Tuesday, 13 September 2016

Family Planning Prevents Prolong Obstructed Labour, Fistula – Umma-Bala

Over half of Nigerian married women aged between 15 and 49 want to avoid pregnancy and plan their families, but, lack access to modern contraception according to the Nigeria Demographic and Health Survey (NDHS). This challenge of non-availability of family planning (FP) supplies in the country’s various health facilities is worsened by the myths and misconceptions about FP which women contend with in their various communities. But, a Reproductive Health/Family Planning, FP, Adviser to Fistula Care Plus, based in Sokoto State, Mrs. Amina Umma Bala in this interview with Chioma Umeha dismisses the myths, declares it number one step out of poverty for couples  saying, it gives couples opportunity to delay, space and choose number of children they want. Excerpts:

There are various perceptions and misconception about family planning. For instance, in some communities, it is believed that if a woman uses a method of family planning, she will not be able to get pregnant again, when she wants to.
Well, myth is myth and misconception is misconception. So by myths, you know these are not true. It is rumours that are being spread by people in the community. So no myths or misconception is true. They are just false. For instance, some women say they cannot use family planning as long as they are breastfeeding. They believe that they won’t conceive based on their previous experience. This is very wrong because anything can change at any time. Nobody can rely on that. Just because she didn’t conceive during her previous encounter does not mean that she will not conceive next time. It is a false belief. Women should not rely on this belief. Some women claim they do not want to space their children because of inheritance. Some will tell you that they and their husbands space their children naturally, because they do strenuous work which weakens their sperm. Some will say, ‘I am afraid to resume sexual relationship while breastfeeding, because it may harm my baby. All these are myths. They simply don’t understand what family planning means.
So, what is family Planning?
Family planning is the initiation and use of natural or modern contraceptive methods to delay space or limit future pregnancies. If a woman uses a method of family planning, she will not be able to get pregnant again until when she wants to. There are different types of family planning. These includes ;Lactational Amenorrhea Method, LAM, Pills, Injectables, Condoms, Implants, IUD, Tubal Ligation and Vasectomy.
LAM is a temporary natural, contraceptive method that uses a pattern of breastfeeding to suppress ovulation and prevent pregnancy. It has more than 98 per cent contraceptive effectiveness and it is provided and controlled by the woman. It is also important for breastfeeding mothers to use contraceptive methods that have no effect on breastfeeding for a breastfeeding baby and mother.
How safe is FP?
Family planning is safe only that there is individual difference in using family planning. The way one individual tolerates family planning is different from another individual’s tolerance to FP. There are some people that can use family planning without showing any sign of adverse effect and there are some women that you can notice very easily that they are having challenges with that particular method.
What is the success rate?
All the family planning methods have its own efficacy. Some are 97 per cent effective; some are between 85 and 93 per cent. Every method has its own efficacy, none of them is 100 per cent reliable and what we mean by that is in 100 women using that method seven women can become pregnant after using that method consistently and effectively.
At what age should a girl adopt family planning?
As soon as that girl is matured, what I mean by matured is at least if the girl is 18 years, she has the right to access family planning. As long as a woman is of age, whether married or not married, she has the right to walk into family planning unit because we have to weigh the implication of not allowing them to access family planning. We have to weigh the risk. What about if they become pregnant and they are not married? So we have to weigh the risk. We are talking about 18 because she can decide on her own. If she is less than 18, the provider should always look for somebody, like the mother or a relation that can verify on her behalf. But, once she is 18 she can just walk in and have it.
Can you describe the link between family planning and obstetric fistula?
Family planning is one of the strategy that is used to prevent the occurrence of fistula, in the sense that when you use family planning it allows one to prevent unwanted pregnancy and it is only when you are pregnant that you would have prolong obstructed labour during delivery and you will also have fistula. So if you didn’t even allow the pregnancy to occur, you won’t have fistula.  That is one of the ways you can use family planning to prevent the occurrence of fistula.
What have been the responses of Sokoto women to FP?
Oh, fantastic, we recently conducted an outreach section, and I was highly impressed honestly with the way people were turning out from every corner, coming to access family planning. Some were even fighting to get it. And what surprised me most is they go for the long acting and permanent methods.
What are the benefits?
For the nation; reliable contraception is an extremely good value because it enables people to avoid pregnancy long enough to enter gainful employment and stable family relationships without depending on public assistance. For families, it gives couples the ability to choose the number and spacing of their children. It also ensures healthy spacing of pregnancy, increase chances of healthy outcomes for both mother and baby. Also, healthy timing and spacing of pregnancy improves the health of the mother and reduces infant, newborn and child deaths. It reduces the chance of problems during the next pregnancy and allows mothers to breastfeed for two full years.
What is your advice to husbands?
My advice is let our men think it over again. Let us see FP in a different perspective not the previous knowledge or explanation about FP. Family planning is just saying we should plan our family for better health, family health and better community health. We are just saying or telling mothers to space their family at least not less than two years apart. The problem of family planning lies in the men, because men involvement that is where we always have problems. We want our men to understand and share this burden together with their women. Let them understand the concept of family planning, because it is for their own good, the family good, not just the woman’s good. They should understand that it should be a collective responsibility between couples.

This story was published in Independent on Sep 4, 2016

NCDC Confirms Lassa Fever Spread To Four States, One Death
The Nigeria Centre for Disease Control (NCDC) has confirmed five more cases of Lassa fever across four states in the last 11 days.
Two cases were reported from Plateau State, one from Rivers, and one each from Bauchi and Gombe, NCDC said in a statement Friday night.
Four of the infected people are alive, but the fifth case, from Gombe, died on August 22.
“We commend the early detection and reporting of the most recent cases, as it significantly improves the likelihood of survival for the cases and also reduces the risk of further transmission,” said NCDC chief executive officer Chikwe Ihekweazu.
“We also urge all States to report cases immediately for Lassa fever while improving on the timeliness of their reporting generally.”
Ministries of health in the respective states, the NCDC and the Nigerian Field Epidemiology and Laboratory Training Programme are investigating and managing those infected.
An NCDC advisory recommends steps states have to take to prepare for and respond to all cases of Lassa fever and other haemorrhagic fevers.
NCDC has opened communication lines where suspected cases can be reported, including its twitter handle @NCDCgov, Facebook Messenger m.me/NCDCgov and a phone line 080097000010.

This story was published in Independent on Sep 4, 2016

FG, WAMCO Renew MOU On Dairy Development Programme

Federal Ministry of Agriculture and Rural Development (FMARD) and one of the country’s leading dairy companies, FrieslandCampina WAMCO, makers of Peak, Three Crowns and Friso brands of milk have renewed their memorandum of understanding (MoU) on dairy development in the country.
The Minister of Agriculture and Rural Development, Chief AuduOgbeh, and the Managing Director, FrieslandCampina WAMCO, Mr. Rahul Colaco, signed the MOU at a ceremony held in Abuja, recently.
WAMCO is the first dairy company in Nigeria to sign such a pact with the Federal Government. The Minister and his team had visited the Netherlands earlier in the year, to see how the Dutch dairy chain is organized from “grass to glass” and how FrieslandCampina guarantees the safety and quality of her products.
A statement issued by the company’s Corporate Affairs Director, Ore Famurewa, explained: “This is an enormously positive development for FrieslandCampina WAMCO and we see our partnership with the Federal Government as key in rolling out new dairy programmes designed to safeguard food and nutrient security in Nigeria.
“Five years ago in 2011, we signed an MoU with the Ministry of Agriculture and Rural Development (FMARD) to improve dairy farming and we made good progress in areas such as networking of milk suppliers, training of dairy farmers and improving the quality of raw milk. “Today, we are restating our mutual commitment to developing the Nigerian local dairy industry by creating a sustainable value chain that contributes to food security, provides jobs and prosperity,” she said.
Famurewa confirmed the company’s decision to invest N3 billion in its small holder dairy farmer programme in Nigeria and has also agreed to provide support to a FMARD subsidiary, Milcopal, in Kaduna.
The Dairy Development Programme (DDP) is an initiative of WAMCO Nigeria PLC. It is a private-public partnership that will trigger growth in the agro-economic sector of Nigeria.
The DDP is significant  in the history of FrieslandCampina WAMCO “and we believe it will enhance dairy farming in Nigeria as it affirms our unwavering commitment to the provision of quality dairy nutrition to Nigerians,” Famurewa said.
The signing ceremony was attended by the Minister for Agriculture & Rural Development, Chief AuduOgbeh; the Permanent Secretary, Federal Ministry of Agriculture and Rural Development, Dr. Shehu Ahmed; Hon. Mohammed Monguno, Chairman, House Committee on Agriculture Production and Services, National Assembly; Dr. Danazumi Mohammed Ibrahim,   Director General National Office for Technology Acquisition and Promotion; Chairman, Board of Directors, WAMCO, Mr. Jacobs MoyoAjekigbe and the Managing Director, WAMCO, Mr. RahulColaco.

This story was published in Independent on Sep 4, 2016

Ambode’s Wife Pledges Support For Adolescents Living With HIV
The wife of the Lagos State governor, Mrs Bolanle Ambode has expressed concern over adolescents living with HIV in the state, and pledged to support them to actualise their potentials.
Addressing journalists at an “Adolescent Advocacy Meeting with policy makers on the sexual and reproductive health of adolescents living with HIV in Nigeria, the representative of the wife of the Lagos State Governor, Mrs. Bolanle Ambode, Mrs Rhoda Ayinde, said the state has put in place vocational skill centres that will foresee to the training of adolescent living with Human Immune Virus, adding that it will not rest on its oars.
She however stated: “I will team up with other governors’ wives of states like Akwa-Ibom, Anambra, Benue, FCT and Kaduna. We will empower and sensitize these adolescent and also involve all stakeholders to see that HIV is totally eliminated. The two weeks summer camp from August 23 to  September 2,  is geared towards these course ”
Also speaking at the event, the Permanent Secretary of the Lagos State Ministry of Health, said the state has 344 health facilities to prevent Mother to Child Transmission of HIV in Lagos State, adding that 104 of the health facilities are private hospitals.
The PS however said that Lagos State has established adolescent and youth centres and care givers have been trained to keep matters of these HIV-positive youth confidential.
She said the awareness of the virus has increased across board but access to treatment is slim, commending the Lagos State Action AIDS Control Agency (LSACA) and called on the youth present living with the virus to continue in the line of determination to achieve their desired goal.
The United Nations Children’s Fund (UNICEF) HIV Specialist, Dr. Victoria Isiramen stated that, “about 196,000 of adolescent living with HIV in Nigeria and globally accounts for 10 per cent of adolescent living with disease.”
Isiramen added that no society should neglects its youths, stating that, “UNICEF launched ‘The All In Initiative’ in 2015 which means that all hands must be on deck to ensure adolescent are brought to ground level and meet with the needs of all adolescent living with HIV.”

Nigeria Must Reduce Infection In Adolescents To Be HIV-free – Umoh

Mr. Francis Umoh is the Programme Manager, Positive Action for Treatment Access (PATA), Lagos who was in charge of a two-week national mentorship and leadership training programme for Adolescents Living with HIV in Nigeria (ALHIV) with the support of UNICEF in collaboration with the Lagos State AIDS Control Agency (LSACA). In an interview with CHIOMA UMEHA, Umoh discusses the purpose of the just-ended vacation training and how about 196,000 Nigerian adolescents living with HIV can have improved health and quality of life. Excerpts:
Can you give details of the just-ended national mentorship and leadership training programme for Adolescents Living with HIV in Nigeria (ALHIV) organized by PATA?
The event promotes access to HIV treatment education, care and services; advocate for access to affordable, qualitative diagnostic and monitoring tests, drugs and commodities to treat HIV and its attendant problems. Our youth mentorship and leadership programme is for adolescents aged between 10 and 19 living with HIV. It is usually a summer programme and is done during their long vacation. The idea is to bring together adolescents from different states, to promote team bonding. This programme enables them meet with other peers from other states, share experiences and bond as a group. We also seized the opportunity to educate them on sexual reproductive health issues. They were supposed to be 54 from seven states, but, we had 50 adolescents from Kaduna, Federal Capital Territory, Abuja, Akwa Ibom, Benue, Anambra and Lagos in this year’s event. One of the states was unavoidable absent. We also had their care-givers with them; the aim was to ensure that they take their drugs.
Are these adolescents aware of their status?
Most of them are, but not all of them are aware of their status, because not all of them got it from their parents. Some may be positive, but their parents will not tell them. However, part of the criteria for this programme is – knowing your HIV status, because at the camp we mention issues of HIV openly and we don’t want anybody to be embarrassed. But, they are not openly positive because we maintain issues of confidentiality.
What are the challenges of adolescents living with HIV?
One of their challenges is the issue of access to treatment. The drugs are there,though, sometimes we have isolated cases of stock out at the clinic. However, the adolescents lack access to available drugs. Also,we see cases of stigmatisation, for instance, we have seen cases where the children were denied admission because of their status. We have some that have been thrown out of their house because of their status. In some cases, their parents are dead and their relatives tried to take them in, but when they discovered their status, they threw them away.
In PATA, we have home for this type of cases called ‘Mary’s Home’, named after the first adolescent diagnosed with HIV. We have about five adolescents living in the home right now. The home caters for their accommodation, feeding, health and other needs, and ensures that they can live a normal life. So stigma is still strong in Nigeria. The next issue is that of limited access to information on sexual reproductive health and HIV. We did a research some years ago and we found out that many adolescents with HIV have poor knowledge of HIV compared to their negative peers, so some of them don’t have basic information. Also, some of them experience sexual urge, so they need capacity building on issues of sexuality and reproductive health.They also need information on their future careers, so these are some of the issues.
What are the ways to reach out to the unidentified adolescents living with HIV?
Part of the campaign going on is to promote HIV testing and uptake for adolescents. It is only when you test that you can know if the person is positive or negative, so there is a serious campaign to promote testing and then uptake of service for the positive ones. Right now the whole world is talking about 90-90- 90 treatment target by year 2020, and HIV-free generation by 2030. For us to achieve that, about 20 million have to be tested, the 20 million diagnosed people have to be on drugs and the 20 million on drugs should have a suppressed viral load. So for Nigeria to achieve this global target there must be massive HIV testing and uptake for adolescents. The only way to do this is to go out to these adolescents, not expect them to come to you. Most importantly, when they are tested positive, they need to be provided with treatment.
How do you go about the issue of follow-up?
During testing and counselling, of course their basic data are collected and they are linked to service, but, one challenge they have is transiting from paediatric to adult care. This is still a big issue. In Nigeria, once you are 15, you transit to adult clinic but, you know at 15 the child is not yet a full adult. So you have a case of children that is used to paediatric clinic, and instead of transiting the child to adolescent clinic, you move the child straight to adult. This sometimes causes loss to follow-up, because when they get there and see only adults, they get scared and leave. One way to solve this is to have a day or time set aside to attend to the adolescents; there should be that platform for adolescents. On our part, we have tried to solve this case by peer mentorship where the peers counsel their peers on transitioning. Also, we have issue of poor attitude of caregivers. Though, this is improving, but, the caregivers need to know that an adolescent might not react the way an adult does, so you have to be patient with them.
Does poverty affect access to treatment?
Although treatment is free, poverty indirectly affects uptake of treatment, but, this is also related to stigma and discrimination. We have situation where clients have a treatment Centre close to them, but, because of fear of stigma, they go to a far treatment centre. In this case transport fare becomes an issue. Also, when we talk about comprehensive access to treatment, it goes beyond having drugs; you have to have a lab test done, checkups including, viral loads and even nutrition. So, all these involve money. If you are taking your drugs and you are not eating well or in school, this affects the children psychologically. So, yes poverty is still an issue.
Do you think Nigeria is having more cases of adolescents with HIV?
Yes it is increasing. As at 2014, according to UNICEF, 160,000 adolescents aged between 10 and19 were living with HIV/AIDS in Nigeria, in 2013 about 11,000 died, while 17,000 were infected. Although, the issue of mother to child infection is being checked, sometimes, you see some women accessing antenatal care, but when they want to deliver, they drop out and go to a Traditional Birth Attendant (TBA) this leads to more mother-to-child infection. Nigeria needs to improve on our accountability and transparency in implementing the programme, so that service gets down to the people that matter. There is also need for capacity building for adolescents and service-friendly services.

This story was published in Independent on Sep 7, 2016


Monday, 12 September 2016

Poor Funding Hinders Malaria Research – NIMR

Following World Health Organisation (WHO) latest survey which shows that not less than 51 million Nigerians, equivalent to 30 per cent of the population, tested positive to the malaria parasite in 2015, researchers have decried growing paucity of funds required for research which is impeding the roll out of malaria interventions and others.
The researchers who are from Nigeria Institute of Medical Research (NIMR),Yaba, Lagos, while noting that the highest number of Malaria cases occurred in the North West and North Central zones of the country, raised alarm that Nigeria is not on track for malaria elimination.
Lamenting, the Deputy Director (Research) and Head, Malaria Research Programme (NIMR) Dr. Sam Awolola, said with such high malaria burden, and continued reliance on foreign intervention, the country is far from being on track to end the malaria scourge.
Awolola, who raised the alarm at a forum organised by NIMR in commemoration of this year’s World Malaria Day, said the theme: “End Malaria for Good,” was not meant for a country like Nigeria which he said was far from pre-elimination not to talk of elimination.
His said: “The 2014 and 2015 World Malaria reports testify to this fact. The Nigerian National statistics shows that malaria accounts for 60 per cent of hospital out-patient visits, 25 per cent infant deaths, 30 percent of all under-five deaths and 11 per cent of maternal mortality annually.”
“Unless our government funds research by creating enabling environment, putting the right infrastructure in place and human capacity to do research, we cannot make progress.”
According to him, although there has been improvement in malaria interventions, but the parasites indices remain high and that shows how far Nigeria is from elimination.
He noted that if nothing is done, many of the gains and progress made in the field of malaria research and control will be lost, as “defeating malaria today is investing in our tomorrow.”
He cited the instance where NIMR had to drop a research work on the characterization of sites for malaria test vaccines due to lack of funds, saying vaccines cannot just be brought into the country without testing them.
“We cannot equally develop vaccines without research, because it is research that develops vaccines, and if money is not invested, how do we get results,” he asked rhetorically.
Currently, NIMR is carrying out site characteristics for the testing of a new malaria vaccine in Nigeria, but he noted that the Institute should have advanced beyond that.
Awolola explained; “research has a key role to play in the quest towards malaria elimination, as findings from research works are needed to guide policies, yet very little is done by government to improve on research funding.”
Research he said is not a jamboree because it requires the right infrastructure, human capacity and the right environment so unless government investments properly in it, “our health research institutions will remain what they are.”
He told Independent that though he can no give figures on government support, but “for the last five years I have been the head of the malaria department, I can tell you Research funding has been very poor, not only malaria research, but generally.”
He stressed the need to accord the importance of research in developments, “we are in a country where research is not recognised,” he added.
“Nigeria has a vaccine development laboratory but for many years, no money has been made available to run it. The American government has put close to $20 billion in developing genetically modified mosquitoes in the last 20 years, and up till now they have not been successful, but with us here, within one or two years we want results. Research is a long term venture, but result will definitely come at the end,” Awolola lamented.
The malaria group boss pointed out that external bodies fund most research in Nigeria, “When foreigners fund research they want their results and this affects us negatively.”
“And as long as our researches and interventions are donor driven, he that pays the piper dictates the tunes,” he expressed.
Corroborating, WHO Malaria Containment Representative in Nigeria, Dr. Tolu Arowolo, in her presentation confirming the recent malaria prevalence conducted across Nigeria, and published in April 2016, said it shows that the North West and North Central zones have high prevalence of malaria cases.
Her words: “North West has 37 per cent; North Central, 32 per cent; North East, 26 per cent; South South, 19 per cent; South West, 17 per cent, and South East 14 per cent. But when you look at the 2010 Malaria Indicator Survey result, it was the opposite, because the South West appeared to have the highest malaria burden, but now it has changed.
“Currently, Nigeria is at 27 per cent, by the time we would repeat the survey by 2020, it is expected to be less than five per cent and this is achievable because our prevalence in 2010 was 42 per cent and now we have 27 per cent which is about 15 per cent reduction.”
She however canvassed for robust integrated data management to reach out to population at risk, accurate diagnoses of all person at risk, activities that will encourage use of material that prevent malaria, availabilities of commodities in all healthcare facilities among others.
Arowolo told Independent that malaria eradication is possible in Nigeria: “We have tools, interventions and strategies like our malaria strategic plan which targets pre elimination in the country by 2020 through deploying all the current evident based interventions to scale.
In the same vein, Arowolo noted: “we are also seeking to increase generation of funds to be able to conduct research as well as put in place good accountability mechanism in place to coordinate the plan.”
Arowolo stated that new studies about insecticide and drug resistance are ongoing since it’s been constantly reported that mosquitoes are getting resistant to them.
She identified the challenge of people boycotting interventions like the use of long lasting mosquito nets due to epileptic power supply as studies has shown.
On his part, the Director General of Nigeria Institute of Medical Research, NIMR, Prof. Innocent Ujah lamented the high percentage of deaths caused by malaria.
“In spite of the global effort to end malaria, it is still a major public health problem in Sub-Saharan Africa and Nigeria in particular which the 2014 and 2015 world malaria reports testify to this fact,” the DG said.

This story was published in Independent on May 26, 2016


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