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  • Revitalizing Primary healthcare in Post-COVID pandemic – By Carl Umegboro

    Revitalizing Primary healthcare in Post-COVID pandemic – By Carl Umegboro

    By Carl Umegboro

    The fears, distresses that followed the contagious epidemic – Coronavirus which practically crumbled the world economy cannot be forgotten in a hurry. The pandemic led to shutdown of all businesses, schools, religious worship centres and leisure spots except essential services. An unimaginable, unprecedented global lockdown that apart from members of nuclear families, everyone isolated, restricted closeness with other persons for fear of infection. Sneezing became like a taboo let alone coughing. Wearing of face masks, compulsory hand-washing and use of hand-sanitizer suddenly became a norm. Governments and financial institutions across the globe operated skeletally with only management staff, and mostly from home digitally. The masses living on daily incomes without huge deposits in the banks were worse hit. These incidents cannot be forgotten in a hurry. It was hitherto unbelievable.

    To confront the quandary squarely, nations across the globe synergized with sturdy policies, imposed travel bans on international tours, shut down airspaces, and set up jab centres for COVID vaccines.  Although the concerted energies confronted severe conspiracy theories from some quarters, the fight against the pandemic was sustained. However, amid the dilemma, many people lost their lives even in the developed nations with functional primary healthcare systems including USA, Europe, among others.

    Strangely, these developed nations recorded the highest casualties in the COVID deaths despite their huge commitments to the primary healthcare (PHC) compared to Africa particularly Nigeria with meagre attention to the health sector.  In fact, some estimates at the WHO believe that COVID-19 deaths have been undercounted across the globe and that the worldwide tally of nearly 6.3 million deaths may actually be two times higher. Last month, May 2022, in the United States alone, the Centre for Disease Control and Prevention reported that America has aggregately surpassed one million deaths attributed to the disease.

    One could only but imagine what would have happened if the epidemic had its way at the same rate in the developing countries in deficit vis-à-vis primary healthcare. For example, all public officeholders and the affluent class in Nigeria depend on the western world for their healthcare and nuclear families. The healthcare in Nigeria is literally left in miserable conditions for the helpless masses except private hospitals, hence the tradition for government officials to always queue for foreign medical trips, sadly from tax-payers’ coffers. Nonetheless, the pandemic created some emergency interventions to primary healthcare in Nigeria including setting up COVID vaccination centres by governments.

    Now, in this post-COVID pandemic, revitalizing the primary healthcare (PHC) in the country should be given a priority by the authorities as what happened during the pandemic should be an eye-opener. PHC, an ‘essential health care’ that is based on scientifically sound and socially acceptable methods and technology is the first level of contact for individuals, family and the community with the national health system, and addresses the main health problems in the community, providing health promotion, preventive, curative and rehabilitative services accordingly.  Amongst its scope are routine medical checkups, screening for common health issues, prescribing necessary medications, treatment of minor illnesses and injuries, managing chronic conditions, and management of acute health conditions. Health, it is held, is wealth. Thus, revitalizing primary healthcare will impel economic recovery in post-COVID pandemic.

    The second reason is the alarming WHO records which reveals that about 3,000 children die each day of preventable diseases resulting from lack of primary healthcare. Bringing it home, Nigeria from the said data represents 1 in 7 of the global maternal deaths, expressed in 119 preventable maternal deaths daily, and the impact this has on family health and child survival in general cannot be underrated. Furthermore, Nigeria is the top country in the world in terms of number of zero dose children (children who never received any single dose of vaccine since they were born). This is precarious. Necessarily, it is incumbent on the authorities to give the ‘one PHC centre per ward policy’ utmost commitment, alongside sensitization on child immunization.

    In Lagos state recently, Mrs. Muyiwa Idowu-Olaleye, a resident in a ward in Ifelodun LCDA narrated how an emergency call to a health worker in a PHC centre saved the life of her 6year old kid, Sidikat from Cholera infection which began at midnight and almost dried up the child by strained vomiting and stooling in the middle of the night. She wondered what could have happened if she didn’t get anticipated attention from the health worker. The above story suggests that revitalizing Primary Healthcare in every ward with efficient services is essential.

    Arguably, the ‘one PHC centre per ward policy’ in Lagos is rapidly gathering momentum. For instance, Lagos presently, has no fewer than 392 PHC centres spread across its 377 wards – (245 wards created by federal government and 132 wards created by the state from its 37 LCDAs) and strategic places, and progressively being boosted with needed workforce. According to the Permanent Secretary of the Lagos State Primary Health Care Board (LSPHCB), Dr. Ibrahim Mustafa, the state government employed 925 health workers in its recent recruitment drive including medical doctors, pharmacists, nurses, community health extension workers, laboratory scientists and technicians, environmental officers and health information management officers. This should be a template for other states for replication.

    Furthermore, through funding from the Bill & Melinda Gates Foundation and support from CHAI, a development partner, Lagos reportedly has in place an effective and efficient data monitoring system. MTN Foundation had also donated six Mobile clinics to the state. Avid donors like USAID, European Union and other partners to the national body, NPHCDA deserve credits. More corporate organizations should key in as a social responsibility. The ‘one PHC centre per ward’ policy is a desideratum and should be jauntily implemented across the nation. Above all, sensitizing the rural communities on the importance of PHC is necessary particularly the worth of jabs against vaccines-preventable childhood diseases. Also, regular hand-washing for hygiene and hand-sanitizing embraced during the pandemic need to be sustained. These chores will no doubt boost PHC delivery.

     

    Umegboro, ACIArb, a public affairs analyst and social advocate writes via umegborocarl@gmail.com

  • Nearly one billion people have mental disorder worldwide – WHO

    Nearly one billion people have mental disorder worldwide – WHO

    The World Health Organisation (WHO) says that nearly one billion people worldwide suffer from some form of mental disorder, according to latest data by the United Nations (UN).

    The data released on Friday said the staggering figure was even more worrying because it included around one in seven teenagers.

    “To make matters worse, in the first year of the COVID-19 pandemic, rates of common conditions such as depression and anxiety went up by more than 25 per cent,’’ it said.

    It said in its largest review of mental health since the turn of the century, that WHO had urged more countries to get to grips with worsening conditions.

    According to the data, social and economic inequalities, public health emergencies, war, and the climate crisis are among the global, structural threats to mental health.

    It said that depression and anxiety went up by more than 25 per cent in the first year of the pandemic alone.

    It offered examples of good practices that should be implemented as quickly as possible in recognition of the important role that mental health played in positive and sustainable development.

    “Everyone’s life touches someone with a mental health condition. Good mental health translates to good physical health and this new report makes a compelling case for change.

    “The inextricable links between mental health and public health, human rights and socio-economic development mean that transforming policy and practice in mental health can deliver real, substantive benefits for individuals, communities and countries.

    “Investment into mental health is an investment into a better life and future for all,’’ WHO Director-General, Tedros Ghebreyesus said

    Ghebreyesus said that even before COVID-19 hit, only a small fraction of people in need of help had access to effective, affordable and quality mental health treatment, citing latest available global data from 2019.

    He said, for instance, more than 70 per cent of those suffering from psychosis worldwide did not get the help they needed.

    “The gap between rich and poor nations highlights unequal access to healthcare, as seven in 10 people with psychosis receive treatment in high-income countries, compared to only 12 per cent in low-income countries,’’ Ghebreyesus said.

    According to him, the situation is more dramatic for cases of depression, pointing to gaps in assistance across all countries including high-income ones.

    “Only one third of people who suffer from depression receive formal mental health care.

    “Although high-income countries offer ‘minimally-adequate’ treatment for depression in 23 per cent of cases, this drops to just three per cent in low and lower middle-income countries,’’ he said.

    “We need to transform our attitudes, actions and approaches to promote and protect mental health, and to provide and care for those in need.

    “We can and should do this by transforming the environments that influence our mental health and by developing community-based mental health services capable of achieving universal health coverage for mental health,’’ he said.

  • WHO to rename Monkeypox, publishes guideline on vaccination

    World Health Organisation (WHO) says it is working with partners on renaming Monkeypox and its variants, and also to put in place a mechanism to help share available vaccines, more equitably, as the need arises.

    WHO Director General, Dr Tedros Ghebreyesus, disclosed this at a news conference on Tuesday in Geneva.

    He said WHO had published guidelines on vaccination against Monkeypox and also published recommendations for governments regarding case detection and control of the disease.

    Speaking to journalists in Geneva, WHO Smallpox expert, Dr Rosamund Lewis, said it was crucial to raise awareness in the population about the level of risk and explain the recommendations to avoid infecting close contacts and family members.

    Lewis explained that although the disease sometimes only produced mild symptoms, such as skin lesions, it could be contagious for two to four weeks

    “We know that it is very difficult for people to isolate themselves for so long, but it is very important to protect others.

    “In most cases, people can self-isolate at home and there is no need to be in the hospital,” she said.

    Monkeypox is transmitted through close physical contact with someone who has symptoms.

    The rash, fluids, and scabs are especially infectious. Clothing, bedding, towels, or objects such as eating utensils or dishes that have been contaminated with the virus can also infect others.

    However, it is not clear whether people who do not have symptoms can spread the disease, the expert reiterated.

    While some countries have maintained strategic supplies of older smallpox vaccines – a virus eradicated in 1980 – these first-generation vaccines held in national stockpiles are not recommended for Monkeypox at this time.

    This is because they do not meet the current safety and manufacturing standards.

    Newer and safer (second and third generation) smallpox vaccines are also available, some of which may be useful for Monkeypox and one of which (MVA-BN) has been approved for the prevention of the disease.

    According to the UN health agency, the supply of these new vaccines is limited, and access strategies are being discussed.

    “At this time, the WHO does not recommend mass vaccination.

    “Decisions about the use of smallpox or Monkeypox vaccines should be based on a full assessment of the risks and benefits in each case,” the guidelines indicate.

    For the contacts of sick patients, post-exposure prophylaxis with a second- or third-generation vaccine is recommended, ideally within four days of first exposure to prevent disease onset.

    Pre-exposure prophylaxis is recommended for healthcare workers at risk, laboratory personnel working with orthopoxviruses, clinical laboratory personnel performing diagnostic tests for Monkeypox, and others who may be at risk.

    Lewis explained that most of the data on the smallpox vaccine was old or from animal studies. “There aren’t a lot of [current] clinical studies,” she said.

    WHO underlined the importance of vaccination programme being supported by comprehensive surveillance and contact tracing, and accompanied by information campaigns and robust “pharmacovigilance”, ideally with collaborative studies on vaccine efficacy.

    WHO to determine if Monkeypox is an International Emergency June 23

    Meanwhile, the World Health Organisation (WHO) has on Tuesday announced that the International Health Regulations Emergency Committee will meet on June 23 to determine if Monkeypox should be declared ‘Emergency of International Concern’.

    The WHO Director General, Dr Tedros Ghebreyesus, said at a news conference at the agency’s headquarters in Geneva, that the Committee had been convened due to the spread of the Monkeypox virus to 32 non-endemic countries.

    The experts will meet on June 23 to assess whether the continuing outbreak represents a Public Health Emergency of International Concern, the highest level of global alert, which currently applies only to the COVID-19 pandemic and polio.

    So far this year, more than 1,600 confirmed cases and almost 1,500 suspected cases of Monkeypox have been reported to WHO, across 39 countries – including seven countries where monkeypox has been detected for years, and 32 newly-affected nations.

    At least 72 deaths have been reported from previously affected countries.

    No deaths have been registered so far from the newly affected countries, but the agency is seeking to verify news reports of a related death in Brazil.

    “The global outbreak of Monkeypox is clearly unusual and concerning,” Ghebreyesus said, calling to step up the response and international coordination.

    Ibrahima Socé Fall, WHO Deputy Director for Emergency Response, explained that the risk of spread in Europe is considered “high”, w hile in the rest of the world “moderate” and that there are still knowledge gaps regarding how the virus is being transmitted.

    “We don’t want to wait until the situation is out of control,” he said.

    WHO has published recommendations for governments regarding case detection and control.

    WHO Smallpox expert, Dr Rosamund Lewis, said it was crucial to raise awareness in the population about the level of risk and explain the recommendations to avoid infecting close contacts and family members.

    Lewis explained that, although the disease sometimes only produces mild symptoms, such as skin lesions, it can be contagious for two to four weeks.

    “We know that it is very difficult for people to isolate themselves for so long, but it is very important to protect others. In most cases, people can self-isolate at home and there is no need to be in the hospital,” she added.

    Monkeypox is transmitted through close physical contact with someone who has symptoms.

    The rash, fluids and scabs are especially infectious. Clothing, bedding, towels, or objects such as eating utensils or dishes that have been contaminated with the virus can also infect others.

    However, it is not clear whether people who do not have symptoms can spread the disease, the expert reiterated.

  • Special Report: How persistent blood shortages, poverty drive blood black-market in Nigeria

    The World Health Organisation (WHO) says Nigeria needs at least two million pints of blood annually, a far cry from the 25, 000 it currently generates.

    Three months ago, a Federal Civil Servant residing in Abuja Louis Obafemi, was in search of blood for his wife who was due to have their baby in March.

    Obafemi’s wife had received a list from the Government General Hospital Kubwa where she had registered for her antenatal care, containing items she was required to provide during delivery, including blood, which is standard procedure across major hospitals in Nigeria.

    As an O positive blood type recipient, she could only receive blood from O positive and O negative donors, making her husband of the B positive blood type, ineligible to donate blood to her.

    The fact that her O positive blood type tops the chart of donated blood in Nigeria should have made their search less challenging, but it did not. The situation compelled them to expand the scope of their search to include friends, and finally strangers.

    “My fear was that I wanted to know the person that owns the blood before transfusion. I wasn’t just comfortable taking blood from someone I don’t know. I wanted to know the character of the person that owns the blood. It’s just my personal belief,” Obafemi told our reporter.

    Through the help of a colleague who directed him to the Nigerian Red Cross, he was able to get a matching voluntary donor, and only had to pay N8,000 for blood screening and storage.

    The story was different for an insurance staff Yetunde Afolabi, who underwent a myomectomy procedure in 2021 at a private health facility in Isolo, Lagos State.

    Afolabi who has the B positive blood type, said she was asked provide two pints of blood before her surgery, which she admitted was sourced from the blood black-market at the cost of N25,000 per pint.

    “I don’t have close family or relatives here in Lagos so I had to get it (the blood) through an agent. Altogether, I paid N50, 000 for two pints of blood,” she disclosed.

    The need for blood is universal, but access to safe blood and safe blood products for all those who need it is not. Shortages of safe blood are particularly acute in many developing countries like Nigeria.

    In the wake of the recent attack on a church in Owo, blood donors where sourced from various states to meet the demand of victims, after those donated by friends and relatives proved insufficient.

    Head of Information and Advocacy for the Nigerian Red Cross in Owo Ibrahim Laide, confirmed to TNG that blood donations were received from Akure the Ondo state capital, as well as other states like Edo, Ekiti, Osun and Port-Harcourt, until the blood banks at the Federal Medical Centre and St. Louis Catholic Specialist Hospital Owo reached their maximum capacities.

    “People donated from the University of Benin Teaching Hospital, University of Port-Harcourt then from Ayo Babalola University teaching Hospital too,” he told our reporter.

    As the world mark the World Blood Donor Day today, the WHO used to opportunity to opportunity to thank voluntary, unpaid blood donors for their life-saving gifts of blood and also raise awareness on the need for safe blood and blood products to save more lives.

    This year, the World Blood Donor Day slogan “Donating blood is an act of solidarity. Join the effort and save lives”, aims to draw attention to the roles that voluntary blood donations play in saving lives and enhancing solidarity within communities.

    “We don’t sell blood” – Hospitals

    Humans have 35 major groups or families of blood group antigens, as well as other minor groups, but to ensure that a transfusion recipient receives compatible blood, only two antigens are considered – the ABO (which has A, B, O, and AB categories) and RhD (which has negative and positive categories) groups.

    A spokesperson in the Servicom unit of the National Hospital Abuja simply identified as Jacob said emphatically, that the hospital does not sell blood to patients, but that he is aware some patients enter into private arrangements with paid donors.

    “We don’t sell blood, it’s not possible. If there is anyone who has a case where blood was sold to them at the hospital, they should let us know. I want to know.

    “There are certain sensitive blood groups such as O positive that we may not get on time and patients would have to source for donors and pay them. So patients bring people to come and donate blood and they would give them money on their own. We’re not involved, we only ask them to pay for screening the blood,” he informed TNG.

    Jacob added that before any procedure is carried out, patients usually sign a form consenting to donate any unused blood to anyone that requires it within the hospital.

    Head of Laboratory at Nisa Premier Hospital Abuja Emmanuel Enejoh, explained that it is a world health standard practice to require patients to provide blood prior to a delivery or surgical procedure.

    Here too, patients give consent that the blood supplied is non-refundable and where the blood is not transfused to the patient, it is used to cater to emergency situations that may arise.

    “We have the emergency wing of our hospital. We have sickle-cell clinic. When these crisis or emergencies come up, we don’t ask these people to go and look for blood, provided we still have blood that are within the expiration date of 27-30 days.

    “How do we refund screening please? So if I now buy Enzyme Linked Immuno-Sorbent Assay (ELISA) kit to screen blood for somebody, I will now return the screening fee back to the patient?” he queried.

    Enejoh, further explained to our reporter that although, the hospital’s first line practice is to use relative donor, its sometimes recruits paid donors for patients who do not have and charges only a screening fee afterwards.

    “If you don’t have your donor, that is where the remunerated donor comes in. Some of them will tell you they don’t even want to know these people. In this part of our world, because of the level of poverty, people have not woken up to the reality that you should come and donate blood free.

    “Once we recruit a donor for a patient, we allow them reach an agreement on pricing. We don’t charge patients any fee outside screening fee,” he stressed.

    However, corroborating Afolabi’s claim about the blood black-market, Operations Manager at Haima Health Initiative Ayobami Bakare, during an interview with our reporter, disclosed that Nigeria has an active blood black-market which charges very exorbitant fees.

    “At Haima Health Initiative, we organise blood drive for the NBSC (National Blood Service Commission) and we screen those blood and issue them out at N6, 000. Where the discrepancies come from is that there are a lot of private blood banks, especially in Lagos and Abuja, where people pay donors to get blood.

    “There is also an active blood black-market in Nigeria which is very exorbitant. The price of a negative blood can cost between N25, 000 – N30, 000, depending on the location (Abuja or Lagos). So they just extort patients because of the deficit. At every point in time, Nigeria needs between 1.8 million to 2 million pints of blood,” Bakare said.

    Inability to fractionate whole blood still a major challenge – Commission

    The National Blood Service Commission is in charge of coordinating, regulating and ensuring the provision of safe, quality blood transfusion services in Nigeria.

    Nigeria established a national blood transfusion policy through a published set of guidelines in December 2006, essentially made up of sets of action plans geared toward the provision of safe, available, and affordable blood donor units, where and when they might be needed in the country through.

    The policy guideline provides five main structures – the National Blood Service Commission (formerly called the national blood transfusion service), the zonal blood service centers, state and local government areas blood service centers, the armed forces blood service, as well as private and other nongovernmental health establishments – to ensure universal coverage of the country, right to local government councils.

    The Commission has disclosed that most hospitals in Nigeria transfuse whole blood to patients even when only specific components of the blood is required because the equipment for blood fractionation are expensive and not readily available.

    Technical Assistant to the Director-General of the NBSC Uneku Offor, disclosed this during an interview with our reporter as a major challenge the commission is working to surmount in the near furture.

    Offor revealed that only eight percent of Nigeria’s population donate blood voluntarily, the most of which come from relatives and that the Commission has rolled out an initiative that targets to grow voluntary blood donation from 25, 000 per annum to one million, as part of its 10-year strategic plan launched last year.

    An individual can only donate blood a maximum of three times a year and in Nigeria, the highest voluntary blood donor is Benjamin Aghoro, who as at May 2022 has donated 106 pints of blood.

    “There should be a reserve such that when such emergencies, mass casualties are encountered, such as the Owo church attack, we can easily mobilise those units of blood to the area that they may need it. That is what the one million safe blood units’ initiative is all about.

    “Through the one million safe blood units’ initiative, we will start diversifying into components like red blood concentrates and the plasma, once we get a substantial amount of donated blood.

    “Because the equipment used for this fractionation is not readily available and is really expensive, most hospitals, especially in Nigeria just give whole blood, whether the person has need for whole blood or not,” Offor said.

    She further stated that some of the 11 state centres of the NBSC already have component platelet machines through which they are able to extract just the platelet concentrate and distribute to those that need them per time.

    The NBCS has six zonal centres which in addition to the 11 state centres make a total of 17 centres across the country.

  • MonkeyPox: Nigeria records 10 additional cases in 7 days – NCDC

    The Nigeria Centre for Disease Control (NCDC ) has recorded 10 additional Monkeypox cases in the last seven days in the country.

    The NCDC disclosed this via it’s official website, in its latest monkeypox situation report released on Friday.

    As global monkeypox cases continue to rise, public-health officials and researchers are questioning whether the current outbreaks can be contained.

    The World Health Organization (WHO) has said that the situation was unlikely to escalate into a full-blown pandemic.

    But, there are now more than 1,000 confirmed infections, in nearly 30 countries where outbreaks do not usually occur.

    Countries including Canada, the United Kingdom and the United States have begun implementing a strategy called ‘ring vaccination,’ to try to halt the spread of the virus.

    This involves administering smallpox vaccines — which are thought to be effective against monkeypox, because, the viruses are related to people who have been exposed to monkeypox through close contact with an infected person.

    The Agency said that this was reported in epidemiological week 22, from  May 29 to June 5, 2022, in the country.

    It stated that between January 1 and June 5, the country had confirmed a total of 31 cases in 12 states, including the Federal Capital Territory (FCT).

    The NCDC  also confirmed that no fewer than 110 suspected cases of the disease had been reported in the country, up from the previous 66 suspected cases.

    “From January 1 to 5 June, 2022, there have been 110 suspected cases in total and 31 confirmed cases from 12 states.

    They are: Adamawa 5, Lagos 6, River 3, Cross River 2, FCT 2, Kano 2, Delta 2, Bayelsa 2, Edo 2, Imo 2, Plateau 2, and Ondo 1.

    “One death was recorded in a 40-year old man, with co-morbidity that was receiving immunosuppressive drugs.

    “There were 10 new positive cases in Epi week 22, 2022, from six states – Edo 2, Rivers 2, Plateau 2, Lagos 2, Ondo 1 and Imo 1,” it said.

    Recall that cases of monkeypox,  a rare, little-known disease, are being investigated in European countries, including the UK, as well as in the US, Canada and Australia.

    In the UK, there have been more than 300 confirmed cases in recent weeks.

    Infections are usually mild and the risk to the general population is low, but the UK government has bought stocks of smallpox vaccine to guard against monkeypox.

    Monkeypox is caused by the monkeypox virus, a member of the same family of viruses as smallpox, although it is much less severe and experts say chances of infection are low.

    It occurs mostly in remote parts of central and west African countries, near tropical rain forests.

    In those regions, there have been more than 1,200 cases of monkeypox since the start of the year.

    Two main strains of the virus, west African and Central African, are known to exist, and it’s the milder one from west Africa which is now circulating in other regions of the world.

    The unusually high numbers of people infected with monkeypox outside of Africa, with no travel links to the region, means the virus is now spreading in the communities.

  • Tobacco Harm Reduction: The Imperative for Alternatives – By Olufisayo Adeoti

    Tobacco Harm Reduction: The Imperative for Alternatives – By Olufisayo Adeoti

    By Olufisayo Adeoti

    There are concerns the world over, about the health effects of tobacco, which is mostly consumed by smoking cigarettes, cigars or pipes.

    In January 2021, the company Johnson & Johnson Consumer Health, donated nicotine patches worth $800,000 to Jordan to help the country in its efforts to lower smoking rates. The donation was received by the country’s ministry of health.

    This was after the public health groups sounded the alarm on the prevalence of smoking among Jordanian citizens as Jordan became the country with the highest smoking rate in the world. A government study carried out in 2019 in collaboration with the World Health Organisation (WHO) had revealed that eight out of every 10 Jordanian men smoked or regularly used nicotine products.

    The WHO Representative for Jordan, Maria Cristina Profili, in response to the donation stated; “We are grateful for this donation which builds on WHO’s existing efforts and a comprehensive programme to fight tobacco control in Jordan. The nicotine replacement therapy will help thousands of people in Jordan quit tobacco and lead a healthier life.”

    But still, WHO and several public health organisations maintain a prohibitionist approach towards tobacco harm reduction. Their position is that smokers must quit the habit or face the consequences of death or a myriad of health complications. Agreed, quitting is the best option for smokers but what alternative choices or reduced risk products are available to consumers who cannot or do not want to quit?

    A growing number of public health experts believe that providing less risky tobacco or nicotine products will achieve the same objective of reducing the health effects of smoking tobacco and in some instances help smokers quit. These experts in many ways are the proponents of Tobacco Harm reduction.

    In a statement by Professor David Nutt of Imperial College London, published by Counterfactual, where he urged WHO leadership to launch a comprehensive rethink of its approach to tobacco control he says about alternative products: “There is no real scientific doubt that these smoke free products are much safer than smoking and that they can help smokers quit. So we should be working hard to make that happen”

    Tobacco Harm Reduction (THR), is a public health solution. The argument is that the harmful effect of tobacco is predominantly caused by the way it is consumed – smoking, but if the element of combustion (smoking) is removed and consumers are provided with less risky or alternative ways to consume tobacco or nicotine then the public health concern on the health impact of tobacco is reduced. Increasingly, proponents of THR are revealing success stories. A significant number of these stories or acceptance of THR are from developed economies and hopefully, it will begin to gain acceptance in less developed ones.

    For instance, In the United Kingdom (UK), tobacco harm reduction within a regulated framework, encouraging smokers to use non-combustible tobacco or nicotine products, is supported by the UK government and most of the public health communities. The National Institute for Health and Care Excellence (NICE) which issues evidence-based guidance on the most effective ways to prevent, diagnose and treat diseases and ill health published a guidance on tobacco harm reduction. The guidance recognizes that quitting smoking is always the best option for smokers but it supports the use of licensed nicotine containing products (NCPs) to help smokers not currently able to quit to cut down and as a substitute for smoking. Public Health England (PHE) also published an independent evidence review on electronic cigarettes which concluded that the devices are significantly less harmful than smoking.

    Furthermore, in the United States of America (USA), the food and drug administration (FDA) has begun to license alternative products as “modified risk tobacco product.”

    Sweden has long been considered by keen industry observers as a trailblazer in cutting down smoking rates among men. But their strategy was the use of reduced risk tobacco products like snus. Snus is a nicotine pouch which a lot of smokers have switched to over the years. It enables smokers who are unable or unwilling to quit enjoy nicotine without having to contend with the dangerous substances that accompany combustible tobacco products.

    In December 2020, Frost & Sullivan, a consulting firm that is world-renowned for its role in helping investors, corporate leaders and governments navigate economic changes and identify disruptive technologies, mega trends, and new business models reported that Japan had recorded a 34% drop in sales of cigarettes between 2015 and 2019 (attributing this decline to the availability of non-combustible, reduced risks products, mainly heated tobacco products (HTP). The report supports the position that the availability of non-combustible alternatives, less risky options is crucial for any society to achieve a decline in smoking among its citizens.

    While the proponents of tobacco harm reduction have always called for the availability of alternative products, the response of WHO to the aforementioned donation of nicotine patches to Jordan would seem to lend credence to this notion as it openly celebrated the provision and availability of alternative products, reduced risk options to cigarettes.

    It is imperative we develop a balanced approach in our polity. In seeking a drop in smoking rates in Nigeria or across Africa, what strategies do the relevant health authorities and regulatory agencies have? What is their stance on tobacco harm reduction (THR) and reduced risk alternative products?

    How well do they understand THR? What independent researches and studies are they undertaking to improve their knowledge and understanding to enable an objective appraisal of this concept?

    If the ultimate goal is to achieve a decline in smoking rates and reduce the adverse health impact of tobacco, evidence from countries that are succeeding continues to show that tobacco harm reduction must be pursued as a public health solution despite or in addition to ongoing smoking cessation initiatives.

    Nigeria, as with other African countries (particularly in Sub-Saharan Africa) must institute robust dialogues and engagements with all relevant stakeholders to formulate effective policies and guidelines for the availability and use of reduced risk products. Policies enacted on scientific evidence and the rights of consumers to have access to these products is not just essential but is a crucial step to reduce smoking rates and health impact of combustible tobacco products.

    Leaving things the way they are will have limited impact on the reduction of smoking incidence and will not help the government to achieve swiftly the public policy objectives of reducing the health risks associated with combustible tobacco.

    Olufisayo Adeoti sent this piece from Lagos

  • Malaria remains significant public health threat – WHO

    Malaria remains significant public health threat – WHO

    The World Health Organisation (WHO) says malaria remains a significant public health and development challenge with about 95 per cent estimated 228 million cases occurring in the WHO and AFRO Region,

    Dr Matshidiso Moeti, WHO Regional Director for Africa, made this known in a message to commemorate the 2022 World Malaria Day with the theme “Harness innovation to reduce the malaria disease burden and save lives”,

    Newsmen reports that World Malaria Day, celebrated every year on April 25, is an occasion to highlight the need for continued investment and sustained political commitment to malaria prevention and control.

    “Malaria remains a significant public health and development challenges. In the last year, about 95 per cent of the estimated 228 million cases occurred in the WHO/AFRO Region, along with 602 020 reported deaths,” she said.

    Moeti said that six of the countries, the worst impacted by malaria in the region, are reported to have accounted for up to 55 per cent of cases globally, and for 50 per cent of these deaths.

    She called on countries and communities affected by malaria to work closely with development partners to advance the countries along the road to elimination.

    “This aligns with my call to urgently scale up innovation and the deployment of new tools in the fight against malaria.

    “While advocating equitable access to malaria prevention and treatment, within the context of building health system resilience.

    ”In spite of some slowing of progress to reduce malaria cases and deaths and the disruptions to health services caused by COVID-19, Africa is still much further ahead than we were in 2000.

    “We need to reignite that momentum and build on the recent advances,” she said.

    For example, she said, Seasonal Malaria Chemoprevention (SMC) campaigns were implemented as planned in 2021, ensuring protection for an additional 11.8million children.

    “Indoor residual spraying was also carried out, and long-lasting insecticidal nets were distributed, largely as planned.

    “Other notable achievements include the scaled implementation of RTS, vaccine pilots in Ghana, Kenya and Malawi, which reached up to 900 000 children,” Moeti said.

    According to her, the ultimate goal is to reduce the number of people catching and dying from malaria.

    ” This requires a focus on research and on leveraging available evidence to ensure that our targeted interventions are an efficient use of resources, which produce measurable results.

    “We also need to work on drug and insecticide resistance, as well as focus on new strains of malaria arising in the Region, which are more difficult to detect, and treat,” she said.

    Moeti said that malaria was, however, about much than medical and technological interventions.

    According to her, malaria affects households and communities, and these communities need to be empowered to play an active role in the fight against this disease.

    “As WHO in Africa, we recognise that a whole-of-society approach requires us to listen to, and learn from, those who are worst impacted.

    “The day is an occasion to renew political commitment and encourage continued investment in malaria prevention and control.

    She said that the past year has seen significant breakthroughs in malaria prevention and control, in spite of the COVID-19 pandemic.

    Moeti said that the landmark recommendations on the use of the first vaccine against malaria – RTS,S – were released by the WHO in 2021.

    “This vaccine will be used to prevent malaria among children aged six months to five years, who live in moderate- to high-transmission settings.

    She said that while the vaccine was a groundbreaking advance in the development of new tools to fight the disease, with the potential to save millions of lives, supplies are currently limited.

    “As such, it is important to ensure that the doses that are available are utilised for maximum impact while ensuring the continued availability of other preventive measures to those most at risk.

  • DRC declares new Ebola outbreak in Mbandaka – WHO

    DRC declares new Ebola outbreak in Mbandaka – WHO

    World Health Organisation (WHO) has reported that health authorities in the Democratic Republic of the Congo (DRC) on Saturday declared an outbreak of Ebola in Mbandaka, a city in the north-western Equateur Province.

    WHO, in a statement, stated that DRC declared an outbreak of Ebola after a case was confirmed in the city on April 5.

    The infected patient was a 31-year-old man who began experiencing symptoms on April 5 and after more than a week of care at home, sought treatment at a local health facility.

    On April 21, he was admitted to an Ebola treatment centre for intensive care but died later that day. Having recognised the symptoms, health workers immediately submitted samples to test for Ebola virus disease, WHO explained.

    So far, just one case has been confirmed and investigations to determine the source of the outbreak are ongoing.

    “Time is not on our side,” Dr Matshidiso Moeti, WHO Regional Director for Africa, said, noting that “the disease has had a two-week head start and we are now playing catch-up.”

    According to her, the positive news is that health authorities in the DRC have more experience than anyone else in the world at controlling Ebola outbreaks quickly.

    This is the 14th Ebola outbreak in the Democratic Republic of the Congo since 1976.

    The new outbreak is the sixth since 2018 – the most frequent occurrence in the country’s Ebola history.

    Previous outbreaks in Equateur Province were in 2020 and 2018, with 130 and 54 recorded cases respectively.

    WHO informed that the deceased patient received a safe and dignified burial, which involves modifying traditional funeral ceremonies to minimise the risk of contagious fluids infecting attendees.

    Health authorities are also identifying contacts to monitor their health and disinfected the health facility where the patient was treated.

    Moreover, plans to kick off vaccination in the coming days are underway with stockpiles of the rVSV-ZEBOV Ebola vaccine already available in the cities of Goma and Kinshasa.

    The UN health agency assured that vaccines would be sent to Mbandaka and administered through ‘ring vaccination strategy – where contacts and contacts of contacts are vaccinated to curb the spread of the virus and protect lives.

    “Many people in Mbandaka are already vaccinated against Ebola, which should help reduce the impact of the disease.

    “All those who were vaccinated during the 2020 outbreak will be revaccinated,” Moeti said.

    Ebola is a severe, often fatal illness affecting humans and other primates. Case fatality rates have varied from 25 per cent to 90 per cent in past outbreaks.

  • Unreported COVID cases in Africa higher than expected – WHO

    Unreported COVID cases in Africa higher than expected – WHO

    The World Health Organisation (WHO), has disclosed that the number of unreported cases of COVID-19 infections among the 1.3 billion residents in Africa is far higher than previously reported, according to its latest findings.

    Matshidiso Moeti, WHO regional director for Africa, said on Thursday that “New WHO analyses show that over two-thirds of the people on the African continent may have acquired a certain level of immunity following exposure to the COVID-19-virus,”.

    Referring to an as yet unpublished study by the WHO, she said the official figures only scratched the surface of the problem.

    The true infection figures could be 97 times higher than the number of registered, confirmed cases.

    “This compares to the global average, where the true number of infections is about 16 per cent higher than the number of confirmed, reported cases,” Moeti said.

    Officially, Africa has registered some 11.5 million infections so far, of which 250,000 were fatal.

    In spite of the higher numbers, however, there was no reason to panic, she said, also referring to Africa’s relatively young population.

    Extensive testing and vaccination, however, remained a priority.

    She also stressed that many health emergencies in Africa could now be traced back to climatic conditions.

    The WHO has just published a study to this effect, according to which the entire health basis of the continent is endangered by increasingly severe climate events.

    Considering this, the awareness of African countries about climate change has been strengthened.

  • Ukraine war: UN 2nd convoy reaches Sumy, Mariupol access impeded

    Ukraine war: UN 2nd convoy reaches Sumy, Mariupol access impeded

    The United Nations (UN) humanitarian agencies and partners on the ground in Ukraine, have arrived in the town of Sumy, in the country’s northeast on Thursday but access to the besieged and stricken city of Mariupol is yet to be reached.

    UN Spokesperson, Stéphane Dujarric, while speaking with newsmen in New York, said the first convoy had arrived Sumy nearly two weeks ago, with another inter-agency relief mission reaching nearby Kharkiv, earlier this week.

    “In today’s convoy, which included seven trucks, delivered food, medicines and hygiene products that will be distributed by the Ukrainian Red Cross Society and its local partners, and that will take place in the days ahead.

    “This included food for nearly 6,000 people provided by the World Food Programme (WFP) and the NGO ‘People in Need;’ hygiene products for around 6,000; blankets, sleeping bags and solar lamps for more than 1,500 from the UN refugee agency, UNHCR,” he said.

    He said critical medical supplies for more than 10,000 people for the next three months were also supplied by the World Health Organisation (WHO).

    “We and our partners have still not been able to reach areas where people are in desperate need of support, including Mariupol, Kherson and Chernihiv, despite extensive efforts and ongoing engagement with the parties to the conflict.

    “We are continuing our dialogue with both parties to the conflict with the aim of urgently, immediately and consistently negotiating and facilitating the delivery of critical humanitarian assistance to the people who have been hardest hit by this ongoing war,” Dujarric said.

    The United Nations High Commissioner for Refugees (UNFPA) said it had transported 3,000 ‘dignity kits,’ containing soap, underwear and other basic items, but essential hygiene items to social service centres, shelters and crisis rooms for gender-based violence survivors, in Dnipro, Poltava and Zaporizhzhia.

    The UN migration agency IOM, received a shipment of 20,000 high energy biscuits at its warehouse in Lviv, Dujarric said.

    The mission will send the stock to eastern Ukraine and distribute to those most in need, targeting children and pregnant and lactating mothers in particular.

    He added the UN had also “just received nearly 80 million dollars in the last few days on our humanitarian appeal for Ukraine, which puts the 1.1 billion dollar appeal at about 51 per cent funded.”

    Commissioner for Refugees Filippo Grandi, appealed on Thursday “in the strongest terms” for an end to the Russian offensive, calling on the international community to provide sustained support to the millions of civilians impacted by the fighting.

    “The speed of the displacement, coupled with the huge numbers of people affected, is unprecedented in Europe in recent memory.

    “I have spoken with women, with children, who have been gravely affected by this war.

    “Forced to flee extraordinary levels of violence, they have left behind their homes and often their families, leaving them shocked and traumatised.

    “The protection and humanitarian needs are enormous and continue to grow. And while critically urgent, humanitarian aid alone cannot give them what they really need – and that is peace,” he said at the end of a visit to Lviv, in western Ukraine.

    The head of gender agency UN Women, Sima Bahous, issued a strong statement on Ukraine on behalf of women and girls, warning that as they represent 90 per cent of all those fleeing their homes.

    “They are uniquely exposed to gender-based specific risks such as trafficking, sexual and gender-based violence and denial of access to essential services and goods,” she noted.

    She added that reports of some of these risks, “already becoming reality have begun to surface. This demands an urgent gender-intentional response to ensure the specific rights and needs of women and girls are prioritized.”

    She reiterated the UN Secretary-General’s urgent call for peace: “The war must stop now.”

    She added that women’s civil society organisations inside Ukraine, and in neighbouring countries, were “uniquely qualified” to help meet the needs of women and girls on the run.

    “The majority of these organisations remain operational, committed to supporting Ukraine’s women and girls, increasingly at the risk of their own lives.

    “Women’s organisations lie at the heart of UN Women’s response in Ukraine.

    “We have directly allocated immediate funds to women’s civil society organisations, with more to follow, alongside additional funds coming through the United Nations Women, Peace and Humanitarian Fund for which UN Women is the Secretariat.”