Friday, June 19, 2009

Puzzle Over A Strange Illness

As the date for the yearly promotional examination of the students of the Federal Government Girls’ College (FGGC) Bwari in the Federal Capital Territory (FCT) of Nigeria draws near, one question that will not cease to give the authorities of the school sleepless nights is how many of such students would be available for the examinations.

Going by the notice placed on the school’s main gate, any student who fails to be part of the examinations will have himself to blame. The school located on the hilly side of Bwari-almost 45 minutes from the city centre-has been in the news for the past three weeks. No thanks to the strange illness that has afflicted the students and to which even the federal government appears incapable of finding a solution to. As a result of the severity of the disease, parents have been forced to quickly withdraw their wards, albeit temporarily to allow for proper investigation, thorough check-up and appropriate medications.

Although the Federal Ministries of Health and Education have explained the strange illness as ‘Mass Adolescent Hysteria’, parents and indeed, many Nigerians appear unimpressed with the official response to what should otherwise be an emergency situation. For example, many are left wondering why it took the authorities a long time to respond to the situation considering the fact that more than half of the students population live within the school’s premises and could have come from other parts of the country.

Not even the visits of the two ministers in the Education Ministry, Prof. Fabian Osuji and Hajia Bintu Ibrahim Musa to the school could help unravel the circumstances behind the illness.

In the early part of last month, information got round that young girls affected by the disease had joint pains and could not walk about freely as their legs shake and wobble. Though the school authorities swept the strange illness under the carpet, it became apparent that the worrying parents who were left to cater for their children could no longer keep sealed lips over the ‘alleged official negligence’ and they started trooping into the school to register their displeasure.

One of the parents pointedly accused the school management of not doing enough to contain the spread of the ailment, a charge the school’s principal, Hajia Bunmi Jamila Gold firmly denied, saying the management had taken all necessary measures to contain it. But it appears that the more officials try to cover up the story of the illness, the more it comes out. More students were being taken home by their guardians, thereby giving a lie to the official claims.

For example, when the principal conducted the Minister of State for Education round the affected students lately, she was confident that in a question of days, the ailment would be contained. She had identified it as mere fever. Perhaps, it was the same optimism that informed the submission by her visitor on the national television that she was satisfied with the steps taken so far.

According to her, “The staff and students are co-operating, so I am satisfied with the steps taken so far”. But despite the assurances by the minister that all would be well, the contrary seemed to be the case prompting another visit to the school last week of Professor Osuji to see things himself.

After he had been conducted round by the principal, Osuji told reporters that “the reports we gathered from the director of public health and chief epidemiologist, both of the Federal Ministry of Health confirmed that the sample they took from here did not indicate any viral or bacterial illness. In other words, there was no medical reason for any condition to exist. They said that what they could identify was what they described as mass hysteria among the children and such a condition could exist during examination or during conditions of stress. So in any case, they could not label any disease.

“Moreover, as the children who suffer from such syndrome get well after taking Vitamin C complex and Paractamol, we are glad that whatever it was, the condition no longer exists”.

Justifying his position, the Minister claimed he had been dealing with students for a long time and ‘I know that during examinations it does happen everywhere”. Some of the parents were quick to disagree pointing out that the students of the 10-year old institution had been preparing and taking examinations for about ten years now. Therefore this particular case must have something behind it.

Asked what he thought the ministry could do to prevent a recurrence, Osuji said, “how would you prevent a disease if it is not a disease or if it is not a medical condition? That is what is said, how can I take steps to prevent it. I am telling you that I can only work with what doctors say. If they tell us that there is an infection here, or a bacterial condition or an epidemic, we will have cause to review our reaction. We can even go as far as asking the Federal Ministry of Health to examine whatever steps necessary to prevent the recurrence”.

For now Osuji said the government was not contemplating closing down the institution as being demanded by some parents because according to him, the situation had not warranted that kind of extreme measure. He believed that closing down the school at this time could create unnecessary fear and panic in the minds of the students and their parents.

Funke Adedoyin, the Minister of State for Health also attributed the condition to ‘mass hysteria’ while speaking with newsmen in Abuja recently blaming the strange ailment on a symptomatic disorder.

She gave the medical name as ‘discriminative disorder’, claiming that it was discovered after a clinical analysis of the ailment. She however added that the result she gave was a preliminary outcome, saying the ministry would not rely solely on the result of the clinical analysis in the process of finding solutions to the problem.

According to her, the ministry was awaiting the outcome of the epidemiological analysis of the ailment before drawing conclusions on the causes of the health problem. She expressed optimism that whatever results that came out of the clinical analysis would be confirmed or supported by the result of the analysis of the ailment done outside the country.

While the final word is being awaited, an independent observation of the environment made shocking revelations.

One fact both the government and the school authorities do not seem to be addressing is the area of congestion, coupled with poor sanitary conditions in the hostels. For instance, a parent who visited one of the hostels at the peak of the crisis gave a vivid account of the state of congestion in the hostel. She cited instances where two students share the upper bunk of the bed that was ordinarily meant for a student.

This is not peculiar to the school. It is a condition that replicates itself in virtually all the 102 unity schools spread across the country. The Minister of Education while giving his yearly press briefing in Abuja recently admitted as much and blamed it on the pressure on those institutions.

The good news, however is that the government has realised the danger of young persons studying under such conditions. According to the minister, government has concluded plans to inject funds for the massive rehabilitation of all unity schools throughout the country. Specifically he announced that about N4 billion would be expended on these schools in the current session. This is in addition to the promised improvement on feeding and other overhead costs.

Parents have not completely joined the government in shouting freedom. Consequently some of them have adopted a wiser approach of temporarily withdrawing their wards from the boarding houses. A student of the college confirmed that most of her colleagues would prefer for now to be coming from home.

“We are still afraid of coming back to the dormitory. Most of us now come from home. Though my own case is different since my parents stay here in Bwari but those residing outside Bwari town find it difficult and they are being forced to come to school once in a while”, she said.

Asked if the story about poor sick bay was correct, she said, “Well I have not been there before and I don’t intend to go there since most of my friends who have been often complain of dirty environment, lack of drugs and sub-standard drugs where available”.

Mrs. Philomena Obadawe whose daughter is in the school said her daughter still goes to school from home until everything about the epidemic is rested. Though her daughter was not affected by the disease, she insisted that her girl would not return to the hostel until the situation is medically certified.

“My daughter is not affected but she is still coming from home due to the fear of recurrence of the epidemic and would continue like that until the Federal Ministry of Health confirms the situation normal”.

She would rather her daughter loses a session than losing her out rightly stressing that life of her daughter is more important.

The Chief Medical Director of Wuse General Hospital where some of the students were initially admitted, Dr. Anthony Momoh, confirmed that some of the students of FGGC Bwari were brought into the hospital. He said nine of them were admitted.

“Yes, about nine of the students were admitted here. Six were admitted initially and later another three making it nine in all”, he said.

Asked what the cause of the epidemic was, he replied that he did not know but when asked how he began to treat patients without knowing the cause of their ailment, he said, “Well, we did physiotherapy and administered drugs on them. Actually, we treated them for shaking and wobbling legs which was the major symptom of the epidemic”.

Dr. Momoh also added that the affected students were certified healed before they left the hospital, though there was no post medical examination to monitor their progress and response to the treatment. But situations on ground still indicate that it is not yet safe in FGGC Bwari as a notice posted on the school main gate reads:

• Any boarding student who is still experiencing wobbling and shaking legs is free to be coming from her home.

• Students are also reminded that promotional examination comes up on July 9, 2004

• Any student who fails to be part of this examination will have herself to blame.

Thursday, June 18, 2009

Edo Kerosene Blast Victims Need Justice

They were a grisly sight to behold. Eyes popping out of burnt sockets. One woman had no arms and her neck was half gone. Others had their skin burnt black.

There were more like actors in a horror movie only this time the barely claded victims were victims of the 2001 kerosene explosions in Edo State, Nigeria. The presence of the 22 badly burnt victims foisted a graveyard silence in the Press Centre of the Nigeria Union of Journalists in Abuja.

Most pathetic of the sights were nine children who had much of their arms and legs shrivelled by the burns. The mammary glands of some of the once beautiful women were gone. Their spokesman and a member of a non-governmental organisation Lifetag shocked his audience when he announced that only 23 million was needed to conduct plastic surgery on the victims.

The petroleum product was said to have been certified and piped as kerosene (DPK) and supplied by the Nigerian National Petroleum Corporation (NNPC) depot in Benin City. About 2000 people were affected, with more than 300 deaths and another reasonable number with varying degrees of burns beside the loss of their property.

At a press conference in Abuja over the incident, the joint body of Kerosene Fire Victims Welfare Association (KEVA), Women/Child Kerosene Fire Victims Welfare Association (WOKEVA) and Lifetag said they were prompted into making their stand known because of the ‘recent propaganda by agents of Edo State Government that it had brought a team of surgeons from the United States of America to undertake reconstructive surgery’ on the victims.

The Executive Director of Lifetag, Mr. Tony Erha, said “it’s another attempt by the Edo State government to mislead the public into believing that the plight of these victims is being looked into. It is another decoy to undermine the genuine efforts now being put in place by the public to us, where Edo State government has failed so woefully”.

He questioned the competence of Igbinedion Hospital Okada to carry out such complex operation on so many people within the given time.

He said, “If it could take a fairly burnt victim an average of three months to undergo a fairly successful surgery in the advanced world with its advanced medical facilities and expertise, how come that the Igbinedion Hospital Okada could perform such a feat given the deplorable facilities and low morale, within so short as two-week duration?”

Erha said the coalition had taken their case to court to seek justice and restitution for the neglect that they are suffering as a result of the government’s indifference.

The petition reads in part: “Unfortunately, four years after the horrific explosion, we have been neglected to our own peril, as mere palliative or nothing was given to the victims as succour, from the concerned authorities. Most of us, victims still have festering sores and bizarre disfigurement, rendered homeless; as we now live unhealthy and abnormal lives. Dying by instalments is now our unfortunate fate. Where succour is expected, there is an abundant lack of dire medical and social needs.

“To stay alive, some of the victims now resort to begging for alms under unbearable and dehumanising conditions. Victims are mostly vulnerable children and women, amongst the underclass of the Nigerian society. Most of the child victims have been thrown out of school hence their parents can no longer endure it and they are denied enrolment because of their monstrous look, which scares other pupils away.

“Even though the NNPC was variously indicted by the investigation committees into the matter, such as those of the Department of Petroleum Resources (DPR), the NNPC headquarters Abuja, the House of Representative Committee on Petroleum Resources and the judicial commission of inquiry established by Edo State government, the NNPC has not deemed it fit to adequately rehabilitate and compensate us the victims. This is more so that the NNPC itself had belatedly admitted to being the cause and/or partial cause of the explosion. It has also reneged on an earlier promise to establish a Kerosene Victims Burns Trust Fund, for the Edo victims and others in the country”.

It went on: “But the uncomplimentary actions and inactions of the agents of Edo State government, led by Luck Igbinedion, is our greatest undoing and it has thwarted our efforts to getting the adequate assuagement from the NNPC. Our prayer therefore is for you to carry out full investigations on the understated and act accordingly:

• The shocking revelation by Governor Igbinedion and those concerned top officials of his government, some years after, that a paltry charitable sum of about N15.4 million, which he admitted was all donations which had poured in, was trapped in the failed Savannah Bank Benin City branch where the Edo government said it had lodged it. This is against the background that Edo government only acted as a trustee for the explosion victims, over these funds, which ought to have been instantly deployed to ameliorate the critical conditions of the victims;

• The illicit contract of a plastic surgery exercise by Governor Igbinedion and Mr. Ovbiagele to one Miss Modupe Ozolua (a non-medical expert) with her BEARS Foundation and the Igbinedion Hospital Okada belonging to the governor and his father, Chief Gabriel Osawuru Igbinedion. This was against a genuine outcry of ours and the public;

• Contracted thus at a mind boggling N106 million for each of 50 of the entire 400 victims, who were originally meant to be given the surgery at N26 million. Obviously, by implications, the victims and Edo State are coughing into some private pockets N848 million for surgery in respect of all the 400 victims whereas N822 million would have been saved in the process;

• That some nine months after, the cost of the surgery has risen from N26 million for all the victims to N106 million to each of the 50 victims;

• That Governor Igbinedion, Mr. Ovbiagele and others turned down the safest and best cost-saving offer by the World Health Organisation, Nigeria Country Office, which offered for all the victims’ free surgery abroad. In a letter written to the victims via Access to Justice, one of the their advocates, Edo State government obviously lied that it had years back done the surgery on all the victims;

• That only a very few of the original 2001 kerosene explosion victims(for whom the fund was meant) were actually the beneficiaries of the so-called extensive surgery exercise by BEARS Foundation at Okada Hospital, which indeed turned out to be a skin grafting exercise for all those treated, who were much lesser in number than the original 50. Those who largely benefited from the scandalous exercise were victims of acid burns, natural deformities and others who are relatives of agents of the Edo government;

• Still on the surgery, we also wish to make further request that you look into our N25 million donation from NNPC which Edo State government said it has already made as part payment to Miss Ozolua(BEARS Foundation), including all that transpired in that respect.

According to them, they have lost confidence in the ability and genuineness of the state government to further handle the explosion issues. The victims urged investigation into all the monies which Edo government has so far received in respect of the surgery from the NNPC, the Niger Delta Development Commission (NNDC) and other sources.

“Finally, we are pledging our total support to the efforts to unravel the puzzle of the explosion as we have the necessary documentary and other evidence to buttress our claims”, they said.

The solution according to the victims lies in their restitution and the willingness of the government to intervene and do what is expected given that the innocent women and children are dying in instalments.

Thursday, June 11, 2009

Criminal Transmission of HIV/AIDS: The Legal Aspect

For those living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome, preventing others from becoming infected too could be a major source of concern. However not all HIV positive people take the precautions that they should to avoid transmitting the virus to others. Stories of people deliberately and recklessly transmitting the virus to others abound and a good number of them have also been criminally charged and imprisoned for their actions. The latest addition to the scare story is that of a famous German pop singer, Nadja Bernaissa who was arrested recently.

On April 11 2009, Nadja was arrested in Frankfurt, Germany shortly before she was due to give a solo performance, on the allegation of criminal transmission of HIV. Later appearing in the court the presiding judge ruled to have her remanded in custody on the ground that she could repeat the offence. The public prosecutor said the singer was being held because of the ‘urgent suspicion that the accused had unprotected sexual intercourse with three people in the years 2004 and 2006 without telling them beforehand that she was HIV positive’. She could face up to 10 years in prison under German law if found guilty.

This case is not a peculiar one. Couple of months earlier a court in Victoria, Australia sent a man to prison for 18 years on the ground of intentional and reckless transmission of HIV. Michael Neal, 50, of Coburg, was found guilty by a county court jury on 15 counts, including two of rape and eight of trying to infect another person with HIV. The court heard that Neal arranged ‘conversion parties’ and had unprotected sex without revealing he had HIV. County Court judge David Parsons jailed him for 18 years and nine months saying his offending behaviour continued up until his arrest despite repeated warnings from health authorities.

In Miami, Florida a man was arrested and charged for having sex with a woman without disclosing his serostatus to his partner. Miguel Barrie, 37 was charged under Florida ‘Fla. Stat. Ann. § 384.24(2)’ law which states that ‘It is unlawful for any person who has HIV, with knowledge of such infection and having been informed that he or she may communicate it to others through sexual intercourse, to have sexual intercourse with any other person, unless the other person has been informed of the presence of HIV and has consented to the sexual intercourse’.

In Nigeria, a 29 year-old man from Umuahia, Abia State was recently sentenced to two years in prison for rape and indecent assault charges after raping an eight year-old girl who subsequently tested HIV-positive. Sentencing him the presiding magistrate, Kanu Onuma, observed that the offence was committed last year, while the charge was brought to the court in April 2009. This made it hard for him to sentence the accused on the ground of rape because the law is that rape charges must be brought to court not more than two months after the offence was committed. He therefore sentenced the accused not for rape but for indecent assault and further transmitting HIV to her.

Round the world same stories abound leading many countries into making it a criminal offence for knowingly, intentionally and recklessly transmitting HIV/AIDS to others. Some of these countries went an extra mile in making it very difficult for offenders to plead ignorance. In these countries, the intentional or reckless infection of a person with the virus is considered to be illegal and those found guilty can be charged with either criminal transmission of HIV/AIDS, manslaughter, murder, attempted murder or assault. Some states have enacted laws expressly to criminalize this, as in the United States, while others charge under the existing laws, as in the United Kingdom.

For over 25 years, AIDS has ravaged the lives and livelihoods of millions of people. Since the early 1980s, nearly 30 million people have died from AIDS while every effort made so far to get a cure for it has proved futile. However in the last few years a great advancement in the field of research has led to manufacturing of drugs that could enable the victims of the diseases to live healthily and as long as they could. More are still to be done because there is no cure yet.

Testing to know one’s serostatus remains the only way to know if someone is infected or not. As a result most countries have placed the responsibility of knowing their serostatus on the individual and therefore less likely to accept ignorance as a defence in the court of law. Apart from HIV/AIDS, prosecutions are also possible for the transmission of other sexually transmitted infections like hepatitis B and C.

In the United Kingdom particularly in England and Wales the law in use for prosecuting the criminal transmission of the virus is the 1861 Offences Against the Persons Act. In Scotland which has its own unique legal system charges are made under the Scottish Common Law offence of Reckless Injuring. Of course these laws do not specifically mention people living with HIV/AIDS because the virus was only discovered about 25 years ago. However recent judgements, landmark ruling and judicial interpretations especially in England and Wales are in agreement that criminal transmission of HIV/AIDS falls under the 1861 law.

Transmission generally, may fall under Sections 18, 20, 23, 24 or 47 of the Offences Against the Person Act of 1861. However, there have been several convictions for the sexual transmission of HIV in England and Wales under Section 20 of the 1861 Act which, inter alia, criminalizes the reckless inflicting of grievous bodily harm. Five of these convictions were of men accused of infecting female partners during sex (including Mohammed Dica, Kouassi Adaye, Feston Konzani, Paulo Matias: three African men, two of whom were asylum seekers and one a refugee, and a migrant from Portugal), one of a man who pleaded guilty to infecting a male partner, and one (in Wales) of a woman who pleaded guilty to infecting a male partner. Another woman, Sarah Jane Porter, was convicted of grievous bodily harm through the reckless transmission of HIV, and was sentenced to 32 months in prison. In the case of Adaye, the defendant had never received a diagnosis of being HIV-positive, but he was charged on the basis that a GP had told him he was at high risk of having HIV.

In only two of the cases were there a 'not guilty' plea, and both went to appeal. In R. v Dica, the Court of Appeal held that a person was reckless if, knowing that they were HIV-positive, he or she transmitted HIV to a person who had not been told of the infection. They acknowledged that there could be a higher standard of disclosure expected of someone in a relationship, compared with the ‘known risks’ involved in casual sex.

In R. v Konzani, the same court held that a person accused of recklessly transmitting HIV could only raise the defence of consent, including an honest belief in consent, in cases where that consent was a ‘willing’ or ‘conscious’ consent. In other words, the court distinguished between ‘willingly running the risk of transmission’ and ‘willingly consenting to the risk of transmission’. This suggests that consent will only operate as a defence-in all but the most exceptional of cases-where there has already been prior disclosure of known HIV-positive status.

Under the 1861 law, there are specifically two possible offences highlighted therein. The first is the offence of reckless transmission as outlined under Section 20 while the second is intentional transmission as outlined under section 18. Therefore the crux of the matter here is that for one to be held liable for criminal transmission of HIV/AIDS in England and Wales, the prosecutors must prove beyond reasonable doubt that there was an intention ab initio on the part of the defendant to transmit the virus intentionally and recklessly.

However since the first person in England and Wales was imprisoned for recklessly transmitting HIV/AIDS to a partner, there has not been a successful prosecution for intentional transmission and part of the reason is that in the court of law, it is often impossible to prove an intention behind any crime unless the defendant suddenly decides to provide the information. This however does not happen often. For intentional transmission to be proved it would need to be shown that the accused actually and maliciously wanted to give the other person the virus. From the nature of this offence nobody may end up being prosecuted for intentional transmission since the circumstance is not only rare but could as well be difficult to prove.

Similarly there is also a possibility of a charge of ‘attempted intentional transmission’ where even in the absence of infection someone can be convicted of trying to infect someone. Again this case has not ever been recorded within the English legal system. On the other hand a good number have been successful prosecuted for reckless transmission as noted at the outset. Under this circumstance however, the prosecutors are also expected to prove that the defendant did in fact infect the complainant, that the defendant was aware of the danger of transmission at the relevant time and that the complainant did not consent to that risk.

The requirement that the prosecutor must prove that the defendant actually infected the complainant is problematic especially in cases where the two parties involved are not faithful. Partners in an open relationship would find it absolutely difficult to prove this first requirement but for those who are faithful to each other, that could be a little easier though often very difficult too since the virus could be transmitted through other means apart from sexual transmission.

However recent advancements in HIV/AIDS studies could solve this problem through a complex scientific test known as Phylogenetic Analysis. Through this process the viruses of both the complainant and defendant are compared. If the two viruses appear to be different then this proves that there was no HIV transmission between the two parties and therefore no crime. If however they appear to be similar, it means that the HIV transmission from the accused to the complainant could possibly have taken place but it does not always prove it. It is still possible the complainant in fact transmitted HIV to the accused or that both were infected by another person or other people sharing the same type of virus.

Usually before the commencement of the court proceedings, an investigation of the past sexual contacts of both parties are ordered, to decide whether it can be proved beyond reasonable doubt that it was the accused and not someone else who infected the complainant. This could be very uncomfortable because not only will your sexual history be exposed, anyone with whom you have had sex before testing HIV positive will have to be contacted and blood samples taken to rule out the possibility that they infected you.

The process can be intrusive and distressing for both the accused and the complainant and since it could be difficult to prove that one person infected another, it may not result in a conviction. This is a very difficult situation and often difficult to prove which is why it has been rare for someone who pleads not guilty to be found guilty of this offence after all.

Besides, where the complainant can prove that he or she was infected by a partner who is HIV positive, the court would also require him or her to prove that there is also either a case of reckless transmission or intentional transmission and that he or she was forced to perform the act that led to the transmission. If the defendant did not use any form of protection during the sex that could be an advantage for the prosecutors since that could be a clear case of reckless transmission. However, a consensual protected sex may not pass as a defence before a judge if the defendant did not disclose his/her serostatus prior to the act.

The reasoning behind this is very simple. It is possible on very few occasions for someone to get HIV even when a condom is used, for example when it slips or breaks, but as long as the condom was being used with good faith in its effectiveness there is no crime. The law is not yet clear as to what to do if you have HIV and you notice that the condom has slipped or broken during sex. However the best thing to do especially for your partner and from the legal perspective is to rush to a sexual health clinic and ask for PEP (Post-exposure prophylaxis) which is a month-long course of treatment capable of halting the transmission of HIV within the first 72 hours of infection.

It is also very possible to hold a person liable for reckless transmission of HIV/AIDS even if the person is not aware he is HIV positive. Under this circumstance, the court is making a case that it is the responsibility of individuals to look after their sexual health and ensure that at all time they are aware of their serostatus since their body belongs to them. This line of argument is not far from the principle of ‘Ignoratia legis non excusiat’, which could be translated under this circumstance to mean that one’s inability to know about their sexual health or serostatus is never an excuse or a ground for leniency in the court of law. The court in this case holds the defendant culpable for being careless with his or her sexual life and as a result recklessly endangering other people’s life.

Things are much easier for the defendant if he can prove to the presiding judge that prior to the sexual act, he informed the complainant of his serostatus or doubt surrounding this. In this case the court is much likely to throw the case away in favour of the defendant since a case of either intentional or reckless transmission cannot be proved.

Friday, June 05, 2009

Nigeria And The Fiscal Threat Of Malaria

Malaria has infected humans for over 50,000 years and references to the unique periodic fevers of malaria are found throughout recorded history even as far back as 2700 BC in China. The term Malaria probably got its origin from the medieval Italian mala meaning bad and aria meaning air. The combination of the two gives us Malaria which translates to ‘bad air’ in English because by the then it was thought to be as result of bad air. Malaria is also called ague or marsh fever due to its association with swamps and marshland.

It was once common in most of Europe and North America, where it is no longer endemic, though imported cases do occur. Two hundred and twenty five children die every two and half hour in Africa as a result of it. This is not in addition to those infected but eventually killed by something else. The infection is already wrecking a huge havoc in the continent leading the experts to the conclusion that Malaria today poses a greater problem to Africa compared to Acquired Immune Deficiency Syndrome (AIDS).

Malaria causes about 250 million cases of fever and approximately one million deaths annually. The vast majority of cases occur in children under 5 years old. Pregnant women are also especially vulnerable. Despite efforts to reduce transmission and increase treatment, there has been little change. Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years. Precise statistics are unknown because many cases occur in rural areas where people do not have access to hospitals or the means to afford health care. As a consequence, the majority of cases are undocumented.

This situation underscores the place and importance of Roll Back Malaria Campaign undertaken by the World Health Organisation (WHO) and a few other organisations. Designed in 1998 and adopted at the Abuja Summit of 2000, the campaign is embarked upon annually to create further awareness on the need to adopt preventive methods and attitudes towards the disease. On April 25, 2000, heads of state and other senior representatives from 44 countries in Africa came together in Abuja to attend the first ever summit on Malaria.

Out of the world’s 300 million reported cases of Malaria, 255 million are said to be found in Africa. Malaria is more endemic in Nigeria than in any other country in Africa. About 60 million people in Nigeria experience malaria attacks twice a year while over 80 percent of the entire population are exposed to the disease.

Malaria a vector-borne disease is widely spread in tropical and subtropical regions. Each year, there are approximately 350–500 million cases of malaria which kills between one and three million people, the majority of whom are young children in Sub-Saharan Africa where ninety percent of malaria-related deaths occur. Malaria is commonly associated with poverty, but is also a cause of poverty and a major hindrance to economic development.

It is one of the most common infectious diseases and an enormous public health problem. The disease is caused by protozoan parasites of the genus Plasmodium. Five species of the plasmodium parasite can infect humans of which the most serious forms are caused by Plasmodium falciparum. Malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae causes milder disease in humans that is not generally fatal. A fifth species, Plasmodium knowlesi, causes malaria in Macaques but can also infect humans. This group of human-pathogenic Plasmodium species is usually referred to asmalaria parasites.

Usually, people get malaria from female Anopheles mosquito bite. Only female can transmit malaria, and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken, which contains microscopic malaria parasites. About one week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten. The parasites multiply within red blood cells leading to illness.

Today Malaria is a devastating scourge in Africa. According to the report of the Roll Back Malaria Summit, while 225 children in Africa die of Malaria within two and half hours, 100 die of AIDS within the same time frame. Similarly, about 2173 children under the age of five die from Malaria daily in Africa. Medical experts are unanimous that Malaria has been the major cause of death in Africa more than any other single disease, even war and famine. The World Health Organisation recently declared Mosquito as “public health enemy No. 1”. Dr. Kazeem Behbehani, Director of the Division for Control of Tropical Diseases at WHO noted that, “malaria as a single disease has a bigger impact on the world than any other thing”.

According to the African Regional Office of the WHO, in areas of high and moderate malaria transmission, the infections in pregnant women contribute to development of severe anaemia in the mother which results in an increase risk of maternal mortality.

Malaria is a drain on developing economies. Former Nigerian president, Olusegun Obasanjo noted that Africa loses between $7 billion and $12 billion to it yearly. Professor Jeffrey Sachs of the Harvard Institute of International Development seconding Obasanjo observed that the prevalence of the disease has continued to be a major cause of the underdevelopment in Africa and viewed that until Malaria was effectively tackled; macro-economic policies might continue to fail in addressing the African development crisis.

Toeing the same line of argument, the then USAID/Nigeria Acting Mission Director, Natalia Freeman observed that malaria has remained a major barrier to social and economic development. She noted that Malaria is a primary cause of natal miscarriage, stillbirth and low birth weight in most African countries and reiterated that Malaria accounts for 11 percent of all maternal mortality in Africa.

Another expert, Professor Akin Osibogun of Lagos University Teaching Hospital expressed similar view noting that “Africa would have advanced economically by as much as 32 percent over the present state” but for the scourge of Malaria. Dr. Okokon Ekanem, the President of the Malaria Society of Nigeria, concurred with him adding that about 5000 Malaria infections occur weekly in the country and this impedes the socio-economic development and well-being of the citizenry, causing untold discomfort and loss of valuable man hour.

Common symptoms of Malaria include chills and fever accompanied with fatigue, severe headache and nausea. The disease comes in stages. The first stage causes uncontrollable shivering which lasts for about one to two hours. This is followed by the second stage which is rapid spike in temperature and can be as high as 106F and would last for between three and six hours with an intensive sweat. The symptoms maybe repeated daily and could last for one month.

The best way to control Malaria is being aware of the risk of the disease, avoiding Mosquito bites, taking preventive medicine when one is travelling to disease-prone regions and early diagnosis as well as appropriate treatment. Sleeping in rooms with windows and doors properly screened with gauze and fumigating of the rooms are quite important and vital in avoiding Mosquito bites. The use of Mosquito nets treated with insecticide such as Pyrethrum which is a harmless substance manufactured by extracting Chrysanthemum is highly recommended.

Nevertheless, a bleak story from USAID’s Freeman is that despite the awareness of these methods, only about 10 percent of the vulnerable Nigerians use the net. However it is projected that more than that would use it if it becomes widely available. Insecticide Treated Nets (ITN) has been shown to decrease severe Malaria by 45%, reduce premature births by 42% and reduce child mortality and morbidity considerably. By consistently sleeping under an insecticide treated nets, families can protect themselves from Mosquitoes that bite at night.

Eyitayo Lambo, a professor and former Nigerian Minister for Health, noted that the net has been found to be efficacious because “it has been scientifically proven that it is one of the tools needed to roll back this disease”.

The nets reduce transmission and prevent infection and according to an evidence-based research the consistent use of Mosquito nets treated with the appropriate insecticide is effective against Malaria. In the last couple of years Roll Back Malaria partners have made concerted efforts at ensuring that Nigerians especially children under five years have access to effective treatment within 24 hours of infection.

Besides, the use of Mosquito repellent cream containing Diethyltoluamide (DEET) is also recommended as a bite-preventive measure. According to health experts, it has an excellent safety profile in adults, children and pregnant women. However, it is advised that the manufacturers’ warning be followed particularly when it is being applied on infants. Insect repellents containing over 30 percent DEET can effectively repel Mosquitoes when applied to the exposed skin. Refined Lemon Eucalyptus Oil on skin has also been found to be useful since Lemon scent was discovered to protect citrus groves from Mosquitoes.

In Nigeria, at least half the population of adults suffer from at least one episode of Malaria annually while under five years have between three and four relapses yearly. For instance the incidences of Malaria among children under five years across the six geographical zones of the country painted a gloomy picture. In the South-South, it was 32.7% while South-West, South-East, North-Central, North-East and North-West had 36.6%, 30.7%, 58.8%, 55.3% and 33.6% respectively.
Against that background, experts are worried that despite the danger posed by Malaria, it has not been able to receive adequate budgetary allocation of recent to nip it on the bud when compared to other less catastrophic diseases such as HIV and AIDS. About 85 million US dollars is globally spent a year on Malaria research which expert say is just half of the allocation to Asthma research. A recent British study reveals that $3,274 is spent on AIDS research for each fatal case, while only $65 is spent on Malaria for same case.

It was as result of this that the Roll Back Malaria was founded 1998 by the quartet of the World Health Organisation, United Nations Development Programme, United Nations Children’s Fund and the World Bank. The main objective of the programme is aimed at reducing the preponderance of the disease by half of its current statistic in few years. Various governments, civil societies and multi-nationals are in partnership with the programme including the ExxonMobil, Nigerian National Petroleum Corporation (NNPC) and the Mobil Producing Nigeria Limited (MPN). The upstream subsidiary, Mobil Producing Nigeria Limited with its joint venture partner, NNPC, initiated a robust roll back malaria programme which includes support for the allowances of medical personnel to riverside communities to encourage adequate presence of doctors in highly mosquito-infested areas in Nigeria. The NNPC/MPN joint venture has also facilitated the operation of the New Nigerian Foundation, a non-governmental organisation that is promoting community health service programmes in designated communities in Akwa Ibom and River States of Nigeria.

In line with the Roll Back Malaria campaign, the joint venture has erected educational billboards at strategic locations all over the federation to educate people on the dangers of the diseases. MPN over the years has also focused on the provision and upgrading of health facilities in hospitals, polyclinics and healthcare centres to ensure a focused fight against the scourge of Malaria. Between 2004 and 2005, ExxonMobil Corporation committed over $7 million in grants for the fight against Malaria. The grant was provided for programmes promoting research and development of new medicines specific to nine African countries including Nigeria.

In Nigeria, two non-governmental organisations Safe Blood for Africa and Medisend International received grants in support of on-going programmes aimed at ensuring diseases-free blood supply and provision of medical supplies and equipment to hospitals in the country. Part of this support was used in provision of ITNs to 12 boarding schools n Akwa Ibom State.

Lately, the Mobil Oil Nigeria PLC, the downstream subsidiary of ExxonMobil kicked-off a Malaria-prevention programme in Nigeria which is geared towards the distribution of Insecticide Treated Nets. This is in conjunction with USAID NetMark and the Lagos State Ministry of Health. It was aimed at the most vulnerable segments of the society such as pregnant women and children. With this type of response from organisations such as the ExxonMobil subsidiary companies, UN agencies and national governments, the aim of Roll Back Malaria Initiative could be achieved soonest.

However, the good news is that the World Health Organisation and the Nigerian scientists have are already on clinical trial of the new anti-malarial drug, Artemisinin-based Combination Therapy (ACT) in Damboa in Borno State. Then WHO Representative in Nigeria, Dr. Bayo Fatunmbi confirmed this and noted with joy that out of 40 countries that have adopted the ACT, 20 are in Africa and Nigeria is one of them.

Disclosing that health workers and patent medicine dealers have been trained on the management of home-based methods, Professor Lambo quoted earlier, revisited the reasons for the nation’s adoption of the ACT as the new first line drug for Malaria treatment.

“To overcome widespread resistance to Chloroquine and Sulphadoxine/Pyrimethamine, the Malaria Treatment Policy has just been revised to adopt Artemisinin Combination Therapy as the new first line drug. With assistance from the Global Fund, Roll Back Malaria partners have commenced plans to distribute the new therapy in 12 pilot states. This will be expanded to all 36 states once additional funding is received”, said the former health minister.

The workability of this is not known yet but experts are unanimous in their views that community heads and health workers in rural areas should be co-opted for it to be a success and to achieve the Abuja Declaration on Roll Back Malaria.

Saturday, May 30, 2009

Imbalance Access To Anti-Retroviral Therapy: A Shameful Medical Injustice!

Mark was four when his parents died of Acquired Immune Deficiency Syndrome (AIDS). He was forced to live with his 80-year old grandmother but things were not as easy as he thought for the grandmother was too poor to take adequate care of him. He was disappointed but that was just the beginning of the agony.

At 12 when his Human Immunodeficiency Virus (HIV) metamorphosized into AIDS, the last resort became the government hospital which became a hell he never expected. He was ostracised and dehumanised by patients and health workers. They felt very uncomfortable with him and told him that to his face. He lived in isolation broken-hearted.

Meanwhile the only life-saving drug that could keep him going is beyond his reach. He is poor and his grandmother died two years earlier. The government, the last resort in this battle cannot cope anymore with the increasing number of victims whose last resort relies on the drug. That was the last straw that broke the camel’s back. Mark died few months later, even though he could have lived as long as he wanted if the drug and care was there for him.

Mark’s case is not strange but just a fragment of what numerous others with the virus go through to prolong their life. The Anti-retroviral drugs are not there and when they are, they are beyond their reach. Poverty and poor healthcare system are the two main reasons for this injustice especially in developing worlds with the sub-Saharan Africa as the worst hit.

In Sub-Saharan Africa the anti-retroviral is still eluding vast majority of the people living with the virus. In the early 1990s when the drug became available, HIV/AIDS was transformed from a death sentence to a manageable disease but only for some. The cost of the drugs coupled with unequal distribution pattern prevented about 95 percent of those living with the virus from getting access to them.

The worldwide fury that millions were dying because of income inequality in accessing the drugs resulted in its price reduction and the 2002 foundation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through the Fund and the US President’s Emergency Program for AIDS Relief, the world saw a massive production and distribution of antiretroviral treatment in many developing countries. Since then healthcare workers have adapted to settings where people often could not access even the most basic care. At the moment millions of lives which otherwise might have been lost are being saved. Equally important, providing treatment is becoming a focal point of the efforts to prevent further spread of the disease.

Presently more than three million more people around the world are alive due to the drugs. This is a big jump from 350,000 just about five years ago. If this trend continues, by 2010 more than five million people are likely to have access to these drugs.

However we still have a long way to go before the victims who need them can access them. Presently the need is for about 10 million people, but until we can control the growth in new infections, that number will continue to grow. Africa is obviously the place this attention needs to be shifted as a result of the havoc the virus is causing there and the inability of the victims to access the drugs. Poverty remains the main reason for this. Poor health care system and corruption are other major reasons.

Six years ago at the opening of the 11th International Conference for People Living with HIV/AIDS in Uganda, Ben Plumley, Chief Executive Officer at the UNAIDS decried that it is a, “serious injustice to see that only one percent of the 4.1 million people in sub-Saharan Africa who need anti-retroviral therapy have access to it”. He charged the conference to look for ways to close this vast gap opining that they are under a moral obligation to do so and tackle the intolerance, corruption, fear and inequalities that prevents people from accessing the services they need. Sadly the situation still remains the same.

For more than 25 years, HIV/AIDS have been ravaging the lives of millions of people. Since the outbreak, nearly 30 million people have died. But over the past few years, a quiet global revolution has enabled millions infected by the virus to live healthily. However more are still to be done! For instance in Haiti with a population of 9.6 million, 115,000 people are living with the virus while only 13,586 are on anti-retroviral treatment. India has a population of about 1.13 billion with 2.5 million living with the virus while only 126,400 are on the treatment. Mali with a population of 12.2 million has 130,000 living with the virus with only 15,450 on the treatment.

In Peru with a population of 27.9 million, 10,400 are on the treatment out of 93,000 living with the virus. Russia has 31,000 on the treatment out of 940,000 living with the virus in a population of 143.2 million. In Rwanda out of 150,300 living with the virus only 44,400 are on the treatment in a population of 9.2 million. South Africa has a population of 47.4 million out of which 5.5 million are living with the virus but it is only 488,739 that are receiving the treatment. In the neighbouring Swaziland with a population of 1 million, about 20,610 are on treatment out of 220,000 living with the virus while in Vietnam with a population of 84.2 million, 132,628 are living with the virus while 14,180 receives the treatment. Nigeria with a population of 145 million has about 3.5 million infected with the virus with only 124,572 on the treatment. What happens to the rest of the population that could not be placed under this therapy? Pain, agony and sorrowful death become the only way out!

The good news is that free antiretroviral treatment is saving millions of lives today and that is enough reason to continue widening access to it. However, the main challenge is preventing new infections and confronting the injustices in accessing the drugs especially for millions in the third world. Worldwide three people are infected by HIV for every person that begins treatment. To stem the tide, we must reverse those numbers. In doing so, fear and stigma is reduced, more people will dare to be tested and it will become easier to talk openly about how it spreads and how to protect against infection.

But there are still other challenges. Even where those infected have access to antiretroviral treatment and their immune systems begin to recover, infections and illnesses they have already developed because of HIV may take their lives. Tuberculosis continues to be the leading cause of death likewise Hepatitis, liver diseases, Pneumonia and HIV-related cancer. Nonetheless Anti-retroviral treatment is generally successful. After six months on the treatment, eight out of every ten people who started are still alive.

The success in rolling out antiretroviral treatment against terrifying obstacles should inspire us to go for the test and since there is no cure yet, testing remains the only way to nip it on the bud.

Saturday, May 23, 2009

Staving Off Threats To The World’s Children

Despite the universal embrace of standards for protecting children and childhood, a new United Nations Children’s Education Fund (UNICEF) report released recently shows that more than half of the world’s children are still under the bondage of extreme deprivation owing to poverty, war and the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic.

These are “conditions that are effectively denying children the good childhood they deserve and holding back the development of nations”, says UNICEF in its 10th Annual Report on the State of the World’s Children.

The State of the World’s Children’s Report which is an annual publication by the UNICEF, records progress made globally on the improvement recorded in the area of the welfare of children. It highlights the agenda for the coming year by emphasising the critical areas that require urgent attention in order to ensure child survival, development and participation campaigns.

The report with the theme, “Children Under Threat” examines three of the most widespread and devastating factors threatening children today namely HIV/AIDS, conflict and poverty. The report is of the opinion that more than 1 billion children are denied the healthy and protected upbringing promised by the 1989 Convention on the Rights of the Child stressing that the failure by governments to live up to the Convention’s expectations causes permanent damage to children. This situation the report noted, blocks progress towards human rights and economic development.

Launching the report at the London School of Economics, the Executive Secretary of UNICEF, Carol Bellamy decried the fate of world’s children in recent times. “When half of the world’s children are growing up hungry and unhealthy, when schools have become targets and whole villages are being emptied by AIDS, we’ve failed to deliver on the promise of children. Too many governments are making informed, deliberate choices that actually hurt childhood. Poverty doesn’t come from no where, war doesn’t spread by choice of its own. These are our choices”, Bellamy said.

The report which was launched at the same time around the world also held that more than half of the world’s children are suffering extreme deprivations from poverty and lacks the simplest basic amenities that are very essential for the welfare of life and highlighted that while one in six children is severely hungry, one in seven lacks basic health care and one in five has no safe water with another one in three having no toilet or sanitation facilities at home.

The report raised an alarm on the havoc being done by HIV and AIDS pandemic on women and children and noted that the virus is not only killing parents but also destroying the protective network of adults in children’s lives. UNCIEF says that almost half a million children under the age of 15 died of AIDS in 2003 while another 630,000 were infected with HIV during same period. By 2003 some 2.1 million children under 15 were living with HIV/AIDS, most of them infected during pregnancy, birth or through breastfeeding. From 2001 to 2003, the number of children who had lost one or both parents to AIDS rose from 11.5 million to 15 million. About 80 percent of those affected live in sub-Saharan Africa.

“HIV/AIDS is tearing at the very fabric of childhood. Around 15 million children under the age of 18 had been orphaned by the pandemic by the end of 2003. Eight out of 10 of these children live in sub-Saharan Africa. Unless action is taken swiftly and decisively, to stem the tide of infections and losses, it is estimated that by 2010 over 18 million African children would have lost one or both parents to HIV/AIDS”, the report further revealed.

“The loss of a parent implies the disappearance of a care-giver. It pervades every aspect of a child’s life, their emotional well-being, physical security, mental development and overall health. It deprives them of the right to live in a family environment. Many of the ailing and dying are teachers, health workers and other adults on whom children rely. And because AIDS prevalence grows in condensed pockets, once adults start dying the overall impact on surviving children in a community is devastating”, it added.

According to the State of the World’s Children report, the proportion of women living with HIV has risen steadily that “nearly half of those who are HIV positive are women or girls. The pandemics ‘feminisation’ is most apparent in sub-Saharan Africa where close to 60 percent of those who are HIV positive are female”.

The report was of the opinion that “faced with economic hardship, women and girls become more vulnerable to prostitution and trafficking in which they have little power to negotiate safe sex” and revealed that girls are likely to succumb to the lure of transactional sex, entering into relationship with older or wealthier men in exchange for money, goods and other basic services. This transactional sex, the report said, greatly increase their risk of contracting the HIV virus even as it strongly added that the world has the capacity to reduce poverty, conflict and HIV/AIDS and improve the plight of its children.

The presentation of the report in Nigeria coincided with the World Human Rights Day and while speaking on the relevance of the day to the report, the Executive Secretary of the Economic Community of West African States (ECOWAS), Dr. Mohammed Ibn Chambas, who spoke through a representative, described children as the most valuable assets that must always come first and be put into consideration when human rights are being discussed since they are voiceless.

His words, “We cannot celebrate human rights without taking into account the most important assets, the children. Unfortunately the right of children are not being respected world-wide especially in Africa and West Africa in particular”.

The ECOWAS boss, made a passionate call to the Governments of the sub-region to take a closer look at the Convention on the Rights of Child opining that development begins with the children. His view echoes that of the UNICEF report which affirms that the world has an unparalled opportunity to fulfil the rights of the children in terms of “resource, knowledge, money, technology, strategies and people are available in abundance”.

Bellamy put it in unambiguous phrase, “the quality of a child’s life depends on decisions made everyday in households, communities and in the halls of government”.

In Nigeria, the situation has constantly been one of woe for children particularly in the rural settlements. The Nigerian child has continued to suffer child labour, negligence, trafficking, brutality, sexual exploitation and many other vices from the adult folk. People are not even aware of the paedophiles and we do not have sex offenders register. A recent attempt to persuade a part of the country to stop early marriage of the girl-child was met with a very stiff opposition with a holy book as a reference. Apart from the concerted efforts of some non-governmental organisations, little has been seen beyond the lip service from the government.

The Minister of Women Affairs, Obong Rita Akpan, had while launching the report given an assurance that her ministry has put in place measures to implement some of the provisions of the report. She promised that the measures would include a child advocacy campaign and would be well circulated to all stakeholders.
“I am optimistic that at the end of the day the report will bring better living conditions for our children”, she promised.

Meanwhile President Olusegun Obasanjo had in a recent special presidential media chat with four members of the Nigerian Children’s Parliament, assured that his administration would do all within its power to see that children’s rights are always protected opining that “you are very important to us and you are the future leaders of this nation. We therefore cannot take your welfare for granted otherwise we will suffer for our negligence tomorrow”.

The presidential promise has a ringing tone akin to that of a rain in a desert. While the rest of the worlds are busy backing up their words with action, Nigeria is still fiddling and promising while its children are burning. Against this backdrop of endless promises and inaction, the UNICEF boss warned, “If we fail to secure childhood, we will fail to reach our larger, global goals for human and economic development. It’s that simple”.

Bellamy’s warning echoes that of the United Nations Secretary-General, Kofi Annan, “Much as we move closer to realising the rights of all children, will countries move closer to their goals of development and peace”.

Friday, May 22, 2009

WHO And A Quest For A Disease-Free World

The World Health Assembly, the supreme decision-making organ of the World Health Organisation (WHO) concluded its 58th session recently. More than 2,200 people from WHO’s 192 member states, non-governmental organisations and other observers attended the meeting. A controversy over the participation of Taiwan in the Assembly nearly marred it. For the umpteenth time, apparently on the direction of China, a permanent veto-enjoying member of the United Nations Security Council, Taiwan was refused an observer status.

China had in a submission made to the Assembly objected to the acceptance of the request of Taiwan to be given an observer status, claiming that Taiwan is not a sovereign entity but an indivisible part of the mainland China. The Assembly under the presidency of Elena Salgado, the Minister of Health and Consumer Affairs of Spain, after a long and careful deliberations on the health condition of the region which once threatened the whole world with SARS epidemic, politely voted to reject China’s request.

The commencement speeches at the opening ceremony highlighted the Assembly’s passion to see in no distant future a disease-free world. WHO Director-General, Dr. Lee Jong-Wook, encouraged delegates to determine the best ways to bring available health solutions to everyone who needs them while the president of the Republic of Maldives and guest speaker of the Assembly, Maumoon Abdul Gayoom, spoke on the recent devastation caused by the tsunami and the continuing efforts to reconstruct homes, communities and lives.

Bill Gates, billionaire owner of the Microsoft and co-founder of the Bill & Melinda Gates Foundation, addressing the Assembly in person for the first time announced an additional donation of $250 million towards solving some of the world’s health problems especially in Africa and developing countries. The Money brings to $450 million the amount Gates has committed to his Grand Challenges in Global Health Programme project created few years ago. Grand Challenges in Global Health Programme project is a sort of competition intended to entice the world’s foremost scientists, researchers and inventors into finding groundbreaking solutions to health problems.

Ann Veneman, the Executive Director of UNICEF, while stressing the importance of child survival in a world where almost 11 million children die before their fifth birthday eulogised the naming of the Vienna Philharmonic Orchestra as WHO goodwill ambassador.

A landmark achievement of the Assembly was the adoption of the revised International Health Regulations which govern national and international response to disease outbreaks. “This is a major step forward for international health. These new regulations recognise that diseases do not respect boundaries. They are urgently needed to help limit the threats to public health”, said Jong-Wook.

The revision of the International Health Regulations has been under way for several years. The original one agreed to in 1969 was designed to help monitor and control five serious infectious diseases viz Cholera, Yellow fever, Smallpox, Relapsing fever and Typhus. The new one will govern a broader range of public health emergencies of international concern including emerging diseases like Swine flu. The purpose of the International Health Regulations is to ensure the maximum protection of people against the international spread of diseases while minimising interference with world travel and trade. It includes a list of diseases such as Smallpox, Polio and SARS whose occurrence must be notified to WHO and also a matrix for countries to decide whether other incidents constitute public health events of international concern.

Also a new global partnership aimed at improving public health decision-making, through better health information was approved and adopted by the Assembly. Tagged, “The Health Metrics Network” (HMN), the partnership comprising of countries, multilateral and bilateral development agencies, foundations, global health initiatives and technical experts will increase the availability and use of timely reliable health information by catalysing the funding and development of core health information systems in developing countries.

“Today despite the efforts of many countries, regional and global partners, there are significant gaps in the health information that is available to policy makers and health practitioners. In some areas of the world, even basic facts such as a person’s birth, death and cause of death are not recorded”, said Jong-Wook.

The Health Metrics Network will work to close this gap by helping countries improve their ability to gather this vital health information”, he added.

Another major highlight was the approval of the proposed programme budget for 2006-2007, which includes a four percent increase in the Regular Budget and the establishment of the World Blood Donor Day as an official annual event to be celebrated every June 14. The Assembly in adopting the date noted that it reached the agreement in order to raise awareness and promote voluntary blood donation globally. The theme for the first edition is “Celebrating Your Gift Of Blood” and will highlight true stories of people whose lives have been changed by blood.

The day will be celebrated across the globe with one city representing the fulcrum of activities. London the capital of the United Kingdom was chosen for the first edition remembrance as a result of what the Assembly described as ‘capital of a country, which has a solid tradition of collection of safe blood supplies by relying on voluntary unpaid donation’. The day will provide the global community the opportunity to raise awareness on the need for blood and blood donors. Over 80 million units of blood are donated every year around the world but only 39 percent is collected in developing countries where 82 percent of the global population live.

A reliable supply of safe blood is essential for scaling up health at several levels particularly for women and children. For instance, more than half a million women worldwide die every year from complications related to pregnancy and child birth, 99 percent of them in developing countries. Haemorrhage, accounting for 25 percent of the complications is the most common cause of maternal deaths. Up to 70 percent of all blood transfusions in Africa are given to children with severe anaemia due to malaria, which accounts for about one in five of all childhood deaths in Africa.

Reviewing progress made so far in Polio eradication, the Assembly identified what needs to be done to interrupt the final chains of wild-type Poliovirus transmission world-wide by the end of the year. According to WHO six countries are hot spots for the virus in the world and they include India, Pakistan, Afghanistan, Egypt, Niger and Nigeria. They have to be tackled. Of all these, Niger and Nigeria have the highest rate. Nigeria is actually leading.

On the issue of HIV/AIDS, the Assembly welcomed the progress made so far in scaling-up treatment and care within a co-ordinated and comprehensive response even as it underlined the urgency of Smallpox vaccine reserves and research on the Smallpox virus. Nigeria with more than 3.7 million people living with HIV and AIDS still has an unenviable record of being the third highest nation with HIV and AIDS victims in the world after South Africa and India.

Similarly the 58th Assembly also addressed the issue of increasing cases of multi-drug resistant Tuberculosis and worsening morbidity and mortality among HIV-positive Tuberculosis patients by adopting a resolution on sustaining financing for Tuberculosis prevention and control. The resolution called on member states to set up collaboration between TB and HIV programmes and to integrate the prevention and control of TB in the mainstream of their health development plans.

Recognising that too many people suffer and die in crises and disasters as a result of untreated and often preventable health problems, the World Health Assembly adopted another resolution on health action in crisis and disasters with particular emphasis on the earthquakes and tsunamis of December 26, 2004. The resolution called on WHO to provide early warning of disease outbreaks, improve access to clean water and sanitation and increase the availability of health care for people’s physical and mental health even as it urged member states to formulate disaster preparedness plans and pay more attention to gender-based violence as an increasing concern during crises.

To address the more than one million preventable deaths caused by malaria each year, the Assembly agreed on a resolution to step up efforts to fight the disease. “Malaria remains the infectious diseases that takes more lives of children in Africa than any other, three times as many as HIV infection”, said Ann Veneman, the Executive Director of UNICEF.

According to a recent WHO report, in 2003, some 350 to 500 million people worldwide became ill with malaria, a slight revision of the estimate of 300 to 500 million annual cases that WHO has used since 2000. Against that backdrop the Assembly called on WHO to intensify its collaboration with member states to reach internationally agreed malaria control goals, including the possibility of WHO undertaking bulk purchase of insecticide-treated nets, anti-malarial medicines and vitamin A supplements when people are immunised.

Responding to the rising level of cancer worldwide, the World Health Assembly agreed to promote a cancer prevention and control strategies for all member states. “It is the second leading cause of death. More than 20 million people are living with cancer and seven million people die annually. The incidence of cancer is on the rise in both developing and developed countries as a result of increased exposure to cancer risk factors such as tobacco use, unhealthy diet, physical inactivity as well as some infections and carcinogens. A rapidly ageing population in many countries is also a contributing factor”, the Assembly noted and therefore called for an improved cancer prevention measures, better early detection and treatment and increased palliative care.

On the much-hyped Millennium Development Goals, the Assembly adopted a resolution on “Accelerating the achievement of the internationally-agreed health-related goals including those contained in the Millennium Declaration”, urging developed countries to make efforts to scale-up official development aid to 0.7 percent of gross national product and called on African countries to fulfil the commitment made at the African Summit in Abuja 2001 to allocate 15 percent of their national budgets to health.

Infant and young child nutrition was also discussed leading the Assembly to adopt a resolution calling on member states to continue to protect, promote and support exclusive breastfeeding for the first six months of a baby’s life as a global public health recommendation. Member states were urged to inform health care workers, parents and other care givers on the best practices for preparation, use and handling of powdered infant formula in order to minimise health hazards even as it warned them to be cautious of the fact that powdered infant formula may contain pathogenic micro-organisms and therefore should be prepared and used appropriately.

The 58th Assembly also deliberated passionately on the hydra-headed issue of the international migration of health personnel, particularly highly trained and skilled health personnel moving from developing to developed countries. Against this backdrop a resolution was adopted requesting the WHO Director-General to strengthen WHO’s programme on human resources for health. It was unanimously agreed that the issue of development of human resources for health would be the theme of the 2006 World health Report and World Health Day 2006 and would also be a key area of work in WHO’s General Programme of Work for the period 2006-2015.

The Assembly noted that the countries from which these health personnel are emigrating from have already started experiencing a drain in their health sector and raised an alarm that if nothing is done to halt the trend, it would not only hinder the countries’ quest to achieve the Millennium Development Goals (MDGs), but also increase drastically their disease burden.

WHO had earlier noted that Africa which has 25 percent of the global burden of disease boasts a meagre global health workforce of 1.3 percent. About 23,000 qualified academic professionals emigrate annually to Europe and America in search of the proverbial Golden Fleece. Nigeria has the highest rate of international migration of health personnel in Africa. Newly registered doctors declined from 1,750 in the year 2000 to 800 in 2002, a 60 percent reduction. By 2002, Nigeria had a nurse population ration of 1:20,700 compared with the WHO recommendations of 1:1000.

A resolution on disability was also approved by the Assembly which is aimed at substantially improving the lives of some 600 million people living with disabilities. It also gave a substantial time to the issue of Iodine Deficiency Disorder (IDD) which is a leading cause of brain damage in childhood and therefore called for renewed efforts to eradicate the problem in member states with a higher incidence of iodine deficiency. A lack of iodine intake during pregnancy and early childhood results in impaired cognitive and motor development in young children. The solution to IDD is simple and cost-effective as iodine can easily be added to table salt.

Though iodised salt intake is essential for healthy growth and development, the excess intake of the substance is also a major contributory factor to the increasing incidence of high blood pressure while low intake could result in goitre and low Intelligent Quotient (IQ) especially in growing children and other similar diseases like cretinism (reduced growth), dry skin, constipation, still births and miscarriages.

Friday, May 15, 2009

In Search Of Agenda For Youth Empowerment

Nigeria born world-acclaimed computer guru, Philip Emegwali, once gave a lead on the danger of not laying a solid foundation for the nation’s teeming population of youths. In his famous speech on brain drain he raised a poser: “How do we reverse the brain drain?”

Giving the background to the issue, he observed: “We came to the United States on student visa and then changed our status to become permanent citizens. Our new citizenship status helped us sponsor relatives and inspired our friends to immigrate here. What few realise is that Africans who immigrate to the United States contribute 40 times more wealth to the American than to the African economy. Furthermore, because a significant percentage of African doctors and nurses practice in the US hospitals, we can reasonably conclude that African medical schools are de facto serving the American people not Africans”.

He made a suggestion: “I believe those with skills should be encouraged and rewarded to stay, work and raise their families in Africa. The best African musicians live in France. The top African writers live in the United States or Britain. The soccer superstars live in Europe. It will be impossible to achieve a renaissance without the contributions of the talented”.

The dilemma facing the Nigerian youths in an attempt to heed Emegwali’s advice formed the fulcrum of a discussion at a recent programme in Kaduna, Kaduna State, Nigeria. Participants at the national youth parley organised by the British Council examined this issue and took government to task on the need for a sustainable action plan for this critical sector of the nation’s population.

Steven Kidds, one of the forum participants and the national chairperson of the Scottish Youth Parliament, for instance, could not see the reason why Nigerian cannot usefully tap the potentials of its teeming and resourceful youths.

“This is the first time am coming to Nigeria. When I was coming, I heard a lot of horrible things about Nigeria which are supposed to dissuade one from coming. But here I am today. In fact, Nigeria is blessed with a good number of talented youths. But I think the problem is that Nigeria as a nation has no blueprint on youth empowerment and inclusion in governance”, he said as a matter of fact.

His view was re-enacted by Dr. Osisioma Nwolisa a professor in the Political Science Department of the University of Ibadan. He reeled off: “He who wishes to walk on a cold ground must first pour water on the ground. The youth (of a nation) are regarded as the leaders of tomorrow. Leadership is a sacred function, which is quite different from rulership, headship or command; and therefore requires proper and adequate education, training and orientation. In serious societies that plan their lives and progress far ahead of time, the youths are given proper, adequate and functional socialisation, training, education and orientation to equip them.

“Unfortunately in Nigeria, nobody cares about the youths and the tomorrow they are to lead. Since independence in 1960, youths when gathered for a function are told that they are the leaders of tomorrow but that tomorrow has never been allowed to come and they are not being prepared for that leadership”.

Flustered by what they see as a truism in Nwolisa’s assertion, the participants in a twelve-point communiqué demanded that: “there should be a considerable and consistent youth representation in the decision-making bodies in the country. Policies should be geared towards building the capacity of youths to participate in government through the acquisition of information and communication technology skills, conflict management and cultural exchange programme to enhance the quality of their participation in decision-making processes”.

They also said, “That the 1999 constitution of the Federal Republic of Nigeria currently in use needs to be amended with specific reference to the reduction of the age limit of qualification for election and appointment into political offices to correspond with the voting age. Also copies of the constitution should be simplified and translated into various indigenous languages and made readily available to all youths both in formal educational institutions and in the informal sector”.

As they put it, there is nothing wrong in empowering the youths and including them in the helms of affairs of a nation which will eventually fall on them tomorrow. It is because of this that any serious minded nation does not joke with the interest and future of its youth. This is with due respect to the often-repeated cliché that the youths of today are the leaders of tomorrow. The orientation they receive today is exactly what will help them tomorrow to pilot the affairs of the nation as elders for if the youths fail then tomorrow is not assured.

Kidds said the 300 member Scottish Youth Parliament is a body of youth representatives from the provinces of Scotland recognised by the law and the government with the task of developing and enhancing the welfare of the youths. They also look into issues that affect them and how best to solve them in order to give them a bright future. A case of young people talking to young people.

According to Kidds, “we want to be different. We want to make the views of young people heard by those people who should be listening to us, but we want to do it in a thoroughly innovative way. We recognised that traditional models don’t always work and it is our belief that young people should be able to make a difference in a way that suits them. We think it is possible to make the whole process interesting and exciting”.

The idea of a youth parliament is still very foreign to African nations and Nigeria in particular. They can do this by taking their future into their hands. The need for them to form a very strong national pressure group cannot be overemphasised. Our future is in our hands. Nigerian youths thrive in thuggery, violence and the likes apparently because of their poverty, unemployment and selfish motives of some unscrupulous politicians.

In the words of Osisioma: “In Nigeria, the youths are not just neglected but are also being wasted in several ways despite the presence of the National Youth Service Corps programme and several ministries of youth and culture. The most outstanding way of youth’s wastage in Nigeria is the absence of a programme to generate millions of jobs annually. As a result, millions of youths are not productively engaged to increase national wealth and thus are forced to become parasites on the society”.

This has a negative effect on the thinking of present day youths and even on the nation. One of the effects is the problem of brain drain among young talents who leave the shores of Nigeria to look for the Golden Fleece in America and Europe.

Against this background one of the young participants, Yemi Asaju, raised a poser: “What is the need for me to stay in Nigeria to contribute towards it when the nation is not ready to appreciate my contributions. Moreover if the government cannot make a sacrifice to train me, why would I make a sacrifice to contribute to the government?”
But the simple truth is that even as these youths have a head flowing with dreams, visions and ambitions, the Nigerian government in particular has got no blueprint to tap them, the forum stated.

Yusuf Pam, Attorney-General and Commissioner of Justice in Plateau State of Nigeria while addressing the forum said, “As young people, a comprehensive knowledge of your rights is vital to your development and positive contribution to the improvement of our societal norms and values in future. You are the future of Nigeria and its hope for stability and prosperity. You must educate yourselves in these matters and take full advantage of the benefits of a forum such as this. Sharpen your leadership skills, dedicate yourselves to the service of your country and strive to serve to the best of your ability”.

On the contributions youths can make towards national growth and development, Dr. Imman Abdulrahman of the Centre for Conflict Management and Peace Studies of the University of Jos opined that the youths have a formidable role to play in the area of ensuring an everlasting peace in the nation. In his words, “when we talk of peace and national development, youths assume a central position along this continuum. This explains the axiom ‘youths are the leaders of tomorrow’ because it is to them that the baton of governance, administration and leadership shall be released tomorrow. The onus of leadership and continuity in any society rests squarely on the youth. They possess the agility and the intellect that can be tapped to make a positive development and a remarkable change in the different sectors of the national life.

“But for them to become a responsible entity in the society will require their maximum utilisation via gainful employment. This in the long run will prevent youth restiveness and youth engagement in violent conflicts, armed conflicts and unnecessary soldiering that have now become the vogue of our time. Let it be made clear that Nigeria has no secured tomorrow without well prepared youths to lead that tomorrow in global competition in this era of globalisation”.

Is there a solution in sight? “We must stop the wastage of our youths and come out at levels of government with well-prepared programmes for our youth development based on a well-articulated national youths development and empowerment policy. This should be backed up with a well planned and adequately funded educational system. Finally for this country to know, feel and enjoy domestic security, the Federal Government should call a meeting of all states and local governments along with itself and the private sector on how to generate two million jobs annually for the next five years”, advised Osisioma.

Talk of acknowledgement of the fact that something drastic needs to be done to appropriately shape Nigerian youths for meaningful adulthood and everyone concurs. But what exactly needs to be done and how to do it remains the Herculean task.