Removing the Barriers to Pandemic Control in Nigeria

Pandemics are threats that still exist even with advances in medicine and technology. The closeness of the Ebola epicentre poses another risk. This country remembers too well the toll the last Ebola outbreak took on her people and health system. The relief of its successful control is tempered by the realization that it takes just an infected person and poor surveillance at ports of entry to be in the position we were in 2014.

On a wider scale, the current COVID19 outbreak has nations around the world grappling with overwhelmed health systems, a deluge of cases and deaths. It is a race against an ever-mutating virus to employ a variety of ways to protect citizens and prevent further spread of the SARSCov2 (the virus causing COVID19). This, unlike Lassa and Ebola, is transmitted via droplets and contaminated surfaces. The spread of all three can be curtailed by effective risk communication, early reporting, isolation and treatment of identified cases, personal protective measures like handwashing and debunking of dangerous myths.

There are many factors preventing the ordinary Nigerian from fully protecting himself from pandemics. Among these are widespread poverty, lack of education, poor awareness about the spread of infectious diseases, insecurity and poor health-seeking behaviour.

Busy Street in Lagos, Nigeria. (Credit: Unsplash)

Perhaps the overarching challenge many Nigerian communities face is that of infrastructure. Irregular power supply often means lack of running water. This greatly reduces the number of times people practice handwashing. When members of a household have to go long distances in search of clean water, it is inevitable that they will minimize the use of this for hand hygiene. Many communities also lack a health centre with qualified health workers who disseminate information and conduct house-to-house checks to ensure hygiene is observed. In addition, many markets and slaughterhouses are poorly designed and so infectious waste is left lying around and may even contaminate fresh produce. Many do not have adequate bathroom facilities and thus hands used to handle faecal matter are also used to touch food for sale. Improved level of facilities will surely help in this area. However, community-owned interventions could be used temporarily to bridge this gap by alternate sources of power and clean water supply, provision of containers at strategic places with soap for regular handwashing.

Handwashing is a crucial part of infection control. (Credit: Unsplash)

Many areas are cut off from communication channels. They may thus rely only on radio services to keep abreast of information regarding a new epidemic. This gap unfortunately leaves room for fake news and rumours to spread. There may also be panic and prejudice which in turn help the epidemic to spread faster. Initiatives like call centres such as that used by EpidAlert during the 2014 outbreak have been shown to provide much-needed information for communities. This equips them to take appropriate measures to protect themselves and their families. It also debunks dangerous myths, quells rumours and reduces panic and stigma often found among the uneducated public.

Every Nigerian deserves to feel safe enough in their communities to play a board game like these two men. (Credit: Canva)

Poverty is a major barrier to good health. The reduced spending power of individuals in a society without adequate welfare plans for its citizens puts them at a disadvantage. This is because, they have to prioritize their spending on perceived basic necessities like food and shelter. The global toll of the coronavirus on world economy is a further worsens the situation. This often leaves little or nothing to cover the cost of personal hygiene in soap, personal provision of water, face masks, accessing care and information, balanced diet and comfortable accommodation that is not overcrowded. This category of people are usually left on their own and this portends doom for us all. Thus, welfare packages should be considered to help them. They are also more likely to live in overcrowded slums which make it impossible for them to keep safe distance from one another. This borders on political will in providing adequate housing and jobs. But on the organizational level, packs containing hygiene products, free outreaches and community awareness programs are to be employed to include them in prevention efforts.

Another problem which exposes people to risk during pandemics is insecurity as seen in many communities during the lockdown. Entire lives are upturned, socio-economic strata are levelled and the priority is more on safety than healthcare. The insurgency in the northern part of the country has for years deterred efforts in healthcare provision. People fleeing conflict often leave property behind, are forced to stay in cramped displaced person camps where rates of infection are higher as a result of a strain on the few facilities available. Community-led vigilante efforts often employ methods like burning tires which pose grave risk to health manifesting down the line in respiratory disease and even death. Handwashing and other protective measures take low precedence in their daily lives with overcrowded quarters, loss of access to credible information and the general feeling of despondency further putting them at risk. Attacks on health workers, disruption of transportation and essential services keep the people affected away from accessing healthcare services. In this regard, the responsibility lies with the security agencies to intensify efforts at securing lives and property of citizens. Internally displaced persons camps must also be included in epidemic control strategy.

For many communities, harmful cultural practices and beliefs hold sway over proven medical information on disease spread. It is not uncommon to find handwashing and other forms of hygiene to be greeted with scorn, with the few who try to practice this being discouraged. In addition, women and children are often not included in health seeking decisions and are thus at the mercy of male and older relatives. Female children are not given an education making them less likely to practice safe health practices. In some cases, the male head of household has to grant permission before medical care can be sought. Where he is unwilling and unavailable, this leads to a huge gap in care. This causes a situation where some individuals know the right thing to do but are not able to practice it. Some cultural practices around gatherings, greetings of physical touch, handling babies and so on to be a source of infection spread. Community health workers need to be deployed to these areas with adequate sensitization and involvement of the decision makers to illustrate why it is important for these practices need to be changed.

These and other barriers must be taken care of to make pandemic control efforts become more effective. Thus collaboration is required across board to ensure that the country contains this virus.

References

  1. https://www.who.int/emergencies/diseases/managing-epidemics-interactive.pdf
  2. Parveen, S., Nasreen, S., Allen, J.V. et al. Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health 18, 483 (2018). https://doi.org/10.1186/s12889-018-5365-1

Written by

Dr Mariam Toye

Editor, OumissaInspire

Clean Water and Land

I used to really enjoy car rides over the different bridges linking Lagos mainland to the island. Looking at the vast expanse that adults said led to Benin, Togo ; even London and America of water calmed and amazed me. The purity, the endless grey that met the sky somewhere beyond where my eyes could see kept me in awe. That was back when most products were packed in glass bottles or paper and other recyclable materials. My more recent trips over the bridge and moreso to a couple of beaches have wiped that pristine view of my childhood. Plastic bottles, product nylon wrappers and all sort of debris now litter our waterways. The beaches are slightly better off as they employ cleaners to constantly rake the dirt that settle there. Tourists get the short end of the stick as this dampens their experience and of course they have to pay for this increased cost of maintenance. All hope isn’t lost however as good natured Nigerians- keen on being the change and not sitting on the fence complaining- have come up with ways to tackle the massive pollution if our environment. Kids4Clean Seas Foundation and The Nigerian Child Initiative, two NGOs have been organizing beach cleaning exercises. And of course encouraging the young ones to imbibe a good attitude towards our environment. It is really concerted and consistent efforts no matter how little that make the greatest effect. Join them tomorrow at the Kids Beach Garden tomorrow January 27th at 7am to do your part towards making a difference and of course Sustainable Development Goals 14 and 15. If like me,you didn’t know all of them before, now is a good time to check them all out and find out how you can make them achievable. -Oumissa 11.50pm 26 January 2018 Lagos, Nigeria

Run in Someone’s Veins

What would our world be like if we all donated blood instead of shedding it? If we all decided to help our fellow human instead of hurting them? How will it be if we all did our best to save a life instead of devaluing or taking it?

We are inundated by the second with reports of mindless ways in which men, women and children like us are being killed, maimed or otherwise damaged for life. It thus gladdens the heart when we find concerted efforts to save lives. We realize that while some choose to destroy, others preserve life- the sanctity of which can not be fully expressed.

Blood is very essential in saving lives as science has still not found a complete substitute for it. It is used in the treatment of many who are sick, involved in car crashes, wars and other conditions that lead to life-threatening blood loss. A single pint of blood (half a litre/50cl) can save more than one person.

How would you like to run in someone’s veins? How would you like to be part of someone’s good health for life? Your blood cells multiplying exponentially and contributing to their vitality?

According to studies published in the American Journal of Epidemiology, blood donors are 88% less likely to suffer a heart attack and 33% less likely to suffer any type of cardiovascular event.

When you come around today to give blood, you will receive a life saver certificate with which you can receive blood whenever you need it. You also get to know your hepatitis status,blood group,genotype and HIV status(optional)

If you reside in Lagos or its surrounding suburbs, please try and make it to the blood donation exercise today Wednesday, the 26th of August, 2015 at
•New Great Hall, Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos.
•New Hall, University of Lagos, Akoka, Yaba, Lagos.

Be a part of West Africa’s single largest blood donation exercise. Be a lifesaver.

#YouAreSomebody’sType

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This Blood Donation exercise is part of the Annual Islam Propagation Week, a ten-day programme organized by the Muslim Students’ Society of Nigeria, CMUL/LUTH branch. (College of Medicine of the University of Lagos/Lagos University Teaching Hospital) in conjunction with the Haematology Department of the Lagos University Teaching Hospital.

Proudly Nigerian

Right now it may not be so fresh to be a Nigerian.

From the Boko Haram-induced insecurity to the grinding poverty and all that is in between, many Nigerians simply wish they had been born in some other country. But the truth is no one can propel Nigeria to greatness apart from her people.Our current situation will not change until we stop complaining and begin to hope for a better Nigeria. Even though I’m rushing this piece before PHCN  withholds the gift of light and my internet connection is more of turbulent flow than laminar, I still stand tall and say to the world,

“I’M PROUD TO BE NIGERIAN!!!!!”