Friday, 26 June 2009

Road safety: the new immunization?

by ndubuisi edeoga

The jury is out; with the World Health Organizations (WHO) recent, first ever report on worldwide road safety shows that low and middle income countries like Nigeria account for more than 90% of traffic fatalities worldwide. The breakdown of the report shows that about 1.3millon people die each year on our roads and between 20 and 50 million people sustain non-fatal injuries.

Do you know that traffic injuries cost about $518 billion dollars a year, not counting the lives lost for which we may not have a dollar value for? Have we been barking up the wrong tree?

The WHO goes on to tell us what we already know, but have refused to implement.
  • Strictly enforce speed limits
  • reduce drunk driving
  • tighter seat-belt laws
  • helmet laws
  • more research on road planning and design
Road design is important since the report goes on to show that vulnerable road users listed as pedestrians, cyclists and motorcyclists popularly known as okada men, account for 46% of all traffic deaths. The road safety chief; Corps marshall and Chief executive of the FRSC Mr. Osita Chiduka has not been sleeping, see his vision 2020 plan here. But this new call by the WHO merits his undivided attention. (sadly...again the FSC website is "down"

WHO recommends that road safety laws need to be made more comprehensive, and that enforcement of road safety rules needs to be strengthened. The Global status report on road safety is a call to action for all stakeholders, most importantly us.

Looking at the WHO fact site... Nigeria has a seat-belt law, motorcycle helmet law, drink-driving law amongst others but no Child restraint law. I’m Nigeria and I love my kids so much and I know most other Nigerians do love their kids. Not making enabling laws to protect our children by the Nigerian government leaves a lot to be desired. It looks like we don’t love our children enough to immunize them, now they make seat-belt laws and forget our kids, what next?

Now...lets us shall take the law into our hands. Spread the message to your friends and family, next time you are going home plan to buy some car seats for your friend and family, next time you are driving make sure you have your seat-belt on and ask everyone in your car to put their belt on too, next time you have to drink and drive, remember that it could be you, and that you are not immortal as we all believe, next time your speedometer gets above 100kph make a detour to the race course who knows you might be the next Michel Schumacher, and make some money while you are there. If we all make these little adjustments we will not have to wait for the Nigerian government to save us from ourselves.

Next time you are taking that new baby home from the hospital make sure you have the survival kit viz: mosquito net, car seat, immunization schedule in hand, and pray that the guy driving past you in car lot just read this blog.

Friday, 19 June 2009

We learn the hard way...

When in 2003, the Polio crisis first broke in Kano and threatend the Global Polio Eradication efforts, the public health community around the world were dumbstruck. First we ignored the situation, but then as the outbreak spread across Africa and beyond we reacted with anger. But finally we realised that neither silence nor anger was going to solve this one.

We needed to go back to those ancient public health tools of community engagement and social mobilisation. So a process of slowly regaining the support of the population in Northern Nigeria started.

Thisday reports that on the 6th of May foremost traditional leaders from Northern Nigeria met in Kaduna and expressed their commitment to ensuring that polio is totally eradicated from the region. What a turn of events!

The Sultan of Sokoto, His Eminence, Alhaji Sa'ad Muhammad Abubakar III, tasked the traditional rulers to be personally involved in polio eradication initiatives. He is the head of the Nigerian National Supreme Council for Islamic Affairs and is considered the spiritual leader of Nigeria's muslims. On November 2, 2006, Sa'adu Abubakar succeeded his brother, Mohammadu Maccido, who died on ADC Airlines Flight 53.

The Sultan has been a relevation since his emergence in the Nigerian polity.

Now we have learnt that to win the hearts and minds of the people ...we have to speak to them. Our leaders have to engage. See if you recognise any of these...

You will probably be wondering where the president of the country with the most case of Polio in the world is...but thats an isue for another day. Today, let us celebrate The Sultan.

But talking is not enough. Polio vaccination too is not enough. With routine vaccine coverage remaining persistently below 40% since 1997, measles has remained hyperendemic in many parts of the country, especially the north...which we have frequently blogged about.

Improving routine immunisation (as opposed to campaigns) can prevent many deaths, yet we do not seem to be able to muster the required resolve to pursue this goal without disease specific targets. A window of opportunity exists to broaden the benefits of these vertical programmes beyond the specific disease, in this case poliomyelitis. Active efforts should be made to plan for the diversification of these skills. This can only be achieved if the donor that supports these programmes actively demands integration.

Sustained vaccine coverage for measles of below 40%, as in Nigeria, in an era of regular national immunisation days for polio eradication is a modern tragedy.

These are the issues we expect the Sultan to challenge the Government on, indeed these are issues we should all challenge our government about. With the renewed energy in the National Primary Health Care Development Agency...Nigerians are hopeful.....we deserve more.

Wednesday, 17 June 2009

MANSAG - Still going strong!

Organising Nigerian doctors will never been an easy task. The Medical Association of Nigerian Specialists and General Practitioners have been doing this in the UK since 1997. As is tradition every year it recently held its annual charity ball. This was a ball with a difference as it had the ebullient Nigerian (rather than Nigerian-born) comedian Gina Yashere, who held the audience spell bound with her jokes....(would love to see her on stage with BasketMouth)

But it was a night of serious affairs too.
MANSAG has been very active in supporting specific charities every year. This year the chosen charity was "Stepping Stones" Stepping stones works in Nigeria with the Child Rights and Rehabilitation Network (CRARN) and our sister NGO - Stepping Stones Nigeria to protect, save and transform the lives of children who have been stigmatised as being 'witches'.

No doubt, MANSAG has matured as an organisation. Guided by the able leadership of Professor Stanley Okolo and his team. It has done its bit in defending the interests of Nigerian doctors in the UK. Speaking to Stanley at his last Ball as president, he says that one achievement he is proud of in the engagement of the next generation Nigerian doctors in the UK in MANSAG's activities. As the new executive comes in...they will have to carry on with this challenge. Of the literarily thousands of Nigerian doctors in the UK, at best, less than 200 are active in the activities of MANSAG.

At the dinner was Nigeria's High Commissioner to the UK, Senator Dalhatu Tafida, a former Honourable Minister of our Federal Republic and a colleague. Watch out for what Dr. Tafida said at the dinner and why it matters in subsequent posts.

But for now, on save the date of the next
20th MANSAG conference and AGM in October 2009 Plymouth (Weekend: 30 October - 1 November 2009).

Between July 14 - 19
MANSAG is collaborating with the Association of Nigerian Physicians in the Americas and the Nigerian Medical Association to organise a conference in Abuja. Find the programme here.

So...if you are in the UK and a doctor, don't sit on the fence, engage with MANSAG. Check out their website at (...and yes...they are working on a better website :))

Monday, 15 June 2009

The good news, the bad news…and some hope

Last week I was at the annual conference of the European Society of Pediatric Infectious Disease in Brussels.

There was a buzz in the room as the new tools available in our arsenal to do battle with our microbial competitors in our ecosystem were discussed. In addition to cutting edge new drugs, there were some papers that were amazing not for their science but for their implementation. One of particular interest was by Dr Pettit of the University of Geneva Hospital who showed how through several “simple” but meticulously implemented measures as like hand-washing,are able to push down the rate of hospital acquired infections, saving lives and saving money. I thought back to my time working at the University of Nigeria Teaching Hospital Enugu and our struggle to get running water. I think of the efforts of students pouring water over the surgeons hands from a bucket as he prepared for surgery, to then imagine that this is the premier tertiary health facility in Eastern Nigeria…goose pimples emerge at the thought of what the effects are. Health care associated infections is an area we have not even scratched in Ill not bore you.

So...guess what are the two biggest vaccine-preventable diseases which together account for more than 35% of all child deaths every year, the majority of which are in the developing world. ...not measles, meningitis, diptheria.... not TB

The two are "diarrhoeal disease" and "pneumonia"

The good news - What I will share with you is the availability of two “new” vaccines. They are not really new, but their impact on the lives of children is just becoming obvious.

1. A vaccine has been included in the routine vaccination schedule against 10 subtypes of the bacteria – pneumococcus, the most common cause of pneumonia in children, but also a cause of meningitis and sepsis in many developed countries. A 7-valent vaccine has been available for some years now. WHO has issued a recommendation for the introduction of pneumococcal vaccines into immunization programs in developing countries to save millions of lives, starting with the currently available 7-valent pneumococcal conjugate vaccine.

One African country has added the pneumococcal vaccine to its schedule: Rwanda. Several others have plans in advanced stages...for details look here....and sorry Nigeria is NOT one of them!

2. A new vaccine against the rotavirus, already widely used in many parts of the world, including most of Latin America has now been shown to work effectively in African settings too following studies conducted in Malawi and South Africa. On the 5th of June during the ESPID conference last week in Brussels, the World Health Organisation recommended the global use of the rota virus vaccine.

These new vaccines bring real hope to millions of children in Africa, sadly not yet ours. The agency responsible for delivering on immunisation in Nigeria as been in the wilderness for years, with neither the will nor the leadership to deliver on its mandate. We have barely been able to deliver the primary vaccines that have been on our schedule for years.

But now with new leadership (more on this in future posts) at National Primary Health Care Development Agency, the agency responsible for immunisation in Nigeria there is renewed hope. The agency is working towards to re-defining itself and to restore some of the legacies of Professor Kuti and protect the lives of the most vulnerable. For now, these kids will continue to die from pneumococcal disease...just because they were born in Nigeria and not Rwanda! What a turn of events!

Meanwhile...see here my means of transport in Brussels....lovely city!

Sunday, 7 June 2009

How we hurt ourselves...

For a few years I have reviewed abstracts for the International AIDS conferences. Nigerians have often met in these conferences. While we remain proud of our increasing contribution to the knowledge base....many ...many of the abstracts submitted leave a lot to be desired.

Plagiarism is considered one of the worst offences in academia. This is defined as "the use or close imitation of the language and thoughts of another author and the representation of them as one's own original work"

Find below and email I have just received from the conference organisers:

Dear IAS 2009 Abstract Reviewer,

We are writing to inform you that it has been discovered that one of the abstracts that were part of your IAS 2009 reviewing assignment in March was in fact plagiarized. The title of the abstract was the following:

Using information & communication technology (ICT) products to reduce stigmatization of HIV+ female sex-trafficked deportees as a measure of increasing access to antiretroviral treatment (ART) and Care in Edo-State, Nigeria

The conference secretariat is informing all reviewers who scored abstracts that have been found to be plagiarized to ensure that the record and reputation of the original author(s) stands protected. It is particularly critical in the event that you or the other reviewers would have identified a study/research as previously presented elsewhere.

Please do not hesitate to contact me if you should have questions or need further information.

...our problems are deep....but together we will continue to hold ourselves to account...

Friday, 5 June 2009

A Minister's promise - "You can count on us"

A few weeks ago I got a message from the PA of the Honourable Minister of Health of our Federal Republic. He was passing through London enroute Nigeria from the World Health Assembly in Geneva. He asked to meet me. It was short notice and I was in the middle of managing a major infectious disease incident. I was worried of being berated for articles on this blog that might be considered critical. But at the end of the day, I rescheduled a few meetings and hopped into a cab to meet Professor Osotimehin at a London tube station. It always feels a bit strange when you meet an important Nigerian politician looking very ordinary, without the entourage and the hangers on. But there he was, standing beside the "Boots" shop as arranged. We looked for a quiet restaurant to talk. Thanks to the small bundles of technology we carry around these days, I quickly found a quiet place. "Its a 10 minutes walk, Sir". "No problem" he said....

We found somewhere, and sat facing each other, removed jackets, and ordered water (I could have done with some brandy :))

First he said...he wanted to listen.
I had structured my thoughts a bit and did my best to share my views (shared with many of you that read this blogs). He listened patiently

....then he spoke; passionately, articulately, in extemporaneous detail, very much aware of the small window he has bring the change we seek.

I thought hard about the appropriateness of reproducing his words on this blog. I have not had the time to go back to ask, now I do not have to. Professor Osotimehin has written a letter to the Nigerian people, published in THISDAY on 05/06/09. He says all the things he said to me...but most importantly...he says it to the Nigerian people, and us to "COUNT ON HIM".

Find the entire letter re-produced below. It is an important read, as it discusses many of the issues we have been highlighting here.

We are grateful for his promises, we will keep the letter and hold him to account in 2 years time.

For now...lets work together ...for the best interest of the people who it is all about!

Our Health System: Matters Arising

By Babatunde Osotimehin, 06.05.2009

Our health situation has lately invited us to ponder on steps to take in initiating immediate and long term solution. Without sounding immodest, the leadership of the Health Ministry understands the urgency of our situation and is responding with its entire zeal, within the broader spirit of President Umaru Musa Yar’Adua administration’s promise of efficient service delivery. We understand the recent threat of swine flu, and the subsisting presence of Lassa fever, cerebrospinal meningitis, and polio situation, amongst others. Overall, we are saying, it is important to improve our health care delivery system. In fact, our Primary Health Care system does need rejuvenation. We have been working at this, as it is important to focus on nearly every area of our health care system, not least so is maternal and child health. To bring about this improvement, I have said it elsewhere; it will need an alert from all tiers of government, particularly the state and the local. Resources would then have to be adequately provided, while human resources should not be lacking. Then the management of drugs and consumables have to be better than it is, apart from the institution of a good referral system. What should stop us from achieving these? Absolutely nothing really.
I say nothing if we are determined as a people. There is absolutely nothing that a collective will cannot make us achieve. By encouraging our health workers who labour across the length and breadth of the country, without being celebrated, we should have taken a significant step forward. Human resources galvanize. It drives processes to the desired level, and may be undermined only at our own peril. This cannot happen at a time we are even striving to accomplish a significant programme, which is the 7-point agenda of President Yar’Adua. We understand that the Nigerian health system and the health status of the citizens are experiencing a low rating from the estimation of the World Health Organisation. But like I have been saying, we can collectively increase our ranking.
On the part of the government, we are already providing the required energy in the system, through a repositioning of the environment and the leadership to enable the right contribution from all. Then we are seeking to improve our health service delivery not only via a holistic change in our Primary Health Care, but by strengthening referrals with secondary and tertiary institutions to reduce the disease burden that would then shore up the countries’ health status.
Besides, we are enhancing the financial resource mobilization through the expansion of the NHIS and other Public Private Partnership (PPP) arrangement. Then again, we are enhancing the coordinating role of the ministry and its interface with states and local governments, while also providing the much needed improvement in its overall performance. This is because the requisite human resources must be ready in all its right combination, just as the skewed distribution of workforce need to be dealt with. More than this, because one of the key weaknesses in the Nigeria’s health system is the lack of data to guide planning, a strengthened Health Management system is necessary to provide this needed data. Rest assured that the ministry is working on urgent steps to strengthen HMIS.
In the area of communication and public relations management, we are mobilizing and galvanizing public support for increased personal responsibility for health through utilization of preventive and health promotive services. The media is crucial in this role, which is why we are utilizing several media to ensure that timely and comprehensive evidence-based information about its activities are made available to build broad-based understanding of and foster acceptance and support for the new strategic agenda of the ministry and government.
Without any doubt, the above elements of our stewardship over the next 24 months or so are also being worked into the much broader and long term national strategic health development plan. Importantly, we started the process of developing a costed National Health Investment Plan. At the same time, we were embarking on a parallel initiative, a follow-on programme to the Health Sector Reform Programme (2003-2007), as the health sector contribution to NEEDS2. This was just before NEEDS was re-christened by government as the National Development Plan (NDP). The two initiatives: Health Investment Plan; and the Health Sector/NEEDS2 initiatives have now been harmonized into the preparation of a National Strategic Health Development Framework and Plan (NHSDP) process that is being led by the Federal Ministry of Health working with all the states, development partners, and non-state actors, amongst others. This process is currently being managed via the Health System Forum, and has attracted participation from many.
The NSHDP is aimed at a single country health plan, a single results framework, a single policy matrix and a costed plan that will be the basis for funding. There are also one single policy matrix; one costed plan that will be the basis for funding; one single mutual monitoring and reporting process; one single country-based appraisal and validation process for country health plan; one single fiduciary framework; benchmarks for government performance, benchmarks for development partner performance; agreement on aid modalities; and process for resolution of non-performance and disputes. These are the cross cutting principles of the IHP+ built on the Paris Declaration on Aids Effectiveness.
We recognize that domestic funding should make a significant contribution in meeting the challenges for Health-MDGs. Thus, the government has steadily improved on its funding support for Health-MDGs in recent years: N15 billion in 2008; and N22.5 billion proposed for 2009. We are internally challenged by issues of efficiency and in spending wisely and we are thus looking for technical assistance in this regards, especially in building capacity for power costing for Health-MDGs, and in innovative mechanisms that offer tremendous potential to save lives through new and creative solutions. Domestic funding alone is unlikely to meet all the challenges of funding Health-MDGs. We also remain concerned on whether or not we are making real progress in terms of the indicators.
Arguably, the greatest burden of disease in Nigeria is attributable to the index diseases of HIV/AIDS, malaria, and tuberculoses (ATM), and the diseases are at the heart the Health-MDGs Global compact. As mentioned above, the level of resources, both from within and external, to fight these diseases has increased steadily. However, the national response remains complex and confusing with multiple overlaps and poor coordination. Progress has been very slow. We certainly can do far more and we intend to do so. For this reason, a task force on ATM has been established, under my direct supervision, as part of a renewed spirited effort to ensure visible progress on Health-MDGs.
Membership of the task force are drawn from the Federal Ministry of Health, other Federal Ministries (National Planning, Ministry of Finance/Budget Office), and representative of state MOHs, members from cooperating partners active in ATM, representatives from civil society, and representatives from private sector bodies. The committee has focal point persons from the Federal Ministry of Health to assist in both technical and administrative work of the committee. I shall be the Chairman, with the Honourable Minister of State for Health serving as Alternate Chairman and member of the committee. Importantly, we have since moved forward, and we are continuing in this trend. Constant review and determination as exemplified in the President Yar’Adua’s directive remain our top priority and we shall not shirk our responsibility in this respect.

You can count on us.
• Prof. Osotimehin is Minister of Health.

Thursday, 4 June 2009

The health of our prisoners - who cares?

Have you ever wondered...with the state of health care facilities in Nigeria, what the health services available to prisoners would be like?

While in medical school at the University of Nigeria Teaching Hospital, was a regular feature of our days to see a prisoner being brought to the hospital in a wheel barrow.

I remember one particular young man. He was brought to our unit with "crusted scabies", a severe form of scabies that would usually only occur in imunocompromised patients. Despite the usual challenges of raising the funds to pay...he was slowly managed to better health. We spoke a lot during his time at the hospital. Together with other medical students on our team, we bought him the odd bottle of coca cola and groundnuts. Despite his illness he was happy for the 1-week in hospital. He tried to explain the situations under which prisoners live in Nigeria. For us young medical students, about to dedicate the rest of our professional lives to the concept of "saving lives" was difficult to come to terms with. Probably why I cannot forget this guy....

It is easy to forget that prisoners have just as much a right to health as the rest of us. I have not yet head of a prison sentence that includes the removal of the right to health.

It is also easy to forget that most prisoners currently in prison are going to come out soon and return to society, our society, so that the diseases/conditions they potentially acquire in prison...will soon become part of our society's burden, and potentially transmitted to the rest of us...the "good ones" (who might ourselves be ending up in prison soon!). This is to illustrate that "prisoners" are not a separate breed...they are us!

In preparing this blog, I was happy to find that the Nigerian Prison Service does have a website!...and has a Directorate of Health and Social Welfare charged with the physical, psychological and developmental well-being of the inmates and staff. They, for the most part try to provide for the health care of prisoners themselves by directly employing doctors and other health care professionals. How well this is tell me!

....then I looked up Pubmed to search for any articles on the health of prisoners in Nigeria. I barely found a handful, a few on HIV/AIDS...a few on psychiatric consequences.

....then I searched the web for an NGO that worked for the health of prisoners in Nigeria....and I found one (Prison Rehabilitation Mission International (PREMI) (if you know of any other, pls holla)

....then I looked out for politicians speeches talking about the health of prisoners...and you can guess what I found.

There is a general ignorance about prisons and prisoners, there are no votes in them, so politicians ignore them. The rest of us feel embarrassed to be associated with "them" so we pretended they do not exist.

I contend that we do need to know what goes on in prisons, and what happens to the health of prisoners. Even if it is for selfish reasons as "they" will return to our communities. "Their" physical and mental health when they return does should matter to us! you know that:

  • Most of the total prison population have not been convicted!
  • Many are locked up 24 hours a day because there are not enough warders to prevent escapes.

  • Cells are dirty, hot and hold scores of people.

Read more on the BBC

- Over 150 inmates have broken out of an overcrowded prison in Nigeria's south-east during a midnight escape bid.

- Andrew Walker visits a prison in the south-eastern city of Enugu where some people who have not committed any crime are locked up for years on end.