Monthly Post Collection: October 2014

PROMOTING HEALTH IN NIGERIA: WHY IT HAS TO TAKE A VILLAGE

Yashua Alkali Hamza MD, FWACP, MPH

The rigid traditional western concept of health based entirely on diseases or the absence of has done little to reduce the burden of diseases particularly in third world countries. In its most recent report, the World Health Organization identifies Nigeria as having the world’s second-highest number of maternal deaths with approximately 59,000 of such deaths taking place annually. Majority of these cases occur because less than 10% of deliveries are attended to by skilled personnel. In our communities, people distrust the hospitals; they prefer to deliver at home partly because they feel more comfortable being attended to by relatives who though are unskilled understand them better. This gap between modern medicine and societal needs have not served my people well. It has contributed to the unacceptably high rates of maternal mortality and the subsequent deaths of the children left behind.

Health promotion as a public health concept first came into existence in the 20th century following a long period of time when public health was viewed mostly as a field of “sanitary legislations and reforms” Following the first International conference on health promotion by the World Health Organisation in Ottawa in 1986 and a series of others, the final one held in Thailand in 2005 ended with the resolve to reduce health care inequality by globalising health care.

Health promotion involves the individual and the community in decision making about their own health. It also takes into consideration the decision making process by policy makers because the more people value health, the more willing they will be to make the appropriate allocation and resources to promote and safeguard their own health. While social and cultural factors contribute to the high maternal mortality rates in Nigeria, the problem is also a political and economic one. The failure of the government to adequately regulate and fund the health system has sustained the prevalence of maternal death in the country”.

The new shift in healthcare approach has interesting implications for health care providers and the relationship between health care providers and their patients. Involving the community in healthcare decision-making may be difficult at first for a society that has been led to believe in the “Doctor knows it all” philosophy. It would take a lot of awareness creation on the benefits of health promotion. This concept however, has been met with a dose of scepticism particularly from the doctors whose training has been biased towards the traditional concept. Other health care providers would most likely welcome the concept that would give them more far-reaching powers. I sincerely believe that it is only through this huge shift in mind-set of health care providers and patients that we can begin to achieve the health for all objectives and begin to see a society more appreciative of health and living as a whole.

 

 

Case Report: Acute malaria in an 8 year old boy who was RDT negative

 Hamza Y.A1, Kaumi L.2, Oladimeji O.2, Bahago D3.

Malaria is a major public health problem in Nigeria where it accounts for more cases and deaths than any other country in the world. Nigeria contributes to 23% of global cases of malaria making it one of the countries that contributes the most to the global burden, (along with democratic republic of Congo, Ethiopia, Tanzania and Kenya).

As our case report illustrates, if properly and promptly diagnosed, the effects are immediately mitigated.

According to  the United states embassy in Nigeria December 2011 malaria fact sheet, there is an estimated 100 million cases with over 300,000 deaths per year in Nigeria, this is more than the total figure  215,000 death   per year in Nigeria from  (HIV/AIDS).  Despite these statistics, many patients visiting both private and public health facilities still believe malaria is over diagnosed. According to the National malaria control programme (2014), malaria is responsible for 60% of outpatient visit to health facilities, 30% of childhood deaths in under 1 year and 11% maternal deaths in Nigeria. Nigeria loses about N132 billion to malaria in form of treatment cost, prevention and loss of man hour yearly.

Image A is a thick blood smear showing many rings. Note the classic “head phones” appearance of many of the rings.    X1

Image A is a thick blood smear showing many rings. Note the classic “head phones” appearance of many of the rings. X1

This is a case report of an 8 year old that presented with a high grade fever (38.9 degrees centigrade on presentation), said to be intermittent, and associated with chills and rigors, with vomiting of 5 days. He had previously been on antibiotics for the treatment of tonsillitis, but his clinical state didn’t improve. His temperature spiked to as high as 40.1 degrees centigrade. On examination, he was febrile, weak, moderately dehydrated. Blood samples were taken for various tests including Rapid Diagnostic Test for malaria which was negative, a blood film for malaria parasite, however revealed numerous trophozoites of the plasmodium falciparum and gametocytes which signified acute malaria. His Hemogram showed an elevated neutrophil count and his renal function was normal.  He was promptly treated with an artesunate combination therapy after the diagnosis of acute malaria was made.

Image B a thin blood Smear showing Gametocyte with rings. Note the presence of the “Laveran’s bib” which is always not visible. X100

Image B a thin blood Smear showing Gametocyte with rings. Note the presence of the “Laveran’s bib” which is always not visible. X100

This case illustrates the daily challenges that health care facilities face in accurately diagnosing and treating malaria. In this case, the patient was accurately diagnosed and made a fast recovery; however, many facilities are poorly equipped and have diagnostic challenges. It is important that we have a high index of suspicion when dealing with possible malaria cases in the tropics as a negative result does not always exclude malaria.

 

  1. Department of Paediatrics, Childcare & Wellness Clinics, Abuja Nigeria
  2. Department of Family Medicine, Childcare & Wellness Clinics, Abuja Nigeria
  3. Department of Laboratory Sciences, Childcare & Wellness Clinics, Abuja Nigeria

 

References

1. Cox-Singh J, Singh B. Knowlesi malaria: newly emergent and of public health importance?  Trends Parasitol. 24:406-10, 2008.

2. World Health Organization. World Malaria Report 2013. [Accessed 1 August  2014]. Available at:http://www.who.int/malaria/publications/world_malaria_report_2013/en/

3. Antinori, S., Galimberti, L., Milazzo, L. Corbellino, M. Plasmodium knowlesi: The emerging zoonotic malaria parasite, Acta Tropica 125, 2013; 191– 201

4. Kantele A, Marti H, Felger I, et al. Monkey malaria in a European traveler returning from Malaysia. Emerg Infect Dis. 14:1434-6, 2008.

5. Public health England Malaria imported into the United Kingdom in 2013: Implications for those advising travellers. Health Protection Report. Volume 8 Number 16, 25 April 2014. [Accessed 1 August  2014]. Available at:http://www.hpa.org.uk/hpr/archives/2014/hpr1614_trvl-mlr13.pdf

6. Public Health England,  Imported malaria cases and deaths, United Kingdom: 1994 – 2013. Reviewed April 2014. [Accessed 1 August 2014]. Available at:http://www.hpa.org.uk/Topics/InfectiousDiseases/Infections AZ/Malaria/EpidemiologicalData/malaEpi10CasesandDeaths/

7. Health Protection Agency. Foreign travel-associated illness – a focus on those visiting friends and relatives, 2008 report. [Accessed 1 August 2014]. Available at:http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/123141 9800356

8. Checkley, A.M., Smith, A., Smith, V. et al. Risk factors for mortality from imported falciparum malaria in the United Kingdom over 20 years: an observational study, BMJ 2012;344:e2116, [Accessed 1 August  2014] Available at: http://www.bmj.com/content/344/bmj.e2709.full.pdf+html