By Cosmas Omegoh
Nigeria’s healthcare system is heavily burdened at the moment, writhing with pain and strain and that is the truth. People who understand this reality say that the health sector is heavily weighed down, emphasising that, that vital area of the country’s life has never been as stressed and stretched as it is now. At least, not in the recent past. According to them, things have never been the same for the health sector over the years. So much has changed and have been evidently so. 
According to Dr Sunday Lengmang, head of Department of Family Medicine, Bingham University, Jos, “the health challenges in the country now are enormous on account of COVID-19,” regretting that so much attention has been concentrated on COVID-19 at the expense of other disease conditions.
Over the years, for instance, Nigeria has had to grapple with her seemingly weak healthcare delivery system. Often, the country has been nearly overwhelmed by many of her own share of epidemics – malaria and typhoid fevers, cholera, tuberculosis, VVF, Lassa fever, HIV/AIDS, among others health challenges.
Now, the arrival of COVID-19 early in 2020 has placed extra burden on the country. The virus has changed a lot of things and now, COVID-19 had brought new vistas to the system that was already stretched on all sides, leaving the sector seemingly distressed.
As it stands, more attention has been shifted to the disease that has placed the world on edge with the argument being that COVID-19 has assumed the world’s current number one enemy because it is virulent, easily transmissible and quick to kill.
But Dr Daniel Gbadero who works with one of mission university teaching hospitals in Oyo State maintained that “COVID-19 is a distraction from malaria, typhoid fever, cholera and other diseases affecting our people.”
His considered opinion is that “we need to address our own health challenges – malaria, cholera and other issues – rather than wasting our time on COVID-19.” 
The pandemic, according to him, “is not the biggest problem in Nigeria.” That he wants everybody to know.
According to him, the truth is that people always want to take advantage of every crisis in the West to make money in Africa while ignoring the reality.
He is insistent that “we can throw away all their vaccines into the Atlantic Ocean as long as people who travel take precaution not to bring the virus home.
“We have been with this problem for two years now, yet we have been with the same narrative.
“Now, that narrative should change. COVID-19 is not a hot-climate disease. Thank God what we have here is unlike what they have out there in temperate countries, otherwise that would have added greatly to our burden.”
So far, more and more available resources have been channeled towards fighting COVID-19 which has continued to prove formidable following new strains of the virus sweeping down in new waves.
But sadly, other existing diseases have seemingly been neglected – even when they have remained unrelenting in their onslaught, roving, raging, and ravaging without taking their feet off the throttle. They keep taking down their victims in their numerous vicious savageries. Mortality rates from these diseases have been rising as before. In some instances, the authorities with their attention much wholly focused on the “new normal,” have virtually forgotten that those health challenges that existed are still here.
HIV/AIDS still 2nd largest epidemic
HIV/AIDS has remained deadly. Many are still getting infected, yet very little is said about it nowadays.
But, according to UNAIDS 2019 estimate, “around two-thirds of new HIV infections in West and Central Africa in 2019 occurred in Nigeria.”
The body says that “together with South Africa and Uganda, the country (Nigeria) accounts for around half of all new HIV infections in sub-Saharan Africa every year. This is despite achieving a 13 per cent reduction in new infections between 2010 and 2019.”
The report further recalled that “unprotected heterosexual sex accounts for 80 per cent of new HIV infections in Nigeria, with the majority of the remaining HIV infections occurring in key affected populations such as sex workers.”
USAID added that “Nigeria has the second largest HIV epidemic in the world, and one of the highest rates of new infection in sub-Saharan Africa,” lamenting that “many people living with HIV in Nigeria are unaware of their status.”
The USAID report has it that regrettably “1.9million Nigerians are living with HIV/AIDS,” adding that “1.5 per cent of this population are adults whose ages range between 15 and 49 years.
But while the nation focuses greater attention on COVID-19, 130,000 new infections are said to occur every year. The report further noted that 55,000 adults and 35,000 children respectively are placed on antiretroviral treatment, while 53,000 AIDS-related deaths occur annually.
It says approximately 45,000 people died from AIDS-related illnesses in Nigeria in 2019.
The good news, however, is that “since 2010, AIDS-related deaths have decreased by 35 per cent (up) to 2019.” But “89 per cent of those with a positive diagnosis in Nigeria are (still) accessing antiretroviral treatment.”
Tuberculosis
USAID also reported that closely related to HIV/AIDS is tuberculosis. According to the body, “Nigeria also has the fourth largest tuberculosis epidemic in the world, with HIV and TB co-infection now becoming an increasing concern for people living with HIV.”
In a related development, WHO in July 2021, reported that “response to the Coronavirus pandemic notwithstanding, data indicate that there has been an increase in annual tuberculosis (TB) case notification due to strategic intervention by the National Tuberculosis, Buruli Ulcer and Leprosy Control Programme (NTBLCP), in collaboration with World Health Organisation and other stakeholders working on TB control and elimination in Nigeria.”
The WHO report added that “for instance, in 2020 a total of 138,591 (TB) cases were notified; 15 per cent higher compared to 106,533 and 120,266 cases notified in 2018 and 2019 respectively. Also, comparing first quarters of 2019, 2020, 2021 case notification are 28,823, 33,132 and 43,838 (32 per cent increase in Q1 2021 compared to Q1 2020) respectively.”
The National Coordinator, NTBLCP, Dr Chukwuemeka Anyike was reported to have said: “The country is very impressed with the 2020 programme performance despite the COVID-19 pandemic,” revealing that “Nigeria has over 440,000 incident TB cases, and over 300,000 are estimated to be missed annually.
“This implies that with additional resources channeled towards TB case finding, scale-up of innovative strategies and a focused and targeted approach, the country can actualise its goal of finding all missing TB cases and possibly ending TB in Nigeria.”
Malaria kills 10 Nigerians every hour
From time, malaria has been a major killer of both children and adults across the country.
In October 2021 alone, National Malaria Elimination Programme (NMEP) said that 10 persons died of malaria-related causes every hour.
The agency said that “over 90,000 malaria or malaria-related deaths are recorded in Nigeria every year, adding that “Nigeria accounts for about a quarter of global burden of malaria.”
NMEP Advocacy Communication and Social Mobilisation (ACSM) officer, Eunice Subair, was quoted as saying that “progress has, however, been made in the control of malaria, with prevalence going down from 42 per cent in 2010 to 27 per cent in 2015, and 23 per cent in 2018 (MIS 2010 and NDHS 2018).”
She, however, admitted that “malaria is still of significant burden in Nigeria,” and asked for media assistance “in achieving malaria elimination goal by making the disease an important agenda for public discourse, including malaria issues….”
She called on media professionals to educate the public on the importance of sleeping inside mosquito-treated nets every night to protect themselves against mosquito and other bites.
Subair was said to have touched on the need “for pregnant women to visit clinics early in pregnancy for antenatal care, and admonished Nigerians to always go to the hospital whenever they suspect malaria,” thereby reinforcing the message and underlining the reality that malaria remains a deadly enemy of the people.
VVF still big problem
Vesico-Vaginal Fistula (VVF) expert, Dr Lengmang, now an associate professor, says despite the prevalence of COVID-19, loads of women are still presenting with fistula challenges.
Lengmang’s position is reinforced by the trio of Oluwasomidoyin Olukemi Bello, Imran Oludare Morhason-Bello and Oladosu Akanbi Ojengbede in their essay: “Nigeria, a high-burden state of obstetric fistula: a contextual analysis of key drivers,” published in May, 2020. The trio said that “approximately two million women were estimated to be living with unrepaired vesico-vaginal fistula (VVF) and about half of the total from developing countries were from Nigeria.
“In Nigeria, prevalence of obstetric fistula is 3.2 per 1,000 birth and it was estimated that about 13,000 new cases occur annually, suggesting that the backlog of unrepaired cases may take about 83 years to clear at the present rate of repair.”
The trio quoted the United Nations International Children’s Emergency Fund (UNICEF) report that “Nigerian women currently living with (VVF) range from 400,000 to 800,000 and annually (while) an additional 50,000 to 100,000 new cases occur in the country.”
Cholera marches on
According to NCDC Director General, Ifedayo Adetifa, compared to COVID-19, the country recorded “a little more than 3,600” deaths from cholera in the last 11 months while the total fatalities recorded from Coronavirus since 2020 when the index case was recorded still stands at 2,977.”
He acknowledged that his agency “has been working behind the scene to mitigate the spread of cholera, as the public attention is more on COVID-19 than other diseases.
“We are dealing with some fresh outbreaks; there is a connection between this and the rainy season, for example.”
In June, 2021, for instance, NCDC acknowledged an increase in infections across the country and even had to activate its Cholera Emergency Operations Centre to combat the monster.
According to a report, “as of October 24 there have been 93,932 suspected cases and 3,293 associated deaths in 2021. This puts the case fatality rate at 3.5 per cent, which is higher than the annual outbreaks of the past four years.”
Cholera outbreak, it was learnt, affected 32 states of the federation, hitting mostly children between five and 14 years.
Aside cholera, Adetifa goes on to remind everyone about another health challenge other than COVID-19 that looms this dry season, and that is meningitis.
He said: “We are currently preparing for the meningitis season; all the refresher training, all the sensitisations are already in the works.
“So, behind the scenes, we would like all of these other areas to receive equal or even more attention, but we have no choice, but to focus on all of the diseases that are likely to have public health impact on the country according to the mandate that we have been given.”
LASSA fever still prowling
Sunday Sun gathered that in the middle of the year, there was a spike in the number of new confirmed cases of the deadly Lassa fever across states such as Edo, Ondo, Anambra, Taraba and Benue.
Between January and June this year alone, a total of 79 deaths were reported, representing a cumulative fatality rate (CFR) of 18.9 per cent.
It was learnt that “in total for 2021,16 states have recorded at least one confirmed case across 62 local government areas.”
In all of this, medical workers have also been victims.
On December 8, 2021, for instance, it was reported that Lassa fever killed a pregnant woman at a health facility in Nasarawa State. The doctor who attended to her also took ill. Similar Lassa fever incident was also reported in the FCT during the period.
NCDC said on account of that, it had, had to intensify its national multi-sectoral and multi-disciplinary Lassa fever Technical Working Group (TWG) for Lassa fever surveillance and response to deal with the situation. That gives an idea that the disease has not shown any sign of relenting.
Danger of over focusing on COVID-19
Dr Lengmang is emphatic that government’s neglect of other health challenges would boomerang sooner than later.
“Yes, people are talking less about other diseases that had existed before COVID-19,” he told our correspondent.
According to him, “the neglect will lead to a situation whereby there will be a backlog of cases and diseases; there will be increase in the number of cases because no attention has been given to them.”
His fear is that “then cases that ought to have been given due attention will increase in intensity and lead into mortality. Smaller cases will develop into more complicated issues such that more people will be dying from them.
“There is likely going to be increases in the number of cases compared to a situation when there was a continuous normal process of tackling them.”
Drawing from his own experience, he said that “for us in the area of fistula, we have got that in mind, and have decided that we will continue to provide services in the normal way we have been doing so.
“But we are also taking precaution because it is not enough that we will be providing fistula services without taking prevention against COVID-19.
“So, we have provided a component of COVID-19 in the services we give. We are not forgetting the troubles that can come from the virus.”
For Dr Gbadero, the authorities are doing a lot of damage by not focusing on the real health challenges that affect the people just because “some people are smiling to the bank with COVID-19.
“They are getting allowances – money because of COVID-19.”
He insisted that it amounts to deceit because “Boko Haram is Nigeria’s number one health challenge.
“Of course, the next is insecurity which is going to lead to a serious food crisis in the country.”
He is unhappy that “some people in power are rather reading the script written by the West; whatever problem they have, they force them on us and we take them hook, line and sinker.
“If they are having the malaria we have here, they would have stopped it over 50 years ago.”
He, therefore, wants more attention to be paid to the country’s own real challenges rather than excessive focusing on COVID-19.
“We see people dying every day from road accidents, people being abducted every day.
“Sadly, sometimes, we magnify our problems so that people can help us. We present other people’s problems as ours so that people can make money from them,” he said.
Advice to government
And now, Dr Lengmang is asking that “the Federal Government should not give a lopsided attention to the COVID-19 pandemic.”
Although he wants government to increase the quota of resources to help tackle the pandemic, he is calling that “other diseases should get the attention COVID-19 is getting.”
He claimed that “if we fail to do that, we will be suffering ourselves running in one direction only to come back running in other directions.
“We have to give a multi-prong effect to tackling all health care situations. It is best for us to do an integrated approach by taking care of other diseases the same way we are tackling COVID-19.”
Advice to the people
He advised the people not to allow COVID-19 deter them from going to the hospitals when they feel unwell, urging them to observe the various non-pharmaceutical prevention measures.
“People need to visit the hospitals; they will not be turned back.
“But they must know that all the NPIs are part of the universal precaution. They help health professionals to be able to respond to them.
“Yes, vaccines help, but we do not have what it takes to achieve a very high level of vaccination at the moment.
“So, what is going to work for us are the non-pharmaceutical measures – wearing our facemasks, avoiding mass gathering and washing our hands regularly.
“If the people have access to the vaccines, let them participate in the programme,’ he advised.