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Tuberculosis: Physicians suggest measures to prevent spread, reduce burden

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Some public physicians on Thursday suggested strategic measures to prevent spread and reduce the burden of tuberculosis (TB) in Nigeria.

They said the burden of TB was heightened by various factors.

The factors included unclean environment; unhealthy living; lack of screening; open defecation; malnutrition; overcrowding; and uncompleted treatment.

Tuberculosis is caused by bacterium (Mycobacterium tuberculosis) that often affects the lungs.

It is spread from person to person through the air. When people with TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

Statistics from the World Health Organisation show that Nigeria ranks first in Africa and sixth among 30 countries globally with the highest burden of the disease.

Nigeria also ranks first in Africa with the number of undetected cases.

A public health physician, Dr Chidiebere Thaddeus, blamed the high incidence of tuberculosis, which was common among rural and city slum dwellers in Nigeria, on the current economic hardship in the country.

Thaddeus identified malnutrition as a factor that had reduced TB patient’s chances of surviving treatment.

According to him, the economic hardship and inflation in the country made it difficult for a lot of people to afford a balanced diet or feed adequately.

He said that unhealthy living environments and open defecation were practices still common in Nigeria, that greatly contributed to the burden of tuberculosis.

He said, “Nigeria is ranked the highest country with open defecation and Lagos is the highest city in Africa with open defecation.

“This implied that a lot of people in the country still randomly urinate and defecate without minding the health implications of such acts.

“Unhealthy environment due to pollution and open defecation/urination increases the chances of contracting diseases like TB.”

He advised that every act that could result in environmental pollution and an unhealthy environment should be discouraged as part of an effort to curb the burden of TB.

Also, a Medical Laboratory Scientist, Mr Olumide Fadipe, expressed worry over the position of Nigeria as the sixth and first in rank among countries with high TB cases in the world and Africa respectively.

Fadipe, the Chairman, Association of Medical Laboratory Scientists of Nigeria (AMLSN), Lagos State Chapter, said that finding hidden cases remained the major challenge with Tuberculosis control in the country.

According to him, there is a need to focus more on TB screening and treatment as more Nigerians have less access to good meals which can boost their immunity against the infection.

“Nigeria remains one of the 30 countries globally with the highest burden of the disease. Nigeria also ranks first in Africa in the number of undetected cases.

“Since we are dealing with a highly infectious but treatable disease, we have to focus on detecting these cases and then caring for the affected ones to prevent the spread.

“Detection of new cases and placing them on care should be the major focus point,” he said.

A general physician, Dr Ayodele Ademola, also advised that people should devise other means of exchanging pleasantries and appreciation, rather than hugging.

Ademola, also the Medical Director, StrongTower Hospital and Advanced Fertility Centre, said that overcrowding and close contact were major means of contracting the TB infection.

“TB can easily be transmitted through close contact with an infected person. Maintaining social distancing is key in preventing its spread. You can show love or appreciation without embracing.

“Another core challenge is patients who break their treatment plan and stop taking their drugs, which gives room for multi-drug resistant tuberculosis. This makes the bacteria become resistant to treatment and drugs become ineffective,” he said.

Ademola emphasised the need for more advocacy on tuberculosis particularly at the grassroot to educate the masses about the disease.

“Tuberculosis is one of the most violent infectious diseases; it still needs to be tackled, and a major way to curtail it is through advocacy.

“Therefore, communities need to know how the disease spreads and how it can be prevented and controlled.

“This is important now because the economic situation denies people good food, which has brought malnutrition and has made the antibodies of tuberculosis patients almost impotent,” he said.

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Health

FG bans use of foreign syringes, needles in tertiary hospitals 

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The Federal Government has mandated all Chief Medical Directors (CMDs) and Medical Directors (MDs) of Federal Tertiary Hospitals to procure needles and syringes solely from NAFDAC-approved local manufacturers.

The new directive is contained in a circular addressed to all CMDs and MDs signed by the Minister of State for Health, Dr Tunji Alausa, on Friday.

The minister said that the directive was aimed at boosting domestic production and shielding the country’s manufacturing sector from the influx of foreign goods.

The circular also mandated NAFDAC to stop issuing licences for the importation of foreign manufactured needles and syringes.

Alausa said the health sector had dentified local pharmaceutical industries that produce needles and syringes that were in serious trouble because of the practice.

He also said that out of the nine local pharmaceutical companies that produced needles and syringes eight years ago, six have folded up due to the dumping of largely substandard goods into the market.

“Mr President has directed that this must stop. We all agreed to take the necessary steps to immediately remedy this sad situation.

“Pursuant to this, NAFDAC has been mandated to stop issuing licences for the importation of foreign manufactured needles and syringes.

“It is also to de-list companies involved in the importation of these products going forward,” he said.

Alausa said ”all our tertiary hospitals are hereby directed to procure needles and syringes for your hospital needs from only the NAFDAC-approved local manufacturers listed below are listed either directly or through any of their vendors.

“EL-Salmat Pharmaceuticals Company Ltd Block, Brand Name: Salmaject, HMA Medical Ltd., with brand Name: Deleject and Afrimedical Manufacturing and Supplies Ltd.”

He also listed some of the distributors of the listed companies in some states of the Federation for easy access to assist in making the procurement process easier in the various institutions.

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KDSG trains 180 Red Cross volunteers on Lassa Fever intervention

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The Kaduna State Ministry of Health has begun a three-day training for 180 Red Cross volunteers on Lassa fever intervention.

The training, which is facilitated by the ministry and funded by the Red Cross, is meant to equip the volunteers selected from 5 LGAs in the state with necessary skills.

The volunteers were drawn from Zaria, Igabi, Kaduna South, Kaduna North and Chikun Divisions.

The State Epidemiologist, Dr Jeremiah Dikwu, said the volunteers were trained with  the knowledge needed to massively intervene during cases of Lassa fever in the state.

He said that the intervention would include Risk Communication and Active Case Search, Psychological First Aid, Rodent Control and Hygiene Promotion for the next 3 months.

Dikwu said the training started  with 30 volunteers on surveillance and would end with the training of 150 volunteers on Risk Communication and Community Engagement .

According to him, Lassa fever is a viral hemorrhagic fever transmitted by rats.

He added that Lassa fever  has been known since the 1950s, but the virus was not identified until 1969, when two missionary nurses died from it in the town of Lassa in Nigeria.

Dikwu added that Lassa fever was caused by a single stranded RNA virus and disseminated systemic primary viral infection.

“The main feature of fatal illness is impaired or delayed cellular immunity leading to fulminant viraemia,” he said

The epidemiologist said that Lassa fever presented  symptoms and signs indistinguishable from those of febrile illnesses such as malaria and other viral hemorrhagic fevers such as Ebola.

“It is difficult to diagnose clinically but should be suspected in patients with fever (e”38°C) not responding adequately to antimalarial and antibiotic drugs.

“The most useful clinical predictors of Lassa fever are fever, pharyngitis, retrosternal pain, and proteinuria for diagnosis; and fever, sore throat, and vomiting for outcome,” Dikwu said.

He said that Ribavirin and general support were needed.

“Ribavirin is almost twice as effective when given intravenously as when taken orally, and if given within six days of the start of illness it may reduce deaths by 90 percent.

“Dehydration, oedema, hypotension, and poor renal function are common; fluid replacement or the use of blood transfusion requires careful monitoring,” he said.

 Dikwu said the volunteers would  be carrying out Risk communication and Community engagement, Active Case Search, Psychological First Aid, Rodent Control and Hygiene Promotion

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Health

Assembly passes Kano Pre-Marital Health Screening Bill

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Kano State House of Assembly has passed a bill for a law to compel intending couples to undergo HIV, hepatitis and sickle cell anaemia screening before marriage.

The passage followed deliberations in the Committee of the Whole House during plenary session,
presided over by the Speaker, Ismail Falgore on Monday in Kano.

After deliberations, the lawmakers approved the 3rd reading of the bill, read by the Deputy Clerk, Alhaji Nasiru Magaji.

Shortly after passage of the bill, the Majority Leader of the house, Lawan Hussein (NNPP-Dala), stated that “any person
intending to marry shall first submit self for medical examinations.”

He said the bill was considered and passed after the 3rd reading, following various legislative processes.

The leader further said that the bill was passed because the state had been battling with different health issues, including
HIV because people go into marriages without medical screening.

He said that the bill, if signed into law, would save many lives and curb the spread of life-threatening diseases.

“The bill will safeguard the health of citizens by institutionalising pre-marital testing to check the spread of diseases
like hepatitis, HIV and sickle cell anaemia,” he added.

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