Health
Challenges Of Female Genital Mutilation
Female Genital Mutilation (FGM), popularly known as female circumcision, is the cultural practice of partial or total removal of the external female genitalia. It includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The procedure has no health benefits for girls and women.
FGM is performed on infants, girls, and women of all ages, depending on where it is done. The age at which girls are cut can vary widely from country to country, and even within countries. Most often, it happens before a girl attains puberty. Sometimes, however, it is done just before marriage or during a woman’s first pregnancy.
In Egypt, about 90% of girls are cut between 5 and 14 years old. Research has shown that the average age at which a girl undergoes FGM is decreasing in some countries, such as Burkina Faso, Co’t d’ Ivoire, Kenya and Mali.
The reasoning is that with more awareness and legislation, more girls and women deliberately opt out of it, leaving only the ignorant and the under-age at the mercy of the practice.
Researchers also think it is possible that the average age of FGM is getting lower so that it can be more easily hidden from authorities in countries where there may be laws against it. It is also widely believed that FGM is performed on younger girls because they are less able to resist.
There are four notable types of FGM . They are: Type 1, called clitoridectomy. It is the partial or total removal of the clitoris and, in very rare cases, only the prepuce, the fold of skin surrounding the clitoris is left. This is also called Sunna Circumcision, it is the least mutilating of all.
In Type 2, known as excision, the clitoris and part of the labia are excised and then sewn together by sutures, thorns, or tying the girl’s legs together until the edges have united.
Type 3, called infibulations, or pharaonic, is the most extreme. In this case, the clitoris, labia minora are excised and incisions made in the labia majora to create raw surfaces that are then either stitched together or kept in close contact until they seal and form a cover for the urethrae meatus. A very small orifice is left for the passage of urine and menstrual flow.
Due to the fact that this type is the most mutilating, the medical, obstetrical and psychological complications are more profound. In many regions, it is the most common procedure performed.
Type 4, regarded as any other form, includes all other harmful procedures to the female genitalia for non-medical purposes. Examples are pricking , piercing, incising, scraping and cauterizing the genital area.
FGM is practiced in 30 countries in Western, Eastern, and North Eastern Africa, in parts of the middle East and Asia, and within some immigrant communities in Europe, North America and Australia.
A recent UNICEF report states that Egypt has the world’s highest total number with 27.2 million women having undergone FGM, while Somalia has the highest prevalence rate of FGM at 98%.
In July 2003, at its second summit, the African union adopted the Maputo protocol, which promoted women’s rights and called for an end to FGM. The agreement came into force in November 2005, and by December 2008, 25 member countries had ratified it.
According to UNICEF report made available to newsmen, 24 African countries have legislations or decrees against FGM practice. These countries are: Burkina Faso, Benin, Central African Republic, Chad, Cote d’Ivoire, Djibouti, Egypt, Ethiopia, Ghana and Guinea.
Others are Guinea-Bissan, Nigeria (some states), Senegal , Somalia, Sudan (some states), Tanzania, Togo, Uganda, Zambia and South Africa.
Findings across these countries have shown that beyond the institution of legislation, little has been done in terms of enforcement for various reasons, which mostly have to do with the belief system of the people involved. The result is that there have been inconsistencies in the rate of FGM. In most cases, there have, in fact, been an increase in FGM practices, and legislations have been of little or no use in checking the trend.
In Nigeria, a 2008 Demographic and Health survey revealed that 30% of the country’s women have been subjected to FGM. This contrasts with 25% reported by a 1999 survey, and 19% by 2003 survey. This suggests no trend unreliable past or most recent survey data in some regions, as well as the possibility that a number of women are increasingly willing to acknowledge having undergone FGM.
In some parts of Nigeria, the vagina walls are cut in new born girls or other traditional practices performed, such as the angurya and gishiri cuts, which fall under Type IV FGM classification of the World Health Organisation (WHO).
Over 80% of all FGMs are performed on girls under one year of age. The prevalence varies with religion in Nigeria: it is prevalent in 31% of Catholics, 27% of protestant and 7% of Muslim women. There is currently no federal law banning the practice of FGM in Nigeria.
Opponents of these practices have hitherto relied on section 34 (1) (a) of the 1999 constitution of the Federal Republic of Nigeria that states “no person shall be subjected to torture or Inhuman or degrading treatment” as the basis for banning the practice nationwide.
Consequently, Nigeria ratified the Maputo protocol in 2005. By 2010, 13 states of Nigeria had enacted laws against FGM practice. These states which include Abia, Bayelsa, Cross River, Delta, Ogun, Osun and Rivers, are being mocked by those who conduct FGMs and who dare any law enforcement agent to arrest them.
There is however an improvement in the legal backing to the quest to abolish FGM in Nigeria with the passage of the violence Against persons’ prohibition (VAPP) Bill by the Nigerian Senate on May 6, 2015.
There are various reasons behind FGM practice, all of which could be categorized under social, economic, and political. For instance, some of those who support it believe that it will empower their daughters not to be promiscuous and ensure that the girls get married and protect the family’s good name.
In some groups, FGM is performed to show a girls growth into womanhood and, in other cases, it marks the start of a girls sexual debut. It is also performed to keep a woman’s virginity by limiting her sexual behaviour.
In some groups, women who are not cut are viewed as dirty and are stigmatized, discriminated upon, or ostracized. There are also other superstitions beliefs attached to the practice.
In Abu/Odual Local Government Area of Rivers State, Nigeria, for instance, the act is carried out seven months of a woman’s first pregnancy. The belief is that if it is not done, the woman and her child would die during delivery.
Others are that the clitoris will continue to grow as a girl gets older and so it must be removed, as well as the one that views external genitalia as being unclean and capable of causing the death of an infant during delivery.
Complications associated with FGM are numerous and could be short-term or long-term. A research carried out by Network of Reproductive Health Journalists in Nigeria (NRHJN), Rivers State chapter, on sixty women and girls in the South-South zone of Nigeria, who have undergone FGM, revealed that about 70% of them were infibulated. Ten percent of them under-went excision, while 20% experienced clitoridectomy.
A particular case of infiblation in the research, which falls under long-term complication, revealed that the woman who was “circumcised” as an infant, currently in her mid-forties, has a growth covering her vagina, making it difficult for her to have sex.
“I first realized the abnormality in my private part when I was in secondary school, about twelve years old. When I enquired from my mother, she explained that it was normal and was in accordance with the belief of our people.
“Years into marriage as a teenager, I noticed a growth gradually covering my vagina, which I must shift before having sexual intercourse. I’ve not been able to get pregnant after over twelve years of marriage”, the woman lamented.
Other common long-term complications include: urinary incontinence, cysts, urogenital track infections, infertility, pelvic inflammatory disease, and obstetrical problems such as delayed or obstructed second stage labour, trauma, and hemorrhage.
The major immediate complications include hemorrhage from the dorsalartery, shock and then infection, urinary retention and tetanus, which can lead to mortality.
Research has also shown that FGM is a key contributor to HIV infection. This is because in most cases the same instruments are used on several girls and women without being sterilized.
In order to check the trend of FGM, much have been postulated, with virtually all relying on specific legislation.
Developments have, howver, shown that there is the need to go beyond coming up with legislation against FGM practice. This is because while legislation is important, the actual willingness to check the practice lies in the conviction of those practicing it to stop it. This can only be achieved when groups, communities , etc practicing FGM own the process.
One way for them to own the process is for key stakeholders, such as traditional rulers, women groups, opinion leaders, etc getting involved in the process of disabusing the minds of their populace about beliefs attached to FGM. By so doing, strict compliance to legislation can be achieved. This is the challenge of truly institutionalising the fight against FGM.
Sogbeba Dokubo
Health
‘How Micro RNA Research Won Nobel Prize’
Two United States scientists who unraveled the human micro RNA have won the Nobel Prize in Physiology or Medicine 2024.
Victor Ambros and Gary Ruvkun won the coveted prize for their work on microRNA as their discoveries help explain how complex life emerged on earth and how the human body is made up of a wide variety of different tissues.
MicroRNAs influence how genes – the instructions for life – are controlled inside organisms, including humans.
Every cell in the human body contains the same raw genetic information, locked in our DNA.
However, despite starting with the identical genetic information, the cells of the human body are wildly different in form and function.
The electrical impulses of nerve cells are distinct from the rhythmic beating of heart cells. The metabolic powerhouse that is a liver cell is distinct to a kidney cell, which filters urea out of the blood.
The light-sensing abilities of cells in the retina are different in skillset to white blood cells that produce antibodies to fight infection.
So much variety can arise from the same starting material because of gene expression.
The US scientists were the first to discover microRNAs and how they exerted control on how genes are expressed differently in different tissues.
The medicine and physiology prize winners are selected by the Nobel Assembly of Sweden’s Karolinska Institute.
They said: “Their groundbreaking discovery revealed a completely new principle of gene regulation that turned out to be essential for multicellular organisms, including humans.
“It is now known that the human genome codes for over 1,000 microRNAs.”
Health
WHO Begins Regulation On Antibiotic Waste
The World Health Organisation (WHO) has begun acting to curb effects of antibiotic pollution.
The new guidance on wastewater and solid waste management for antibiotic manufacturing sheds light on this important but neglected challenge ahead of the United Nations General Assembly (UNGA) High-Level Meeting on antimicrobial resistance (AMR) taking place on 26 September 2024.
The emergence and spread of AMR caused by antibiotic pollution could undermine the effectiveness of antibiotics globally, including the medicines produced at the manufacturing sites responsible for the pollution.
Despite high antibiotic pollution levels being widely documented, the issue is largely unregulated and quality assurance criteria typically do not address environmental emissions. In addition, once distributed, there is a lack of information provided to consumers on how to dispose of antibiotics when they are not used, for example, when they expire or when a course is finished but there is still antibiotic left over.
“Pharmaceutical waste from antibiotic manufacturing can facilitate the emergence of new drug-resistant bacteria, which can spread globally and threaten our health. Controlling pollution from antibiotic production contributes to keeping these life-saving medicines effective for everyone,” said Dr Yukiko Nakatani, WHO Assistant Director-General for AMR ad interim.
Globally, there is a lack of accessible information on the environmental damage caused by manufacturing of medicines.
“The guidance provides an independent and impartial scientific basis for regulators, procurers, inspectors, and industry themselves to include robust antibiotic pollution control in their standards,” said Dr Maria Neira, Director, Department of Environment, Climate Change and Health, WHO. “Critically, the strong focus on transparency will equip buyers, investors and the general public to make decisions that account for manufacturers’ efforts to control antibiotic pollution.”
Health
Kebbi Harmonises Doctors’ Salaries To Curb Brain Drain
In a concerted effort to curb brain drain, the Kebbi State Government has harmonised medical doctors’ salaries to be at par with their colleagues in the federal government’s tertiary health facilities.
Kebbi State Commissioner for Health, Musa Inusa-Isma’il, disclosed this at the handing over of ambulances to the state-owned health facilities at the Ministry of Health in Birnin Kebbi yesterday.
Inusa Isma’il, according to a statement by Ahmed Idris, the Chief Press Secretary to the governor, said the essence of the harmonisation was to retain the existing medical doctors and attract more to the services of the state.
According to him, the doctors across the state had already started enjoying the new salaries from August 2024.
He said the release of the vehicles was in fulfilment of Governor Nasir Idris’ promise to uplift health care services in the state.
“His Excellency said I should inform you, the beneficiaries of this gesture, that the vehicle should be strictly used for the intended purpose. It should not be used for anything else.
“If there is no referral case, each of the vehicles must be parked at the hospital by 6 pm. The governor said you should warn your drivers against reckless driving as well as violating the instructions.
“We should also do everything possible to reciprocate the gesture by working according to the terms and conditions attached,” he advised.
The benefiting health facilities included Sir Yahaya Memorial Hospital, Birnin Kebbi; State Teaching Hospital, Kalgo; General Hospital, Argungu; General Hospital, Yauri; General Hospital, Zuru; and General Hospital, Bunza.
In his speech, the permanent secretary of the ministry, Dr Shehu Koko, recalled that the ambulances were handed over to the ministry last Friday by the governor for the onward handover to the benefiting hospitals.
He observed that the ambulances would go a long way in improving the referral system in the state, adding that delays in reaching the secondary and tertiary facilities would be eliminated.
The permanent secretary attributed the high rate of maternal mortality in the country to delays in getting to the health facilities for proper medical care.
“We believe with the provision of these ambulances, part of the gaps we have in our referral system will be addressed, whereby patients who require secondary healthcare could be easily transported to secondary and tertiary health centres, where they can get such help,” he said.
In a goodwill message, Commissioner for Information and Culture Alhaji Yakubu Ahmed expressed gratitude to the governor for the support he has given to the ministry to excel.
While advising the beneficiaries to use the vehicles judiciously, the commissioner advised that services and maintenance of the vehicles must be prompt to derive the maximum benefits from the vehicles.
The commissioner also highlighted some achievements recorded by the government in the last year, including beautification of the state capital, completion of a multimillion-naira ultramodern state secretariat, road construction, construction and renovation of classrooms and upgrading of some health facilities, among others.