Monday, 1 October 2018

Stakeholders Worry Over Future Of Health In Nigeria

...As Royal Philips New Survey Reveals Ailing Sector

By Chioma Umeha
There is growing concern over the state of healthcare in Nigeria. Many pundits have it that there is no future to the country’s healthcare system.
According to them, it is a scenario where uncertainty governs access and the structure is largely powered by out-of-pocket payments in the private sector and an over-burdened public sector.
The answer does not even lie in government simply putting more money in the health sector, but the solution is restoring the confidence of the Nigerian public in the system.
It was not surprising therefore that the issue was a focus on the a recent summit in Lagos, tagged, ‘Future of Health In Nigeria’ organised by Royal Philips, one of the global leaders in health technology, in collaboration with KPMG Africa.
The deliberation which attracted many health industry key players who brainstormed on way forward for the sector witnessed the release of a new health survey in Nigeria.
Data from the survey which comprised over 500 Nigerians via interview showed, “52 per cent trust the healthcare system, although only 36 per cent feels that their healthcare needs are being met.”
The survey also highlighted a clear discrepancy between the expectations of Nigerians and the reality of the healthcare system, indicating inefficiencies and ample room for growth.
With more than half of Nigerians leaning on hospital facilities for the most minor of ailments, there is a clear need for improved access to primary care practitioners, local health facilities, tracking health indicators and a wider availability of information about health, nutrition and fitness.
The survey further said, “majority of Nigerians (65 per cent) believe that improved access to health facilities would make them more effective in managing their health, thus alleviating pressure on the system.”
Commenting, Radhika Choksey, Philips Group Communications, Africa, explained that the survey was aimed at understanding what the ‘Future of Health’ might look like in the country and its associated challenges.                                             
Choksey further said that the Agency One Voice Connect conducted the survey online between April 11 and 24, 2018 among 503 Nigerian adults, majority of whom are aged from 18 to 34 years.
A breakdown of the geographical zones involved in the survey showed that 80 per cent of urban/city were covered, while 13 per cent and six per cent consisted of the suburb as well as rural areas respectively.
Further analysis of the regions showed that the North Central states of Benue, Kogi, Kwara, Nasarawa, Niger, Plateau, Federal Capital Territory comprised 17 per cent of the figure, while  North East states Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe consisted  four per cent.
Seven per cent of the figure came from the North West states including, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, Zamfara; South East states including, Abia, Anambra, Ebonyi, Enugu and Imo made up eight per cent of the figure.
However, 16 per cent of the figure was from the South South states including Akwa Ibom, Cross River, Bayelsa, Rivers, Delta and Edo and the South West  states –  Ekiti, Lagos, Ogun, Ondo, Osun, Oyo shared the remaining  48 per cent.
On his part, Kunle Elebute of KPMG Africa declared open the summit with his discourse on the importance of partnerships towards ensuring equitable healthcare.
He stressed on the importance of harnessing capacity in the private healthcare sector to fill gaps in the public sector.
In his keynote address, Michael Jackson, healthcare futurist, spoke about the recipe for change which includes computing, communications, connectivity, among others. Jackson also illustrated the changing face of technology and how this has impacted the world and the day to day life of its people.
He spoke about the evolution of business which now focuses more on skills, knowledge, decentralisation, partnerships and digital engagement and the fast pace of technological development, encouraging healthcare professionals to emulate this progression in rolling out digital healthcare solutions for Nigeria and Africa.
There was a panel session which looked into the role of technology in the transformation of healthcare in Nigeria during which Jasper Westerink, CEO, Philips Africa, posited that besides the provision of important healthcare solutions through technology, Philips is committed to educating and creating awareness towards the reduction of risk factors associated with unhealthy lifestyles. He added that provision of technologies that enable a healthy lifestyle also remained a key priority for Philips Africa.
Westerink also gave specific examples of healthcare product innovations from Philips such as handheld probes and the importance of training opportunities for non-healthcare professional to operate them.
He said that having a wide spectrum of healthcare attendants embedded in communities would go a long way to fixing issues with the overburdened primary healthcare systems. He noted that access to technologies that capture early diagnosis is another way to alleviate this burden.
The Philips Africa CEO emphasised the need for collaborations, partnerships and the provision of fast-paced healthcare technologies towards making positive impact on lives. He noted that challenges exist but so do opportunities to bring together resources and partnerships to leapfrog sustainable healthcare in communities.
Citing the private sector, government and Nigeria’s young and vibrant population as key stakeholders to bring to the table, he concluded the session by reiterating the importance of education, prevention,  focus on acute challenges and harnessing the resources of stakeholders who want to make a change in Nigeria’s healthcare sector.
He added that in principle one could solve Nigeria’s healthcare challenges with the structures in place. Furthermore, he gave examples of digital, connected technologies being developed in Africa and delivering healthcare solutions to Africans today.
He cited the example of Philips’ community life centres using solar power in Kenya. He said that technology can help tackle challenges right here in Nigeria such as the inequitable ratio of (one medical doctor) 1 MD: 25000 patients and the language gap across the 500 dialects spoken here, encouraging healthcare professionals to adopt this tactic: simplify, smarten-up, specialise.
Dr. Jide Idris, Commissioner of Health, Lagos State, in his submission touched on the importance of training to ensure healthcare professionals are well-equipped, applied technologies, health promotion and preventative solutions.
He also spoke about the importance of communication and behavioural change initiatives in order to leapfrog from education to ensuring that technologies are well understood and applies in communities.
Another discussant, Ms. Clare Omatseye, President, Healthcare Federation of Nigeria, opined that with technology being a major driver of change, especially today when patients are digitally and empowered, healthcare solutions must be incorporated into everyday innovations and meet patients where they are.
She added that while Nigeria has as many skilled consultants in other countries such as the USA and the U.K. due to brain-drain, there was a need to close the digital divide so that consultancy services can be delivered seamlessly across borders.
She observed some challenges facing the healthcare sector including financing and access to capital as well as the importance of collaboration with sectors outside healthcare in order to deliver viable solutions.
Focusing on the issue of brain-drain, she said that some of the top reasons for this including remuneration, access to technologies and better working environments all of which she said can be fixed with the right level of commitment and investment.
She also talked about Nigeria’s vibrant private healthcare sector, which is unfortunately fragmented due to gaps in solutions. She said it was important for government to partner the private sector and bring in their passion in order to achieve the ideal formula for success in healthcare delivery.
She then decried the phenomenon of patients getting more impoverished when they get sick and the need for alternative and cost effective means to access quality healthcare through PPP is made available to all. She encouraged governments to provide a pool of funds towards this, to advocate for mandatory universal healthcare and to spend more time on prevention rather than cures.
On his part, Martins Ifijeh, Head, Health Desk, This Day Newspaper, talked extensively about the need for prioritisation by government of more budget allocation to healthcare provision in Nigeria. He said Nigerian government could do more with regards to universal health coverage, stating that it has to be constitutionally mandated to achieve the desired results.  He also said that the issue of universal healthcare should be highlighted more in Nigeria’s political discourse and emphasised the need for collaboration between government and stakeholders.

Facts About Assisted Reproductive Technology

By Our Correspondents

Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
Types of ART
Common methods of ART include: In vitro fertilization (IVF), meaning fertilization outside of the body. IVF is the most effective and the most common form of ART.
Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer – This is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s fallopian tube. Fertilization occurs in the woman’s body. Few practices offer GIFT as an option.
Intracytoplasmic sperm injection (ICSI) is often used for couples with male factor infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg as opposed to “conventional” fertilization where the egg and sperm are placed in a petri dish together and the sperm fertilizes an egg on its own.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her own egg. The child will be genetically related to the surrogate and the male partner.
Gestational Carrier
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn’t become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by her partner’s sperm and the embryo is placed inside the carrier’s uterus.

Unsafe Water: Reducing Threat Of Water-Borne Diseases, Child Mortality

By Chioma Umeha 

Many people of Bangai in Riyom Local Government Area(LGA), Plateau State were still less ignorant when Samuel died. He was a 10-year-old pupil of Bangai Community primary school.
‘Samuel was pressed to pass feaces, so he quickly dashed into the closest bush. With his tiny frail hands, he quickly reached out for a short stick and quickly he has made a little hole. There he passed feaces. Immediately, he plucked some fresh leaves from a nearby plant to clean his butt. He hurriedly cleaned himself, leaving some of the feacal matter on his hands.
Then it was common practice for not only children, even adults to defecate openly in many communities in Bangai.
Washing of hands was hardly practiced. The only stream in the school community was less than one kilometre away. But, the path to the stream was rough, hilly, unsecured and its water was not safe for drinking.
Bangai is one example of hundreds of communities in Nigeria where access to safe water, adequate sanitation and hygiene facilities is still lacking.
Bangai is in Riyom Local Government Area of Plateau State.
Many people in the area practise bad hygiene, including open defecation. But, when the United Nations Children’s Fund (UNICEF), sensitised the populace to the dangers of poor hygiene, they decided to turn a new leaf.
The crisis of lack of access to safe water, adequate sanitation and hygiene facilities in Bangai seems like one of the ugly narrative of a crisis-laden health sector according to some community members.
Mrs. Victoria Gyang Head Teacher, Community Primary School, Bangai Local Education Area in Plateau State confirmed this said when spoke to DAILY INDEPENDENT.
Gyang said, “Before now, to defecate was simple in Bangai community, but unhealthy. All that anyone needed to do was to just use a stick and make a hole, then pass faeces in it.
“People easily reached out for any nearby fresh leaves to clean their butts.  Washing of hands with or without soap was completely a strange exercise,” she added.
The Head Teacher bemoaned deaths of many Bangai children from water-borne diseases.
She said, “Then, we often had emergencies as children were often coming down with waterborne disease such as cholera, diarrhoea, among others.”
“It is sad, we have lost many children in this community due to lack of access to safe drinking water and poor hygiene,” Gyang further said.
“Samuel was an orphan and a Primary Three pupil being raised by her relatives. He was among those whose parents died during the 2008 crisis.”
She lamented, “Many of the children die before the age of five and their dreams are buried with them.”
Open defecation is almost common everywhere around the country. Recently, back in the city of Lagos, for instance, a young man dashed out of his shop with clenched teeth, pulled open his trousers, took a quick look around, retired to a small bush by the church building, and dropped off lumps of smelly faeces.
His action did not surprise many passers-by who merely looked away, for it is a ritual of sort in many parts of the country. In nearly every open space in and around rural communities, heaps of faeces literally jostle for space with human beings. From some homes, faeces wrapped up in newspapers are thrown from windows, scattering into a spatter mess; it piles the streets as though they are articles of ornament. However, no one appeared to worry about it.
In Bangai, Yakubu Bwede, the chief of the community, said, “What you often found in few privileged homes was a makeshift toilet in which wooden plank platform were constructed with buckets under it.
“Family members often dropped off lumps of smelly faeces into the bucket which they disposed later.  The sight of such was quite repulsive.
However, the European Union (EU) funded UNICEF programme, has changed all that in Bangai. It did not only provide borehole for the community school, but has built a modern toilet for it. So far, the facilities have started to improve hand-washing compliance and water and sanitation standards in the school.
The students on their part have become change agents as they spread the good news to their parents, educating them of the benefits derivable from such practice.
Explaining measures which are taken to ensure that all pupils in Bangai Primary School use the toilet and do not defecate in the bush, Catherine John, Toilet/Health Prefect said, they often discipline those who defecate in the bush to serve as deterrence. “We flog those that still go to toilet in the bush and ask them not to go to the bush again.”
Concerning maintenance of hygiene in the toilets, Catherine said; “We ensure that the toilets are locked and whoever wants to use it often requests for the key to gain access to it. The reason we lock the toilet is to ensure that they flush it after use.” As at the time DAILY INDEPENDENT visited Bangai in March, the community has embraced good hygiene.
Confirming this, Bwede, said they have gradually, but steadily embraced the new development. He said the community had agreed to make it mandatory for every household to provide toilet facility.
The chief of the community also said, “Those who do not comply with this directive, which is monitored periodically, are fined N2000 as penalty for not doing so.
“Such money collected is used to provide public toilet for the community so that everyone could be part of this live-saving intervention from UNICEF. This has reduced the incidents of death occasioned by bacteria-induced infections by over two third. And we are grateful to EU/UNICEF,” he told DAILY INDEPENDENT.
Corroborating, Danlami Choji, Chairman, Parents Teachers Association (PTA) Bangai Community Primary School, said since the borehole was built we don’t see people go to the river again. Most people in this community now use the borehole instead of going to the river.
Choji also said, “The borehole is better than the river. Though the river is close, but people are now using the borehole instead of the going to the river.
“Fetching water from the borehole is more convenient, safer and healthier than the river. Stories of children bitten by dangerous reptiles or fighting inside the river has become a past thing.
“Water-borne diseases like cholera, diarrhoea, typhoid and so on were common, when we were using water from the river. But since we started drinking water from the borehole, this has reduced. We have about 10 boreholes and they are all are working.”
Challenge of unsafe water and poor hygiene
Safe water, adequate sanitation and hygiene facilities are critical to the survival, growth and well-being of the child. This is because safe water is essential for life and sanitation. Good hygiene also enhances good health.

In Nigeria, however, access to clean water and sanitation is generally improving – but at a slow pace.
The recent Multiple Indicator Cluster Survey (MICS), conducted by the government in 2016/17 indicated that about 40 per cent of households and over 69 million people do not have access to clean water in Nigeria.
Water-borne diseases and childhood mortality
However, UNICEF indicated that children without access to safe water are more likely to die in infancy or during childhood from waterborne diseases.
It added that diarrhoea remains the leading cause of death among children under the age of five in Nigeria.
The UNICEF report said, “Waterborne diseases also contribute to stunting of growth in children. A stunted child is shorter than she or he could have been and will never be able to reach her or his full cognitive potential.”
“Children are dying every day from diseases, such as diarrhoea, even though we know how to prevent them,” said Clarissa Brocklehurst, chief of water and sanitation for UNICEF.
“We must work hand in hand – health professionals alongside engineers – to ensure that improvements in water supply, sanitation and hygiene reach everyone.”
UNICEF noted that diarrhoea, cholera, typhoid and other diseases can easily be prevented with cheap and proven interventions such as pit latrines and hand-washing with soap.
Regardless, progress has been ‘painfully slow’ in many developing countries, the organisation said.

Lagos Creates Consultant Pharmacist Cadre In Govt Service

•It’s Testament To Global Best Practices –PSN

By Chioma Umeha 

Lagos – History has been made in the quest for health workers’ career progression as the Lagos State Government has approved the creation of Consultant Pharmacist cadre in its scheme of service.
In a letter of appreciation to Mr. Akinwunmi Ambode, Lagos State governor, Pharm. Bola Adeniran, Chairman, Pharmaceutical Society of Nigeria   (PSN) Lagos State chapter, thanked the Lagos State Government for the gesture.
Pharm. Adeniran said that the creation of the consultant cadre was a testament to the global best practices expected of a Centre of Excellence like Lagos.
She said the creation would eventually ensure that the professionals would be able to practice to the best of their ability in enhancing patient-centred healthcare services.
“We look forward to the speedy implementation of the circular,” she said.
The creation of the consultant cadre for pharmacists was sequel to the approval of the submission of the Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) made to the Head of the Civil Service of the Federation on May 8, 2017 on the need to review the Scheme of Service for Public/Civil Service Pharmacists.
The letter of approval was signed by Dr. A. K. Muhammad, Permanent Secretary (SPSO) for Head of the Civil Service of the Federation.
In the submission, the AHAPN contended that the current Scheme of Service had no provision for the Fellowship programme of the West African Postgraduate College of Pharmacists (FPCPharm).
“Under the extant scheme, Pharmacists are stagnated at Grade Level 16 or even 15 because there is only one provision for Grade Level 17 which is the directorship position. It is important to state that a good number of Pharmacists spend over 12 years on Grade Level 16 with many of them retiring without the attainment of Grade Level 17.
“Therefore the request for review has been necessitated by the fact of the establishment of the West African Postgraduate College of Pharmacists to acquire more skills through specialist courses which they undertake in a four year programme thus qualifying as consultants.
“The approval and the commencement of the six-year Pharm D Programme, a clinical-oriented and patient-specific programme whereby pharmacists shift from the traditional dispensing to offering a comprehensive pharmaceutical care, rational drug use, therapeutic drug monitoring, providing drug information services and pharmacovigilance.”
The AHAPN also said that public service pharmacists had been engaged in manufacturing and quality assurance of pharmaceutical products used in public hospitals both at State and Federal levels thus helping in improving the quality of products and services rendered by pharmacists in public health institutions and the increasing role of Pharmacists involvement in policy formulation on drug use, distribution, control and management.
“In the light of the above, we hereby propose two distinct schemes, one for the General Practice Cadre and the other for the Consultant Cadre in order to eliminate stagnation and frustration while restoring equity, justice and team spirit in the health sector.”
The submission was submitted in 2008 during the National Council on Establishment meeting held in Jos, Plateau State following which the NCE set up a technical committee which went round to verify the claims in the submission. The team visited Lagos, Enugu, Plateau and Kano states after which it submitted its report to the Prof. Oladipo Afolabi, the then HoCSF.
The Committee headed by the Head of Service of Benue State was mandated to harmonise the submission and make recommendations to a larger council. The council sitting in Abuja in Agust 2011 approved the submission.
The Council upheld the recommendation of the Committee and approved the request for the creation of Pharmacists Consultants Cadre in the Public Service and the Scheme of Service for the Cadre.
In the new scheme of service, Consultant Pharmacist would be on GL 15; Principal Consultant Pharmacist  GL 16 while the Chief Consultant Pharmacist would be on GL 17.
Recall that JOHESU is currently on nationwide strike over alleged Federal Government’s failure to meet their demands.
The union suspended its last nationwide strike on September 30, 2017, after signing a Memorandum of Terms of Settlement (MOTS), with the Federal Government.
The MOTS was supposed to be implemented within five weeks after the date of suspension of the strike. However, the union noted that six months after the suspension of the nationwide strike, government was yet to do anything tangible over the pending issues.
However, the striking Joint Health Sector Workers (JOHESU) last Wednesday, directed all its members in states and local governments to join the in a nationwide indefinite industrial action beginning today’s midnight.
The directive was announced by Comrade Biobelemonye Joy Josiah, the National President of the union, at a press conference in Abuja.
According to him, the directive was sequel to another deadlocked meeting between JOHESU and the federal government delegation led by the Minister of Labour and Productivity, Chris Ngige.
Earlier, the strike was limited to the tertiary health institutions, but Biobelemonye said JOHESU had decided to involve its members at both State and LGAs levels following government unresponsiveness to their demands.
He blamed the government for not showing any seriousness to meet the demands of the union for adjustment of the CONHESS salary structure which affects over 95 per cent of the health workforce nationwide.
The National President said: “The Government has not shown enough commitment to tow the path of honour and meet our demands, especially, the core demand for the upward adjustment of CONHESS Salary Structure as agreed in the Memorandum of Terms of Settlement signed on September 30, 2017 with JOHESU.
“So we are left with no other option than to direct States and Local Governments to commence and join the strike action nationwide from midnight of today, Wednesday,  May 9, 2018.”
Biobelemonye further alleged that members of JOHESU have continued to be shortchanged by the Federal Government in favour of medical doctors.
“We wish to bring to your attention, that the preferential treatment given to Medical Doctors has remained the major albatross to the peaceful coexistence of Health Practitioners in the Health Industry in Nigeria.”
He added, “On the issue of CONHESS adjustment, which we regard as the flagship of our demands, government in 2014 granted CONMESS adjustment to Medical Doctors and immediately two months arrears while other months were spread.
“CONHESS review is the upward adjustment of the CONHESS Salary table in-line with the same principles used in adjusting the CONMESS table for Medical Doctors who work with us in the health team.
“Our own demand for the adjustment of CONHESS that affects over 95 per cent of the health workforce nationwide has been frustrated, and part of the reason for this is that the Minister of Health as well as the Minister of State for Health are all Medical Doctors, while the Minister of Labour and Employment, who should be a neutral umpire in Trade Disputes is equally a Medical Doctor.
“They, therefore, feel unconcerned on matters of welfare of other healthcare providers.  This is quite unfortunate,”
“However, after three rounds of meetings held on Thursday, April 26, 2018, May 2, 2018, and  May 7, 2018 respectively, at the instance of the Minister of Labour and Employment to find a way forward, but alas, the Federal Ministry of Health is bent on thwarting all efforts at reaching an amicable settlement of the issues of our demands.
“This  is particularly concerns the upward adjustment of CONHESS Salary Structure.
“Despite the superior argument of National Salaries, Incomes and Wages Commission to the effect that basic salaries are always the same apart from the 1991 distortion which was later corrected by a Federal Government policy with the Harmonised Salary Structure of 1988, while relativity is based on the entry point of Doctors and other Health Professionals,” he stressed.
“Government has not shown any seriousness to meet our demands and the existence of fifth columnists in and out of government who are bent on escalation to prolong the strike for their selfish interest of privatisation of government hospitals, and buy these government legacies for themselves has not helped the matter,” he added.
JOHESU commended their members who despite all provocations and intimidation have stood firm to defend their right.
The union further appealed to the general public and Nigerians to bear with it for the withdrawal of their services, which can be attributed to the insincerity of government, particularly, the Federal Ministry of Health.
It accused the leadership of the Federal Ministry of Health for behaving like a ‘Federal Ministry of Doctors’ rather than a Federal Ministry of Health.
However, due to various appeals and intervention from well-meaning Nigerians and Opinion Leaders, JOHESU said, it has decided to temporarily put on hold other activities such as; street protest/processions; rallies at state capitals, and joint zonal picketing.
Under the then President, His Excellency Alhaji Umaru Musa Yar’Adua, the Nigerian Government in 2009 had approved two different Salary Structures in the Health Sector.
These two Salary Scales were known as Consolidated Medical Salary Scale (CONMESS) and Consolidated Health Salary Scale (CONHESS).Medical Doctors in the Service of the Nigerian Civil Service are on CONMESS, while every other person working in the Health Sector was placed under the CONHESS structure.

Hypertension: Pharmacists On Awareness Drive, Offer Free BP Checks

Chioma Umeha

A diagnosis of High Blood Pressure, HBP, or as known by its medical terms, Hypertension is never a good news to the patient.  However, being aware of the condition is good because it helps the patient to modify his lifestyle.
According to recent survey by the World Health Organisation (WHO), there are at least 1.13 billion people globally suffering from Hypertension.
But, that is not the end of the bad news. The survey also found that incidences of hypertension had doubled in the last 40 years.
Another WHO’s recent gender comparison data on hypertension prevalence further rated Nigerian adult high with 51 percent for males and 49 percent for females, followed by Ghana with 41 percent male and 38 percent female.
It is against this background that pharmacists marked this year’s World Hypertension Day via a walk against high Blood Pressure (BP).
The pharmacists who organised the event under the auspices of West African Postgraduates College of Pharmacists Nigeria (WAPCP), Lagos Zone, in partnership with Association of Public Health Pharmacists of Nigeria (APHEPON)also did free BP screening and health talk. The theme of the day was “Know Your Blood Pressure.”
Dr. Arinola Joda, Publicity Secretary, Pharmaceutical Society of Nigeria (PSN) while speaking for WAPCP and APHEPON in an interview with DAILY INDEPENDENT, said that the two groups united to generate awareness about hypertension.
Joda noted that since hypertension is a silent killer and do not show any symptoms till gets chronic, awareness is vital to hinder its prevalence.
She reasoned; “If people know their status, BP-wise, then they are better able to protect themselves – keep themselves healthy because hypertension has been identified as a single risk factor for many cardiovascular diseases and endocrine problems.
“But, a lot of people don’t know their status, so you find people getting out of bed and just collapsing or developing a stroke because of some high blood pressure they didn’t know they had, so they were not managing it.”
The seasoned pharmacist further explained that when people know their BP status, they will be able to seek care quickly, control their BP, and prevent these other adverse outcomes.
That is why WAPCP, Nigeria chapter, Lagos zone thought it fit to organise a programme to create awareness so that people can go out to find their BP status, Joda said.
Concerning the walk, she said that it was aimed at creating awareness for people to take advantage of the free screening exercise and determine their BP status.
According to her, the lecture was a forum for more information about BP and other cardiovascular issues to be shared.
Warning against the dangers of hypertension as a silent killer and symptom-less disease, Joda stressed that though the sufferer does not show symptoms; he is ‘developing complications anyway.’
Giving instances, she said, “You can have macrovascular complications; you can have things like diabetes developing because of hypertension, you can have eye problems developing because of hypertension.”
The erudite pharmacist pointed diet and sedentary lifestyle as major contributing factors to hypertension.
She said that those who do jobs that require them to sit for long hours; doing no physical exercises at all are prone to hypertension.
According to her, the scenario not necessarily prevalent among the middle class alone, because even the jobs of many low-income earners are not so physical in nature, but make them sit and confined for long.
Then the food they eat is very unhealthy, she said, adding, “You can see somebody with a large bowl or plate of starch, and very little protein, and a lot of fat.”
The common types of hypertension in Nigeria, she said are Pre-hypertension, Stage 1 hypertension and Stage 2 hypertension. The normal blood pressure is 120/80, pre-hypertension tends to 139/89, Stage 1 tends to 159/99, while any blood pressure higher from 160/100 is Stage 2.
On treatments, Joda observed that if hypertension has not developed complications, managing BP is fairly straightforward, and can be done at any secondary care facility around.
She therefore recommended exercising and control of diet, noting that these are preventive measures.
“For people that are in that pre-hypertension stage, the best treatment is something we call lifestyle modification, Joda also said.
“If they manage their diet, increase their level of exercise, avoid some certain things like salt in the diet, stop smoking and reduce their level of alcohol intake, there will be an effect on the blood pressure.”
The walk
The pharmacists took a walk to the popular Makoko market where sellers and buyers were sensitised on the need to check their BP from time to time, so as to curb hypertension, in order to avoid an escalation of an already dangerous situation.
Literary materials on heart diseases, strokes and hypertension were also distributed as part of the sensitisation. On the way to and from the market, pedestrians and road users also received sensitisation materials, and the invitation to benefit from the the free BP check was also extended to them.
Free BP check
Recipients of the Free BP check and participants at the lecture commended the efforts. Sarah Ogunsanya, a civil servant working with the Yaba Local Government (LCDA) said; “The programme was nice. I checked my blood pressure, and it was found to be normal.”
Ogunsanya said that they were counseled on how to maintain blood pressure.
She encouraged people to go and check their BP, noting, “Some people die suddenly as a result of not checking their BP. So I thank the pharmacists.”
Another participant, Mrs. Omawunmi Ologududu, also a civil servant, told DAILY INDEPENDENT, “The programme was ok, and I love it. I checked my BP and it was normal.”
Ologududu also said, “They advised us not to eat too much salt, to stop smoking, eat balanced diet; a little garri (eba), plenty vegetables and fruits. Visibly excited at the positive outcome of her BP check, she said, “I want them to be doing the programme every month, to enable people check their BP here.”

WHO Releases Its First Essential Diagnostic List

Chioma Umeha
Following its Advisory meeting in April 2018, the World Health Organisation (WHO) has issued its first listing of Essential Diagnostics. The list is split into general laboratory tests (n= 58) and specific tests for key infections (HIV. TB, hepatitis, syphilis and human papilloma virus) (n=55). It is also split into sections relating to testing in primary care settings versus hospital laboratory settings.
With respect to fungal diseases and mycology, several key tests are included: microscopy, blood culture, other cultures and cryptococcal antigen test. These provide a good start for a mycology service.
Four levels of clinical setting and laboratory services are mentioned from primary care point of care testing, through district hospitals with laboratories, to regional and specialized hospitals and laboratories and finally national reference laboratories. All tests are not appropriate for all settings, either because of complexity or because of the need to deliver results fast.
The WHO will issue a call for proposals each year to incorporate additional tests. They will base such applications on need and on the evidence supporting the clinical value of each test.
Professor David Denning of the University of Manchester and President of the Global Action Fund for Fungal Infections declared: ‘This is an excellent first step by the WHO in ensuring that ill people can have a proper diagnostic evaluation, which for fungal infections is critically important. GAFFI engaged with the WHO ahead of the Advisory meeting and is pleased that some of the key tests required for fungal disease have been included, and that the door is open for more on an annual basis.’
Professor David Denning  giving his welcome speech at the Essential Diagnostics for Advanced HIV and Serious Fungal Diseases workshop in April at Hotel Africana, Kampala, Uganda
In June 2016, Lee F. Schroeder, Jeannette Guarner, Ali Elbireer, Philip E. Castle, and Timothy K. Amukele published a call to the WHO for a Model List of Essential Diagnostics1. In March 2017, the WHO Expert Committee on Selection and Use of Essential Medicines recommended the development of a Model List of Essential In Vitro Diagnostics (EDL), to complement the WHO Model List of Essential Medicines (EML). The announcement today is the product of this announcement and plan.

Ebola : Africa Centres For Disease Control Deploy Epidemiologists, Others To Congo

Chioma Umeha 
Urges long-term action to build resilient health systems locally and national public health systems to pick up events rapidly.
Kinshasa/ Bandaka/Bikoro, 20 May 2018 – The Africa Centres for Disease Control and Prevention (Africa CDC) is deploying 25 epidemiologists, laboratory experts, and anthropologists to support the government of the Democratic Republic of Congo’s (DRC)  efforts to control the recent Ebola virus outbreat in Mbandaka and Bikoro. Following the announcement on 8 May 2018 of the Ebola outbreak by the government of DRC, the Africa CDC deployed an assessment mission within 48 hours and activated its Emergency Operational Centre to link, scan and monitor the situation.
“The global community needs to respond to this outbreak as a crisis and not as an emergency, by quickly deploying public health assets to the affected areas expiditiously”. I want to applaud the Minister of Health of the DRC for his exemplary leadership in managing this current outbreak so far. “All our efforts should be geared towards supporting his leadrship” said Dr. John Nkengasong, the Director of the Africa CDC, upon his return this week, with a high level delegation, to the affected areas in Mbandaka and Bikoro.
The DRC government is working with partners to improve coordination mechanisms, enhance surveillance, laboratory confirmation, contact identification and follow-up, case management, infection prevention and control, safe and dignified burials, social mobilisation and community engagement, logistics, risk communication, vaccination, partner engagement, research and resource mobilisation.
During the Africa CDC team’s visits they assisted the Ministry of Health, together with other partners,  to develop three strategies: a) surveillance and contact tracing, b) Defining the various health areas affected, and c) laboratory testing and network. The Africa CDC will provide up to USD 2 million to support Africa CDC interventions. Due to the remote nature of the Equateur Province, it is expected that more efforts will need to be put in supply chain issues to ensure that essential items needed are delivered swiftly. Last week the African Union Peace and Security Council was briefed on the situation and will continue to receive reports.  Under Article 6(f) relating to its mandate with regard to humanitarian action and disaster management the Council can authorise deployment of military and civilian missions and assets to tackle emergency situations as it did in August 2014 in the Ebola outbreak in the West Africa sub-region. This outbreak is the 9th outbreak of the Ebola virus disease over the last 4 decades in the country. The affected health area of Bikoro covers 1 075 km and has a population of 163 065 inhabitants. This huge population is supported by only 3 hospitals and 19 health centres, most of which have limited functionality.
The risk of speard of the virus is high at national and regional levels due in part to the proximity of the epidemic focus to the Congo River which links with the capitals of the Republic of Congo and the Democratic Republic of Congo and the Central African Republic. As such, Africa CDC is coordinating with these countries to ensure that their surveillance systems are activated and information is shared in real time.

Growing Concerns Amid Low Adoption Of Family Planning

Chioma Umeha 
There are increasing calls for Nigeria to consider family planning so as to effectively control the number of birth amid rising population of almost 200 million people in the in the face of scarce resource.
There are also series of awareness campaigns by government and health related non-governmental organisation aimed at taking the message of effective family planning (FP) across homes in towns and villages.
Despite increased awareness programmes on family planning in the country, the uptake remains very low.
As method of ensuring effective population control, the global community has set 2020 as a target for more women and girls around the globe to be able to plan their families and their future via family planning programmes.
Visibly acting in line with this global commitment, Nigeria also set a target to increase its Contraceptive Prevalence Rate (CPR) from 15 per cent to 27 per cent that by 2020.
The CPR which is ‘the percentage of women of reproductive age who are currently using, or whose sexual partner is currently using, at least one contraceptive method, regardless of the method used’, is often reported for women aged 15 to 49 who are married or in a union.
To achieve the 27 per cent target, state governments also gave themselves target and Lagos state made a commitment to increasing its CPR to 74 per cent by 2020.
Less than two years to the global target, recent reports obtained by DAILY INDEPENDENT shows that the state CPR is drastically reducing, despite concerted efforts by the government.
Latest Multiple Indicators Cluster Survey (MICS) conducted by National Bureau of Statistics (NBS) shows that the contraceptives prevalence rates (CPR) is generally reducing in the South west states with Lagos sharing the lowest figure after Edo, Ogun and Ondo.
The 2017 figures showed that Edo had the lowest use of contraceptives with 15.7 per cent, Ogun and Ondo had 21.3 per cent and 21.8 percent respectively, while use of contraceptives in Lagos was 22.6 per cent.
The report showed a sharp drop in the use of contraceptives since the last ten years in Lagos state from 40.6 per cent in 2007 to 22.6 per cent.
To this, experts say they are ‘seriously worried’ about the trend in in view of growing need and demand for contraceptives. The development has raised many difficult posers about the reasons for the trend.
Worse still, unmet need for contraceptives among married women in the South west region was lowest in Lagos state in 2007.  While unmet need for contraceptives among married women in the entire South west region was put at 12.1 per cent of the national figure, Lagos state alone shared 8.1 per cent of that figure.
Ten years later that is by 2017, unmet contraceptive need had dropped significantly across the region. But, unmet need in Lagos (29.6) had become higher than the regional average (28.4).
Obviously, there are 29.6 per cent of Lagos women whose needs for contraceptives were still not met.
Did something undesirable happen to family planning efforts over the last decade in Lagos?  Why is the use of one contraceptives on the decline  in the state? These are some of the recurring questions among analysts.
Reacting, stakeholders in the health sector of the Lagos State have attributed the trend to growing misconceptions that have continued to trail family planning in the state and its environs.
Among the most common are beliefs that family planning causes excessive bleeding and infertility, they lamented.
Experts believe that there is need for providers of family planning services in the state to counsel clients on the various methods available and the side effects, so that they can make an informed choice.
They emphasised on the need to focus on both providers and clients with regards to attitude change.
Commenting recently, Dr. Jide Idris, the Commissioner for Health, identified misconceptions and myths as part of the major barriers to the uptake of family services in the state.
Idris spoke at the Isolo Local Council Development Area (LCDA) Town Hall Meeting on Family Planning in Lagos, called for collaboration among all stakeholders from every sector to improve family planning services.
He listed some traditions and misconceptions militating against adequate Family Planning uptake, especially Modern Contraceptive Prevalent Rate (MCPR) in the state.
Some of them, he said are beliefs that family planning causes excessive bleeding, cancer, infertility among other issues.
Similarly, Dr. Folashade  Oludara, Director, Family Health Unit, Lagos State Ministry of Health, corroborating the Health Commissioner stressed that some old beliefs are seriously mitigating family planning services in the state.
Sharing some of their experiences, Oludara told some select journalists from different media platforms, including DAILY INDEPENDENT in her office, recently said; “Some people told our family planning team in one of their sensitisation programmes that family planning is bad.

“They insisted that a woman need to bring out all the eggs God have given her by birthing, else it would turn to cancer.”
In some instance, she said “There are communities we go to in Lagos State that vehemently refuse immunisation and life-saving commodities, saying it is government’s ploy to make their children infertile and family planning is not left out,” she explained.
The Director, Family Health Unit also listed some benefits of FP to include; child spacing, high productivity of the mother, improved quality life of the children as well as the family.
She further tasked the media to ensure propagation of accurate information on Family Planning.
Oludara said, “Media needs to spread the correct information at all times, and not confuse the people the more.”
She therefore charged the media to help change these myths and misconceptions surrounding the usage of FP services in the country in order to increase its uptake and safe women from dying from preventable causes.
On her part, Dr. Moriam Olaide Jagun, the Senior Programme Officer, Palladium Technical Support Unit, corroborating the views of the Health Commissioner, identified behaviour change as a method of tackling misconceptions against family planning in the state.
Jagun who is currently working with the Lagos State Ministry of Health to implement its family planning programme noted that the State is making progress with regards to family planning commodities.
She explained that Lagos State is the first state to put in money to the last mile distribution.
The procurement of the commodities is done by the United Nations Population Fund (UNFPA) and given to the Federal Ministry of Health and it’s been distributed to various states in the country but Lagos State pays money for it to get to various facilities (last mile distribution), Jagun explained.
But, she stressed, that there is big gap in the area of unmet needs of married women seeking contraceptives.
The family planning expert lamented; “There is still more room for improvement. The number of unmet need is high. What we need to do as media practitioners is to advocate reaching the State’s 74 per cent target.”
She also tasked the media for its support to help change the myths and misconceptions surrounding the use of family services in the State in order to increase its uptake and save women from dying from preventable causes.
Jagun said; “When churning out reports, let’s write stories that will raise the profile of family planning. The awareness concerning family planning is high but what people need to know is that family planning methods are safe, free in both public and private health facility.

“Government is interested in pushing family planning forward and increase uptake. More people are using it, but most people are still scared to talk about it.
Jagun added; “Most people know about family planning, but we need to transcend from awareness to usage. I encourage people who are using family planning method to advocate for it. It will help increase uptake.
The reproductive health expert who spoke with journalists at a three-day  Pathfinder International/Media Dialogue on Family Planning, said with family planning, mothers and babies become healthier, because risky pregnancies are avoided, adding that fewer children means more food for each child.
“Family planning is cheap and abortion is expensive, you can get family planning free at any public health facility because the government has made provision for it.
Listing the economic benefits of family planning, she said; “Once it is administered to the woman, she will have enough time to take care of her existing children, husband and family at large. The woman will be economically viable to her family.
“For every dollar spent on family planning, six dollars is been saved for the country and the six dollars can be used to do other things in the health system.”
“For the myths and misconceptions, we need to debunk it, she insisted, adding, “The side effects are real for some of the methods, some people bleed, have headaches and even gain weight but there is different method for everyone.
“That is why the clients must be properly examined to check the various methods and the right one to choose from.”

Should Screening Of Genes Precede Pregnancy?

Our Correspondents

What if you could find out your odds of having a child with a genetic disorder before you even got pregnant? Modern testing makes it possible. With at-home tests, it’s easier than ever to get screened.
Doctors usually recommend this step for parents-to-be who have a higher risk of passing on certain diseases, like cystic fibrosis. And because of these screening tests, the number of people who have some disorders, like Tay-Sachs disease, has gone way down.
But what if you’re not considered high risk? Should you check your genes before you get pregnant? Your doctor or a genetic counselor can help you decide.
How does genetic tests work?
Many genetic disorders happen when a person has two bad copies of a gene, one from each parent. If you have only one faulty copy, you won’t have any symptoms of the condition, but you are a ‘carrier’ for it. Your baby will be born with the disorder only if both you and your partner pass the bad gene to him.
•To do a genetic carrier screening, also called preconception testing, your doctor will take a small sample of your saliva or blood during a checkup before you get pregnant. She will send the samples to a lab for testing. If you use an at-home kit, you’ll take the sample and send it to a lab yourself. The tests look closely at your DNA for genes that are linked to certain diseases. Standard screening tests check for: Cystic fibrosis
•Fragile X syndrome
• Blood disorders such as sickle cell disease
• Tay-Sachs disease
• Spinal muscular atrophy
Newer tests, called expanded genetic carrier screenings, can also find flawed genes for more than 400 other disorders, some of which are rare and have few treatments. Universal testing and at-home screening kits have opened the door for people of all risk levels to check their genes before pregnancy.
Who needs screening?
Your doctor will probably recommend a test for you and your partner if either of you is at a higher risk of being a carrier. This could happen if:
•A disorder runs in your family.
•You belong to an ethnic group with a high risk of genetic diseases, including:
•Ashkenazi Jewish (Tay–Sachs disease and others)
•African (sickle cell disease)
•Mediterranean and Southeast Asian (thalassemia)
If you are not in one of these groups, think about what the results of a screening might mean for you before you decide to get one.

Essence of genetic carrier screening
A test can’t tell you without a doubt whether your child will have a disorder before you’re pregnant. Results from a genetic screening test only help doctors more accurately predict your chances of passing problem genes to your children.
Still, there are some pros and cons to having the test. Some of the positives:
• It can find unknown problems. Many of the flawed genes these screening tests find aren’t linked to your race, ethnicity, or family history. You might never know you or your partner carries them. If you know your risk, you can make better informed decisions about your family.
• It can provide answers about your family history. The results can help you figure out if you’re in a high-risk group, especially if you don’t know your family history or if you come from a multiethnic background.
• The test itself is easy. Tests you get after you’re already pregnant, called prenatal tests, can have some risks for you or your baby. Taking a blood or saliva sample before you’re pregnant is quick and harmless.
Some cons:
• Results may be incorrect. No test is 100 per cent accurate. Yours could say you are not a carrier for a gene when you really are. On the flip side, very rarely, a result could say you carry a faulty gene when you do not. These incorrect results, or the possibility that your tests might be wrong, can be stressful when you are making choices about having a baby.
• You cannot always know how the genes will affect your baby. Even if you know there is a chance your child will inherit flawed genes, you may not be able to tell if she will show symptoms of the disorder, how severe they will be, or if they will get worse over time, depending on the disease.
What Else to Consider
Genetic carrier screening tests can give people important information, but they are not right for everyone. Think things through before you make your decision:
• How might the results affect me? Will knowing your chances of passing down a genetic disorder make you more or less worried during pregnancy?
• How might the results affect my family? Sharing (or not sharing) your results with family members who may also be affected by the information could cause tension.
• What will my next steps be? Think ahead about how you might handle news of your results. It may help to talk with a genetics counselor, who can help you think about the possibilities and your options. Ask your doctor to refer you to someone.
You and your partner might also consider in-vitro fertilization (IVF). With this method, doctors can combine the egg and sperm in a lab and check the embryo for any gene problems before you carry it in your womb. It’s called pre-implantation genetic screening. A genetics counselor can help you decide if it’s a good option for you.

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