Entrapped by a rash of bad governance and economic vicissitudes, Africa faces a daunting challenge in the health sector, with an impending outbreak of a deadly mix of diseases. A prognostication by the independent international medical humanitarian organisation, Medicins Sans Frontiers, warned of the likely return of the deadly Ebola Virus Disease, which recently ravaged a quartet of West African countries, namely Guinea, Liberia, Sierra Leone and Nigeria, leaving in its trail an estimated 11,315 deaths and a litany of social and economic woes.
Other infections that could reach epidemic proportions in Africa and other developing countries before the end of the year, as predicted by MSF, are Dengue Fever, Kala Azar and Zika Virus, which is spreading like wild-fire, especially in South America. The United States Centres for Disease Prevention and Control has already placed travel restrictions on 32 of the countries affected by Zika, as part of control measures. This calls for immediate preemptive measures by other countries, Nigeria inclusive, to ensure that they are not taken unawares.
“Cholera, malaria, measles and meningitis epidemics will also take place this year in a dimension that we have never seen before. They will incapacitate and kill many if nothing is done,” Monica Lull, MSF’s Operational Health Adviser, told a World Health Organisation meeting in Geneva last month. To complete the scary prediction, she said, “We know that thousands of lives will be at risk with the outbreaks. But we also know that the means to prevent these diseases exist.”
This is indeed frightening for Nigeria and other developing countries, with characteristically very weak health care infrastructure. It is however heartening that the situation is not completely hopeless. Lull’s warning carried a caveat, “if nothing is done.” It also emphasised the fact that the “means to prevent these diseases exist.” It therefore goes without saying that if the right steps are taken, the impending disaster could be averted. This warning was definitely not heeded in Lagos State where 25 children have reportedly died of measles at Otodo Gbame community of Eti-Osa Local Government Area of the state.
While countries with sound health care system can easily deal with preventable diseases, such as cholera, malaria and other communicable diseases, in Africa and other developing countries with weak health care infrastructure, they become multiple killers. This was the case with the last outbreak of Ebola.
When West Africa suffered the most deadly outbreak of Ebola in history between December 2013 and late 2015, the disease was able to spread freely and rapidly because of the absence of robust health care facilities. In some of the affected countries, emergency health centres had to be created, while a shortage of bed spaces forced the sick to sleep on the bare floor. The situation was so bad that, in rare cases, sick people were turned back when the facilities could no longer cope.
A BBC report, quoting Afri-Dev.Info, claimed that Liberia, which was the worst hit with 4,809 deaths, had just 51 medical doctors, 978 nurses and midwives, as well as 269 pharmacists to serve a population of 4.2 million. Sierra Leone, which lost 3,955 of its citizens, fared only slightly better. With a population of six million, the country had 136 doctors, 1,017 nurses and midwives and 114 pharmacists. Nigeria was able to get away with just eight fatalities because of the edge she had over the other countries in terms of health personnel and facilities, and the creative response of the Lagos State Government.
While diseases like malaria, cholera, measles and meningitis have always been around, causing many deaths yearly, Zika and Kala Azar offer a different challenge entirely. Globalisation has made it possible for diseases hitherto restricted to certain regions to easily spread to other places. For instance, WHO says dengue fever, caused by a virus that has no cure, is gradually announcing its presence in strange places, including Europe. Also, Zika virus, said to be hitherto domiciled in Uganda, has now invaded the Americas.
What is needed in Nigeria is an upgrade in medical facilities, as well as an enlightenment campaign by the government on measures to prevent the spread of these diseases or to manage them in places where they occur. For instance, since Zika — strongly linked to birth defects (microcephaly) — malaria parasites and dengue virus are all mosquito-borne organisms, it makes sense to target the destruction of mosquitoes and curb their transmission through bites. Apart from attacking mosquitoes with insecticides, they should also be denied breeding opportunities in places such as ponds, stagnant water, marshes and wetlands where they can easily lay eggs and multiply. Like Brazil, we can use gamma rays to target and eliminate mosquitoes.
Cholera, an acute diarrhoeal infection capable of killing in hours, can be controlled through personal hygiene and elimination of open defecation. Flies perching on an infected faecal discharge or vomit could spread the infection. In severe cases where patients become dehydrated, lost fluid could be replaced through oral rehydration therapy while medical intervention is being sought.
Measles, though preventable through vaccination, is described by WHO as one of the leading causes of death among young children globally, killing 114,900 in 2014, down from 2.6 million before widespread vaccination that began in the 1980s.
Meningitis, an inflammation of the membrane surrounding the brain and the spinal cord, is a serious health problem in the northern part of the country. Caused either by virus or bacteria, it is common in a stretch of sub-Saharan Africa starting from Senegal and stretching to Ethiopia. According to the US CDC, fatality rate could be up to 70 per cent if urgent medical intervention is not sought. But the best approach is prevention, through vaccination.
For Nigeria’s health authorities, this is the time to put in place measures to check these diseases. Thankfully, Nigeria was able to deal with Ebola even though she did not prepare for it. But if early warnings had been heeded, perhaps the outbreak would have been prevented altogether. If handled right, some of these diseases can even be eliminated outright. That is what Nigeria should be aiming at.
