The Burden Of Infectious Diseases In Nigeria And Control Strategies

 

June 20. Anthony Olayemi.Nzube Ekpunobi.Tunde Animashaun

With a population of more than 200 million, Nigeria is known as the most populous country in Africa. Over the past few years, the country’s health sector has faced several difficulties that have exposed its strengths and weaknesses. The health sector has, however, not measured up to what is expected of a national health system in this twenty-first century due to several reasons varying from the lack of political will of the government, a heavy burden of infrastructure deterioration, to the total lack of effective policy implementation. This has resulted in a situation where the nation is handicapped when it comes to its readiness and reaction to emerging and re-emerging infectious diseases. To promote efficient infectious disease prevention, response, and control, the Federal Ministry of Health (FMoH) had earlier established the National Emergency Response and Preparedness Team. (Muhammad et al., 2019). Nevertheless, this hasn’t done much to stop the waves of these outbreaks and their catastrophic impacts on the country’s human and financial resources. Numerous infectious diseases plague Nigeria, including malaria, cholera, TB, HIV/AIDS, and emerging and re-emerging infections like Monkeypox, Lassa fever, yellow fever, Ebola and poliomyelitis still continue to impact the health system in Nigeria since the year 2000. While creating the Nigeria Center for Disease Control (NCDC) has marked a significant advancement in the country’s efforts to combat infectious disease outbreaks, (NCDC, 2020), there is still a huge gap left. The national public healthcare system’s ability to effectively prepare for and respond to infectious disease control strategies is still hampered by factors such as infrastructure development, a shortage of personnel, vector control, immunization, preventive measures, health education and awareness, surveillance, and response.

BURDEN OF INFECTIOUS DISEASES IN NIGERIA.
Nigeria bears a heavy burden of infectious diseases, with malaria standing out as one of the most prevalent and deadly. According to the World Health Organization (WHO), Nigeria accounts for a significant proportion of the global malaria burden, with an estimated 25% of malaria cases worldwide occurring in the country (WHO, 2020). The impact of malaria is particularly severe among children under five and pregnant women, contributing to high rates of morbidity and mortality. The disease is caused by Plasmodium parasites transmitted through the bites of infected Anopheles mosquitoes. Among the species causing malaria in Nigeria, Plasmodium falciparum is the most prevalent and deadliest, responsible for the majority of malaria-related deaths (WHO, 2020). The disease contributes to anaemia, low birth weight, and other complications, exacerbating existing health disparities and hindering socioeconomic progress.

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, TB can affect various parts of the body, most commonly the lungs. Nigeria ranks among the top countries globally for TB burden, with millions of new cases reported each year (WHO and Onaja, 2019).
TB is endemic in Nigeria, with transmission occurring through the inhalation of respiratory droplets containing Mycobacterium tuberculosis. The disease disproportionately affects vulnerable populations such as people living with HIV/AIDS, malnourished individuals, prisoners, and those living in overcrowded and poorly ventilated settings (NCDC, 2020).

Cholera also remains a persistent public health threat in Nigeria, causing recurrent outbreaks and contributing to significant morbidity and mortality across the country. As a waterborne disease, cholera thrives in areas with poor sanitation and limited access to clean water, making Nigeria particularly vulnerable (Nwachukwu and  Yusuff, 2020). Cholera is caused by the bacterium Vibrio cholerae and is typically spread through the ingestion of contaminated food or water. In Nigeria, cholera outbreaks occur sporadically, with seasonal variations often associated with heavy rainfall and flooding. Urban slums and crowded, under-served communities are particularly susceptible to cholera outbreaks due to inadequate sanitation infrastructure and poor hygiene practices  (WHO,2020).

According to Dafis et al. (2018), Lassa fever is an acute viral hemorrhagic fever brought on by a single-stranded RNA virus belonging to the Arenavirideae family. Eighty percent of those infected are reported to be asymptomatic, while the remaining individuals may show acute symptoms like fever, weakness, chest pain, and gastrointestinal (GI) side effects like nausea, vomiting, and diarrhoea (Mazzola et al., 2018). Severe symptoms, such as irregular bleeding from the face orifices, hearing loss, tremors, encephalitis, coma, and death, occur in approximately 1–15% of symptomatic cases. Lassa fever has been found to be closely correlated with seasonal variations, peaking in the dry season typically between the months of December and April (Mofolorunsho, 2019). This is believed to be caused by rodent reservoirs migrating into human settlements in search of food. Lassa fever has an incubation period of six to twenty-one days. One infectious disease that has caused outbreaks to emerge and reemerge in Nigeria is Lassa fever. Ever since it was found in 1969 in Lassa, Borno State (Frame et al., 2017).

Acute viral hemorrhagic fever, or Ebola virus disease, is brought on by the Ebola virus, which is a member of the Filoviridae family (Folarin and Ehichioya, 2019). On July 25, 2014, the first case of Ebola virus disease was confirmed in Nigeria. This led to an outbreak that killed eight people (CFR = 40%) and infected twenty others (Folarin et al., 2019). On October 20, 2014, the World Health Organization (WHO) declared that there was no longer any risk of Ebola transmission in Nigeria after the outbreak was brought under control in record time (Osifo-Dawodu, et al., 2017).

The yellow fever virus, which belongs to the Flaviviridae family, is the cause of yellow fever disease, an acute viral hemorrhagic fever spread by infected female Aedes mosquitoes. Lagos had Nigeria’s first known yellow fever epidemic in 1864 (Obi, 2016).

There are very few other symptoms of poliomyelitis, other than mild headaches, stiff necks, and stiff arms and legs. The disease is highly contagious and is brought on by the poliovirus, which is a member of the Enterovirus family. It causes paralysis or weakness of the limbs. (Kroger and Wolfe, 2016). The last significant outbreak in Nigeria occurred in 2007, affecting 69 children in Northern Nigeria. It was directly caused by the locals’ refusal to vaccinate their children because of anti-vaccination religious propaganda (NCDC, 2016).

The monkeypox virus, a member of the Orthopoxvirus genus, is the causative agent of monkeypox. Although primates, including monkeys, and rodents are the primary hosts of the virus, humans are susceptible to infection. Usually, direct contact with infected animals, their bodily fluids, or contaminated materials results in human infections with monkeypox (Ekpunobi et al., 2023). While usually milder, the symptoms of smallpox, another Orthopoxvirus infection, are comparable to those of monkeypox in humans. Fever, headaches, aches in the muscles, and a recognizable rash that frequently starts on the face and spreads to other areas of the body are among the symptoms (Ogunleye et al., 2017). In 1970, the Democratic Republic of the Congo saw the first human cases of monkeypox (WHO, 2017). Since then, Nigeria and other Central and West African nations have experienced periodic outbreaks. Nigeria has seen cases of monkeypox in recent years; outbreaks are usually associated with contact with infected animals or ingestion of contaminated bushmeat (NCDC, 2019).

Additionally, Nigeria grapples with the dual burden of HIV/AIDS, with an estimated 1.9 million people living with HIV in the country (UNAIDS, 2020). While significant progress has been made in scaling up access to antiretroviral therapy, HIV/AIDS continues to pose a formidable challenge to Nigeria’s healthcare system(WHO, 2019).

In recent years, the emergence of outbreaks such as Lassa fever and the COVID-19 pandemic has further strained Nigeria’s healthcare resources. Lassa fever outbreaks occur annually, primarily in the southern regions of the country, resulting in high morbidity and mortality rates (NCDC, 2020). Similarly, the COVID-19 pandemic has highlighted weaknesses in Nigeria’s healthcare infrastructure and underscored the importance of robust infectious disease control measures (NCDC, 2020).

 

CONTROL STRATEGIES FOR INFECTIOUS DISEASE IN NIGERIA

Nigeria faces challenges in controlling infectious diseases effectively. However, through a combination of prevention, diagnosis, treatment, and surveillance strategies, significant progress has been made in mitigating the impact of these diseases.

PREVENTION STRATEGIES:

a. Immunization Programs: Immunization plays a crucial role in preventing the spread of infectious diseases. Nigeria has implemented robust immunization programs targeting diseases such as polio, measles, yellow fever, and others. The National Primary Health Care Development Agency (NPHCDA) oversees immunization campaigns, ensuring widespread coverage and access to vaccines across the country (WHO, 2017).

b. Vector Control: Vector-borne diseases such as malaria and dengue fever are major public health concerns in Nigeria. Vector control strategies, including the distribution of insecticide-treated bed nets, indoor residual spraying, and environmental management, are employed to reduce mosquito populations and prevent disease transmission (WHO, 2017).

c. Health Education and Promotion: Public health campaigns and community engagement initiatives are essential for raising awareness about infectious diseases and promoting preventive behaviours. Health education programs provide information on disease transmission, symptoms, treatment options, and preventive measures, empowering individuals and communities to protect themselves (WHO, 2020).

DIAGNOSIS AND TREATMENT

a. Enhanced Healthcare Infrastructure: Strengthening healthcare infrastructure is critical for improving the diagnosis and treatment of infectious diseases. Nigeria has invested in expanding healthcare facilities, equipping laboratories with diagnostic capabilities, and training healthcare workers to enhance their capacity to diagnose and manage infectious diseases effectively (Ogoina et al., 2019).

b. Access to Essential Medicines: Ensuring access to essential medicines and treatments is essential for controlling infectious diseases. Nigeria works to improve the availability and affordability of antimalarial drugs, antibiotics, antiretroviral therapy for HIV/AIDS, and other medications necessary for treating infectious diseases (WHO, 2020).

SURVEILLANCE AND RESPONSE:

a. Disease Surveillance Systems: Effective disease surveillance systems enable early detection, rapid response, and containment of infectious disease outbreaks. Nigeria’s Center for Disease Control (NCDC) coordinates national surveillance efforts, collecting and analyzing data to monitor disease trends, detect outbreaks, and inform public health interventions (NCDC, 2019).

b. Outbreak Response: In the event of an infectious disease outbreak, prompt and coordinated responses are essential to prevent further spread. Nigeria mobilizes resources, deploys healthcare workers, and implements control measures such as quarantine, contact tracing, and vaccination campaigns to contain outbreaks and minimize their impact on public health (NCDC, 2019).

RESEARCH AND INNOVATION:
a. Investment in Research: Research and innovation are vital for developing new tools, technologies, and strategies to combat infectious diseases. Nigeria collaborates with local and international research institutions to conduct epidemiological studies, clinical trials, and vaccine development efforts aimed at addressing priority infectious diseases (Yinka-Ogunleye and Aruna, 2022).

b. Capacity Building: Building research capacity and fostering collaboration between researchers, policymakers, and healthcare professionals are essential for advancing infectious disease control efforts in Nigeria. Training programs, workshops, and knowledge-sharing platforms facilitate the exchange of expertise and promote innovation in the field of infectious disease research ( Damisa et al., 2020).

THE BRIGHTER FUTURE FOR NIGERIA HEALTHCARE

The burden of infectious diseases disproportionately affects vulnerable populations, exacerbating health inequities and hindering efforts to achieve sustainable development goals (NCDC, 2020). However, Nigeria has made notable progress in implementing control strategies aimed at reducing the impact of infectious diseases. These strategies include preventive measures such as immunization programs, vector control efforts, and health education campaigns. Additionally, investments in healthcare infrastructure, diagnostic capabilities, and treatment services have improved access to essential healthcare interventions (WHO, 2020). Furthermore, Collaboration between the government, private sector, and international partners will be crucial for mobilizing resources and ensuring the sustainability of these improvements.  By investing in improved capabilities and infrastructure, Nigeria can transform its healthcare system and deliver better health outcomes for its citizens. Focusing on infrastructure development, human capital investment, and technological advancements can create a more accessible, equitable, and efficient healthcare system. At Metaphor Nigeria, we develop high-quality clinical laboratories in sub-Saharan Africa that can support global clients in the areas of virtual diagnostics-related staffing, training and consulting, group purchasing of instrumentation, and reagents/supplies. We believe that the challenges can be addressed by a commitment to;

Building a Stronger Foundation: Investing in Infrastructure Development

Upgrading healthcare infrastructure which includes the construction of health and diagnostic centers is vital to creating a more robust system. Enhancing access to diagnostic tools like X-ray machines, ultrasound equipment, and pathology laboratories is crucial for accurate diagnosis and timely treatment. Telemedicine, which allows remote consultations with specialists, can also be explored to address geographical disparities in access to diagnostics.

Empowering the Workforce: Investing in Human Capital

A skilled and motivated healthcare workforce is the backbone of any effective healthcare system. Investing in training programs for specialized fields like critical care and infectious disease management can improve the quality of care for complex cases. Training and deploying community health workers can play a crucial role in rural areas. These workers can provide basic healthcare services, promote disease prevention, and act as a bridge between communities and healthcare facilities.

Harnessing Technology for Transformation

Technological advancements offer exciting possibilities for improving the Nigerian healthcare system.  Leveraging data analytics tools to track disease outbreaks and identify high-risk populations can help target public health interventions more effectively. Additionally, telemedicine consultations can connect patients in remote areas with specialists in urban centres. Mobile health (mHealth) applications can provide patients with information on disease prevention, medication adherence reminders, and appointment scheduling. Also, Implementing EMR systems can improve patient care coordination, reduce medication errors, and streamline data collection for public health initiatives.

 

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