Trained Manpower, Appropriate Technology Will Reduce Misdiagnosis.

The recent alarm on rising global incidence of cancer by the World Health Organisation (WHO) should worry African countries, including Nigeria, where the disease is becoming prevalent. Available statistics show that Nigeria accounts for  10,000 cancer deaths annually, while 250,000 new cases occur yearly. Prof. Innocent Ujah, Director- General of the Nigerian Institute for Medical Research (NIMR)Yaba, Lagos, in this interview with Chioma Umeha, announced that  the prevalence study for Humanpapilloma Virus (HPV) that causes cervical cancer will be out this year. Excerpt:

The issue of misdiagnoses is a serious problem in this part of the world. How do you think we can improve on laboratory services, especially as concerns Cancers?
Diagnosis involves the technician that is manpower development. The next is the technology.  Are we using the appropriate technology? If we are using the updated technology, then with trained manpower, we should be able to reduce misdiagnoses to barest minimum. The other thing is the technique. Are we using the right technique? If we are using the right technique, then we will get the right answer. We need to train because capacity development is very important. We also have to continue to calibrate our equipments; otherwise it may give the wrong diagnosis.

What is  your assessment on  NIMR’s effort in cancer research on Human Papillomavirus, malaria among other tropical diseases and their national prevalence?
The institute is also involved in nationwide cancer research concerning Human Papillomavirus and its national prevalence. The centre is equipped with a specialize machine, Cobalt 4800 for the characterization of the subtypes of Human Papilomavirus (HPV).
Another area of study is drug resistance to malaria and mosquito resistant insecticide treated nets. One of the researchers is doing the study with a grant from World Health Organization, (WHO) and some private partners. So, we want to track Artemisinin-based combination therapies (ACTs) that have been in use and study and confirm the magnitude of resistance and discover what to do to prevent this.

The institute commissioned a cancer centre last year.  When will it take off and what would be the areas of focus?
The cancer research centre has already taken off. As soon as we carry out research, the findings will be made known to the public, just as we will provide brief to the government through the Federal Ministry of Health and this will help to shape the magnitude of the problem, to develop a policy issue regarding a specific modalities of treatment and train more people. The truth of the matter is that apart from equipment, we need training and it should be regular as it is practiced in Europe and America.
The problem Nigeria has is funding and research is not being taken seriously. Funding for health is about five or six per cent and that really cannot do anything considering the country’s population. Look at National Institute of Health of America (NIA), they have billions and they even give grants to developing countries like Nigeria. The Centre for Disease and Control (CDC) form that we are using is from NIA and Medical Research Council (MRC) in the United Kingdom and they vote a lot of money for research. We believe that the government of Nigeria should vote substantial amount of money to health sector. And as for the outcome, health is capital intensive, health research is even more capital intensive, the equipments are not cheap.

Your institute has a mandate and it is to carry out research for National development. Can you say that it is on track in fulfilling its mandate?
Yes, NIMR,  has a mandate and it is to carry out research for National development. We are to research into diseases of public health importance communicable and non -communicable. In addition, we are to disseminate our research findings and carry it to the public and this is done through scientific publications and policy brief for government and creating awareness to the public.

What do Nigerians hope to expect from NIMR?
The goal of the institute is to position itself   in the area of dissemination of findings from many ongoing researches and also do policy brief to the government through Federal ministry of health. Once we finish collecting data, we need to analyze the data, we do not want to hurriedly put something in place, we want to be sure that whatever we say is what it is. Research is an ongoing process. We intend to build capacity of many of our researchers this year and other support staff. We will recruit in some areas where we do not have sufficient manpower. At the moment, we are trying to get approval from National Board for Technical Education (NBTE) to train in the areas of Bio-medical engineering and technicians  as well as award some Diplomas in specific areas of Bio-technology and Bio-medical  training.

Specifically what kind of work are you doing to address the issue of drug resistance  to malaria?
We have researches going on in this area with a focus to manage and incubate mosquitoes. We have a very strong malaria research group. I earlier discussed about tracking the malaria resistance, ACT drugs, of course you know that the essence of insecticide treated net is to kill the mosquitoes once they touch the net.
But, the drugs are now Malaria resistant…
It used to kill mosquitoes, but it is becoming resistant. It will just demobilize the mosquitoes for a while that is why we talk about genetic mutation. We are to study further on that, so that we overcome it. That is the essence of research, we are doing that and we are in the field.

What stage is the institute?
We are in the stage of doing a laboratory work, the laboratory studies on mosquitoes. We do this with mosquitoes and also on the parasite itself and in that case, at the end of it all, we will be able to come up and say, this is the degree of prevalence of the resistance to insecticide treated net; this is the degree of prevalence of resistance to ACT and then of course we begin to discuss how we can overcome it, then compare our efforts to other centers and countries so that we can also key in and work together in collaboration.

Many countries of the world, for instance, Thailand is expecting to achieve malaria elimination  by 2030. What is the situation in Nigeria?
There has been increased momentum on the areas of malaria prevention since 2002 till date. The federal government has a programme for this. What the institute is doing is to conduct research to follow up and to track because initially when the ACTs emerged, nobody was talking about resistance but, we have been tracking it and the insecticide treated net. We have an out station in Maiduguri to study trans- border diseases, including malaria and their own type of mosquitoes there, but, because of the insurgency we cannot go there.

Is that the only place we have trans-border disease control Centre?
We cannot have stations in every border, but, we use that as a model to study trans- border diseases. We have another station in Kainji to study neglected tropical diseases.

What is the place of medical research in the National Health Act which was signed into law by former President, Goodluck Jonathan?
In fact, the National Health Act has captured very strategically health research. So in terms of its role it has the whole section of research committees. What we are looking for is the implementation. Several other committees are working to see how we can start the implementation process. We will also ensure that the National Health Act is monitored thoroughly.


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