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Malaria Control: Need For Motoring And Evaluation

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Damiete Oruwari is a fish
erman from Ido, a community in Asari-Toru Local Government Area of Rivers State.
As much as he could remember, fishing had been the key profession of his family. Unfortunately, as unfavourable as the days of his fathers were, the economic hardship made it impossible for them to get the least net to catch fishes, according to the 45 year old primary four drop out.
Narrating his sordid background which was further worsened by the biting economic downturn that affected every segment of the Nigerian economy, Mr  Oruwari said  what looked like succour came to him when in 2007 the government commenced the distribution of free Long-Lasting Insecticide Nets (LLINs).
According to him, a couple of years before then, he could hardly feed his family of seven, made up of five children, a wife and himself. The major reason was that he could not afford to purchase and maintain a good fishing net from his subsistence fishing.
With the commencement of the distribution of the LLINs, however, his story changed: rather than use the nets for what they were meant for, he adapted them as various forms of fishing nets, sometimes combining two or more, as the case may be.
“What I do is to get as many of the nets, even if I have to beg others or pay them small money. I then sew them into various shapes, depending on what type of net I want. When the ones I used get torn, I get new ones.
They are easier and cheaper to get than the real nets. The only difference is that the real nets  last longer because they are meant for fishing.
But it does not matter to me because it helps me to feed my family.
“At least I know that if my family feed well, our, body can withstand some level of malaria. But if we don’t  have  food, malaria will affect us more. So, I prefer to feed my family than use the net to cover them at night,” he said.
To a large extent, Oruwari’s story is pathetic and there seems to be some sense in his reasoning. But one thing is certain: if he uses the LLINs for the prevention of mosquito bites, which is the sole reason it was made, it will reduce malaria infection on his family.
This scenario including several others, constitute the numerous gaps in malaria  control, which had made it difficult to attain the Millemium Development  Goals (MDGs) 6, which aims to reduce HIV/AIDs, Malaria and others infections .
One key lesson to be learnt in Oruwari’s scenario is that he is ignorant of the implications of malaria infection. Another one is that not enough measures have been put in place to monitor the extent to which the distributed LLINs are used to prevent mosquito bites.
There is no doubt that so much has been done to either check or eliminate malaria globally, particularly in Africa, which is the worst hit in malaria infection, with Nigeria worst off. Such measures include both preventive and curative. Inspite of this, however, the existence of various forms of gaps as shown in the Oruwari’s  Scnerio, has in no small way hampered the achievement of the MDG’s 6.
The result is that the global malaria burden does not portray the level of investment aimed at eliminating the ailment. According to World Malaria Record (WMR) in 2013 and 2014, an estimated 3.3 billion people are at risk of  contracting malaria with Nigeria accounting for a quarter of the global malaria burden with 97%  of the country’s about 180 million population at risk.
In her presentation in a recent media round table discussion programme on malaria control held in Lagos, the Country Director of “Malaria No More,” Dayo Oluwole, said 25% of the world’s malaria burden is in Nigeria and that out of 1000 children, 128 die annually, while over 4000 maternal deaths occur within the same period.
She said that about 1 billion is lost to productivity every year in Nigeria due to malaria, a quarter of the global malaria burden is in Nigeria, and 32% of global deaths as a result of malaria occur in Nigeria.
Beyond these embarrassing figures, which is basically in the  health sector, Oluwole further revealed that the malaria burden cuts across other sectors of human endeavour including sports, economy and education.
Giving an example of what impact malaria could have in sports, Oluwole recalled how Nigeria’s dependable central defender, Kenneth Omeruo, was ruled out of a major warm-up game against Scotland in 2014. The import of this is that malaria is capable of hitting an immeasurable blow on a team if it affects key members of the team in a major championship.
The Malaria Country Director said that malaria also takes its bite on the economy of affected countries: in Africa, for instance, she said annually malaria cost the continent about $ billion in productivity. Nigeria, on the other hand, loses N132 billion. This factor is factored in costs of health care, absenteeism, days lost in education decreases    productivity due to brain damage from cerebral malaria and loss of investment and tourism.
“Malaria is bad for business: the disease is responsible for employee absenteeism, healthcare spending and decreased productivity, all of which can negatively impact a company’s reputation. Malaria can strain national economies, impacting some nation’s Gross Domestic Product (GDP) by as much as an estimated 5-6%,” she said.
As regards education, Oluwole said children miss up to 10 million school days per year due to malaria. Also, malaria leads to anemia, a side-effect of frequent malaria, which interferes with children’s ability to concentrate and learn and causes chronic fatigue .
In order to control malaria, therefore, so much has not only been invested by countries, governments organizations and various stakeholders in terms of funding, but also in strategies, some of which had taken relatively longer time and planning to put the ailment under control thus far.
One of such organizations is malaria no more (MNM), an international organization with a focus on creating a world where no one dies from mosquito bites which has taken up the initiative to involve the media in malaria response and control.
To address the issue of ignorance, MNA, in collaboration with Exxon Mobile and other key stakeholders incorporated the media on effective dissemination of information on malaria. With support from media partners, MNA also bought and distributed 4.9 million LLINs in 16 countries.
In Rivers State, as part of responses aimed at achieving the targets set to control malaria, the state government has also distributed anti-malaria drugs/commodities and carried out anti-malaria measure such as provision of 7.4 doses of ACT for malaria case management; provided 1.8 million RDT kits for malaria diagnoses as well as 1.6 doses of SPs for malaria prevention pregnancy.
By The Tide’s investigation, the state also provided  7.6 million LLINs for prevention of malaria transmission through mosquito bites, made available 20,990 doses of injectable Artesunate, confirmed malaria by laboratory diagnosis using Rapid Diagnostic Test (RDT) Kits and microscopy before treatment, training and use of Community Directed Distributors (CDDs) in communities to diagnose and treat malaria in six local government areas (LGAs).
Also, the Clinton Health Access Initiative (CHAI) was into supporting 10 states in Nigeria through a UNITAID funded project to facilitate adoption of infectable antesunate.
The implication of these attention on malaria only goes to re-emphasis the focus on all stratagies  but that of Monitoring and Evaluation (M&E). At  best, this area had always been given lip service by most stakeholders involved in malaria control. At given points, provision has been made by stakeholders but there had not been strict monitoring and evaluation mechanism to ascertain the efficacy of such provisions.
This, obviously, gives the likes of Mr Oruwari some of who either sell malaria commodities or allow same to rot away to have a filled day fustrating the efforts to malaria control. It should also amount to an unequivocal declaration on the need to make M & E in malaria control a key strategy like others.
One way to achieve this is for countries, states, local government areas and stakeholders to come up with legislation aimed at checking the rightful use of malaria commodities for the purposes they are meant for. In the case of Mr Oruwari, for instance, if there was such a legislation, and an effective monitoring mechanism put in place, he would have been apprehended and made to face the law.
Beyond legislation, however, there is also the need to involve the media more in a two-pronged awareness creation: the first, to create adequate in the use and benefits of malaria commodities while also making people aware of the consequences that await defaulters.

 

Sogbeba Dokubo

Minister of Health, Dr. Isaac Adewole (left), with the Minister of State, Dr. Osagie Ehanire, at a public event  in Abuja, recently.

Minister of Health, Dr. Isaac Adewole (left), with the Minister of State, Dr. Osagie Ehanire, at a public event in Abuja, recently.

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Benefits Of Green Tea

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Experts’ review of studies of green tea suggests that daily intake of green tea has significant protective effects against influenza and other upper respiratory tract infections.
Researchers reviewed six random control trials (RCTs) and four prospective cohort studies to evaluate the evidence supporting the effectiveness of tea gargling and tea catechin consumption in preventing viral respiratory infections.
They explain that catechins (or flavanols) present in green tea inhibit the proliferation of viruses in the upper respiratory tract (URT) by forming a protective barrier in the pharynx.
On flavanol, in particular, epigallocatechin gallate (EGCg), has a direct anti-viral effect and physically binds to and flushes out viruses in the URT.
According to them, “EGCg and epigallocatechin (EGC) bind to the hemagglutinin spike on the viral surface and neuraminidase to inhibit attachment of the virus to the cell surface, thereby preventing influenza infection.
“Given the evidence that EGCg, a main component of tea catechins, provides effective protection against influenza virus and adenovirus, it may also protect against respiratory infections caused by other viruses.”
Interest in non-pharmaceutical interventions (NPIs) that may slow or prevent the spread of the infectious disease has increased due to recent pandemics involving influenza, severe acute respiratory syndrome-coronavirus (SARS-CoV), and COVID-19.
Measures that can reduce their impact and severity in the early stages is deemed key in the fight against infection. There is considerable research on the efficacy of NPIs, such as hand washing, wearing masks and physical distancing, in reducing the transmission of respiratory infections have been performed, but limited documentary proof supporting the effectiveness of tea gargling and tea catechin, therefore the efficacy of the intervention is “not well accepted”.
One study reviewed by the team demonstrated consumption of catechin capsules reduced the incidence of influenza-like symptoms by 32.1 per cent, and another noted “strong effects” following consumption of large amounts of catechins per day.
The cohorts from the four studies were selected from populations with a custom of gurgling black tea and green tea, consumption of black tea and green tea, and those who consumed Goishi tea, a local type of green tea produced in the Kochi prefecture in Japan.
Interventions in the RCTs included data from 3,748 subjections and consumption of either green tea extracts (catechin solution for two RCTs, and catechin-containing capsules for two RCTs) or bottled green tea (two RCTs), with placebo (four RCTs) or water (two RCTs) as the control group.
Culled from Tribuneonline

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Family Planning Leads To Healthier Children – Expert

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A Professor/Consultant Obstetrician and Gynaecologist, College of Medicine, University College Hospital (UCH), Ibadan, Prof. Christopher Aimakhu says families that use family planning usually have stronger and healthier children, while  young people that embrace family planning have the likelihood of remaining in school longer than those who do not.
Aimakhu in a lecture entitled: “Analysis of Family Planning Budget in Nigeria”, at a Rotary Online Training of Journalists explained that family planning is an important tool in the prevention of child and infant deaths, unintended pregnancies, risky births, unsafe abortions, and maternal mortality deaths.
Noting that Nigeria has a population of about 201,000,000 with a modern Contraceptive Prevalence Rate (mCPR) of 12 per cent and a fertility rate of 5.3, he expressed worry that by 2050 Nigeria’s estimated  population  would be 543 million if not checked.
He said if all unmet needs for modern contraception in Nigeria were satisfied, unintended pregnancies would drop by 77 per cent from 2.5 million to 555,000
“If a full provision of modern contraception were combined with adequate care for all pregnant women and their newborns, maternal deaths would drop by 68 per cent from 61,000 to 19,000 per year) and newborn deaths would drop by 85 per cent from 255,000 to 38,000 per year.
“As a result, the annual number of unplanned births would decrease from 885,000 to 200,000 and the number of abortions would drop from 1.3 million to 287,000.
Another expert and Consultant Obstetrician/Gynaecologist, Dr Olagunju Ayodele has emphasized that access to contraception will help Nigeria to curb population explosion, reduce its high fertility rate and ultimately balance the country’s demography.
Ayodele who spoke in an interview with Good Health Weekly explained that access to family planning means the human resource will become optimal while material resources and human resources will be balanced.
Noting that too many children means much load and burden on the working population, Ayodele who is also the Chef Executive Officer, Purple IVY Medical Consultants Hospital, Ibadan, said the situation will worsen poverty in the environment, especially in a country with one of the highest fertility rate in Africa.
“Imagine our fertility rate as high as 5.6 per woman, meaning that an average Nigerian woman is likely to deliver about 5 to 6 children, which is very high compared to countries like Sweden where their fertility rate is 1.
Ayodele said unchecked fertility rate will lead to population explosion, escalation of crimes, increased poverty, and conditions will get worse while Nigeria will not be able to manage its natural resources that will become too little for the population.
“It will also mean that the little educational packages we have will not be able to take the population, job challenges will increase because more people will not have jobs and more will be searching for jobs if we don’t have access to contraception.”
He said it was also necessary to pay special attention to the contraception needs of adolescents that will grow into becoming the country’s reproductive population.
“It is important for the country to improve adolescents’ contraceptive package so that challenges of abortion will go down.  As we speak now, in Sub-Saharan Africa, the top five killers of women is haemorrhage meaning any condition that results in excessive bleeding.
Number two are hypertensive disorders like eclampsia, and the third is unsafe abortion which means that effective contraception will reduce it, and in addition, reduce morbidities from the procedure.
He stressed the need for Nigeria to remove the human interface between contraception and adolescents for effective family planning services.
“The services here in Nigeria are so complicated such that when you go to a facility to buy condoms it is usually kept close to the cashier and they will give them grudgingly with an attitude showing that why are they having sex?   These attitudes discourage people from accessing contraception.
“Contraception will benefit the country because it will reduce maternal mortality if done effectively.  It will give the country better outcomes because in future the adolescents will be the ones that will now grow into the reproductive population of the country.  If  a lot of them come down with sexual dysfunction it will affect the economy of the country.    They will be spending money on treating their sexual dysfunction, dropping from work and will not contribute optimally to the services of the country,” he stated.

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Vaccination: 25m Children Under Threat – UNICEF

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United Nations Children’s Emergency Fund (UNICEF), has warned that 25 million children are under threat of different transmittable diseases due to lack of vaccination.
Executive Director of UNICEF, Catherine Rusell, gave the indication in a paper she delivered early this week at an event to mark ending the Covid-19 pandemic equitable access to vaccines.
She observed that upto 21 million children did not receive the vaccine against diphtheria, tetanus, and pertussis —/ a marker for immunization coverage in general.
“This is the largest, sustained drop in the rates of routine childhood vaccinations in a generation — potentially wiping out 30 years of progress if we don’t get back on track”, she declared.
Data so far released indicate that of late August, 12.4 billion doses of COVID-19 vaccines have been administered globally.
As the world’s largest single buyer of vaccines and humanitarian supplies in the world, said stated that UNICEF supply division has been instrumental in this effort – with a focus on reaching underserved communities and strengthening health systems.
“With our COVAX partners, we implemented the largest ultra-cold chain scale-up in history — financing and delivering 800 ultra-cold chain freezers to nearly 70 countries in 2021 alone Rusell stated.
She revealed that,” last month, UNICEF shipped more than 20,000 units of the COVID-19 antiviral drug, molnupiravir to Cambodia, which was the first shipment of a novel antiviral by ACT-A partners.
“All these joint efforts to ensure an equitable response to the pandemic are beginning to pay off.
According to her 10 member states have achieved 100 per cent vaccination of health care workers – and coverage for other high-priority groups, including people over 60 and pregnant women, has increased.
While noting that gradually progress is being made to keep up the momentum to protect the world against future surges and new variants,as long coverage continues to be inequitable with communities liable to unprotected and underserved exposure which poses threat to children.
Rusell reasoned that though children may not be the face of the pandemic, but they are certainly among its biggest victims, since the secondary impacts of the pandemic on children’s health, education, and well-being have been devastating.

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