Name of Student: Nwabughiogu Innocent Ugochukwu
Programme: Masters in Public Health (MPH)
Project Title: Impact of Infectious Diseases on the Nigerian Public Health
Year/Month of Study: March, 2015
ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
CVD Cardio Vascular Disease
NDHS National Demographic Health Survey
DNDI Drug for Neglected Diseases Initiative
NACA National Agency for the Control of AIDS
FAO Food and Agriculture Organi¬zation
NBS National Bureau of Statistics
GAVI Global Alliance for Vaccines and Immunization
FMH Federal Ministry of Health
GEM Gender Empowerment Measure
GFFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
HDI Human Development Index
HHVI Human Hookworm Vaccine initiative
HIV Human Immunodeficiency Virus
HPI Human Poverty Index
MDGs Millennium Development Goals
MMV Medicines for Malaria Ventures
ND Neglected Disease
SARS Severe Acute Respiratory Syndrome
STD Sexually Transmitted Disease
UNAIDS United Nations AIDS
UNDP United Nations Development Program
WHO World Health Organization
YLD Years Lived with Disability
YLL Years of Life Lost
GEM Gender Empowerment Measure
FIND Foundation for Innovative New Diagnostics
FEPA Federal Environmental Protection Agency
ARV Antiretroviral drugs
DALY Disability Adjusted Life Years
CDC Centre for Disease control
GDI Gender-related Development Index
Abstract
In spite of the achievements of vaccination programs for polio, childhood diseases and other diseases like HIV/AIDS, malaria, tuberculosis, acute respiratory infections and diarrheal disease are causing high mortality rates in Nigeria. The burden of diseases also comprises of health impact measured by disabilities, deformities, loss of productivity, care and treatment caused by a variety of diseases like lymphatic filariasis, schistosomiasis etc. The impact of infectious diseases can be traced according to economic performance of Nigerian states showing that 20 out of 36 states are classified as low- income economies. The burden of disease in Nigeria is further devastating since it affects all components of human development including income, health and education.
The impact of infectious diseases in Nigerian states has presented a challenge to many sectors. Beyond health issues, these diseases should globally be seen as a development concern affecting education, income and social status, productivity and economic growth and other direct and indirect components of human development such as gender equality and human rights.
Public-private partner¬ships and global harmony are needed to tackle the health problems of shortage and lack of treatments, resistance and the need for new drugs, vaccines and diagnostic procedures.
Certain infectious diseases mainly vector-borne infections have either been increased, rare or entirely absent in most high income countries during the last ten decades. Important shifts in political and economic values have led to a shift in resources for infectious disease control particularly in low and middle – income states in Nigeria in particular and the world at large. The potential capacity to detect and report disease outbreaks has quickened due to the advent of global information and communication systems.
Introduction
Infectious diseases is among the major causes of mortality in Nigeria. Diseases like HIV/AIDS, cholera, tuberculosis, malaria, hepatitis etc. are threatening and also causing suffering and mortality to many Nigerians. The burden of disease expressed in terms of socio-economic costs such as productivity losses, care and treatment, hospitalization and handicap is enormous in Nigeria. The global burden of disease is measured in terms of Disability Adjusted Life Years (DALYs) which is a combination of Years of Life Lost (YLL) through premature death, and Years Lived with Disability (YLD). Based on level of development, countries are economically classified into two groups as developed and devel¬oping countries. At some point, a third group is identified as least developed countries. Using the per capita income, the World Bank has introduced four levels of income namely: high-income, higher-middle-income, lower-middle-income and lower income (World Bank, 2003). Considering a broader definition of development that supplement income by other components like levels of health and education, the United Nations have developed five main composite indices to measure the average achieve¬ments in basic human development i.e. human development index (HDI), gender-related development index (GDI), human poverty indices (HPI-1 and HPI-2) and the gender empowerment measure (GEM). HDI is the most used index giving a summary measure of human development. HDI is a three dimensional composite index obtained as a mean of three indicators weighed equally: health (life expec¬tancy at birth), standard of living (GDP per capita) and education (literacy and enrolment) (UNDP, 2006).
The impact of infectious diseases will be considered on the development of Nigeria displaying that beyond health issues, diseases must be seen as a development concern affecting education and knowledge acquisition, income and social status, productivity and economic growth and other sectors of human development.
Cases of certain infectious diseases like vector-borne infections have been increased, rare or entirely absent in most high income countries during the last 100 years (Murray & Lopez, 1996). Important shifts in political and economic values have led to a shift in resources for infectious disease control particularly in low and middle – income countries (Lee, 2003). Diseases know no bounds, they spread, multiply and mutate, taking advantage of every opportunity to flourish. This led to outbreaks that have consequences as we saw with the emergence of EBOLA, Severe acute respiratory Syndrome (SARS). EBOLA and SARS quickly spread death and human sorrow among Nigerians. It also led to economic disaster. Business suffered as a result of fear and uncertainty. There were other epidemics such as Lassa fever, cholera outbreaks and others. These diseases are posing serious threat to Nigerians, pregnant mothers, children and unborn babies. Of little regards to public health then were zoonotic diseases which are still being regarded as one of the neglected diseases especially in the tropics because they affect the poorest of the poor and can be referred to as global threat and enemy.
OBJECTIVE
The impact of infectious diseases on the public health of Nigerians are dominated by death, disability, hardship, diseases and epidemics that interrupts people’s livelihoods, alter planned use of resources, interfere with economic activities and reduce development.
In the pursuance of reducing the impacts of infectious diseases on Nigeria public health, the government of Nigeria formulated a public health policy which cut across health sector to address and control effects of infectious diseases. The Nigerian public health aims at reducing the negative impact of infectious diseases and strengthening of health establishments, affiliations and enhancing the health and development process by limiting the potential disasters this may bring. The Federal Ministry of Health (FMH), Centre for Disease control (CDC) and Federal Environmental Protection Agency (FEPA) were actively involved in policy framework at all levels. When infectious diseases impacted negative in the country, the poor and socially disadvantaged suffers most.
Table of Contents
ACRONYNS…………………………………………………………………………1-
ABSTRACT……………………………………………………………………………2-
0. INTRODUCTION…………………………………………………………………3
0.1. OBJECTIVE………………………………………………………………….3-
I. SECTORIAL IMPACT…………………………………………………….….
1.1. Impact on Health…………………………………………
1.2. Impact on Economy………………………………………
1.3. Impact on Education……………………………………………………
1.4. Global Impact on Economy and Human Development………………..
II. MATERIALS AND METHODS…………………………………………….16-17
V. RESULTS………………………………………………………………………17-19
VI. DISCUSSION…………………………………………………………19-20
VII. CONCLUSION………………………………………………………….20-21
VIII. RECOMMENDATION………………………………………………………..21-22
VIII. REFERENCES………………………………………………………………….22-24
Impact on Health
In Nigeria, HIV/AIDS, diarrhea, respiratory diseases, malaria, tuberculosis and other infectious diseases are directly affecting health and demographic indicators such as mortality rates, life expectancy, sex and age distributions. Large number of healthy Nigerians are cut off from population due to infectious diseases. In Nigeria, women live longer than men with their life expectancy rising from 47 years in 1990 to 55 years in 2012 while the men life expectancy rose from 45 years in 1990 to 53 years in 2012. From 1995-2000, 38 African countries had a mean life expectancy of 47 years representing tens of years of loss attributable to infectious diseases globally.
Life expectancy declined by 12.1 years during the period 1995-2000 mostly affected by HIV/AIDS. Infant mortality are ruining Nigeria (1.0). The impact of infectious diseases on health affects individuals, households, communities and the entire nation. In Nigeria, HIV/AIDS and other infectious diseases are mobilizing more than half of all hospital beds.
The first two cases of HIV and AIDS in Nigeria were identified in 1985. At first the Nigerian government was slow to respond to the increasing rates of HIV transmission and it was only in 1991 that the Federal Ministry of Health made their first attempt to assess the situation with HIV and AIDS in Nigeria. The results showed that around 1.8 percent of the population of Nigeria were infected with HIV. Subsequent surveillance reports revealed that during the 1990s, HIV prevalence rose from 3.8 percent in 1993 to 5.4 percent in 1999 and 5.8 percent in 2001, HIV prevalence then declined steadily throughout the decade. When antiretroviral drugs (ARVs) were introduced in Nigeria in the early 1990s, they were only available to those who paid for them. As the cost of the drugs was very high at this time and the overwhelming majority of Nigerians were living on less than $2 a day, only the wealthy minority were able to afford the treatment.
In some states, 30%-50% of hospital admissions, about 50% of out-patient visits are due to malaria which is also responsible for more than 25% of hospital deaths and many Nigerian states have lost a large part of their healthcare workforce due to AIDS, malaria and other infectious diseases. In other countries, midwives and health workers are affected by infectious diseases (UN, 2004).
The National Bureau of Statistics (NBS) in a recent report stated that most deaths in the country were disease-related. From the diseases identified in the report, HIV/AIDS accounted for much of the deaths. But the National Agency for the Control of AIDS (NACA) insists Nigeria is winning the war against HIV/AIDS.
The National Bureau of Statistics (NBS), in its recent report entitled ‘Statistical Report on Women and Men in Nigeria’, identified malaria, pneumonia, tuberculosis, diarrhea, hepatitis B and measles and some others as among the killer diseases in the country. From the diseases mentioned in the report, HIV/AIDS accounted for the highest proportion of infected females (63.5 percent) as against 36.5 percent reported for males in the referenced period (2010-2013). It resulted in 59.3 percent of documented female deaths and 40.7 percent male deaths in Nigeria between 2010 and 2013. Malaria, a second killer disease according to the report, accounted for 53.4 percent female patients and 46.6 percent male patients within the same period. In Nigeria, an estimated 300,000 children die of malaria each year. This accounts for over 25 percent of infant mortality (children under the age of one), 30 percent of childhood mortality (children under five), and 11 percent of maternal mortality. According to the National Demographic Health Survey (NDHS) 2008, about 50 percent of the population has at least one episode of malaria annually while children aged less than 5 years have 2 to 4 attacks annually. Malaria is particularly severe among pregnant women and children under 5 years of age due to their relatively lower levels of immunity. Malaria in pregnancy compromises the health of the woman and that of the unborn child. It causes negative pregnancy outcomes like stillbirth, spontaneous abortion etc. The national coordinator, National Malaria Elimination Programme, Dr Nnenna Ezeigwe, said before 2010, the prevalence of malaria in the country used to be more than 50 percent, in fact as high as maybe 75 percent, but from when the Roll Back Malaria initiative started and a lot of resources and commitment went into the fight, there has been a gradual reduction in prevalence.
Impact on Economy
According to 2010 National estimate percentage of people falling below poverty line, the Nigeria population is below poverty line of about 70%. Over 100 million people have inadequate or no access to life-saving treatments. More than 80% of these deprived people are living in developing states where infectious diseases constitute serious impediments to economic development by reducing productivity, setting aside saving possibilities and slowing economic growth in general. In many Nigerian states, majority of public health expenditure is a consequence of infectious diseases. This is a case in rural areas with limited access to preventive and curative health facilities, malaria can have devastating consequences on agricultural households by a simple occurrence that coincides with a plantation or harvest season. It is estimated that malaria costs Nigeria over 132 billion naira annually, slowing its economic growth by 1.3% annually. Contrary to the majority of diseases, HIV/AIDS kills and disables adults in the best productive part of their lives, affecting business, investment, industry and agricul¬tural sustainability. Nigerian agricultural labor force is particularly affected.
More globally, infectious diseases are reducing families’ income and slowing economic growth as indicated by the recent report released by the World Bank on tuberculosis control, showing that besides deaths, tuberculosis costs more than US$3.3 billion annually in lost productivity though important economic benefit is at hand.
At present, it is difficult to estimate precisely the real economic impact that infectious diseases are having in Nigeria. Many studies have attempted to evaluate the disease burden case by case or country by country. In the case of HIV/AIDS, the cost was estimated to be between 11.7 and 35.1% of the GNP in Africa.
Impact on Education
Education is very important for human develop¬ment and needs to be improved in Nigerian states. Unluckily, malaria, tuberculosis, HIV/AIDS and infectious diseases are reversing the trend towards the achievement of universal primary education i.e. MDGs goal one in most Nigerian states. In Nigeria, less than 70% of children are enrolled in primary school mostly the northern part of the country and thousands of enrolled children will prematurely leave school under the pressure of infectious diseases, including orphans, disabled, impoverished and those who withdraw to look after ill members of their families. (Table 3). From 1999-2004, orphaned children represented 12.3% of all children under age 18 and the percentage of child labour reached 41% in Nigeria. These diseases are seen to have numerous impact on education. They affect the cognitive ability of children, the capacity of teachers, the upbringing of families and the efficiency of staff and managers.
Global Impact on Economic and Human Development
Infectious diseases are globally affecting economic and human development of Nigeria in particular and the world at large. Malaria is responsible for over 10% of Nigeria’s disease burden and the current GDP is thought to be lower than it would have been without malaria. The devastating impact of HIV/AIDS is identified in the majority of national human development reports. These reports give details of the impact of HIV and AIDS on household welfare, orphaned children, education sector, health sector, agricultural production, business and public service delivery. They also stress that HIV/AIDS and its far-reaching consequences mean that the disease is no longer a crisis only for the healthcare sector but presents a challenge to all sectors. It has the potential to reverse those gains made in human development in the last few years.
Economically, 10 Nigerian states belong to the poorest states and lower-income group, sixteen states are lower-middle-income while only ten states are classified as higher-middle-income states. According 2006 UNDP report, infectious diseases are affecting all components of human development (HD) in Nigeria in particular and world at large. Nigerian states have made little progress in preventing and controlling infectious diseases like HIV/ AIDS, malaria, tuberculosis, diarrhea, respiratory disease and many of the neglected diseases.
MATERIALS AND METHODS
Descriptive survey was used to provide descriptive investigation on the assessment of the influence of infectious diseases on the urban and rural communities in Benue State of Nigeria. The research work covered all the urban and rural communities in the twenty three (23) local government areas of Benue State. The population of the study was five thousand (5000) officers in the 1500 registered urban and communities in the 23 local government areas of Benue State. Their characteristics vary in terms of age, sex, occupation, marital status and educational qualifications. Three thousand and five hundred (3500) respondents were sampled out of the 5000 officers of the registered communities associations as sample. The sample was drawn by employing simple random sampling technique. 50 percent of the population was sample. The instrument used for data collection was a 4- point structured questionnaire. The reliability was determined by administering 70 copies of questionnaire to seventy (70) officials of urban and rural community development associations in Otukpo and igwe areas both in Benue State. The communities have similar characteristics with the study area in terms of historical and cultural backgrounds. 1500 copies of the questionnaire to the 1500 official members sampled with the assistance of 60 trained research assistants. At the end, one thousand and three hundred (1300) copies of the questionnaire were returned.
RESULTS
Table 1. Estimated and projected impact of HIV/AIDS on mortality indicators in the most affected regions in Nigeria
1995 – 2000 2010 – 2015
Life expectancy at birth (years)
Without AIDS 62.3 67.0
With AIDS 50.2 37.6
Absolute difference 12.1 29.4
Number of deaths (millions)
Without AIDS 3.0 3.0
With AIDS 5.0 10.0
Absolute difference 2.0 6.0
Infant mortality rate (per 1000)
Without AIDS 55.4 40.7
With AIDS 66.1 54.6
Absolute difference 10.2 13.9
Child mortality rate (per 1000)
Without AIDS 80.2 56.9
With AIDS 108.8 100.2
Absolute difference 28.6 43.3
Data on Table 1 above reveals the extent to which HIV/AIDS have influenced the health of urban and rural communities in Benue state.
As seen on the data, the number of deaths in million increased rapidly from 1995-2000 and 2010-2015 i.e. the death rate increases as the year increases. The life expectancy at birth (years) of people living with AIDS decreased from 50.2 to 37.6. The infant mortality rate and child mortality rate of people with AIDS was higher compared to those without AIDS from 1995-2000 with the rate of 66.1 as against 55.4 and 108.8 as against 80.2 respectively while from 2010-2015, the rate was 54.6 as against 40.7 and 100.2 as against 56.9 respectively. There is an improvement regarding the declining rate of AIDS between 1995-2000 and 2010-2015.
In Nigeria in general and in the most affected countries in particular, HIV/AIDS is seriously affecting life expectancy, rates of mortality and child mortality. If nothing is not done to reverse the trend or at least get the situation stabilized then Nigerian states will be exposed to disaster.
Table 2. Costs and Economic Benefit of HIV/AIDS in Nigerian states in billions of dollars (2006-2015).
Nigerian States Disease Status Costs Benefits Ratio
Nigeria 12.24 129.44(112.81-146.07) 11(9-12)
Nigeria High HIV+ 9.45 97.57(85.83-109.35) 10(9-12)
Nigeria Low HIV+ 2.79 31.85(26.89-36.80) 11(10-13)
High Burden Nigerian States 7.70 81.06(71.34-90.77) 11(9-12)
Data on Table 2 above shows the extent to which Nigerian states have spent on malaria and how it has affected the citizens. The sum of $12.24 was spent from 2006-2015 on states with high and low HIV+ patients at the rate of $9.45 and $2.79 respectively. The burden on the Nigerian states is $7.70, diverting the attention of Nigerian states on other areas where the money would have been properly utilized for development to fighting infectious diseases. No benefit seen yet because money spent on people with High HIV+ is still higher than the one spent on those with Low HIV+.
Nigerian states can make important economic benefits by controlling HIV through an adequate and reliable preventive strategy. The ratio between benefit and cost can be greater than 10.
Table 3. Impact of Orphanhood on school attendance among 10-14 years-olds (%)
% in school SE
5 States SW 6 States SS
6 States NE
6 States NC 6
States NW 7 States All 36 States
Non-orphan 67 75 70 48 64 63 76
Orphan 58 69 54 44 52 50 69
Double Orphan 57 58 49 40 50 49 63
Ratio Double VS Non Orphan 0.86 0.94 0.72 0.69 0.81 0.79 0.85
Data on Table 3 above shows that the orphan’s school level of attendance is poor in northern states compared to the southern states of Nigeria. The number of orphans attending school between the ages of 10-14 years are lower than non-orphans. In Nigeria, orphan children are more probably to miss school than others. Malaria is the leading cause of mortality in the under-five Nigerian children and it affects the education capacity of Nigerian states. On top of high mortality figures, diarrhea is highly affecting school attendance.
DISCUSSION
Climate change and weather contributes to infectious diseases burden in Nigeria and this occurs as a result of heavy rains giving rise to increased breeding sites for mosquito vectors and increases mosquito-borne infectious diseases. Breakdown of public health measures i.e. breakdown in vector control is instrumental to increased abundance and distribution of the mosquito vectors of dengue and spread of dengue hemorrhagic fever. Poverty and social inequality have also subjected many Nigerians in eating unhealthy foods detrimental to their health.
Nigerian nation is suffering from infectious diseases today due to lack of political will to report infectious diseases. The reasons for the deteriorating situation of infectious diseases in Nigeria are as a result of:
weaknesses in the national budget, constant policy and structural changes, weaker capacity for sustained laboratory diagnostic services, grossly inadequate private service providers, inadequate incentives for access to formal healthcare services. Health system incapacity, human behavior, inappropriate drug use relating to prescribing practices, drug use and compliance.
Main factors influencing the detection and investigation of diseases in Nigeria is due to delays in the decision-making process, lack of resources and motivation from the public health staff, the potential political or religious impact on acknowledging the epidemic. As health is generally identified as a public concern, governance is challenged by the lack of resources, the sensitivity of minorities and quick response to any emergence.
Availability of basic control measures could make a substantial contribution to the risk management but their effective implementation is also dependent on political, economic and cultural factors beyond the control of communicable disease and public health professionals.
The early detection of diseases through surveillance is critical for their cost-effective management and such surveillance helps in the evaluation of intervention measures, thereby enabling limited resources to be targeted most effectively. Surveillance for human infectious diseases in Nigeria is totally reduced by a lack of systematic surveillance networks both within local governments and states.
The availability of financial and human resources are major limitation yet, there are good surveillance networks for specific programmes such as the polio eradication programme and Nigeria government has succeeded in this and have been declared polio free in 2015 by the world health organization but there are still other areas where infectious diseases are still threatening the lives of Nigerian citizens.
Conclusion
In Nigerian states, millions of people live with less than $1 per day and most of them lack access to basic health services, safe drinking water, education etc. Few states are putting health, science, technology and innovation at the center of their strategies.
The most affected states are unable to cope with the burden of disease considering the treatment cost of these infectious diseases and the level of poverty. For health strategies to be successful in Nigeria, consolidated international and public-private partnerships are needed to tackle the menace of infectious diseases, problems of shortage and lack of treatments, resistance and the need for new drugs, vaccines and diagnostic procedures. In this direction, several programmes have already been launched such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFFATM), Global Alliance for Vaccines and Immunization (GAVI), the Drug for Neglected Diseases Initiative (DNDi), Roll back Malaria, etc.
In order to reduce the incidences of specific diseases, control the spread of epidemics and development of complications and improve the health management of human and material resources, health decision makers, non-governmental organizations (NGOs), research institutions, community groups and individuals must join their efforts.
A comprehensive infectious disease strategy that links prevention, treatment and care should be established because treatment has been the most neglected component in developing states where millions of people will die from AIDS and other diseases in the near future if they do not receive treatment. Combined efforts between donor nations and affected states will provide reasonable amount of money per year required to scale up the response against malaria in endemic areas. A recent cost-benefit analysis by WHO showed that achieving the global MDG target in water and sanitation would bring substantial economic gain in both health and other benefits. Thousands of deaths can be avoided in Nigeria and billions of dollars saved by reducing the impact of infectious diseases.
Recommendations
Government should promote capacity in science and technology
There is government need for urgent investment to repair and develop health systems
Promotion of capacity building in the health worker crises should be strengthened
Every state should develop the spirit of building information and management systems for health and using them to build capacity
Strengthening infrastructure including access to affordable diagnostics should be among state governments top priority
The center for disease control and federal ministry of health should develop an effective diagnostics and invest in training of health workers who will always work tirelessly in preventing, controlling and eradicating infectious diseases.
Availability of vaccines to all nooks and crannies of the country are potentially the most promising strategy for controlling infectious diseases in Nigeria.
Government should make early detection and treatment a fundamental strategy for the prevention of transmission of infectious diseases.
Members of the public should be educated on the need for regular medical checkup in order to prevent occurrence of a disease. This is important because, in many Nigerian states, individuals present themselves to health facilities when their illness has advanced.
The three tiers of government should take the responsibility of mass media campaign and training of traditional leaders, religious leaders, political leaders, market leaders who will go round and educate their people on keeping up to date with immunization, use of treated water, use of insecticide treated nets, hand hygiene, using condoms during sex etc.
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