Dr. Ehanire
- Nigeria Accounts for About 25% of Africa’s NTD Cases
- NTDs Flourish Mainly in Rural Areas, Conflict Zones – WHO
Kazeem Akolawole
Prior to the outbreak of COVID-19 in 2020, it was estimated that about 100 million people in Nigeria were at-risk for at least one Neglected Tropical Diseases (NTDs) and this is according to international charity organizations, Sightsavers.
However, a maiden study recently commissioned by the END Fund and conducted by Deloitte Nigeria, shows the data has increased from 100 million pre-COVID-19 period to about 165 million which represents 84 percent of the entire population with a projected population increase of 263 million by 2030
NTDs include diseases like Lymphatic Filariasis, Onchocerciasis, Schistosomiasis, Soil Transmitted Helminthes, Buruli Ulcers, Leishmaniasis, Dengue, Guinea Worm Disease, Trachoma, Leprosy, Rabies, Noma, Yaws, Mycetoma.
Also, Snakebites are included because they are also prevalent in poor communities, especially as occupational hazard to farmers and herders and Noma is being considered for inclusion since 2021.
Nigeria has the most significant NTD burden on the continent, accounting for about 25% of Africa’s NTD cases. About 165 million Nigerians currently need treatment for one or more types of NTDs, representing 84% of the entire population.
With a projected population increase of 263 million by 2030, NTDs must be effectively addressed. Nigeria is one of the most endemic countries in the world for NTDs, with an estimated 100 million people in the country at-risk for at least one NTD, according to international charity Sightsavers.
As highlighted by the World Health Organisation (WHO), NTDs flourish mainly in rural areas, in conflict zones, and in hard-to reach-regions. The diseases thrive in areas that lack quality and affordable health care services, where access to clean water and sanitation is also a big problem.
In Nigeria, according to a 2019 USAID report, only 44% of the population have good sanitation access and 39% have access to safe-to-drink water in rural areas – leaving people very vulnerable to NTDs. Meanwhile, nearly a third of Nigeria’s children don’t have adequate water supply to meet their daily needs, according to UNICEF.
According to the Senior Director, Public Affairs for Africa, The End Fund, Oyetola Oduyemi: “In 2020, there were 120 million Nigerians at risk of one or more NTDs, and the population was 202 million people.
She said: “Now, the population has grown. Also, what COVID-19 did was a significant setback because for these diseases to be effectively tackled and eliminated, we have to sustain treatment.
“Over the COVID-19 period, there were interruptions. That meant that the treatments that should have been delivered were not. For the people that would have been prevented from getting these diseases, it was just a free for all. As a result, there was a significant increase in the number of people.”
Effect of NTDs on Nigerians
NTDs have a serious impact on individuals, families, communities, and economies. For individuals, they can cause serious short and long-term harm to the health and well-being of those affected.
Nigerians living with NTDs also often face stigma, isolating them from their communities and impacting their chances to access education, employment, community services, and more. This traps individuals in a cycle of poverty.
But NTDs also enhance other existing inequities too, like gender, ethnicity, and disability, and, as a result, NTDs are most prevalent among those populations least able to access essential services, including women, children, ethnic minorities, and displaced people.
Living with NTDs also puts real strain on the families affected. Since Nigeria’s poorest communities are the most affected by NTDs, there is a high chance of the diseases pushing families even further into poverty. Why? Because these families have to spend their already low incomes to help take care of their affected loved ones, negatively impacting the economic stability of families and communities at large.
Economic Benefit from NTDs Elimination
The Deloitte Nigeria survey indicates that the Nigerian economy will reap USD 18.9 billion from its citizens’ increased productivity if NTD elimination is achieved by 2030.
A lot of effort in terms of financing and resource allocation is needed to control and ultimately eliminate NTDs in Nigeria and, in so doing, mitigate their impact on well-being, education, and productivity.
Causes of NTDs in Nigerian Communities
According to Dr. Nse Akpan, National Coordinator of Nigeria’s NTDs elimination programme, clean water, sanitation, and good hygiene practices are key to tackling NTDs, so a lack of access to these is a significant factor.
He further highlighted that a lack of consistent funding is also a major challenge particularly amid the pandemic, with funds needed to help eradicate NTDs being reallocated to tackle COVID-19 instead.
Since its founding in 2012, The END Fund, which focuses on delivering NTD treatments to those in need and mainly works in Africa, has provided over a billion treatments for NTDs – including treating 92 million people in 2020 alone. It’s further trained 3.5 million health workers, and has performed over 43,000 surgeries to treat conditions like trachoma (which can cause blindness) and lymphatic filariasis.
Victims Stigmatization
Zubairu Auwal, a 40-year old from Kabi Mangoro Village in Kuje Area Council in the Federal Capital Territory shared his experience from tropical disease.
He said: “It all started when I was a boy in still in school. My cousin used to have a tingling sensation. His parents suspected he had contracted leprosy. So they isolated him from the rest of the family and locked him up in one room”
“One day I visited them but his parents did not allow me to see him. Being ignorant of his health condition, I gained access to him by jumping through the window.
Unknown to Auwal he contracted leprosy from that encounter with his cousin. “I started having this tingling sensation in two fingers of my right hand. My parents could not explain what was wrong.
“As the symptoms persisted, my parents gave me herbal remedies, but it continued. After some time, I could no longer write so I had to stop going to school.
“When I was eventually diagnosed with leprosy it hit my parents like a ton of bricks. Their initial reaction was that it was sent to me by evil spirits.
“My mother thought I was bewitched because her sister’s son had the same issue,’’ he said.
Salisu said at the age of seven he was rejected by the society; he could no longer play with other kids, was not able to go to school, adding that any time he was hospitalised nurses would speak to him through the window.
“I have lived with the stigma for over 37 years. I have also contemplated suicide.
“Sometimes I become overly aggressive towards people, but I know I should not. I do it because I suspect they will treat me badly, so I react first’’, he said.Also, Mr Yakubu Garba, a 49-year old leper, said because of stigma and discrimination he was not treated by medical personnel. He said this resulted in him moving into a lepers’ colony to avoid further humiliation by members of the public.
“Having access to quality care is a big problem we face as lepers. We self-medicate most times. During the COVID-19 pandemic we were all told we will die. The government did not consider us in its prevention policy.
“We did not fit into their plans; we are yet to be vaccinated up till today, not even our children get the regular immunisation. We are seen as evil; as cursed people, even the health workers that come to look after our children are reluctant to come.
He said that stigma has affected their lives, leading to self-isolation and eroded their confidence.
“Addressing stigma by health workers is crucial to delivering equitable, quality care and achieving optimal health,” he said.
Public health experts consider stigma as an overriding concern of people with NTDs such as leprosy.
The National Coordinator, National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP), Dr Chukwuma Anyaike, said that stigma has a range of concepts including the internal and external.
“People affected by NTDs are frequently the target of social stigma. Not much attention had been paid to mitigating the effect of stigma on victims of NTDs.
“Stigma among health workers also undermines access to diagnosis, treatment, and successful health outcomes. When persons affected by leprosy are aware of negative perceptions by health workers, they may be hesitant to seek help,” he said.
Actions Needed for Nigeria to Tackle NTDs
The WHO has developed a global roadmap working towards eradicating NTDs by 2030. The roadmap calls for stronger accountability, intensified cross-cutting approaches, and a change in the operating model and culture – with every country affected taking full responsibility and ownership of their actions.
Based on the roadmap, the WHO has identified five key interventions to combat NTDs, including: making preventative medications widely available; targeting insects like mosquitoes and ticks, and other “vectors” that help NTDs spread; ensuring clean, safe water, sanitation and hygiene for all people; and breaking the chain of NTDs spreading from animals to humans, such as rabies.
Work Done so Far to Eliminate NTDs
According to the National Coordinator of the NTD programme at the Federal Ministry of Health, Dr. Nse Akpan called for more funding in order to interrupt the spread of NTDs and eliminate them totally by 2030.
According to him: “There has been a marked reduction in lymphatic filariasis, onchocerciasis, and for cases like trachoma, we are almost at the stage of elimination.
“We have been able to eliminate these diseases in some states. Like onchocerciasis. If you get to Nasarawa and Plateau States, you don’t have it any longer. At the moment, we have been able to interrupt the transmission of these diseases in some Local Government Areas (LGAs).
“Nigeria is so much concerned to see if we can eliminate the five NTDs that is in the country today – Soil-transmitted Helminths (STH), Schistosomiasis, trachoma, onchocerciasis, and lymphatic filariasis (elephantiasis). If we can eliminate these diseases, the WHO will be so happy with Nigeria that we have been able to go far, and of course, as we are eliminating these diseases, we are reducing disabilities and contributing to the economic growth of the nation.”
“In order to achieve these monumental gains, additional resources are required from all relevant stakeholders to achieve this, including the Federal and State Ministries of Health, multilateral and development organizations, local NGOs, businesses, community-based associations, philanthropic organizations, and the media.
“And so enjoin one and all to collaborate with us in ensuring that no one is left behind, and so that we will achieve a more economically buoyant, productive and healthier Nigeria, free from the burden of NTDs, by 2030.”
Federal Government Commitment to Eliminate NTDs
The Minister of Health, Dr Osagie Ehanire at the launch of Reviewed NTD Masterplan 2023 to 2027, said, Nigeria is particularly interested in Neglected Tropical Diseases (NTDs), because they are a group of communicable and non-communicable diseases occurring mostly in isolated areas of developing countries with poor sanitation and nutritional status, unsafe water supply, substandard living conditions and low level of education.
“Though sufferers may be many, the diseases are still “neglected” because they are almost absent from the global health agenda and are associated with stigma and social exclusion. Neglecting the population also helps perpetuate the cycle of poverty and limited access to professional opportunities”.
Ehanire however said the government shall focus on the millions of people with little or no access to prevention, treatment and care, in the roll out of the 10-year NTD road map for 2021-2030 by World Health Organization (WHO) on 28th of January 2021, proposed ambitious targets and the innovative approaches to tackle NTDs and provide blueprint and direction to global elimination.
He explained the plan is an integrated approach to deliver programmes, with emphasis on three approaches such as, moving from process to impact measuring for accountability; putting in place effective multi-sectoral approach and integration of NTDs, country ownership and political commitment for sustainability.
