Jul 8•Nzube Ekpunobi
There has been an increased focus on health improvement and system strengthening as a result of recent epidemics across the globe. However, despite the limited progress that has been made, infectious diseases still place a significant strain on Nigeria’s health system. The WHO noted that Nigeria’s health outcome indicators are still unacceptably high and that there is a significant discrepancy in health status between the various states and geographical zones, with a clear rural-urban split, in its annual report for 2021. Malaria, HIV, Tuberculosis, Cholera, Lassa Fever, Yellow Fever, Meningococcal Meningitis, and other infectious diseases continue to wreak havoc on the nation.
According to the NAIIS-2018, Nigeria has the fourth-highest HIV burden in the world with an estimated 1.8 million people living with the illness. According to the Global AIDS Monitoring – GAM 2020, 95% of these patients are currently aware of their status, 96% are receiving ART, and 89% of ART recipients have viral suppression. Additionally, malaria is still a major source of morbidity and mortality in Nigeria. According to the World Malaria Report 2021, Nigeria is responsible for 27% and 32% of the predicted global malaria cases and fatalities.
Calls for the declaration of a national health emergency by the NCDC were made in 2020 as a result of Lassa fever, which had spread to 27 States and resulted in 689 confirmed cases and 118 fatalities as of February 2020, compared to 381 confirmed cases and 83 fatalities for the same period of time in February 2019. With a cumulative total of 111,062 and 3,604 suspected cases and deaths in 2021, Nigeria also suffered one of its worst cholera epidemics.
In addition, after a period of 21 years without an outbreak, Yellow Fever returned on September 12th, 2017, in Ifelodun Local Government Area (LGA) of Kwara State, Nigeria, with an index case, a 7-year-old boy who arrived with fever, jaundice, and blood vomiting but had no history of travel or immunization. The total number of suspected cases increased to 337 at the end of the year, with a case mortality rate of 13.6% and a suspected case prevalence rate of 23.3%. Four States (Kwara, Kogi, Kano, and Zamfara) had already received confirmation at this point (Soyemi, 2021).
To combat the outbreaks and end the endemicity of these infectious diseases, many tactics have been suggested and implemented, including surveillance by active case search and entomological surveys, sample collection for laboratory testing, immunization and vaccination, and sample collection for laboratory testing. These strategies have, however, failed to address the menace caused by these diseases and there has been a continuous re-emergence.
The WHO in its 2021 annual report noted some major challenges that have hitherto been met in the bid to address the issue of infectious diseases. They include:
• Inadequate and suboptimal functionality of the WHO Recommended Rapid Diagnostic tests (e.g. GeneXpert MTB/RIF machines, limiting access to diagnosis and treatment).
• Suboptimal specimen referral system for moving specimens to sites for diagnosis.
• Deficient management capacities of available human resources at the sub-national level.
• Data Paucity for decision-making
The gap in early diagnosis continues to pose a major challenge in addressing the menace caused by these infectious diseases and thus there is a need for the creation of certified diagnostic centres across the various states to enable early detection and commence treatment. Also, there is a need for the establishment of an electronic laboratory reporting system used for all reportable conditions to transfer data to the local and/or state health department in Nigeria. This would help inform public health surveillance and can be used to help in disease prevention and the determination of control measures.
References
1. Nigeria Centre for Disease Control. Epidemiological Report.a.
2. World Health Organization. World Malaria Report. 2021
3. The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS)
4. Soyemi, T. (2021). Neglect of common infectious disease outbreaks during the COVID-19 pandemic: an impending crisis in Nigeria? African Journal of Clinical and Experimental Microbiology. 22 (2): 113-116.
