International University of Africa

Faculty of Medicine and Health Sciences

African Medical Students Association

Health Problems in Africa: Is there any hope left?
10 11 January 2013 AD/ 28 -29 Safar 1434 AH Khartoum - Sudan

Major Health Problems in West Africa

Nigeria

Prepared by:

Jibril Umar Umar, MBBS Level 4, Umar Muhammad Sani, MBBS Level 4, Bintu Muhammad Mustapha, MBBS Level 3
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GENERAL INTRODUCTION
Nigeria
Nigeria, officially the Federal republic of Nigeria, is a federal constitutional republic comprising 36 states and its federal capital territory Abuja. Bordering the republic of Benin in the West, Chad and Cameroon in the east, Niger in the North and Gulf of Guinea in the south, Nigeria has a total land area of about 923,768 squares kilometers. Nigeria is the most populous country in Africa, with an average estimated population of 171,123,740 as at 2012. The country is composed of more than 250 ethnic groups, speaking more than 500 languages, with official language been English, and recognized national languages being Hausa, Yoruba, Igbo, Fulani. Nigeria lies between 4 16 and 13 53north latitude and between 2 40 and 1441 east longitudinal. Climate in Nigeria varies; equatorial in the south, tropical in the middle, and arid in the north. Crude oil is the main driver of the countrys economy with high income for crude oil sales and high external resources. Yet there is still high incidence of poverty in the country which has been hobbled by corruption, political instability, inadequate infrastructure, and poor macroeconomic management.

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STATISTICS
Total population Gross national income per capita (PPP international $) Life expectancy at birth m/f (years) Probability of dying under five (per 1 000 live births) Probability of dying between 15 and 60 years m/f (per 1 000 population) Total expenditure on health per capita (Intl $, 2010) Total expenditure on health as % of GDP (2010) 171,123,740 2,240 53/54 not available 377/365 121 5.1

FREQUENTLY DIAGNOSED DISEASES/TOP CAUSES OF DEATH IN NIGERIA

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Malaria HIV/AIDS Influenza & Pneumonia Diarrheal diseases Tuberculosis Stroke Coronary Heart Disease Birth Trauma Low Birth Weight Maternal Conditions Diabetes Mellitus Meningitis Pertussis Lung Disease Road Traffic Accidents Congenital Anomalies Violence Kidney Disease Hypertension Deaths 219,833 213,667 213,099 173,878 97,669 87,717 71,732 68,213 67,212 50,867 34,528 33,935 32,386 25,241 24,850 19,116 18,422 16,892 14,829 Frequency % 12.88 12.52 12.49 10.19 5.72 5.14 4.20 4.00 3.94 2.98 2.02 1.99 1.90 1.48 1.46 1.12 1.08 0.99 0.87

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20 Other Injuries

14,392

0.84

THE TOP 5 MOST FREQUENTLY DIAGNOSED DISEASES AND MOST CAUSES OF DEATH IN NIGERIA

Malaria HIV/AIDS Influenza & Pneumonia Diarrheal diseases Tuberculosis

A. Malaria In Nigeria
Nigeria is known for high prevalence of malaria and it is a leading cause of morbidity and mortality in the country. Available records show that at least 50 per cent of the population of Nigeria suffers from at least one episode of malaria each year and malaria accounts for over 45 per cent of all out-patient visits. It is reported that malaria prevalence (notified cases) in 2000 was about 2.4 million. The disease accounts for 25 per cent of infant mortality and 30 per cent of childhood mortality in Nigeria. Therefore, it imposes great burden on the country in terms of pains and trauma suffered by its victims as well as loss in outputs and cost of treatments. Malaria has remained a major public health problem in Nigeria. It accounts for over 60% outpatient visits and 30% hospital admissions in Nigeria. The disease has impacted negatively on the economy with about 132 Billion Naira lost to the disease. Malaria is an infectious disease caused by the parasite of genius Plasmodium. The four identified species of this parasite causing human malaria are Plasmodium falciparum, P. vivax, P. ovale and P.malariae. In Nigeria 98% of all cases of Malaria is due to Plasmodium falciparum. This is the species that is responsible for the severe form of the disease that leads to death. It is transmitted from

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bites of an infected female anopheles mosquito to man, these species of mosquito breeds in clear stagnant water especially in unused discarded tyres, broken pots and other areas where water can collect. Malaria is highly endemic in Nigeria. It poses a major challenge to the country as it impedes human development. It is both a cause and consequence of underdevelopment and remains one of the leading causes of morbidity and mortality in the country. Malaria accounts for about 63% of all visits to public health facilities (Out-patient attendances). Thirty percent of hospital admissions are also due to malaria. It is responsible for 29% of childhood death, 25% of infant mortality and 11% of maternal mortality. The economic loss to Nigeria due to malaria is estimated at N132 Billion annually due to loss of man hours resulting from sickness absence and cost of treatment. It is a major cause of absenteeism from work and school. It contributes to poverty and results in poor pregnancy outcome.

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The most vulnerable groups are under-fives, pregnant women, visitors from non-endemic areas, those with sickle cell anemia, HIV/AIDS.The economic cost of malaria, arising from cost of treatment, loss of productivity and earning due to days lost from illness, may be as high as 1.3% of economic growth per annum. The disease is a major cause of maternal mortality and poor child development. Traditionally, the malaria problem has been seen as a challenge for the health sector alone with little or no involvement by other sectors or the general community.

B. Hiv/Aids In Nigeria
Human Immunodeficiency Virus (HIV) infection and AIDS in Nigeria remain a major public health crisis. Nigeria is Africas most populous nation and is home to more people living with HIV than any other country in the world, except South Africa and India. The prevalence rate has increased progressively since the first reported case of HIV in Nigeria. HIV prevalence among adults aged 1549 years, increased from 1.8% in 1991 to 5.8% in 2000, and in 2005, declined to 3.9 %. Although the prevalence rate is lower than it is in South Africa, it is estimated that about 2.9 million people are living with the virus in Nigeria. First case of HIV/AIDS was reported in 1986. In 2010, HIV prevalence is highest in urban areas, the North Central zone, Benue State and among the 30-34 years age group.HIV prevalence among youth age 15-24 declined from 6% in 2001 to 4.3% in 2005, 4.2% in 2008 and 4.1% in 2010.More than 80% of HIV transmission in Nigeria is through heterosexual sex. Among key populations at higher risk, HIV prevalence is 24% among sex workers; 17% among MSM and 4% among IDUs respectively (IBBSS 2010). The drivers of the epidemic in Nigeria include high illiteracy, high rates of Sexually Transmitted Infections (STIs) invulnerable groups, poverty, low condom use and general lack of perceived personal risk. Estimated No of people living with HIV/AIDS: 3.1 million Annual HIV positive births: 56,681. Cumulative AIDS deaths: 2.1 million (Male; 970,000; Female; 1.61 million) Annual AIDS Death: 215,130 (Male; 96,740; Female; 118,390)

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Number requiring Antiretroviral therapy: 1,512,720 (Adult; 1,300,000; Children; 212,720 New HIV infection: 281,180 (Adult; 126,260; Children; 154,920) Total AIDS Orphans: 2,229,883 Mode of transmission studies show that IDU, FSW and MSM alone, who constitute about 1% of the adult population, contribute almost 25% of new HIV infections. IDU, FSW, MSM and their partners, contribute as much as 36% of new infections even though they constitute only 3.4% of the adult population.

C. Tuberculosis In Nigeria
Among the twenty-two high-burden TB countries, Nigeria ranks the 10th in the world. WHO estimates: 210,000 new cases of all forms of TB occurred in the country in 2010, equivalent to 133/100,000 population. There were an estimated 320,000 prevalent cases of TB in 2010, equivalent to 199/100,000 cases. There were 90,447 TB cases notified in 2010 with 41, 416 (58%) cases as new smear positives, and a case detection rate of 40%. 83% of cases notified in 2009 were successfully treated. The main goal of Nigerias TB program is to halve the TB prevalence and death rates by 2015. TB death rates have declined from 11% in 2006 to 5% in 2010. TB i still a major public health problem in Nigeria, with the country ranking 5th among the 22 high TB burden countries which collectively bear 80% of the global burden of TB. The number of TB cases notified in the country increased from 31,264 in 2002 to 90,307 in 2008; more than 450,000 TB cases have been successfully treated free of charge in the past 5 years in Nigeria. The TB burden in Nigeria is further compounded by the on-going HIV/AIDS epidemic and the emergence of multi-drug resistant tuberculosis (MDR-TB). Control The National Tuberculosis and Leprosy Control Programme was launched 1991. The programme operates at all three tiers of government, with each level having a well-trained officer in charge of coordination in

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all the 774 Local Government Areas in the 36 states of the country and FCT.

D. Pneumonia In Nigeria The African Region has, in general, the highest burden of global child mortality. Although it comprises about 20% of the worlds population of children aged less than 5 years, it has about 45% of global under-5 deaths and 50% of worldwide deaths from pneumonia in this age group. By contrast, less than 2% of these deaths take place in the European Region and less than 3% in the Region of the Americas. More than 90% of all deaths due to pneumonia in children aged less than 5 years take place in 40 countries (with Nigeria (204 000deaths) among The two causes of bacterial pneumonia that are vaccine-preventable are Hib and pneumococcus.Pneumonia etiology studies that incorporate viral studies show that respiratory syncytial virus is the leading viral cause, being identified in 1540% of pneumonia or bronchiolitis cases admitted to hospital in children in developing countries, followed by influenza A and B, parainfluenza, human metapneumovirus and adenovirus. E. Cholera Epidemiology In Nigeria (Vibrio Cholerae 01 Eltor) Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium, Vibrio cholera. CholeragenicV. cholera O1 and O139 are the only causative agents of the disease. The two most distinguishing epidemiologic features of the disease are its tendency to appear in explosive outbreaks and its predisposition to causing pandemics that may progressively affect many countries and spread into continents. Despite efforts to control cholera, the disease continues to occur as a major public health problem in many developing countries. The later part of 2010 was marked with severe outbreak which started from the northern part of Nigeria, spreading to the other parts and involving approximately 3,000 cases and 781 deaths. Sporadic cases have also been reported. In Nigeria, since the first appearance of epidemic cholera in 1972, intermittent outbreaks have been occurring.

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Cholera outbreak in 2010 and 2011: Background In Nigeria, the infection is endemic and outbreaks are not unusual. In the last quarter of 2009, it was speculated that more than 260 people died of cholera in four Northern states with over 96 people in Maidugari, Biu, Gwoza, Dikwa and Jere council areas of Bauchi state. In Nigeria, the first series of cholera outbreak was reported between 1970- 1990. Despite this long experience with cholera, an understanding of the epidemiology of the disease aiding its persistence in outbreak situations is still lacking. This review therefore provides the knowledge gaps of the infection with the hope that it will help to develop targeted approaches to controlling the infection and pandemics. The outbreak was attributed to rain which washed sewage into open wells and ponds, where people obtain water for drinking and household needs. Most of the Northern states of Nigeria rely on hand dug wells and contaminated ponds as source of drinking water. Usually, the source of the contamination is other cholera patients when their untreated diarrhea discharge is allowed to get into water supplies.

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From January to December 2010, Nigeria reported 41,787 cases including 1,716 deaths (CFR 4.1%) from 222 LGAs in 18 States of the country. The most affected states were Borno, Bauchi and Katsina. Only very few cases were reported after week 44.This outbreak affected three other neighboring countries of the "Lake Basin" area: Niger, Chad and Cameroon. The link between the different outbreaks affecting the different states was not clearly established. In 2011, the number of cholera cases started to increase during week 8 to reach a first peak of 1200 weekly cases at the beginning of April. As of 23 October, 22 454 cases including 715 deaths (CFR 3.2%) are reported in 25 states (195 LGAs) NON COMMUNICABLE DISEASE MORTALITY RATE 2008 ESTIMATE (2008) MALES FEMALES Total NCD deaths 254.6 285.2 NCD deaths under age 41.5 41.8 60(percent of all NCD deaths)

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AGE-STANDARDIZED DEATH RATE PER 100 000 (2008) All NCDs 818.2 792.6 Cancers 89.4 98.8 Chronic respiratory diseases 119.0 71.6 Cardiovascular diseases and 435.9 475.7 diabetes NCD MORTALITY RATE ESTIMATE 2008
900 800 700 600 500 400 300 200 100 0 total NCD NCD death All NCDs deaths under 60 per 100000 Cancers Chronic CVD and respiratory Diabetes diseases MALES FEMALES

2008 prevalence (%) Raised blood

METABOLIC RISK FACTORS Males Females 41.5 44.0

Total 42.8

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pressure Raised blood glucose Overweight Obesity Raised cholesterol

6.9 24.2 4.6 13.6

10.0 29.3 8.4 18.5

8.5 26.8 6.5 16.1

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NCDs are estimated to account for 27% of all deaths.

PROPORTIONAL MORTALITY (% OF TOTAL DEATHS, ALL AGES)

Communicable, maternal, p erinatal and nutritional conditions Other NCDs

Diabetes

Respiratory diseases

Cancers

BRAIN DRAIN IN NIGERIA

Drive Influences Stumpy and corroding wages and salaries Substandard living conditions, deficiency of transport, housing, etc. Under-utilization of qualified personnel; lack of satisfactory working conditions; low prospect of professional development Lack of research and other facilities, including support staff; inadequacy of research funds, lack of professional equipment and tools Social unrest, political conflicts and wars

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Declining quality of educational system Discrimination in appointments and promotions Lack of freedom

Appealing Influences Higher wages, income and standard of living. Better working conditions; job and career opportunities and professional development. Substantial funds for research, advanced technology, modern facilities; availability of experienced support staff. Modern educational system; prestige of foreign training. Political stability, transparency and intellectual freedom.

Conclusion
1. Little attention has been given to health information generation and management or health systems research to build evidencefor a response to emerging needs. 2. Currently, there is a little linkage between health research and health policy. 3. Reliable data are lacking, there is often under-reporting, and data obtained from sources are often inaccurate or conflicting. 4. There are still problems of inadequate infrastructure and lack of monitoring, support and budgetary provision for health problems both at regional and country levels. 5. Data are rarely used at the level generated or for policy formation. 6. Decision-making or management of basic primary health care programsis relatively insufficient. 7. Other problems of health information systems in Nigeriaare: Poor financing Shortage of staff Shortage of materials Inadequate coordination of data flow Complexity and overlap of data collection instruments Lack of feedback from the peripheral levels

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Huge backlog of unprocessed data

Recommendations
1. The need for improved basic infrastructure both regionally and country wise through provision of infrastructural aids at all levels. 2. Increasing health care providers encompassing both public and private providers of health services through provision of both under graduates and post graduate scholarship. 3. Establishing high medical institutes for under graduate and post graduate studies and also providing a satisfactory working condition and facilities. 4. Promote a spirit of cooperation and shared responsibility among all providers of health services both regionally and country wise through supporting medically oriented bodies both locally and at international level e.g. AMSA-IUA. 5. Provide people living inWest Africa with the best possible health services through enriching the community with adequate health care centers and basic medical facilitiesand establishing well equipped medical institution. 6. Set out rightsand build motivations in health care providers, health workers, and health care professionals through provision of substantial funds for research, advanced technology, modern facilities and availability of experienced support staff.

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Refrences
World Health Organization - NCD Country Profiles,2011. WHO: Country Cooperation Strategy (2008-2013)

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