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Combating yearly Lassa fever, cholera scourges

NIGERIA is engaged in an endless war with several scourges as a result of poor health infrastructure, insufficient investment in healthcare, inaccessibility of quality health services and a stagnating health workforce. Among the annual debilitating deadly outbreaks are Lassa fever and cholera disease. Lassa fever has infected 659 persons this year. Fatally, 123 deaths have been recorded across 91 local government areas from confirmed cases of the disease in 2022, according to the Nigeria Centre for Disease Control. This is a huge burden that needs a concerted strategy.

A deadly outbreak of cholera is also on the loose. In 2022, 470 suspected cases have been reported in 10 states. Taraba State has the highest number of cases. Nine persons have died so far from it, says the NCDC.

Both diseases have had a negative devastating impact on Nigeria for a long time. Cholera, an acute diarrhoeal infection, killed 3,604 Nigerians from 111,062 cases in 2021, official NCDC figures stated. These numbers are scary, prompting the Federal Government to declare them as “unacceptable.” It afflicted 33 of 36 states and the Federal Capital Territory last year.

On its part, Lassa fever, an acute haemorrhagic disease caused by the Lassa virus, and contracted through close contact with an infected animal, specifically the Mastomys rat species, killed 174 people from 833 confirmed cases in 2019. In 2020, 244 Nigerians died from 1,189 confirmed cases; 79 died from 418 confirmed cases in 2021.

This year, Ondo State has topped the infection chart with 29 percent. Edo and Bauchi states accounted for 24 and 15 percent of the infections respectively, representing an increase in the number of cases in 2021. The World Health Organisation says the infected rat can shed the Lassa virus in its urine or faeces in food through which infection can occur. Person-to-person transmission is also possible from direct contact with an infected person’s blood, urine or other bodily secretions.

Unfortunately, frontline health workers who directly provide services where they are most needed are bearing much of the deadly brunt of Lassa fever. No fewer than 45 of them have been infected this year alone.

Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. At-risk areas include slums and camps for internally displaced persons where minimum requirements of clean water and sanitation are not being met. It affects both children and adults and can kill within hours if untreated.

Sadly, in many Nigerian communities, open defecation is the only known means of faecal disposal. The United Nations Children’s Fund stated that residents of 703 LGAs in Nigeria still practice open defecation. Since Vibrio cholerae multiplies in the intestine of a carrier and is present in his faeces, open defecation also allows for release of the pathogenic bacterium into the environment and results in contamination of farm products. From there, human beings are infected by the contaminated food, if not properly handled.

An upsurge of cholera infection occurs during the rainy season because many Nigerians who lack access to potable water drink from wells, open rivers or streams that have been contaminated by floods which convey the pathogen from septic tanks and other polluted sources. Insufficient vaccines and inadequate health facilities have been adduced as some of the factors militating against its eradication.

The task is made more challenging because of the prevalence of extreme poverty, as Nigeria is the global capital with more than 90 million persons. Additionally, Nigeria, with a population of 211 million, has a doctor-to-patient ratio of 4:10,000 versus the recommended 1:600. This adds greatly to health risks. The Nigerian Medical Association says the country needs “about 303,333 medical doctors now, and at least 10,605 new doctors annually to bridge the manpower gap in the health sector.”

While the country languishes, oil-rich Qatar leads the way globally with 77.4 physicians per 10,000 people, followed by Monaco (71.7), Cuba (67.2), Greece (54), and Spain (49.5). In the United Kingdom where the President, Major-General Muhammadu Buhari (retd.) frequently goes on medical vacation, over 328,000 medical practitioners are employed, reflecting an overall increase from 2010 when there were 227,000, says Statista.

In spite of the Abuja Declaration of 2001 which mandated African Union member countries to allocate 15 to 20 percent of their annual budgets to the health sector, the Federal Government continues to allocate meagre resources to the sector. In 2019, the sector received N372.7 billion (4.18 percent); in 2020, it got N414.5 billion (4.16 percent) and in 2021, N549.8 billion (7.01 percent). Out of the 2022 budget of N17.12 trillion, N380 billion and N134 billion were earmarked as recurrent and capital expenditures respectively.

For the average Nigerian, the challenges are many. Without a viable health insurance scheme, many Nigerians struggle to pay for health services. The World Bank estimates that Nigeria has one of the highest out-of-pocket expenditure rates on health, at 70.52 percent. This places it in the category of countries infamous for poor human rights, civil unrests and gross abuse of resources such as Turkmenistan, Myanmar, Equatorial Guinea and Bangladesh. African countries which score better than Nigeria include the Gambia (23.19 percent), Kenya (34.30 percent), Uganda (38.26 percent) and Ghana (36.22 percent).

The Minister of Health, Osagie Ehanire, recently pledged to strengthen the Primary Health Care system. The Buhari regime should deliver on this promise. The state governments should build and revive more hospitals in their domains. LGs should accord priority to efficient primary health centres. The three tiers should stock adequate supplies of vaccines.

Individuals and groups should also take responsibility for their health. Families should maintain a high level of hygiene around the home and in the environment to prevent the infestation of rats and other pests. Waste landfills should be sited far away from residences, and structures provided to contain these rodents and prevent their entry into homes and food production chains in farms and markets. State governments should revive and make the sanitary inspectors system more effective, clean drains and ensure every house built has a standard toilet and a sewage system.

A multifaceted approach is essential to control cholera, and reduce deaths. Provision of potable water, sanitation and hygiene and use of oral cholera vaccines should be encouraged through intense advocacy.

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