Monday, 31 December 2007

The health of Nigerians in 2007....Some hope, Many Disappointments ...and 10 stories

When we started off....we said....

When your neighbour dies from measles, during child birth, in a car accident, rather than conclude it was as "God wanted it", think, ask and act on the failures; the missed chance at vaccination, inadequate antenatal care or non-existent emergency services that might have prevented these deaths. The alternative would be to conclude that God really has a problem with us Nigerians; why else would he let so many of us die from causes no one else is dying from? We will ask the hard questions.

....we hope we have. We hope too that you have enjoyed reading our BLOG. We hope that it has lead you to ask some hard questions...and sometimes go the extra mile.

If you have found the information in this blog useful, join us in raising awareness on health issues in Nigeria. Send out the link, add to your favourites, subscribe to the RSS fee or email....and send in your comments.

Have a healthier 2008!

Nigeria go better!

Find below 10 stories that we felt most affected the health of Nigerians in 2007. We will come back to them at the end of 2008.

Chikwe & Ike





1. NEW MINISTER, RENEWED HOPE


Health must be seen, felt and palpated in every household. Words of the new Nigerian Minister of Health, Prof Adenike Grange. The optimism surrounding her recent appointment seems justified looking at press reports. In her first meeting with key stakeholders in the Nigerian health sector, she emphasized that it is time to move from a focus on policy to implementation and evaluation.

She seems to have made the reduction of Maternal mortality the focus of her tenure in office. The key question is how? Prof Grange has definitely got her job cut out... She comes across as honest, strong willed and self-assured. The hope of 140 million Nigerians rest on her shoulders...Restoring Health to the agenda, is a matter of life and death

2. MEASLES OUTBREAKS

We blogged severally about measles in our first year...and we hope that we will not have to do so in 2008. We keep coming back to this because we still have not found the answer to the question Why is it still alright for children to die from a Measles, a disease that can be prevented with a vaccine that costs less than a bottle of coke in NIGERIA?...

- How THISDAY reported the measles outbreak in Zaria
- Sad - Yet another Measles outbreak
- Why children continue to die from a disease that can be prevented with 50 cents!
- Measles outbreak update, civil society oversight and some cheering notes
- Another Measles Outbreak

Find below the profile of Mrs Titilola Koloese-Adelekan. The Chief Executive of the Nigerian Primary Health Care Development Agency, into which the National Programme for Immunisation (NPI) was merged into in 2007.



3. OUR PRIMARY HEALTH CARE CENTRES


The 18bn naira ($145m) contract to build health clinics across the country said to have been awarded to a company believed to be owned by a former aide to Mr Obasanjo was canceled by the Yar'Adua government. This has finally been confirmed.
The contractor cried blue murder and asserted that the project was 50% completed....he believes that we will miss the Millenium Development goals as a result of the cancellation!
We are not sure weather to laugh or cry! Since the emergence of the Obasanjo government in 1998, we have shouted to all that the "BUILDING" of health care centers, is no way to improve "HEALTH". What is the planning for this? Who will manage them? Our local governments? What happens to all the monies invested already? What is the Yar'Adua government doing other than "cancelling"? HOW DO WE MOVE FORWARD in providing primary health care? What exactly is the role of the National Primary Health Care Development Agency (NPHCDA) - Nigeria....which has been building the famous "virtual" primary care centres around the country for the past 8 years of the previous government. While we await for an articulate, innovative primary health care development programme, with emphasis on quality and standards of care to be provided and not just buildings, we hope that these are not left in the hands of our so called "Local Governments"...or they are doomed to fail.


4. THE RENOVATION OF OUR TEACHING HOSPITALS


In addition to the virtual health care centers the single other marginally visible project is the refurbishment of the Nigeria's teaching hospitals undertaken by the Obasanjo government in its 8 years of power. Yes...8 years!!!. This was awarded in 2002 to Albert Awofisayo, a socialite and prince of Ile-Ife and his company Vamed Engineering Austria at a total cost of N28.5 billion for the refurbishing of 14 Teaching Hospitals in Nigeria. It is believed that he got the contract through the support of the Obasanjo family to which he is said to be very close. This project has been controversial from the beginning. President of NARD, Dr. Adedamola Dada questioned the reduction of MRIs and delay in the execution of the project.According to The Guardian some of the installed state-of-the-art medical equipment procured for the hospitals are not in use, as there are not enough trained Nigerians to man the equipment, some of the equipment are yet to be installed, leaving them at the mercy of unfriendly weather.

However as this report in the Guardian describing "When Refurbished UNTH Came On Streams" shows....there is hope.

5. THE PFIZER TROVAN CONTROVERSY RUNS AND RUNS


In early 1996, Nigeria was hit by the one of the worst meningitis epidemics in history. Government officials have placed the final death toll at over 11,000. At the time, Pfizer had just developed a new antibiotic called Trovan to treat a variety of infections. But Pfizer had a problem: In order to secure certification from the Food and Drug Administration (FDA) in the US, it still needed to conduct a clinical trial. The meningitis epidemic in Nigeria came at just the right moment. Since then it has been claims and counter claims. And more claims ...and even more

We asked; Who is lying?, and 9 other questions
...we still have no answers.

6. POLIO...our Achilles heel..


Minister of Health, Professor Adenike Grange said the prospects of achieving the 2008 target of eradicating polio were bright, as the country for the first time since 2002, recorded a decline of 80 per cent in the number of children affected with wild polio virus between January and August 2007, compared to the same period in 2006. While still celebrating the possibility of success....THE NEWS BROKE! ... that the biggest outbreak of vaccine-derived polio virus (known in the shorthand of polio as VDPVs) in the literature has been going on in Nigeria with 69 cases of children paralyzed by polio related to the virus in the vaccine. There had been rumours for months.... Why would an outbreak be going on for more than a year and a half and we have nothing at all about it until now? The bottom line is....whatever skepticism we might have about how the initial outbreak was handled, whatever our disappointment might be in the present communications strategy, our views (of which there are always plenty :))....WE CANNOT AFFORD TO DROP THE BALL, NOT NOW, AND NOT IN NIGERIA.


7. HIV/AIDS - THE STRUGGLE CONTINUES


Nigeria is estimated to have the 3rd largest number of people living with HIV in the world after India and South Africa. On December 1, we wrote...While the rest of the world marked the World AIDS day, it seemed to have been marked with deafening silence in Nigeria. Our colleagues at JAAIDS informed us that this was not the case on radio and TV in Nigeria. We looked at the accounts of the Global Fund...and found out that of the US$9.9 billiomn committed worldwide, US$400,000,000 has been approved for projects in Nigeria. Find details of individual project allocations here.
Flipping through the dailies in Nigeria, it was good to note how HIV/AIDS prevention messages have evolved and developed ....from the days of "AIDS KILLS!".


8. ROAD TRAFFIC ACCIDENTS....HOW DO WE PREVENT THEM? WHERE DO WE TREAT THEM?


Yes...Osita Chidoka is. He tells us that 4,944 Nigerians were killed in 9,114 road accidents, while 17,390 were injured in 2006. We think that it is a gross underestimate. At this time of the year, the reports keep pouring in as here and here. Our ex-President Olusegun Obasanjo described as 'unacceptable' the current statistics that show that over 32,000 lives are lost on our roads yearly...OK the numbers vary...but statistics have never been our strength in Nigeria. Our leaders are flown abroad for kidney ailments, knee injuries, ...

Is it too much to ask for one efficient, equipped and resourced accident and emergency unit in each state?

Else we will continue reading stories like this

9. PIPELINE EXPLOSIONS

In December 2006 more than 260 people died after a gasoline pipeline tapped by thieves Abule Egba district of Lagos, Nigeria. Another 60 were severely burnt. . You would think that we would learn, but sadly....not. On exactly the same day in 2007, December 26th it was reported that 50 people were roasted alive yesterday at Adagbo village of Iru, Victoria Island local government Area of Lagos State. Why is life so cheap in our country. The image below was in TIME International, the world's leading print brand for news and information, with a worldwide circulation of more than 5.4 million...With such publicity, no amount of image laundering will make our country a desirable one to visit.


10. SOME MISCELLENOUS GOOD NEWS STORIES TOO!


Attending TEDGlobal was where the whole idea of a blog started! Unbelievable inspiration!

Akunyili @ 53. She proves that sometimes one person can make a difference.

Nigeria is finally moving against British American Tobacco.

The Medical and Dental Council of Nigeria awakens...

Igbinedion University , Nigeria's first private university graduated its first set of 29 medical students.

Kanu Heart Foundation: Proving skeptics wrong



Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has...Margaret Mead

If you have found the information in this blog useful, join us in raising awareness on health issues in Nigeria. Send out the link, add to your favourites, subscribe to the RSS fee or email....and send in your comments.

Have a healthier 2008!

Aluta

Monday, 24 December 2007

How THISDAY reported the measles outbreak in Zaria

Sometimes it is difficult to gauge the media coverage of events in Nigeria, so I was happy to receive a copy of the Thisday newspaper from a reader of this blog showing us the 3 pages of in depth coverage given to yet another tragic measles outbreak. KUDOS TO THISDAY.

Just maybe....someone ...somewhere will answer the question....

Why is it still alright for children to die from a Measles, a disease that can be prevented with a vaccine that costs less than a bottle of coke in NIGERIA?...


Imagine if this child is yours...



Now read the rest and be shocked. Measles is known to most medics as one of the easiest diseases to diagnose clinically. I.e. any nurse/doctor can identify a case of measles from its distinctive rash....especially in an endemic country like ours. But guess what Kano's Commissioner of health did when the outbreak was reported...

He went on a "fact finding tour"....!






....when asked about what can be done in the future to prevent future outbreaks....he pointed to improved reporting systems...OK Yes..its important...but what about vaccinating the children???

This can hardly help the 200 kids that have died....and if you expected to read a bit of remorse here...you'll have to look elsewhere...

...Thisday ended its 3-page coverage with 2 interviews...Great stuff apart from a plethora of factual inaccuracies. I am not sure this is a misinterpretation of information given ...or wrong information given...These are highlighted here as consequences of wrong information in health issues can be deadly...

Dr Elijah Kehinde of Gambo Sawaba General Hospital Zaria is reported to say...

1. Measles is age specific. Wrong Any susceptible individual can be infected by the measles virus, but the risk of an adverse outcome such as death is higher in children.

2. The first sign the health worker should look for is redness of the eyes...what we call cophlix spots. Wrong...yes readness of the eyes should be looked for...this is called conjunctivitis, Koplik spots are small, white spots (often on a reddened background) that occur on the inside of the cheeks early in the course of measles.

3. Every child is supposed to undergo vaccination at 3 months. Wrong For measles..the schedule in Nigeria is measles at 9 months, but can be given from 6 months in outbreak situations.

...read on..


Monday, 17 December 2007

Sad - Yet another Measles outbreak

How many children will have to die from measles in Nigeria?

Avid readers of this blog will know that the occurrence of measles outbreaks in Nigeria causes us particular pain.
Early in our existence, we blogged about an outbreak in Borno in June, with a reported 60 deaths. In October, we asked why children continue to die from a disease that can be prevented with 50 cents!...Prof. Professor Idris Mohammed, a one time Chairman of the Board of Management of National Programme for Immunisation (NPI), described it as a conduit pipe for diverting immunisation funds to private accounts of a few people on an unbelievably massive scale...in his recently published book "Academics, Epidemics and Politics: An Eventful Career in Public Health"

This month...yet another outbreak is reported in Kano with 200 deaths!

As usual...this was widely reported by the press, by Reuters, VOA as well as expert sites like the highly regarded ProMed...one of the most important sources of infectious disease news globally.

A colleague asked ...How many children will have to die in Nigeria?

There are many health problems that are difficult to prevent (e.g Cancers)...and some even more difficult to treat (e.g. AIDS)....
...but here we have an illness that we can prevent by giving our children a vaccination that costs less than a bottle of coca cola and free to the patient in most cases.


When asked how they'll respond...Mahmud Mustapha, director of the National Primary Health Care Development Agency in charge of seven north-western states...is quoted to say ... the agency plans to do house-to-house vaccinations in January 2008.

Dear Sir...vaccination campaigns will help...but they will not solve the problem. Until we build a routine vaccination programme that works, in which people have the confidence to bring their children to...we will keep having outbreaks of measles...children will keep dying...and I will have no answer for my collagues to the question...How many children will have to die in Nigeria?

Friday, 7 December 2007

Ember months and Road Traffic Accidents


It’s December, the season of the so-called “ember months” in Nigeria when road traffic accidents (RTAs) seem to occur with increased frequency. Nigerians have often put forward various reasons for the death toll on the roads during this season (from the presence of “blood-sucking witches on the roads” to other less exotic reasons like the increased number of road users during the festive season), it is perhaps fitting that we focus on the question of road traffic accidents. These are an important preventable cause of death and disability in Nigeria, and most Nigerians have lost friends and family to road traffic accidents. Only recently, a prominent political leader, Chief SB Awoniyi died following injuries sustained in a road traffic accident.

There are of course many facets to the problem of road traffic accidents, from the poor condition of the roads to unsafe driving practices (including the daredevil antics of the okada motorcyclists) to the absence of ambulance services and trauma units. Some of the reasons identified for the rising rate of deaths include the increasing numbers of vehicles on the roads, poor enforcement of traffic safety regulation (including roadworthiness tests and driver licensing) and poor health infrastructure.

I can’t help but marvel at the fact that alcoholic drinks are sold openly and copiously in the motor parks, and that many of the commercial drivers spend their time while waiting for passengers in the various bars that dot these motor parks. And often the passengers collude in their lives being put at risk by either ignoring the state of the driver, or making ineffectual pleas for the driver “to take it easy” Similarly, the average Nigerian non-commercial driver thinks nothing of taking to the road after downing several bottles of beer or stout or whatever the favoured alcoholic beverage is. Think of how many accidents occur in the night on the way back from parties and other social gatherings.

Similarly, it is shocking that motorcyclists and their passengers are not made to wear protective helmets which would protect them against head injuries.

Poor planning of roads without provision for pedestrian crossings, and overhead pedestrian bridges is another problem and where they exist, are often ignored by pedestrians.



Enforcement of existing laws and changing behaviour must be at the heart of making any progress in this area- making it clear that by drinking and then driving people put their lives and those of other road users at risk, introducing breathalyser tests for drivers leaving motor parks, scrapping the sale of alcoholic drinks in motor parks, insisting on the use of helmets for motorcyclists, enforcing speed limits and raising public awareness of the problem.

The Federal Road Safety Commission has launched an awareness campaign for the “ember months” and SAVAN ,Lifeline, and Road Safety Nigeria are some of the organizations working in this area but there needs to be a sustained and coordinated effort including the Federal Ministries of Health, Works and Transport as well as the Federal Road Safety Commission

Sunday, 2 December 2007

World AIDS day in the Nigerian Press...Fatigue or Indifference


While the rest of the world marked the World AIDS day, it seemed to have been marked with deafening silence in Nigeria.

Yes...NACA did release a statement, which maybe was available in the print editions of the dailies, but was nowhere to be found on the online versions. NTA's network news did not carry a single story about AIDS on the day. So what effect does a statement have if no one reads it?

Carried on by the always reliable JAAIDs forum...the highlights were...

~ Nigeria currently provides free, comprehensive anti retroviral treatment, care and support to about 170,000 people living with HIV/AIDS.


~ Nigeria has installed capacity to treat much more and we have increased access with treatment centres located in over 250 sites across the landscape of our country.


~ Leadership is required... not just political leadership but governmental, religious, traditional, community, cultural, youth and family. Thus, it involves all of us, you and I.




...An article in the ever popular Nigerian Village Square, by Churchill Okonkwo sees the biggest challenges in the informal sectors – the market men and women, the Road Transport Workers, the street Traders. How do we get then actively involved and informed?

I have not read a more disjointed, ill-informed and error-filled article that that in Nigerian Business Day A taster: "The AIDS pandemic remains the most dreaded disease to afflict mankind in such a devastating manner
that the whole world literally caught cold within its first year of discovery."


Sadly ...sadly the cure claims have not gone away....

"eminent" colleague Dr Abalaka and his cure for AIDS has not gone away...In a recent report by the Science and Development Network, The Nigerian Academy of Science is being sued by the doctor after casting doubt on his unproven claims to have invented a vaccine for HIV.

In most other countries, people that make such claims without proper trials are struck off the medical register at the very least as here

Coincidentally this same week, his compatriot Mr Abdulahi who came on the AIDS scene in Nigeria around the same time has been given lots of newspaper space by The Sun where he contends that the Nigerian government is being led by the nose by Western powers and the United States of America (USA) in believing that the dreaded disease cannot be cured.

...I guess they have all been emboldened by the Gambian President's claims....

Yet we all seem to keep quiet, scared to criticise these claims...lest we be seen as doubting the prowess of our compatriots!. How long will our governments keep quiet while innocent patients are used as guinea pigs? How long will our press continue giving coverage to these stories without any critical appraisal? Who really cares?

Making Every Nigerian Mother and Child Count



A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy.
Maternal mortality is one of the most powerful indicators of the quality of a health care system. In a 2003 report, the WHO and UNICEF, the world average was 400, the average for developed regions was 20, and for developing regions 440. The worst countries were: Sierra Leone (2,000), Afghanistan (1,900), and Malawi (1,800),. Maternal mortality ratio for Nigeria, 6th largest Oil exporter in the world was 800 maternal deaths per 100,000 births, i.e 1 in every 125 pregnancies resulted in the death of the mother in Nigeria. To compare our status; it is 540 in Ghana, 570 in Togo and 730 in Cameroun. We had the second highest in absolute numbers (37,000), behind India at(136,000).

The Minister of Health Professor Adenike Grange seems to have made this the focus of her tenure in office. During the Lancet lecture she delivered in London where she pointed this out as evidence for the state of health in Nigeria. She has declared that lowering this would be one of the major trusts of her administration. The key question is how?

At another conference in London, the Woman Deliver Conference the Nigerian Ministry of Health was praised for showing the will to tackle the frightening state of maternal and infant health in the country, evident in the Maternal Newborn Child Health System (MNCHS) developed by the ministry. The ministry is reported to be creating an investment plan for women with so much emphasis on community participation.

There have been several reports in the newspapers lately on the launching of "Free medicare for pregnant women and children". What no journalist has bothered to find out is what services exactly are free? Just the delivery of the child? The ceasarian section if required? The drugs? etc etc Where exactly will these free services be delivered? By whom? While these answers might all be clear in the files of the Minister, it is rather sad that journalists throw out banner headlines without asking these important questions!

In this report, The Guardian lauds the Federal Government on its plan to introduce these free services. We also know that the Federal governments is only directly responsible for health care services in 1 center per state in most instances, a teaching hospital or Federal medical Centre. Providing these services free here does not equate to "nationwide" as insinuated by this report!!! But it will be a great start...

Champion reports that the Honourable minister attributed maternal deaths to lack of adequate nurses, doctors and health facilities in most primary Health care centres in the country. It quotes Prof Grange thus "The time is now for government to leave no stone unturned in making the nations health care system efficient, affordable and reliable in order to serve the common man who cannot afford to fly abroad for treatment". While all politicians love phrases like "leave no stone unturned"... Nigerians would still love to hear how!

Meanwhile...the States start announcing with fanfare:
Abuja: FCT PREGNANT WOMEN TO GET FREE MEDICAL CARE-MODIBBO

And the heir to Chief Onifade Ibori's estate in Delta State welcomed Prof Grange to Asaba to kick of his programme with the usual fanfare...



It is a sign of courage that Prof Grange has picked this important indicator of health to be judged by. Being a woman and a mother...she knows what is at stake. In public health terms...there can be no better indicator for the health of a population....and non easier to evaluate... we will be watching as we hope that every Nigerian Mother and Child will count...