Oncologist with the UCH, Ibadan and who is the initiator of the Society of Oncology and Cancer Research of Nigeria, SOCRON, told PREMIUM TIMES there was no established figure.
On that morning in May, Mrs Akpojaro and her daughter, Ifoghalo, saw the Oncologist they were referred to in LASUTH and the doctor offered to help despite his own volume of patients, because his professional friend at LUTH had made the referral.
The doctor ordered a test that amounted to N55,000 while Ifoghalo had only N6, 500. “There was nothing more the doctor could do for us. He had many indigent patients like us and had exhausted all the money he earmarks to assist patients who can’t afford certain bills so could not assist us financially,” she said.
The Oncologist wanted to refer them to Benin but was told the only Oncologist in the state was out of the country at that time. The two women traveled back to Delta state to borrow more money for the test.
“It took me a week to raise N80, 000 and it wouldn’t have been enough. There was no place in Delta state where we could even do the test worse still, at a cheaper rate, so we had to go back to Lagos,” she said.
But as they arrived Lagos, Mrs. Akpojaro, now under unbearable pains as her condition worsened, died while she was already at Ikeja close to the hospital, her daughter told PREMIUM TIMES.
Now, with no support, Ifoghale spends more time out of school after her mother’s death. She continues to tend her mother’s farm, venturing out early morning, and returning early to sell her wares at the market.
“My education is suffering, my grades in school are dropping. My mother was poor while alive but she was even better than my uncles and aunts. They (her uncles and aunts) are very poor; they barely eat three square meals so can’t help me with at least my education.”
Members of the Enema family are now scattered with no place to call home. Mr. Enema squats with a friend in Ojodu Berger, an outskirt of Lagos, where he keeps three menial jobs in order to raise money to pay back all his creditors. His wife is back to her parent’s family in Zabin Zaria, Kaduna state, where she helps other women sell their farm produce, baby sits and does laundry.
She is assisting her husband raise funds in paying back the loans owed. The couple presently cannot fend for their three kids, hence, two now live with two different relations in Taraba and Adamawa states respectively while the eldest who is 11 years old is now a househelp to a French man in Jos, Plateau state.
“When we finish paying the debt and can afford to pay for a room, we will come together as a family again. For now, we have to remain like this,” Mrs Enema told PREMIUM TIMES.

Many accidents on our highways could be linked to drivers with epilepsy -Psychiatrist

Dr. Ogunnubi

Dr. Ogunnubi Oluseun Peters is the Public Relations Officer of the Nigerian Medical Assosciation, NMA. In this interview with me, the senior resident psychiatric at the Lagos University Teaching Hospital, LUTH, Idi-Araba unveils more about epilepsy, a health condition which is still shrouded in mystery in Nigeria. Excerpt:
So much has been said and is still being propounded and believed about the health condition called epilepsy. As a specialist in this aspect of health, what is it really about?
When you talk about epilepsy, in very simple layman’s term it’s abnormal discharge in any part of the brain because the brain has wires which we call neurons; they are like wires, they conduct electricity and this wire sometimes is like a current carrying loads of electricity and before you know it, at times, they may be of high voltage. In epilepsy, what happens is that when neurons in some parts of the brain are of high voltage, the thing will now spark and fire. And when it sparks and fires, it can now manifest in different ways.
Please, what are these different ways?
It can manifest in a motor way and if it happens this way, the person will be jerking. The body, the legs, the hands, head, everything will freeze, and be contracting and that is the one people usually call epilepsy.
But do you also know that the brain, that is those wires I mentioned, they are neurons but I will call it wires so that every reader will understand, if it over charges, it can also cause another form of epilepsy in the behavioural type which we call psychic epilepsy. The person is still having the same cause of epilepsy but this time around it is not a motor function; it is a behavioural and psychic form. What happens to that patient is that he or she can be in a state of automatism in which he will be doing something that he won’t be aware he can move from here to Ojuelegba, he will kill somebody and come back and will sit down at home after everything when the discharge has stopped if you say what happened, he will not remember because everything he did was at that point of discharge. There are other forms of epilepsy but unfortunately, as a result of our culture people cannot explain it because it is something that is happening inside the brain, people just see people that have epilepsy and say that it is from the devil, it is a curse and begin to run away from the person especially those that have motor type. They will say don’t let the saliva touch you, they go and put ashes around the person and he or she is highly stigmatised and that is why you have a lot of suicide. I’m working on a study on study in epilepsy and discovered its overwhelming presence and because of this social stigma. But between you and I, epilepsy is a medical condition caused by abnormal discharge in the neuron of the brain.
What really causes the abnormal discharge? Could the lifestyle of the patient be a part of it?
You have asked a big question but there are many causes of epilepsy. Let’s start from pregnancy. If a pregnant woman has some infections such as HIV, rubella, there’s no immunization during pregnancy, or they gave birth to the child and there’s no immunization against this diseases it can affect this part of the brain and this abnormal discharge can occur. Delivery problems could also be responsible. Some babies may be when their mothers got pregnant she was busy eating all sorts of junks the baby now became so big or the mother had diabetes such a baby should be delivered through caesarian operation but you now see the baby being delivered through normal form of delivery.
So what happens?
The baby gets stuck in the birth carnal and before you know it, there would be prolonged labour and can affect the brain such a baby when he grows up can develop epilepsy. Another problem is after giving birth to a baby, everybody is happy greeting the mother and maybe during the naming ceremony while everyone is carrying the baby, the baby falls down or he or she is carelessly put by the side of the bed and the baby rolls off and falls down, the baby at that time cannot complain at that time. He or she cries a little and they quickly take him or her back, only for epilepsy to creep in years later. I have a case of a patient with epilepsy who was left with the house help some years ago, the baby fell down several times in the househelp’s hands, the parents never knew, the house help went away only for the baby to grow up and started having epilepsy. Further retrospective history made them get the house help and she confessed that the baby fell down one time along the staircase and the mother never knew. So, intrauma- head injury through an accident even in an adult can lead to such a condition. The adult may survive the road accident but may have suffered a head injury which would make him start having epilepsy in future. Another thing is cancer. There are some cancers that when in the brain, it would be irritating that part and would be causing abnormal firing of that neuron and that’s why when you do brain scan, ECG, you’ll see the result of this problem.
Please, epilepsy is not a spiritual problem, it is not evil from mother-in-law, father-in-law, it is a medical condition that requires medical care. And there are lot of medical care for it.
What are the symptoms of this health condition?
We have aura. Someone will just realise that where he is is strange, we call it generalisation. Or you yourself you feel or discover you’ve changed from the environment, it’s called personalisation and in the process of either of these two environmental changes the person would begin to have epilepsy. In some, they realise that their intestine or stomach is twisting, it may be a sign that epilepsy is about to occur. We call it seizure and it’s when you have two or more seizures that it becomes epilepsy. If it is only one, it’s called seizure and when more than one, it’s called epilepsy. Some, they will just realise that their limbs are very weak, they wouldn’t be able to move their legs, and some, because majority of epilepsy occurs in the night, they are usually undetected. The ones that occur during the day, you see the person foaming in the mouth, the eyes closed, the person urinating on him or herself, that’s the common ones many people know but the ones at night which are less known does occur very well. People who have it during the day must have been having it in the night without knowing thus present themselves late to the hospital. We have different types such as generalised in which you have loss of consciousness, will be urinating among others. We also have the petite one in which someone can just be sitting and holding something and the thing he’s holding falls down, he starts blinking, within two minutes he is okay and he continued his activity; it’s still epilepsy. Someone is looking at the board and suddenly everything is blank, even if he is talking to someone and everything about him just goes blank, he could be having seizure.
How can they be managed?
People must always be attentive to their friends, relatives and people around them for any persistent thing as this and encourage them to go to the hospital for investigation. We have basic, biological and social management. The first thing is to first control that seizure because the more you continue to have seizure, the more it damages the brain. There are drugs for this purposes and once taken, stabilises the condition. It cannot be cured, but can be controlled because whatever has caused it may still be there bit if it is the one caused by cancer and you’re able to remove the pox, blood, that one is curable. But if it is a brain injury, then you simply have to control the episodes of seizure. Maybe it occurs everyday, the control mechanism would reduce it to the barest minimal episode. After that, the patient has to prevent or stay away from things that cause that seizure. Tell them not to go to where there is too much bright light, that is why when you watch some movies, they warn ahead that the movie is not for people with certain health conditions because when it begins to change scenes, it could affect someone with epilepsy. It is not good for people with epilepsy to be changing channels or go to places with loud noise where drums and all sorts of noise take place. Some people go to church and end up having seizures. They must know and avoid whatever makes them have these seizures. Again, they must avoid driving or operating machines because they don’t know when a seizure could occur. We’ve seen the case of a driver with almost 40 passengers in a bus who had epilepsy and the bus was just going and resorted to an accident. Who knows, some of the accidents on our highways could be as a result of epilepsy fit.
What is the prevalent rate of this condition in Nigeria?
At least three out of every 10 persons in the Nigerian population have it but they don’t know thus don’t take care of themselves. You don’t know if the driver driving you to the East or North has epilepsy and you’ll just get to Lokoja bridge and the man has a fit and you think he’s still there and the bus is just going and could resort in an accident. Early detection and care is still the best way to manage this condition. Don’t go to native doctors, native healer or spiritualist who’ll tell you that call on the name of God and you shall be saved.
Are you saying spiritual healing is not valid in this case?
What I am saying is that call on the name of God but go to the hospital for management as God responds to our actions of faith. He made the Physicians.
How can this condition be prevented from occurring in the first place?
Mothers should attend antenatal sessions. There should be good obstetrics practice, government should equip our hospitals, so that mothers and babies would be saved from this condition among others. Women should stop attending Traditional Birth Attendants where for three days a woman is still labouring. I can tell you, such a child is likely going to have epilepsy or cerebral palsy.
Why?
Because cerebral palsy can cause epilepsy and epilepsy can cause cerebral palsy because they have almost the same cause. That is, pre-natal, intra-natal or post-natal cause, among other causes.
Is epilepsy hereditary?
Yes, it could be. Studies have shown that there are some genetic traits that makes one to be prone to epilepsy.

NIGERIA’S DIRT DELIVERY HOSPITALS!!!

Toilet meant for patients at Sura Primary Health Centre, Lagos Island, Nigeria.

More scenes from General Hospital, Lagos Island.

Adjacent the windows of ward C1, General Hospital, Lagos Island, Nigeria. This heap of refuse has been here for over three weeks without any obvious plans of them being cleared.

Is a hospital supposed to have these grasses overlooking any of its wards? Well, this is the case at General Hospital, Lagos Island, Lagos state.

The photographs you are seeing above are some of the sights and scenes of some health facilities in Lagos state, Nigeria. In the process of providing healthcare, some of these healthcare centres succeed at worsening the health condition of patients as they operate in unkempt environments. Patients, who go to these hospitals, most times, are at risk of contracting infections and other diseases other than that which they go seeking treatment for.
Examples of such healthcare facilities are the Primary Healthcare Centre, PHC, in Ward G, Ojokoro Local Council Development Area, Ajegunle – Alakuko, Ilo, in Ifako-Ijaiye Local Government Area; General hospital, Lagos Island, as well as Primary Health Centre, Sura, Lagos Island.
When I visited the General Hospital, Lagos Island recently, its overgrown grasses and heap of furniture debris remained uncleared. They have maintained the same position for over three weeks without obvious plans of being cleared. Situated right in front of the windows of ward C1, these overgrown grasses which are home to mosquitoes and other rodents, ushers every visitors into the various wards and are unhealthy companions to occupants of the male wards especially ward C1.
My investigations revealed that though the ward has window nets to wade off mosquitoes, the malaria causing creatures and other rodents still find their way into the ward. No thanks to the overgrown grasses right in front of the ward windows.
Again, just adjacent ward C1 windows, main entrance to the various wards from the security point via the hospitals exit gate are heaps of furniture debris. These, like the grasses, have been there for over three weeks providing room for rodents and mosquitoes which find their way into the various wards especially ward C 1 which is closest to it.
The son to a patient who pleaded anonymity on the ground that his father is yet to be operated told me that “C1 is better though mosquitoes are seriously dealing with my father in the ward. We used to be in one other ward before and that one is worse than C1.
“Definitely, my father will take malaria medicine immediately he is discharged because there is no way he will not end up coming down with malaria after living in a mosquitoes infested place as this”.
General Hospital, Lagos island is however better than some other health facilities in the state.
When I visited Sura PHC, Lagos Island recently, patients freely urinated in the gutters in the premises of the healthcare facility.My investigations revealed that the PHC does not have a presentable toilet for patients. When I requested to use the toilet, I was initially told that there was none, but after pleading for a while, I was given a key by a staff of the centre and directed to the convenience which turned out to be an indescribable eyesore. Though without another option, I left the health centre without easing herself as the toilet is a veritable source for more infections other than the malaria I went to seek treatment for.
My investigations further revealed the two earlier mentioned hospitals are child play when compared to the PHC, in Ajegunle – Alakuko, Ilo, in Ifako-Ijaiye Local Government Area.
When I visited the place recently, rodents ran about freely, while there was no running water in the healthcare facility. Our findings indicate that the taps are dry because the only borehole on the premises has long stopped functioning. With no reliable source of water, patients resort to purchasing and utilising packaged water (pure water) sachets.
When I paid the centre another visit during one of its post-antenatal clinic days, I was welcomed by more dirt and unkempt everywhere. The surroundings, including the road leading up to the premises was overgrown with weeds. Mothers improvised with packaged water sachets popularly known as pure water to step down their children’s high body temperatures before injections were administered on them. This explains why the health facility’s premises is always littered with empty packaged water sachets.
If nothing is done about this when the rains come pouring, this PHC which is in disarray and unbefitting of a health institution, would be a veritable source of cholera as its septic tank (soak-away) has collapsed and toilet facilities are in severely deplorable states.
My investigations also revealed that any woman with a first time pregnancy who goes to the centre does so at her own risk as the PHC does not handle first time pregnancies.
“The only service we provide here is antenatal and post natal care. We cannot handle your case since it’s your first pregnancy” a nurse told this reporter who had made enquiries about care for her feigned pregnancy.
She however added that “you can still come if you cannot go to private hospital but when it (the supposed pregnancy) has developed to the eighth month, we would have to refer you to one hospital along Lagos-Abeokuta express way where they can take care of you”.
The Centre which was meant to care for child delivery and management of other health complications and primarily paediatric related issues is falling short of that. The healthcare facility which ought to run 24 hours daily, remains open for just a few hours and is idle most of the day. Our investigations also revealed that even when patients turn up for treatment and other services, they wait endlessly for attention.
Still baffled by the deplorable condition of the PHC, residents of Ward G, Ojokoro LCDA now doubt the safety and reliability of diagnoses and treatments carried out at the centre. Consequently, they now depend on primary health facilities at Oke-Odo, and private hospitals in adjoining communities in the neighbouring Ogun State.

Malaria, still a major public concern

David discussing with Nuer settlement prior to dist ITNs on Baro RiverDSC_0039 (Photo credit: UNICEF Ethiopia)

Sleeping under treated mosquito nets remains a veritable mode of preventing malaria in Nigeria.

Malaria, Nigeria’s number one disease and one of the world’s most prevalent sources of illness took centre stage in global health last week Thursday as the world marked the World Malaria Day. Studies so far indicate that malaria remains the most prevalent tropical disease in the world today. Each year, it causes ailment in approximately 650 million people and kills between one and three million, most of them, young children in Sub-Saharan Africa. Unfortunately, one of such countries is Nigeria and has become well known for a high prevalence of malaria, which is also a leading cause of morbidity and mortality among its citizenry.
Latest scorecard released by NOI Pollsa leading opinion polling and research organisation which works in partnership with the Gallup organization (USA) to develop opinion research in Nigeria, on April 16, revealed that almost 7 in 10 Nigerians (66%) had malaria at least once in 2012, and about 13% treated the ailment with the use of local herbs such as Agbo, Dogonyaro, Neem leaves and lemon grass. The former, accounts for over 45 percent of all outpatient visits in hospitals. This, medical experts note is not unconnected with the infection most Nigerians suffer during the first five years of life, thus making it a major public health problem.
Further analysis by geo-political zones revealed malaria to be more prevalent in the South than in the North. Again, the malaria scorecard indicated that majority of the residents in the northern regions; North- Central (43%) North-East (38%) and North- West (38%)) have not had malaria over the past 12 month while the southern regions; South-South (77%), South-East (75%) and South-West (64%) have the largest percentage of people who have had malaria more than once over the last 12 months. The latest score card however explained this disparity between geo-political zones to be due to the greater presence of rivers, seas and lakes in the south where mosquitoes are prevalent; while the North is mostly land locked.
Nationwide, the NOI Polls latest scorecard further indicated that many (44 percent) Nigerians visit the hospital to see a doctor when they have malaria, while 38 percent simply buy medicines from the pharmacy or chemist. Furthermore, four percent do not use any medicine at all.
The scorecard further revealed females visit hospitals more than males, as a greater proportion of males were discovered to simply visit the pharmacy to buy malaria medicines or opt for native herbs, than females. Analysis along regions showed that majority of the residents in the southern regions selfmedicate, while most of them in the northern regions go to the hospital. An in-depth view of the malaria snap poll indicated that the North-West has the highest proportion (71%) of residents who visit the hospital, while the South-East has the highest percentage (52%) that simply buy malaria medicine from the pharmacy; also the South-West has the highest proportion of respondents (19%) that use native herbs.
Even statistics by the National Malaria Control Programme (NMCP) indicate that in 2010 the disease accounted for 25 per cent of infant mortality and 30 per cent of childhood mortality in Nigeria thereby imposing a great burden on the country in terms of pains and trauma suffered by its victims as well as loss in outputs and cost of treatments.
Consequently, reports by the World Health Organization (WHO) reveal malaria still remains one of the most significant public health problems in Nigeria and perhaps the commonest cause of ill health in Africa. The world health body disclosed that almost all the entire population of Africa is at risk of this parasitic disease that has continued to claim at least one million lives.
“It is mosquito-borne and one of the killer diseases of the world, currently accounting for about 300 to 500 million clinical cases annually and over 1.2 to 2.7 million deaths worldwide each year” WHO reports.
As a result of these, the Federal Government through the Ministry of Health has over the years developed several methods and programmes in combating the scourge of both malaria and drug-resistant malaria in the country. One of such strategic interventions is the Roll Back Malaria (RBM) programme.
According to the Minister of Health, Prof. Onyebuchi Chukwu, RBM in Nigeria anchors on the global strategies for malaria control which are multi-pronged and of proven efficacy. Some of these include prompt and effective case management, intermittent preventive treatment of malaria in pregnancy and Integrated Vector Management. The IVM includes the use of Insecticide Treated Nets (ITNs) such as the Long Lasting Insecticide treated Nets ( LLIN) which has become a part of most homes as over five million nets have been distributed alone in Nigeria. It also includes Indoor Residual Spraying (IRS) and Environmental Management.
Other cross-cutting interventions include Advocacy, Communication and Social Mobilization, Effective Programme Management, Monitoring and Evaluation, Partnership and Collaborations.
Notwithstanding these, malaria remains a global health problem, and public health efforts today focus on controlling it. Consequently, over the years, a lot of efforts have gone into controlling it in the country and in other African countries, but the problem has not shown any sign of abating. The reasons discovered so far for the limited success in efforts to eradicate malaria -a disease of poverty in Nigeria, include poor health practices by individuals and communities and resistance to drugs.
The Malaria Day, which was instituted by the World Health Assembly at its 60th session in May 2007, is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity for countries in the affected regions to learn from each other’s experiences and support each other’s efforts. The theme for this year’s edition is: Invest in the future. Defeat malaria.

Diabetic? Eat what you like

Diabetes affects all ages, race and sex, but can be detected on time through frequent medical check up.

…but in moderation
Are you diabetic and restricted to a meal of beans and unripe plantain – a meal most Nigerians living with diabetes are made to believe is the only right food for them? This piece of news should be of interest to you. Experts say you can eat any food you can lay your hands on available to you even with your condition. There’s however a caveat: you must do so in moderation.
This was revealed yesterday by Dr. Femi Oyegbile, a Permanent Secretary with the Lagos State Ministry of Health, during the launch of the insulin support centre at the General Hospital, Ikorodu, Lagos state.
The Insulin Centre is a one-stop shop set up by Novo Nordisk, a global health care company with its headquarters in Denmark: The centre will see to the conducting of diabetes care training for the key stakeholders such as doctors, nurses, pharmacists and peer educators, as well as ensuring availability of insulin at GHI. All these are to ensure that insulin is sold at affordable price – lower than N50 for a day use while patients are educated on how to live healthier lives.
According to Dr. Oyegbile, living with diabetes is neither a death sentence nor a restriction to living life to the fullest. “With proper education about wellness; people living with diabetes can still live normal and healthier lives” he disclosed.
A Nigerian, Mrs. Grace Ayokanbi confirmed Dr. Oyegbile’s stance. Speaking in an exclusive interview with me yesterday, she revealed that for the past 50 years, she has been eating anything and living a normal life.
“I have been living with diabetes for the past 50 years and have been eating and living a normal life. I was born with the condition because I inherited it from my parents.
“There’s no food a diabetic patient cannot take, if he or she has the right information at the finger tips as education about wellness is paramount to living a rich and fulfilled life notwithstanding the condition.
“For instance, unlike the general belief out there, a diabetic can actually eat eba, semo or wheat but when this is eaten, it must be followed by physical activities so that he or she can use the energy at that particular time. But the physical activities must not be so strenuous. It could be cleaning, mopping, being active in the kitchen or washing. At least, do something to burn down that energy” she stated.
You can never guess that Mrs. Ayokanmi is diabetic as she looks so beautiful, radiant and full of life. She says the secret to her youthful radiance is arming herself with vital information about wellness and the health condition.
For instance, she reveals further that one of the most important things diabetics will do for themselves in order to live life to the fullest as she is doing, is taking a lot of vegetables, water and fruits. And of course rest!

Mrs. Ayokanbi, Nigerian living with diabetes from birth.

“The important thing is taking a lot of vegetables, a lot of water and a lot of fruits. And we need rest because it is not all the time we’re supposed to be active. But all these must be taken in the right proportion, that is, not too much and not too small. And we are not supposed to take all fruits because we don’t take the ones that are sweet; we take fruits like cucumber, garden eggs, and when in season, wall nuts”.
Records indicate that diabetes is emerging as the leading cause of cardiovascular diseases (CVDs) with strong link to a large number of cases of heart attacks and hypertension, especially among black people. The diabetes situation in Nigeria is not different from the global trend which shows that the condition kills one person every eight seconds.
According to experts, no fewer than 239 million Africans between the ages of 20 to 79 years would be diagnosed with diabetes come 2030, while a large number of these will be Nigerians. Unfortunately, a majority of people with diabetes in the country do not have access to treatment thus dying in silence while those who do, spend nothing less than 20,000 naira every month on medication. This is a major issue the Novo Nordisk insulin centre is addressing. According to the company’s Vice President, African Gulf and India, Mr. Mads Bo Larsen, “the centre targets low income earners living with the condition in order to alleviate the burden of affordability of their medication since insulin will be sold at very reduced rate in the centre. And this, with time, will be replicated all over the country”.
This ailment which does not discriminate against age, race and sex is responsible for no fewer than four million lives lost every year, no fewer than one million amputations done in a year as well as most of the manpower hour lost in most organizations worldwide. It is actually one of the major underlying causes of death among those living with other ailments. Worldwide, diabetes has been discovered to be one of the five major killers of humans at all age levels.

Mads Bo Larsen inaugurating the insulin centre at General Hospita Ikeja, Lagos, Nigeria yesterday

Even four-year-old kids are today being diagnosed with type 1 diabetes requiring them to take two injections a day. Unfortunately, most of these people do not even know that they are diabetic, how much more knowing the type of diabetes they are living with.
There are three types of diabetes namely Type 1, type 2 and Gestational diabetes. The type 1 is characterized by destruction of the pancreatic beta cells leading to absolute insulin deficiency. Sufferers with this variety have an absolute lifelong requirement for insulin therapy and will develop diabetic ketoacidosis (DKA) if not given insulin.
Its onset is usually before the age of 30 but may occur in any age group. Research for a cure for this form of diabetes is still on-going. The type 2 on the other hand, has an alarming rising prevalence rate over the last decade while this is predominantly linked to the trends in obesity and sedentary lifestyle. People living with this form of diabetes present a combination of varying degrees of insulin resistance and relative insulin deficiency which both contribute to this form of diabetes.
The clinical features of the type 2 form of diabetes can rise through genetic or environmental influences making it difficult to determine the exact cause in patients individually. Quite different from these earlier mentioned two; gestational diabetes develops during pregnancy, the reason for its name. Like other types of diabetes, gestational diabetes affects how the sufferers cells use sugar (glucose) Ñ the bodys main fuel. Gestational diabetes causes high blood sugar that can affect pregnancy and a babys health.
In gestational diabetes, blood sugar usually returns to normal soon after delivery. But anyone who has had gestational diabetes is at risk for future type 2 diabetes. Such one will need to continue working with her health care provider to monitor and manage her blood sugar. For most women, gestational diabetes doesnt cause noticeable signs or symptoms. Rarely, gestational diabetes may cause excessive thirst or increased urination.
Are you diabetic and want to live a more robust life? Novo Nordisk, provider of the Insulin centre at GHI advice you:

• You eat your breakfast , lunch and dinner early, while the latter must be eaten before 7.30pm
• You exercise at least for 10 to 15 minutes before going to bed
• .Always keep your feet clean
• Dry feet well especially in between your toes
• Check under your feet regularly
• If you can see under your feet, check with a mirror or get someone to check for you
• Never cut corns or use sharp objects  on your feet
• Avoid wearing long boots
• Avoid tight socks
• Avoid high shoes with no support
• Avoid extreme heat
• Never put your feet near open heart
• Never walk bare foot
• Wear well fitting flat shoes.

What Parents of Overweight Kids Need to Know

English: These children, playing in a public space, vary in their proportion of body fat. (Photo credit: Wikipedia)

It’s no secret that America has a childhood obesity epidemic. The health risks that can accompany childhood obesity are so regularly featured on news reports that it’s amazing the problem is still so prevalent. And although many parents can identify a weight problem in their child, they might not know what to do about it, especially when it comes to handling the situation without damaging her self-esteem. Here is some food for thought for parents of overweight children, along with some practical, real-life advice for handling the situation.
Your Doctor Might Not Tell You
Your doctor might not let you know that your child is overweight or obese. This may be because he assumes you do not want to know. As a parent, it is easy to turn a blind eye to things like your kids being overweight or even when your kids develop a bad habit. If you have a suspicion that your child is overweight, you should approach your doctor about it. This will show him that you are interested in learning more about the issue and are willing to work with his suggestions on what to change or tweak in your child’s life.
You Are Not Alone
Sometimes it’s difficult to realize that you are not the only one with overweight kids. There are others out there who are just as concerned as you are and who are willing to share their wisdom. Search out those other parents and work together to achieve a common goal. That extra support is just the thing you need to keep on track, and having another overweight child working toward becoming a healthier size will help put your child at ease and encourage her to work hard at losing that extra weight.
Exercise Is Always a Good Thing
Not everyone enjoys exercise, but it’s essential for kids’ health and physical development. Come up with an exercise schedule that everyone in the household sticks to. There’s no reason to send your kid off to the gym for an aerobics class while you sit at home. Make it a family event that everyone looks forward to. If everyone likes to do something different, then create a schedule that includes all of the activities throughout the week. Working together as a family not only creates a built-in support system, it can also boost the health of everyone in the family and gives you an opportunity to model the habits you want your child to adopt.
She Shouldn’t Have to Make Changes Alone
Along the same lines as exercising with your child, don’t make them go through any aspect of this experience alone. Singling him out will just create tension and remorse that doesn’t need to be there at all. If the doctor says he needs to change his diet, change the diet of your entire family. Clean out that pantry of the junk food and fill it with healthier alternatives, encouraging everyone to eat better. Even members of your family at an average weight can benefit from cutting out the empty calories.
Some Foods Should Be Avoided
Going out for fast food three times a week is a bad habit to get into, regardless of how convenient it might be for time-strapped parents. All of the grease that is typical of fast food has no place in a child’s diet. And, keep in mind the word “diet” does not mean counting calories and starving your child. She still needs a decent amount of food. After all, she is growing and changing. With how much energy children burn throughout each day, chances are they need to eat more food than you would expect. They just need healthier fare than deep-fried potatoes and genetically modified meat.
Counting Calories Isn’t Always Right for Kids
The strict course of counting calories is a lot of pressure to put on a child and will single them out more than their weight already does. Stress can even be a trigger for kids and adults who are prone to emotional eating. So skip the added stress of counting calories and think about ways to instill healthier habits as a whole.
Your Child May Have Low Self-Esteem
It is possible that your child is being picked on at school or being made fun of by his peers because he is overweight, and he may very well be too embarrassed about the bullying to tell you about it. Sometimes kids don’t even necessarily mean to be cruel, but it can still feel that way to your child when his differences are being highlighted at every turn. If you think your child may be being picked on at school, speak with the guidance counselor to see what she has noticed and what she suggests that you do, but make sure that you’re making efforts to boost his self-esteem at home as well.
It’s Okay to Embrace Your Child’s Weight
Most importantly, embrace the way your child is no matter what. She should feel comfortable with who she is no matter what her weight is and understand that your focus on her weight is out of concern for her health rather than an emphasis on her looks. Just because she is overweight doesn’t mean she’s not a good child, and she needs to know that.

What are you eating this weekend?

So, what are you eating this weekend?

You will not believe this: Nigerian workers feed better during the weekdays than weekends! A study by a group of clinical students at the University of Ibadan (UI) recently revealed that workers in Lagos and Oyo state tend to eat fairly nourishing meals during the week though mostly unplanned, while they go for outright junk and calories loaded meals that do not complement their health when it is weekend.
The researchers discovered that a majority of the working class people in the two states still maintain a fairly healthy diet routine, inspite of the hard times, between Mondays and Friday mornings. This however fizzles out as the weekend approaches. Many of these workers start the weekend with oily or greasy foods which are followed with the consumption of more junks and alcohol, especially at parties from Friday evenings through Sundays. Many of the respondents, according to the research findings disclosed that they always look forward to enjoying better and nutritious meals at weekends but these often turn out to be mere varieties of carbohydrates, especially rice. Those who venture to take their family out for weekend outings usually end up with snacks and more varieties of carbohydrates and sugar-laden drinks.
My investigation also revealed that many Nigerians tend to start their Saturdays with treats loaded with oils and too much calories with reckless abandon, putting finishing touches to these when they arrive parties. However, Mrs. Doris Aniemiena, a Nutritionist and Dietician at Ace Medicare Clinic, Otta believes that Nigerians eating habit during the weekends is just a bit worse than what obtains during the week.
Speaking in an interview with me recently, she disclosed that Nigerians generally eat junks throughout Mondays to Sundays, not just the weekends alone and the worst aspect is that they do not exercise even after eating these junks. It is not only workers that are involved in this cycle of junk eating cycle.
Even children are affected by the rice and junk syndrome because mothers these days are fond of giving their children 20 naira to buy rice at any given time of the day she added.
Noting that Nigeria is really blessed with different foods and vegetables, the dietician beamed the flashlight on mothers, whom she stated should always have a planned meal menu which should cut across all food nutrients.
“Mothers should have diet plans in mind and on their shopping lists before going to the market and prepare as many different vegetables as possible, notwithstanding what part of the country they are from.
“These do not cost a fortune compared to how much is to be spent on hospital bills. They (mothers) must learn to go to the kitchen more and cook nutritious meals for their families, not just rice simply because it comes handy” Aniemiena advised.
So, what are you eating this weekend? Here are some tips to the rescue:
*Never load your kitchen with lots of high-calorie snacks, rather, keep fresh fruits, vegetables, and whole grain crackers for nutritious snacking. *Start your Saturday and Sunday mornings with a healthy breakfast particularly with foods rich in protein and fiber.
Some good choices include eggs, moin-moin, pap, fried beans, akara, while meals for lunch and dinner should include fruits and vegetables like ugu, shoko, gbure (water leave), okro, bitter-leaf. Experts recommend that adults do not consume more than two eggs in a week.
*A great way to stay motivated to eating a healthy diet is keeping track of the foods you eat. Make your own food diary, taking note of the Calorie Count.
*Give yourself a small treat during the week because any diet that leaves you feeling deprived will ultimately fail.
For instance, you could enjoy a small piece of chocolate, candy or one scoop of ice cream during the week.
*Eat lots of fruits and vegetables for they are low in calories, and high in nutrients and fiber. Fiber is very important because it keeps you energetic and helps digestion.
*Eat less at restaurants because most restaurants serve very large portions. Make sure you include salad in your meal. But if you order a large meal, take half of it home for a delicious lunch the next day.
*Eat before going shopping even if it is just window shopping because if you go hungry, you are much more likely to give in to the temptation of unhealthy foods.
*Get some exercise each day.
For instance, you could walk from home to the bus-stop or use the stairs rather than the elevator. Going for a walk helps burn calories, thus improving your mood and distracting you from unneeded cravings.
With a little thought and preparation, you will get used to these and continue eating healthy, yet enjoying your weekends. De bon weekend!