On Thursday June 4, Nigeria’s Federal Ministry of Health released, for the first time, comprehensive data on the national distribution of two major neglected tropical diseases (NTDs) — schistosomiasis and intestinal worms. This new information, gathered by the government of Nigeria and a network of partners, found that across 19 states and the Federal Capital Territory (FCT) approximately 24 million Nigerians were at risk for schistosomiasis and 21 million were at risk for intestinal worms. Children between the ages of 5 10 had the highest prevalence of infection. The results also showed that men were more likely than females to have one of the diseases.
Nigeria is said to have the highest burden of NTDs in sub-Saharan Africa. While the government and NGO partners have already taken several steps to address the burden of disease, comprehensive epidemiological mapping had not been available until recently. Moving forward, the data gathered from this mapping project will aid the Federal Ministry of Health in planning effective intervention measures for both schistosomiasis and intestinal worms.
People infected with NTDs like schistosomiasis and intestinal worms are often unable to work or attend school – resulting in an endless cycle of economic hardship. Treating these diseases is critical to reducing poverty and boosting economic prosperity. Given the strong association between NTDs and economic development, NTD control and elimination should be considered an important factor in achieving the Sustainable Development Goals (SDGs) in Nigeria. Nigeria’s quest to be one of the 20 major economic players globally by 2020 as captured in it Vision 20: 2020 will depend on a healthy and productive society that does not neglect the less fortunate.
The prevalence mapping survey was completed by analyzing 50 55 children from five randomly selected schools in the 19 states and FCT. The Task Force for Global Health which uses smart phones for data collection and cloud based data reporting and management.
The results showed an overall prevalence rate of 9.5 percent for schistosomiasis and 27 percent for intestinal worms.
The data gathered from the mapping survey will enable Nigeria to receive the appropriate amount of donated medicines to treat schistosomiasis and intestinal worms, so that they can deliver the medicine to where it is most needed. In addition to providing actionable data, the mapping project helped build and improve the capacity of health workers across Nigeria for the country’s NTD programme. The project also fostered a platform for cross-sector learning and skills sharing, which ultimately improved programme coordination.
Moving forward, the Federal Ministry of Health has recommended that all levels of government (Federal, State and LGAs), NTD partners and other stakeholders — with the cooperation of the communities — scale up uninterrupted provision and administration of appropriate medicines alongside other environmental improvement interventions such as clean water and sanitation provisions. Plans should also be put in place for impact assessment after the third year of consistent Mass Administration of Medicines.
While there is much work to be done, the successful completion of epidemiological mapping for schistosomiasis and intestinal worms is a promising sign. Armed with this information, Nigeria can strategically and effectively scale up their efforts to control and eliminate these debilitating diseases for a more prosperous Nigeria. Nigeria’s new government, led by President Buhari, should take advantage of this cost effective and relatively simple intervention in order to make a tremendous impact on the country’s most vulnerable populations.
Photos provided by Nigerias Federal Ministry of Health.
My interest in health issues naturally started very early in life when I had made up my mind that I was going to study medicine. The story has it that I took an uncle’s stethoscope from his clinic when I was 7 or 8 years old and refused to return it, while insisting that I was going to be a doctor. I don’t quite recall that incident, but I do know that the central focus of my life has been to manage the sick. I co-founded the first on-campus HIV/AIDS outreach programme at a Nigerian university as a medical student in Jos, and my encounter later with public health issues among internally displaced persons camps in Liberia finally swayed me towards population medicine.
2. What is your role as Global Network’s National Neglected Tropical Disease (NTD) Advisor in Nigeria?
As the Global Network’s NTD advisor in Nigeria, I advocate for increased government commitments to the fight against NTDs. I work closely with NTD partners to support the government through evidence-based advocacy to sustain and incrementally grow federal and other tiers of governments’ political and funding commitments in order to expand NTD treatment access and coverage. I do this by demonstrating that NTDs should be a priority for the federal and select state governments in Nigeria. My role as Global Network’s National NTD Advisor is to also foster the establishment of policies and/or mechanisms towards sustainable NTD programing in all of Nigeria. I will also work with partners to provide technical support to the National NTD Steering Committee in order to enhance its capability for advocacy.
3. In your view, what are the biggest challenges standing in the way of Nigeria’s efforts to control and eliminate NTDs?
The major challenges in Nigeria’s efforts to control NTDs has largely been around funding; over dependency on donor interventions and inconsistent funding by government counterparts. As much as we situate the critical funding gap for NTDs with state governments, an often overlooked significant funding gap also exists within the local governments, which ordinarily should be major implementers of primary health care and third tier government partner for the NTD programmes in Nigeria. The second issue is the lack of community –based manpower to implement the NTD programme.
4. Does Media (social media, print and others) play a role in the fight against NTDs? How can we leverage this tool to effect change?
Media does play a major role in the fight against NTDs. Because NTDs remain ‘neglected’ in policy, programme, and perception, the power of media to effectively communicate and give the NTD programme a voice is critical to moving the issue further away from public neglect to the front burner of policy. Media has a great function within any public health system, whether in Nigeria or elsewhere. It is worth noting that new media such as social media has enhanced communication and knowledge management for health, as it has bridged the gap between persons, establishments and systems, and has deepened potential for targeted and non-targeted messaging with the potential to boost public health communication of all kinds.
To leverage these tools we have to begin to understand the data on utilization of the media forms and social media adoption in policy, programme and perception management for public health outcomes. The good part is there has been marked public health interest lately in this domain. NTDs can leverage the lessons learned from other programmes in order to move forward.
5. Why is Nigeria a focus when it comes to NTD control and elimination?
Let’s play back to 2014; Nigeria received its Guinea Worm Eradication Certificate from the World Health Organisation — an achievement that made headlines. In the same year, Nigeria managed to free itself from the Ebola Virus Disease pandemic that ravaged several African countries, and the world heaved a sigh of relief. Even though Ebola is not one of the NTDs, it further emphasized the potential of good stewardship, financing and sheer determination at the frontlines.
Nigeria’s success is critical to the fight against NTDs because Nigeria holds the highest NTD burden in sub-Saharan Africa. Nigeria’s NTD burden reduction will have a significant impact on the global burden of NTDs, considering that for some time now, Nigeria has been regularly ranked in the top 10 nations with the highest NTD burden. Now we have the opportunity to reduce the NTD burden through sustainable funding and effective implementation of programmes.
Dr. Ohanyido is the Global Network’s National NTD Advisor in Nigeria. Stationed in Abuja, he works with national NTD partners to strengthen stakeholders’ advocacy efforts for Nigeria’s NTD programme. Over the last 15 years, Ohanyido has worked with diverse international organizations like UNHCR, UNICEF, and WHO across Africa, as well as various USAID projects in Nigeria. He has also served as an Advisor to the Senate Committee on Health in Nigeria. Recently, he served as the National Pneumonia Coordinator in Nigeria, in collaboration with USAID and UNICEF.
He has a medical degree from University of Jos, and postgraduate trainings in diverse areas such as public health, information communications technology and management. He is a fellow of both the Royal Society for Public Health (UK) and the Royal Society for Tropical Medicine & Hygiene (UK), and Senior Fellow of the Academy of Learning Nigeria. He is a martial artist, poet and strong advocate for African Renaissance.
All seven of the most common neglected tropical diseases (NTDs) are found in Nigeria. With an estimated 100 million people at risk for at least one NTD, Nigeria has the highest burden in Africa.
While Nigeria has a multi-year plan to control or eliminate the seven most common NTDs by 2020 –additional resources are still needed to reach all communities at risk of contracting NTDs.
To support Nigeria’s NTD efforts, the END7 campaign donated $84,000 towards MITOSATH, a Nigerian nonprofit organization that works to control and eliminate NTDs within the country. Specifically, END7 funds supported MITOSATH’s efforts in Bauchi State.
Thanks to the generosity of END7 supporters, more than 2,500 school teachers, community drug distributors and health facility staff members were trained on how to carry out a mass drug administration (MDA). END7 funds also supported MITOSATH’s efforts to increase awareness among community members about NTDs.
In total, these combined efforts ensured the treatment of more than 740,000 people in three Local Government Areas (LGAs) within Bauchi state. Even more, 9,000 of these were school children who were treated for schistosomiasis and intestinal worms for the first time, signaling another step towards NTD control and elimination!
The following guest blog post from Benjamin Nwobi, resident program advisor for RTI International and the ENVISION project in Nigeria, and Sunday Isiyaku, country director for Sightsavers in Nigeria and lead for the UNITED Project, details a new alliance aimed at strengthening Nigeria’s Neglected Tropical Disease (NTD) program and maximizing the impact of resources directed at NTD control and elimination.
If we are to succeed in reaching the World Health Organization (WHO) NTD control and elimination targets for 2020, we must focus on Nigeria – a country with one of the highest NTD burdens in the world. We therefore commend the government of Nigeria for making NTDs a priority and working with partners to implement the national integrated NTD control and elimination plans. Such efforts have contributed to the eradication of guinea worm and will surely contribute to efforts such as the Saving One Million Lives Initiative.
It has been one hundred years since Nigeria’s independence and while much has changed through substantial development and investments, Nigeria’s rating against the World Health Organization’s (WHO) Health-Indicators still lags; maternal and child morbidity and mortality remain high and quality and affordable health services are either lacking or not readily accessible, especially for the 70 percent of Nigerians living on less than $2 a day.
It is not surprising then that Nigeria carries one of the highest burdens of neglected tropical diseases (NTDs). These communicable diseases are inextricably linked with poverty and are prevalent in areas with poor sanitation, inadequate safe water supply and substandard housing conditions. In late March 2014, Nigeria and its partners celebrated the country receiving the WHO certification for officially eradicating Guinea worm disease. Nigeria had been the most endemic country in the world for guinea worm with over 800,000 cases documented. Scale-up efforts are now underway to achieve control and elimination of other high prevalence NTDs such as onchocerciasis, soil transmitted helminths (STH), schistosomiasis, trachoma and lymphatic filariasis (LF) by the year 2020.
An enormous task
An undertaking so ambitious requires unprecedented partnership and coordination. Nigeria is a federated country consisting of 36 states and 774 local government areas and each level of government plays a specific role in fighting NTDs. Implementing a national NTD programme that can effectively wipe out these diseases is an enormous task.
An estimated 31 million people are currently at risk for onchocerciasis across 32 states of the country. Though prevalence mapping is still underway, Nigeria is ranked third highest in the world for LF, with 63 million persons at risk, and is estimated to have one of the highest STH burdens in Africa. Trachoma is the second major cause of avoidable blindness in the northern part of Nigeria. Ongoing mapping efforts will provide more information on exactly which areas require treatment.
As Dr. Bridget Okoeguale, Director of Public Health at Nigeria’s Federal Ministry of Health so aptly expressed, “We must work as a team or we cannot go anywhere.”
This is why USAID’s Sightsavers, are establishing a new working order to donor-driven support for the national NTD programme in Nigeria an alliance, aimed at exploiting synergies, eliminating duplication of efforts and maximizing impact of resources directed at NTD control and elimination.
With ENVISION working primarily in central and southern Nigeria and UNITED in northern Nigeria, the alliance helps the national program to maintain consistency and promote standardization of approaches across the various states, supporting not only the integrity of programming but also management functions such as drug logistics and data reporting, playing off the respective strengths of the partner organisations.
Maximizing reach and impact
Teams from ENVISION and UNITED support many of the same core programme areas in the states where they work; activities like mass drug administration and community education and sensitization. But each project also brings additional areas of support, not necessarily provided by the other project. Forming this alliance has allowed more geographic reach for this expertise than could be achieved otherwise.
RTI International has introduced a new planning tool, the NTD Tool for Integrated Planning and Costing (TIPAC) across the country, and this is now being used nationwide to improve planning and costing. RTI has also worked with the WHO to develop an integrated NTD database platform that will allow the country to store, manage, analyze and report NTD data more effectively across all states.
Sightsavers has been focusing on improving supply chain management for commodities such as drugs in its project states. The national-level component of this project supports clearing of all NTD drugs to the national Drug Storage. Again, in this case, all other states benefit from strengthened supply chain capacity and are therefore able to maximize output. They have also developed behaviour change tools and strategies that will be applied across Nigeria.
The synergies that have resulted from this close alliance bring unique benefits to Nigeria’s national NTD programme and its ability to advance towards its elimination timeline, especially when coupled with the comparative advantages for implementation achieved through the coalition of organisations working across the nation.
As we enter another century in Nigeria’s history as a country, we are hopeful that this alliance will continue to be one of the critical pillars in supporting the Nigerian Government in reducing the NTD burden. Together we will see how, when a country is committed and aid organisations and international governments synchronize and combine their efforts, ambitious goals can be achieved and the lives of Nigerians improved forever.