Fred Ezeh, Abuja
They are river blindness, elephantises, rabies, snake bike envenoming, leprosy, Guinea worm, Yaw, buruli ulcer, helminthis (soil transmitted parasitic worn) and many others. They are called Neglected Tropical Diseases (NTDs). This is because they are mostly found in tropical or Sub-Saharan region with poor population.
They are in a group of 20 disease conditions and are closely associated with poverty, poor sanitation, poor safe water resources, sub standard housing conditions and deficient health care system. They might have been forgotten by some people or given less attention but they exist, and are actively attacking people some of whom are unaware of the disease, symptoms and devastating health impact.
They are called “neglected” because they affect world’s poorest people especially in Africa. Regrettably, they receive less attention from world leaders. These diseases are caused by viruses, bacteria or protozoa. They that affect over 15 billion people, of which 40 per cent are in Africa.
They disfigure, disable, keep children out of school and parents out of work thus limiting their potential and keeping communities in continuous poverty.
Overview of NTDs in Nigeria
All the states are endemic for one NTD or the other, according to records. It is estimated that 122 million Nigerians (more than half of the population) are at risk of one or more NTD. Of the number, 20 per cent are pre-school age children, 28 per cent are school age children (five to 14 years old) and 52 per cent are adults (15 years and above).
Data from the Federal Ministry of Health indicated that no fewer than 119.8 million people are at risk of elephantises (lymphatic filariasis), 51.4 million for river blindness (onchocerciasis), 28.8 million school age children and 20.5 pre-school age children are for soil transmitted parasitic worn (helminthis), 26.8 million for trachoma, 23.8 million school age children for snail fever (schistosomiasis).
National Coordinator, National Tropical Diseases Elimination Programme (NTDEP), Dr Chukwuma Anyaike, at a recent meeting with journalists at Ibadan, explained: “NTD is a serious threat to huge number of Nigerians. The negative impact could be disastrous and catastrophic if not attended to, as quickly as possible.
“The impact of NTD ranges from end organ damages due to chronic infection, significant impact on maternal, newborn and child health, promotion of poverty, poor intellectual development, to low productivity which is a devastating obstacle to attainment of Universal Health Coverage (UHC).
“Our utmost desire is to control, eliminate or possibly eradicate NTDs which would result in significant reduction of morbidity and mortality rate to the barest minimum. We equally want to ensure a break in transmission of NTDs through mass drug administration and environmental control.”
Programme Manager, National Trachoma Elimination Programme (NTEP), Dr Nicholas Olobia, said trachoma is the leading infectious cause of blindness in the world, and the causative agent is a bacterium called chlamydia trachomatic:
“The disease is highly prevalent in Northern Nigeria because the region falls within the trachoma belt. The causative agent is found in most vulnerable communities disproportionately affecting children and women, and associated with poverty and low standard of living characterized by overcrowding, poor environmental and personal hygiene.
“It can be transmitted from person to person through direct contact, sharing of personal items like towels, handkerchief and other pieces of cloth that are often used to wipe face or eyes. Also, flies can easily transfer the bacteria from eyes of an infected person to another healthy person. The strategy for the elimination of the trachoma is mostly through the SAFE formula.
“S stands for surgical correction; A for Antibiotic treatment with either zithromax or tetracycline eye ointment; F for facial cleanliness which can be achieved through health education and improved hygiene; while E stands for environmental sanitation to reduce breeding opportunities for the trachoma vector.”
He disclosed that report of recent mapping exercise conducted in 449 Local Government Areas (LGAs) in 24 states revealed that 122 LGAs are endemic for the disease. The endemic states include Benue, Plateau, Nasarawa, Niger, Jigawa, Kaduna, Kano, Katsina, kebbi, Sokoto, Zamfara, Bauchi, Borno, Gombe, Taraba, Yobe, Ebonyi, Edo and FCT.
Onchocerciasis (River blindness)
Programme Manager, National Onchocerciasis Elimination Programme (NOEP), Micheal Igbe, said the situation of the disease is alarming and requires urgent attention from the Federal Government and international community to prevent devastating record in no distant time:
“No fewer than 50 million Nigerians are at risk of the disease. At inception, Nigeria had interventions covering 32 states and the FCT, but currently 27 states and FCT have fallen in the endemic for the disease.”
Data indicated that transmission of the disease is on going in eight states, namely; Ogun, Ondo, Benue, Enugu, Anambra, Imo, Abia, and Cross River, while transmission has been interrupted in Kaduna, Plateau, Kebbi, Nasarawa and Zamfara states. Ten states including FCT are on track for elimination of the disease by this year.
Schistosomiasis and soil transmitted helminthiasis (Snail Fever)
Manager of the programme, Dr Obiageli Nebe, said: “Schistosomiasis otherwise known as snail fever is a parasitic disease caused by tiny blood dwelling worms. The infection occurs when an individual, particularly children, come in contact with contaminated water.
“Over 200 million people worldwide are already infected with the disease and 90 per cent of infected people live in sub-Sahara Africa. Over 700 million people are at risk of the infection if transmission is not interrupted.
“Snail Fever is a disease of low socio-economic status, affecting the poorest communities and most neglected, vulnerable people. Infants and children are especially prone to the infection due to their less developed immune system. It is transmitted when larval forms released by freshwater snails penetrate human skin during contact with contaminated water.
“Additionally, schistosome worms infect people when they pierce through the skin into the blood system and travel with the blood to the liver. There are two forms of the disease, the intestinal and urogenital schistosomiasis. The effectiveness depends on the species of the infecting schistosome worm.”
Manager, Snakebite Envenoming Programme (SEP), Fatai Oyediran, said snakebite is a major medical problem in Nigeria’s rural communities: “Estimated incidence of snakebite in Nigeria is 497/1000. The carpet viper specie of the snake is responsible for 90 per cent of the bites and 60 per cent of deaths.
“Between 2015 and 2020, 39,458 cases of snakebite were reported in Nigeria and 633 people died with 280 recorded last year. Snakebite is highly prevalent in Gombe, Taraba and Bauchi states. It has low prevalent in Katsina, Jigawa, Rivers and Osun states.”
He pleaded with the government and donor agencies to support the effort for local production of anti-venom: “Number of snakebite cases recorded in a year is far above the available anti-venom that is used for response. More people may die or be deformed of snakebite if nothing is done urgently.”
Lymphatic filariasis (Elephantises)
Programme Manager, National Lymphatic Filariasis Elimination Programme (NLFEP), Emmanuel Davies, said the disease is still much around even though many people may ignore it: “It is transmitted by infected female mosquito (anopheles) during human blood meals. The life span of adult parasite is between four and six years.
“The lymphatic mapping completed in 2018 in all the 774 LGAs indicated that lymphatic is endemic in 583 (75.3 per cent) out of the LGAs. Out of the 583 endemic LGAs, 528 (90.6 per cent) of them with a population of 134.5 million are under lymphatic treatment, while 39 LGAs (6.7 per cent) with 8.8 million people have stopped MAM in Nasarawa, Plateau, Cross River states and FCT.
“There are 16 (2.7 per cent) endemic LGAs with population of seven million in Borno, Lagos, Oyo and Rivers states, that are yet to receive lymphatic treatment as at 2019. The cost of treatment runs into millions of Naira.” He solicited the support of international community for funds and logistics.
Testifiers of efficacy of mectizan, albendazole
Evidently, mectizan and albendazole have proven to be effective in response to some NTDs as testified by a user, Sunday Solomon, 50, Onipe, Oluyole Local Government, Oyo State. He was healed of seven years’ blindness.
Wife of the traditional ruler of the community, Olori Florance Opaleye, who administered the drug, said she has been responsible for the distribution and administration of Mectizan and Albendazole to the community members, and it has been effective against elephantises, blindness and several other NTDs:
“In addition, many of the community members that took the drug were healed of different other ailments unknown to them. A woman whose menstruation cycle was halted for many years regained it, thus resulting in a conception. Indeed, the drug has been very effective and useful to our people.
“The only challenge we have is the non-availability of the drug. It is being supplied by some people from government, but they are not consistent in providing the drugs. Also, the challenge of distribution is another cause for concern.
“People who bring the drug to me to distribute don’t give me enough money for distribution. And many come to me from different villages around Onipe to collect the drug. I even end up spending my own money to ensure that they get the drug.”