Combating the spread of diphtheria

Nigeria is afflicted on many fronts, battling endlessly with several scourges and outbreaks because of poor health infrastructure, insufficient investment in healthcare, inaccessibility of quality health services and a stagnating health workforce.

Amidst the debilitating deadly annual outbreaks of Lassa fever, cholera; an ongoing war against a global pandemic caused by the Coronavirus disease, a deadly outbreak of diphtheria is also on the loose.

Diphtheria, according to the Nigeria Centre for Disease, is a highly contagious infectious disease caused by a bacterium Corynebacterium diphtheriae, which makes a toxin. It is the toxin that can cause people to get very sick.

The infection affects the nose, throat, and sometimes, the skin of an individual. Diphtheria is fatal in five to 10 per cent of cases, with a higher mortality rate in young children.

According to the NCDC, the diphtheria bacteria spread from person to person, usually through respiratory droplets, like from coughing or sneezing.
People can also get sick from touching infected clothes, objects, or open sores. People who are at increased risk of contracting diphtheria are children and adults who have not received any or a single dose of the pentavalent vaccine (a diphtheria toxoid-containing vaccine).

Others at risk are people who live in a crowded environment, people who live in areas with poor sanitation, healthcare workers, and others who are exposed to suspected or confirmed cases of diphtheria.

Recently, Nigeria reported an outbreak of the disease from Kano State. The Kano State Commissioner for Health, Aminu Tsanyawa, who confirmed the outbreak of the deadly diphtheria disease, which was reported to have killed no fewer than 25 persons in the state, noted that the state rapid response team had been reactivated and had set in motion an action plan to check the spread of the deadly disease there.

It is instructive to note that one of the most effective ways to prevent the spread of diphtheria is through vaccination. So far, the NCDC says 34 people have been killed.

According to reports, despite the benefits of childhood immunisation, routine vaccination coverage for all, the recommended Expanded Programme on Immunisation on vaccines has remained poor in Africa. Nigeria, Africa’s most populous country, was on 31 per cent as of 2018; Ethiopia (43 per cent, 2019), Uganda (55 per cent, 2016) and Ghana (57 per cent, 2014).

Regrettably, vaccine-preventable diseases are still the most common causes of childhood mortality in the world, with an estimated three million deaths annually, mainly in Africa and Asia.

According to a study entitled, ‘Factors influencing childhood immunisation uptake in Africa: a systematic review’ and published in the journal, BMC Public Health, an estimated 29 per cent deaths among children aged zero to 59 months were due to vaccine-preventable diseases. For Nigeria to combat diphtheria and other infectious diseases, the health authorities need to do more to increase the rate of vaccination in the country.

In addition to vaccination, it is essential to raise awareness about the symptoms and transmission of diphtheria. This includes educating people on how to recognise the early signs of the disease, such as sore throat, fever, and difficulty in swallowing, as well as how to prevent its spread by practising good hygiene and avoiding close contact with infected individuals.

Furthermore, it is important to strengthen the country’s surveillance and response systems to quickly identify and contain outbreaks. This includes providing adequate resources and training for healthcare workers, and establishing effective communication channels between health authorities and the public.

The task is made more challenging because of the prevalence of extreme poverty, as Nigeria is the global capital with 133 million living in multidimensional poverty.

Additionally, Nigeria, with a population of 216 million, has a doctor-to-patient ratio of 1:5,000 versus the recommended 1:600 by the World Health Organisation. This adds greatly to health risks in Nigeria. In 2022, the Nigerian Medical Association noted that the country needed “about 303,333 medical doctors now, and at least 10,605 new doctors annually to bridge the manpower gap in the health sector.”

While the country languishes, oil-rich Qatar leads the way globally with 77.4 physicians per 10,000 people, followed by Monaco (71.7), Cuba (67.2), Greece (54), and Spain (49.5). In the United Kingdom where the President, Major-General Muhammadu Buhari (retd.), frequently goes on medical vacation, over 328,000 medical practitioners are employed, reflecting an overall increase from 2010 when there were 227,000, says Statista.

Despite the Abuja Declaration of 2001 which mandated African Union member countries to allocate 15 to 20 percent of their annual budgets to the health sector, the Federal Government continues to allocate meagre resources to the sector.

For the average Nigerian, the challenges are many. Without a viable health insurance scheme, many Nigerians struggle to pay for health services. The World Bank estimates that Nigeria has one of the highest out-of-pocket expenditure rates on health, at 70.52 per cent.

This places it in the category of countries infamous for poor human rights, civil unrest, and gross abuse of resources such as Turkmenistan, Myanmar, Equatorial Guinea and Bangladesh. African countries which score better than Nigeria include the Gambia (23.19 per cent), Kenya (34.30 per cent), Uganda (38.26 percent) and Ghana (36.22 per cent).

The Minister of Health, Osagie Ehanire, had recently pledged to strengthen the Primary Health Care system. The Buhari regime should deliver on this promise. The state governments should build and revive more hospitals in their domains. LGs should accord priority to efficient primary health centres. The three tiers should stock adequate supplies of vaccines. Religious leaders should sensitise their followers on the need to get children immunised.

Nigeria can no longer fold its arms and watch feebly as vaccine-preventable diseases kill its population, notably infants. The vaccine innovation did not come from its medical researchers despite the country’s embarrassing global status of childhood disease burden and the concerned authorities must be up and doing in pragmatic research to tackle diverse diseases in the country.

Efforts must be made to block areas in the vaccine supply and administration chain, which criminal-minded and greedy Nigerians often exploit for selfish ends. In the past, many of the donated insecticide-treated mosquito nets were diverted by corrupt public officials for sale.

Individuals and groups should take responsibility for their health. Families should maintain a high level of hygiene around the home and in the environment.

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