Saturday, 20 December 2014

De-worming: Amosun’s wife counsels school children


To achieve the Millennium Development Goals (MDGs) targeted at increasing the rate of children’s survival, the Wife of the Governor of Ogun State, Mrs. Olufunso Amosun has appealed to children to wash their hands and body regularly to prevent infectious diseases caused by germs. 

She advised the students to always maintain a clean environment by avoiding unhygienic places; washing of their hands with soap and clean water after using the toilet, and before preparing food or eating and among others. Speaking during the 2013 De-worming Exercise organised by the wife of the governor in collaboration with Emzor Group for school children in Ogun State held at Obafemi/Owode Town Hall in Obafemi/Owode Local Government area of the state, Mrs. Amosun urged children to always avoid all forms of habits that could affect their health. 

Photo: Wife of the Governor of Ogun State, Mrs. Olufunso Amosun, demonstrating to the school children how to be hygienic by washing one’s hands regularly during the 2013 De-worming Exercise for public schools in the State at Obafemi/Owode Town Hall in Ogun State
She explained the de-worming exercise was embarked upon to rid school age children of intestinal worms which could cause mental and physical retardation, poor health and low blood levels, saying, the state government was committed to implementing a sustainable health care programme for the people, particularly children who are the future leaders. Mrs. Amosun added the programme was to reach school aged children across the state particularly in areas where children are more pre-disposed to worms, urging children to avoid sucking and biting their fingernails as well as putting dirty objects in their mouth as such things could have been contaminated. 

According to her, “Our children are the future of leaders and it is important that we secure their lives by safeguarding their right to quality health care. So, we have laid down plans in conjunction with Emzor Group to conduct an extensive de-worming exercise across the state. Our desire is to lay a solid foundation for children by de-worming them periodically to enhance their health and well-being.” Also speaking at the event, the Group Managing Director of Emzor Group, Dr. (Mrs.) Stella Okoli said “worms are enemies not just to children but the whole family,” adding that “worms are very often referred to as enemies within.” “Most of these worms live in the intestinal tract where they compete with you for food, causing malnutrition and other health problems. 

Children are obviously at greater risk in terms of morbidity associated with heavy worm burden. Over 30,000 de-worming kits have been donated to public schools in Ogun State for the 2013 De-worming Exercise,” she said. Over 500 school children drawn from across the state were present at the occasion. The highlight of the programme was the symbolic administration of the de-worming drugs on the school children by the wife of the governor, Emzor Group, officials from the state Ministries of Health and Education and among others.

This story was published in Newswatch Times on November 14,  2013.
Full term pregnancy redefined: Premature babies have higher rates of diseases – Study

By: Chioma Umeha

A new study has redefined full-term pregnancy and moved it to 39 and 41 weeks, just as the researchers noted that babies born in the early term have higher rates of respiratory, blood sugar and infection issues.
Doctors used to define 37 to 42 weeks as the time span of a full-term pregnancy. However, an online report Monday, said that a U.S. OB/GYN group has divided that range into different classifications after learning about critical differences in the final weeks of gestation.

According to the American College of Obstetricians and Gynecologists, the last few weeks of pregnancy have been divided into the following new groups: 37 to 39 weeks – ‘Early term’ ; 39 to 41 weeks – ‘Full term’ ; 41 to 42 weeks – ‘Late term’ and 42 weeks or more – ‘Post term.’

Premature Babies
“These new categories make sense because of research supporting the differences in infants at these various stages. Babies born in the early term have higher rates of respiratory, blood sugar and infection issues,” the report said. Infants born after the ‘early term’ period have been reported to have fewer problems with breathing, hearing and learning.

Why women may postpone an elective c-section
According to The American College of Obstetricians and Gynecologists, a baby’s lungs, brain and liver are among the last organs to fully develop. During weeks 35 to 39 of pregnancy, the baby’s brain grows by about one-third. Also, layers of fat develop under the baby’s skin to keep the infant warm after birth.

A major importance of the new terminology is to inform women of the differences between the stages, which could make mothers-to-be to reconsider induced labour after week 37 because they think it has been a full-term pregnancy.

It is also important for doctors to use this information to easily communicate the risks of giving birth before week 37 when it is not medically necessary. The importance of changing the wording is to give doctors a way to externally validate the differences in time ranges to women. As doctors, we’re sympathetic when it comes to women in the late stages of pregnancy, and women usually think there are no benefits to put off the birth after week 37, resulting in induced labour or c-sections.

These new, more precise definitions of pregnancy are now the standard of care, it’s important for physician groups to spread the word to their patients.

This story was published in Newswatch Times on November 14,  2013.
Grassroots advocacy, key to end world’s toilet problem – UNICEF


Toilets are still out of reach for more than one-third of the global population, with devastating consequences to the health and development of children, UNICEF said on Tuesday, during the World Toilet Day. However, the key to bridging the gap lies within communities themselves, the organization emphasized. Since 1990 almost 1.9 billion people gained access to improved sanitation, but in 2011 the total without access was still 36 per cent of the global population, or approximately 2.5 billion people. 

“Access to toilets remains the unmentionable, shameful secret for even some very prosperous countries,” said Sanjay Wijesekera, the global head of UNICEF’s Water, Sanitation and Hygiene (WASH) programmes. “But its invisibility doesn’t make it harmless; in fact it is quite the reverse. Lack of access to toilets is quite literally killing children, making adults sick, and slowing progress – day after day after day.” Toilets are still out of reach for more than one-third of the global population, with devastating consequences to the health and development of children. In Nigeria, over 100 million people do not have access to improved toilet facilities out of which over 45 million defecate in the open. Lack of toilets pose a great danger to public health and general well-being as evidenced during the recent cholera outbreak in several parts of the country. However, the key to bridging the gap lies within communities themselves. Since 1990 almost 1.9 billion people gained access to improved sanitation globally, of which Nigeria accounted for approximately 13 million. In 2011 the total number of people without access stood at approximately 2.5 billion people. 

According to figures released by UNICEF earlier this year, lack of access to safe water, sanitation and hygiene is a leading cause of deaths from diarrhoea in children under five, amounting to approximately 1,600 children dying each day globally. In Nigeria, about 194,000 children under five years die annually due to diarrhoea and in addition, respiratory infections kill another 240,000. Recent report from Federal Ministry of Health revealed that 2,771 cases of cholera with 124 deaths have been recorded in many parts of the country so far. All these are largely preventable with improvements in water, sanitation and hygiene. UNICEF’s has spearheaded a social change movement that that has led more than 25 million people to end the practice of open defecation and now use toilets. The Community Approaches to Total Sanitation (CATS) programme, encourages communities to take the lead and identify their own measures to end open defecation, and has been achieving results at scale. 

At the last count, over 50 countries have implemented CATS and many governments have mainstreamed a similar approach into their national policy. But despite this success, Wijesekera said more still needs to be done, and urgently, by countries, communities and individuals, principally to bring the taboo subject of toilets and open defecation from the shadows, discuss it frankly, and agree on tackling the problem. The CATS approach works precisely because it depends on people taking their own decisions, and coming up with their own solutions. As more governments and communities apply the method to eliminate open defecation and scale up access to toilets, many more people stand to benefit, especially from a reduction in WASH related diseases. Also, through its on-going global “No access” campaign at its website, UNICEF is promoting major pushes around the world on World Toilet Day, to bring awareness to the dangers of open defecation and the problem of lack of access to improved sanitation. In India, where in 2011 approximately 65 per cent of the population did not have access to improved sanitation, and over 620 million people defecated in the open. 

This even as  UNICEF India is rolling out Poo2loo, an on-line campaign addressing the issue of open defecation in the country. In Mali, on World Toilet Day, UNICEF is launching a Sanitation Marketing Project in partnership with PSI-Mali and the National Directorate of Sanitation. In Eritrea, there will be celebrations of certifications of Open Defecation Free communities throughout the country. “Every action which spurs people to change their way of dealing with defecation brings us closer towards the goal of sanitation for all,” said Wijesekera. “It is not easy, but it is certainly doable, and moreover, it is absolutely indispensable if we are expecting to live healthy lives in the 21st century.” World Toilet Day, long observed on November 19 was made an official United Nations Day by a UN General Assembly resolution in 2013. 

The Millennium Development Goal (MDG) target is to reduce the proportion of the global population without access to improved sanitation, from 51 per cent in 1990 to 25 per cent by 2015. Although since 1990 almost 1.9 billion people gained access to improved sanitation, in 2011 the total with access was still only 64 per cent of the global population. Improved sanitation refers to sanitation facilities that hygienically separate human excreta from human contact. Improved sanitation facilities include those with sewer connections, septic system connections, pour-flush latrines, ventilated improved pit latrines and pit latrines with a slab or covered pit.

This story was published in Newswatch Times on November 21,  2013.
Experts brainstorm on health dangers, management of climate change


Researchers who just concluded a brainstorming session weekend, lamented inadequate funding as a major limitation to research findings that will help to manage the effects of climate change to human health The researchers, who met during the 4th edition of annual scientific conference of the National Institute of Medical Research (NIMR), Yaba, Lagos, noted that climate change effects are obvious today in the environment, but for inadequate researches on them. 

Opening the conference, Director General of the Institute, Prof Innocent Ujah observed that the theme of this year’s annual conference: ‘Impact of Climate Change on Health: Identifying the Research Gaps,’ is timely. According to him, the confab could not have come at a better time, given the recent series of calamities resulting from the effect of climate change on man and the environment in particular, and the ominous predictions of such occurrences for the future. The recent sad occurrence in the Philippines on Friday, November 8, 2013, the super typhoon Haiyan, which according to reports has claimed over 10,000 lives, destroyed homes and communication facilities, is sad reminder of some of the effects of climate change. 

Cross-section of participants at the 4th edition of Annual Scientific
Conference of the National Institute of Medical Research (NIMR),
Yaba, Lagos, last weekend. 
Prof Ujah said that the recent fire incident in Australia, the numerous Tsunamis, hurricanes, typhoons, tornados in the U.S, radioactive / chemical discharges from the nuclear plant turbines in Japan, and the tropical cyclones are also some of the effects of global warming on the environment and health. Also, in Nigeria, reports indicate that in the last week, some 22 school children with some of their teachers could have died from inhaling fumes of chemicals released from a nearby company but for prompt and effective emergency health intervention, he said. He lamented the dangerous consequences of climate change, noting that it has become an issue of global concern. His words: “Climate change endangers human health, affecting all sectors of society, both domestically and globally.” Prof. Ujah listed the environmental consequences to include; sea-level rise, changes in precipitation resulting in flooding and drought, heat waves, more intense hurricanes and storms, and degraded air quality. 

He insisted that these affect human health both directly and indirectly. The DG further noted that the influence of climate change on nutrition include: ‘Increased malnutrition and related disorders, diarrhoea; water borne and watershed diseases, outbreaks of malaria as a result of increase in number and spread of vector-borne diseases due to higher temperatures; and disasters resulting from floods as witnessed in about 23 states in Nigeria in 2012.’ He said; “the evidence on climate change shows that changes in global average temperatures, rainfall patterns, widespread melting of snow and ice, and rising sea levels all affect human livelihood through changes in water quality and supply, food production, ecosystem resources and changes in human settlements and health.” According to him, climate change can be caused by human factor through the release of green house gases into the atmosphere, adding that the countries that are mostly affected are the developed ones and the fast growing economies of China, India and Brazil. He said: “Climate change, in addition to natural events, also has the human component through accumulated releases of green house gases into the atmosphere with the major emitters being the developed countries and the fast growing economies of China, India and Brazil.” 

Giving the breakdown, Prof. Ujah said that Africa contributes 2.5 per cent of the global cumulative carbon dioxide (CO 2) emission from fossil fuel, insisting that the major emitters are the fasting growing economies and developed countries. This is even as he added that the major green house gases are CO2, mostly from fossil fuel and land use change, methane and nitrous oxide. He also said that the United Nations Framework Convention on Climate Change (UNFCCC) which approved the Kyoto protocol to help reduce the greenhouse gas emissions has the ultimate objective of stabilizing greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system. Health impacts of extreme weather events hinge on the vulnerabilities and recovery capacities of the natural environment and the local population, the DG said, adding; “Changes in prevalence and spread of infectious diseases are some of the most widely cited potential effects of climate change which could have significant consequences for human health as well as economic and societal impacts.” He bemoaned the effects of climate change in Africa, saying that the continent is one of those with the highest risk. “Africa is one of the most vulnerable continents to climate change, with its situation further worsened by poverty, poor economic development and low adaptive capacity,” Ujah said. 

He also noted that the framework for public health adaption to climate change is to provide scientific and coordinated response to climate change adaptation needs of countries, especially in the Africa region that is saddled with burden of poverty and frequent famines that have exacerbated its ability to adapt and prevent the effects of climate change. Regrettably however, such evidence is scanty and especially deficient in understanding of the potential impacts of climate change on the health of the continent, he said. The DG lamented that recurrent food shortage in the horn of Africa has resulted in malnutrition as a result of formers’ inability to cope with increasingly unpredictable weather due to their over-dependence on rain-fed agriculture. The rest he said are; environmental variations causing health-related complications include change in diet and lifestyles which have been shown to have led to rise in incidence of cancer, diabetes and cardiovascular diseases even among rural communities. He, therefore, said that the conference was used as a platform to brainstorm on the strategies to bridge health research gaps in view of the few recognized and little regional research in the African region. 

Also, the deliberations of the conference is helpful in reviewing poor and unreliable data and inadequate disease surveillance and poor health data which should include the generation of local knowledge on climate change and human health that cuts across geographical regions building codes, warning systems, disasters policies, evacuation plans and relief efforts, Ujah said. Other benefits, he said are effective coordination of the various government agencies and NGOs involved in the planning and response to natural disasters. According to him, the Interagency Working Group on Climate Change and Health (IWGCCH) recommendation on relevant research needs include research on mitigation and adaptation strategies, insisting that this requires basic and applied science, and covers technological innovations and capacities, public health infrastructure, communication and education. Ujah, also advocated that these should be clearly stated in national health research agenda, noting that the use of scientific research results for applications and decision making should be adopted. He also said that an enabling environment must be created for researchers to be able to design research protocols, adding that the institute’s E-Library under construction will certainly provide the appropriate learning and research environment for improved health research productivity. 

Chairman, NIMR Governing Board, Handel Okoli lamented that there is a gap in funding health research in the country that will help in managing the effects of climate change. Okoli noted that climate change is an emerging risk factor for human health challenges, adding that its health implications of are yet to be fully documented in Nigeria. The Chairman further said that the essence of the conference is to strategise and come up with ideas that will enable the country to be prepared to manage the health implications climate changes. He said Nigeria needs to be properly positioned to cope with the health challenges associated with global warming, adding that the researchers have a lot of role to play in the process. “As health, social and environmental scientists you are expected to provide the nation with creative ideas that will help to strategize on how the Nation should prepare and cope with the health implications of climate change,” Okoli said. He insisted that the nation is not paying adequate attention to the need for properly funded health research policy in the country. His words: “This fourth edition of the scientific conference of NIMR with the theme: Effect of climate change on health; identifying the research gaps, is quite timely considering the significant climatic changes in the world and their effects on our health. As a nation, we are yet to pay adequate attention to the need for a robust and well funded Health research policy in Nigeria.” 

In view of this, he said that the governing board of NIMR have adopted a plan of action which is aimed at strengthening the capacity of the institute in critical areas of its mandate. According to him, the plan includes; strengthening NIMR’s financial resource base to reduce dependence on statutory allocation, expanding its research areas through the provision of the necessary physical infrastructure and opening up the institute to the entire health sector with a view to maintaining its status as the premier research institute in Nigeria. Others are; exploiting government policy on public private partnership, attracting local funding in order to complement the efforts of international partners and donor agencies and the review of the enabling law establishing the institute. 

This story was published in Newswatch Times on November 21,  2013.
NAFDAC labs get International Accreditation


The National Agency for Food and Drug Administration and Control (NAFDAC) has recorded another major breakthrough in her regulatory activity with the international accreditation of her two major laboratories. 

A statement yesterday, signed by Alhaji Abubakar Jimoh, Director, Special Duties, NAFDAC, confirmed that the Mycotoxin and Pesticides Residues Laboratories located at Oshodi in Lagos have just obtained the ISO 17025 accreditation conducted by the American Association of Laboratory Accreditation. The statement also said that the accreditation project which was sponsored by United Nations Industrial Development (UNIDO) has launched the two laboratories into the league of internationally recognized and respected laboratories. 

Dr. Paul Orhii - DG, NAFDAC
The statement further said that the Director-General of NAFDAC, Dr. Paul Orhii dropped the hint about the accreditation project, saying; with the ISO 17025 accreditation of the two laboratories, value-added agricultural exports tested and certified by the Agency will now be accepted worldwide without query. Dr. Orhii also said this is a major boost to the country’s image and agricultural transformation agenda of the Federal Government. He explained that all products analyzed for export purpose by the two laboratories will now carry a special logo making the commodities accepted all over the world. 

The Director-General said some other laboratories of the Agency are also undergoing international accreditation which would greatly boost current efforts to get some pharmaceutical companies to obtain World Health Organization (WHO) Pre-qualification. Dr. Orhii thanks UNIDO and the American Association of Laboratory Accreditation for the support and cooperation accorded NAFDAC in attaining this great feat.

This story was published in Newswatch Times on November 21,  2013.

Monday, 15 December 2014

Only 23.9% Pregnant Women Access ARV In Nigeria

By: Chioma Umeha

Thirteen years after Nigeria launched the prevention of mother-to-child HIV transmission (PMTCT) the country has only attained 23.9 per cent coverage in Antiretroviral (ARV) treatment or prophylaxis among HIV positive pregnant women, while 40.64 per cent of them have been counselled, tested and received their results.

This is even as experts have warned that unless the country leverage on current international focus on her and the readiness to assist her in scaling up PMTCT services it may not meet its target of eliminating Mother-to-child transmission (MTCT) by 2015. They noted that the persisting high burden of HIV infected pregnant women and MTCT in the country is an indication of the need to urgently scale-up the PMTCT program and make the services accessible to all women especially those in the rural areas.

In 2009, the country developed a five-year national scale up plan towards elimination of MTCT of HIV which span from 2010 to 2015. It adopted a combination of World Health Organisation (WHO) 2010 Guidelines Option A and Option B regimens for prophylaxis. Adult HIV prevalence (ages between 15 and 49) in country, estimated at 3.6 per cent in 2009, appears to have stabilized over the past five years. HIV prevalence among pregnant women, 3.6 per cent, is comparable to the general adult population. Maternal mortality was still very high in Nigeria (630/100,000 live births) in 2010 and it is estimated that 230,000 pregnant women and 360,000 children were living with HIV in 2010.

PMTCT programme coverage was very limited as only 4.7 per cent of ANC facilities in Nigeria offer the services. Although HIV testing among pregnant women increased from one per cent in 2005 to 14 per cent in 2010, it was also considered very low. Worse still, only 18 per cent of pregnant women living with HIV (PWLHIV) received more effective ARVs for PMTCT 2011. Also, only 11 per cent of children born to PWLHIV received ARVS for PMTCT, and only four per cent of infants born to PWLHIV were tested for HIV within two months of birth in 2010. Furthermore, only 40,465 (23.9 per cent) assessed ARV for prophylaxis, while the target was 169,484 in 2012. In addition, only 1,679, 988 (40.64 per cent) were counselled and tested and received their results, while the target was 4,133,752 the same year.

Perhaps more worrisome is the latest report by the United Nations which showed that Nigeria has the highest number of children contracting the Human Immunodeficiency Virus, HIV, in the world. The report says nearly 60,000 Nigerian children were infected with the virus in 2012, a figure higher than that of any other country in the world, and is a source of worry for experts with one describing it as “alarming.” The report titled “2013 Progress Report On The Global Plan: Towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive” is the most recent on the global plan which seeks an elimination of new HIV infections among children by 2015, as well as keep their mothers alive. The programme was launched in July 2011 at the UN General Assembly High-Level Meeting on AIDS (acquired immune deficiency syndrome).

Experts have therefore cautioned that the failure of the nation to attain 50 per cent target in the PMTCT  global plan makes it share 32 per cent global burden in PMTCT and may tarnish the much celebrated success in the reduction HIV infection from 4.6 per cent in 2008 to 4.1 per cent. Recent reports confirmed that nation recorded PMTCT of HIV of less than 25 percent between 2011 and 2012. There are fears that this trend may also scuttle efforts to reduce HIV incidence among 15 to 49-year-old women by 2015 by at least 50 per cent unless urgent steps is taken to scale down the rising incidence of paediatric HIV infection through PMTCT.

Corroborating earlier views were university dons, in their article titled: Agboghoroma CO, Sagay SA, Ikechebelu JI. Nigerian prevention of mother to child transmission of human immunodeficiency virus program: The journey so far. J HIV Hum Reprod 2013;1:1-7, • As gap in mother-to-child HIV transmission widens the academics decried the PMTCT situation in the country.

In addition, Dr. Rajiv Shah, the Administrator of United States Agency for International Development (USAID), recently announced that United States government spent a total $16 million prevention of mother to child transmission of HIV last year. Estimates from the joint United Nations AIDS programme (UNAIDS) have also showed that not less than 3.14 million Nigerians were found living with HIV as at the end of 2011. This corresponds to 4.1 per cent of over 150 million being the estimated total population of people in Nigeria according to the most recent National Demographic Health Survey (NDHS of 2008)- carried out in the country.  The NDHS was based on population estimates obtained by the Nigerian Population Commission (NPC) during the 2007 nationwide census.

Daily Newswatch also learnt that 281,180 new infections also occurred during the period in focus, of which 154,920 were children. According to the 2011 UNAIDS statistics, globally, Nigeria alone accounts for 21 per cent of new infections in children.Further statistics made available by the United Nations Children Fund (UNICEF) showed that in Nigeria, 10 per cent of all HIV infections are as a result of mother-to-child transmission. Also, records from the Federal Ministry of Health show that in 2011, only 15. 89 per cent of HIV-positive pregnant women received ARVS to reduce the risk of mother to child transmission, just as only 2.3 per cent of infants born to HIV-infected women (HIV-exposed infants) received ARV prophylaxis to reduce the risk of early mother-to-child- transmission in Nigeria.

About six million babies are born in Nigeria yearly. At the end of 2011, 229,480 pregnant women were found to be HIV positive, just as an estimated 57,000 infants are exposed to the virus yearly.
PMTCT is an intervention that aims at reducing to less than two percent the risk of Mother to Child Transmission of HIV through the use of anti-retroviral (ARVs) as either prophylaxis or therapy given to women in pregnancy, labour and during breastfeeding. In situations where a mother is not receiving ARVs during the breastfeeding period, the breastfed infant is placed on ARV prophylaxis until one week after cessation of all breastfeeding. Where breastfeeding is not possible, the use of commercial infant formula is usually advised as alternative.

Dr. Oliver C. Ezechi, Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba Lagos, Nigeria, lamented over the dismal situation saying; “Nigeria contributes 32 per cent to the world gap in achieving a global target of eradicating MTCT.” Ezechi who spoke during an interview with Daily Newswatch observed that the nation conceived to achieve 50 per cent target in PMTCT for 2012, but regretted that PMTCT coverage falls short of the target with 16 per cent. The Clinical Scientist said; “PMTCT coverage still remains low with only 1,120,178 (16.9 per cent) pregnant women counseled and tested for HIV and receiving their results in 2011.”

He continued; “17.6 per cent of the HIV-infected pregnant women in 2011, received antiretroviral insisting; “there is major challenge in the area of PMTCT coverage which is 16 per cent only.” Also, a United Nations Development Programme (UNDP) report, recently confirmed that the nation reported prevention of mother-to-child transmission (PMTCT) of HIV of less than 25 percent, thus joining six other sub-Saharan Africa countries — Angola, Chad, Congo, Eritrea, Ethiopia and South Sudan — which also recorded a not-impressive performance between 2011 and 2012. The UNDP tweeted a Joint United Nations Programme on HIV/AIDS’ (UNAIDS) Regional Fact Sheet for 2012, observed a decline in new HIV infections and AIDS-related deaths across the region. The UNDP report stated that in the area of preventing new infections among children between 2009 and 2011, the report noted that the number of children newly infected with HIV in sub- Saharan Africa fell by 24 percent.

Dr. Rosemary Audu, Head, Human Virology Laboratory, said there is there need  to scale up PMTCT even as she lamented that many women know their HIV status but hardly disclose it to their partners. Audu said: “there is urgent need for PMTCT scale up, many women know their status but, disclosure of HIV status to partner remains difficult.” Mother-to-child transmission is the term used for vertical transmission of HIV from an HIV-infected mother to her newborn child said Dr. Dan Onwujekwe who added that effective PMTCT could be achieved through “Primary prevention of HIV infection in women of reproductive age group and their partners, prevention of unintended pregnancies among HIV-positive women as well as prevention of HIV transmission from HIV-infected mothers to their unborn babies and infants, especially during deliveries.”
In Nigeria, the national PMTCT program commenced in 2002 with supports from the World Health Organisation (WHO) and UNICEF. There are currently about 1, 320 PMTCT service points across the country.
Meanwhile, the coverage for the people in need of PMTCT still remains low. Out of 210,000 HIV positive women, only 22 per cent are covered by ARV/ART for PMTCT. This is considered low compared to the corresponding MTCT rate of 32 per cent as at last year. Globally, HIV is a leading cause of death in women of reproductive age and since nearly all HIV infections in children are acquired from their mothers, the global epidemiology of HIV in children reflects that of HIV in women. Over 90 per cent of infections in children are acquired through MTCT. With over 60 per cent of adults living with HIV being women, the number of infected children has been growing. This, experts say occur during pregnancy, labour and delivery or during breast-feeding. In the absence of interventions, the risk of such transmission is worse- 45 per cent.

A member on the National Task Team on PMTCT, Emmanuel Enabulele, in a report said that MTCT is fast becoming a burden in Nigeria compared to the rest of the world due to higher prevalence of HIV in women of reproductive age, high total fertility rate, characteristically prolonged breastfeeding culture, stigmatization by healthcare givers, and poor access to PMTCT interventions as a result of the Federal Government not living up to its promises among others. The federal government had, in 2010, committed to reducing by at least 50 percent HIV incidents among women aged between 15 and 49 be reduced by 2015 as well as ensure that at least 90 per cent of all pregnant women have access to quality HIV counselling and testing by 2015.  It has also conceived that by 2015 at least 90 per cent of all HIV positive pregnant women and breastfeeding infant-mother pairs will receive ARV prophylaxis, at least 90 per cent of all HIV exposed infants have access to early infant diagnosis services and at least 90 per cent of pregnant women requiring ART for their own health receive life-long ART. This is based on the Joint United Nation AIDS Programme (UNAIDS) target of achieving zero mother-to-child HIV infection by December 2015. 

This might be some huge steps towards bridging the PMTCT gap if the nation lives up to its commitment. To fix the missing links, experts have said there is need for Nigeria to increase funding for PMTCT by  government at all levels, strengthen health systems capacity building, improve co-ordination and integrate Maternal, Newborn and Child Health (MNCH) programmes.  Also, Osahon Enabulele, the President of the Nigerian Medical Association, NMA, said there is a huge gap in the prevention of mother to child transmission of HIV, PMTCT, and added that more strategic policies in the area of PMTCT need to be implemented. Enabulele, observed that access to antiretroviral drugs and awareness about the virus has helped reduce the prevalence of HIV in Nigeria, but the country is still off-track in combating mother to child transmission (MTCT) of HIV. 

Experts are optimistic that if the nation lives up to her commitment to the UNAIDS target of achieving zero mother-to-child HIV infection by December 2015, nearly all cases of MTCT of HIV infections can be prevented by PMTCT programmes that provide highly effective ART and ARV prophylaxis interventions.

This story was published in Newswatch Times on August 29,  2013.
Why simple strategies are not enough for bedwetting

By: Chioma Umeha

Waking in the middle of the night to change your child’s sheets after a bedwetting episode is practically a rite of passage for parents. And it is more common than you think. Scientists have said that there is no one single cause of bed-wetting, but if you want an easy target, look no farther than your own DNA. 

Reasons for bedwetting are not totally understood, but experts think it may be associated with the time it takes children to develop control over the bladder, a complex milestone. The timing varies from child to child. From five to seven million children wet the bed some or most nights – with twice as many boys wetting their bed as girls. After age five, about 15 per cent of children continue to wet the bed, and by age 10, 95 per cent of children are dry at night. 

While techniques such as fluid restriction can help some children who have problems with bedwetting, alarms and medications are more effective, a new study finds. “Simple behavioural therapies such as rewarding the child for dry nights or taking the child to the toilet during the night can sometimes help with bedwetting, and is better than doing nothing,” said study leader Dr. Patrina Caldwell, a pediatrician at the Children’s Hospital at Westmead and senior lecturer at the University of Sydney, in Australia. “However, there are more effective treatments such as bedwetting alarm training or medications,” she said. But alarm training is more difficult, she noted. Bedwetting affects about  five  million children in the United States, with up to 20 per cent of five-year-olds having the problem. 

Most kids outgrow the problem, known medically as nocturnal enuresis, and only two per cent of adults are affected. However, bedwetting can be frustrating, stressful and traumatic. Remedies and treatments abound, but with much debate about which are best. In the United States, two medications are approved for childhood bedwetting – desmopressin (DDAVP) and imipramine (Tofranil) – although others are also used off-label. Dr. Trevor Resnick, chief of neurology at Miami Children’s Hospital, said he only prescribes medication on an as-needed basis, such as to spare children embarrassment on a sleepover. The new report was published recently in The Cochrane Library. For the review, Caldwell’s team reviewed 16 published studies involving more than 1,600 children, with about half trying simple interventions. Among them were fluid retention, rewards for dry nights (such as stars on chart), and lifting children and taking them to the bathroom after they have been asleep. No one simple strategy worked better than another, the researchers found. When they compared alarm training with the simple strategies, the alarm training was more effective. And treatment with medication alone was better than the simple interventions. 

However, the researcher noted that “the findings from this review should be interpreted cautiously due to the poor quality and small sizes of the trials.” The findings suggest that parents may want to start with simple treatments, Caldwell said, “then move to alarm training or medication if simple treatments do not work after trying for six months.” “Younger children generally take longer to respond to treatment,” she said. “Don’t get annoyed with the child, because bedwetting is usually out of their control.” While the alarm system, which sounds an alarm when drops of urine are detected, is effective, it is difficult to do, Caldwell said. Another downside she has sometimes seen is when children become dry on alarm training then develop sleepwalking or night terrors. 

“Bedwetting and night terrors and sleepwalking are all parasomnias (sleep disorders) and are known to be associated,” she said. The new findings mirror what U.S. expert Resnick has seen in his patients. “I’d say behavioural therapies work about 50 percent of the time,” said Resnick, who was not involved in the study. If simple treatments do not work, Resnick said he may consider medications, but he only prescribes them on an as-needed basis, since the medications have side effects.   

To be continued next week.

This story was published in Newswatch Times on August 31,  2013.
Nigeria can generate $500m from shea butter, sesame export – Expert

By: Chioma Umeha 

An expert has said that Nigeria can generate over $500 million yearly from shea nut butter and sesame oil. Stating this was former project 172 coordinator, Nigerian Export Promotion Council (NEPC), Mrs Omowunmi Osibo, who maintained that  the country has the capacity to increase its 336,000 metric tonnes of shea butter production per year and create jobs. 

She spoke during a training organised by  National Agency for Food and Drug Administration and Control (NAFDAC) for traders, exporters and enforcement officers on the World Trade Organisation (WTO) / Standards and Trade Development Facility (STDF) Project 172. Speaking on the theme, ‘Robust System For Safer Products And Exports Of Sesame Seeds And Shea Butter’, she said a larger percentage of the product was being smuggled to neighbouring countries, adding that the Federal Government should shift its attention to the sector to generate more revenue. 

NAFDAC Director-General, Dr Paul Orhii said his agency was drafted into the project monitoring group (PMG) as a collaborator on safety and quality chain values to ensure safety and regulation of the product. He said the programme was in conformity with Mr President’s transformational agenda, stressing the need for a non-oil agricultural-based trade. 

Orhii said training will enhance the export of shea nut/ butter and sesame seeds, adding that the aim was to inform participants on the trade and regulatory requirements of the production, exportation and sales of the products.

This story was published in Newswatch Times on August 31,  2013.
NAFDAC will soon start herbal medicine trial


To ensure that only good quality, safe and effective herbal medicines are distributed and used, the National Agency for Food and Drug Administration Control, NAFDAC, and Nigeria Institute of Pharmaceutical Research and Development, NIPRID, plan to commence limited clinical trial on some Nigerian herbal medicines used for life-threatening ailments like HIV/AIDS among others. 

The Director-General of NAFDAC, Dr. Paul Orhii, said this weekend, in Lagos during a one-day symposium to celebrate this year’s International Traditional Medicines Day, adding that the clinical trial had become necessary following recent noticeable swing from the earlier bias in favour of orthodox medicine to greater acceptance of traditional medicines in the country. Orhii said with this new trend, the need to ensure that only good quality, safe and effective herbal medicines were distributed and used became paramount to the Ministry of Health. His words: “With this new trend, the need to ensure that only good quality, safe and effective herbal medicines are distributed and used became paramount to the Federal Ministry of Health.” He added that the agency decided to carry out the trial due to the burden of unauthorised advertisement of herbal medicines with unsubstantiated claims on cure of serious diseases with the intention to deceive unsuspecting members of the public. 

The NAFDAC boss said: “In furtherance of this, we have a burden of unauthorized advertisement of herbal medicines with unsubstantiated claims on cure of serious diseases with the intention to deceive unsuspecting members of the public.” He said that the agency had set up a National Expert Committee on Verification of Claims by herbal medical practitioners, adding that by the first quarter of 2014, the agency, in collaboration with NIPRID, would also begin evaluation of herbal medicines. Orhii said: “We have established standards and guidelines for the registration of herbal medicinal products in Nigeria to ensure successful implementation of the aspects of the mandate relating to herbal medicines. 

“NAFDAC has banned illegal advertisements of herbal medicinal products and bogus claims of cure for disease conditions.” According to him, the NAFDAC Decree No. 15 of 1993 as amended, now Act Cap Nl Laws of the Federation of Nigeria (LFN) 2004 mandated the agency to regulate and control the manufacture, importation, exportation, distribution, advertisement, sale and use of food, drugs, medical devices, cosmetics, chemicals and packaged water.

This story was published in Newswatch Times on Sept 5,  2013.
Insomnia sufferers lose focus – Scan suggests


Brain scans of people who say they have insomnia have shown differences in brain function compared with people who get a full night’s sleep. Researchers at the University of California, San Diego, said the poor sleepers struggled to focus part of their brain in memory tests. 

Other experts said that the brain’s wiring may actually be affecting perceptions of sleep quality. The findings were published in the journal Sleep. People with insomnia struggle to sleep at night, but it also has consequences during the day such as delayed reaction times and memory. The study compared 25 people who said they had insomnia with 25 who described themselves as good sleepers. MRI brain scans were carried out while they performed increasingly challenging memory tests. 

One of the researchers, Prof Sean Drummond, said: “We found that insomnia subjects did not properly turn on brain regions critical to a working memory task and did not turn off ‘mind-wandering’ brain regions irrelevant to the task. “This data helps us understand that people with insomnia not only have trouble sleeping at night, but their brains are not functioning as efficiently during the day.” 

A sleep researcher in the UK, Dr Neil Stanley, said that the quality of the sleep each group was having was very similar, even though one set was reporting insomnia. He said: “What’s the chicken and what’s the egg? Is the brain different and causing them to report worse sleep? 

“Maybe they’re perceiving what happened in the night differently; maybe what is affecting their working memory and ability to focus on the task at hand is also causing insomnia.”

This story was published in Newswatch Times on Sept. 5,  2013.
Scientists find cure for high blood pressure


Scientists have discovered that de-activation of certain nerves in the neck can cure high blood pressure. An agency report Tuesday claimed that scientists experimented with rats and found that de-activating certain nerves in the neck can effectively treat high blood pressure – a discovery that could be an advance in tackling one of the world’s biggest silent killers. 

However, researchers at Britain’s Bristol University found that in rats with high blood pressure, when they removed nerve links between the brain and the carotid body – a nodule about the size of a grain of rice on the side of each carotid artery – the animals’ blood pressure fell and remained low. The researchers’ results, published in the journal: Nature Communications, have already led the team on to conduct a small human trial of the technique, with results expected at the end of this year. Hypertension, or high blood pressure, is referred to by the World Health Organization (WHO) as one of the world’s biggest silent killers because most people who have it cannot feel or see it. It affects around one in three people worldwide and can cause stroke, heart attacks and kidney failure. 

After diagnosis, treatment of high blood pressure needs to be life-long and many patients are able to manage their condition with anti-hypertension drugs. But experts say that for around one in 50 of them, medication does not help. The Nigerian Medical Association (NMA) recently said that a staggering fifty- six million Nigerian people suffer from high blood pressure (HBP). This is based on the statistics carried out by World Health Organization (WHO) which said that one out of every three persons around the globe has hypertension, a situation which the world body said is deadly to the survival of mankind. 

This figure is ten times higher than what was obtained in the last 23 years. In July, 1993, the then health secretary, Dr. Christopher Okogie through the Federal Ministry of Health gave the report that 5.5 million Nigerians are already hypertensive. This is even as experts have decried outdated statistics on hypertension. For instance, Emeritus Professor of Medicine, University of Ibadan, Oyo State, Oladipo Akinkugbe, recently, condemned the fact that the last study on hypertension in Nigeria was done 20 years ago. Prof. Akinkugbe further noted that Nigeria could not tackle its growing population of hypertensive patients if it was still working with outdated statistics. 

Nigeria is one of many developing countries where the health services have focused on treating infectious diseases, such as malaria and tuberculosis, but in recent years, non-communicable conditions have become an increasing problem. One of the most prevalent non-communicable.

This story was published in Newswatch Times on Sept 5,  2013.
Aggressive behaviour in children linked to carbonated drinks – Study

By: Chioma Umeha

A recent study has shown that children who drink soda tend to score slightly higher on scales that measure aggressive behaviour than those who don’t drink the carbonated beverages. The study’s lead author cautioned, however, that the increase may not be noticeable for individual children and the researchers cannot prove soda caused the bad behaviour. 

“It’s a little hard to interpret it. It’s not quite clinically significant,” Shakira Suglia, of Columbia University’s Mailman School of Public Health in New York, said. Despite the study’s limitations, Janet Fischel, director of developmental and behavioural pediatrics in the department of pediatrics at Stony Brook University School of Medicine in New York, said the study is a step in the right direction. “I think it’s really important and a giant first step in gathering an evidence base for what’s becoming a very widespread dietary habit. I think that’s really important,” said Fischel, who wasn’t involved in the new study. Previous work by some of the study’s authors had found connections between soda drinking and violent behaviour, but the link had not been studied in young children. For the new analysis, the researchers used an existing study of mothers and their 2,929 children from 20 large US cities. 

Mothers completed a checklist on children’s behaviours over the previous two months to measure withdrawal, attention and aggression. “It’s things like how often does a child destroy his or her own belongings and how often do they destroy the belongings of others,” Suglia said. The mothers were also asked how many servings of soda their children drank per day and about other habits such as TV watching. Overall, 43 percent of the children drank at least one soda per day and 4 percent drank four or more servings. Aggressive behaviour was measured on a scale between 0 and 100 – with higher scores indicating more aggression. Suglia said the average score is 50, and 65 is usually used as a clinical marker of when children should be evaluated for a problem. Children who reportedly drank no soda scored 56 on the aggression scale, on average. 

That compared to 57 among children who drank one serving per day, 58 among those who drank two servings, 59 among those who drank three servings and 62 for four soda servings or more per day. After taking into account habits that may have influenced the results – such as how much TV the children watched, how much candy they ate and their mother’s race and education – the researchers still found that drinking two or four or more servings of soda per day was tied to higher aggression scores. Overall, children who drank four or more servings of soda per day were twice as likely to destroy other people’s belongings, get into fights and physically attack people, compared to children who didn’t drink soda. Soda drinkers also scored higher on scales measuring signs of withdrawal and attention problems, write the researchers in The Journal of Pediatrics. Suglia says that although the increased aggressive behaviour may not be noticeable for each child, it’s moving all children closer to the scale’s clinical threshold. “Furthermore, if they’re drinking this much soda, it’s probably taking away from other nutritional things the child could be eating,” she says. 

The researchers write that they can’t tell from their study what may explain the association between soda and behaviour problems in children, but one possibility is that an ingredient in soda – like caffeine or high fructose corn syrup – could directly increase aggression. Another possibility, however, is that an underlying condition – such as low blood sugar – could make children more aggressive and make them crave soda and sweets, they add. Suglia also says it’s important to note that the results may not apply to the general population, because most of the mothers were single and African-American or Latina.

This story was published in Newswatch Times on August 24,  2013.
Tough times await dealers of fake pharmaceutical products

By: Chioma Umeha

It will no longer be business as usual for dealers of fake and substandard pharmaceutical products as the National Agency for Food, Drug Administration and Control (NAFDAC) has concluded plans to proscribe open drug markets.

Consequently (NAFDAC) in Lagos on Tuesday inaugurated the State and Mega Drug Distribution Centres (SMDDCs) to tackle challenges posed by the present drug distribution system in the country.
Speaking at a stakeholders’ sensitisation meeting, ahead of the commissioning of Megacentre pharmaceuticals Limited, Onitsha, the Minister of Health, Professor Onyebuchi Chukwu, said the uncoordinated drug distribution in Nigeria had posed a big challenge to the pharmaceutical sector. During the meeting which was organised by NAFDAC to sensitise stakeholders towards the September 3, 2013 commissioning of Mega Centre Pharmaceuticals Limited, Onitsha, Prof. Chukwu said fake, adulterated and sub-standard drugs in circulation constituted a threat to the healthcare delivery system.

Prof. Chukwu Onyebuchi who declared an emergency in drug distribution system in the country to address the chaotic situation, said that drugs would no longer be sold in the open market in Nigeria, from June 30, 2014. The Health Minister said: “The aim of the recently launched revised National Drug Distribution Guideline is to phase out illegal open drug markets across the country and we are determined to implement it.
Represented by the Director, National Drug Policy Programme, Mrs. Joyce Ugwu, Chukwu traced the present uncoordinated drug distribution in the country to import liberalisation in the early 80’s which allowed all manners of people to import drugs into the country.

Bemoaning that Nigeria was still faced with challenges of illegal open drug markets, he announced that the present States’ Central Medical Stores, CMSs, could be used as the take-off hubs for the newly introduced State Drug Distribution Centres, SDDCs. He said: “The main attraction of the new National Drug Distribution Guidelines is that drugs will no longer be sold in open market with effect from June 30, 2014, as manufacturers and importers will channel drugs to only SDDCs, MDDCs and other channels in the provisions of the guidelines, while defaulters will face varying degrees of sanctions. Healthcare facilities at all levels, including private facilities, are guided by the guidelines in their drug procurement activities in order to avoid the current practice that is lacking in professionalism.

The Director-General, NAFDAC, Dr. Paul Orhii, corroborated earlier views, adding: “We have not really had an effective way of sanitizing drug distribution in Nigeria and that remains a major challenge. While the new guideline provides a distribution channel which would help identify sources of drugs at every level of healthcare and create orderliness in drug distribution system, this move will ameliorate the chaotic nature in the present drug distribution system which encourages sales and distribution of sub standard medicines in open drug market among genuine brands.”

He further explained that the concept of Mega Pharmaceutical Distribution Centre is ‘based on the dynamics of the commercial and cultural trade practices of having markets delineated for particular line of products.’ According to him, the Mega Drug Distribution Centres are to be securely delineated with customized buildings and conducive environment for the wholesale of drugs. Orhii pointed out that the buildings or shops under the Mega Drug Distribution Centres are meant to be rented to licensed pharmaceutical manufacturers, importers and wholesalers. The NAFDAC boss also observed that the entry of pharmaceuticals into the distribution centre will be controlled and restricted to drugs that have satisfied all NAFDAC requirements for quality and safety.

He further outlined the benefit of the effective operation of Mega Drug Distribution Centres, including: ensure proper storage and distribution of NAFDAC registered medicines, promote rational use of medicines, access to quality and safe medicines; provide an audit trail for medicines. Others are to ensure a system of effective recall of medicines as well as provide information on medicine utilization and enhance compliance with medicine laws and regulations.

This story was published in Newswatch Times on August 24,  2013.

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