Why malaria may never be eliminated from Nigeria

Malaria may never be eliminated in Nigeria as efforts suffer setbacks

By Chukwuma Muanya

The global drive to eliminate malaria by 2030 is gaining momentum. The optimism is derived from the fact that several diseases have successfully been eradicated and eliminated such as smallpox and yaw.
Experts on the occasion of the World Malaria Day (WMD), April 25, have come up with another slogan, “Zero malaria starts with me,” a grassroots campaign that aims to keep malaria high on the political agenda, mobilise additional resources, and empower communities to take ownership of malaria prevention and care.

Unfortunately, more reasons have emerged why malaria may never be eliminated from Nigeria and perhaps worldwide.

According to the World Health Organisation’s (WHO) 2018 World Malaria Report, after more than a decade of steady advances in fighting malaria, progress has levelled off and no significant gains were made in reducing malaria cases in the period 2015 to 2017. The estimated number of malaria deaths in 2017, at 435,000, remained virtually unchanged over the previous year.

Why?

Funding gap, sectarian crisis, misuse smear marginal progress
In Nigeria, funding gap is threatening the marginal progress made in reducing malaria cases and deaths.

National coordinator, National Malaria Elimination Programme (NMEP), Dr. Audu Bala Mohammed, in an exclusive interview with The Guardian said there appears to be some increase in the reported number of cases since 2015.

The NMEP boss said the recent increase in cases, though not mortality, are attributable to significant shortfalls in funding requirement. He said about $1.12billion (N403.2 trillion) is needed, for the period 2018 – 2020, for the procurement of the malaria intervention commodities.

Mohammed, however, said the government and development partners could only meet about 50 per cent of this need and so in the last 18 months thereabout, malaria intervention has not been on any significant scale in 13 states of the country.

Mohammed said they already anticipate the implication of that in the next round of reporting and government has approached some banks – World Bank, Africa Development Gap, and Islamic Development Bank (IsDB) to raise some financial instruments to address the gaps in these states and hopefully, the activities will commence again in the third quarter (Q3) of the year.

Mohammed said there are also challenges of places that are difficult to reach either because of sectarian crisis or difficult terrain that makes access challenging. He said there are also issues with misuse, non-use or abuse of some of the intervention commodities. “We have instances of the nets being used for a variety of non-malaria related activities such as farming, there is the inadequate practice of testing before treatment and inadequate capture of data especially of activities from the private health sector,” Mohammed added.

Fake drugs top reasons malaria still kills so many
Some studies have blamed the slow progress in efforts to eliminate malaria to rise in fake anti-malarials.

According to a report published by The Conversation, research on the pharmaceutical industry has revealed that one reason for malaria’s continued virulence in the developing world is ineffective medicine. In fact, in some poor African countries, many malaria drugs are actually expired, substandard or fake.

According to recent WHO estimates, globally, some 200,000 preventable deaths occur each year due to anti-malarial drugs that do not work. Substandard and counterfeit medicines may be responsible for up to 116,000 malaria deaths annually in sub-Saharan Africa alone.

A 2014 article in the Malaria Journal showed fraudulent pharmaceuticals are on the rise and reports of counterfeit or falsified anti-malarials rose 90 percent between 2005 and 2010.

How true is this and what is the situation and efforts to curb the menace in Nigeria? The NMEP boss said evidence from surveys by researchers and the National Agency for Food and Drug Administration and Control (NAFDAC) has not demonstrated that the country has such a large-scale challenge of fake drugs when it comes to the Artemisinin-based Combination Therapies (ACTs).

Mohammed added: “We will continue on our pharmacovigilance. There is a general context of combating fake drugs in the country. But my point here is that we do not have a situation on our hands where we need to attribute any increase in malaria burden to fake drugs. We need to continue to be vigilant but we also need to do the right things when it comes to malaria. Let us get tested and be sure it is malaria we are treating instead of blaming non-response on fake malaria.”

Meanwhile, in 2012, a research team from the U.S. National Institutes of Health found that about one-third of anti-malarial medicines distributed in Southeast Asia and sub-Saharan Africa were of poor quality. A few years prior, fully 44 percent of anti-malarial supplies in Senegal had failed quality control tests.

For as long as effective medicines have existed, people have produced fake versions. That is because counterfeiting pharmaceutical drugs is profitable business for manufacturers. This illegal activity is most common in places with little government oversight and limited access to safe, affordable and high-quality medicines.

Various reports have found that many fake medicines originate in India, followed by China, Hong Kong and Turkey. Some illicit drug manufacturers appear to have connections with organised crime groups.

Poor sanitation and waste disposal fuel proliferation of mosquitoes
Refuse dumps and stagnant water bodies are common sites in most Nigerian cities and even villages.

Unfortunately, several researches have shown that poor sanitation and waste disposal fuels the proliferation of the malaria vector, mosquito.

According to the WHO, mosquitoes transmit the world’s most important parasitic infectious disease, which breed in fresh or occasionally brackish water.

A study published in the Nigerian Journal of Medicine concluded that regular cleaning of house surroundings was associated with reduced prevalence of malaria infection in rural areas in Nigeria.

Another study published in African Journal of Health Sciences found inhabitants of houses surrounded by bushes or garbage heaps and swamps or stagnant water showed higher malaria parasite prevalence and densities compared with those from cleaner surroundings.

“Our data indicates that poor environmental sanitation and housing conditions may be significant risk factors for malaria parasite burden…”

President, Pharmaceutical Society of Nigeria (PSN), Mazi Sam Ohuabunwa, urged Nigerians to clean their environment, especially by draining stagnant water to put malaria, a disease caused by anopheles mosquitoes, at bay.

Ohuabunwa said malaria thrives in dirty environment, thus cleaning the surroundings is non-negotiable to rid the country of the disease.

He said: “The PSN calls on the community to take action by cleaning your environment, get rid of stagnant water and pools; cover up gutters in residential areas and ensure your garden is not over grown. Interrupting at least three mosquito life cycles can potentially stop the transmission of malaria parasite by mosquito.”

The PSN President, however, said a concerted effort is required to achieve this and therefore called on Local Development Authorities to coordinate and implement an environmental policy to achieve this.

Growing drug and insecticides resistance
The largest ever-genetic study of mosquitoes revealed the movement of insecticide resistance between different regions of Africa and finds several rapidly evolving insecticide resistance genes.

According to the study published 2017 in the journal Nature, mosquitoes transmit malaria and rising resistance to insecticides is hampering efforts to control the disease.

Earlier genetic analysis of mosquito populations in Africa showed that recent successes in controlling malaria through treated bed-nets has led to widespread insecticide resistance in mosquitoes.

Also scientists at the Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, had in June 2017 revealed that mosquitoes in 18 states in Nigeria have developed resistance to the Long Lasting Insecticide treated Nets (LLIN) insecticide nets, with Lagos, Ogun and Niger state having the highest incidence of cases.

Other states where the resistance were also detected include Jigawa, Katsina, Kebbi, Sokoto, Zamfara, Benue, Kwara, Nasarawa, Plateau, Anambra, Enugu, Rivers, Ondo, Osun and Oyo state, with the outcome of the study identified as a major threat to the eradication of malaria in Nigeria by 2030.

Also, scientists had in 2017 alerted to the rapid spread of ‘super malaria’ in South East Asia, which they said posed a global threat to efforts to eliminate the mosquito-borne disease.

They feared that this dangerous form of the malaria parasite has become untreatable with the WHO recommended drug-of-choice, ACT.

The researchers from the Mahidol-Oxford Tropical Medicine Research Unit in Bangkok in their study published in The Lancet Infectious warned that the menace is spreading. It emerged in Cambodia but has since spread through parts of Thailand, Laos and has arrived in southern Vietnam.

The fear is palpable in Nigeria and indeed Africa where resistance to the drugs would be catastrophic, since 92 per cent of all malaria cases happen in the continent.

What is the current situation in the country as regard resistance of the malaria parasite to the drug of choice and the growing resistance of the malaria vector, mosquito, to insecticide-treated bed nets?

Mohammed, however, said without equivocation that malaria remains sensitive to the nationally recommended ACTs. He said the drug efficacy studies continue to demonstrate sustained sensitivity of 95 per cent and above to the drugs.

The NMEP boss said the major challenge is the need to optimise testing before treatment and need to emphasize that not all fevers are due to malaria. He said they are aware of various anecdotal claims of resistance to the ACTs but each rigorously conducted study proves to the contrary in Nigeria.

Mohammed said they are also aware of the challenge of resistance in South East Asia and are collaborating with partners to monitor resistance in Nigeria. “So, for now, we do not have resistance to ACTs but we encourage testing to be sure that malaria is the cause of a given fever episode,” he said.

Mohammed, however, the NMEP have evidence of insecticide resistance in some parts of the country and are currently conducting entomological surveillance so as to update the map. He said, for the places where resistance to the insecticide has been reported, they are making efforts to deploy a different type of LLIN.

What is NMEP doing about growing insecticide? Mohammed said: “We remain focused on monitoring and responding appropriately to resistance issues as they emerge. For now, we are fine with the drugs. For the nets we are assessing where the resistance level warrants a change in the type of net to be deployed and we are acting accordingly with our partners.”

Nigeria carries more than 25% per cent of global burden
Despite efforts by the governments at all levels and the international community, malaria still kills no fewer than 81,640 Nigerians and infects 53.7 million yearly.

The country also loses N450 billion yearly in intervention and treatment costs due to malaria.

Mohammed said: Currently, it is estimated that about 53.7million cases of malaria occur in Nigeria. Nigeria has 25 per cent of global burden and 53 per cent of cases in West Africa annually and with about 81,640 deaths that is 19 per cent of global burden and 45 per cent of deaths in West Africa.”

How much does Nigeria lose to malaria yearly? Mohammed said: “It is difficult to estimate. Some scholars had estimated this to be N132 billion annually. But that was an old study and the commodities we use for malaria control has changed since that publication.

“In 2013 another study indicated that at the household level, direct expenditure is between N4000 to N7000 for malaria. With about 40 million households this figure will be translating to N160 – N280 billion directly lost to malaria. As indicated above the need by the country is close to N450 billion. If Nigeria was to be free of malaria, close to half a trillion could be saved in intervention costs.”

Mohammed, however, said from 2010 -2018 there has been a steady decline in malaria-related deaths from 145,000 to the current figure to current figures of greater than 81,640. Regarding cases, he said, there was a decline up to 2015 but since then there appears to some increase in the reported number of cases.

What are the economic implications of malaria to Nigeria? Mohammed said malaria affects the country economically in terms of cost of its prevention and treatment, demonstrable reduction in productivity of the farming population, significant loss of work days for victims of malaria and their relatives who have to look after them, and overall impairment on the development.

Lack of tested, effective, cheap and available vaccine
Despite Nigeria having the greatest burden of malaria in Africa and indeed the world, Malawi last week became the first of three African countries to launch of the world’s first malaria vaccine in a landmark pilot programme.

According to the WHO, Malawi is the first of three in Africa in which the vaccine, known as RTS,S, will be made available to children up to two years of age; Ghana and Kenya will introduce the vaccine in the coming weeks.

Malaria, according to the WHO, remains one of the world’s leading killers, claiming the life of one child every two minutes.

Why was Nigeria not chosen? The WHO explained: “Following a request by WHO for expressions of interest, the pilot countries were selected from among ten African countries. Key criteria for selection included well-functioning malaria and immunization programmes, and areas with moderate to high malaria transmission.”

What informed the pilot studies? Proven results: Thirty years in the making, RTS,S is the first, and to date the only, vaccine that has demonstrated it can significantly reduce malaria in children.

Can malaria truly be eliminated considering the complications and how?
Globally, the elimination net is widening, with more countries moving towards zero indigenous cases: in 2017, 46 countries reported fewer than 10 000 such cases, up from 44 countries in 2016 and 37 countries in 2010.

The number of countries with less than 100 indigenous cases – a strong indicator that elimination is within reach – increased from 15 countries in 2010 to 24 countries in 2016 and 26 countries in 2017.

WHO certified Paraguay as malaria free in 2018, while Algeria, Argentina and Uzbekistan have made formal requests to WHO for certification. In 2017, China and El Salvador reported zero indigenous cases.

One of the key Global Technical Strategies for malaria 2016-2030 (GTS) milestones for 2020 is elimination of malaria in at least 10 countries that were malaria endemic in 2015. At the current rate of progress, it is likely that this milestone will be reached.

In 2016, WHO identified 21 countries with the potential to eliminate malaria by the year 2020. WHO is working with the governments in these countries known as “E-2020 countries” to support their elimination acceleration goals.

Although 11 E-2020 countries remain on track to achieve their elimination goals, 10 have reported increases in indigenous malaria cases in 2017 compared with 2016.

The World Health Assembly adopted the GTS in May 2015. It provides a comprehensive framework to guide countries in their efforts to accelerate progress towards malaria elimination. The strategy sets the target of reducing global malaria incidence and mortality rates by at least 90 per cent by 2030.

However, the WHO said urgent action is needed to get the global response to malaria back on track – and ownership of the challenge lies in the hands of countries most affected by malaria.

Founder/Chairman, Safe Medicines Foundation and Immediate Past President of PSN, Ahmed I. Yakasai, that he sincerely believe that if Uzbekistan, Iraq, Argentina, Costa Rica, Oman, Turkey, Georgia, Syria and Sri Lanka can eliminate Malaria, then Nigeria can. But, the pharmacist said, for Nigeria to eliminate malaria it cannot be business as usual, that it will require committed and concerted efforts by all stakeholders.

Yakasai said government must increase funding to malaria elimination programmes and decisions on strategies to adopt including surveillance must be evidence-based.

“Timely detection and reporting of malaria incidence must be systemized, high risk area must be adequately spared. Education on hygiene, malaria prevention, and use of Long Lasting Insecticides Nets must be strengthened. This information must reach the people in rural communities not just urban centres. It must cascade to the grassroots,” he added.

Yakasai said Nigeria is currently the world capital of malaria but honestly that should not be the case. He said Nigeria could eliminate malaria in the next two decades if only we look inward not outward. “Harness all our human and capital resources and declare a war against malaria in the best interest of our citizens and nation,” Yakasai said.

Mohammed said: “Malaria can be eliminated from any geographical entity and ultimately eradicated globally. However, to achieve this, it requires the concerted effort of all. It is not only government-based actions. Individuals, organisations, politicians, private sector, researchers, media, teachers, religious leaders, etc. all have their roles. The approach consists of disease prevention, correct diagnosis, effective treatment, active surveillance, and effective use of data. There is a need for stronger political will and well-coordinated engagement of relevant sectors.”

He said the WMD celebration is not primarily to celebrate successes but Nigeria has made progress. “Malaria deaths continue to drop, we are getting back on track with net distribution, Most places have ACTs, there is some increase in domestic resources, malaria will benefit from the Basic Health Care Provision Fund and primary health care is being strengthened.

However the major goal of the WMD is to sensitise the world, the nation and all stakeholders about the unfinished business of malaria elimination.

Hence the theme for this year’s celebration is “Zero Malaria Starts With Me” and to this we are saying Join Me,” Mohammed said.

WHO’s Strategy for Malaria Control, which forms the basis of the Roll Back Malaria initiative, identifies four main interventions:

*Reducing mortality, particularly among children, by early case-detection and prompt treatment with effective anti-malarial drugs

*Promoting the use of insecticide-treated bed nets, especially by children and pregnant women

*Prevention of malaria in pregnancy by applying intermittent preventive therapy

*Ensuring early detection and control of malaria epidemics, especially in emergency situations.

Where appropriate, the WHO said, countries and communities are being encouraged to reduce mosquito-breeding sites by filling in and draining water bodies and through other environmental management schemes.

Ohuabunwa added: “We also call on other health professionals to ensure quick and effective response to save lives especially in at risk populations, children under five and pregnant women. To end malaria for good, while communities are taking actions to control the vector, we must do our part by providing effective treatment. A combination of disruption of breeding and elimination of parasite from the system has been proven to lead to zero malaria.

“Finally we call on the policy makers including the Federal Ministry of Health to strengthen National Malaria Surveillance by incorporating reports from pharmacists operating in community settings. Evidence currently shows that most patients visit their community pharmacist first when they suspect malaria. Therefore health data reports from community pharmacists will improve data quality and resulting intervention. Today we start a zero malaria community and it start with me.”

Credit : The Guardian

How to stay healthy during pregnancy — Expert

How to stay healthy during pregnancy — Expert

By Usman A. Bello, Benin

It is important for women to do some things and also avoid certain habits and practices in order to stay healthy during pregnancy as experts have said doing so also helps protect the health of the foetus up to birth and thereafter.

A Consultant Gynaecologist and Obstetrician, Dr. Victor Ohenhen, said certain peculiarities of pregnancy, including lifestyle and socio-cultural factors, predisposed pregnant women to illnesses and diseases.

Dr. Ohenhen explained that human pregnancy began from the point of fertilisation of the female gamete (ovum) by the male spermatozoa to form a zygote.

“It is important to stress that pregnancy is not a disease, but a normal process in the female reproductive cycle,” he said.

A mother of four, Mrs. Ifueko Omonigho, said observing health dos and don’ts during her pregnancy made her have “stress and disease-free pregnancies”.

Mrs. Omonigho said it also contributed in ensuring her children were healthy even after birth.

Dr. Ohenhen, who is also the Head of Department of Obstetrics and Gynaecology of the Central Hospital, Benin, Edo State, gave the following tips for staying healthy when pregnant:

Plan every pregnancy: Adequate planning improves outcome for both mother and baby. Also, because every pregnancy takes its toll on the health of the mother, it is important to avoid getting pregnant frequently. It is recommended that women give at least a two-year gap between pregnancies.

Seek care early: Seek ante-natal care early. It is advised that the pregnancy is booked at the second missed period to allow for early identification and treatment of possible problems.

Get plenty of sleep: Getting between seven to nine hours of sleep per day keeps the pregnant woman refreshed and mentally alert. Also, midday naps are an excellent choice during pregnancy.

Reduce stress: Stress wears the body out. It is, therefore, wise to limit activities when pregnant. Get help for certain things beyond your reach whenever possible.

Eat right: Eating the right meals in adequate proportions ensures that you and your baby stay healthy throughout the entire pregnancy period.

Get a support system: This is one aspect of staying healthy that is too frequently ignored. The pregnant woman needs assurance and guidance from her social network. It is not a time to live in isolation but a period to build support systems. This is important for her mental health.

What to eat and do when pregnant

Dr. Ohenhen also advised that women should eat or do the following:

Water: Simple things mean a whole lot during pregnancy. Pregnancy increases your need for water due to a drop in plasma volume that occurs. Water helps to prevent constipation, haemorrhoids and Urinary Tract Infections (UTI). It is recommended that a pregnant woman takes at least eight cups of water daily.

Fruits and vegetables: The importance of fruits cannot be overemphasised. Fruits like avocado are an excellent source of Vitamins C, E and K. They are also rich in fibre. Spinach and orange are rich in folic acid, an important nutrient that helps to prevent neural tube defects during the early phase of pregnancy.

Legumes: Legumes are a superb store of protein, iron, folate and calcium. Examples of legumes are beans, soybeans and groundnuts.

Sweet potato: They are rich in beta carotene that is converted to Vitamin A which is important for a healthy diet.

Eggs: Eggs are the ideal health food because they contain a little bit of almost all nutrients. They are a great addition to your meals during pregnancy.

Lean meat: Moderate amounts of beef, pork and chicken are excellent sources of high quality protein.

Exercise: Reasonable degree of physical activity that suits your tolerability is helpful when pregnant.

The medical expert also advised that women should not eat or do the following when pregnant:

Alcohol: Alcohol consumption during pregnancy is a harmful habit that has well documented effects on the developing child. Examples of these are birth defects and slow growth of the baby referred to in medicine as Intrauterine Growth Restrictions (IUGR). Alcohol consumption, especially when heavy during pregnancy, causes Foetal Alcohol Syndrome (FAS).

Herbs and plants: Pregnancy period is not a time to use herbal products or supplements as this may result in very serious conditions in the baby, especially congenital defects at birth.

Caffeine: Several studies have shown a link between high amounts of caffeine intake and miscarriage.

Junk food and refined sugar: These are not advised during pregnancy due to their effects on the child. It is important to limit the consumption also of carbonated drinks during pregnancy.

Cigarette: Cigarette smoking generates a number of free radicals which immensely affect the health of the baby.

Dr. Ohenhen added that pregnancy period was an exciting time and should be regarded as such.

“With proper health behaviour and adequate diet, a healthy baby and mother is the outcome of the nine-month ‘journey’”, he said.

Credit : Daily Trust

Seven Ways To Take Care Of Your Skin Without Spending A Dime

Seven Ways To Take Care Of Your Skin Without Spending A Dime

Skincare is of utmost importance to every individual in the world but taking care of our skin sometimes isn’t a priority due to conflicting demands on our time and finances. Since our skin is a reflection of how are on the inside; a mirror showcasing the stress and wear of the life we live daily it is of vital importance that we take out time to pamper our skin as frequently as possible. Below are a few ways to care for your skin without spending a kobo

Shorten Your Shower

Taking long showers everyday can actually strip your skin of its natural oils. Practice taking short showers and moisturize immediately after drying off.

Slay in Your Sunnies

Skincare expert Dr. Imahiyerobo-Ip says “always wear your sunglasses. The skin around the eyes is the thinnest skin on our bodies and is very susceptible to damage from UV rays. Wearing sunglasses will help prevent fine lines and wrinkles as well as skin cancer.”

Ice Cubes

The Coded skincare trick making the rounds in beauty circle is the power of Ice Cubes. It involved rubbing ice cubes on your face create the illusion of firmer, glowy skin, after taking a lukewarm 10minds shower. It is advised though, that you put on a skin barrier first, like a cream, oil or even yogurt from the fridge before applying the ice cubes.

Put In What You Take Out

Water and exercise is great for your skin but be cognizant of the balance between your water intake and water loss. According to Dr. Helen Knaggs, Vice President of Global Research and Development at Nu Skin, having more or less of either one is what contributes to dry skin.

Accept Changes

Yes you will have breakouts or sudden skin rashes any more at one point or the other in life. The simply rule to help you out on the other end with your great skin is to accept it and leave it alone. Covering it with more makeup or going on a frantic beauty product spree may leave you worse off.

Zhao says, “for example, anything that occurs right before your period, such as cramps, breast tenderness, blemishes, bloating is considered pre-menstrual syndrome.”

Reduce Caffeine and Salt Intake

Limiting salt, caffeine, and cutting out sugar will help reduce skin and body’s water retention, which in turn will help tremendously in reducing bloating.

Less is more!

Your skin naturally knows what to do to rejuvenate, so sometime it best to leave your skin especially your face as God intended it. Simply wash your face with a mild moisturising soap and leave it be.

Asthma: Avoid dust, smoking

Asthma: Avoid dust, smoking

By Paul Adunwoke

As World Asthma Day comes up on Tuesday, experts have cautioned person who are susceptible to shun things that could trigger the ailment. Similarly, they should avoid smoking, wash curtains and beddings regularly, clean surfaces with damp cloths, avoid dusty areas, as well as regularly clean fans and change air-conditioner filters, among others.

Consultant Respiratory Physician at Lagos State College of Medicine (LASCOM), Lagos State University Teaching Hospital (LASUTH), Dr. Olayinka Olufunke Adeyeye said asthma is a chronic respiratory condition in which the sufferers’ airways are inflamed, the muscles of the airways contract and the airway linings are twitchy, swollen and the lumen becomes smaller with limitation to airflow.

She said: “The sufferers have chronic cough, particularly at night, episodic breathlessness, chest tightness and noisy breathing wheeze. This occurs on and off and may get better with or without treatment. Some patients may complain of cold that frequently becomes chesty.

“Asthma results from a complex interactions between genetics and environment. Some types of asthma are inherited, some run in families, whereby some members have what is called atopy. This includes itchy eyes, recurrent running nose and some skin diseases and atopic dermatitis.

“Interaction with the environment leads to development of such symptoms as air pollution, both indoor and outdoor. Some individuals are allergic to dust mite and cockroaches, among others. In the younger age, more males are affected compared to females, but after 14 years, more females will be at risk of having asthma. Obesity also increases the likelihood of developing asthma.”

Adeyeye explained that exposure to certain triggers, such as dust and exrcise can lead to development of symptoms in those that are already predisposed.

She said: “Although asthma cannot be cured, it can be totally controlled. The process required cooperation between the patient and healthcare managers. Treatment of an asthmatic is not only with medication. There must be good and continuous education about the disease, the long-term nature and the need for the sufferer to take charge. He or she needs to know about the triggers, dust, cold, change in weather, exercise and emotional issues, all of which can increase the symptoms.

“Patients should avoid non-steroidal anti-inflammatory drugs (NSAID) for pain relief and B blockers, among others. Drug treatment includes, reliever medications and preventer medications.

“The preventer medications are those the patients must use every day, whether or not they have any symptoms, while the reliever medications are used only when they have symptoms to ameliorate it. Unfortunately in our environment, many asthma sufferers are under-treated and so suffer immense discomfort, hospitalisation, absenteeism from work and school, with even the risk of death from a severe attack just because they are not taking preventer medications.”

Adeyeye said asthma is common and that sufferers can have good quality life, be productive and be symptom free. But to achieve this, they need to partner with their doctors to achieve total control.

“It is not a thing to be ashamed of,” she explained. “An asthmatic needs clean environment, and should understand his/her triggers and avoid them. He/she will need to have daily preventer medications and reliever medications to be used when necessary. Asthma need not limit anyone’s aspiration. There is need for more awareness about asthma.

“There is need for government to increase awareness about asthma, so that cases can be diagnosed early and treatment commence. Government needs to partner with pharmaceutical companies to make available low cost medicine for asthma sufferers.”

A Family Physician Dr. Chukwuma Ogunbor, said: “Although asthma most commonly develops in early childhood, a significant percentage of sufferers have their first attack during adulthood. This is known as adult-onset asthma (AOA).

“It is impossible to predict when asthma will strike, and the best course of action is to steer clear of so-called triggers. A trigger is anything that causes inflammation in the airways, leading to asthma symptom.”

He urged parents to protect their children against dust mites, which are tiny insects that feed off human skin and hair and are one of the most common asthma triggers. They tend to live in beds, carpeting, upholstered furniture and soft toys.

“Dust mites can be killed by steam-cleaning mattresses and furniture and washing clothes, toys and bedding at temperatures higher than 55ºC.

Children should avoid contact with pets. This is because at least 30 per cent of people with asthma are allergic to animals, especially those that have dogs.

“However, pets are not to blame, just that people should try to protect their children from playing with pets. The problem is the body’s reaction to a protein found in the animal’s dander, dead skin flakes, saliva, urine and feathers. If you have a pet, limit your child’s exposure to the animal.

“People should also limit their stress level because people who are under stress tend to have higher asthma rates. Researches have shown that up to 69 per cent of asthmatics regard stress as a trigger.

“Stress causes the so-called “fight or flight” response in our bodies, involving a surge of hormones like adrenaline and cortisol. This leads to among other things shallow and fast breathing, which puts us at a higher risk of asthma symptoms like tight chest and coughing.

“It is very important for asthma patients to get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.”

Credit: The Guardian

Sleep could fight infections

Sleep could fight infections’

By Appolonia Adeyemi

Researchers in Germany said adequate sleep could contribute to many aspects of physical and mental well-being. According to their findings published in the ‘Journal of Experimental Medicine,’ sleep contributes to the proper functioning of the immune system. The research team from the University of Tübingen in Germany found a mechanism linking sleep to the functioning of the immune system.

The study shows, according to them shows that sleep could enhance the target ability of immune cells inside human body to help fight off infection. The National Sleep Foundation (NSF), stated that adequate sleep (AS), defined as seven to nine hours per night regularly for adults, was a critical factor in health and health-related behaviours.

The NSF is a United States (U.S). non-profit organisation that promotes public understanding of sleep and sleep disorders. While previous studies have shown that being sleep deprived was akin to over drinking when it comes to its effects on the brain, the recent research suggested that poor sleep increased pain sensitivity and might raise the likelihood of developing cardiovascular problems. According to the report of the current study, “This finding shows that sleep has the potential to enhance the efficiency of effector T cell responses.” Researchers said that compared with the wake condition, sleep significantly increased the mean fluorescence intensity of T cells, a type of white blood cell that fights off infection inside human body.

“Our results demonstrate that a couple of hours of sleep loss suffice to reduce the adhesion capacity of antigen-specific T cells,’’ the researchers stated. They asserted that the findings could help develop new therapeutic strategies with the aim of improving the target ability of T cells, especially when they are killing tumour cells.The ‘Medical News Today’ reported that T cells contributed to the body’s immune response when a potentially harmful foreign body enters the system.

A T cell, or T lymphocyte, is a type of lymphocyte (a subtype of white blood cell) that plays a central role in cell-medi ated immunity. These immune cells recognise pathogens then activate integrins, which are a type of protein that allows T cells to attach to and tackle their targets. The researchers noted that little was known about how T cells activate integrins, as well as what may prevent these cells from attaching to potentially compromised targets.

It’s not advisable to use tissue paper during menstrual period —Researcher

It’s not advisable to use tissue paper during menstrual period —Researcher

A medical researcher, Dr. Bamidele Iwalokun, on Thursday condemned the use of tissue paper as sanitary pads by women, saying it could lead to severe health complications.

Iwalokun, who is the Head, Immunology and Vaccinology Research Department, Nigerian Institute of Medical Research, Yaba, said this in an interview with the News Agency of Nigeria in Lagos.

He said that some tissue papers were products of waste paper, and such tissue papers were not hygienic for draining blood during menstruation.

“The habit of using tissue paper in form of sanitary pads is a poor hygiene practice on the part of any woman.

“Because no health policy has supported the use of tissue paper as sanitary pads, it’s a bad behaviour and should not be adopted.

“It doesn’t have any credibility of use. This should be a way of informing women that it carries a serious public health risk.

“The practice places such women at risk of having infection, which may pass through the vagina cavity and enter the bloodstream, creating serious health problems,” Iwalokun said.

The researcher said that the use of tissue paper during menstruation could affect the reproductive organs and that it could lead to other health complications.

“Sometimes, it may be chronic infections that may not give serious symptoms to warrant going to the hospital, but it is indirectly damaging the reproductive system or that pathway.

“One of them is the Pelvic Inflammatory Disease, which many women may not know they have until when issues of infertility comes up, as untreated PID is a major cause of infertility.

“It also depends on the pathogens that are coming from such paper; so, it is important to identify the types of pathogen that are isolated from such tissue papers.

“There must be quality study that will show the various types of pathogens, in order to identify the type of damage it can cause.

“However, women should abstain from the practice of using tissue paper as sanitary pads, in order to avoid such health complications.

“Women should always adopt proper hygiene at all times, especially during their menstrual period,” he counselled.

(NAN)

How to overcome low sperm count

Low sperm count: How to overcome it

by Dr Joel Akande

Low sperm count or as it’s called in medical world, oligospermia, is a major biological and reproductive issue. At the risk of being accused of hyperbole, low sperm count puts survival of humanity at risk. There is no doubt that in some parts of the world, population is increasing such as in Nigeria. But in other regions of the earth, population is diminishing. We all know that even within a country such as Nigeria where population increase is a problem, not everyone desiring a baby gets one because of low sperm count. Low sperm count is common in Nigeria and the rate is increasing, especially amongst the young generations.

All said, the individuals that are suffering from low sperm count are, obviously, very concerned as I have seen in my fertility practice on so many occasions. As the reader may know, a third of infertility issue is due to male issue which in the end is due to low sperm count. Another third is due to female and the couple together shares the remaining third. Yet, in the male factor, low sperm count or oligospermia is a major contributor and indeed, the most significant contributor to the male infertility problem. Quantity or count of sperm is just a part of the sperm problem. Sperm numbers, to be effective, should be in the order of at least 20million. That is not the end of the story.

Quality of the sperm is another great concern. For sperm to be of good quality, the sperm must be able to move actively and freely within the suitable environment of the reproductive tract of the female. The individual sperm must be free from structural abnormalities in shape and form. Fertility doctors are most concerned with sperms that are dead or sluggish even if the quantity is sufficient. Sperms must be able to penetrate the covering of the female egg before or just prior to fertilisation taking place. Failing, low sperm count and low quality of sperm remain a challenge for the childless and the attending fertility physicians.

What causes low sperm count? The life style of men accounts for a significant cause of low sperm count. Obesity and being overweight are major causes of low sperm count along with hypertension and diabetes. Nicotine or cigarette consumption is another reason. Heat around the male reproductive organs (testes and scrotum) constitutes a danger to male fertility.

Heat could impair the normal development of sperms. Heat from wearing tight pants, long distance driving and soaking the testes in hot water bath, are not friendly to sperm development. Heat from long use of laptop placed over the scrotum is a danger to sperms. There is a speculation also of mobile phones placed near the testes, causing impairment to normal sperm development.

Occupation as drivers as well as working in places where one is exposed to industrial chemicals may lead to low sperm count. Medically, infection such as HIV, gonorrhoea, Chlamydia and mumps to mention a few, which may interfere with sperm production, could lead to low sperm count and of poor quality. Remember also that infection from the female reproductive tract may be transferred to the male partner to cause sperm abnormality.

Cancers of reproductive tract may impair sperm development. Ejaculation problem, retrograde ejaculation should be noted as causes of low sperm count. In some cases, testes that are not descended into the scrotum and growths that affect male reproductive tracts are other reasons that account for low sperms. In some unfortunate cases, the sperm may suffer from anti-sperm antibodies that work against the sperm itself.

We should also bear in mind that genetic abnormalities such as Klinefelter syndrome could affect development of the testes and of the sperm production. Some medications even when legitimately prescribed could affect sperm production. This category includes chemotherapy, some antifungal, anti-ulcer medications and antibiotics could all work against sperm quality and quantity. Substances and drug abuse such as cocaine and marijuana could reduce the quality and quantity of sperm

Prevention: Stop smoking. Avoid heating the testes. Avoid hot water bath. Readers in cold clime may have to use shower instead of bath. Wear loose pants or as is recommended, wear boxers instead of pants. Stop use of alcohol and steroids if they are responsible for the low sperm count. Avoid misuse of drugs. Severe and prolonged mental stress could cause low sperm count. Avoid stress whatever it takes. Pesticides could affect sperm count. Avoid it. If you are overweight and obese, lose weight. Regular, structured exercise has been shown to benefit and improve quality of sperms and thus improve conception chances.

Solutions: Thankfully, some of the problems that cause low sperm count can be both prevented and treated. Drugs and medications that cause oligospermia can be stopped to allow the testes and sperm production to recover.

In some cases, surgery may be required to correct any abnormality discovered. There are some supporting medications, which fertility doctors can use to boost sperm quality and count. If everything else fails, fertility treatment such as in vitro fertilization or assisted conception may be called for.

Credit: The Nation

Causes, treatment, prevention of meningitis

CAUSES, TREATMENT, PREVENTION OF MENINGITIS

Medically reviewed by George Krucik, MD, MBA on January 12, 2016 — Written by Verneda Lights and Elizabeth Boskey, PhD

What Is Meningitis?
Meningitis is an inflammation of the meninges. The meninges are the three membranes that cover the brain and spinal cord. Meningitis can occur when fluid surrounding the meninges becomes infected.
The most common causes of meningitis are viral and bacterial infections. Other causes may include:
cancer
chemical irritation
fungi
drug allergies
Viral and bacterial meningitis are contagious. They can be transmitted by coughing, sneezing, or close contact.

Types of Meningitis
Viral and bacterial infections are the most common causes of meningitis. There are several other forms of meningitis. Examples include cryptococcal, which is caused by a fungal infection, and carcinomatous, which is cancer-related. These types are rare.

Viral Meningitis
Viral meningitis is the most common type of meningitis. Viruses in the Enterovirus category cause 85 percent of cases. These are more common during the summer and fall, and they include:
coxsackievirus A
coxsackievirus B
echoviruses
Viruses in the Enterovirus category cause about 10 to 15 million infections per year, but only a small percentage of people who get infected will develop meningitis.
Other viruses can cause meningitis. These include:

West Nile virus
influenza
mumps
HIV
measles
herpes viruses
Coltivirus , which causes Colorado tick fever

Viral meningitis typically goes away without treatment.

Bacterial Meningitis
Bacterial meningitis is contagious and caused by infection from certain bacteria. It’s fatal if left untreated. Between 5 to 40 percent of children and 20 to 50 percent of adults with this condition die. This is true even with proper treatment.
The most common types of bacteria that cause bacterial meningitis are:
Streptococcus pneumoniae , which is typically found in the respiratory tract, sinuses, and nasal cavity and can cause what’s called “pneumococcal meningitis”
Neisseria meningitidis , which is spread through saliva and other respiratory fluids and causes what’s called “meningococcal meningitis”

Haemophilus influenza , which can cause not only meningitis but infection of the blood, inflammation of the windpipe, cellulitis, and infectious arthritis
Listeria monocytogenes , which is a foodborne bacteria
How Contagious Is Meningitis? »
SYMPTOMS
What Are the Symptoms of Meningitis?
The symptoms of viral and bacterial meningitis can be similar in the beginning. However, bacterial meningitis symptoms are usually more severe. The symptoms also vary depending on your age.

Viral Meningitis Symptoms
Viral meningitis in infants may cause:
decreased appetite
irritability
sleepiness
lethargy
a fever
In adults, viral meningitis may cause:
headaches
a fever
stiff neck
seizures
sensitivity to bright light
sleepiness
lethargy
nausea
decreased appetite

Bacterial Meningitis Symptoms
Bacterial meningitis symptoms develop suddenly. They may include:
altered mental status
nausea
vomiting
a sensitivity to light
irritability
a headache
a fever
a stiff neck

Seek immediate medical attention if you experience these symptoms. Bacterial meningitis can be deadly. There’s no way to know if you have bacterial or viral meningitis just by judging how you feel. Your doctor will need to perform tests to determine which type you have.

COMPLICATIONS
What Are the Complications from Meningitis?
These complications are typically associated with meningitis:
seizures
hearing loss
brain damage
hydrocephalus
a subdural effusion, or a buildup of fluid between the brain and the skull

RISK FACTORS
What Are the Risk Factors for Meningitis?
The following are some of the risk factors for meningitis:
Compromised Immunity
People with an immune deficiency are more vulnerable to infections. This includes the infections that cause meningitis. Certain disorders and treatments can weaken your immune system. These include:
HIV
AIDS
autoimmune disorders
chemotherapy
organ or bone marrow transplants
Cryptococcal meningitis, which is caused by a fungus, is the most common form of meningitis in people with HIV or AIDS.
Community Living
Meningitis is easily spread when people live in close quarters. Being in small spaces increase the chance of exposure. Examples of these locations include:
college dormitories
barracks
boarding schools
day care centres
Pregnancy
Pregnant women have an increased risk of listeriosis, which is an infection caused by the
Listeria bacteria. Infection can spread to the unborn child.
Age
All ages are at risk for meningitis. However, certain age groups have a higher risk. Children under the age of 5 are at increased risk of viral meningitis. Infants are at higher risk of bacterial meningitis.
Working with Animals
Farm workers and others who work with animals have an increased risk of infection with Listeria .

DIAGNOSIS
How Is Meningitis Diagnosed?
Diagnosing meningitis starts with a health history and physical exam. Age, dorm residence, and day care centre attendance can be important clues. During the physical exam, your doctor will look for:
a fever
an increased heart rate
neck stiffness
reduced consciousness
Your doctor will also order a lumbar puncture. This test is also called a spinal tap. It allows your doctor to look for increased pressure in the central nervous system. It can also find inflammation or bacteria in the spinal fluid. This test can also help determine the best antibiotic for treatment.
Other tests may also be ordered to diagnose meningitis. Common tests include the following:
Blood cultures identify bacteria in the blood. Bacteria can travel from the blood to the brain. N. meningitidis and S. pneumoniae can cause both sepsis and meningitis.
A complete blood count with differential is a general index of health. It checks the number of red and white blood cells in your blood. White blood cells fight infection. The count is usually elevated in meningitis.
Chest X-rays can reveal the presence of pneumonia, tuberculosis, or fungal infections. Meningitis can occur after pneumonia.
A CT scan of the head may show problems like a brain abscess or sinusitis. Bacteria can spread from the sinuses to the meninges.

TREATMENTS
How Is Meningitis Treated?
Your treatment is determined by the cause of your meningitis.
Bacterial meningitis requires immediate hospitalisation. Early diagnosis and treatment will prevent brain damage and death. Bacterial meningitis is treated with intravenous antibiotics. There’s no specific antibiotic for bacterial meningitis. It depends on the bacteria involved.
Fungal meningitis is treated with antifungal agents.
Viral meningitis isn’t treated. It usually resolves on its own. Symptoms should go away within two weeks. There are no serious long-term problems associated with viral meningitis.

PREVENTION
How Is Meningitis Prevented?
Maintaining a healthy lifestyle, especially if you’re at increased risk, is important. This includes things like:
getting adequate amounts of rest
not smoking
avoiding contact with sick people
If you’ve been in close contact with one or more people who have a bacterial meningococcal infection, your doctor can give you preventive antibiotics. This will decrease your changes of developing the disease.
Vaccinations can also protect against certain types of meningitis. Vaccines that can prevent meningitis include the following:
Haemophilus influenzae type B (Hib) vaccine
pneumococcal conjugate vaccine
meningococcal vaccine
How Can I Avoid Getting Meningitis? »
Who Should Be Vaccinated Against Meningococcal Meningitis?
These five groups are considered at risk and should get a meningitis vaccine:

college freshmen who live in dorms and haven’t been vaccinated
adolescents who are 11 to 12 years old
new high school students who haven’t been vaccinated
people traveling to countries where meningococcal disease is common
children who are ages 2 or older and who don’t have a spleen or have a compromised immune system

Understanding Cataracts: Causes, Prevention And Treatment

Understanding Cataracts: Causes, Prevention And Treatment

BY DR ZUBAIR ABDULHI

A cataract is a clouding of the eye’s natural lens. It is the most common cause of vision loss in people over age 40. It is also the principal cause of blindness in the world affecting more than 20 million people globally with over 51% of them in developing countries like Nigeria. It is speculated that over 600,000 Nigerians may have cataracts by the year 2020.The lens is a clear part of the eye behind your iris that helps to focus light or an image on the retina, which helps us to see via a complex mechanism.

The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image will appear blurry, cloudy, misty or faded.

Types of cataracts

Cataracts develop slowly and can be found in one or both eyes. It cannot spread from one eye to the other. There are three types of cataracts:
• A subcapsular cataract occurs at the back of the lens. It is common in diabetics.
• A nuclear cataract forms in the central area of the lens.
• A cortical cataract starts in the periphery of the lens and works its way to the centre in a spoke-like fashion.

What causes cataracts?

Ageing is the commonest cause of cataracts. Yet, certain things make it more likely that a person will develop cataracts.
• Secondary cataract can form after surgery for other eye problems like glaucoma.
• Cataracts can also develop in people who have other health problems like diabetes.
• Cataracts are sometimes linked to steroid use.
• Cataracts can develop after an eye injury, sometimes years later.
• Some babies are born with cataracts or develop them in childhood, often in both eyes. These are usually due to maternal infections.
• Cataracts can develop after exposure to some types of radiation.

Symptoms

• Your sight is misty and cloudy. You may feel like your glasses are dirty and need cleaning, even when they don’t.
• Colours seem faded or look a little more washed out than they should be.
• Double vision.
• Frequent prescription changes.
•Sensitivity to light and glare – headlights, lamps or sunlight may seem too bright. You may also see a halo around lights.
• Night blindness.

How can one prevent the development of cataracts?

Besides elderliness, there are risk factors for cataracts. They can be managed to reduce the onset and severity of symptoms as well as the progression of cataract. These steps include:
• Control your blood sugar and blood pressure if you are diabetic and/or hypertensive.
• Wear appropriate eye wears to shield the eyes from ultraviolet radiation from sunlight and other sources.
• Keep fit and maintain a healthy weight.
• Quit smoking.
• Use steroid-containing medications only on doctor’s orders.
• Protect your eyes from trauma during sports and avoid violence.
• Reduce your alcohol consumption.
• Eat more fruits and vegetables.

Cataract treatment.

The definitive treatment for cataracts is surgery with the replacement of the lens using an artificial lens. The procedure is very safe and patients regain near perfect vision after the procedure. N.B: If you think you have a cataract, see an eye doctor for an exam to find out for sure.

Habits To Curb Mouth Odour

Habits To Curb Mouth Odour

By Millicent Arebun Onuoha

Everyone, at one point or the other in life, has had to deal with bad breath. Unfortunately, if the smell does not improve after brushing, flossing, and rinsing the mouth with an alcohol-free mouthwash, it may be chronic.

Consistently having bad breath is not only off-putting but can morph into a health issue with life threatening consequences if left unchecked.

Bad breath, also called halitosis in medical terms, is the emanation of a foul smell or odour from the mouth cavity. This odour can originate in the mouth, throat or tonsils and can be acutely embarrassing to anyone. The condition which afflicts approximately 50 per cent of the world population is brought on by consistent unhealthy oral hygiene and lifestyle.

The oral odour is usually caused by a group of anaerobic, sulphur-producing bacteria that breed beneath the surface of the tongue and often in the throat and tonsil area. The term ‘anaerobic’ literally means living without oxygen, and in fact, these bacteria do not require oxygen to live. They occur naturally in the oral environment and are essential because they assist in digestion by breaking down proteins into amino acids.

As these bacteria feast on proteins in the mouth, sulphur compounds are released from the back of the tongue and throat. The bacteria excrete waste as hydrogen sulphide, methyl mercaptan, and other odorous and bad tasting compounds known as volatile sulphur compounds. As long as the anaerobic bacteria feed on proteins and excrete volatile sulphur compounds unchecked, your breath will become worse and worse.

The good news is that; with a few simple adjustments to food, lifestyle and oral hygiene, anyone afflicted with chronic bad breath can breathe easy without fear of embarrassment.

Listed below are 11 simple and super easy self-care techniques to help minimise and eliminate bad breath.

1. Prevention: This is always better and less expensive than cure, so develop and cultivate the right habits always.

2. Proper oral care: Brush and floss your teeth at least twice a day. Be sure to get a toothbrush with soft bristles (as to not damage tooth enamel or gums) and also use fluoride toothpaste. Brushing and flossing helps to remove any food and plaque which can be used as a fuel source by the anaerobic, sulphur-producing bacteria that are at the root of this problem.

3. Brush occasionally with baking soda: The bacteria that causes bad breath thrives in an acidic oral environment. Brushing your teeth with baking soda helps neutralise excess acid found in the oral cavity.

4. Eat foods rich in fibre: High fibre foods help prevent halitosis. Avoid or reduce your intake of heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream.

5. Stimulate your salivary flow: Prevent dry mouth with chewing gum, lozenges, or mints that are sugar free.

6. Never use alcohol based mouthwash: Some mouthwash or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually make the problem worse.

7. Drink green and black tea: They contain polyphenols that help eliminate sulphur compounds and reduce oral bacteria.

8. Avoid products with sodium lauryl sulphate or alcohol: Do not use any oral hygiene products that contain sodium lauryl sulphate or alcohol because the alcohol makes the mouth very dry, one of the most common causes of bad breath.

9. Clean your mouth after eating meat, fish or dairy products: Practicing consistent and thorough oral hygiene is an effective prevention tool.

10. Stop smoking: Studies have shown that smokers are at higher risk of developing periodontal disease and dry mouth. Furthermore, people who smoke may also engage in other habits that promote this condition such as dieting, drinking alcohol, and suffering from chronic anxiety conditions that require exacerbating prescription medications.

11. Eliminate dairy products from your diet: Lactose intolerance can be an underlying cause of halitosis.

Credit: Leadership