Despite concerted efforts by government and other stakeholders to curtail disease outbreaks, Nigeria has remained a fertile breeding ground. PATIENCE IVIE IHEJIRIKA and ODIRI UCHENUNU-IBEH, in this report, e-ray the factors
The recurring outbreak of diseases like cholera, Lassa fever and Cerebrospinal Meningitis has become a major concern in the country as it constitutes a serious threat.
According to the Nigeria Centre for Disease Control (NCDC), Weekly Epidemic Report, May 20, 2018, 19 suspected Cerebrospinal Meningitis (CSM) cases were reported from 12 local government areas (LGAs) in five States; Borno with five cases, Ebony with two cases, Katsina with 10 cases, Nasarawa and Yobe with one case respectively, while there were 128 suspected cases with six laboratories confirmed and four deaths from 45 LGAs (12 States) at the same period in 2017.
In the report, between weeks one and 20, 2018, 2970 suspected meningitis cases with 79 laboratory confirmed and 184 deaths from 242 LGAs (29 States) were reported compared with 9472 suspected cases and 596 deaths from 288 LGAs (31 States) during the same period in 2017.
on Lassa fever, the epidemic report indicates that between weeks 1 and 20, 2018, there were 1968 suspected cases with 431 laboratory confirmed cases and 118 deaths from 141 LGAs in 29 States reported compared with 286 suspected cases with 60 laboratory confirmed cases and 48 deaths from 55 LGAs in 21 States during the same period in 2017.
on cholera, the report said that there were 190 suspected cases with 17 laboratory confirmed cases and 17 deaths reported from 11 LGAs in seven States; Adawama has 100 cases, Bauchi has 22 cases, Borno has 20 cases, FCT has one case, Kaduna has two cases, Kano has 44 cases and Zamfara has one case) in week 20, 2018 compared with three suspected cases reported from Kaduna South LGA, Kaduna State, during the same period in 2017.
According to the centre, between weeks one and 20, 2018, 4827 suspected Cholera cases with 154 laboratory confirmed and 76 deaths from 56 LGAs in 18 States were reported compared with 83 suspected cases and four deaths from 15 LGAs in 11 States during the same period in 2017.
This worrisome situation has raised concerns in the country as the problem remains unabated despite combined efforts by states and federal government, international organisations, civil society organisations, faith based organisations and even individuals.
However, stakeholders in the health sector have identified some factors promoting infectious diseases as poor personal hygiene, poor environment hygiene, lack of infrstructure, illiteracy, poverty, flooding, lack of Infection, Prevention and Control (IPC) guidelines in hospitals, limited access to health care, humanitarian crises as well as environmental degradation.
Chief Executive Officer (CEO), NCDC, Dr. Chikwe Ihekweazu, said flooding for instance can cause disease outbreaks such as cholera, dysentery, typhoid fever, poliomyelitis and vector-borne diseases such as malaria and yellow fever.
To reduce the spread of such infectious diseases, Ihekweazu advised that precautionary measures should be taken. He urged Nigerians not to drink flood water, or use it to wash dishes, brush teeth, or wash/prepare food.
“Communities should ensure chlorination of the public source of water supply and ensure proper disposal of waste and clearing of sewage. Nigerians should always remember to wash their hands frequently with soap and clean water and discard all medicines, food and bottled water contaminated by flood water.
“In homes, we should ensure water is well boiled before drinking, avoid open defecation and indiscriminate refuse dumping, avoid mosquito bites by using an Insecticide Treated Net, ensure safe food preparation techniques and if we experience sudden fever or diarrhea, we should please visit a health care facility immediately.”
According to him, the NCDC has been working assiduously towards ensuring that members of the public are adequately informed about epidemics and how to curtail them.
“In my first year, my priority is to move NCDC from where I found it to another level. This is possible because we have been able to build some credibility so far. We are now bringing in some resources to support the work we do,” he stated.
The NCDC boss also urged health workers to observe universal care precautions at all times.
Speaking on reactiveness, Head, Risk Communication, NCDC, Dr. Olufemi Oyoola, said NCDC has been very proactive, “every day at NCDC, our people are in the field working with the state partners to educate, carry out advocacy, educating them about the risk potential of risk priority diseases like cholera, Lassa fever, CSM.
On the recent cholera outbreak, he said, even before the outbreak, the centre had sent out public advisories to all the states, advising them and training them on what they supposed to do in preparation for raining season, knowing that cholera is usual common in raining season as a result of open defecation.
“NCDC cannot go to each states to go and provide safe water for people, it is the responsibility of the state and local governments, so if people are not getting safe water and they are not disposing their waste and are still practicing open defecation, there is no way we will be able to control outbreak of cholera for example,” said Ayoola.
In the same vein, the commissioner for health, Lagos State, Dr. Jide Idris, said there is need for Nigeria to formulate an IPC guidelines to help curb disease outbreaks.
Idris said though Nigeria is constrained by finances but can still combat disease outbreaks with the help of the IPC guidelines that stakeholders are trying to formulate because prevention is cheaper and better than cure.
He said it is very essential for Nigeria to have a guideline on IPC, as it is the only way to prevent infection and disease outbreaks, adding that it is a habit and culture that all Nigerians, including healthcare professionals need to imbibe for preventive measure and the earlier Nigerians start doing that, the better for everyone.
“We will continue to have epidemic if IPC is neglected, because most of the outbreaks are coming from the hospital,” he said.
Identifying hospital structure as part of the issues, Deputy vice-chancellor, (Development Services), College Of Medicine, University Of Lagos, Prof. Folashade Ogunsola said that the possibility of catching an infection is very high due to the way hospitals are structured in the countrynjk.
She said, “We have a lot of people who have been taught on how to protect themselves, but we don’t have anybody pushing that discipline. Right now, most health professionals would tell you I do IPC, simply because they wash their hands but IPC goes beyond that.
“It is really about risk management, managing the risk of acquiring an infection. Presently, most people who do IPC, do it like a secondary thing, so it is not well done and that is why we will continue to have sometimes, the signal of Lassa fever when some one within the hospital catches it. Whereas, if IPC was a way of life, they would treat the patient without catching it.”
Addressing the issue, Ogunsola said, “What we are proposing and what we have done was to develop a curriculum to train health professionals in IPC and they are the ones that will now drive IPC programs in healthcare facilities.”
A resident doctor in Abuja, Dr Ogbona Joshua, said insurgency is the northeast is also promoting recurrence of these infectious diseases as many health facilities in the area have been destroyed.
He therefore urged government to confront the crisis with sincerity so that those internally displaced can return home and have a better life, “as long as humanitarian crisis persist in the country, outbreaks of diseases like cholera will remain unabated,” said Ogbona.
Meanwhile, the Sustainable Development Goals (SDGs) target 6.1: is to achieve universal and equitable access to safe and affordable drinking water for all by 2030. Target 6.2 is to achieve access to adequate and equitable sanitation and hygiene for all by 2030.
However, The United Nations Children’s Fund (UNICEF) report estimates that about 70 million Nigerians, out of a population of 171 million, lacked access to safe drinking water, and over 110 million lacked access to improved sanitation in 2013.
According to the report, every year, 124,000 children under the age of 5 die because of diarrhoea, mainly due to unsafe water, sanitation and hygiene.
In the World Health Organisation (WHO) /UNICEF JMP 2015 report, Nigeria ranks among top 3 countries in the world with largest number of people practicing Open Defecation.
The WHO Country Representative to Nigeria, Dr Wondimagegnehu Alemu, in his 2018 World Health Day message, tasked Nigeria and other African countries on University Health Coverage (UHC).
Meanwhile, the minister of Health, Prof. Isaac Adewole, noted that Nigeria spends less on health than nearly every country in the world and this is seen in 2016, where government health spending was 0.6 per cent as a share of GDP.
Adewole said for the country to accelerate progress to UHC, federal and state governments will need to significantly invest more in health.