There is no gain saying that the nation’s healthcare sector since independence has been plagued with the challenge of achieving the delivery of quality healthcare to the majority of its populace. These are evident in the state of inadequate infrastructure and lack of basic amenities some healthcare institutions in the country are confronted with.
Though several governments in the past and present have carried out one form of refurbishment of facilities at these health institutions, some existing health services are either not affordable or inaccessible to the vulnerable group especially the poor and people living in rural and underdeveloped area.
This can be reflected in the nation’s health induces which shows that Nigeria has one of the worst maternal, newborn and child mortality statistics in the world with an estimated 52,900 Nigerian women and 250,000 newborn dying annually from causes that are largely preventable if appropriate interventions are made available by Skilled Birth Attendants (the midwives) in the rural communities.
In the light of this, medical experts at the recent 4th Nigerian conference on telemedicine and ehealth with the theme “Driving eHealth and Telemedicine in Nigeria” called for the deploying telemedicine and e-health (electronic health) tools which will go a long way in improving the quality and accessible healthcare delivery in the country.
In an interview with BusinessDay, Olajide Adebola, President, Society for Telemedicine and e-Health in Nigeria, (SFTeHIN) said that telemedicine involves the use of medical information transferred from one site to another through electronic communications to improve patient’s health care including diagnosis and treatment.
Adebola hinted that whereas telemedicine may be as simple as two medical professionals discussing a case over the telephone, or as advanced as using video teleconferencing systems, eHealth involves the acquisition and transmission of patient’s medical data such as radiological studies, laboratory results and biomonitoring information to a physician at a convenient time for assessment offline.
According to Adebola “It is time to enact changes in the health care sector in Nigeria through the use of information communications technology (ICT) to improve quality and extension of health care services for the development of the nation. Public health monitoring, disease surveillance, research and quality monitoring require data that depends on the wide spread adoption of eHealth tools & services.
It will be recalled that on the 17th October 2006, there was a meeting of the Society with the then President Olusegun Obasanjo, the minister of health and the ministry key staff with head of other key agencies to discuss on developing eHealth in Nigeria. It was agreed that the committee will be constituted and Nigeria will have a national budget for eHealth in 2007.
The Society was informed about the creation of the national telemedicine programme under the department of Hospital services in the ministry of Health mid 2007 but no policy or guidelines on the programme is available for all stakeholders to know which areas of activities is the focus for deployment of eHealth tools and services till date. We will continue to engage the government on the need to have eHealth governance mechanism in Nigeria because without this, telemedicine/ehealth and Health ICT in general will not thrive.
For his part, Muhammad Ali Pate, Executive Director/CEO, National Primary Health Care Development Agency, (NPHCDA) stated that there is therefore a compelling need for multi-sectoral collaboration among healthcare providers/institutions and the telecommunication industry to ensure the delivery of quality healthcare services to hitherto underserved populations in rural and sub-urban communities of our country given the reality that maternal, newborn and child mortality constitutes a grave challenge to human capital development and the attainment of MDGs 4 and 5 in Nigeria.
In his words “In recognition of the critical role of ICT in strengthening health care development, the NPHCDA conceptualised the Midwives Service Scheme (MSS) with an ICT-based rapid reporting and communication tool which involves data transmission via internet, SMS and voice calls among the various drivers of the scheme. The MADEX (Mobile Application Data Exchange) Application as it is called is Nigeria’s initial footprint on the great sands of mHealth which is driven by the NPHCDA. At the moment, about 1000 mobile phone lines, distributed among 652 health facilities in rural hard-to reach locations linked to 163 referral General Hospitals. These facilities are distributed across all states of the federation and are involved in the collection, transmission and dissemination of health statistics for the purpose of monitoring and evaluation of health service delivery at the primary health care level.”
No doubt, given the increasingly important role of telemedicine and eHealth in contemporary healthcare delivery, there is the need for aggressive advocacy to telecommunications operators to support telemedicine and ehealth initiatives as the government cannot do it alone.
For participants who spoke to BusinessDay at the conference, there should be
National eHealth Committee comprising all stakeholders such as SFTeHIN, Federal Ministry of Health, Federal Ministry of Communications, and the Nigeria Communications Commission (NCC), National Information Technology Development Agency, National Primary Healthcare Development Agency, National Space Research and development Agency (NASRDA), etc. which should be set up.
Also, the subject should be introduced in the curriculum of health science schools; Centres of Excellence where short-course training in telemedicine and eHealth can be conducted should be identified.
However, the committee to be constituted should as a matter of urgency, work out modalities for the development of a national strategy, policy and draft legislation required to successfully implement and sustain telemedicine and eHealth programmes in Nigeria. Aside this, government should formulate policies that will create the enabling business environment and provide incentives for telecommunications operators, so as to encourage existing telemedicine programmes and development of new ones, particularly in the private sector.
alexander chiejina
Monday, September 27, 2010
Sanofi Aventis, medical experts brainstorm on the management of peptic disorders
…as it launches antacid ‘Maalox’ into Nigeria
Alexander Chiejina
More often than not, some Nigerians develop one form of abdominal pain, bloating and abdominal fullness, nausea, copious vomiting, painful sensation at the chest while eating, copious vomiting etc. no name but a few. This discomfort experience by these individuals propels them to purchase pain relieving drugs like NSAIDs (non-steroid anti-inflammatory drugs) like aspirin, diclofenac, ibuprofen, ketoprofen etc. across the counter without the prescription of a physician.
To some, after consumption of this drug without eating, or side effects end up with sudden large bleeding which at the end may become life-threatening. For some, it may degenerate to the development of a stomach disorder which results in the erosion of the gastro-intestinal wall and the spillage of stomach or intestinal content into the abdominal cavity. Giving this avoidable realty, experts have called for the care in the use of antacids in the management of acid peptic disorders.
Speaking at the launch of Maalox, an antacid developed by Sanofi Aventis in Lagos recently, Funmilayo Lesi, consultant gastroenterologist, College of Medicine, University of Lagos, said that acid peptic disorder encompass a broad range of clinical disorders involving the oesophagus, stomach and duodenum with significant impact of the disease on morbidity and quality of life, economic activity and productivity. Lesi revealed that a major causative factor of gastric and duodenal ulcers in humans is chronic inflammation by bacterium Helicobacter pylori which colonizes the antral mucosa of the stomach.
The medical expert stated that the immune system is unable to clear the infection, despite the appearance of antibodies hence the bacterium cause a chronic active gastritis (type B gastritis), resulting in a defect in the regulation of gastrin production by that part of the stomach, and gastrin secretion which can either be decreased or increased.
In her words “Gastrin stimulates the production of gastric acid by parietal cells and, in H. pylori colonization responses that increase gastrin, the increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation. However, the timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers.
A gastric ulcer would give epigastric pain during meal as gastric acid is secreted or after the meal as the alkaline duodenal contents reflux into the stomach. Symptoms of duodenal ulcers would manifest mostly before the meal when acid (production stimulated by hunger) is passed into the duodenum. However, this is not a reliable sign in clinical practice. Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient's age.
Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane. Pain is usually caused by the ulcer but may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the breastbone; it may last from few minutes to several hours and may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relived by taking anti-acid medication.] However, peptic ulcer disease symptoms may be different for every sufferer,” Lesi disclosed.
Lesi noted that another major cause of ulcer is the use of NSAIDs and stress which as a possible cause, or at least complication, leads in the development of ulcers.
Explaining the dynamics of antacids used to the treatment of ulcer, Chijioke Onyia, managing director, Pinecrest Healthcare limited revealed that antacid performs a neutralization reaction, i.e. they buffer gastric acid, raising the pH to reduce acidity in the stomach.
Onyia stated that when gastric hydrochloric acid in the stomach reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous system. He noted that this happens when these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers in the esophagus or the duodenum.
In his words “antacids like Maalox show the most rapid onset of action and provide faster relief of symptoms. However they may cause an "acid rebound not suitable for all patients owing to its components like calcium carbonate and sodium bicarbonate which counteracts stomach acidity.”
No doubt, with stomach pain been the first to signal a peptic ulcer, it is important that people who develop this see their physician as they may treat ulcers without diagnosing them with specific tests and observe if the symptoms resolve, meaning their primary diagnosis was accurate.
For Frank Umeh, Medical Manager, North East Zone, Sanofi Aventis Pharmaceuticals, Maalox chewable tablets are used for relieving pressure, bloating, and gas in the digestive tract. Umeh hinted that It may also be used for other conditions as determined by your doctor.
“Maalox chewable tablet is an antiflatulent. It works by breaking up gas bubbles, which makes gas easier to eliminate. Contact your doctor or health care provider right away prior to the usage of the drug. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you: if you are pregnant, planning to become pregnant, or are breast-feeding, if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement etc. This is because some medicine may interact with Maalox. However, no specific interactions with Maalox Anti-Gas Chewable Tablets are known at this time. More importantly, Check with your health care provider before you start, stop, or change the dose of any medicine,” Umeh concluded.
Alexander Chiejina
More often than not, some Nigerians develop one form of abdominal pain, bloating and abdominal fullness, nausea, copious vomiting, painful sensation at the chest while eating, copious vomiting etc. no name but a few. This discomfort experience by these individuals propels them to purchase pain relieving drugs like NSAIDs (non-steroid anti-inflammatory drugs) like aspirin, diclofenac, ibuprofen, ketoprofen etc. across the counter without the prescription of a physician.
To some, after consumption of this drug without eating, or side effects end up with sudden large bleeding which at the end may become life-threatening. For some, it may degenerate to the development of a stomach disorder which results in the erosion of the gastro-intestinal wall and the spillage of stomach or intestinal content into the abdominal cavity. Giving this avoidable realty, experts have called for the care in the use of antacids in the management of acid peptic disorders.
Speaking at the launch of Maalox, an antacid developed by Sanofi Aventis in Lagos recently, Funmilayo Lesi, consultant gastroenterologist, College of Medicine, University of Lagos, said that acid peptic disorder encompass a broad range of clinical disorders involving the oesophagus, stomach and duodenum with significant impact of the disease on morbidity and quality of life, economic activity and productivity. Lesi revealed that a major causative factor of gastric and duodenal ulcers in humans is chronic inflammation by bacterium Helicobacter pylori which colonizes the antral mucosa of the stomach.
The medical expert stated that the immune system is unable to clear the infection, despite the appearance of antibodies hence the bacterium cause a chronic active gastritis (type B gastritis), resulting in a defect in the regulation of gastrin production by that part of the stomach, and gastrin secretion which can either be decreased or increased.
In her words “Gastrin stimulates the production of gastric acid by parietal cells and, in H. pylori colonization responses that increase gastrin, the increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation. However, the timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers.
A gastric ulcer would give epigastric pain during meal as gastric acid is secreted or after the meal as the alkaline duodenal contents reflux into the stomach. Symptoms of duodenal ulcers would manifest mostly before the meal when acid (production stimulated by hunger) is passed into the duodenum. However, this is not a reliable sign in clinical practice. Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient's age.
Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane. Pain is usually caused by the ulcer but may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the breastbone; it may last from few minutes to several hours and may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relived by taking anti-acid medication.] However, peptic ulcer disease symptoms may be different for every sufferer,” Lesi disclosed.
Lesi noted that another major cause of ulcer is the use of NSAIDs and stress which as a possible cause, or at least complication, leads in the development of ulcers.
Explaining the dynamics of antacids used to the treatment of ulcer, Chijioke Onyia, managing director, Pinecrest Healthcare limited revealed that antacid performs a neutralization reaction, i.e. they buffer gastric acid, raising the pH to reduce acidity in the stomach.
Onyia stated that when gastric hydrochloric acid in the stomach reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous system. He noted that this happens when these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers in the esophagus or the duodenum.
In his words “antacids like Maalox show the most rapid onset of action and provide faster relief of symptoms. However they may cause an "acid rebound not suitable for all patients owing to its components like calcium carbonate and sodium bicarbonate which counteracts stomach acidity.”
No doubt, with stomach pain been the first to signal a peptic ulcer, it is important that people who develop this see their physician as they may treat ulcers without diagnosing them with specific tests and observe if the symptoms resolve, meaning their primary diagnosis was accurate.
For Frank Umeh, Medical Manager, North East Zone, Sanofi Aventis Pharmaceuticals, Maalox chewable tablets are used for relieving pressure, bloating, and gas in the digestive tract. Umeh hinted that It may also be used for other conditions as determined by your doctor.
“Maalox chewable tablet is an antiflatulent. It works by breaking up gas bubbles, which makes gas easier to eliminate. Contact your doctor or health care provider right away prior to the usage of the drug. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you: if you are pregnant, planning to become pregnant, or are breast-feeding, if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement etc. This is because some medicine may interact with Maalox. However, no specific interactions with Maalox Anti-Gas Chewable Tablets are known at this time. More importantly, Check with your health care provider before you start, stop, or change the dose of any medicine,” Umeh concluded.
Experts task Nigerians on regular cardiovascular checks and healthy living
…as the world celebrates World Heart Day
Alexander Chiejina
More often than not, some Nigerians have been confronted with the issue of managing cardiovascular diseases (CVDs) like heart attacks and strokes, mainly caused by a blockage that prevents blood from flowing to the heart or brain, which experts believe is number one cause of death globally.
Sadly, recent statistics from the World Health Organisation (WHO) suggests that more people die annually from CVDs than from any other cause with an estimated 17.1 million people dying from CVDs in 2004, which represents 29 percent of all global deaths. Of these deaths, an estimated 7.2 million were due to coronary heart disease and 5.7 million were due to stroke.
In the report, low and middle income countries are disproportionally affected: 82 percent of CVD deaths take place and occur almost equally in men and women. However, it is projected that by 2030, almost 23.6 million people will die from CVDs, mainly from heart disease and stroke.
As Nigeria joins the rest of the world to celebrate World Heart Day every September 27th, medical experts in the country have tasked Nigerians to observe regular checkups and live healthy lives in a bid to safeguard themselves from this impending danger.
In a recent interview with BusinessDay, Anam Mbakwem, consultant nephrologist at the Lagos University Teaching Hospital (LUTH), Idi-araba, Lagos said that cardiovascular disease is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure
Mbakwem stated that though no country wide data on CVD in Nigeria, available data from 1990 national survey on NCDs in Nigeria shows that they have hypertension with only 11.2 percent of Nigerians having hypertension with only 33.8 percent of these aware that they have hypertension.
In his words “The burden of CVDs in the world is enormous and the majority of those affected are in developing countries. Patients denied access to health care for CVD or deterred by high costs from seeking it cause public health systems to incur even greater health care costs in the long run. This is as a result of the need to treat the same patients later at greater expense because the disease is more advanced. The potential costs of this CVD epidemic for African countries are staggering.
However, cardiovascular disease (direct and indirect) is estimated to cost the United States about US$300 billion annually, equal to the entire gross domestic product of the African continent. Clearly, even a fraction of such cost has the potential to cause enormous damage to the economies and development trajectories of African countries.”
Lending his view, Olufemi Fasanmade, Consultant Endocrinologist at LUTH stated the most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity and tobacco use. Fasanmade disclosed that the effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity are intermediate risk factors to one developing CVDs.
In his words “The good news is that 80 percent of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention. More importantly, having one’s blood pressure checked, knowing one’s blood sugar and body lipids is essential. This is because raised blood glucose (diabetes) and blood cholesterol increases the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.”
Giving this economic management of this disease which negatively affects the GDP of nations, there is the need for a comprehensive action which seeks to reduce the risks in Nigeria with strategies that target individuals at high risk of CVDs. Examples of population wide interventions to reduce CVDs include comprehensive tobacco control policies, taxation to reduce the intake of foods that are high in fat, sugar and salt, building walking and cycle ways to increase physical activity, providing healthy school meals to children.
For instance, in the United Kingdom, a government-promoted program in consort with the food and drink manufacturing industry successfully reduced salt content in almost a quarter of manufactured foods over several years. In Finland, community-based and national interventions, including health promotion and nutrition interventions, led to population-wide reductions in cholesterol and other risks, closely followed by a precipitous decline in heart disease and stroke mortality.
For Solomon Kadiri, Consultant Nephrologist, University College Hospital (UCH), Ibadan, there is a need for increased government investment through national programmes aimed at prevention and control of CVDs and other non communicable diseases.
In his words “CVD risk factors can be reduced through community based programmes for integrated prevention of NCDs, development of standards of care and cost-effective case management for CVD, developing feasible surveillance methods to assess the pattern and trends of major CVDs and risk factors and to monitor prevention and control initiatives.”
Alexander Chiejina
More often than not, some Nigerians have been confronted with the issue of managing cardiovascular diseases (CVDs) like heart attacks and strokes, mainly caused by a blockage that prevents blood from flowing to the heart or brain, which experts believe is number one cause of death globally.
Sadly, recent statistics from the World Health Organisation (WHO) suggests that more people die annually from CVDs than from any other cause with an estimated 17.1 million people dying from CVDs in 2004, which represents 29 percent of all global deaths. Of these deaths, an estimated 7.2 million were due to coronary heart disease and 5.7 million were due to stroke.
In the report, low and middle income countries are disproportionally affected: 82 percent of CVD deaths take place and occur almost equally in men and women. However, it is projected that by 2030, almost 23.6 million people will die from CVDs, mainly from heart disease and stroke.
As Nigeria joins the rest of the world to celebrate World Heart Day every September 27th, medical experts in the country have tasked Nigerians to observe regular checkups and live healthy lives in a bid to safeguard themselves from this impending danger.
In a recent interview with BusinessDay, Anam Mbakwem, consultant nephrologist at the Lagos University Teaching Hospital (LUTH), Idi-araba, Lagos said that cardiovascular disease is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure
Mbakwem stated that though no country wide data on CVD in Nigeria, available data from 1990 national survey on NCDs in Nigeria shows that they have hypertension with only 11.2 percent of Nigerians having hypertension with only 33.8 percent of these aware that they have hypertension.
In his words “The burden of CVDs in the world is enormous and the majority of those affected are in developing countries. Patients denied access to health care for CVD or deterred by high costs from seeking it cause public health systems to incur even greater health care costs in the long run. This is as a result of the need to treat the same patients later at greater expense because the disease is more advanced. The potential costs of this CVD epidemic for African countries are staggering.
However, cardiovascular disease (direct and indirect) is estimated to cost the United States about US$300 billion annually, equal to the entire gross domestic product of the African continent. Clearly, even a fraction of such cost has the potential to cause enormous damage to the economies and development trajectories of African countries.”
Lending his view, Olufemi Fasanmade, Consultant Endocrinologist at LUTH stated the most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity and tobacco use. Fasanmade disclosed that the effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity are intermediate risk factors to one developing CVDs.
In his words “The good news is that 80 percent of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention. More importantly, having one’s blood pressure checked, knowing one’s blood sugar and body lipids is essential. This is because raised blood glucose (diabetes) and blood cholesterol increases the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.”
Giving this economic management of this disease which negatively affects the GDP of nations, there is the need for a comprehensive action which seeks to reduce the risks in Nigeria with strategies that target individuals at high risk of CVDs. Examples of population wide interventions to reduce CVDs include comprehensive tobacco control policies, taxation to reduce the intake of foods that are high in fat, sugar and salt, building walking and cycle ways to increase physical activity, providing healthy school meals to children.
For instance, in the United Kingdom, a government-promoted program in consort with the food and drink manufacturing industry successfully reduced salt content in almost a quarter of manufactured foods over several years. In Finland, community-based and national interventions, including health promotion and nutrition interventions, led to population-wide reductions in cholesterol and other risks, closely followed by a precipitous decline in heart disease and stroke mortality.
For Solomon Kadiri, Consultant Nephrologist, University College Hospital (UCH), Ibadan, there is a need for increased government investment through national programmes aimed at prevention and control of CVDs and other non communicable diseases.
In his words “CVD risk factors can be reduced through community based programmes for integrated prevention of NCDs, development of standards of care and cost-effective case management for CVD, developing feasible surveillance methods to assess the pattern and trends of major CVDs and risk factors and to monitor prevention and control initiatives.”
New cement policy and the effect on construction industry
Currently, Nigeria has huge percent of cement raw materials that can be tapped to grow the nation’s economy. However, the new policy by the Federal Government has thrown stakeholders in the building and construction sector into various argument as to what good this recent pronouncement holds for the sector writes Alexander Chiejina.
Recently, the media has been awash with claim and counter claims of plans to flood the nation's construction industry with imported cement products. This development may have pitched local cement producers and importers at each other’s throats. This is believed to be connected with the imposition of a 35 percent levy by the Federal Government on the latest importation quotas for bulk cement, effective July 1 2010.
The 35 percent levy comprises the reinstatement of 20 percent import duty on bulk cement, and a new 15 percent surcharge on the cost, insurance and freight price of bulk cement to substitute the N500 per tonnes that was in force before the new policy. The added 15 percent will be towards the development of the Cement Technology Institute.
Other measures rolled out include immediate cancellation of all unutilized cement import licenses from 2002 to 2008; annual review of local production in order to determine the need for cement import license or otherwise and that investors without operational terminals will no longer be considered for cement import license from 2011. In addition, the new policy seeks the importation of 2,500,000 metric tonnes of bulk cement by six local manufacturers to cover the second half of the year.
For the Ministries of Finance, and Commerce and Industry, the new allocation is part of the federal government’s Cement Backward Integration Policy aimed at making the country self-sufficient in cement manufacturing in the next three years. It was also taken as a measure to accelerate the growth of local capacity in cement production and provide the possibility to eventually export the product to other African nations and beyond.
The ministry through the letter notified the Customs Service and the pre-shipment agents of the immediate cancellation of all unused cement import licenses issued between 2002 and 2008. According to the ministry, annual review of local production will be undertaken in order to determine the need for cement import licenses or otherwise.
It said that importers without operational land terminals will no longer be considered for cement import from next year, even as the ministry re-instated the 20 percent import duty on bulk cement, as applicable to other finished products in tandem with the ECOWAS Common External Tariff.
While the new policy on cement is targeted at boosting the local production of cement in the country, this latest development has elicited various reactions from stakeholders as to what this new policy on cement holds for the building and construction sector in the country.
Speaking to BusinessDay, Omo Aisagboni, President/Chief Executive Officer, Omais Investment Group, said that the increase of duty payable on imported cement from 5 percent to 35 percent will no doubt contribute to the ballooning of the price of cement in the country as well as have its tow on real estate developers who will need it for construction.
Aisagboni stated the introduction of 15 percent Cement Technology Institute Levy by the government on a mere 2.5 million tonnes of imported cement to cover only six months of July to December 2010, as cement import will end in 2010, is not investment friendly.
In his words “The gap between demand and locally produced cement is huge and to frame a policy around this may plunge us into crisis. Before the end of the year when the import permits that have been issued out have be exhausted by the allotees, we will find that the locally produced cement will be unable to satisfy the demand for the product and then there will be scarcity.
However, what does the government want to achieve now with 35percent levy on imported cement? Create scarcity and increase in cost of cement? But it is wrong, because the people will be the ultimate losers while a few will be the beneficiaries and profit from the expected rise in price of the essential product.
This is because prices will not go down but will swing upward and may be out of reach of the ordinary people who will intend to construct their own homes. Don’t forget the construction industry is the one of the largest employer of labour with those involved in housing and real estates in the lot. And if this happens, your guess is as good as mine,” Aisagboni stated.
For Toyin Banjo, Managing Director/CEO Cornerstone Savings and Loans, the Federal Government plan to impose 35 percent duty on cement importation is a welcome development.
Banjo stated that before cement import license is given to interested individuals, the government should ensure that they are manufacturers and have a known number of people under the employ of such manufacturer to discourage every Tom, Dick and Harry from coming into the sector.
According to Banjo “the 20 percent import duty on bulk cement should go into a special fund for construction firms whereby they can access this fund for the development of the construction industry. Don’t forget that the import duty is going to affect everyone in the construction sector- from real estate developers to builders, etc. but if this common fund from the duty can be pulled together, people can easily access it with the input of a mortgage bank at a single digit interest rate. This also should be a repayment plan for 15 years with 10 down payments. If this is in place, people won’t mind to building their houses whether the price of cement increase a little.”
However, for Joseph Makoju, Cement Manufacturers Association of Nigeria (CEMAN), he stated that he is happy with the Government on the recent policies and is sure that as a body, Nigeria will not have need for imported cement again and would have been wholly self sufficient before the end of 2011.
Makoju revealed that the boost in production was due to the Federal Government’s policy to encourage local production and ban the issuance of license for importation. According to him, the cement policy was formulated in 2003 but was not implemented until recently.
“The Federal Government’s step is a complete implementation of the road map that would enable the country to be self-sufficient in cement production to the benefit of all. What we have in place now is that the gap between local production and demand will be imported in the short run and it is no longer an all comers’ affair. However, with the huge investment in cement production across the country, the price of cement would soon drop.”
He added that because of the high production of cement, many companies were already exploring ECOWAS countries and beyond for export. He said that cement companies such as Ibese, Benue Cement Plc, Obajana, plants belonging to Dangote Group, would produce more than 20 million tonnes annually.
“Besides, there is also the 4.5 million tonnes of cement from the Nigeria Flour Mills, owners of UniCem while BUA Cement is expected to produce 500,000 tonnes annually. The Bendel Cement plant, AVA Company and other new factories are coming on stream and Nigeria has 95 percent of the raw materials. Such comparative advantage was long overdue to be tapped to grow the nation’s economy and export the commodity to other countries. Don’t forget that nations with less potential had been flooding the Nigerian market with substandard cement, leading to building and construction failure”, Makoju concluded.
No doubt, cement production is not only needed for housing, but is just as critical for infrastructure development. Like all developing countries, Nigeria suffers from a huge housing and infrastructure deficit and is in a mad rush to plug that gap.
In addition, projected economic expansion and high oil prices all point to the fact that the three tiers of government will deploy considerable resources in roads and railway construction, new airports and seaports, the education and healthcare sectors, and agriculture and electricity, which are all dependent on the availability of cement as a critical component of the construction industry.
Moreover, the impression created is that some of more advanced countries don’t
import cement may not be completely true. This is because recent reports suggest that The United States of America, Russia, the United Arab Emirates and Spain still import and producers of cement. With the US President Barack Obama recent plan to plough $50 billion in infrastructure spending over the next five years, the US is believed that local production of cement may not be sufficient for the meet the needed infrastructural plans.
What this implies is that importers of bulk cement still have a critical role to play in making the commodity available and affordable, a goal that can be achieved if levies are not high. In essence, controlled importation of bulk cement can exist side by side local production, until a time producers can match and exceed domestic demand.
Recently, the media has been awash with claim and counter claims of plans to flood the nation's construction industry with imported cement products. This development may have pitched local cement producers and importers at each other’s throats. This is believed to be connected with the imposition of a 35 percent levy by the Federal Government on the latest importation quotas for bulk cement, effective July 1 2010.
The 35 percent levy comprises the reinstatement of 20 percent import duty on bulk cement, and a new 15 percent surcharge on the cost, insurance and freight price of bulk cement to substitute the N500 per tonnes that was in force before the new policy. The added 15 percent will be towards the development of the Cement Technology Institute.
Other measures rolled out include immediate cancellation of all unutilized cement import licenses from 2002 to 2008; annual review of local production in order to determine the need for cement import license or otherwise and that investors without operational terminals will no longer be considered for cement import license from 2011. In addition, the new policy seeks the importation of 2,500,000 metric tonnes of bulk cement by six local manufacturers to cover the second half of the year.
For the Ministries of Finance, and Commerce and Industry, the new allocation is part of the federal government’s Cement Backward Integration Policy aimed at making the country self-sufficient in cement manufacturing in the next three years. It was also taken as a measure to accelerate the growth of local capacity in cement production and provide the possibility to eventually export the product to other African nations and beyond.
The ministry through the letter notified the Customs Service and the pre-shipment agents of the immediate cancellation of all unused cement import licenses issued between 2002 and 2008. According to the ministry, annual review of local production will be undertaken in order to determine the need for cement import licenses or otherwise.
It said that importers without operational land terminals will no longer be considered for cement import from next year, even as the ministry re-instated the 20 percent import duty on bulk cement, as applicable to other finished products in tandem with the ECOWAS Common External Tariff.
While the new policy on cement is targeted at boosting the local production of cement in the country, this latest development has elicited various reactions from stakeholders as to what this new policy on cement holds for the building and construction sector in the country.
Speaking to BusinessDay, Omo Aisagboni, President/Chief Executive Officer, Omais Investment Group, said that the increase of duty payable on imported cement from 5 percent to 35 percent will no doubt contribute to the ballooning of the price of cement in the country as well as have its tow on real estate developers who will need it for construction.
Aisagboni stated the introduction of 15 percent Cement Technology Institute Levy by the government on a mere 2.5 million tonnes of imported cement to cover only six months of July to December 2010, as cement import will end in 2010, is not investment friendly.
In his words “The gap between demand and locally produced cement is huge and to frame a policy around this may plunge us into crisis. Before the end of the year when the import permits that have been issued out have be exhausted by the allotees, we will find that the locally produced cement will be unable to satisfy the demand for the product and then there will be scarcity.
However, what does the government want to achieve now with 35percent levy on imported cement? Create scarcity and increase in cost of cement? But it is wrong, because the people will be the ultimate losers while a few will be the beneficiaries and profit from the expected rise in price of the essential product.
This is because prices will not go down but will swing upward and may be out of reach of the ordinary people who will intend to construct their own homes. Don’t forget the construction industry is the one of the largest employer of labour with those involved in housing and real estates in the lot. And if this happens, your guess is as good as mine,” Aisagboni stated.
For Toyin Banjo, Managing Director/CEO Cornerstone Savings and Loans, the Federal Government plan to impose 35 percent duty on cement importation is a welcome development.
Banjo stated that before cement import license is given to interested individuals, the government should ensure that they are manufacturers and have a known number of people under the employ of such manufacturer to discourage every Tom, Dick and Harry from coming into the sector.
According to Banjo “the 20 percent import duty on bulk cement should go into a special fund for construction firms whereby they can access this fund for the development of the construction industry. Don’t forget that the import duty is going to affect everyone in the construction sector- from real estate developers to builders, etc. but if this common fund from the duty can be pulled together, people can easily access it with the input of a mortgage bank at a single digit interest rate. This also should be a repayment plan for 15 years with 10 down payments. If this is in place, people won’t mind to building their houses whether the price of cement increase a little.”
However, for Joseph Makoju, Cement Manufacturers Association of Nigeria (CEMAN), he stated that he is happy with the Government on the recent policies and is sure that as a body, Nigeria will not have need for imported cement again and would have been wholly self sufficient before the end of 2011.
Makoju revealed that the boost in production was due to the Federal Government’s policy to encourage local production and ban the issuance of license for importation. According to him, the cement policy was formulated in 2003 but was not implemented until recently.
“The Federal Government’s step is a complete implementation of the road map that would enable the country to be self-sufficient in cement production to the benefit of all. What we have in place now is that the gap between local production and demand will be imported in the short run and it is no longer an all comers’ affair. However, with the huge investment in cement production across the country, the price of cement would soon drop.”
He added that because of the high production of cement, many companies were already exploring ECOWAS countries and beyond for export. He said that cement companies such as Ibese, Benue Cement Plc, Obajana, plants belonging to Dangote Group, would produce more than 20 million tonnes annually.
“Besides, there is also the 4.5 million tonnes of cement from the Nigeria Flour Mills, owners of UniCem while BUA Cement is expected to produce 500,000 tonnes annually. The Bendel Cement plant, AVA Company and other new factories are coming on stream and Nigeria has 95 percent of the raw materials. Such comparative advantage was long overdue to be tapped to grow the nation’s economy and export the commodity to other countries. Don’t forget that nations with less potential had been flooding the Nigerian market with substandard cement, leading to building and construction failure”, Makoju concluded.
No doubt, cement production is not only needed for housing, but is just as critical for infrastructure development. Like all developing countries, Nigeria suffers from a huge housing and infrastructure deficit and is in a mad rush to plug that gap.
In addition, projected economic expansion and high oil prices all point to the fact that the three tiers of government will deploy considerable resources in roads and railway construction, new airports and seaports, the education and healthcare sectors, and agriculture and electricity, which are all dependent on the availability of cement as a critical component of the construction industry.
Moreover, the impression created is that some of more advanced countries don’t
import cement may not be completely true. This is because recent reports suggest that The United States of America, Russia, the United Arab Emirates and Spain still import and producers of cement. With the US President Barack Obama recent plan to plough $50 billion in infrastructure spending over the next five years, the US is believed that local production of cement may not be sufficient for the meet the needed infrastructural plans.
What this implies is that importers of bulk cement still have a critical role to play in making the commodity available and affordable, a goal that can be achieved if levies are not high. In essence, controlled importation of bulk cement can exist side by side local production, until a time producers can match and exceed domestic demand.
Friday, September 10, 2010
Unsafe injection, others spur HIV, Hepatitis transmission
Without a doubt, the administration of injections is one of the most common healthcare procedures at health institutions across the country. But that is all the more reason for care because the World Health Organisation (WHO) says a safe injection is one that is given by means of appropriate equipment and does not harm the recipient, nor expose the provider to avoidable risks.
Figures from the WHO put the resultant infection profile resulting from unsafe injections at 250,000 HIV infections, 2,000,000 Hepatitis C infections and 21,000,000 Hepatitis B infections, leading to 1,300,000 deaths.
Even with the considerable improvement in immunisation services in Nigeria, medical experts insist that poor injection and sharp waste disposal practices pose an avoidable risk of transmission of deadly diseases such as HIV/AIDS, Hepatitis B and Hepatitis C to consumers, healthcare providers and the whole community.
Speaking with BusinessDay, Bennett Ogbokor, a practising pharmacist in Lagos, said that the normal disposable syringes are actually very dangerous and inimical to Safe Health and Safe Injection Practices, especially in a country like Nigeria where statistics of infections contracted from unsafe injections are lacking.
Ogbokor stated that the administration of injections have completely overtaken their real need, reaching an all-time proportion that is beyond Standard Medical Practice, as over 90 percent of patients visiting a primary healthcare centre receive at least one injection in developing countries including Nigeria.
According to Ogbokor, “Due to staggering WHO statistics and concern for the health of Nigerians, the then Director General, National Agency for Food and Drug Administration and Control (NAFDAC), Dora Akunyili, gave a 24-month deadline for discontinuation of the use of normal disposable syringes on July 27, 2007, at a forum organised by the Nigerian Medical Association (NMA) and Medical and Dental Council of Nigeria (MDCAN)
NAFDAC, NMA and MDCAN agreed the phase-out of the normal disposable plastic syringes for the auto disable syringes should be done in stages, and the importation of these syringes should stop in 18 months, beginning from August 1, 2007 and their usage should cease 24 months from same date. This move was targeted at aligning the country with the rest of the world in the use of Auto-Disable (AD) syringes. Sadly, though, months after the deadline, conventional syringes are still sold openly in the markets, pharmacies and used in hospitals across the country.
On his part, Emmanuel Okechukwu, chief executive, Action Family Foundation (AFF) , stated that there is an urgent need to use injections safely and appropriately to prevent nosocomial and HIV infections.
“In an Abuja study, it was found that 18 percent of healthcare facilities burnt their solid wastes in local brick incinerators, 36. 3 percent disposed their waste at municipal dumpsites; over 91 percent buried their solid waste. However, none practised waste segregation at source. Again, results of a baseline survey by AFF for National Action Committee Agency (NACA), three projects in four states, Lagos, Ebonyi, Enugu and Borno States, showed that Nigeria still has a long way to go," Okechukwu disclosed.
A close look at compliance with the utilisation of auto-disable syringes in the curative medical sector, as currently practised in many African countries including Uganda, reveal that the Ministry of Health embarked on large-scale sensitisation of health workers and the public across the country on the benefits of the use of auto-disable syringes.
The auto-disable syringes were developed to contribute to safer injection practices and prevent the re-use of syringes, thus the transmission of disease. Auto-disable (AD) syringes virtually eliminate the risk of patient-to-patient infection with blood borne pathogens (such as hepatitis B or HIV) because they cannot be reused. The private sector was also called upon to begin stocking syringes with re-use prevention features in order to respond to created demand.
Uganda’s Ministry of Health proactively advised all importers of syringes not to enter into any new procurement arrangement for the standard disable syringes. This, Nigeria can learn from since Ghana, Kenya, Tanzania and South Africa have also embraced Injection Safety Policy.
Proffering a solution to the current situation, Ogbokor urged the Director General NAFDAC, Paul Orhii, as well as his counterpart in the Federal Ministry of Health, to do their best to be the leaders for the advocacy of safe Injections Policy in West Africa, thus paving the way for its ECOWAS neighbours to follow suit.
He pointed out that NAFDAC would be seen as truly safeguarding the lives of Nigerians when the ban on re-usable spurious disposable syringes is enforced and the use of syringes with re-use prevention features becomes the norm.
It is pertinent to state that advocacy strategies for injection safety should be developed to target not only managers of immunisation services but also government decision-makers and managers, health workers, and the general population. However, promoting the safe use of injections requires a behavioural change strategy, which must involve consumers as well as public, private and traditional health workers.
While the use of AD syringes will greatly reduce the risk of transmitting blood-borne infections, their introduction alone will not ensure immunisation safety. Proper equipment must be accompanied by careful planning, management, training and supervision in the safe use and disposal of AD syringes.
Finally, the experience gained in ensuring injection safety should be used as a model to ensure that all medical injections, including those for preventive and therapeutic services, are safely administered and used injection equipment is safely disposed of after use.
BY Alexander Chiejina
Figures from the WHO put the resultant infection profile resulting from unsafe injections at 250,000 HIV infections, 2,000,000 Hepatitis C infections and 21,000,000 Hepatitis B infections, leading to 1,300,000 deaths.
Even with the considerable improvement in immunisation services in Nigeria, medical experts insist that poor injection and sharp waste disposal practices pose an avoidable risk of transmission of deadly diseases such as HIV/AIDS, Hepatitis B and Hepatitis C to consumers, healthcare providers and the whole community.
Speaking with BusinessDay, Bennett Ogbokor, a practising pharmacist in Lagos, said that the normal disposable syringes are actually very dangerous and inimical to Safe Health and Safe Injection Practices, especially in a country like Nigeria where statistics of infections contracted from unsafe injections are lacking.
Ogbokor stated that the administration of injections have completely overtaken their real need, reaching an all-time proportion that is beyond Standard Medical Practice, as over 90 percent of patients visiting a primary healthcare centre receive at least one injection in developing countries including Nigeria.
According to Ogbokor, “Due to staggering WHO statistics and concern for the health of Nigerians, the then Director General, National Agency for Food and Drug Administration and Control (NAFDAC), Dora Akunyili, gave a 24-month deadline for discontinuation of the use of normal disposable syringes on July 27, 2007, at a forum organised by the Nigerian Medical Association (NMA) and Medical and Dental Council of Nigeria (MDCAN)
NAFDAC, NMA and MDCAN agreed the phase-out of the normal disposable plastic syringes for the auto disable syringes should be done in stages, and the importation of these syringes should stop in 18 months, beginning from August 1, 2007 and their usage should cease 24 months from same date. This move was targeted at aligning the country with the rest of the world in the use of Auto-Disable (AD) syringes. Sadly, though, months after the deadline, conventional syringes are still sold openly in the markets, pharmacies and used in hospitals across the country.
On his part, Emmanuel Okechukwu, chief executive, Action Family Foundation (AFF) , stated that there is an urgent need to use injections safely and appropriately to prevent nosocomial and HIV infections.
“In an Abuja study, it was found that 18 percent of healthcare facilities burnt their solid wastes in local brick incinerators, 36. 3 percent disposed their waste at municipal dumpsites; over 91 percent buried their solid waste. However, none practised waste segregation at source. Again, results of a baseline survey by AFF for National Action Committee Agency (NACA), three projects in four states, Lagos, Ebonyi, Enugu and Borno States, showed that Nigeria still has a long way to go," Okechukwu disclosed.
A close look at compliance with the utilisation of auto-disable syringes in the curative medical sector, as currently practised in many African countries including Uganda, reveal that the Ministry of Health embarked on large-scale sensitisation of health workers and the public across the country on the benefits of the use of auto-disable syringes.
The auto-disable syringes were developed to contribute to safer injection practices and prevent the re-use of syringes, thus the transmission of disease. Auto-disable (AD) syringes virtually eliminate the risk of patient-to-patient infection with blood borne pathogens (such as hepatitis B or HIV) because they cannot be reused. The private sector was also called upon to begin stocking syringes with re-use prevention features in order to respond to created demand.
Uganda’s Ministry of Health proactively advised all importers of syringes not to enter into any new procurement arrangement for the standard disable syringes. This, Nigeria can learn from since Ghana, Kenya, Tanzania and South Africa have also embraced Injection Safety Policy.
Proffering a solution to the current situation, Ogbokor urged the Director General NAFDAC, Paul Orhii, as well as his counterpart in the Federal Ministry of Health, to do their best to be the leaders for the advocacy of safe Injections Policy in West Africa, thus paving the way for its ECOWAS neighbours to follow suit.
He pointed out that NAFDAC would be seen as truly safeguarding the lives of Nigerians when the ban on re-usable spurious disposable syringes is enforced and the use of syringes with re-use prevention features becomes the norm.
It is pertinent to state that advocacy strategies for injection safety should be developed to target not only managers of immunisation services but also government decision-makers and managers, health workers, and the general population. However, promoting the safe use of injections requires a behavioural change strategy, which must involve consumers as well as public, private and traditional health workers.
While the use of AD syringes will greatly reduce the risk of transmitting blood-borne infections, their introduction alone will not ensure immunisation safety. Proper equipment must be accompanied by careful planning, management, training and supervision in the safe use and disposal of AD syringes.
Finally, the experience gained in ensuring injection safety should be used as a model to ensure that all medical injections, including those for preventive and therapeutic services, are safely administered and used injection equipment is safely disposed of after use.
BY Alexander Chiejina
Anti-malaria drug resistance worries stakeholders
…experts discourage ‘across the shelf’ drug purchases
Malaria prevention is one issue that has spurred researchers across the globe to effectively combat the parasite Plasmodium species, which is transmitted via infected mosquito bites. However, despite the use of prophylactic drugs like Fansidar, Quinine, Chloroquine, etc. in areas where mosquitoes are common, little has been achieved, even as issues of partial immunity development in individuals infected with the parasite have arisen.
Interestingly, research by the World Health Organisation (WHO) suggests that the best available treatment is a combination of drugs known as artemisinin-based combination therapies (ACT). Nonetheless, the discovery of low quality supplies of the drugs in some countries has given real cause for concern, besides dampening Nigerians confidence since evidence shows malaria is unrelenting in the level of devastation it causes.
Figures from National Malaria Control Programme (NMCP) show that 50 percent of the population will have at least one attack in a year, with malaria currently accounting for about 130 million clinically diagnosed cases and about 60 percent of all clinic attendance and 30 percent hospital admissions.
Furthermore, some Nigerians have complained of the inability of drugs regimens, including some Artemisinin based Combination Therapies (ACTs), to cure their malaria, prompting concerns from the Federal Ministry of Health.
Only recently, a survey of anti-malaria drugs in three African countries found that the drugs were of poor quality. The joint US and World Health Organisation (WHO) study discovered that up to 40 percent of artemisinin-based drugs in Senegal, Madagascar, and Uganda, failed quality tests. Also, researchers found out that between 26 and 44 percent of the malaria pills tested was of low quality, as some of the the drugs had included impurities or pills not containing enough active ingredients.
Although an inquest to authenticate these claims has been commissioned in Nigeria, medical experts opine that several things could account for the poor quality of the drugs.
Shilaj Chakravorty, consultant pathologist, BT health and Diagnostic centre, Lagos State University Teaching Hospital, (LASUTH), Ikeja, noted that what can cause treatment failure of malaria include incorrect drug dosage, poor drug quality, non-compliance of drug regimen and consumption of substandard anti-malaria drugs, as insufficient active ingredients could hinder the effectiveness of the ACT drug, to mention a few.”
According to him, the aforementioned cause of treatment failure contributes to drug resistance, as it exposes the malaria parasite to sub-optimal drug levels. “Across-the-shelf purchase of anti-malaria drugs and advertisement of various types of anti-malaria drugs in the media, have led people to indulge in self-medication without undergoing medical tests to ascertain whether malaria really is the cause of fever. As a result, inappropriate medication leads to development of resistant strains of the malaria parasite. One should also be aware that cross-resistance is common, which means a parasite developing resistance to one drug will show resistance to any other drug within that drug family. However, as all fever is not malaria, diagnosis for malaria must be done and treated within 24 hours of the onset of symptoms in line with WHO stipulation,” he said.
To Wellington Oyibo, consultant medical parasitologist, college of medicine, University of Lagos, Idi-araba, Lagos, tolerance to ACT, which was reported in Thailand and Cambodia late 2008, showed that when ACT was administered, early stages of the parasite in blood was not cleared but tolerated.
Oyibo disclosed that though the older stages of the malaria parasite were cleared at the tolerance stage, it took a longer time for both parasites and clinical symptoms to be cleared, which became an early warning sign of the onset of resistance.
“There was full resistance reported in 2009 in the Thailand/Cambodia boarder, i.e. ACT resistance. However, in Nigeria, there has been no scientific evidence of resistance ACT resistance though some individual observations have been shared among health workers,” said the parasitologist.
Recently, The Federal Ministry of Health (FMOH) carried out a Drug therapeutic efficacy testing (DTET) in seven centres to ascertain assertions of ACT resistance. The last testing was done in 2003 to ascertain chloroquine resistance. However, globally, a WMNET network is trying to track the ACT resistance gene, as is the case with prophylactic drugs like chloroquine and Fansidar.
It is noteworthy to state that due to poverty, Nigerians still purchase drugs across the counter –like Chloroquine and Fansidar which are already known to be resistant to the malaria parasite. Global Fund through the FMOH is making ACT drugs free in some private and government health institutions and at a subsidised price in private institutions. In this manner, Nigerians would be able to access drugs easily without much difficulty.
For Oyibo, “The government should scale up the supply of ACT drugs by global fund to ensure that Nigerians have access to it. With access to ACTs, the continued use of chloroquine and Fansidar should be stopped forthwith so as to reduce the continued spread of malaria parasite resistance genes in the population. However, for clinical managers, good diagnosis and data management must be in place to manage issues relating to malaria prevention. Caregivers and Nigerians should desist from using Chloroquine and Fansidar for the treatment of malaria ….”
The reason is simple: if ACT fails in the treatment of malaria, where are Nigerians going to take succour from? That is why all hands should be on deck. The well considered policy on malaria diagnosis and treatment which requires the confirmation of malaria through rapid diagnosis or microscopy is expected to curtail the overuse of anti-malaria drugs and thus reduce drug pressure.
..By Alexander Chiejina
Malaria prevention is one issue that has spurred researchers across the globe to effectively combat the parasite Plasmodium species, which is transmitted via infected mosquito bites. However, despite the use of prophylactic drugs like Fansidar, Quinine, Chloroquine, etc. in areas where mosquitoes are common, little has been achieved, even as issues of partial immunity development in individuals infected with the parasite have arisen.
Interestingly, research by the World Health Organisation (WHO) suggests that the best available treatment is a combination of drugs known as artemisinin-based combination therapies (ACT). Nonetheless, the discovery of low quality supplies of the drugs in some countries has given real cause for concern, besides dampening Nigerians confidence since evidence shows malaria is unrelenting in the level of devastation it causes.
Figures from National Malaria Control Programme (NMCP) show that 50 percent of the population will have at least one attack in a year, with malaria currently accounting for about 130 million clinically diagnosed cases and about 60 percent of all clinic attendance and 30 percent hospital admissions.
Furthermore, some Nigerians have complained of the inability of drugs regimens, including some Artemisinin based Combination Therapies (ACTs), to cure their malaria, prompting concerns from the Federal Ministry of Health.
Only recently, a survey of anti-malaria drugs in three African countries found that the drugs were of poor quality. The joint US and World Health Organisation (WHO) study discovered that up to 40 percent of artemisinin-based drugs in Senegal, Madagascar, and Uganda, failed quality tests. Also, researchers found out that between 26 and 44 percent of the malaria pills tested was of low quality, as some of the the drugs had included impurities or pills not containing enough active ingredients.
Although an inquest to authenticate these claims has been commissioned in Nigeria, medical experts opine that several things could account for the poor quality of the drugs.
Shilaj Chakravorty, consultant pathologist, BT health and Diagnostic centre, Lagos State University Teaching Hospital, (LASUTH), Ikeja, noted that what can cause treatment failure of malaria include incorrect drug dosage, poor drug quality, non-compliance of drug regimen and consumption of substandard anti-malaria drugs, as insufficient active ingredients could hinder the effectiveness of the ACT drug, to mention a few.”
According to him, the aforementioned cause of treatment failure contributes to drug resistance, as it exposes the malaria parasite to sub-optimal drug levels. “Across-the-shelf purchase of anti-malaria drugs and advertisement of various types of anti-malaria drugs in the media, have led people to indulge in self-medication without undergoing medical tests to ascertain whether malaria really is the cause of fever. As a result, inappropriate medication leads to development of resistant strains of the malaria parasite. One should also be aware that cross-resistance is common, which means a parasite developing resistance to one drug will show resistance to any other drug within that drug family. However, as all fever is not malaria, diagnosis for malaria must be done and treated within 24 hours of the onset of symptoms in line with WHO stipulation,” he said.
To Wellington Oyibo, consultant medical parasitologist, college of medicine, University of Lagos, Idi-araba, Lagos, tolerance to ACT, which was reported in Thailand and Cambodia late 2008, showed that when ACT was administered, early stages of the parasite in blood was not cleared but tolerated.
Oyibo disclosed that though the older stages of the malaria parasite were cleared at the tolerance stage, it took a longer time for both parasites and clinical symptoms to be cleared, which became an early warning sign of the onset of resistance.
“There was full resistance reported in 2009 in the Thailand/Cambodia boarder, i.e. ACT resistance. However, in Nigeria, there has been no scientific evidence of resistance ACT resistance though some individual observations have been shared among health workers,” said the parasitologist.
Recently, The Federal Ministry of Health (FMOH) carried out a Drug therapeutic efficacy testing (DTET) in seven centres to ascertain assertions of ACT resistance. The last testing was done in 2003 to ascertain chloroquine resistance. However, globally, a WMNET network is trying to track the ACT resistance gene, as is the case with prophylactic drugs like chloroquine and Fansidar.
It is noteworthy to state that due to poverty, Nigerians still purchase drugs across the counter –like Chloroquine and Fansidar which are already known to be resistant to the malaria parasite. Global Fund through the FMOH is making ACT drugs free in some private and government health institutions and at a subsidised price in private institutions. In this manner, Nigerians would be able to access drugs easily without much difficulty.
For Oyibo, “The government should scale up the supply of ACT drugs by global fund to ensure that Nigerians have access to it. With access to ACTs, the continued use of chloroquine and Fansidar should be stopped forthwith so as to reduce the continued spread of malaria parasite resistance genes in the population. However, for clinical managers, good diagnosis and data management must be in place to manage issues relating to malaria prevention. Caregivers and Nigerians should desist from using Chloroquine and Fansidar for the treatment of malaria ….”
The reason is simple: if ACT fails in the treatment of malaria, where are Nigerians going to take succour from? That is why all hands should be on deck. The well considered policy on malaria diagnosis and treatment which requires the confirmation of malaria through rapid diagnosis or microscopy is expected to curtail the overuse of anti-malaria drugs and thus reduce drug pressure.
..By Alexander Chiejina
Saturday, September 4, 2010
Taking traditional medicine to the next level in NIgeria
…as experts call for the establishment of Traditional Medicine Board
There is no gain saying that over 60 percent of Nigerians patronise different forms of traditional medicine (TM) practice and the trade accruing from traditional medicine only is estimated to be over USD1billion.
However, what is worrisome is that while countries like China and India have developed their TM such as acupuncture to become globally accepted and are reaping billions of dollars in foreign exchange, Nigeria is still grappling with giving legislative backing to a practice which is sustaining millions of Nigerians that cannot afford orthodox treatment.
In an interview with BusinessDay with Tamuno Okujagu, Director-General/Chief Executive Officer, Nigeria Natural Medicine Development Agency (NNMDA), said that traditional medicine has been with mankind al binito and has contributed immensely the World Health Organisation (WHO) acknowledges the growing need and potentials of TM and continues to encourage and support its promotion, documentation and research with a view of further developing its potentials and use.
He stated that as Nigeria joins the African continent to celebrate a decade of African Traditional medicine (ATM) with the theme “Universal access and Human Rights”, there is the need for stakeholders in the country to take stock of activities during the decade, the achievements, challenges, lessons learnt from the promotion of TM medicine with a view of chartering a way forward for its integration into the nation’s healthcare system.
Okujagu disclosed that the Federal Government through the Agency produced the first draft policy and legal instrument for Intellectual Property Right (IPR) regime for Traditional Medicine Knowledge and Practice (TMKP) with the draft policy titled: “Traditional knowledge and biological resources protection Act.
In his words “The draft policy is the basis for a proposed draft bill, which builds on an international consensus that traditional knowledge and genetic resources should not be misappropriated, and that some form of protection is required to achieve this. The rights of holders to the effective protection of their knowledge against misappropriation should be recognised and respected. Although the draft policy is the first working document on mechanism for IPR for traditional medicine knowledge and practice, it has not been sent to the National Assembly.”
The Director General added that more needs to be done to further achieve the outcomes of issues of policy, legal framework, institutionalizing TM, inauguration of National Board to regulate traditional medicine, establishment of centers of excellence, promotion of laboratory and clinical evaluation, development of local production, to mention but a few.
Lending his view at a one day symposium to commemorate African Traditional Medicine day in Lagos recently, Mukhtar Abdurahman, Vice Chancellor, Kaduna State University, revealed that disregard for the role of traditional medicine in primary healthcare system by policy makers, lack of sufficient scientific data on safety, efficacy, and quality of TM, absence of regulatory policies as well as problems arising from activities of traditional practitioners are the major challenges facing the sector.
Abdurahman stated that the main objective of the plan of action as agreed by African union head of states and governments at a summit held in Lusaka, Zambia in July 2001 was the recognition, acceptance, development and integration of TM into the public healthcare system of the region.
“Priority areas were developed; sensitization of the society on TM, legislation of TM, institutional arrangement, resource mobilization, research and training, cultivation and conservation of medicinal plants, local production of standardization ATM, partnerships, to mention but a few. Taking a cursory look at the current situation, Nigeria hasn’t fared so well hence the Federal Ministry of Health, Federal Ministry of Science and Technology and other relevant agencies need to pursue the mandate for developing safe and high quality traditional medicine for all,” Abdurahman concluded.
With the launch of WHO’s comprehensive traditional medicine strategy in 2002, which was designed to assist countries develop national policies on the evaluation and regulation for TM practices, promote therapeutically sound use of TM by providers and consumers, a lot needs to be done to the government towards creating the enabling environment to facilitate the development of TM.
For Bunmi Omoseyindemi, Chairman, Lagos state Traditional medicine board, the integration of traditional medicine into the nation’s healthcare system will go a long way in improving the current poor health index.
Omoseyindemi disclosed that “Unlike Nigeria, Ghana and other neighbouring country have centers of excellence where research on traditional medicine is done and training and degrees awarded. In this way, adequate science evidence base is developed and appropriate information to the public is made.”
It is important to state that the bill seeking the establishment of Traditional Medicine Council still before the national assembly waiting its passage into law. It will be recalled that the Federal Executive Council (FEC) had on August 16, 2006, approved a draft policy and a bill on the regulation and practice of traditional medicine in the country. The bill is titled: “Establishment of the Nigerian Traditional Medicine Policy and the Bill to Establish the Traditional Medical Council of Nigeria.”
So, traditional medicine has much to offer global health, especially as new drugs have never been more urgently needed. No doubt, with joined research capacities in equitable collaborations, new scientific techniques could spark a revival in global health research and development. At least, Artemisinin, which is extracted from Artemisia annua or Chinese sweet wormwood, is the basis for the most effective malaria drugs the world has ever seen till date.
by Alexander Chiejina
There is no gain saying that over 60 percent of Nigerians patronise different forms of traditional medicine (TM) practice and the trade accruing from traditional medicine only is estimated to be over USD1billion.
However, what is worrisome is that while countries like China and India have developed their TM such as acupuncture to become globally accepted and are reaping billions of dollars in foreign exchange, Nigeria is still grappling with giving legislative backing to a practice which is sustaining millions of Nigerians that cannot afford orthodox treatment.
In an interview with BusinessDay with Tamuno Okujagu, Director-General/Chief Executive Officer, Nigeria Natural Medicine Development Agency (NNMDA), said that traditional medicine has been with mankind al binito and has contributed immensely the World Health Organisation (WHO) acknowledges the growing need and potentials of TM and continues to encourage and support its promotion, documentation and research with a view of further developing its potentials and use.
He stated that as Nigeria joins the African continent to celebrate a decade of African Traditional medicine (ATM) with the theme “Universal access and Human Rights”, there is the need for stakeholders in the country to take stock of activities during the decade, the achievements, challenges, lessons learnt from the promotion of TM medicine with a view of chartering a way forward for its integration into the nation’s healthcare system.
Okujagu disclosed that the Federal Government through the Agency produced the first draft policy and legal instrument for Intellectual Property Right (IPR) regime for Traditional Medicine Knowledge and Practice (TMKP) with the draft policy titled: “Traditional knowledge and biological resources protection Act.
In his words “The draft policy is the basis for a proposed draft bill, which builds on an international consensus that traditional knowledge and genetic resources should not be misappropriated, and that some form of protection is required to achieve this. The rights of holders to the effective protection of their knowledge against misappropriation should be recognised and respected. Although the draft policy is the first working document on mechanism for IPR for traditional medicine knowledge and practice, it has not been sent to the National Assembly.”
The Director General added that more needs to be done to further achieve the outcomes of issues of policy, legal framework, institutionalizing TM, inauguration of National Board to regulate traditional medicine, establishment of centers of excellence, promotion of laboratory and clinical evaluation, development of local production, to mention but a few.
Lending his view at a one day symposium to commemorate African Traditional Medicine day in Lagos recently, Mukhtar Abdurahman, Vice Chancellor, Kaduna State University, revealed that disregard for the role of traditional medicine in primary healthcare system by policy makers, lack of sufficient scientific data on safety, efficacy, and quality of TM, absence of regulatory policies as well as problems arising from activities of traditional practitioners are the major challenges facing the sector.
Abdurahman stated that the main objective of the plan of action as agreed by African union head of states and governments at a summit held in Lusaka, Zambia in July 2001 was the recognition, acceptance, development and integration of TM into the public healthcare system of the region.
“Priority areas were developed; sensitization of the society on TM, legislation of TM, institutional arrangement, resource mobilization, research and training, cultivation and conservation of medicinal plants, local production of standardization ATM, partnerships, to mention but a few. Taking a cursory look at the current situation, Nigeria hasn’t fared so well hence the Federal Ministry of Health, Federal Ministry of Science and Technology and other relevant agencies need to pursue the mandate for developing safe and high quality traditional medicine for all,” Abdurahman concluded.
With the launch of WHO’s comprehensive traditional medicine strategy in 2002, which was designed to assist countries develop national policies on the evaluation and regulation for TM practices, promote therapeutically sound use of TM by providers and consumers, a lot needs to be done to the government towards creating the enabling environment to facilitate the development of TM.
For Bunmi Omoseyindemi, Chairman, Lagos state Traditional medicine board, the integration of traditional medicine into the nation’s healthcare system will go a long way in improving the current poor health index.
Omoseyindemi disclosed that “Unlike Nigeria, Ghana and other neighbouring country have centers of excellence where research on traditional medicine is done and training and degrees awarded. In this way, adequate science evidence base is developed and appropriate information to the public is made.”
It is important to state that the bill seeking the establishment of Traditional Medicine Council still before the national assembly waiting its passage into law. It will be recalled that the Federal Executive Council (FEC) had on August 16, 2006, approved a draft policy and a bill on the regulation and practice of traditional medicine in the country. The bill is titled: “Establishment of the Nigerian Traditional Medicine Policy and the Bill to Establish the Traditional Medical Council of Nigeria.”
So, traditional medicine has much to offer global health, especially as new drugs have never been more urgently needed. No doubt, with joined research capacities in equitable collaborations, new scientific techniques could spark a revival in global health research and development. At least, Artemisinin, which is extracted from Artemisia annua or Chinese sweet wormwood, is the basis for the most effective malaria drugs the world has ever seen till date.
by Alexander Chiejina
A nation on the brink of cholera outbreak
With over 517 deaths in eight weeks, resulting from 10, 134 cases of cholera attacks in over 10 states in the country, mostly in the North-west and North-east zones, the current outbreak is one of great concern to public health experts in the country given recent epidemiological survey which suggest that the entire country may be at risk of infection.
This warning no doubt should rally unaffected states to act fast against any possible spread that might likely increase the country’s health woes. This is as a total of about ten states have recorded cases of cholera outbreak- Bauchi, and Borno, recording high incidence of the epidemic followed by states like Gombe, Jigawa, Yobe, Taraba, Kaduna, Cross-River, Rivers and of course Adamawa.
In an interview with Innocent Ujah, Director General, Nigerian Institute of Medical Research (NIMR), Ujah regretted the unfortunate deaths of Nigerians in the states being ravaged by cholera outbreak. He stated that cholera is a disease of poverty and ignorance which can be prevented easily through simple hygiene and low technology. He hinted that many lives are needlessly lost largely due to intellectual poverty.
In the words of the Director General; “In response to the devastating pathology caused by outbreak of cholera in 11 states of the Federation, NIMR has dispatched a team of microbiologists to the affected states to work with other health team. In the meantime, the Institute has embarked on research component of the intervention with the sole aim of characterising the disease among others which should assist various governments to develop policies and strategies that will prevent or reduce the avoidable tragedy.”
Explaining the disease in its entity, Shilaj Chakravorty, Consultant Pathologist, BT Health & Diagnostic Complex, Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, disclosed that cholera is an infection of the small intestine by which the bacterium Vibrio cholera releases toxin that causes increased release of water in the intestines, which produces severe diarrhea.
Chakravorty noted that though cholera occurs in places with poor sanitation, crowding, risk factors that predisposes people to get infected with the bacteria include exposure to contaminated/untreated drinking water, living in or travelling to areas where there is cholera. He hinted that symptoms associated with cholera include serious diarrhoea, vomiting, leading to dehydration as within a short incubation period, it can be fatal if not treated in time.
The consultant pathologist disclosed that “In India where infectious disease centers/hospitals exist, people who come down with such diseases like cholera are rushed to such centers. There, clinical examinations are done to ascertain the actual cause of the outbreak. In addition, people affected with the disease are isolated for proper observation so that they don’t infect others within the community.
“The objective of treating people with cholera is to replace fluid and electrolytes lost through diarrhea. The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally. Given adequate fluids, people can make a full recovery,” Chakravorty concluded.
Taking a cursory look at the cholera episode in the country, it will be recalled that Bauchi State Health commissioner Mohammed Jalem blamed the cholera outbreak on poor sanitation and contamination of open wells - the major sources of water in the rural communities. So far, Bauchi state has recorded the highest casualty figures. Going further, tales of prompt medication forced affected victims to resort to self-medication. Recent floods in parts of the North compounded the situation further as houses were destroyed; sewage bursting forth and merging with blocked drainages in the affected areas thus worsening water supply channel.
This current outbreak says a lot about the seriousness of health authorities that a disease whose cause is so well-known should be allowed to occur. It is obvious at this point that government should lay more emphasis on preventive health, than curative as a first step to stopping cholera scourge.
No doubt, if our leaders hold with high esteem the lives of the people they profess to serve, a multi-pronged approach to curbing incessant cholera outbreaks is needed. New strategies are required. Primary health care must improve; this level of healthcare and disease prevention must be strengthened. States may have to work closely with the National Primary Health Care Development Agency and seek the technical support of international agencies. The relevant departments in the states should also be proactive.
Since drinking of contaminated water is a known cause of cholera, state governments must commit themselves to the provision of potable drinking water for people both in rural and urban areas. Going further, sanitation must also be given top priority, with state governments not just naming one Saturday in a month as environmental sanitation day but actually enforcing the clean up exercise by making sure residents came out to clean their surroundings.
More importantly, a lot can be done in the area of public enlightenment and education, with special emphasis on basic hygiene practices. Local government councils must live up to their responsibility of clearing rubbish heaps that are gradually taking over most streets and roads in our towns and cities, by providing standard refuse disposal facilities and ensuring that these too are regularly emptied with refuse disposal trucks to a designated dump site.
Even as the country is already lagging behind in the implementation of the Millennium Development Goals (MDGs) with global target year of 2015, it is instructive that access to potable water is an integral part of the MDGs, a task in which the country must immediately address.
By Alexander Chiejina
This warning no doubt should rally unaffected states to act fast against any possible spread that might likely increase the country’s health woes. This is as a total of about ten states have recorded cases of cholera outbreak- Bauchi, and Borno, recording high incidence of the epidemic followed by states like Gombe, Jigawa, Yobe, Taraba, Kaduna, Cross-River, Rivers and of course Adamawa.
In an interview with Innocent Ujah, Director General, Nigerian Institute of Medical Research (NIMR), Ujah regretted the unfortunate deaths of Nigerians in the states being ravaged by cholera outbreak. He stated that cholera is a disease of poverty and ignorance which can be prevented easily through simple hygiene and low technology. He hinted that many lives are needlessly lost largely due to intellectual poverty.
In the words of the Director General; “In response to the devastating pathology caused by outbreak of cholera in 11 states of the Federation, NIMR has dispatched a team of microbiologists to the affected states to work with other health team. In the meantime, the Institute has embarked on research component of the intervention with the sole aim of characterising the disease among others which should assist various governments to develop policies and strategies that will prevent or reduce the avoidable tragedy.”
Explaining the disease in its entity, Shilaj Chakravorty, Consultant Pathologist, BT Health & Diagnostic Complex, Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, disclosed that cholera is an infection of the small intestine by which the bacterium Vibrio cholera releases toxin that causes increased release of water in the intestines, which produces severe diarrhea.
Chakravorty noted that though cholera occurs in places with poor sanitation, crowding, risk factors that predisposes people to get infected with the bacteria include exposure to contaminated/untreated drinking water, living in or travelling to areas where there is cholera. He hinted that symptoms associated with cholera include serious diarrhoea, vomiting, leading to dehydration as within a short incubation period, it can be fatal if not treated in time.
The consultant pathologist disclosed that “In India where infectious disease centers/hospitals exist, people who come down with such diseases like cholera are rushed to such centers. There, clinical examinations are done to ascertain the actual cause of the outbreak. In addition, people affected with the disease are isolated for proper observation so that they don’t infect others within the community.
“The objective of treating people with cholera is to replace fluid and electrolytes lost through diarrhea. The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally. Given adequate fluids, people can make a full recovery,” Chakravorty concluded.
Taking a cursory look at the cholera episode in the country, it will be recalled that Bauchi State Health commissioner Mohammed Jalem blamed the cholera outbreak on poor sanitation and contamination of open wells - the major sources of water in the rural communities. So far, Bauchi state has recorded the highest casualty figures. Going further, tales of prompt medication forced affected victims to resort to self-medication. Recent floods in parts of the North compounded the situation further as houses were destroyed; sewage bursting forth and merging with blocked drainages in the affected areas thus worsening water supply channel.
This current outbreak says a lot about the seriousness of health authorities that a disease whose cause is so well-known should be allowed to occur. It is obvious at this point that government should lay more emphasis on preventive health, than curative as a first step to stopping cholera scourge.
No doubt, if our leaders hold with high esteem the lives of the people they profess to serve, a multi-pronged approach to curbing incessant cholera outbreaks is needed. New strategies are required. Primary health care must improve; this level of healthcare and disease prevention must be strengthened. States may have to work closely with the National Primary Health Care Development Agency and seek the technical support of international agencies. The relevant departments in the states should also be proactive.
Since drinking of contaminated water is a known cause of cholera, state governments must commit themselves to the provision of potable drinking water for people both in rural and urban areas. Going further, sanitation must also be given top priority, with state governments not just naming one Saturday in a month as environmental sanitation day but actually enforcing the clean up exercise by making sure residents came out to clean their surroundings.
More importantly, a lot can be done in the area of public enlightenment and education, with special emphasis on basic hygiene practices. Local government councils must live up to their responsibility of clearing rubbish heaps that are gradually taking over most streets and roads in our towns and cities, by providing standard refuse disposal facilities and ensuring that these too are regularly emptied with refuse disposal trucks to a designated dump site.
Even as the country is already lagging behind in the implementation of the Millennium Development Goals (MDGs) with global target year of 2015, it is instructive that access to potable water is an integral part of the MDGs, a task in which the country must immediately address.
By Alexander Chiejina
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