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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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‘How Micro RNA Research Won Nobel Prize’

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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.”

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WHO Begins Regulation On Antibiotic Waste

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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.”

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Kebbi Harmonises Doctors’ Salaries To Curb Brain Drain

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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.

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