Oluseye Ojo, Ibadan
In 2017, the World Health Organisation (WHO) reported that 10.4 million people took ill with tuberculosis (TB) and there were 1.8 million TB deaths in 2016, making it the foremost infectious killer worldwide.
Nigeria is currently placed fourth globally in the burden of tuberculosis and it is said to be leading the pack in Africa. One of the major factors said to have been responsible for the current situation is inadequate investment in tackling health challenges in Nigeria and over-reliance on foreign aid.
However, the need for a paradigm shift towards solving the problem of tuberculosis in Nigeria made the Department of Veterinary Public Health and Preventive Medicine, University of Ibadan and its development partners to storm Ibarapaland, an administrative zone of Oyo State in order to set the pace for eradicating the scourge in the country.
The team provided free medical services to Ibarapa people at Eruwa Town Hall as a part of events to mark this year’s World Tuberculosis Day. The beneficiaries were screened for tuberculosis and also given free drugs.
The programme brought together local farmers, representatives of Fulani community, government officials and people from the seven principal towns of Ibarapa with more than 30 villages. The project is named: The Ibarapa Meje One Health Initiative (TIMOHI).
Ibarapaland is located approximately 100 kilometres north of the coast of Lagos, and about 95 kilometres west of Ibadan, the Oyo State capital. Traditionally, it comprises seven principal towns known as the ‘Ibarapa Meje’ (Ibarapa Seven), which are Eruwa, Lanlate, Igbo-Ora, Aiyete, Tapa, Idere, and Igangan.
As at 2011, the total population of the seven principal towns with their surrounding villages and farmsteads was approximately 400,000.They are spread within three local government areas in Oyo State. Eruwa and Lanlate are located in Ibarapa East, Igbo-Ora and Idere in Ibarapa Central, as well as Aiyete and Tapa in Ibarapa North local government area.
It was gathered that at least 30 different villages are under the seven principal towns of Ibarapaland. Igangan comprises Asuranran, Idiyan, Omidigbo, and Akoya. Idere also has Koso, Onigbio, Oke-Oba and Apa. Igbo-Ora consists of Igbo-Ile, Pako, Saganun, Idofin, Iberekodo, and Igboora.
In the same vein, Aiyete is made up of Imofin, Iwafin, Igbodoko and Orile-Odode, while Tapa has Tapa, Iki, Ago, Kogba, and Oba. Eruwa also has Olaribukusi and Akalako.
Lanlate also consists of Adeta, Allala, Ikana, Iwena, and Agasa.
The Ibarapaland is also the host of Oyo State College of Agriculture and Technology (OYSCATECH) at Igbo-Ora; the Ibarapa Polytechnic in Eruwa and Oyo State College of Education, Lanlate.
The area consists mostly of rolling savannah with forests situated along the southern border and in isolated patches along river courses such as the Ogun. This probably made it favourable to pastoralists. Fulani herdsmen are visible in many settlements in Ibarapaland, where they have been rearing their cattle.
Head of Department, Veterinary Public Health and Preventive Medicine, University of Ibadan, Prof. Simeon Cadmus, advocated the adoption of a ‘One-Health’ approach that recognises the interdependence of the health of people, animals and the environment as well as collaboration between the medical and veterinary professionals towards solving the challenge of tuberculosis in Nigeria.
Cadmus, who is the Head of TIMOHI, said the project was geared towards the promotion of total wellbeing of pastoralists’ community and their animals, saying that the ‘One-Health’ approach has been approved by the WHO, World Health Organisation for Animal Health (OIE) and The Union (International Union Against Tuberculosis and Lung Disease).
According to him, there is need for a paradigm shift. For us to move forward in solving the problem of tuberculosis in Nigeria, we need to account for everybody and there must be a conscious collaboration among all sectors.
“Our celebration on Eruwa is unique because for the first time in Nigeria and arguably in the world, we are promoting and putting into practice the ‘ One Health’ approach to support the National TB Control Programme towards achieving the theme: ‘Find and notify all TB cases in Nigeria.’
Cadmus called attention to the challenge of Zoonotic Tuberculosis (ZTB), which according to him, is a neglected firm of tuberculosis, predominantly caused by a closely related specie, ‘mycobacterium bovis.’
“Those at risk are the pastoralists and other livestock workers, including butchers and everyone who drinks unpasteurised milk and milk product (wara) and to some extent consume improperly cooked meat and meat products. The human burden of ZTB cannot be reduced without improvement of standards of food safety and the reduction of bovine tuberculosis in animals,” Cadmus stated.
Experts have described ZTB as a “form of tuberculosis in people caused by Mycobacterium bovis, which belongs to the M. tuberculosis complex.
Cattle are the most important animal reservoir for M. bovis in relation to zoonotic exposure of humans, but the disease can affect many other species and become established in wildlife reservoirs. It results in important economic losses and trade barriers with a major impact on the livelihoods of poor and marginalized communities.”
The Oyo State Officer, National TB Control, Dr. Olutunde Babalola, noted that a total of 6,901 TB cases were recorded in the state in 2017, after close to 40,000 people were screened, adding that 10 GeneXpert MTB/RIF machines are currently in the state as the primary diagnostic tool for TB. He said pressures have been so much on the machines, which is why every of the 33 local government areas of the state should have at least one machine.
The Field Coordinator for African Field Epidemiology Network (AFENET), Dr. Aisha Usman, who spoke on behalf of the Country Advisor for the organisation, Dr. Patrick Nguku, noted that Nigeria has been losing on daily basis, seven children, and 40 adults, which respectively amount to 2,555 children and 14,600 adults, totally 17,155 people annually.
Chairman, Miyetti Allah in Oyo State, Yakubu Bello, and Head of Fulani community in Ibarapa, Alhaji Saliu Kadiri, thanked the organisers of the event, promising to take the message to all members of Fulani community with a view to preventing diseases that human beings usually contract from animals.
Minister of Health, Professor Isaac Adewole, said at a recent event that President Muhammadu Buhari’s administration through the Federal Ministry of Health has taken steps to control tuberculosis in Nigeria, adfing that the government has introduced the use of the GeneXpert MTB/RIF technology as the primary diagnostic tool for TB among all presumptive TB cases in the country.
He explained that the introduction of GeneXpert MTB/RIF technology has scaled up the number of facilities providing GeneXpert services from seven health facilities in 2011 to 318 facilities before the end of 2016 to enhance TB control efforts.
Adewole noted that tuberculosis remains a serious public health problem in most parts of the world causing deaths of nearly one and half million people each year, mostly in developing world.
“The machines would not only provide GeneXpert MTB/RIF technology as the primary diagnostic tool for TB among all presumptive TB cases in the country including PLWHA but also increase the number of notified TB cases, especially in the rural areas,” he stated.
HOD, Veterinary Public Health and Preventive Medicine, UI, Prof Cadmus, noted further that TIMOHI and its development partners would explore a strong evidence-based rationale for community capacity building and community empowerment as part of a strategic response to reduce tuberculosis and other health inequalities in the Ibarapa area.
The students in the three tertiary institutions in Ibarapaland are also expected to benefit from the project as their health would be safeguarded against contracting zoonotic tuberculosis as a result of consuming meat or drinking unpasteurised milk and milk products such as ‘wara’ and ‘fura da nunu.’
Cadmus stated further: “Through this approach, we will adopt four areas of challenge that could potentially drive an implementation gap such as achieving integration and scale, effective community mobilisation, evidencing impact, and achieving a shift in power that will encourage bottom up approach.
“With this strategy in view, we will make each household in Ibarapa tuberculosis free, then each town in Ibarapa, the entire Ibarapa Meje; thus making this area a model in Nigeria in combating tuberculosis and promoting public health.”