‘No Nigerian child should be born with HIV’ By Chukwuma Muanya, Assistant Editor (Head Insight Team, Science and Technology)

• Insight Team, Science and Technology) on February 4, 2016 12:56 am

 

A diagram showing the HIV virus infecting the red blood cells PHOTO CREDIT: google.com/search

• Inadequate domestic funding, insecurity, poor health workers attitude, stigmatization threaten elimination of mother-to-infant transmission of virus
• NACA begins decentralization of services to primary care facilities

In spite of the overwhelming evidence that women with Human Immuno-deficiency Virus (HIV) could have children free of the virus through free Prevention of Mother To Child Transmission (PMTCT) programme, positive couples in Nigeria are still having children with the virus.

Reasons: Daunting challenges remain including inadequate domestic funding in the face of declining support from donors; insufficient capacity (human resource and infrastructure) to effectively provide prevention, treatment and care programmes; poor health seeking habit among the rural population, particularly Ante Natal Care (ANC) attendance and reluctance of pregnant women to deliver in health facilities.

Other reasons are: pockets of insecurity in some parts of the country, which disrupts service delivery, commodity supply and overall coordination of interventions and programmes; and poor health care workers attitude to People Living with HIV (PLHIV), stigma and discrimination related to HIV and tuberculosis.

According to the latest statistics from the National Agency for Control of AIDS (NACA), in 2014, the coverage of PMTCT was estimated at 30 per cent, with 300,000 children aged zero to 14 living with HIV in the country due to Mother To Child Transmission (MTCT) of HIV; and 60,000 new child infections occurred during 2014 and over 30,000 AIDS-related deaths occurred among children. The situation is worrisome at a time where science and know how exist to prevent MTCT and mitigate its impact.

However, the Director General of NACA, Prof. John Idoko, told The Guardian that towards an AIDS free generation by 2030, Nigeria is committed to: increase domestic funding to achieve a fully funded AIDS response; fully operationalize 90-90-90 strategy to eliminate progression to AIDS, premature death and HIV transmission; ensure comprehensive combination prevention for all populations; expand HIV Counseling and Testing (HCT) antiretroviral treatment (ART) and PMTCT service points; pursue a policy of local manufacture of essential commodities- antiretroviral drugs, HIV test kits and condoms; and address barriers to access to HIV/Acquired Immune Deficiency Syndrome (AIDS) prevention and treatment services.

Idoko said the response to MTCT of HIV in Nigeria needs fast tracking and that services to provide PMTCT are being decentralized to the primary health care level thereby increasing significantly the number of PMTCT sites from 11 tertiary health facilities in 2002 to 6,533 facilities providing PMTCT services in 2014.

He said there has also been consistent improvement in the number of pregnant women tested and who know their result reaching 3,067,514 in 2014, a significant improvement from the 907,387 that were tested in 2010.

The NACA D.G. said there is also a steady increase in the number of HIV positive pregnant women who are receiving treatment- from 12,993 in 2006 to 63,350 in 2014- to prevent mother-to-child transmission of HIV and a transition of the PMCTC regimens from the single dose to multiple therapies. But, he said the roll of PMTCT has to be further fast tracked to match the needs. “There is need to quickly approve and implement option B plus- all HIV positive pregnant women on ART for life- as a national policy in Nigeria.

Idoko said the challenges remain important but not insurmountable including: preponderance of traditional and religious beliefs and practices which prevent women from going for ANC and from delivering in health facilities resulting in low utilization of maternal and child health-care services.

Other challenges include: Existing funds of PMTCT are largely from external donors because of a poor buy-in at national and state decision making levels; poor integration of HIV in reproductive health and mother and child health services; significant proportion of identified HIV positive pregnant women do not receive treatment because of stigma and discrimination; a sizeable proportion of the HIV positive women are receiving less than optimal drug regime and of children born to HIV positive women are not receiving antiretroviral treatment; limited access to early infant diagnosis testing; and limited health human resource particularly in rural areas

Idoko, however, said there is hope and elimination of mother-to-child transmission of HIV is not out of reach in Nigeria.

Despite these multiple challenges, the Joint United Nation Programme on AIDS (UNAIDS) estimates that by using an integrated and multipronged approach which includes measures to reduce the number of young women becoming infected with HIV, providing effective contraception to women living with HIV, providing lifelong ARV to HIV positive women, involving communities to reduce stigma and discrimination and increase demand for PMTCT services, Nigeria will eliminate MTCT of HIV by 2020.

UNAIDS estimates that eliminating MTCT of HIV by 2020 will resulting in the following health impact and net return on investment: 240,000 new HIV infection prevented among children; an additional 460,000 new HIV infections prevented in the adult population; a total of 700,000 new HIV infections prevented among adults and children; 340,000 AIDS-related deaths averted; 12 million life year gained; and a net return of $30 billion on investment.

From UNAIDS estimates Nigeria has the second highest burden of HIV in the world – second to South Africa. At the end of 2013, 3.2 million persons were living with HIV with the national HIV prevalence rate being 3.2 per cent. At the end of 2014, Nigeria had placed over 747,382 people on ART. A large population of new HIV infections is also through mother to child transmission: the mother to child transmission rate for MTCT was estimated at 27.3 per cent.

The response to HIV in Nigeria is coordinated through a three-tier system of administration. NACA, under the Presidency, leads the coordination at national level. At the state level, the State Agencies for the control of AIDS (SACAs), under the Office of the Governor, are responsible for the coordination of the multi sectorial response on HIV and AIDS.

NACA and SACAs coordinate joint planning, implementation, monitoring and evaluation of HIV/AIDS programmes at the national and state levels respectively. At the LGA level the Local action committee on AIDS (LACA) have similar broad mandate as NACA and SACAs to coordinate the HIV/AIDS response. The coordination of HIV response across the national and state levels is guided by the “Three Ones” framework thereby promoting effective coordination and efficiency of the response.

The first multi-sectorial action plan developed by NACA was the HIV/AIDS Emergency Action Plan (HEAP). The HEAP aimed to break down barriers to HIV prevention at the community level and support community- based responses, and provide prevention, care, and support interventions. As a result of developments in the global AIDS response, the National HIV/AIDS Policy (2005) and National HIV/AIDS Strategic Framework (NSF 2005–2009) were developed to engender a more robust response.

Based on national response review findings and recommendations, these two strategic documents were revised in 2010 and in addition, the National HIV/AIDS Strategic Plan (NSP 2010 – 2015) was developed.

The World Health Organisation (WHO) indicators were recently used by UNAIDS, Columbia University/Millennium Village Project and Local Health Authorities to validate elimination of mother to child transmission (eMTCT) in Pampaida community (“UN Millennium village”, Kaduna State). This is the first community in Nigeria to report no HIV transmission from mother to child in four consecutive years.

The success of Pampaida with elimination of mother to child transmission of HIV is largely due to the use of ‘development-centred’ approach rather than a ‘project-based’ approach to address the need of the community. With a ‘development-centred’ approach, Pampaida was able to address structural problems, which are critical and central to HIV control – poverty, education, and gender empowerment.

Access to health care was enhanced through girl child education, increased community awareness and male involvement in health decision-making processes. Improved access to cash also improved access to health commodities including food. Gender empowerment increased access of the girl child to school, reduced rate of early girl child marriage. Increased uptake of contraception-increased child spacing, reduced maternal mortality and increased child survival.

An on-going manifestation of the President’s commitment to the welfare of Nigerians was the launching of the President’s Comprehensive Response Plan (PCRP) for HIV/AIDS, which aims to accelerate the implementation of key interventions against HIV, including PMTCT. However, achieving an AIDS free generation will not be possible without eMTCT.

The President clearly recognizes this and emphasizes: “No child deserves to be born with HIV and no mother deserves to die of AIDS, we are equal to the task”. Therefore, in order to increase the momentum in the effort to achieve eMTCT, there is need to enhance political commitment at all levels of government – from the Ward level to the National government. Therefore, this concept note proposes a high level process involving political and other key stakeholders in Nigeria to deliberate on how to advance the eMTCT agenda as articulated in the PCRP and beyond.

This high level process undertaken by the Presidents aims at a political and social mobilization to end the AIDS epidemic among children and it will start with the launching of a National Action Plan to end Mother to Child Transformation of HIV in Nigeria by 2020 to conform to vision 202020 and the transformation agenda, and progress into a vigorous one week long nationwide campaign of accelerated access to PMTCT services.

The key activities include: development of a Comprehensive National Plan of Action to end Mother to child transmission of HIV in Nigeria by 2020; nationwide HIV testing campaign among pregnant women for a week; publicity and media in support of the campaign; media briefing and press conference; and national launch of eMTCT plan of action.

Former President, Dr. Goodluck Ebele Jonathan, said: “Looking back one will remember that under my stewardship Nigeria has become the first economic power of Africa and through our transformation agenda there has been an improvement in many other development indicators in this country. In my whole political life, HIV/AIDS has been a scourge I passionately tackled and moving forward, I will lead a transformative movement to end the AIDS Epidemic among children in our Country, because it is my clear conviction that no child deserves to be born with HIV in Nigeria. Join me in this fight for AIDS-free generations in our Nation.”

Expanding the Funding Options for Healthcare

As Nigeria continue to grapple with fixing the healthcare system, low budgetary allocations and limited funding options have impeded efforts to give the sector a lift. Martins Ifijeh writes

When General Ibrahim Babangida overthrew the then military Head of State, Major General Muhammadu Buhari in August 27th, 1985, one of the major reasons cited for the coup was the claim that Buhari’s government was unkind to the health of Nigerians and that only little priority was given to the sector. But in the first year of Babangida’s reign, the health sector was only allocated 2.7 per cent of the total budget, while defense received 7.8 per cent of the budget; an action that suggested Nigerian leaders do not consider the health of the nation as the pivot on which any economy can thrive.

Fast forward to 31 years after, Nigerians are still grappling with low budgetary allocations to the health sector, which has in no small measure reflected on the various health indices of a country that prides itself as the biggest economy in Africa. From maternal health to mortality rate of children under five years, up to mortality rate of men and women in the country, the indices show the country still have huge gaps to fill to be able to meet world standards in healthcare provision.

As part of efforts to close this huge gap hampering the progress of adequate healthcare provision, especially in developing and underdeveloped countries, where diseases outbreaks and its associated effects are a common occurrence, the World Health Organisation (WHO) in its wisdom recommended that countries should allocate at least 13 per cent of their annual budget to the health sector for effective funding of healthcare system. Also, an Abuja Declaration, signed in 2001 by all member countries of the African Union, including Nigeria, recommended that for the continent to be at par with other nations of the world in terms of healthcare provision, 15 per cent of their annual budgeted, at least, be allocated to the health sector.

Even though some countries have started raising their health budgetary allocation towards fully keying into the WHO recommendation of 13 per cent or the Abuja Declaration by the African Union of 15 per cent, Nigeria still lag behind in this regard, which has had direct consequence on the funding capacity of the Health Ministry, thereby making the fight against poor healthcare unrealistic.

Since the beginning of democratic dispensation, the allocation for healthcare in the country has varied between two per cent and six per cent, and in some instances, education and power sector take more budgetary allocations than the health sector, which is arguably the most important sector in a country, as other areas of the economy depends on how healthy the people and the nation are.

With the coming of a new government in power, one would think the priority given to the health sector would finally be restored. However, this year’s allocated amount fell short of what was envisaged, especially in the face of more health challenges affecting the country. From 5.7 per cent allocated to the sector in 2015, the allocation dropped to 4.3 per cent for 2016, which translates into N221.7 billion from the total budget of N6.08 trillion, a figure far below the N1trillion mark that was envisaged by stakeholders in the industry in view of the increased health issues. Experts had also expected that even if the budget would be below the 15 per cent recommended by the AU, it would at least be higher than the previous year, considering the numerous challenges facing the sector.

According to available data, the cost of immunisation alone across the country this year will be $1.4 billion, which when converted using the current dollar rate of $1 to N330, will be about N466 billion; an amount already far above the entire budgetary allocation for the health sector. This is just a small fraction of the several areas needing health interventions in the country.

The WHO believes if all health intervention areas in Nigeria are put into consideration and adequately captured in the budget, it would mean the government will spend a minimum of N6,908 per Nigerian in a year. But, as it is, the country still spends just a little above N1,500 per Nigerian on healthcare, which means about 80 per cent of healthcare services is being funded from out-of-pocket expenses of Nigerians.

This puts Nigeria as one of the nations of the world with the least healthcare spending per head when compared with other countries, especially in Africa. For instance, it has been reported that South Africa spends about seven times more per head on healthcare than Nigeria does, while Angola spends about three times more per head than Nigeria.

According to analysts, the United States healthcare spending per head stands at $7000, which is about N2.3 million and that of Switzerland is $6000, which is about N2 million. This, when compared with Nigeria’s N1,500 per head for a whole year, suggests why the country still grapple with the poor health indices and the abysmally poor mortality rates for Africa’s ‘giant’.

No wonder various statistics show that Nigeria has one of the worst health records in the world. The country’s average mortality rate is put at 52 years, whereas in some less economically strong countries, even in Africa, their mortality rates rank way better than Nigeria’s. For instance, while the number of deaths of infants under one year per 1000 live births in Nigeria is about 72.7, according to a 2015 report from World Fact Book, that of Rwanda is 58 deaths per 1000 children under five. That of Malawi is 42 deaths per 1000. Gabon is 46, Togo is 45, Kenya is 39, while Libya is just 11.

These indices perhaps explain why experts believe the recent allocated amount for the health sector was done in bad faith, hence the need for it to be revisited, while other funding options are looked into, especially with the recent gradual withdrawal of some donor organisations, due to Nigeria’s recent status as the strongest economy in the continent.

Speaking with THISDAY, a former Director, Federal Ministry of Health, who preferred to remain anonymous, said one of the major challenges the ministry had during her time was the poor budgetary allocation to the sector, hence the need for the government to up its game so that needless deaths can be prevented through adequate funding.

She urged President Buhari and the Minister of Health, Professor Isaac Adewole, to review the current percentage allocated to the sector in a bid to raising the figure. “We should raise the figure from last year budget rather than reducing it. If we put the health allocation at eight per cent, or thereabout, it would at least show that we are putting in efforts to addressing the health crisis in the country,” she said.

She also decried a situation in which majority of the amount for health was used for paying health personnel, whereas the public health issues needing tackling were given just a little fraction of the entire amount. “The bulk of the allocation should go to preventive and promotive care,” she added.

She also called for expansion of financial options, as well as strengthening the contribution of private sector in the provision of healthcare in the country. She believed Public Private Partnership was a strategic way of gaining financial options at all operational levels of healthcare.

According to her, when funds are available and used judiciously on healthcare delivery, it would translate into affordable, accessible and effective healthcare delivery.

She said in expanding funding options for the sector, the government should scale up financial schemes that promote universal coverage, as well as scale up support for states to develop state health insurance, to be monitored by the NHIS.

She advised well-meaning Nigerians and organisations to donate towards healthcare.
“With these systems in place, out-of-pocket expenditure will gradually face out, as it would reduce the financial burden of most Nigerians, who are known to live on less than $2 per day.

Nigeria Needs 100,000 Radiographers to Address Medical Challenges

By Paul Obi

The Radiographers Registration Board of Nigeria (RRBN) has said that Nigeria needs about 100,000 radiographers in order to address health needs and other medical challenges of over 170 million Nigerians.

The board said research across the country has shown that the current number was insignificant and inadequate to address the existing gaps.

RRBN Chief Registrar, Michael Sunday Okpaleke, stated this at the opening ceremony of the Post-Graduate Diploma in ultra sound course 2016/2017 session in Abuja.

"Based on our statistics, we need one radiographer to about a thousand population. We have a population of about 170 million Nigerians and that means we need over 100,000 radiographers in the country if the needs of Nigerians are to be met.

"The profession is attractive and there is no radiographer without a job. As they are graduating from school, they are getting employed. In fact they are appointed on Grade Level 10. So it is attractive, but it is just because radiographers work with radiation which we all know that if not properly used can be harmful. The psyche of working in a radiation environment is what scares people, even though health hazard allowances are paid.‎

"There is a need to improve on the curriculum of radiographers in order to meet up with global trends. To this effect, we have set up fellowship programmes and training and we have also mandated a 5-man panel‎ of experts to look at our curriculum and the reviewed it.

"So the white paper is available and has been sent to universities and other traditional institutions to ensure that the training of radiographers meets global standards and best practices. Radiography is technology dependent and it changes from time to time. It is dynamic.‎"

Okpeleke maintained that the role of radiographers in any health facility cannot be underestimated as they are very instrumental in the diagnosing diseases for treatment and cure.

"The contribution of radiographers is key and very important as there is no standard health facility that does not have a radiography or x-ray department‎ and when we talk about radiography, we are talking about diseases and their diagnosis with an aim of treating them."

"We do not have enough radiographers in the country and that is why we are doing this training. In fact, we have only five to six universities studying the course in Nigeria. We are also approaching other universities to see if they can appreciate the training and follow suit," Okpaleke stated.

He explained that, in order to scale up the performance of professionals in the field and make it more attractive to Nigerians, especially undergraduates, a 5-man committee has been set up to review the radiography curriculum and offer solutions.

The Registrar said this would enable Nigerian universities to adopt the course as only six universities offer it at undergraduate level at present.

Walking Barefoot: Access To Earth’s Healing Power

 

The increased use of consumer electronics and gadgets – radio, television, computer, cell phones and other related appliances – has brought with it negative side effects on users’ health.

However, man has ignored a very vital means of improving his health, walking bare foot on the ground. Mr. Adjei Quaye, health campaigner and naturopath, who made the assertion in a health forum in Lagos said there are natural remedies from herbs and even the ground to bring succour to ailments.

Quaye said there are several man made item that deprive man from getting the much needed electrons from the earth. They include raised beds, synthetic mats, vehicles, synthetic carpeting, baby prams, footwear’s, vinyl covering the floor and even mattresses. He said that the human race is largely being bombarded with electronic gadgets all the hours of the day.

“If you were not using cell phones, someone would be calling, thereby polluting the whole atmosphere with electromagnetic waves. These waves affect our system and these electrons ionise the chemicals that enter the body and turn them to free radicals, which reduces the body’s immunity status.”

Quaye, also physical sciences lecturer at the University of Cape Coast said, “The body is like a ‘system’ made up of organs like the kidney, liver and others, then tissues, cells, molecules, atoms, nucleus and electrons. From the electrons, is produced a magnetic force.

Assuming a liver has 10 electrons, and the free radicals have taken five, it means the immune system gets weaker. So, the issue here is how to get back the lost electrons.”

He said it is all about the general wellbeing of the human body, adding that when the immune system is attacked by free radicals, the body defensive mechanism is compromised. But when the foot is placed on the ground and following the 2nd Law of Thermodynamics, energy moves from one place to another, electrons begin to flow to occupy the places where there is shortage.

It flows from the ground to the body for rejuvenation and there is also a healing process. Quaye revealed that to get replacement of the lost electrons, which is synonymous with boosting the immune system, the bare foot should be placed on the floor for as long as possible.

He said studies have shown that in children, for example, those who walk barefoot recover more quickly in case of ill health than those who don’t.

The benefits of going barefoot Pointing out that since the nerves of our organs (eye, liver, kidney, pancreas, etc) terminate in our palms and under the feet, Quaye said man is most likely to activate an organ like the kidney to function well by going barefoot, thereby giving it a natural acupuncture. Insomnia and arthritis patients, He said have shown positive results just by walking barefoot.

The incidence of fibroids, breast and prostate cancers and other disorders may reduce drastically by walking barefoot. He advised that it is a healthy practice for a pregnant woman to go barefoot.

As the activity of walking barefoot increases such other benefits as better sleep, lower stress, more calmness, relief from migraine and headache, reduced cancer incidence, improved blood pressure and improved fertility and sexuality can be attained.

He claimed that, while normalisation of the body’s biological rhythms could be attained, he however warned that diabetic patients should be careful when walking barefoot to avoid cuts.

Quaye said there are several man made item that deprive man from getting the much needed electrons from the earth. They include raised beds, synthetic mats, vehicles, synthetic carpeting, baby prams, footwear’s, vinyl covering the floor and even mattresses. He revealed that health focused manufacturers are making mattresses with magnets to improve blood and oxygen flow in the body.

530,000 Women Test Positive for Cancer in Niger

By Laleye Dipo
No fewer than 530,000 women in Niger State have tested positive to different types of cancer in the last three years.

The International Centre for Reproductive Rights which disclosed this in Minna recently, said the figure was out of the over 29,170 women screened for the disease by various health organisations and voluntary agencies.

Mr. Dorothy Aken’ova Executive Director INCRESE in the state who made the figures known also said that not less than 119 other cases not ‘really confirmed’ have been sent to the Gwagwalada Specialist Hospital and the Federal Medical Centre Bida for further examination of their cases.

Mrs Aken’ova said once the cases were confirmed the patients would be recommended for treatment before the situation got out of hand.

She blamed lack of awareness and traditional beliefs on the increase in the number of cancer positive people in the state and said that the agency would mount a vigorous campaign in all the nooks and crannies of the state to educate women on the need for them  to seek medical attention once they suspected any strange development in their bodies.

The Executive Director also urged the federal and state governments to set aside special funds for the treatment of cancer patients as they have done for HIV /AIDS.

The Regional Director North Central Region of the Planned Parenthood Federation of Nigeria, Mrs. Mary Bawa in her remarks, said that early detection and treatment would stem the increase in the spread of the disease.

Mrs. Bawa said the PPFN was already working strenuously for the eradication of cancer in the country which she claimed had so far claimed 275 lives.

Female Genital Mutilation now Introduced in Medical Curriculum

Young girls are prone to FGM

Amby Uneze in Owerri

The ugly experiences associated with the age-long practices in some states in the country of Female Genital Mutilation/Cutting (FGM/C) has led to the introduction of the subject as part of the curriculum in the teaching of nurses and doctors by the Nursing Council of Nigerian (NCN) and the Medical and Dental Council of Nigeria (MDCN).

At a recent two-day Media dialogue with editors, feature writers on Female Genital Mutilation/Cutting Abandonment in Nigeria organised by the Advocacy Unit, Child Rights Information Bureau (CRIB) of the Federal Ministry of Information, in collaboration with the United Children's Fund (UNICEF), to mark the World Zero Tolerance to Female Genital Mutilation/Cutting in Osogbo, Osun state, the National President of Inter-Africa Committee on Harmful/Violence Practices against Women and Children, Prof. Modupe Onadeko observed that there was no single benefit from female genital mutilation and cutting.

According to her, it has now become a punishable offence for any medical practitioner, be he/she a nurse or doctor to be involved in the practice of female genital mutilation/cutting, hence the Harmful/Violence Practices against Women and Children was introduced into the curriculum of the medical profession.

In her presentation on, ‘The Practice and Experience of FGM/C in Nigeria’ she said the practice of FGM/C is widely common in parts of South-west, South-south, South-east and areas located around Chad and Niger Republic extending to some areas in North-east like Kano, Abuja, Nasarawa among others where certain cultural practices have infiltrated.

She said, though the prevalence of cutting is more in the South-west and South-south, some tribes are however practicing the unclassified types including one often referred to as medical circumcision.

“Here a medical practitioner helps to carry out the procedure in a facility to eliminate infections. Whichever form or method of mutilation or injury done on the female child, this is unacceptable and it is a harmful practice that must be stopped forthwith”, said Onadeko.

She continued, “It is estimated that between 100 million to 140 million girls and women alive today have experienced FGM. If current trends continue, 15 million additional girls will be subjected to it by 2030. Some communities believe the practice is religiously required. Others believe that FGM will deter pre-marital sex or promiscuity. It’s these entrenched beliefs that the United Nations Population Fund, (UNFPA) and other UN agencies like UNICEF are working to change.

“An estimated 19.9 million Nigerian women have undergone FGM/C meaning that approximately 16 per cent of the 125 million FGM/C survivors worldwide are Nigerians (NPoPC 2014). The overall prevalence of FGM/C among girls and women aged 15-49 years in Nigeria (27 per cent) is lower than in many countries (NDHS 2013)", she stated.

According to Onadeko, who is also Community Health Physician and Consultant Reproductive/Family Health University College Hospital, Ibadan, FGM/C affects women and young girls in various ways such as: infections (genital abscesses), problems having sex (pain), depression and anxiety, painful menstrual periods, urinary problems, Vesico Vaginal Fistula (VVF) or Recto Vaginal Fistula (RVF), problems in childbirth (need to cut the vagina to allow delivery and the trauma that results, often compounded by re-stitching).

She allayed the fears that women who were not circumcised are more prone to promiscuity than the circumcised ones, noting that about 99.9 per cent of commercial sex workers had their genitalia mutilated.

Survivors task National Assembly on breast cancer research, funding, care policy By By Wole Oyebade

Breast cancer survivors in the country have urged the National Assembly to give cancer research grants and support policies some priorities, to stem the tide of cancer-related sicknesses and deaths in Nigeria.

The concerned stakeholders, who spoke at the second Omolara Jolaoso Memorial Lecture to commemorate the World Cancer Day 2016 in Lagos, said that the agony of surviving the disease or deaths, which is common, would drastically reduce with improved research and clear-cut policy on care and survivorship.

Founder/ president of Breast Cancer Association of Nigeria (BRECAN), Betty Anyanwu-Akeredolu, said that aside from poor awareness and ignorant, cancer patients still present late for treatment because they don’t have money to pay “in a health system that is cash and carry.”

“That is why we need to have policies in place that will support our women. Government needs to come in. We can’t wait for our women to die; we have to work on intervention, particularly cancer researches and effective cancer care services,” Anyanwu-Akeredolu said.

She added that the reason why at least 90 per cent of all breast cancer cases in the United States survive is due to priority given to care and research.

She said: “We are beneficiaries of what their (US) researchers are doing over there because they are been extended to us. So, I go to the US Congress to lobby against cutting research funds, because researchers are working day and night on how they can find a cure and also improve our lives.

“But I don’t have access to our own National Assembly complex to tell them about research funds to save our women from die of breast cancer,” she said.

Anyanwu-Akeredolu, herself a breast cancer survivor, said further that the onus is Nigerians to live a healthy life and demand from the government adequate funding for improved infrastructure for breast cancer care, lobby for policy legislation to guide impactful interventions and stimulate the interest of next generation of breast cancer researchers in Nigeria.

Breast cancer is currently the commonest female malignancy and in fact the leading cause of cancer death in the country. It was estimated that at least one woman dies of breast cancer every 10mins.

Global Cancer Facts and Figures for African countries, being 15 per cent of the world population, represents eight per cent of the new cases, but 12 per cent of breast cancer deaths because of poor survival due to late stage at diagnosis and limited treatment.

Professor of Medical Oncology, Seattle Cancer Care Alliance, Seatle, Washington, United States, Dr. Julie Gralow, said that Nigeria need to put in place a comprehensive cancer control programme that also caters for survivors with good survivorship plan.

Gralow noted that as care services improve in the country, the population of survivors are also bound to improve and would need continuous support to deal with long-term effects of cancer treatment even years after.

She informed that there are over 14million cancer survivors in America today and a dedicated National Cancer Institute Office of Cancer Survivorship established in 1996 was promoted their course.

Nigeria makes history in polio eradication initiative By Ado Muhammad

Muhammad

Nigeria, in line with global commitment launched the Polio Eradication Initiative (PEI) in 1996. This was eight years after the World Health Organization (WHO) launched the initiative in 1988. The launch of the global initiative was to attain global eradication of the poliovirus by the year 2000. While many countries achieved the aspiration without much constraint, the road leading to the interruption of the transmission of indigenous wild poliovirus (WPV) in Nigeria was not an easy one. It was fraught with a lot challenges. However, with perseverance, innovations and commitment, the nation overcame these challenges and was formally delisted as a polio-endemic country by the WHO Director-General on 24th September 2015.

Nigeria commenced battling the polio scourge in 1996 with the formal inauguration of the Polio Eradication Initiative (PEI) in the country; and over 350,000 cases reported globally in several countries. As at 2014, only three countries remained in the world that have never interrupted indigenous transmission of the WPV; these were Pakistan, Afghanistan and Nigeria. Nigeria is now out of that list.

Our country has had several challenges, ranging from unfounded rumours on the Oral Polio Vaccine (OPV), suspension of the polio eradication efforts in some States; to the killing of innocent vaccination team members in the course of trying to prevent our children from getting paralyzed. But we were never deterred by these unfortunate events; indeed we grew in our collective resolve as a country, developed innovative strategies to surmount these challenges and built a formidable programme, which subsequently provided a platform to tackle other public health challenges like the Ebola Virus Disease epidemic of July 2014.

Despite the historical public health feat achieved by Nigeria in PEI, however the programme and the nation must sustain the tempo and maintain the momentum, as our ultimate goal is to achieve eradication in the next 17 months. In the interim, a lot of emphasis will be placed on improved surveillance system for the acute flaccid paralysis (AFP), the proxy for the detection of the poliovirus; maintaining high quality of our routine immunization (RI) and the polio campaigns by sustaining and scaling up innovative strategies; but above all, re-positioning of our Primary Health Care (PHC) system for delivery as the critical platform to improve the health outcomes of Nigerians, a key stimulant for national development.

To achieve polio eradication in the next 17 months, surveillance would continuously be improved, while maintaining high quality polio campaigns and also scaling up innovative strategies such as health camps, deepening of partnership with Traditional and Religious Leaders as well as deploying the polio infrastructure to strengthen routine immunization and the broader health system.

The programme therefore needs sustained funding. The commitment of all stakeholders – Local Government Areas (LGAs), health workers, Civil Society Organisations (CSOs), communities etc., is critical to achieving certification by 2017. While also requiring functional PHC system to deliver on essential services, optimize results and provide a platform for improved health system and health outcomes not only for polio but other vaccine-preventable diseases and non-communicable diseases (NCDs). This is a gift Nigerians and indeed the entire African region deserves.
In the last three decades, PHC has consistently remained the cornerstone of our national health system, and a veritable platform for the attainment of Health for All Nigerians. While key achievements have been attained, there are significant systemic challenges of PHC implementation ranging from the governance arrangement to service delivery. These account for suboptimal service delivery at the PHC level with concomitant inefficiency resulting into not too impressive health outcomes. Programme implementation is hamstrung by weak co-ordination within and between the three levels of government. These challenges are further compounded by limitations in coverage and access.

There is the need to institutionalize provision of essential package of care at the PHC level, increase geographical and financial access to health care services, improve the quality and increase demand of the services, and provide financial protection for the vulnerable groups.
The Federal Ministry of Health (FMoH), working with the States and PHC stakeholders is addressing the challenges of the huge out-of-pocket expenses (OPE), which currently stands at over 60 per cent among others, and have made concerted efforts to make the National Health Act operational. Stakeholders are upbeat with optimism that provision for the Basic Health Care Provision Fund (BHCPF) in the Act, has the potential to significantly increase the resource envelope for PHC and ensure some predictability in the availability of funds.

There is also the National Strategic Health Development Plan 2009 – 2015, which is the overarching policy framework for Health Sector programmes, being supported by all stakeholders in the sector. In addition, there is the Ward Minimum Health Care Package, which serves as guidelines for implementation of PHC focusing on making one PHC facility functional in each of the 9572 political wards in the country with a view to scaling up Universal Health Coverage in the country; and also addressing the huge OPE.

At the macro level, there have been concerted efforts towards having one authority coordinating PHC system at the State level in order to enhance efficiency, thus the Primary Health Care Under One Roof (PHCUOR) initiative. This has resulted in the establishment of 32 PHC Agencies.

The National Primary Health Care Development Agency (NPHCDA) is currently assisting in the functionality of these boards. It is expected that the State PHC Agencies will ensure that all the essential components of PHC will be integrated under the new governance structures: the State Primary Health Care Development Boards/Agencies at the State level and the Local Government Health Authorities at the local government level.

The Agency under the oversight of the FMoH has now embarked on PHC revitalization with a vision of building a resilient health system on the principle of equity and social justice through functional PHC systems. We therefore call on all stakeholders, particularly States and LGAs to own and drive the implementation of PHC services in their various localities, as this is critical to our current effort to reposition PHC as the platform to improve health outcomes of all in Nigeria.
*Dr. Ado J.G. Muhammad (OON), is the Executive Director/CEO of the National Primary Health Care Development Agency (NPHCDA)

A partnership to tackle malnutrition, childhood killer diseases By Chukwuma Muanya

Dangote Foundation, Bill & Melinda Gates Foundation commit to boosting nutrition, routine immunization in Nigeria 
Determined to boosting routine immunization (RI) against childhood killer diseases and ensuring that Nigeria is ultimately certified polio free by end of 2017 by the World Health Organisation (WHO), the Dangote Foundation and Bill & Melinda Gates Foundation (BMGF) have signed a new memorandum of understanding (MoU) with Borno, Kaduna, Sokoto and Yobe States.

According to a joint statement by the foundations, strengthening RI takes sustained financial and human resource commitment and it is important that the changes being made during the short MoU period must be “habit forming” changes that are kept in place well after these MoUs end.

The statement noted that the goal of these MoUs is to change the State’s own RI programmes and health system for the long term; the total cost of the six MoUs is $42 million between 2013 and 2018; and the Foundations and the states will provide $14 million each while the federal government will provide the vaccines.

Also, the foundations have signed new MoUs for cold chain with Katsina and Zamfara states.

Dangote Foundation and BMGF have entered into a one-time, 15-month tripartite MoU with Zamfara State and Katsina State to strengthen their cold chain system.

The foundations in a joint statement said: “This is not an in-depth RI MoU like we have established in other northern states. Under the terms of the last round of the Governors’ Immunization Leadership Challenge, the two Foundations committed to recognizing Zamfara State and Katsina State each with $1 million in grant award funds ($500,000 from each Foundation) for their success in remaining polio free in 2013.

“Dangote Foundation and BMGF’s funding will support the purchase of cold chain equipment, while the states have committed to releasing funds to support equipment installation, operation, and maintenance. The two Foundations’ money has been released to United Nation Children Fund (UNICEF) to enable them to do the procurement. The procurement includes walk-in coolers for satellite cold stores, as well as the solar direct drive dual refrigerators to be used at the facility level.”

The Dangote Foundation and BMGF has also announced a combined commitment of $100 million over the next five years (2016-2020) towards ending under-nutrition in Nigeria. This commitment is expected to improve the lives of at least five million families by 2020 and was announced by Alhaji Aliko Dangote and Bill Gates, last week, during a press conference in Abuja.

Meanwhile, there has been huge progress in the fight against the wild poliovirus (WPV) and Nigeria was able to interrupt the transmission. July 24, 2015 marked one year since the last child in the country was paralyzed by WPV, in Sumaila Local Government Area in Kano State.

According to stakeholders, the key now is to keep up the efforts so the trend is not reversed but an estimated 250,000 children in Borno State have not been immunized due to insecurity.

While it is an important indication of progress to have 1.5 years without a case of WPV, Nigeria needs to go through July 2017 without a case anywhere in the country to be declared polio-free. Surveillance must be maintained at global-level standards so that we are not missing anything.

Also, despite rapid economic growth, Nigeria is home to the highest number of stunted children in Africa and the second highest globally. Almost one in five Nigerian children are acutely malnourished and more than one in three children suffer from stunting. With its vital role in child health, growth and cognitive development, better nutrition will be essential to unleashing the potential of Nigeria’s next generation.

Guided by the belief that all lives have equal value, the BMGF works to reduce inequity around the globe. We fund new ideas and encourage innovative partnerships so shared resources will do the greatest well for the most people. In developing countries, we focus on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty.

The foundation invests in proven approaches to improving nutrition, such as focusing on that 1,000-day window, immediate and exclusive breastfeeding, and food fortification and supplementation. Its long-term goals are to prevent 1.8 million malnutrition-related deaths by 2020 and to develop and test new solutions to address the burden of malnutrition that cannot be alleviated using existing interventions.

Dangote Foundation, the philanthropic endeavor of Aliko Dangote is the largest private foundation in sub-Saharan Africa.

Aliko Dangote believes that supporting social and economic change through investments and interventions that improve the lives of the less fortunate can make a positive difference in the growth of a nation. His vision is one where no Nigerian child should suffer and die of under nutrition and disease. Dangote Foundation’s goals are to: help reduce the number of lives lost to malnutrition and disease; support income generation activities and education programs that help lift people out of poverty; and be responsive to people who are affected by natural disasters globally, by providing emergency relief.

Bill Gates said: “Nutrition is one of the highest impact investments we can make in Nigeria’s future growth and prosperity. We know that well-nourished children are more likely to grow up to be healthy, fend off preventable diseases, achieve more in school and even earn higher income as adults.

“This partnership builds on our foundation’s strong commitment to Nigeria – one of several countries where we are working closely with the government, the private sector and civil society to improve health and development outcomes.”

Dangote said: “In the spirit of our new partnership, we encourage even more deliberate and significant commitments from the Government of Nigeria at all levels to step up investments in nutrition. It is time to make strategic investments in interventions to eliminate malnutrition in Nigeria. This will be achieved through a massive scale-up of interventions, matched with effective coordination of efforts and innovative sustainable solutions. We have to ensure that children who are already malnourished receive help and are prevented from dying while we improve the conditions that led to them being malnourished in the first place.”

In a joint statement, the two foundations said they would begin a joint planning process to determine the details of the partnership. Programmes will include community-based approaches and proven interventions linked to behaviour change, fortification of staple foods with essential micronutrients, the community management of acute malnutrition and investments in the local production of nutritious foods. A key objective will be improving the livelihoods of households by supporting nutrition-sensitive agricultural programs that can increase family income, improve diets and empower women and youth.

The two foundations also welcomed the increased political attention to under-nutrition in Nigeria and noted that leadership will be critical to future progress.

Gates

Meanwhile, in late 2012 in Kano, and mid 2014 in Bauchi, Dangote Foundation and the BMGF, entered into MoUs with the states to build a systematic statewide approach to strengthening routine immunization and by extension, a significant part of the primary health care system.

Dangote Foundation and BMGF contribute to a ‘basket fund’ that pools our resources with each State, with progressive responsibility for the budget passing to the State. Annual work plans support all areas of the statewide programme, and have a knock-on effect in strengthening some of the systemic issues that hinder primary health care (budgeting, coordinated work planning with all partners aligned, accountability frameworks, performance management).

The third year of our collaboration in Kano was just completed, with a fourth year extension agreement that was recently formalized on January 20, 2016. In Bauchi we are one and a half years into the three-year MoU.

Traditional Rulers and Leaders have played a critical role in the success of the fight against polio. During the course of the last several years they (Northern Traditional Leaders’ Committee) have contributed in two substantial ways: (a) they’ve provided the polio program with badly needed credibility in the face of a concerted campaign to distort fears about vaccine safety and rumors of a ‘Western’ plot. The Emir of Kano, for example, created a sensation when he went to the urban Local Government Area of Ungogo in 2014 and consumed an entire vial of Oral Polio Vaccine in front of a huge crowd to make the case that there are no impure elements in the vaccine; and (b) they have been the single most effective partner in reducing incidents of ‘non-compliance’ – that’s when families refuse to allow children to be immunized during the campaign by the house-to-house team.

Over several years, the incidents of non-compliance have reduced significantly, and now comprise less than one per cent of the approximately 19 million children missed for immunization during a campaign in northern Nigeria. In some areas of certain states, such as Sokoto, Kaduna and Kano, non-compliance accounted for more than 25 per cent of missed children five years ago.

In 2009, the Federal Government and the Nigeria Governors’ Forum signed what is called the “Abuja Commitments”. These Commitments outline specific actions that the State Governors and the Local Government (LGA) Chairmen are supposed to do every month/quarter to ensure polio eradication. These include public actions such as holding meetings with traditional leaders and actively participating in the polio campaigns.

Stakeholders seek nutrition education for young mothers

Managing Director, Promasidor, Mr. Olivier Thiry(left); President, Nutrition Society of Nigeria, Prof. Ngozi Nnam; and Head of Marketing, Promasidor, Festus Tettey recently at the unveiling of cowbell Tina Infant Formula in Lagos.

Nutritionists in the country have called for proper dietary education among mothers, particularly the young ones.
the experts, who spoke at a symposium organised by promasidor, said that nutrition education was important to break old traditions of feeding babies that are still common till date.

Consultant paediatrician, massey street children’s hospital, dr. abieyuwa emokpae, said one of those traditions is to lure babies to sleep all through the night, citing that many mothers are still in the habit of giving pap to make babies sleep all through the night.but according to emokpae, “at the infant stage, it is not appropriate for babies to sleep all through the night, because they need to feed from time to time.

“in fact, this is dangerous and it can cause the baby to die during sleep because their digestive system is not strong enough to digest such foods,” he said.

President, nutrition society of nigeria (nsn), prof. Ngozi Nnam, stressed that breast milk remains nature’s perfect food for infant adding that nutrition wisdom is vital, especially after the baby is above six month.
Nnam said: “human milk contains hundreds to thousands of distinct bioactive molecules that protect babies against infection and inflammation, and colostrum, which is the first human milk, produced by mothers at birth serves as the first immunisation for babies, because it contains a lot of anti-infective substances.”

Nnam urged mothers to put their infants to breast feed possibly 30 minutes after delivery, because it is the best baby food, and that is why nutritionists advocate for exclusive breast-feeding.

She said: “exclusive breastfeeding is a complete nutritional source for the infant for the first six months of life, as nutrients in breast milk is adequate in quality and quantity to provide all the needs of the infant and for easy digestion, nnam added.

In her presentation titled: ‘the nutrition wisdom of infant feeding choices’, the nsn president said when babies are exclusively breastfed, they hardly pass stool for sometimes one week, because they digest and utilize all the nutrients in the breast milk.

She stressed that breast milk is essential all through the baby’s first year, as most brain cells and connections are formed during this period, and up to 60 per cent of the nutrients are used up by the brain and that is why it is very important to pay attention at this age.

“Inadequate of these nutrients especially iron, iodine, magnesium, vitamin b12, and folate fat leads to insult on the infant’s brain, which reduces iq by 13.5 points leaving this effect permanent and irreversible.”
in regards to the theme, nnam said, nutrition wisdom is important to ensure adequate supply of nutrients to support rapid growth and development of the infant to eliminate malnutrition.

Nutrition wisdom also affords mothers to make informed feeding choices; this protects the infant from developing chronic diseases like diabetes, cardiovascular and obesity among others in adulthood.

In his welcome address, managing director, promasidor, olivier thiry, said that the importance of exclusive breastfeeding, where possible, cannot be over emphasized, but promasidor is introducing a cost effective alternative food supplement to mothers who for a reason or the other cannot breast feed.

Indian Firm Claims To Have Developed World’s First Vaccine Against Zika

 Indian pharmaceutical firm claims that it has developed the world’s first vaccine against mosquito-borne Zika virus, the News Agency of Nigeria has reported.

An Aedes Aegypti mosquito, which transmits the Zika virus is photographed on human skin in a labPunch/AFP

The Head of the Biotech International Limited, Dr. Krishna Ella, said at a news conference that it had already filed for a patent for the Zika vaccine.

“On Zika, we are probably the first vaccine company in the world to file a vaccine candidate patent about nine months ago,” he said.

Ella said the firm, which is based in the southern Indian state of Andhra Pradesh’s capital Hyderabad, had sought the Indian government’s help for carrying out human and animal trials for the two candidate vaccines, which have been developed by its scientists, using a live Zika virus.

The claims came a day after the World Health Organisation said that the Zika virus poses a global public health emergency requiring a united response.

The virus has been linked to cases of microcephaly, in which babies are born with underdeveloped brains.

There have been around 4,000 reported cases of microcephaly in Brazil alone since October.

However, till date, there has been not a single reported case of Zika virus attack in India, though the government was said to have tested a number of samples.