Saturday, 18 October 2014

Total knee replacement surgery: Lagos records more success

By: Chioma Umeha

Efforts of the Lagos State University Teaching Hospital (LASUTH) in the total knee replacement surgery exercise witnessed further advancement with the successful surgery of  another set of beneficiaries, including; two female petty trader, aged 62 and 52. Announcing this Tuesday, was Commissioner for Health, Dr. Jide Idris, during the presentation of recent beneficiaries at LASUTH, who said that the goal of total knee replacement surgery exercise which commenced three years ago in Lagos is to reduce the rate of capital flight which is lost to conducting the exercise overseas. Idris also said that the total knee replacement surgery facilities and services are part of his Ministry’s commitment to build local capacity for surgical procedures.  According to him, this would also provide training for resident doctors aspiring to become certified specialist as nursing staff and physiotherapists responsible for patients’ nursing and rehabilitation management Idris, pointed out that that there have been 15 successful surgeries since the exercise started over three years ago under the auspices of the Limb Deformity Corrective Surgery Programme.

“We started over three years ago under the auspices of our Limb Deformity Corrective Surgery Programme. Knee replacement surgery exercise was started in realization of the high numbers of patient who applied to the state government for financial assistance to travel abroad (usually India) to have the knee replacement surgery procedure done. As a government we thought it wise to discontinue the trend of taking our resources abroad for surgical exercise that can be done in the country, the Lagos state health boss said.

“We felt by starting this exercise, we would not only discourage patronage of overseas treatment, but we would build local capacity for surgical procedures like this and this would also provide training for resident doctors aspiring to become certified specialist as nursing staff and the physiotherapists who are responsible for patients’ nursing and rehabilitation management; and this is exactly what we have been able to achieve in the over three years the programme has commenced, he added. Noting that the number of successful surgeries is inadequate for training, the Commissioner said that his Ministry has made provision for a fixed number of free total knee and total hip prostheses monthly.
Knee Replacement

“This way, the surgeons, nurses and physiotherapists get to manage such cases frequently and therefore become more proficient,” he said. He also said that beneficiaries are mainly the indigent in Lagos state. His words;“the less fortunate Lagosians, who would otherwise have been unable to afford this treatment on account of cost, would be the ultimate beneficiaries this exercise. The State Government through this effort would also be saving a lot of the funds that would otherwise have gone to India and other places abroad.” The Commissioner also observed that the most recent knee replacement surgery exercise was carried out on Saturday, April 27 and Sunday 28, during which two total knee replacements were carried out in LASUTH, under sponsorship of the Lagos State Limb Deformity programme. Both patients had severe osteoarthritis of the knees, a condition characterized by worn-out cartilage at the ends of the bones that come together to form a joint. The worn-out cartilage and some of the underling bone is surgically removed and replaced with prostheses during total joint replacement.

This results in the patient being able to walk again without pain and deformity. Commenting, the Consultant Orthopedic Surgeon LASUTH Dr Ladipo Adewale, explained that osteoarthritis of the knees is common in the elderly than osteoarthritis of the hips in our environment, but in the younger people, it   is commoner in the hips, particularly amongst sicklers (Hb SS and SC) who suffer from avascular necrosis of the head of the femur. These procedures were carried out in LASUTH using INDUS total knee implants made in India, said Adewale. According to the Consultant Orthopedic Surgeon, an Indian surgeon, Prof. Nagare was in attendance to demonstrate the peculiarities of insertion of this particular implant to the LASUTH surgeons and exchange personal experience, while giving a few tips and tricks. Both patients had uneventful post-operative periods and were discharged one week after surgery, he added. Both the 62 year-old petty trader and the 52-year-old petty trader had progressively worsening deformity of the knee (bow leg) and knee instability, Adewale said. Chief Medical Director LASUTH Dr Wale Oke, reiterated the institution’s commitment to build local capacity for surgical and other medical procedures.

This story was published in Daily Newswatch on May 16, 2013.

Nigerians treat malaria through self-medication

By: Chioma Umeha

A recent weekly poll showed that 51 per cent Nigerians treat malaria through self-medication. According to the poll released by NOI Polls Limited, weekend, 44 per cent of Nigerians visit the hospital to see a doctor when they have malaria, 38 per cent simply buy medicine from the pharmacy or chemist, while 13 per cent make use of native herbs such as, Dogonyaro, Agbo, Neem leaves and Lemon grass.  The remaining four per cent do not use any medicine.

The poll also showed that seven out of 10 Nigerians (66 per cent) have had malaria at least once in the last one year. It further stated that women are more likely to visit the hospital than men. This is because majority of Nigerian men simply visit the pharmacy to buy malaria medicines or opt for native herbs more than women, the survey showed. As the survey puts it, “almost seven in 10 Nigerians (66 per cent) have had malaria at least once in the past year, and about 13 per cent treat the ailment with the use of local herbs such as Agbo, Dogonyaro, Neem leaves etc.”

The survey pointed out that 90 per cent of Nigerians identified HIV/AIDS as a critical health challenge in the country and suggested better media and sensitization programmes to increase awareness of the disease.
The result of the survey, which was published by 3ra’fique is an independent marketing communications organization based in Lagos, also stated that there were three key findings from the HIV/AIDS and malaria snap poll conducted in the first week of April, the third in the NOI polls MDG (Millennium Development Goals) series.Respondents to the poll were asked six questions. The first question was to establish the frequency of malaria infection over the past one year. Respondents were asked: In the past 12 months, how many times have you had malaria? According to the results majority of respondents (66 per cent) said they have been infected with malaria at least once over the past one year while 34 per cent said they have not had malaria within the same period.

Further analysis by geo-political zones showed that malaria is more prevalent in the South than in the North. Majority of the residents in the Northern regions; North-Central (43 per cent) North-East (38 per cent) and North-West (38 per cent)) have not had malaria since the last one year; while the Southern regions; South-South (77 per cent), South-East (75 per cent) and South-West (64 per cent) have the largest percentage of respondents who have had malaria more than once within the period.  This disparity between geo-political zones is perhaps due to the greater presence of rivers, seas and lakes in the South where mosquitoes are prevalent; while the North is mostly dry savanna and desert in vegetation, the survey said.

The second question was: How do you treat malaria when you have it?  Responses showed that the majority (44 per cent) of the respondents visit the hospital to see a doctor when they have malaria. However, 38 per cent simply buy medicine from the pharmacy or chemist, even as 13 per cent make use of native herbs such as Dogonyaro, Agbo, Neem leaves and lemon grass with the rest, four per cent not using any medicine. The result based on regions showed that majority of the residents in the Southern regions use self-medication unlike the Northern regions that go to the hospital.  Also, it showed that the  North-West has the highest proportion (71 per cent) that claim to visit the hospital, while the South-East has the highest proportion (52 per cent) that simply buy malaria medicine from the pharmacy even as the South-West has the highest proportion (19 per cent) that use native herbs.

The third question was: how do people get HIV/AIDS? The response showed  that majority of Nigerians (86 per cent) believe that HIV/AIDS can be contracted through sexual intercourse; while 64 per cent are of the view that it can be contracted through the sharing of sharp objects. A further 41 per cent mentioned blood transfusion; with others stating that HIV/AIDS can be transmitted through mosquito bites (one per cent) and through deep kissing (three per cent).

The fourth question bordered on the assertion of international organisations such as the United Nations (UN) and World Health Organisation (WHO) which identified HIV/AIDS as a critical health challenge in the country today. Majority (90 per cent) agreed with the assertion. Based on geo-political zones, the South-South has the highest proportion (55 per cent) of those that strongly agreed with the assertion; while the South-East has the highest percentage that agreed (68 per cent). Bemoaning the menace of malaria in Africa, the survey observed that basically everyone on the continent has been affected by the pandemic. The deadly scourge claims the life of a child every minute and kills 655,000 people yearly (out of which 86 per cent are children). Research has proved that the disease can kill within 24 hours of symptom onset, even as it accounts for 40 per cent of all public health spending in the continent.

It decreases the gross domestic product (GDP) of some high-burden countries by over one per cent. For instance, Africa loses $12 to $30 billion in GDP yearly. According to this year’s report from the World Health Organisation (WHO, 2013) malaria traps families and communities in a downward spiral of insufficiency; disproportionately affecting marginalized and poor people who cannot afford treatment or who have limited access to health care. Insisting that poverty is critical to the malaria scourge in the country and continent as a whole, 3ra’fique, the publishers of the survey, said it has decided to use football which is a celebrated form of sports across the world as a tool of awareness struggle to eliminate malaria scourge.
“Malaria is both a cause and consequence of poverty. Football on the other hand is the most popular sport in the world. The command of the sport fashions an endless stage that provides a vantage point for upholding health awareness fights; for example, using it as a tool in disarming this ‘Weapon of Mass Destruction’ called Malaria,” the  survey quoting the latest WHO’s report noted.

Therefore, 3ra’fique plans to leverage on soccer by engaging a cast of Nigerian Comedians (Team Comedians) and On-Air Personalities (Team OAPs) of radio and television stations to commemorate World Malaria Day (WMD) on April 27, 2013. The football match will draw a great gathering to witness influential individuals of our society as they use football to create an avenue in advocating for sustainable solutions to rid Africa of Malaria. According to Irabor Okosun, Chief Executive Officer (CEO) 3ra’fique Communications,  ‘Join the Cast’ Football Match, the purpose is to use this pool to deliver malaria prevention messages to create mobilization within communities against the disease.

“Defeating malaria requires a comprehensive approach and the technique to curtail it will be essentially collaborative and communicative. Football-based prevention programmes like the ‘Join the Cast’ Football match will employ the competitive, participatory, team-based, and communicative aspects of the game to facilitate both knowledge acquisition and the development of communication, leadership and life skills; such as risk awareness, resilience, self-efficacy, good decision making, and positive behaviours like mutual support and respect,” Okosun said.

At the venue, there will be free mobile platforms for voluntary counselling and testing (VCT) on how to properly treat and prevent malaria as well as treat people who have malaria.
Also, there will be distribution of relevant give-away items such as treated bed nets, insecticides, coils, electronic racquets, Information Education and Communication (IEC) materials such as flyers, pamphlets and other educative materials fortified with useful information about malaria prevention and treatment.
The benefits and expected outcomes are: saving lives through candid awareness about malaria prevention and treatment; positive brand equity positioning for your brand by engaging in a productive CSR; a robust and holistic form of media exposure for your brand; international coverage and opportunity to network.

This story was published in Daily Newswatch on April 24, 2013.
Our primary health care system is in comatose – Akintayo
 By: Chioma Umeha

Olumide Akintayo, is President, Pharmaceutical society of Nigeria (PSN). In this interview with CHIOMA UMEHA (HEALTH EDITOR) Akintayo tackles  issues  of  fake  drug distribution, primary health care among others. Excerpts:

Olumide Akintayo
 The PSN is critical in the efforts to bring sanity to drug distribution and eliminate fake drugs. What are you doing in this regard?
While we were campaigning, I came up with this blue print, a 13-point agenda. The totality of our plans to transform the health sector to the next level was documented in this package. It is not the direct responsibility of PSN to either come up with an agenda of restructuring drug distribution in Nigeria or eliminate fake drugs in the distribution chain. The PSN strictly speaking is a professional body and always tell people this. Because we are a professional, we do not have the requisite regulatory powers to restructure drug distribution among others. There are agencies of the federal government which have a direct statutory mandate to regularize the drug distribution channels; agencies like Pharmacists Council of Nigeria (PCN) and National Agency for Food and Drug Administration and Control (NAFDAC) which is a more popular one at least to members of the consuming public. So these are the agencies of government that have direct statutory mandate or responsibility to carry out those things you are talking about.

For instance, it is within the purview of the responsibility of Pharmacist Council of Nigeria to register pharmaceutical premises based on a written code. It is the responsibility of NAFDAC to approve drug or food products that can be sold in these registered pharmaceutical premises. So it is NAFDAC that have direct responsibility in terms of restructuring the drug distribution channels. Then of course, you have agencies like PCN, the Federal Task Force of Fake and Counterfeit Drugs and the various states task forces of fake and counterfeit drugs; these are the ones that have the direct mandate to tackle the menace of the fake drug syndrome in Nigeria. Based on Section 111a of Pharmacists Council of Nigeria act, that agency has powers to prescribe minimum standards for operators of pharmaceutical premises, be they patent medicine; for instance to say look; ‘you cannot do this, you can do this and if the operators fail to comply with those directives of PCN, PCN can decide to seal such premises. Like I said, it has powers to regulate and control. It’s a government responsibility. Don’t forget that drug matters are on exclusive list. The implication is that it is only agencies of Federal government of Nigeria which have powers to run these processes.

These include: NAFDAC, PCN and National Drug Law Enforcement Agency (NDLEA).
But having said that, we are major stakeholders in this process and that is why naturally these questions will naturally continue to come. Our responsibilities in the area of advocacy to continue to put pressure on these government regulatory agencies to do the needful at all times to support them and make sure our members live up to the expectations of their callings as pharmacists. Also, to sensitise other stakeholders; patent medicine dealers, support staff and pharmacies and the consuming public on where to source drugs, things to look out for among others. I can assure you that the Pharmaceutical Society of Nigeria has never failed in carrying out these responsibilities.

How do you ensure professionalism among your members?
What we try to do is that we tell clients, consumers of medicine, if you want to source for genuine drugs, look out for pharmaceutical premises where you see the green cross emblem with PSN No. Any where you see such things; PSN can vouch for the provision of good quality services in such places. PCN has also come up with another regulatory tool for patent medicine dealers. In Nigeria today, those are the only two levels of providers who are empowered to sell drugs to the consuming public. The beauty of it is that it is within your rights as a consumer to ask for the license, the certificate of registration of that premises, by virtue of the regulations of PSN, it is the original copy that is supposed to be displayed conspicuously in the pharmaceutical premises. So you can ask to be sure that the place is registered. It is also your right to ask for the superintendent pharmacists on duty. Pharmacists are actually the most accessible and cheapest professionals you can consult without any charges or a fee. If there are problems, if you bring such report to PSN, we can trace that pharmaceutical premises and make appropriate recommendations to the regulatory agency. This is possible because it is registered and known in law. There is a value when you patronize pharmaceutical premises.

How can this country weed out the issue of fake drugs?
The only sensible thing to do is to adhere strictly to provisions. Sometimes I’m embarrassed myself because the very first in the series of legislation or acts of parliament designed to tackle fake drugs menace was promulgated way back in 1988. That is some 25 years ago, that law, specifically section 21prohibits the sales of drug in unregistered pharmaceutical premises and places like markets, kiosks, drug hawking, moving forms of transportation, ferries, buses etc, but me and you know that those things happen.

Now what has happened to us as a society?
Probably, this is beyond the pharmaceutical sector, we have a plethora of laws to tackle a lot of social vices we contend with, but somehow the spirit of enforcement has been lax. Probably, this is another opportunity to appeal to federal government to support these regulators, give them tools to work, financial resources and logistics. In Lagos state where I practice, I can tell you that as far back as 2000, in erstwhile 20 Local Government Areas (LGAs) of Lagos state; we carried out a survey in the PSN Lagos branch; we put on record the existence of more than 112,000 illegal premises. Today, I can imagine that it will be two or three times what it was 12 years ago. So there is a ready incentive to perpetrate evil, the evil of spreading unregistered premises because it is obvious that the regulators are not pro-active, probably not because of their own making, but because government too continues to shirk in its responsibilities of sustaining these regulatory structures that have been created through Acts of Parliament. The appeal still goes back to government to do the necessary things, so that we can begin to sing Hallelujah with respect to changing the status quo.

Why has the country remained a dumping ground for fake drugs?
I’ve said it that there is ready incentive to perpetrate or do wrong things; violate Acts of Parliament. Human nature is such that people will never conform; the major difference between the climes they classify as developed nations and ours is that there are people who enforce the law all the time in those climes; people know there are consequences; there are sanctions that will be applied immediately you violate any law. I remember the pioneer Director-General of NAFDAC, way back in 1995 had declared to the National Council of Health, that the major sources of fake drugs in Nigeria are the plethora of drug markets. That is a whooping 18 years ago, those same drug markets has continued to exist; in fact more has come on board. As at 1988, when the fake drug Acts was promulgated by the military, there were about four major drug markets; Ariria in Aba, Head-Bridge, Onitsha, Sabon- Geri, Kano and Idumota, Lagos. But today, we have 27 documented drug markets and more springing up by the day, because government has not been pro-active in dealing decisively with the existing ones. The fake drug law says; prohibition of drug sales in certain places and locations listed in Section 21 of the fake drug Act; and then people are doing exactly that unhindered.

Access the primary health care in the country?
There is no such tier as primary health care in this country. That is truth; it is not non-existent in the ideal context. Yes, there are agencies called primary health care, but, in reality do we have a tier of health care called primary health care? My answer is, ‘no’ that is why basic things are failing in Nigeria, for instance; immunization- you talk of oral polio, why is it impossible to tackle that menace? This is because primary health care structures have failed us. 

Why is it called primary?
This is because it is first level; the basic things are done at this level. 

Who are the first-level health-care providers?  
You think of pharmacists, doctors to a lesser extent, probably nurses and community health care workers.
Ask yourself; if you have headache this afternoon, where do you go to? You go to a community pharmacy to ask for Paracetamol tablet, that is the number one level of intervention for treatment globally. But because we play stupid politics in Nigeria we’ve refused to recognize such places and these are some of the reasons primary health care is failing. Immunization for instance, 80 per cent of immunization basic endeavors is carried out in community pharmacies in US and it is working, including their drugs. But in Nigeria if you mute it, some people are ready to die. And these are reasons why it is failing. You need to bring community pharmacists into primary care endeavors if you want it to work. Like I said, they are the first level of treatment in the global level. If you have malaria, the first place you will go is a pharmacy. You can imagine if you involve such providers to take care of immunization, because a pharmacy today is a centre for health advocacy and health promotion; wellness and disease prevention as well as control. This is because the pharmacist has been trained to tackle all of those things. If you allow him to conduct immunization, all the ‘doubting Thomases’ can be better convinced. Globally, only Nigeria and India alone account for 40 per cent of infant and maternal mortality rates. 

 There are basic tips that can be handled by providers in the community, because the truth is that you don’t have doctors at some of those levels. If we want to get it right, we need to bring all providers who have some level of expertise to offer; we need to recognize them; we need to certify them as primary care centers so that the concept of primary care will work. What we are doing today is a charade, because we play stupid politics, ridiculous politics and people who should know rather than apply themselves as statesmen allow themselves to be hoodwinked along the narrow perspective of professions they belong to and it is tragedy for this country. I am saying that with a sense of responsibility; primary health care has always failed and it will continue to fail because of our attitude, the way we run it. Look at the National Health Insurance Scheme (NHIS); you merge health care facilities together, you should not merge secondary and tertiary care facilities. The only level of health care that can be merged is social health care insurance and those that belong to primary care. If you are looking at it from that perspective it should be a doctor’s clinic. Anything that has more than a clinic that is a consulting room is no longer a primary care centre. The moment you have a pharmacy and laboratory, it is no longer a primary care centre. That is why we need to go back to the drawing board to go and repackage what truly constitute primary care in Nigeria.

The issue of primary care has allowed both secondary and tertiary to fail. People merge specialist hospitals with primary health care centres.  In places like National Hospital, Abuja or Lagos University Teaching Hospital (LUTH), people go there to treat malaria. This is because 60 per cent of clinical visitations in Nigeria are malaria-based, so naturally people will go there to treat malaria. That distracts a tertiary institution from its core mandates of research, training among others. That is why people who should actually see specialists or pharmacists, for instance, those who have serious cardiovascular situation find it difficult to get appointments within days. You are dying and you have Comprehensive Heart Failure (CHF) and you are given an appointment for six weeks to see a consultant. So these are problems and we need a whole range of reformation and you know part of the problem with health care in our country is that people tend to equate a whole multi-disciplinary sector, like the health sector to a baby or platform of only one profession. Rather than reckon with a multi-disciplinary range of professionals, who have expertise and inputs in coming up with health policies, plans and designs; we factor the input of one profession, then we fail ab initio. That is why we have continued contend with systemic failure; a cycle of delinquency in the health care industry.

What is the way out?
Create a level-playing ground.

This story was published in Daily Newswatch on May 16, 2013.
Routine antenatal care reduces maternal death – Experts

By: Chioma Umeha

Experts have agreed that death of women through maternal cause can be avoided if regular antenatal check-up and routine drugs taken throughout the period of pregnancy.
Stating this was the Commissioner of Health, Lagos State, Dr Jide Idris, who insisted that there is need for pregnant and nursing women to be aware of the availability health facilities and personnel and access the necessary services in order to sustain efforts in the reduction of maternal and child mortality. Idris said this on the occasion of the town hall meeting on maternal mortality reduction in Iberekodo, Ibeju, Lekki, Lagos, Thursday,  adding that state government has built hospitals, provide facilities, quality health personnel and literary materials to ensure that ensure that maternal death in the state remains on the decline.

However, he noted pregnant women and nursing mothers may not access these facilities unless they are aware of its availability and the usefulness to them, adding that this is the essence of the town hall meeting.
His word; “We have built hospitals, provided facilities, trained our staff; we have printed free booklets (brochures) which contains information on pregnancy, ante natal and child care, but we have hold this meeting today to ensure a personal interaction with you and confirm that you are aware of the availability of this facilities, its relevance and access them.”

Speaking also, Hon. Kemi Surakat, lamented that maternal mortality is the leading cause of death among women globally, especially in the less developed countries, with Africa witnessing the highest incidences of this plague. Surakat said that emphasis should be placed on preventive medicines and risk factors and diseases such as hypertension, diabetics among others that might lead to maternal mortality.

“On a monthly basis, we maintain monthly health out reaches on immunization to all corners and crannies of our areas to stem the ravages of these preventable diseases. By screening for breast and cervical cancers in our women, in order to eliminate and reduce the ever increasing rate of cancer in our women folks, he said.
Similarly, Senator Gbenga Ashafari, urged women to ensure regular ante natal check-up as well as take their routine drugs, reasoning that this will guarantee good health and safe delivery of pregnant mothers. “Pregnant mothers should visit primary healthcare centres, ensure regular ante natal care and take their routine drugs, throughout the pregnancy period,” Ashafari said. Corroborating, Senator Abike Dabiri pointed out that the brochure contains important information on food nutrients which every woman must know.

This story was published in Daily Newswatch on May 4, 2013.
Nigeria among five countries with 47 % global burden of malaria

By: Chioma Umeha

L-R: Commissioner of Health, Lagos State, Dr Jide Idris, Former Deputy Governor, Lagos State, Princess Sarah Adebisi Sosan and Hon. Abike Dabiri, during the town hall meeting on maternal mortality reduction in Iberekodo, Ibeju, Lekki, Lagos, Thursday. PHOTO: CHIOMA UMEHA

Nigeria is among the five countries DRC, Ethiopia, Tanzania, Kenya which account for 47 per cent of global burden (116 million) of malaria in the world.
In view of this Prof. Chukwu Onyebuchi Chukwu, Minister of Health, has called for accelerated efforts to ensure that the country exits the list of five African countries with the highest burden of malaria in the world.  Prof. Chukwu, made this observation during the breakfast meeting in commemoration of the World Malaria Day at the African Union conference of Health Ministers, at Addis Ababa, Ethiopia, and added that malaria is still an issue of public health importance.

Noting that there are various approaches which have been adopted to tackle malaria, the Minister said, that there is need to completely eliminate the diseases in the continent. His words: “In the African region, malaria is still of public health importance.Globally, it is estimated that there are about 247 million cases per year and Africa accounts for 86 per cent (212million) while five countries in the world. Nigeria, DRC, Ethiopia, Tanzania, Kenya account for 47 per cent of global burden (116million), consequently, there is the need for us to work harder than ever to rid the continent of the disease. Various strategies are being implemented in the control. But we need to move on to elimination and ultimately eradication. For Africa to eliminate Malaria, our approach must be multipronged and integrated.”

To ensure successful elimination of the diseases in the West African sub-region, Prof. Chukwu said that the ECOWAS encouraged member countries to ensure vector control through Integrated Vector Management in addition to implementing large scale larviciding.  “A ground breaking ceremony for a Larvicidal Factory was done in Nigeria a couple of weeks ago in the presence of the President and Vice President of the ECOWAS commission and the Deputy Prime Minister of Venezuela.

The region is also focusing on vector resistance and drug surveillance. Africa must employ Indoor Residual Spraying (IRS) with DDT. There is also a need for scale up of the use of Rapid Diagnostic Test kits (RDTs),” he said.  According to him, Nigeria has distributed 51,703,880 Long Lasting Insecticidal Nets (LLINs) and will continue to distribute nets. However nets alone cannot lead to the expected outcome.  But he insisted; “We must diversify into other strategies such as IRS, Larviciding and environment management.Awareness creation is being scaled up through the use of NIFAA(Nigeria Inter-Faith Association) as well as the investiture of Malaria Ambassadors.”  Prof. Onyebuchi also pointed out that the country has successfully implemented the first three phases of the Malaria Programme Review (MPR) and now at the fourth phase that involves the implementation of the recommendations of the MPR.  Already the preplanning process for the review of the National Malaria Strategic Plan, Malaria Control Policy and other relevant documents has commenced, the Minister said.

He further said that efforts are being channeled to sustain routine LLIN distribution, implement a nation-wide larviciding, IRS as well as establish 18 sentinel sites across the country for malaria vector surveillance. Also, there plans to scale up the use of RDTs as well as ensure the availability of ACTs and SPs for pregnant women; behavioural change communication and complete the Malaria Programme Review process.

This story was published in Daily Newswatch on May 4, 2013.
Facts about gastroparesis

By: Chioma Umeha

Chioma Umeha

Gastroparesis – literally “paralyzed stomach” – is a serious condition manifested by delayed emptying of stomach contents into the small intestine after a meal. There is no cure for gastroparesis, but treatment can speed gastric emptying and relieve gastrointestinal symptoms such as nausea and vomiting.  Gastroparesis most often occurs in people with type 1 or type 2 diabetes, but diabetes isn’t the only cause of gastroparesis. Other possible causes are: post viral syndromes; anorexia nervosa; surgery on the stomach or vagus nerve and medications that slow contractions in the intestine, particularly anti-cholinergics and narcotics.

Others are: smooth muscle disorders, such as amyloidosis and scleroderma; nervous system diseases, including abdominal migraine and Parkinson’s disease and metabolic disorders, including hypothyroidism. Symptoms of gastroparesis: The symptoms of gastroparesis include; feelings of fullness too soon after you start eating, bloating, heartburn, upset stomach, nausea and vomiting. These symptoms may be constant or may flare up from time to time with periods of relief in between.

Some patients have no overt symptoms of gastroparesis and, in people with diabetes; the only sign may be difficulty controlling blood glucose. If the gastroparesis remains untreated, it can lead to additional complications, including malnutrition, dehydration and electrolyte imbalances. Treatment of gastroparesis is often two-fold. First, health care providers aim to improve gastric emptying and control symptoms. Second, they treat the underlying disease causing gastroparesis, if present.

Stomach lining

People with gastroparesis are advised to eat a diet low in fat and fibre. Also, eating six small meals a day, rather than three large ones, may allow the stomach to empty its contents more easily. Some people may benefit from replacing some solid meals with liquid meals, which pass through the stomach more easily. A number of medications are somewhat effective in promoting gastric emptying and relieving the nausea and vomiting of gastroparesis.

These include metoclopramide (Reglan, Metozolv ODT) erythromycin (ERY-C and other brands), cisapride (available in the United States only through a restricted program with the manufacturer because of rare but dangerous side effects) and domperidone (not available in the United States). Doctors may also recommend use of a device called Enterra, which provides intermittent or continuous stimulation to the stomach’s muscles via electrodes implanted under the skin that covers the stomach. The treatment can improve symptoms but has little effect on gastric emptying.

This story was published in Daily Newswatch on May 4, 2013.
Vagrant psychotics is increasing due to stigma – Umeh

By: Chioma Umeha

Dr. Charles S. Umeh, is a lecturer and clinical psychologist at the Department of Psychiatry, University of Lagos Teaching Hospital (LUTH), in Lagos. In this interview with CHIOMA UMEHA (HEALTH EDITOR) Umeh says that stigma is a major factor in the rising incidence of emotional problems in the country.

Dr. Charles S. Umeh
 What are the major problems that those with emotional conditions come down with?
From the wider societal perspective, they use a common term to label a person who has cause to visit psychiatrist, a clinic psychologist that is the person is ‘mad.’ But, we say ‘no’ to such term. The term ‘mad’ has caused a lot of stigma to people who come down with emotional problems and from the look of things, virtually everybody has come down with certain level of emotional problems at what point in time or another; are we going to say, they are mad? Because of this they are cow, they are afraid of how people will see them for visiting a professional that can help them. They keep going on with a problem that can easily be nipped in the bud until it becomes a major issue. Now if you look at yourself, as an example, there are times you get weighed down by work or stress of work and you could see that you might not function very well, at that point in time, all you need is somebody, so that you can unburden. When you are talking about somebody you could talk to, it has to be somebody that understands the dynamics of human behaviour that is where the professional thing comes in. But our people don’t see it that way; that is when stigma is involved in emotional problems. Obviously when you have emotional problems, they will say you are going to visit ‘Yaba Left.’ That ‘Yaba Left’ is a big hitch.

‘Yaba Left’ is a name they call Yaba Psychiatric Hospital. Nobody will see you as the same again for visiting that place; they wouldn’t even why you visited that place, for the fact that you said, you were going to ‘Yaba Left’ then, it is assumed that; ‘oh, you’ve no other business to be there if you are not ‘mad.’ And if you come back to talk to the same person, you see his attitude changes automatically, because he is assuming now that you are now a ‘Yaba Left’ candidate. More so, based on the myth in this part of the world that ‘once a mad person, always a mad person.’ But, I can tell you those emotional ailments are like any other ailment that can be treated; and it is not as severe as some conditions like diabetes and hypertension that you have to live with all your life together with medication. But, because those are more like accepted, nobody is looking at it as an object of stigma, but once you have an emotional issue; yes, you’re mad. For instance, I just finished doing a job with HIV patient who enjoys a chunk of the stigma. The work shows some startling revelation about stigma; that those people are bordered more by stigma from healthcare professionals and family members. And in this kind of this of mental health issues, who are the first people that will label you as mad? Is it not family members; is it not the healthcare professional that you see? This is because if the person does not know you, he might know the condition you are coming with. This is because some emotional problems are masked that if you don’t know the person very well, you won’t know that something is wrong except insiders. And they are the ones that will tell outsider that initiate the stigma.

They are the ones that will tell outsiders; oh, don’t you know him, he has emotional problems; before you know it, the news spreads. And the impact it has on the client or the patient is not measurable, first, you have to explain yourself for every action you take so that people will not misunderstand it as a sign of illness. Even when you are very lucid, you are making very cogent point, nobody will believe you; they will say; ‘he used to have emotional problems, maybe, he is in his state again.’ So these people are trying to impress it on people that ‘for the fact that we have this does not mean that we are not reasonable anymore.’  They are reasonable. Even the so called vagrant psychotic patient you see roaming the street, still have lucid periods. But, to many; ‘nothing good can ever come from them.’ So they still suffer stigma. One of my Professors did a study comparing psychotic patients and normal people, and he discovered that they are the same in all ramifications except for some affective issues and the affective issues are the tune of their illness which could be managed and they go back to function normally again. So, you could see if you keep looking at it that way, the society because someone has been labeled ‘mentally ill’ has rejected the person. So, he can never be part of the society anymore. But, that is wrong. I look back; why is it that if someone comes down with hypertension, the society will not look at it as if he has committed a crime and he will be accepted back after treatment. That’s the way it should be with mental illness, they are sound and okay again. But, probably yes, if they don’t continue with their medication, there could be relapse which happens in all other kinds of accepted illnesses.

This is because if you are hypertensive and you don’t take your medication; what happens? You will relapse. So, why are we not stigmatizing people with hypertension? But, for the fact that somebody has a minor emotional problem like stress or depression, then it becomes a big thing, so the person can function again in the society. So that is one of the major problems people avoid assessing psychiatric services and it is a big issue that must be look into. And the way to look into it is to begin to educate the populace about the nature of emotional problems. They range from very mild to severe. The milder ones are; depression and anxiety.
For instance, there are some people who anxiety is an on-going problem, that it affects their general functioning. Now, if such a person goes to see a psychiatric; are we saying, he is going ‘Ga ga’ from the societal perspective? Are we saying that he anxious to certain level, that he should be stigmatized? Then, all of us are guilty; this is because everybody has had anxiety problem one time or the other, so, all of us are victims of emotional problems. So if you are talking about stigma, you begin from yourself; to stigmatise yourself. So we are working on the society understanding these leverages because some people don’t even know that  anxiety is an emotional problem that will need a clinical psychologist to see. Some of them don’t even know that depression is like everyday issue that needs to be treated and the person becomes normal. But, there is only one category of mental illness that has taken shine over every other person and that is how the society sees people with emotional problems; that is psychotic disorder in which the person is like losing touch with reality. But the good news is that this condition is an illness that is treatable. But, people don’t give those with such conditions the benefit of doubt that; ‘oh, for the fact that they have these things does not mean that their life has ended. Once they access treatment, they recover.’

What are other factors which contribute to rising incidences of emotional problem in the country?
Another important factor that could throw more insight into the rising incidences of emotional problem in Nigeria is circumstances of existence.  Now first, we look at what are the possible causes of emotional problems? We classify them into two broad levels. One is environmental issue, another one is the biological issue, the nature nurture.  And in most cases, we look at the interaction between both in order to explain any condition. Now the environmental issue comes from circumstances of our existence. For instance, if you’re living in an urban area where we have a lot of stresses.  Another factor is that some of these emotional issues are hereditary; temperament. Some people might have the latent threats to develop certain kind of emotional disorders and the threshold of accepting stressors could be very low.

So when they are subjected to certain kind of environmental stressors, they come down easily because they have the genetic predisposition. Another issue is that if the environment is all right, they might have the latent threat, they might not come down because the environmental issues are all right, so you wouldn’t push them into coming down with emotional problems. That is where we look at other socio-cultural factors that are responsible for emotional problems. That is the basis for comparison with maybe what we have outside. In this part of the world, we have a lot of social inter-connectivity; if you have emotional problems, it is either this uncle or aunty will come to your help as against what we have in an individualistic environment in US where people fend for themselves.

Because they don’t have such kind of social structure, the tendency is that they can easily come down with emotional problems over there than here. That is why it is the in-thing to have shrinks as they call it; it is normal thing for everybody to have one or two shrinks they see on daily basis to  enable them cope. But, here, our ability to cope with stress is a bit high. Due to environmental circumstances, people are beginning to breakdown. Because how long can you cope with all these avalanche of problems impinging on you on daily basis. And the next aspect, you don’t even know when going to end; it throws you into an emotional journey that has no end. And a lot of people cave in and come down with that. And these are some of the dimensions of emotional problems we do have. I have not discussed the psychotic ones; those are the severe aspect of it. They could be a product of trauma, genetics and environmental stressors as well. So, the high time we started managing stresses around us, the better we do such management and the more coping skills we adapt, the more some of these problems are put in check. But, the way we going, Nigeria is a developing country and in most developing country, like America witnessed in the 50s, there had a lot of emotional problems coming with the new introduction of technology and ability to cope with the changing environment.

What is the statistics of persons who have faced emotional problems in the last ten years?
It will be very difficult. Here are in Nigeria, people with emotional problems don’t come to hospital until it is severe – the severity comes when you have frank psychotic symptoms; that is the person is beginning to lose touch with reality. The reason why they don’t that is because of the stigma. That is what I’ve trying to emphasize. We’re beginning to do a bit of prevalent studies, but that prevalent study does not say much about what happens in the outer society based on experience.

Is there any statistics on deaths from emotional problems?
Death is not always easy with emotional problem; it is not an emergency that could kill immediately. That is why you can actually quantify the number of people who dies as a result of it. You could see the vagrant psychotics along the road. There are times they will increase in upsurge, there are times you don’t get to see them because some organizations are beginning to provide shelter for them and take them off the road. That is the point we are talking about; why do we have vagrant psychotics because the family the person is coming from disassociated themselves from the client and they push the person outside. Nobody wants to identify with such illness. This is because if they say; he is from our family, then, the future of younger generation there is in jeopardy there. Tomorrow if one of them wants to get married; ‘oh madness runs in that family, nobody wants to there.’ Can you see why it is a bit of a secret thing that nobody wants to be associated with it? Now if you come from a family where people keep making reference to; ‘oh that family, madness runs in that family and you know that ‘madness’ is a genetic thing; will want to go into that family? Even if you’ve the illness, will you want people to know about it? That is the problem we having with all these things. Now we need to debrief the society on the nature of these conditions, so that people will really come out and access treatment and function better in the society. The major problem like I mentioned earlier is stigma. How I wish we can take away stigma from this illness, then people will access treatment and function better in the society and until we start doing that, it is going to still be a deep secret. And sooner or later, we will start having a real study of how much Nigeria is loses.

Is there statistics on what Nigeria is losing following the incidence of emotional disorder among productive people?
You cannot say. Usually, they look at mental illness as the problem of the poor that is why emphasis has not been placed on it for a long time. But, today there are mental illnesses that are associated with psycho-active ills and it is stripping the country gradually and it is becoming a problem to the rich men that run the states because they are the one that can afford the psycho-active substances. And a lot of them are becoming problem to the state. With the way things are going, sooner or later they will start paying attention to it. How will you carry such research if you are not funded? How many of government votes go into mental health research? They will tell you they are concerned more about infant and maternal mortality that is the focus of the health sector now; not knowing that a bigger problem is brewing in mental health.

This story was published in Daily Newswatch on May 1, 2013.
Nets, critical in reducing malaria deaths, illness UNICEF

By: Chioma Umeha

Malaria kills 660,000 people every year, most of them African children. Universal coverage of insecticide-treated bed nets is key in making gains against malaria – one of the biggest killers of children in the world, said UNICEF on World Malaria Day (WMD).  With partners, UNICEF champions and supports governments to undertake free distribution of insecticide-treated nets – especially long-lasting insecticidal nets. When universal coverage – one net for every two people – is reached, this simple, effective barrier can reduce child mortality by 20 per cent.  In 2004, there were just 5.6 million bed nets in sub-Saharan Africa. Until recently, limited competition among producers meant that they were too expensive to scale up. However, by 2010, bulk buying, joint procurement, better financing and extending manufacturing capacity into Africa meant that this number had increased to 145 million. A sustained, driven focus on high coverage with effective anti-malarial intervention contributed greatly to the 1.1 million lives that have been saved and a one-third decline in African malaria mortality rates that had been recorded since 2000.

“It is unacceptable that every day more than 1,500 children still die from a preventable and curable disease,” said Nicholas Alipui, UNICEF’s Director of Programmes. “We must distribute insecticide-treated nets to all who need them, provide timely testing for children and appropriate medicine when they are infected.”
A three-day treatment will cure malaria infections, especially if an episode is diagnosed early enough and treated appropriately – in particular with artemisinin-based combination therapies (ACTs). But many children, especially in Africa, still die from malaria as they do not sleep under insecticide-treated bed nets and are unable to access life-saving treatment within 24 hours of the onset of symptoms.UNICEF supports national efforts to train and provide community health workers with simple tools such as malaria rapid diagnostic tests so that children receive medicine quickly when needed. However, in Africa the proportion of treated children who receive a first-line treatment such as an ACT is less than 30 percent in most countries.
UNICEF, with governments, donors and other partners, also looks for innovative ways to reach the most vulnerable and hardest to reach children in pursuit of universal coverage. For example, in addition to free net distributions during mass campaigns in the poorest and most remote areas, nets are also provided to children during routine immunizations and to pregnant women during ante-natal check-ups. UNICEF is also stepping up its efforts on integrated community case management, which brings a package of life-saving interventions closer to children, families and homes.

It is estimated that enough nets were delivered over the last decade to cover 80 per cent of requirements in Sub-Saharan Africa. Many nets however are reaching the end of their useful life and must be replaced. Countries that had already reduced their malaria burdens by up to 50 per cent can quickly detect increased cases and deaths due to malaria if old, worn-out nets are not replaced. From 2000 to 2010, the proportion of children sleeping under an insecticide-treated net in sub-Saharan Africa grew from less than 5 per cent to over a third. But global procurement of long-lasting lasting insecticidal nets has dropped by 52 per cent against an annual target requirement of 150 million. Such a slowdown risks gravely undermining the gains to date.

“We have made considerable progress in this fight, but cannot take our eyes off the goal of reducing malaria cases and deaths to zero. We must make sure that countries have the funding they need for malaria control and use it to protect their children and expectant mothers,” Mr. Alipui added.

Fighting malaria not only saves the lives of children, but also yields many other health and economic benefits for affected communities. For example, reducing malaria improves the health of pregnant mothers and therefore their newborn babies, reduces school and work absenteeism. Eliminating malaria reduces the burden on over-stretched health centres. It is estimated there is a 40-fold return for every US$1 spent controlling malaria in Africa.There have been impressive gains and successes built on strong partnerships and the generous contributions of many donors – but these gains can be quickly lost if sustained focus and investments are not maintained.

This story was published in Daily Newswatch on April 27, 2013

Drug cloning: Nafdac smashes syndicate in Lagos

By: Chioma Umeha

A syndicate which specialises in cloning several fast moving drug products including locally manufactured anti-malaria and pain-relieving medicines has been smashed in Lagos, by the National Agency for Food and Drug Administration and Control (NAFDAC). The syndicate is said to have perfected its cloning act in China and thereafter imports the cloned drugs into the country.

A member of the syndicate, Mr. Maduabuchi Abuzu, who owns a shop at 21 Ashogbon street, Idumota, Lagos, and has been under NAFDAC’s watch list of fake drug importers since two years, has been arrested, while the agency has began investigations to unravel his China- based partners.
According to sources close to NAFDAC, the agency is determined to take advantage of its collaboration with Chinese government in the fight against fake drugs to ensure that when investigation is concluded in the country and it establishes the culpability of its citizens in the shoddy business, that they will be punished according to their drug counterfeiting laws.
Paul Ohii  NAFDAC DG

Confirming the arrest of the syndicate, the Director of  Enforcement in NAFDAC, Mr. Garba Macdonald in a chat with journalists, in his office in Apapa, Lagos, hinted that Mr. Abuzu was arrested in his house at N0.9 Alhaja Hassana Street, Orile Iganmu with various fake drug products worth over N20 million.
According to Macdonald, “The arrest of Maduabuchi was a major breakthrough in the fight to stem the activities of the syndicate who had in the last two years brought into the country fake drugs with his partners in China”.

He revealed that the suspect had already confessed to have imported the drugs from China through his contacts there and that through intelligence gathering, it was established that the suspect used his house as a warehouse where the cloned drugs were stored. Some of the drugs discovered in his possession at the time of arrest include; Coartem tablets, Amalar tablets, some unlabelled tablets, Maloxine tablets, Ibuprofen tablets, packaging materials, leaflets and  hand sealing machines, among others.

Meanwhile, Maduabuchi is currently assisting the Agency in its investigation to get to the root of the matter just as the fake drugs had been evacuated from his house, sampled against him for laboratory analysis.
The Director who reiterated the agency’s determination to rid the country of fake and unwholesome drugs, called on all Nigerians to report any suspicious activity relating to NAFDAC regulated products around their community for immediate action.

An official of one of the companies whose products were faked who spoke in anonymity lauded NAFDAC for the arrest, which he said, will send a strong signal to the likes of Maduabuchi still at large.
He however decried the activities of the syndicate, saying they were capable of putting government’s initiative of encouraging local production of essentials drugs into jeopardy.

This story was published in Daily Newswatch on April 13, 2013
Cerebral palsy is neither a disease nor contagious - Gbadebo

By: Chioma Umeha

There is more awareness concerning cerebral palsy and its associated problems today.

Yes, since the past few decades, information on the many facets of cerebral palsy has significantly increased. Today, the medical community has great interest in studying cerebral palsy to determine its causes and the most effective ways to treat it. As knowledge and treatment techniques have expanded and improved, so too have the prospects of all children living with cerebral palsy. There are several misconceptions concerning cerebral palsy. Many are unaware that it is not a disease or illness.

Cerebral Palsy is a term used to describe a group of chronic conditions affecting body movements and muscle coordination. !t is caused by damage to one or more specific areas of the brain, usually occurring during foetal development, or during infancy. It can also occur before, during or shortly after birth.
“Cerebral” refers to the brain and “Palsy” to a disorder of movement or posture. If someone has cerebral palsy it means that because of an injury to their brain (cerebral) they are not able to use some of the muscles in their body in the normal way (palsy). This explains why children with cerebral palsy may not be able to walk, talk, eat or play in the same ways as most other children.

Cerebral palsy is neither progressive nor communicable. It is also not “curable” in the accepted sense, although education, therapy and applied technology can help persons with cerebral palsy lead productive lives. It is important to know that cerebral palsy is not a disease or illness. It isn’t contagious and it doesn’t get worse. Children who have cerebral palsy will have it all their lives.

 Many confuse the disorder with diseases?
Cerebral palsy is a broad term which encompasses many different disorders of movement and posture.
To describe particular types of movement disorders covered by the term, paediatricians, neurologists, and therapists use several classification systems and many labels. To understand the different types of cerebral palsy, one must first understand what experts mean by muscle tone. All children with cerebral palsy have damage to the area of the brain that controls muscle tone. As a result, they may have increased muscle tone, reduced muscle tone, or a combination of the two (fluctuating tone). Consequently, the parts of their bodies are affected by the abnormal muscle tone depends upon where the brain damage occurs.

The three main types of cerebral palsy are: Spastic cerebral palsy – (stiff and difficult movement); athetoid cerebral palsy – (involuntary and uncontrolled movement) and ataxic cerebral palsy – (disturbed sense of balance and depth perception). It is possible that there may be a combination of these types for any one person. In which case the condition would be described as; mixed cerebral palsy.

Give statistics of its occurrence?
Because cerebral palsy influences the way children develop, it is known as a developmental disability. In the United States today, more people have cerebral palsy than any other developmental disability, including Down syndrome, epilepsy, and autism. About two children out of every thousand born have some type of cerebral palsy. Studies have shown that at least 5000 infants and toddlers and 1,200 -1,500 pre-schoolers are diagnosed with cerebral palsy each year.

In all, approximately 500,000 people in the United States have some degree of cerebral palsy. There is still no system in place to monitoring cerebral palsy’s occurrence. However, studies have shown that the use of the electronic foetal heart rate monitor during labour and delivery has not decreased the rate of cerebral palsy primarily because of the mistakes made by doctors and nurses during the birthing process. Though children with very mild cerebral palsy occasionally recover by the time they are school-aged, cerebral palsy is usually a lifelong disability. In most cases, the movement and other problems associated with cerebral palsy affect what a child is able to learn and do to varying degrees throughout their life.

Population-based studies from across the world shows prevalence estimates of CP ranging from 1.5 to more than 4 per 1,000 live births or children of a defined age range. Available records estimate that out of every 1000 births in Lagos, there are 60 with developmental delays which a good number of them are later diagnosed with cerebral palsy (CP) in the country. However, statistics shows that seven out of 10 children are referred to Lagos University Teaching Hospital (LUTH) for neurological developmental assessments have cerebral palsy.
Diagnosis of cerebral palsy
When an infant or child has brain damage, a variety of symptoms can lead doctors and parents to suspect that something is wrong. In the first few months of life, an infant with brain damage may demonstrate some or all of the following symptoms: Lethargy or lack of alertness; irritability or fussiness; abnormal, high-pitched cry; trembling of the arms and legs; poor feeding abilities secondary to problems of sucking and swallowing as well as low muscle tone. The rest are; abnormal posture, such as the child favouring one side of their body; seizures, staring spells, eye fluttering, body twitching and abnormal reflexes. During the first six months of life, other signs of brain injury may also appear in an infant’s muscle tone and posture. These signs include: Gradual change in muscle tone from low tone to high tone; a baby may go from floppy to very stiff; the child may hold his hand in tight fists; there may be asymmetries of movement, that is, one side of the body may move more easily and freely than the other side or the infant may feed poorly, with their tongue forcefully pushing food out of their mouth. Once a baby with brain damage reaches six months, it usually becomes quite apparent that he is picking up movement skills slower than normal. Infants with cerebral palsy are more often slow to reach certain developmental milestones, such as rolling over, sitting up, crawling, walking and talking. Parents are more likely to notice these developmental delays and abnormal behaviours, especially if this is not their first child. Sometimes when they express their concerns to their physicians, their child is immediately diagnosed as having cerebral palsy. More often, however, medical experts hesitate to use the term “cerebral palsy”at first. Instead, they may use such broader terms as: Developmental delay, which means that a child is slower than normal to develop movement skills such as rolling over and sitting up.

It can also be described neuromotor dysfunction, or delay in the maturation of the nervous system.
Some term it motor disability, indicating a long term movement problem, while others say it is a central nervous system dysfunction, which is a general term to indicate the brain’s improper functioning. Some experts describe it as static encephalopathy, meaning abnormal brain function that is not getting worse. What this all means is that a cerebral palsy diagnosis is not made over night. Rather, the condition is diagnosed by a complete examination of your child’s current health status. Doctors will test motor skills and look carefully at his or her medical history. They will also look for slow development, abnormal muscle tone, and unusual posture. When diagnosing CP, doctors must rule out other disorders that can cause abnormal movements. Cerebral palsy does not get worse, in other words, it is not progressive. Based on this fact, doctors must make the determination that your child’s condition is not progressively getting worse. Doctors will also use a number of different specialized tests in diagnosing cerebral palsy. For example, the doctor may order a CT (computed tomography). This is an imaging of the brain that can determine underdeveloped areas of brain tissue. Your doctor may also order an MRI (magnetic resonance imaging). This test also generates a picture of the brain to determine areas that may be damaged. In addition to these imaging tests, intelligence testing is also used. This helps to determine if a child is behind from a mental standpoint. In addition to diagnosing cerebral palsy through a complete and thorough examination of the child’s abnormalities and behaviours, a review of the mother’s pregnancy, labour and delivery and care received is also conducted.

How can early intervention help to ameliorate the condition of those living with cerebral palsy?
Children are our most valuable asset so everything we do to nurture their healthy development is an investment in our future. Due to complications at birth, involving mainly pre-term babies, and because they were born with, exhibit, or are at high risk for developmental delays or disabilities, some children under the age of three need extra attention. For such children, experience has shown that the earlier experts work with them, the more successful they are likely to be in minimizing or, in some cases, totally eliminating future concerns. For those who know the signs, children as young as 10 weeks can easily be identified as having developmental delays. Thereafter, occupational therapists working with other experts can work to determine the nature of the delay and possible implications for the future of the child. Once properly diagnosed, it would then be up to special education teachers to nurture the child and steer him towards maximizing the unique talents which such special children always have. The end result of such a process will be more gifted children and very few unskilled handicapped adults in our society. This is why Benola is committed to Early Intervention as a tool to aid the prevention or reduction of the later effects of developmental delays in children through the provision of support, education and access to resources for affected families.

Many used to confuse developmental disabilities with psychological disorder and as a form of disease. Explain?
Development disabilities can be defined as chronic conditions which develop when the brain of a child is still forming. Developmental disabilities may occur during pregnancy or early childhood or they may occur anytime till a person attains the age of 22. They are birth defects which may hamper the proper functioning of a body part or a body system. Most of the developmental disabilities cannot be medically treated; however with therapy their symptoms can definitely be controlled.

Nervous system disabilities
As the name suggests, nervous system disabilities affect the functioning of the nervous system, spinal cord as well as the brain. A child with nervous system disabilities is most likely to suffer from speech disorders, behavioural disorders, movement disorders and may experience convulsions. His learning, understanding and intelligence, might all be affected due to nervous system disabilities.

Attention deficit hyperactivity disorder (ADHD)
Attention deficit hyperactivity disorder can be identified in children by their inability to concentrate, being forgetful and feeling hyperactive all the time. There are a number of ADHD causes such as changes or malfunctioning of certain brain structures, parents suffering from hypertension or a psychiatric disturbance, chemical poisoning, alcoholism, smoking or drug abuse by the woman when she is pregnant and lastly, exposure of the child to certain environmental toxins like lead, polychlorinated biphenyls, etc.

Another example of nervous system disabilities is autism. Various behavioural and speech disorders may be caused in a child due to autism. Although exact cause of autism is not known, still some researchers are of the opinion that it may be caused due to certain genetic, environmental and neural development factors. Differences in the brain chemicals, known as neurotransmitters are the main cause behind autism. Environmental factors such as exposure to certain chemicals, exposure to drugs, eating certain kind of foods can exacerbate this condition.

Cerebral palsy
Most cases of cerebral palsy develop even before the child is born. Very rarely does it occur during childbirth, although if the baby is premature or is under weight and suffers from intraventricular haemorrhages, it can lead to development of this condition in him. But mostly this condition develops when the brain development of the unborn child is affected when the mother is alcoholic, smokes, takes drugs, is malnourished, is exposed to certain chemicals or suffers any mental of physical trauma when she is pregnant. Some other reasons for a child to develop cerebral palsy are any injury to the brain due to accident, asphyxia, bacterial infections such as encephalitis or exposure to certain chemicals and allergies.

Down syndrome
Down syndrome is a chromosomal disorder caused due to an extra 21st chromosome, resulting in mental retardation as well as malformation in a newly born child.

Congenital rubella syndrome
Congenital rubella syndrome is caused when the rubella virus negatively affects the fetus, mostly during the first trimester of pregnancy. A child who has congenital rubella might be deaf and may even have cataracts in the eye.

Most of these conditions of developmental disabilities have no permanent cure. However, by certain therapies and special education classes, children or people suffering from them can lead better lives. Children suffering from the conditions can go in for speech therapy, physical therapy, occupational therapy and behavioural therapy. A combination of these therapies will help in reducing learning, emotional, social, language and physical problems that a child might be suffering from.

What are the developmental milestones for a normal baby?
Most babies at 10 Weeks, startle to sound, hold up their heads and look at objects. At six months, they reach for objects, turn their heads towards sounds, roll over and are able to hold toys. At nine, they continue to babble, sit alone and can imitate actions. They take their first steps, respond to their own name and play with a variety of toys at one; they walk alone, can build a tower of three blocks, use up to 20 words and enjoy interacting with care-givers at 18 months. When they are two, babies begin to use two-word phrases to communicate, walk up and down the stairs and are able to eat and drink independently. However, if you have any concerns about the development of your child, you should see a doctor at the earliest opportunity, who will direct you to an appropriate specialist.

What are the United Nations (UN) standard rules on the equalization of opportunities for persons with disabilities?
The 58th World Health Assembly resolution on disability, including prevention, management and rehabilitation requests the World Health Organization (WHO) Director – General to provide support to member states in strengthening implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities. WHO supports in particular the implementation of the United Nations Standard Rules and promotes their use for the development of national policies related to disability and rehabilitation. For instance Rule 1 is titled: Awareness-raising, says; “states should take action to raise awareness in society about people with disabilities, their rights, their needs, their potential and their contribution.

What is assistive technology?
Assistive Technology is a generic term for devices and modifications (for persons or within a society) that help overcome or remove a disability. The term is also used to describe any device, software or resource that can increase skills and maximize an individual’s potential due to any of the following: economic limitations, language barrier, cultural differences, educational barriers and the disability itself. Often, there are technologies available that can help increase the opportunities of individuals with developmental disabilities and enhance the quality of their life and families. However, adults and families with children who have special needs, especially those living in developing countries, including Nigeria, often have difficulty accessing conventional resources.

This story was published in Daily Newswatch on April 25, 2013.

First Global Vaccine Summit began yesterday

By: Chioma Umeha

Despite tremendous international progress, one child still dies every 20 seconds from preventable diseases like pneumonia, rotavirus, measles, and meningitis, according to a United Nations study. Hundreds of international health experts and government officials therefore convened in the UAE capital yesterday, at the first Global Vaccine Summit to discuss pressing issues in the prevention and eradication of infectious diseases.

This edition of the summit is expected to place special emphasis on polio eradication. “At present, 99 per cent of all countries have eradicated the disease within their borders. However, polio is still endemic in Pakistan, Afghanistan and northern Nigeria,” James Whittington, spokesperson for the renowned philanthropic organisation Bill & Melinda Gates Foundation, told Gulf News ahead of the summit.
Toddler getting vaccine

While fewer new cases of polio have been reported in the first half of 2013 compared to 2012, there is still a lot to be done towards eradication. “Nearly $5.5 billion (Dh20.2 billion) needs to be raised to provide vaccines and protection for the people still at risk. However, if the polio virus is eliminated, the economic benefits that accrue will be much larger. In fact, it could save up to $40 billion (Dh147 billion) worldwide in funds that are now being used to provide protection and monitor the spread of the virus,” Whittington said. A six-year comprehensive plan is expected to be launched at the summit to raise the required funds and initiate international efforts.

The summit coincides with World Immunisation Week celebrations, and will also discuss topics such as universal access to vaccines for children and innovations in vaccine delivery.

 “The Global Vaccine Summit is an historic gathering of global leaders and innovators whose collaboration can have a significant and positive impact on ensuring a healthy global society,” said General Shaikh Mohammad Bin Zayed Al Nahyan, Abu Dhabi Crown Prince and Deputy Supreme Commander of the UAE Armed Forces.
The event is being held in partnership with General Shaikh Mohammad, United Nations Secretary General Ban Ki-moon, and Bill Gates, co-chair of the Bill & Melinda Gates Foundation. Gates will also deliver a keynote address.

This story was published in Daily Newswatch on April 25, 2013.

Blog Archive