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Tuberculosis, Malaria keep spreading in Nigeria despite increased funding, strategic plans

THE Global Burden of Diseases’ (GBD)  report on causes of mortality in 2018 listed both Malaria and Tuberculosis as the fourth and sixth leading causes of death in Nigeria.

The cases of malaria and tuberculosis have since become a burden in Nigeria, as the country keeps recording the highest rate of cases and deaths globally in malaria, while for tuberculosis, it has secured the top position in Africa; second highest globally. 

Malaria — still a burden to Nigeria

Despite being a preventable and curable disease, malaria a major public health issue affecting millions of Nigerians, including children. Malaria is caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. 

Though all ages are at risk of the disease, children are the most vulnerable and prone to attain complications. It could easily lead to the death of under-five children.

Nigeria has continually been marked the highest country with the disease, despite a national malaria strategic plan in 2015 that aimed at reducing it to pre-elimination levels and malaria-related mortality to zero by 2020. 

The plan, titled “Nigeria’s Road to Malaria Elimination by 2020” was presented by Nnenna Ezeigwe, the then National Coordinator of the National Malaria Elimination Programme in July 2015.

Four years down the line, and one year to go, Nigeria still named the country with the highest burden of the disease and more cases in 2017 than in the previous two years.

According to the World Health Organisation (WHO)  world malaria report in 2018, which recorded malaria cases and deaths from 2010 to 2017, Nigeria had continually maintained the topmost burden of malaria both in total cases and deaths. 

Though there had been a slight reduction in the number of deaths from 107,843 in 2014 to 81,640 in 2017, the number of malaria cases appeared to be stagnant and even increased in 2017.

 There were 59, 363,039 reported cases of malaria in 2014 while in 2015, the country recorded 52.7 million cases, similar to that of 2016 which was 52.4 million cases. 

And in 2017, the number of newly reported cases of malaria was 53 million. Thus of the 219 million cases recorded globally, Nigeria shared 25 per cent burden, the highest in the world.

Increased in malaria issue in Nigeria is a worrying trend in the country, despite funds received by the country in fighting the disease.

The latest malaria report estimated that in three years —between 2015 and 2017, Nigeria received  more than $588 million from international donors to fight malaria (more than N213 trillion at the conversion rate of 362 dollars). 

 

The money represented the total received from four different donors which were the Global Fund, the World Bank, the United Kingdom and the United States Agency for International Development (USAID)/President’s Malaria Initiative (PMI).

Funds received by Nigeria to combat malaria have been on the increase each year.

In 2015, a total of $185.3 million was given to Nigeria. It increased to $194 million in 2016. And in 2017, international funds to address the country’s malaria problem was $207.9 million. 

The global health agency having identified Nigeria and 10 other countries with  very high rate of disease’ deaths and cases, developed four approaches for each country in eliminating malaria.

  1. Political will to reduce the toll of malaria: Grassroots initiatives that empower people to take action to protect themselves from malaria, as the Zero Malaria Starts with Me campaign, can help foster an environment of accountability and action. 
  2. Strategic information to drive impact: We are moving away from a ‘one-size-fits-all’ approach to malaria. Through better analysis and the strategic use of quality data, countries can pinpoint where to deploy the most effective malaria control tools for maximum impact. 
  3. Better guidance, policies and strategies: WHO will draw on the best evidence to establish global guidance that can be adapted by high burden countries for a range of local settings. This guidance will be continually updated and refined based on country experience and the development of new tools.
  4. A coordinated national malaria response: Key to success is a more coordinated health sector response complemented by other sectors, such as environment, education and agriculture. Aligning partners behind this country-led approach will 4 ensure that scarce resources are used as efficiently as possible.

Nigeria government is expected to fully incorporate the four strategies in addressing the fourth leading cause of deaths in the country.

Malaria is a preventable disease and its elimination is possible. In May 2019, the WHO certified Algeria as a malaria-free country. It should be noted that the first case of malaria was discovered in the country in 1880. 

“Now Algeria has shown the rest of Africa that malaria can be beaten through country leadership, bold action, sound investment and science. The rest of the continent can learn from this experience,” WHO chief had said.  

Tuberculosis —Nigeria keeps growing in the disease burden

Tuberculosis (TB) is also a prominent health problem in Nigeria. And it is preventable with a vaccine called Bacilli Calmette-Guerin which WHO described as a protector from being infected.

According to the Nigeria National Tuberculosis and Leprosy Control Programme (NTBLCP) during the 2019 World Tuberculosis Day, the disease kills not less than 18 Nigerians in every hour. Also, about 47 people are newly diagnosed with the disease every hour.

TB is an airborne disease, that is, it is spread from person to person through the air. When persons with the TB cough, sniff or spit, they propel germs to the air. If a person inhales only a few of these germs, such a person becomes infected. 

While anybody could be infected, the most at risk are those engaging with or suffering from any of the immunity impaired cases including HIV, diabetes, smoking, alcohol, and undernourishment. TB progresses faster and causes high morbidity and mortalities in HIV patients because of their compromised immunity.

The Nigerian government had established NTBLCP in 1989, a programme within the Department of Public Health in the Federal Ministry of Health, to tackle the issue of tuberculosis in the country.

The agency also had developed a strategic plan that aims at reducing the tuberculosis cases and deaths in the country.

As much as there is an availability of a strategic plan and funds in reducing the burden, Nigeria keeps growing in the disease burden.

According to the global TB report of 2018, which is the latest, Nigeria attained the first position among the countries with a high burden in Africa. It also occupied the sixth position globally. 

The position was in contrary to what was recorded in the 2017 report. That year, Nigeria was the second in Africa and seventh in the world.

According to the 2018 global report, $65 million (more than N23.5 billion at $362) was the amount provided by international funders to support tuberculosis fight in 2017 for Nigeria; $32 million was provided locally. For  2016, the international fund was $90 million and $31 million for domestic funding. 

Between 2014 and 2017, Nigeria had received a total of $330 million (about N119.5 billion at $362 rate). A total of $207 million was from the international donors while $123 million came from within the country which included government support.

Domestic and International funds towards ending tuberculosis in Nigeria

In spite of securing the money each year, tuberculosis is still a major problem affecting the  Nigrian populace, causing deaths of thousands. 

Approximately, there are  418,000 Nigerians that come down with tuberculosis every year but only 118,000 cases are treated and diagnosed. 

“Every single person that is not diagnosed or treated can infect between 10 to 15 other people every year,” said Lucica Ditiu, Executive Director of Stop TB Partnership in Geneva during the 2019 National Tuberculosis Conference in Abuja, Nigeria. 

“So we realise that unless we curtail it, this we keep growing.”

The NTBLCP, during the 2019 World Tuberculosis Day, noted that the low number of people being treated was partly to poor knowledge about TB that influences the health-seeking behaviour of people, and the low treatment coverage.

This could be implied that the Nigerian government is yet to provide enough treatment centres and to create a wide community awareness among the populace.  

“TB is not complicated, though not easy. Nigeria must act fast. Everyone needs to know there’s a TB problem in Nigeria and it is a big one. So, what do we do to our problems? We face them not avoiding them,” said Ditiu.

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