Tuesday, 8 April 2014

Rumors of Ebola in Nigeria: the blind leading the blind?

The Ebola outbreak in parts of West Africa is currently (i.e. in March and April of 2014) in the news. The information one gets in Nigeria is however worryingly little and vague, sometimes simply false.

As early as 22 March, the Voice of America gave details of an Ebola outbreak in Guinea. A report by the World Health Organisation (WHO) outlines the cases and casualties of the outbreak up to 1 April. The report refers to the Ministry of Health of Guinea,; stating that the country has seen 127 cases of which 35 have been laboratory confirmed and 83 deaths. The disease also showed up in neighbouring Liberia. Its Ministry of Health and Social Welfare gave the number of 8 cases and 5 deaths. 

The Nigerian Punch is one of the newspapers covering the current Ebola outbreak. In an article from the 26 March, the Punch informed us about the Federal Government’s announcement to take “proactive measures to ensure that the outbreak of Ebola disease in neighbouring (sic) West African country, Guinea, does not come to Nigeria”. Not only was this not followed up by concrete plans (all the article mentioned are planned discussions about the situation and a vague reference to the monitoring of travellers from the affected area), it also ignored the fact that there are at least four countries between Nigeria and Guinea. Somebody who does not know this might have gotten scared by the proclaimed proximity of the disease. Panic might have been the consequence, especially since on the previous, an alleged case of Ebola was reported in Abuja Leadership. Certainly the general vagueness and lack of information in the news did not do much to put anybody at ease. As for the alleged Nigerian Ebola case, the background of the deceased was given (a young and bright medical student) but no detail on how she had been diagnosed with Ebola.

In reaction to this alleged Nigerian Ebola case, the Minister of of State for Health “inform[ed] the general public that laboratory investigation has revealed that it is not Ebola but Dengue hemorrhagic fever”. Moreover, he explained some similarities of Dengue with Malaria, including that both diseases are transmitted by mosquitoes. This was broadcasted by Channels TV and now can be found on youtube. In a related article by Channels TV, the Minister is quoted as having said “most Nigerians mistake Dengue fever, which is also transmitted by mosquitoes in urban and semi urban areas, for Ebola disease”. The way Channels TV rephrased the minister’s words may give the unintended impression that Ebola is transmitted by mosquitoes! 

The information on Ebola that we are getting from the official side is also very scarce. For instance, the Nigerian Centre for Disease Control does not even have a website, while website of the Ministry of Health has just a single page on the current outbreak of Ebola. It states that there has not been a case of Ebola in Nigeria and then continues for a long while discussing the ways of transmission for Dengue fever and how Dengue fever differs from Malaria and Ebola. Only in the last two paragraphs does the focus return to Ebola. There the ministry advises that Nigerians “should report any illnesses with the above stated symptoms to the nearest health facility”. However, all the “above symptoms” refer to Dengue fever and Malaria. So the ministry’s website does not help us in any way to identify potential cases of Ebola in Nigeria. 

Perhaps the most shocking response came from the Ministry of Information after the Federal Executive Council (FEC) meeting on 2 April. The Minister of Information said “the Ministry has taken every precaution, including getting the vaccines and medicines in case there was any incident in Nigeria”. There is no vaccine for Ebola. However, if the Ministry of Information should have found one recently, they should let us know. Such a breakthrough would certainly deserve the Nobel Prize of Medicine! Thankfully, in another pronouncement on Monday April 4, the Minister of Health has tried to make amends by announcing that there is indeed no vaccine for Ebola, and goes on to authoritatively state, as reported by Channels that "Ebola will not enter Nigeria"!).

As you can see from this account, health communication in Nigeria needs to be improved. The current lack of information and the additional presence of false information on health issues is dangerous. It can have negative impacts on the well-being of a person or a population. Hence it has to be addressed promptly and efficiently.

We offer you, our reader, an excerpt from the Ebola Fact Sheet by the US Centre for Disease Control (CDC). It informs you on the transmission and symptoms of Ebola and, thus, can help you to stay alive and healthy.
“Because the natural reservoir of ebolaviruses has not yet been proven, the manner in which the virus first appears in a human at the start of an outbreak is unknown.  When an infection does occur in humans, there are several ways in which the virus can be transmitted to others. These include: direct contact with the blood or secretions of an infected person [and] exposure to objects (such as needles) that have been contaminated with infected secretions. The viruses that cause Ebola HF are often spread through families and friends because they come in close contact with infectious secretions when caring for ill persons. Exposure to ebolaviruses can occur in health care settings where hospital staff are not wearing appropriate protective equipment, such as masks, gowns, and gloves. Proper cleaning and disposal of instruments, such as needles and syringes, is also important. If instruments are not disposable, they must be sterilized before being used again. Without adequate sterilization of the instruments, virus transmission can continue and amplify an outbreak.
Signs and Symptoms Symptoms of Ebola HF typically include: Fever, Headache, Joint and muscle aches, Weakness, Diarrhea, Vomiting, Stomach pain, Lack of appetite. Some patients may experience: A Rash, Red Eyes, Hiccups, Cough, Sore throat, Chest pain, Difficulty breathing, Difficulty swallowing, Bleeding inside and outside of the body. Symptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8 - 10 days is most common.”

If there is only one thing that we must learn from this ongoing outbreak in West Africa is that it can happen here, and if/when it does happen, we will have to be ready. Really ready: from managing the outbreak itself, to managing who speaks about the outbreak. 

This piece was co-authored by Anja Choon, who is joining the Nigeria Health Watch Team

Friday, 28 March 2014

On World TB Day - what we should know and do

The World TB Day passed quietly in Nigeria. The government probably prefers it this way. Nigeria is among the 22 high TB burden countries in the world and ranks 2nd in Africa. The national response is led by the National Tuberculosis and Leprosy Control Programme located within the Department of Public Health in the Federal Ministry of Health. On a day like the World TB Day – one cannot help but wonder, why they were all so quiet.

At least our colleagues at the Association for Reproductive and Family Health took the advocacy campaign on TB to radios stations around the country.

You may not remember that in our usual way in Nigeria, TB was declared a “national emergency” in June 2006 after which an “emergency plan” for the control of TB in Nigeria was developed. Targets were agreed upon – including; by 2015, to reduce TB prevalence and death rates by 50% relative to the 1990 level. Carrying out well managed surveillance would be the ideal way of measuring the burden of diseases, but in Nigeria we know how challenging this can be. In its place, the alternative is to carry out surveys. Using primarily donor funds two important surveys have been completed on TB in Nigeria in the past few years; one on the prevalence of TB and one on the prevalence of drug resistant tuberculosis. Despite the completion of these surveys – the reports have not been released! They are said to be awaiting sign-off by the Honourable Minister of Health. They have been awaiting sign off for over two years, waiting for a signature! So what could a survey show that would make it so difficult to release? Could it be that the surveys show that we have a much larger prevalence of TB and MDR TB than we have been made to believe?

Between 2010 and 2011, the Federal Ministry of Health, with support from the World Health Organisation conducted a prevalence survey on Tuberculosis in Nigeria. This WHO map clearly shows that this survey has been conducted in Nigeria. The beginning of the survey was reported with the usual fanfare. The results have been ready for over a year - but they have never been formally released. The question you will be asking is why. Although the final report is still not publicly available, but in one of the well hidden reports on what happened on World TB day, the new Nigerian Minister of State for Health, Dr. Khalif Alhassan is reported to have said that
".... the recently concluded National TB prevalence survey has (sic) revealed that actual burden (sic) of TB in the country is about three times higher than the current WHO estimates and five times more than what is being notified by the programme"
Multi-drug resistant Tuberculosis (MDR TB) is a form of TB that is much harder to treat and with worse clinical outcomes. Between October 2009 and November 2010, a prospective MDR TB survey was carried out in Nigeria in 30 randomly selected clinics around the country. The prevalence of MDR strains found was 2.9% among new patients and 14.3% among patients that have had TB previously. Of the study participants, 14.95 were HIV positive. These results were presented at the 44th World Union Conference on Lung Health, held in Paris in December 2013. The abstract from this poster and all other abstracts from the conference can be found here.

As far as we know, (an hopefully we will be corrected), neither of these two important reports have been published, either for peer review or as a report. This is the link to the publication page of the National TB and Leprosy Control Programme (NTLCP) - http://ntblcp.gov.ng/index.php/publications.The leadership of the NTLCP that sent in the abstract for the Paris Conference has done the country a huge favour. At least those that know how to dig through the internet can find the information they need while the rest of the country awaits ministerial signatures.

The whole essence of public health is to drive policy that should improve the health of the population. Why are there no more Nigerians asking why this is not happening. Why are we funding the Public Health Department with our tax-payers's funds when the results of surveys done on our health are never published? Why is the WHO, CDC, etc who supported these studies not insisting that the results be made public to the Nigerian people?

Can this be because TB is often  a disease of the poor? 

This is the entrance to where patients with TB are treated at my alma mata the University of Nigeria Teaching Hospital Enugu. The infrastructure is worse than a veterinary clinic, yet hard working nurses and colleagues keep it going, despite the odds. Are we not all guilty?

Despite all this, the National TB and Leprosy Control Programme is ably led by Dr Joshua Obasanya. He is one of the brightest and committed colleagues I have met, working in Nigeria. Determined to make the best out of his limited resources - he has tried in his efforts to put TB on the agenda. He led on the formulation of a new National Strategic Plan for Tuberculosis and Leprosy Control (2010-2015). But sadly, some important recommendations in the plan that have not been implemented, including plans to engage more private sector institutions to increase the coverage of  TB related services.

It is definitely time that we start asking some hard questions about the state of affairs with some of the biggest public health challenges of our time. TB is definitely is one of them!

P/S. THE LANCET has made a recent complete edition of its journal, focusing on TB completely freely available to readers. Access yours here, so that next time we do not blame our combined inactivity, on a lack of knowledge. When we know - then maybe we can also do something. As Johann Wolfgang von Goethe is famously quoted to have said;  “Knowing is not enough; we must apply. Willing is not enough; we must do.”

Monday, 10 March 2014

Are we really seeing a dramatic fall in maternal mortality rates in Nigeria?

Over the past few months, there have been various reports in the media about a dramatic fall in maternal mortality rates in Nigeria. This has been carried by a few newspapers and blogs quoting various government officials...
Premium Times: The Minister of Health, Onyebuchi Chukwu, has said that the maternal mortality rate in Nigeria dropped from 704 per 100,000 live births in 1990 to 487 per 100,000 live births in 2011. 
Daily Time: Maternal Mortality Rate Drops by 30%, Says President 
The Eagle online: Maternal mortality in Nigeria has reduced by 50 per cent, says expert
HealthNewsNG.com: Maternal mortality rate has reduced to 224 deaths per 100,000 

I have to written everyone in the sector that we have access to, in order for us to share the original data or publications that showed this dramatic decline, so far unsuccessfully. If you have access to this data, or you know who does please do share. If true, this is obviously great news for Nigeria and will show that Mr President's “Transformation Agenda” is having its desired effect. We will keep an open mind and appeal to you, our readers to share these results with us should you find them. It is important to realise that  dramatic falls in maternal and child mortality never happen in a vacuum. They are often as a result of significant changes in the socioeconomic well-being of a population and specific public health interventions. The reports above all quote government officials - right up to the President. No source is given for the data. The statements do not appear to be questioned by the journalists reporting them. The only questioning voice that we have found is in Dr Aminu Magashs's column in the Daily Trust where he asserts that;
 "...the 2012 MDG Survey was done surreptitiously" ..."The way and manner the findings were shared in the meeting revealed that it was a survey conducted in a clandestine manner without credibility and scientific relevance"

Friday, 28 February 2014

Another report, same bad news on childhood mortality in Nigeria

On the front cover of Save the Children's latest report ""Ending newborn deaths" is a newborn baby at a clinic in northern Nigeria. But this is about the only positive thing in the report out of our beloved country. The rest makes for very painful reading; 

The NGO, "Save the Children" invited different stakeholders working on maternal and child health issues to a meeting in Abuja on the 25th February 2014 to launch their new report. It contained data that does not surprise.

Nigeria still has one of the highest under-five and newborn mortality rates in the world, at 123.7 and 39.2 per 1,000 live births and this is not equally distributed in the country. Unsurprisingly, the under-five mortality rate is nearly 2½ times higher among the poorest households than the richest households.

Nigeria is second out of the ten countries with the highest rates of first day deaths and still births during labour in the world, behind Pakistan with 33 intrapartum stillbirths and neonatal deaths on day of birth per 1,000 total births. 

We could go on and on, but these statistics soon leave you feeling numb and perhaps desensitised  to the full scale of the problem. As a country that has become numb to the impact of the terror attacks in the North East that killed innocent school children, the death of women in  childbirth hardly raises a whisper.

Friday, 21 February 2014

Finally some innovation drivers in the health space: Launch of the Private Sector Health Alliance of Nigeria

Our friend and colleague; Dr Femi Sunmonu, Director of PurpleSource Healthcare, a healthcare management and investment company transforming the mass market private healthcare space in Nigeria recently attended the launch of Private Sector Health Alliance of Nigeria. These are his reflections.....

I recently attended the inauguration of the Private Sector Health Alliance of Nigeria (PHN) in Lagos two weeks ago. It was launched by Bill Gates and the patrons of the Alliance to contribute to the SAVING ONE MILLION LIVES  movement. Its goals are to advance progress in meeting the health Millenium Development Goals  (MDGs) by focusing on innovation, partnerships, advocacy and impact investments. Some eyes may already have begun to glaze over as yet another platform promises to catapult Nigerians into a new age of equitable, affordable, quality healthcare just in time for Christmas.

This however is NOT one of those organisations. This is a Private sector-led effort inaugurated by Industry Stalwarts like Aliku Dangote & Jim Ovia, and headed by young, driven professionals at the top of their respective fields. Their CV’s are impressive; entrepreneurs, PHD’s, and Management Consultants who have demonstrated the an ability to deliver results in their respective professions. The highly regarded former Minister of State for Health in Nigeria, Dr Muhammad Pate is joint leader of the alliance. The primary agenda of the PHN is to embrace innovation in all its forms to not only meet the health-related millennium Development Goals but to progress beyond them.

Private Sector Health Alliance of Nigeria
“Innovation”; what really is that you may be asking. One example illustrated below is that the organisation has already made strides towards their goals by partnering with the telecoms industry to utilise the excess power generated at transmission towers to strengthen nearby health facility vaccine cold chain infrastructure. Similarly it has joined forces with the pharmaceutical industry to leverage their supply chain infrastructure to augment primary healthcare systems in select states.

Friday, 14 February 2014

Where are the Nigerian health advocates?

As our public health sector continues to deteriorate, it is impossible not to notice the absence of any sustained advocacy. This is most obvious in the HIV/AIDS arena. Nigeria has the second highest number of people infected in the world, over 3 million of us! Less than 500,000 are on treatment - all funded by donor funds despite N2.1B being allocated to the National Agency for the Control of AIDS  (NACA) in the 2014 budget....and we are all quiet. Very quiet....

To remind us what is possible with powerful targeted advocacy can achieve.

Vuyiseka Dubula is General Secretary of the Treatment Action Campaign (TAC), based in South Africa. As a young woman she joined TAC after learning her HIV positive status. Founded in 1998, TAC advocates for increased access to treatment, care and support services for people living with HIV. Since 1998, TAC has held government accountable for health care service delivery; campaigned against official AIDS denialism; challenged the world’s leading pharmaceutical companies to make treatment more affordable and cultivated community leadership on HIV and AIDS.Today, there are over 2.4 million people on life-saving antiretrovirals in South Africa all funded by the government, but she tells us that her struggle, and more importantly our struggle is not over just yet. Vuyiseka Dubula's TEDxEuston 2013 talk is a a powerful reminder of the courage it takes to change paradigms when it appears that all the odds are stacked against you. Fighting big companies when you are poor and black was deemed impossible by many people. Fighting the government appeared even more daunting. Vuyiseka did it and lives to tell the tale.

Watch her talk HERE and share it with anyone you care about. It may change their life!

Monday, 27 January 2014

Was 2013 the year of the ‘Almost Eradicated’?

Recently the Minister of Health called the press together and presented the WHO certificate of elimination to the President. He is reported to have said during the ceremony that "The Guinea Worm free certificate will further spur his (Jonathan's) administration’s commitment to fight against many endemic diseases such as HIV/AIDS, Malaria, Tuberculosis and of course polio" and that “The certification by WHO is a global recognition of how far we have come and the success of the work that has been done to rid our nation of this scourge. Iruka Okeke contributes this insightful piece to put it all into context. Enjoy!

Was 2013 the year of the ‘Almost Eradicated’?
By Iruka N Okeke

Eradication, the complete annihilation of a disease, is a rare goal and a rarer accomplishment.  The World Health Assembly has signed onto only seven such programs in history.  Three were terminated in failure (malaria eradication in the mid 20th century, yaws and yellow fever) and only two – smallpox and rinderpest – have succeeded so far.  Good progress has however been made for guinea worm disease and polio.  Both guinea worm and polio eradication programs are lagging more than two decades behind their original target dates but eradication is in sight and therefore programs must continue in spite of the challenges. Sadly, Nigeria is among the handful of countries that has struggled in the endgames of both eradication programs.  Nigeria was the source of re-introductions to Cameroon in the 1990s and the principal reason why elimination in our neighbor was delayed.  In 2008, with Ghana, Mali and Sudan, Nigeria was one of only four countries endemic for guinea worm.  The story is similar but more drawn out for polio, where Nigeria, Afghanistan, Pakistan and India (the last now polio-free) were the last bastions and vaccine boycotts in Nigeria led to resurgence of the disease as well as export to polio-free countries.

Wednesday, 15 January 2014

Good news to start 2014: Prof Chukwu says he will accept a call to serve!

It has been circulating through the rumour mill for quite some time, but now it is confirmed. The Minister of Health  has declared that he is ready to serve the good people of Ebonyi State as their Governor, if he is invited!

Professor Onyebuchi Chukwu, Nigerian Minister of Health (culled from Punch Newspapers)
He apparently told journalists in Abuja that;
"...I have a passion for things to be done properly; I have a passion for individuals ..... I am someone who is usually committed to an assignment that is given to me and which I have accepted to do. I am also someone who wants things to be done properly"

Tuesday, 24 December 2013

Analysis of Nigeria's budget for health in 2014

N262B (1.7Billion USD) has been allocated to #health in Nigeria's 2014 budget; of which 82% is going to recurrent expenditure. All the detailed allocations to the Ministry of Health can be found here. We urge you to go to the website, download a copy (who knows how long it will be up) and use it to hold our health sector organisations accountable. Remember that we do have a Freedom of Information Act in Nigeria and we cannot blame government if we don't use it. 

Health Allocation in 2014 Nigerian Budget
The N262B allocated to #health is about 6% of the total budget and second only to defense, education and finance (finance includes debt servicing). It is slightly less than the N279 allocated to Health in 2013. 

Monday, 18 November 2013

An epidemic of accidents in Nigeria

Sadly, we are faced with another tragedy. Award-winning novelist and popular academic unionist, Festus Iyayi, was killed in Lokoja when a vehicle in the convoy of Governor Idris Wada of Kogi State rammed into the bus conveying him, and his colleagues to Kano. The group were on their way to attend a meeting of the Academic Staff Union of Nigerian Universities (ASUU), which has been on a nation-wide strike for four months. A commander of Federal Road Safety Commission (FRSC), Olakunle Motajo, is reported to have said that a preliminary report on the accident revealed wrongful overtaking on the part of the government vehicle.