Some common Health Conditions in Nigeria

Malaria

Malaria is a serious and sometimes fatal disease caused by a parasite called Plasmodium.

It is primarily spread to humans through the bites of infected female Anopheles mosquitoes, which act as the vector (carrier).

Key points about malaria:

• Cause: A parasite of the genus Plasmodium. Five species cause malaria in humans, with P. falciparum being the deadliest and most common in Africa.
• Transmission:
  • Mainly through the bite of an infected female Anopheles mosquito.
  • Less commonly, through blood transfusions, organ transplants, or from mother to unborn child.
• Symptoms: Typically appear 10 days to 4 weeks after the mosquito bite and often resemble the flu. They commonly include:
  • High fever and chills (often in cycles)
  • Headache
  • Sweating
  • Nausea and vomiting
  • Muscle or joint pain
  • Untreated malaria, especially P. falciparum, can progress rapidly to severe illness with complications like cerebral malaria, severe anemia, and organ failure, which can be fatal.
• Treatment: Malaria is treatable and curable with specific antimalarial medications. Early diagnosis and prompt treatment are critical to prevent severe complications.
• Prevention: Prevention methods include:
  • Taking antimalarial tablets (chemoprophylaxis) when traveling to high-risk areas.
  • Avoiding mosquito bites, especially at night, by using insect repellent, wearing protective clothing, and sleeping under insecticide-treated bed nets.
  • A malaria vaccine is also available in some endemic areas for children.

Chronic Obstructive Airway Disease

The term Chronic Obstructive Airway Disease (COAD) is an older name for what is now most commonly called Chronic Obstructive Pulmonary Disease (COPD).

COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs, making it difficult to breathe. It is a progressive disease, meaning it typically worsens over time.

COPD is an umbrella term that mainly includes two conditions:

1. Emphysema: Damage to the walls of the air sacs (alveoli) in the lungs, which reduces their elasticity and ability to exchange oxygen and carbon dioxide, leading to “air trapping.”
2. Chronic Bronchitis: Long-term inflammation and irritation of the lining of the airways (bronchial tubes), which causes them to thicken and produce excessive mucus, further blocking airflow.

Key Information on COPD

Causes

The primary cause of COPD is long-term exposure to lung irritants.

• Cigarette Smoking: This is the most common cause in high-income countries, accounting for the vast majority of cases.
• Secondhand Smoke: Exposure can also contribute to lung damage.
• Occupational Exposures: Long-term exposure to chemical fumes, dusts, and vapors in the workplace.
• Indoor Air Pollution: Exposure to fumes from burning fuel (wood, coal, animal dung) for cooking and heating in poorly ventilated homes (a major risk factor in many low- and middle-income countries).
• Alpha-1 Antitrypsin (AAT) Deficiency: A rare genetic condition that makes the lungs highly susceptible to damage.

Symptoms

Symptoms typically develop slowly and worsen over many years, often not becoming noticeable until middle age or older.

• Shortness of breath (Dyspnea): Especially during physical activity.
• Chronic cough: A persistent, often “chesty” cough that may bring up mucus (phlegm or sputum). This is sometimes dismissed as a “smoker’s cough.”
• Wheezing: A whistling or squeaky sound when breathing.
• Chest tightness
• Frequent respiratory infections (colds, flu, pneumonia).
• Fatigue.

Symptoms can sometimes suddenly worsen in what is known as a flare-up or exacerbation, which often requires urgent medical attention.

Treatment and Management

While the damage to the lungs cannot be reversed, treatment can manage symptoms, slow the progression of the disease, and improve quality of life.

1. Smoking Cessation: This is the single most important step in any treatment plan to prevent further lung damage.
2. Medications: Typically delivered via inhalers.
   • Bronchodilators: Medicines that relax the muscles around the airways to open them up and make breathing easier (short-acting for quick relief, long-acting for daily use).
   • Inhaled Steroids: Used to reduce airway inflammation, often in combination with long-acting bronchodilators.
3. Pulmonary Rehabilitation: A program that combines exercise training, disease education, nutrition counseling, and psychological support to improve a person’s physical and emotional well-being.
4. Oxygen Therapy: For individuals with low blood oxygen levels, supplemental oxygen may be needed to improve quality of life and prolong survival.
5. Vaccinations: Getting an annual flu shot, the pneumococcal vaccine, and the COVID-19 and RSV vaccines is essential to prevent infections that can trigger severe flare-ups.

Prevention

COPD is largely preventable. The best way to prevent it is to never smoke or to quit smoking as soon as possible. Avoiding other lung irritants like secondhand smoke and occupational dust/fumes is also critical.

Lassa Fever

Lassa fever, also known as Lassa hemorrhagic fever, is an acute viral illness that is endemic in parts of West Africa. It is a type of viral hemorrhagic fever caused by the Lassa virus, a member of the Arenaviridae family.

The disease is named after the town of Lassa in Nigeria, where it was first identified in 1969.

1. Cause and Reservoir

• Causative Agent: Lassa virus (LASV).
• Animal Reservoir: The primary host is the multimammate rat (Mastomys natalensis), which is found throughout sub-Saharan Africa. The rat sheds the virus in its urine and feces throughout its lifetime without showing symptoms.

2. Transmission

Lassa fever spreads primarily through contact with the infected rat, but human-to-human transmission is also possible.

Rodent-to-Human Transmission (Primary)

Humans are typically infected by:

• Inhalation: Breathing in tiny particles of the rat’s dried urine or droppings that are stirred up into the air (aerosol).
• Ingestion: Eating food or household items contaminated with the rat’s urine or feces.
• Direct Contact: Touching items or surfaces contaminated with rodent excreta, or having direct contact with an infected rat through broken skin or mucous membranes. In some areas, infection can occur through consuming the rats as a food source.

Human-to-Human Transmission

This transmission is less common and usually occurs through direct contact with the blood, tissue, secretions, or excretions (like urine or semen) of an infected person.

• Healthcare Settings: This is a risk, especially when proper infection control and personal protective equipment (PPE) are inadequate.
• Sexual Contact: The virus can be shed in semen for a prolonged period after recovery.

3. Symptoms

The incubation period for Lassa fever ranges from 2 to 21 days.

• Mild or Asymptomatic Cases (about 80%): Most people infected with the Lassa virus have no symptoms or only very mild, undiagnosed flu-like symptoms (slight fever, general malaise, and headache).
• Severe Cases (about 20%): The disease can progress to a more serious multi-system illness. Symptoms often begin gradually and may include:
  • Fever, general weakness, and malaise.
  • Headache, sore throat, cough.
  • Muscle pain, chest pain, and abdominal pain.
  • Nausea, vomiting, and diarrhea.
  • In severe, life-threatening cases, symptoms can include:
    • Facial swelling.
    • Bleeding from the gums, nose, eyes, or gastrointestinal tract (hemorrhaging).
    • Difficulty breathing (respiratory distress).
    • Low blood pressure (shock).
    • Seizures or disorientation.

Complications

• Hearing Loss: A common and often permanent complication, occurring in up to 25% of patients who survive.
• Pregnancy: Lassa fever is particularly severe in pregnant women, often resulting in high rates of maternal death and fetal loss, especially in the third trimester.
• Multi-organ Failure: Death, in fatal cases, usually occurs within 14 days of symptom onset due to shock and multi-organ failure.

4. Treatment and Prevention

Treatment

• Antiviral Drug: The antiviral drug Ribavirin has been used to treat Lassa fever, but its efficacy is best when administered early in the course of the illness.
• Supportive Care: This is the cornerstone of treatment, including:
  • Maintaining fluid and electrolyte balance.
  • Managing blood pressure and pain.
  • Treatment of secondary infections.

Prevention

Prevention focuses on rodent control and good hygiene in endemic areas.

• Rodent Control:
  • Storing food and garbage in rodent-proof containers.
  • Keeping the home and surrounding area clean to discourage rats from entering.
  • Trapping rats in and around homes.
• Infection Control: In healthcare settings, strict infection prevention and control measures, including the use of Personal Protective Equipment (PPE), are essential to prevent person-to-person spread.
• Travel Precautions: Travelers to endemic areas should be careful about food handling and storage, and avoid contact with rodents.
• Vaccine: There is currently no approved vaccine for Lassa fever, although candidates are in development.

Urine Tract infection

A Urinary Tract Infection (UTI) is a common infection that affects any part of the urinary system, which includes the kidneys, ureters, bladder, and urethra.

Most UTIs involve the lower urinary tract—the urethra and the bladder. UTIs are significantly more common in women than in men.

1. Causes

UTIs are typically caused by bacteria entering the urinary tract through the urethra and multiplying.

• Primary Cause: The most common cause is the bacterium Escherichia coli (E. coli), which normally lives in the gastrointestinal (GI) tract.
• How Bacteria Enters: Due to the female anatomy, the urethra is shorter and closer to the anus, making it easier for E. coli to spread to the urinary tract.
• Types of UTIs: The symptoms experienced depend on the part of the urinary tract that is infected:
  • Urethritis: Infection of the urethra.
  • Cystitis: Infection of the bladder.
  • Pyelonephritis: A more serious infection of the kidneys, which occurs when the bacteria travel up the ureters.

2. Symptoms

Symptoms vary based on the severity and location of the infection.

Location of Infection	Symptoms
Lower Tract (Bladder/Urethra)	* A strong, persistent urge to urinate.
(Cystitis/Urethritis)	* A painful or burning sensation during urination (dysuria).
	* Passing frequent, small amounts of urine.
	* Urine that is cloudy, dark, or has a strong, foul odor.
	* Blood in the urine (hematuria), making it appear red, pink, or cola-colored.
	* Pelvic pressure or discomfort in the lower abdomen (suprapubic pain).
Upper Tract (Kidneys)	* High fever and chills.
(Pyelonephritis)	* Pain in the back or side, just under the ribs (flank pain).
	* Nausea and vomiting.
	* Confusion or agitation (especially in older adults).

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3. Diagnosis and Treatment

• Diagnosis: A doctor will typically perform a urinalysis (to check for white blood cells, red blood cells, and bacteria) and often a urine culture (to identify the specific bacteria and determine which antibiotics will be most effective).
• Treatment: UTIs are primarily treated with antibiotics.
  • The type and duration of the antibiotic course (usually 3 to 7 days for uncomplicated UTIs) depend on the patient’s symptoms and health history.
  • It is crucial to complete the full course of antibiotics as prescribed, even if symptoms improve quickly.
  • Pain relievers (like ibuprofen or paracetamol) can be used to manage pain and discomfort.
  • Supportive Care: Drinking plenty of water helps to dilute the urine and flush bacteria out of the urinary tract.

4. Prevention

Preventive measures focus on hygiene and promoting a healthy urinary environment:

1. Stay Hydrated: Drink plenty of fluids, especially water, to help flush the urinary tract frequently.
2. Practice Proper Hygiene: After using the toilet, women should wipe from front to back to prevent bacteria from the anal region from spreading to the urethra.
3. Urinate After Sex: Urinating immediately after sexual intercourse can help flush out any bacteria that may have entered the urethra.
4. Avoid Irritants: Avoid using scented products (sprays, douches, powders) in the genital area, as they can irritate the urethra.
5. Change Underwear: Wear cotton underwear and avoid overly tight-fitting clothes to keep the area dry.
6. Don’t Hold Urine: Urinate as soon as you feel the urge to empty the bladder completely and regularly.

If left untreated, a UTI can lead to a serious kidney infection (pyelonephritis), which can cause permanent kidney damage or potentially lead to sepsis (a life-threatening blood infection).

Stroke

A stroke (sometimes called a “brain attack”) occurs when the blood supply to part of the brain is blocked or a blood vessel in the brain bursts. This lack of oxygen and nutrients causes brain cells to die, which can lead to permanent damage, disability, or death.

There are two main types of stroke:

Types of Stroke

Type	Cause	Percentage of Cases
Ischemic Stroke	A blood clot blocks a blood vessel in the brain, cutting off blood flow. This is the most common type.	About 87%
Hemorrhagic Stroke	A blood vessel in the brain ruptures and bleeds into the surrounding brain tissue, which damages cells and increases pressure in the brain.	About 13%
Transient Ischemic Attack (TIA)	A temporary blockage of blood flow to the brain, often called a “mini-stroke.” Symptoms last only a few minutes to an hour and don’t cause permanent damage, but a TIA is a serious warning sign of a future full stroke.	N/A (Warning Sign)

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Signs and Symptoms: Think F.A.S.T. 🚨

Recognizing stroke symptoms quickly is crucial, as immediate treatment can significantly reduce brain damage. Use the acronym F.A.S.T. to remember the most common signs:

• Face Drooping: Ask the person to smile. Does one side of the face droop or feel numb?
• Arm Weakness: Ask the person to raise both arms. Does one arm drift downward?
• Speech Difficulty: Ask the person to repeat a simple sentence. Is their speech slurred or difficult to understand?
• Time to Call: If you observe any of these signs, call emergency services immediately. Note the time when symptoms first started.

Other sudden symptoms can include:

• Sudden confusion or trouble understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden dizziness, trouble walking, or loss of balance/coordination.
• Sudden, severe headache with no known cause.

Treatment

Emergency treatment depends entirely on the type of stroke:

Type of Stroke	Emergency Treatment
Ischemic Stroke	Clot-busting drugs (like tPA) must be given within 4.5 hours of symptom onset to dissolve the clot and restore blood flow. Endovascular procedures (like mechanical thrombectomy) may be used to physically remove large clots.
Hemorrhagic Stroke	Treatment focuses on stopping the bleeding and reducing pressure on the brain. This may involve medications to control high blood pressure or surgery to repair the ruptured blood vessel (e.g., clipping an aneurysm) or drain blood.

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Risk Factors and Prevention

Many risk factors for stroke are manageable through lifestyle changes and medical treatment.

Modifiable Risk Factors (Things you can change):

• High Blood Pressure (Hypertension): The single most important controllable risk factor.
• Smoking: Damages blood vessels and increases blood pressure.
• Diabetes: Poorly controlled blood sugar can damage blood vessels.
• High Cholesterol: Can lead to plaque buildup (atherosclerosis) and blockages.
• Heart Diseases: Especially Atrial Fibrillation (Afib), which can cause blood clots to form in the heart and travel to the brain.
• Obesity/Physical Inactivity: Contributes to other risk factors like high blood pressure and diabetes.
• Diet: A diet high in saturated fat, salt, and sugar.

Non-Modifiable Risk Factors (Things you can’t change):

• Age: Risk increases as you get older.
• Family History: A genetic predisposition can increase risk.
• Race/Ethnicity: Certain groups (such as Black and Hispanic Americans) have a higher risk.
• Prior Stroke or TIA: Having one significantly increases the risk of having another.

Migraines

A migraine is a neurological disease characterized by recurrent attacks of moderate to severe headaches, often accompanied by other debilitating symptoms such as nausea and extreme sensitivity to light and sound. It is much more than a typical headache.

Migraines can be a genetic disorder, and attacks often progress through several distinct phases.

Symptoms and Phases of a Migraine Attack

A migraine attack can progress through four potential phases, though not everyone experiences all of them:

1. Prodrome (Warning Phase):
   • Occurs up to 24 hours before the head pain starts.
   • Symptoms can include: unexplained mood changes (depression or euphoria), food cravings, neck stiffness, increased thirst/urination, and frequent yawning.
2. Aura:
   • Occurs in about one-third of people with migraines, typically just before or during the headache.
   • Aura consists of reversible neurological symptoms that usually last 5 to 60 minutes.
   • Most common: Visual disturbances (seeing flashing lights, zigzag lines, or temporary blind spots).
   • Less common: “Pins-and-needles” sensation (tingling or numbness) in an arm, leg, or the face; difficulty speaking.
3. Attack (Headache Phase):
   • The main phase, lasting from 4 to 72 hours if untreated.
   • Pain: Typically moderate to severe, described as throbbing or pulsing, and often located on one side of the head (but can be on both).
   • Other Symptoms: Nausea and/or vomiting, extreme sensitivity to light (photophobia), sound (phonophobia), and sometimes smell (osmophobia). Pain often worsens with physical activity.
4. Postdrome (The Aftermath):
   • The phase following the headache, often called a “migraine hangover,” and can last for a day or two.
   • Symptoms include feeling drained, fatigued, confused, or having difficulty concentrating. Sudden head movements may briefly cause pain again.

Common Triggers

While triggers vary widely from person to person, common culprits include:

• Stress: Both during periods of stress and the “let-down” period afterward.
• Hormonal Changes: Fluctuations in estrogen, especially around menstruation (menstrual migraine).
• Sleep Changes: Too much or too little sleep, or changes to a regular sleep routine.
• Dietary Factors: Skipped meals/fasting, alcohol (especially red wine), caffeine (withdrawal or overconsumption), and certain food additives (like MSG or aspartame) or aged foods (cheese, cured meats).
• Sensory Stimuli: Bright or flickering lights, loud noises, and strong odors (perfume, fumes).
• Environmental Changes: Sudden changes in weather or barometric pressure.

Treatment and Prevention

Migraine treatment is generally divided into two categories:

1. Acute (Attack) Treatment

• Taken during an attack to stop the pain and symptoms.
• Over-the-Counter: NSAIDs (ibuprofen, naproxen) or combinations with caffeine/acetaminophen for mild to moderate attacks.
• Prescription:
  • Triptans: Medications that target serotonin receptors to constrict blood vessels and block pain pathways; highly effective for moderate to severe attacks.
  • CGRP Receptor Antagonists (Gepants): A newer class of drug used for acute treatment.

2. Preventive Treatment

• Taken regularly (daily or less often) to reduce the frequency, duration, and severity of attacks.
• Preventive treatment is usually considered for people who have frequent attacks (e.g., four or more migraine days per month).
• Medications: Originally developed for other conditions but found effective for migraine prevention, including certain blood pressure medications (beta-blockers), anti-seizure drugs, and some antidepressants.
• Newer, Migraine-Specific Treatments:
  • CGRP Monoclonal Antibodies (CGRP mAbs): Injectable medications that specifically target CGRP, a protein involved in migraine pain transmission.
  • Botox Injections: Used for chronic migraine (15 or more headache days per month).

Lifestyle and Self-Care

• Migraine Diary: Track attacks, symptoms, and potential triggers to identify personal patterns.
• Consistency: Maintain regular sleep, meal, and exercise schedules.
• Hydration: Drink plenty of water.
• Trigger Avoidance: Avoid known personal triggers (e.g., specific foods, smells, or sensory environments).
• Relaxation: Use techniques like meditation, yoga, or biofeedback to manage stress, a major trigger.

Osteoarthritis (OA)

-is the most common form of arthritis, often referred to as “wear-and-tear” or degenerative joint disease. It is a chronic condition that affects the entire joint, leading to pain, stiffness, and loss of mobility.

What is Osteoarthritis?

OA occurs when the cartilage—the firm, slippery tissue that cushions the ends of bones in a joint—gradually wears down over time.

• In a healthy joint, cartilage allows for nearly frictionless movement.
• In OA, as the cartilage deteriorates, the bone surfaces eventually rub directly against each other.
• This process also causes changes in the bone (like the formation of bone spurs or osteophytes), weakens supporting ligaments, and can cause mild inflammation in the joint lining.

OA can affect any joint but most commonly targets the hands, knees, hips, and spine.

Symptoms of Osteoarthritis

Symptoms of OA typically develop slowly and worsen over many years:

• Pain: The affected joint aches or hurts, especially during or after movement or activity. In advanced stages, pain can be constant or disturb sleep.
• Stiffness: The joint may feel stiff, most noticeably upon waking up or after periods of inactivity (sometimes called “gelling phenomenon”). Stiffness is usually brief (less than 30 minutes).
• Loss of Flexibility: Difficulty moving the joint through its full range of motion.
• Grating Sensation: A feeling, or sometimes a sound (like popping or crackling, called crepitus), when the joint is moved, due to the rubbing of bone on bone.
• Tenderness: The area around the joint may feel tender when light pressure is applied.
• Swelling: May occur due to soft tissue inflammation or the formation of bone spurs around the joint.

Causes and Risk Factors

While OA is a disease of the whole joint and not simply “wear and tear,” several factors increase the risk of developing it:

• Age: The risk of OA significantly increases after age 50.
• Sex: Women are more likely than men to develop OA, especially after age 50.
• Obesity: Extra body weight increases stress on weight-bearing joints (knees, hips, and spine). Fat tissue also produces proteins that can cause harmful inflammation.
• Joint Injuries: Previous injuries (e.g., sports injuries, fractures, ligament tears) can accelerate the breakdown of cartilage, even many years later.
• Joint Overuse: Jobs or sports that involve repetitive stress, heavy lifting, squatting, or twisting.
• Genetics: An inherited tendency can make some people more susceptible to developing OA.
• Bone Deformities: Being born with malformed joints.

Treatment and Management

There is no cure for osteoarthritis, but treatment focuses on managing symptoms, improving mobility, and slowing progression.

1. Lifestyle and Non-Drug Management (Core Interventions)

• Exercise: Regular physical activity, especially low-impact exercises (like walking, swimming, or cycling), strengthens muscles around the joint, which provides support and stability.
• Weight Management: Losing excess weight is one of the most effective ways to reduce stress and pressure on weight-bearing joints like the knees and hips.
• Physical and Occupational Therapy: Therapists can teach correct movement, provide personalized exercise programs, and recommend supportive devices (canes, braces, shoe inserts) to protect the joints.
• Heat and Cold Therapy: Applying heat (e.g., warm bath, heating pad) can relax muscles and ease pain; cold packs can relieve swelling and inflammation.

2. Medications

Medications are used to relieve pain, but they do not reverse the joint damage.

• Oral Pain Relievers:
  • Acetaminophen (Paracetamol): Often recommended first for mild pain.
  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Ibuprofen, naproxen, or stronger prescription NSAIDs can relieve both pain and inflammation.
• Topical Pain Relievers: NSAID gels or capsaicin creams rubbed onto the skin over the painful joint.
• Injections:
  • Corticosteroid Injections: Injecting a strong anti-inflammatory drug directly into the joint for short-term relief of pain and swelling.
  • Hyaluronic Acid (Viscosupplementation) Injections: Used primarily in the knee, this substance is intended to mimic natural joint fluid.

3. Surgical Options

Surgery is generally reserved for severe cases when other treatments have failed and the joint damage significantly impairs daily life.

• Joint Replacement (Arthroplasty): Replacing the damaged joint with an artificial one (e.g., total knee or hip replacement).
• Osteotomy: A procedure to cut and realign bones to shift body weight away from the damaged part of the joint.

Hepatitis

Hepatitis is a general term for inflammation of the liver. It is a serious global health concern that can be caused by viral infections, excessive alcohol consumption, toxins, certain medications, or an autoimmune disease.

The most common cause is a viral infection, specifically the five main strains of the hepatitis virus: A, B, C, D, and E.

1. Types of Hepatitis

Hepatitis is categorized into Viral and Non-Viral types.

Viral Hepatitis (A, B, C, D, E)

Type	Causative Virus	Transmission Route	Course of Illness	Prevention / Cure
A (HAV)	Hepatitis A Virus	Fecal-oral route (contaminated food/water, close contact)	Acute (short-term) only. Usually mild and resolves completely within a few weeks to months.	Vaccine is safe and effective.
B (HBV)	Hepatitis B Virus	Contact with infected bodily fluids (blood, semen, vaginal fluids) – often via mother-to-child during birth, sexual contact, or shared needles.	Can be Acute (most adults clear it) or develop into Chronic (long-term, lifelong) infection, leading to cirrhosis or liver cancer.	Vaccine is highly effective. Chronic infection is managed with antiviral drugs.
C (HCV)	Hepatitis C Virus	Contact with infected blood (primarily via shared needles, rarely via sexual contact, or mother-to-child).	Often develops into Chronic infection, leading to severe liver damage (cirrhosis or cancer) over time.	No vaccine (as of yet). Curable in most cases with Direct-Acting Antiviral (DAA) medications.
D (HDV)	Hepatitis D Virus	Contact with infected bodily fluids (similar to B).	Only occurs in people already infected with Hepatitis B. Dual infection with B and D is the most severe form of chronic viral hepatitis.	Hepatitis B vaccine prevents Hepatitis D.
E (HEV)	Hepatitis E Virus	Fecal-oral route (contaminated food/water).	Usually Acute and self-limiting, but can be very dangerous for pregnant women and people with weakened immune systems.	Vaccine available in some regions.

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Non-Viral Hepatitis

• Alcoholic Hepatitis: Liver inflammation caused by excessive and prolonged alcohol use. Can be reversible if alcohol consumption is stopped.
• Autoimmune Hepatitis: A chronic disease where the body’s immune system mistakenly attacks the liver cells, causing inflammation. It is managed with immunosuppressive medications.
• Toxic/Drug-Induced Hepatitis: Liver damage caused by exposure to certain medications (e.g., high doses of acetaminophen), toxins, or herbal remedies.

2. Symptoms

Many people with hepatitis, especially chronic hepatitis B and C, have few or no symptoms for many years. When symptoms of acute hepatitis (any type) do appear, they may include:

• Jaundice: Yellowing of the skin and whites of the eyes.
• Fatigue and malaise (general feeling of being unwell).
• Fever (often low-grade).
• Gastrointestinal distress: Nausea, vomiting, loss of appetite.
• Abdominal Pain: Discomfort or pain in the upper right quadrant (where the liver is located).
• Dark Urine and Light/Clay-Colored Stools.
• Joint pain.

Symptoms of chronic hepatitis (B, C, D) are often more subtle and may include signs of chronic liver disease, such as cirrhosis (scarring), which can manifest as swelling in the legs, easy bruising, or confusion.

3. Diagnosis and Treatment

Diagnosis

• Blood Tests: The primary method for diagnosis. They check for:
  • Liver Enzymes (ALT, AST): Elevated levels indicate liver inflammation/damage.
  • Viral Markers (Antibodies and Antigens): These detect the presence of the virus or the body’s immune response to a specific type of viral hepatitis (A, B, C, etc.) and determine if the infection is acute or chronic.
• Imaging Tests: Ultrasound or a specialized ultrasound (elastography) can assess the stiffness or scarring (fibrosis/cirrhosis) in the liver.
• Liver Biopsy: Removing a small tissue sample to determine the exact cause and extent of liver damage.

Treatment

Treatment varies greatly depending on the type and stage of the infection:

Type	Treatment Focus
Hepatitis A and Acute E	Supportive Care: Rest, proper nutrition, and hydration. The body usually clears the virus on its own.
Acute Hepatitis B	Supportive Care and Monitoring: Most adults clear the virus spontaneously. Antiviral treatment is rarely used unless the disease is severe.
Chronic Hepatitis B	Antiviral Medications: Drugs like tenofovir and entecavir are taken long-term to suppress the virus, slow liver damage, and prevent complications like cirrhosis and cancer.
Hepatitis C	Direct-Acting Antivirals (DAAs): Oral medications taken for 8-12 weeks that can cure the infection in over 90% of cases.
Non-Viral Hepatitis	Addressing the Cause: Abstinence from alcohol (alcoholic hepatitis) or stopping the causative drug/toxin. Autoimmune hepatitis requires immunosuppressive therapy.
Severe Liver Damage	Liver Transplant: May be necessary if hepatitis has led to irreversible liver failure or advanced, untreatable cancer.

Pneumonia

Pneumonia is an infection that inflames the air sacs (alveoli) in one or both lungs, which may then fill with fluid or pus. This can lead to symptoms like coughing, fever, chills, and difficulty breathing.

Here is a brief overview of the causes, symptoms, diagnosis, and treatment of pneumonia:

Causes

Pneumonia can be caused by various organisms:

• Bacteria (most common cause, e.g., Streptococcus pneumoniae)
• Viruses (e.g., flu, COVID-19, RSV, common cold viruses)
• Fungi (less common, usually affecting people with chronic health problems or weakened immune systems)

Symptoms

Symptoms can range from mild (sometimes called “walking pneumonia”) to severe and can vary depending on age and overall health. Common symptoms include:

• Cough (which may produce greenish, yellow, or bloody mucus)
• Fever, sweating, and shaking chills
• Shortness of breath
• Chest pain when breathing or coughing
• Fatigue and low energy
• Nausea, vomiting, or diarrhea
• Confusion or altered mental awareness (especially in older adults)

Diagnosis

A doctor will usually start with a physical exam and medical history. Diagnostic tests may include:

• Chest X-ray: To look for inflammation in the lungs.
• Blood tests: To confirm an infection and try to identify the germ.
• Pulse oximetry: To measure the oxygen level in the blood.
• Sputum test: To analyze mucus to pinpoint the cause of the infection.

Treatment and Prevention

Treatment depends on the cause of the infection:

• Bacterial Pneumonia: Typically treated with antibiotics. It is important to complete the entire course of medication.
• Viral Pneumonia: Usually improves on its own with rest and fluids. Antiviral medications may be used in some cases (e.g., for flu-related pneumonia). Antibiotics are not effective against viruses.
• Fungal Pneumonia: Treated with antifungal medications.
• General Care: Rest, drinking plenty of fluids, and taking medication (like acetaminophen or ibuprofen) for fever and pain are important for recovery.

Prevention strategies include:

• Vaccinations: Getting the yearly flu shot and the pneumococcal vaccine (recommended for children, adults over 65, and those with certain health conditions) can prevent some types of pneumonia.
• Good Hygiene: Frequent hand washing.
• Lifestyle: Not smoking, avoiding secondhand smoke, and maintaining a healthy lifestyle to keep the immune system strong.

If you suspect you or someone you know has pneumonia, it is important to see a healthcare provider for proper diagnosis and treatment.

Drug Abuse in Nigeria

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Drug abuse is a major public health and social challenge in Nigeria, with a high prevalence that surpasses the global average.

Based on the 2018 National Drug Use Survey by the United Nations Office on Drugs and Crime (UNODC) and the Nigerian government, the key issues are:

1. High Prevalence

• Overall Rate: The past-year prevalence of any drug use in Nigeria is estimated at 14.4% (or about 14.3 million people) among the population aged 15–64 years. This rate is significantly higher than the 2016 global annual prevalence of 5.6%.
• Demographics: Drug use is most common among people aged 25 to 39 years. While use is generally higher among men, the non-medical use of prescription opioids and cough syrups shows a less marked gender difference.
• Regional Variation: Higher prevalence rates are often found in the Southern geopolitical zones (South-East, South-West, and South-South) compared to the North.

2. Commonly Abused Substances

The most frequently abused substances include both illicit drugs and diverted pharmaceutical products:

Category	Primary Substances	Note
Cannabis	Marijuana, Indian hemp	The most commonly used illicit drug.
Opioids	Tramadol, Codeine, Morphine	The non-medical use of prescription opioids (especially Tramadol and Codeine) is a significant problem.
Cough Syrups	Codeine or Dextromethorphan containing syrups	Widely abused for their euphoric effects.
Stimulants	Cocaine, Amphetamines, Methamphetamine (“mkpurummiri”)	Methamphetamine abuse has been a rising concern, particularly in the South-East.
Others	Heroin, Solvents/Inhalants (e.g., glue), and other prescription sedatives (e.g., Rohypnol).

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The ease of obtaining prescription drugs without a doctor’s prescription from pharmacies and open drug markets contributes heavily to the pharmaceutical drug abuse crisis.

3. Socio-Economic Impact

Drug abuse has severe negative effects on Nigerian society and the economy:

• Health Burden: Increased rates of mental health disorders (depression, psychosis), HIV/AIDS, and Hepatitis C, particularly among people who inject drugs. Drug-related admissions often strain the capacity of psychiatric hospitals.
• Crime and Insecurity: Substance abuse is linked to higher rates of violent crimes, armed robbery, kidnapping, and domestic violence.
• Economic Cost: Significant losses in labor productivity and increased expenditure on healthcare and law enforcement. High rates of youth unemployment and poverty are often cited as underlying factors driving people into drug use or the illicit trade.
• Social Disintegration: Breakdown of family structures, social isolation, and pervasive stigma against drug users, which hinders seeking help.

4. Government Efforts and Challenges

The Nigerian government, through agencies and partnerships, is actively working to combat the issue:

• Key Agency: The National Drug Law Enforcement Agency (NDLEA) is the primary body responsible for enforcing drug laws, interdiction, and public awareness.
• Policy Framework: The National Drug Control Master Plan (NDCMP) provides a comprehensive strategy focusing on supply reduction, demand reduction, and access to controlled medicines.
• International Cooperation: Nigeria works with partners like the UNODC, the EU, and the US DEA for intelligence sharing, capacity building, and project implementation.

Major Challenges:

• Focus on Criminalisation: Nigeria’s drug policy historically has a strong focus on punishment and law enforcement, with limited funding and inadequate infrastructure for public health approaches like treatment and rehabilitation.
• Governance Gaps: Weak regulation and enforcement allow for the widespread illegal diversion of pharmaceutical opioids.
• Stigma and Underfunded Healthcare: Addiction is often seen as a moral or spiritual failure, leading to cultural stigma that discourages people from seeking medical treatment. Only a small percentage of tertiary hospitals offer specialized addiction services.
• Socioeconomic Drivers: High unemployment and poverty continue to push vulnerable populations toward drug use and the drug trade.

Some Common Psychiatric Illness in Nigeria

Depression

Depression, or Major Depressive Disorder (MDD), is a serious and common mood disorder that causes a persistent feeling of sadness and a loss of interest or pleasure in activities. It is a medical condition, not a sign of weakness, and it affects how a person feels, thinks, and behaves, leading to various emotional and physical problems.

The symptoms must last for at least two weeks for a diagnosis of MDD.

Common Signs and Symptoms

A diagnosis typically requires a person to experience a majority of the following symptoms, with at least one being a depressed mood or loss of interest:

Emotional/Cognitive Symptoms

• Persistent Sadness: Feelings of sadness, tearfulness, emptiness, or hopelessness.
• Anhedonia: Loss of interest or pleasure in most or all normal activities (hobbies, sex, sports).
• Irritability: Angry outbursts, frustration, or irritability, even over small matters.
• Negative Thoughts: Feelings of worthlessness, guilt, helplessness, or fixating on past failures.
• Concentration Difficulty: Trouble thinking, concentrating, making decisions, or remembering things.
• Suicidal Ideation: Frequent or recurrent thoughts of death, suicidal thoughts, or suicide attempts.

Physical/Behavioural Symptoms

• Sleep Disturbances: Insomnia (difficulty falling or staying asleep) or sleeping too much (hypersomnia).
• Fatigue: Tiredness and lack of energy, where even small tasks require extra effort.
• Appetite/Weight Changes: Reduced appetite and weight loss, or increased cravings for food and weight gain.
• Psychomotor Changes: Slowed thinking, speaking, or body movements, or, conversely, agitation and restlessness.
• Physical Aches: Unexplained physical problems like headaches, back pain, or digestive problems that do not respond to treatment.
• Social Withdrawal: Avoiding contact with friends, neglecting hobbies, and difficulty performing at work or school.

Types of Depressive Disorders

MDD is the most severe and common type, but others include:

• Persistent Depressive Disorder (Dysthymia): A chronic form of depression where symptoms are less severe than MDD but last for at least two years.
• Bipolar Disorder (Manic Depression): Involves episodes of depression alternating with periods of excessively high mood (mania or hypomania).
• Seasonal Affective Disorder (SAD): Depression related to changes in seasons, typically starting in the fall and continuing through winter.
• Perinatal Depression: Depression that occurs during pregnancy or in the weeks and months after childbirth (postpartum depression).
• Psychotic Depression: Severe depression accompanied by symptoms of psychosis, such as delusions or hallucinations.

Causes and Risk Factors

The cause of depression is complex and believed to be multifactorial, involving a combination of:

• Biological Factors: Changes in brain chemistry, particularly disruptions in neurotransmitters like serotonin, norepinephrine, and dopamine.
• Genetic Factors: Depression can run in families, suggesting inherited traits and gene-environment interactions play a role.
• Environmental/Psychosocial Factors: Severe early stress or trauma, chronic illness, substance use/abuse, and recent negative life events (e.g., divorce, financial loss, grief).
• Hormones: Changes in the body’s balance of hormones, such as those that occur during pregnancy, postpartum, or with thyroid problems.

Treatment Options

Depression is highly treatable, and the most effective approaches usually involve a combination of professional care:

1. Psychotherapy (Talk Therapy):
   • Cognitive Behavioral Therapy (CBT): Focuses on changing negative thinking patterns and behaviors to improve mood.
   • Interpersonal Therapy (IPT): Focuses on improving personal relationships and resolving interpersonal conflicts that contribute to depression.

1. 2. Medication:

1. • Antidepressants: These medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), work by adjusting levels of certain brain chemicals.

1. 3. Brain Stimulation Therapies (for severe or treatment-resistant cases):

1. • Electroconvulsive Therapy (ECT): Used for severe depression, especially when other treatments haven’t worked or when there is acute suicidality.
   • Transcranial Magnetic Stimulation (TMS): Uses magnetic pulses to stimulate nerve cells in the brain.

1. 4. Lifestyle Changes:

1. • Regular physical activity (exercise).
   • Maintaining a healthy diet and sleep schedule.
   • Avoiding alcohol and illicit drugs.
   • Building a strong social support system.

If you or someone you know is experiencing symptoms of depression, particularly thoughts of self-harm or suicide, it is crucial to seek professional help immediately.

Depression and Anxiety

The most common psychiatric illnesses in Nigeria, consistent with global trends, primarily include Depression and Anxiety Disorders.

However, other disorders are also highly prevalent and represent a major public health concern. The World Health Organization (WHO) estimates that about one in four Nigerians (nearly 50 million people) suffer from some form of mental illness.

Here is a breakdown of the common psychiatric morbidities in Nigeria:

1. Depression (Major Depressive Disorder)

Depression is one of the most frequently reported mental health conditions in Nigeria. It is characterized by persistent low mood, loss of interest or pleasure, and can lead to significant functional impairment.

2. Anxiety Disorders

Anxiety disorders, which include conditions like Generalized Anxiety Disorder (GAD), specific phobias, and social anxiety disorder, are very common. The high levels of economic hardship, insecurity, and social stressors in the country are often cited as contributing factors.

3. Substance Use Disorders

Substance abuse, particularly among young people involving drugs like cannabis, tramadol, and methamphetamine, is a significant and increasing problem. It is strongly associated with the incidence of psychosis and other mental disorders.

4. Psychosis/Schizophrenia

Schizophrenia and other psychotic disorders are commonly diagnosed, often representing the more visible and severe cases of mental illness that attract public attention. Untreated psychosis is a major factor in the high number of individuals with mental illness who are homeless.

5. Trauma-Related Disorders (e.g., PTSD)

Post-Traumatic Stress Disorder (PTSD) and other trauma-related conditions are a major burden, especially among individuals who have experienced conflict, violence, displacement (such as internally displaced persons or IDPs), and the general high level of insecurity across parts of the country.

Contributing Factors to the High Prevalence

The high incidence of mental illness in Nigeria is often linked to a complex interplay of factors:

• Socioeconomic Stressors: High rates of poverty, unemployment, economic hardship, and the pressure to succeed (the “japa syndrome” or desire to emigrate) contribute to chronic stress, anxiety, and depression.
• Insecurity and Conflict: Exposure to communal violence, armed conflict, and general insecurity leads to high rates of trauma and emotional distress.
• Lack of Access to Care: There is a severe shortage of mental health professionals (e.g., only about 250-350 psychiatrists for a population of over 200 million), inadequate infrastructure, and poor funding for mental healthcare.
• Stigma and Cultural Beliefs: Strong cultural and religious beliefs often attribute mental illness to spiritual causes, evil spirits, or possession. This leads many people to seek help from religious leaders or traditional healers instead of clinical professionals, which delays or prevents access to evidence-based treatment.

Neglected Tropical Diseases
Nigeria faces the highest burden of Neglected Tropical Diseases (NTDs) in Africa, with an estimated 100 million people at risk of at least one NTD and around 25% of Africa’s total NTD burden. These diseases cause significant morbidity, disability, and economic loss, disproportionately affecting the poorest and most marginalized populations, particularly in rural areas.

The country’s NTD control strategy focuses on both Preventive Chemotherapy (PC-NTDs) and Case Management (CM-NTDs).

Major Neglected Tropical Diseases in Nigeria

Nigeria is co-endemic for several NTDs, with the following five being the primary focus of national mass drug administration (MDA) programs:

Disease	Causative Agent	Burden/Prevalence	Primary Control Strategy
Schistosomiasis (Bilharzia)	Parasitic worm (Schistosoma species)	Highest global burden: Over 29 million people infected, 100 million at risk.	MDA with Praziquantel, improved sanitation.
Soil-Transmitted Helminths (STH) (Intestinal Worms)	Various parasitic worms (Hookworm, Roundworm, Whipworm)	High prevalence, especially among school-aged children.	MDA with Albendazole or Mebendazole, improved sanitation and hygiene.
Onchocerciasis (River Blindness)	Parasitic worm (Onchocerca volvulus)	One of the highest global burdens. Found in 478 Local Government Areas (LGAs) at risk.	MDA with Ivermectin (Mectizan), vector control (blackflies).
Lymphatic Filariasis (LF) (Elephantiasis)	Parasitic worm (Wuchereria bancrofti)	Endemic in most LGAs (over 500 mapped), with a large population at risk.	MDA with Ivermectin and Albendazole, Vector control (mosquitoes).
Trachoma	Bacterium (Chlamydia trachomatis)	Endemic in several northern states, with millions at risk of blindness.	SAFE strategy: Surgery, Antibiotics (MDA with Azithromycin), Facial cleanliness, Environmental improvements.

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Other Endemic NTDs (Case Management Focus)

These diseases are also present but are typically managed case-by-case due to the lack of tools for large-scale preventive treatment:

• Leprosy (Hansen’s disease): A bacterial disease leading to nerve damage and disability.
• Human African Trypanosomiasis (HAT) (Sleeping Sickness): Protozoan infection transmitted by the tsetse fly.
• Buruli Ulcer (BU): Bacterial skin infection (Mycobacterium ulcerans) causing chronic, destructive ulcers.
• Leishmaniasis: Parasitic disease spread by sandflies, with cutaneous forms endemic in some areas.
• Rabies: Viral disease transmitted through animal bites.

Control and Elimination Efforts

Nigeria’s Federal Ministry of Health (FMoH) manages the NTD program, collaborating with international partners (WHO, USAID, The Carter Center, Sightsavers, etc.) to implement control strategies.

1. Mass Drug Administration (MDA): The cornerstone of the strategy for PC-NTDs, involving the periodic, large-scale provision of free, donated medicines to at-risk populations.
2. Morbidity Management: Providing care, surgery, and rehabilitation for people with chronic effects of NTDs, such as lymphedema from LF, trichiasis (in-turned eyelids) from Trachoma, and wounds from Buruli ulcer.
3. Cross-Sectoral Collaboration: Implementing interventions that involve multiple sectors, such as:
   • WASH (Water, Sanitation, and Hygiene): Essential for controlling diseases like Schistosomiasis, STH, and Trachoma.
   • Vector Control: Strategies to reduce blackfly populations (Onchocerciasis) and mosquitoes (LF).
4. Successes:
   • Dracunculiasis (Guinea Worm Disease): Nigeria was certified free of this disease in 2013.
   • Transmission Interruption: Several LGAs have successfully interrupted the transmission of Onchocerciasis and Lymphatic Filariasis, achieving significant milestones towards elimination.

Key Challenges

Despite significant efforts, Nigeria faces several challenges that complicate the elimination of NTDs:

• Under-reporting: Cases, especially in remote rural areas, often go undocumented, masking the true burden.
• Poverty and Socioeconomic Factors: NTDs thrive in conditions of poverty, lack of access to clean water, and poor sanitation.
• Health System Weaknesses: Inadequate funding, limited infrastructure, and poor knowledge of NTDs among some healthcare workers hinder early diagnosis and effective case management.
• Myths and Stigma: Cultural beliefs linking NTDs to witchcraft or spiritual punishment often lead to delayed health-seeking behavior and resistance to MDA campaigns.
• Sustainability: Maintaining funding and political commitment for control

Filariasis in Nigeria

Filariasis in Nigeria represents a significant public health challenge, with the country bearing one of the highest burdens of the disease in Africa. The term “filariasis” encompasses several diseases caused by parasitic thread-like worms (nematodes) that are transmitted to humans by the bites of infected insects.

The two main types of filarial diseases prevalent and targeted for elimination in Nigeria are:

1. Lymphatic Filariasis (LF) – “Elephantiasis”

• Causative Agent: The parasite Wuchereria bancrofti (responsible for about 90% of LF cases globally and the only species found in Africa).
• Vector: Primarily mosquitoes, particularly species of Anopheles (which also transmit malaria).
• Prevalence: Nigeria is estimated to have the highest burden of LF in Africa, with an estimated 80 to 135 million people at risk of infection. The disease is widespread across the country.
• Clinical Manifestations:
  • Lymphedema/Elephantiasis: Marked swelling, thickening, and hardening of the limbs (usually legs, giving the disease its common name).
  • Hydrocele: Swelling and fluid accumulation in the scrotum in men.
  • Acute Attacks: Episodes of fever and painful inflammation of the lymph nodes and vessels (adenolymphangitis).

2. Onchocerciasis – “River Blindness”

• Causative Agent: The parasitic worm Onchocerca volvulus.
• Vector: The blackfly (Simulium species), which breeds in fast-flowing rivers and streams.
• Prevalence: Onchocerciasis is historically prevalent in many parts of Nigeria, which contributes a significant portion of the global burden. The disease is strongly associated with rural communities near riverine areas.
• Clinical Manifestations:
  • Severe Itching (Pruritus).
  • Skin Damage: Disfiguring skin conditions (dermatitis), skin thickening, and depigmentation (leopard skin).
  • Onchocercomas: Nodules under the skin where the adult worms reside.
  • Visual Impairment and Blindness: Caused by the migration of microfilariae (larvae) to the eyes.

3. Loiasis (African Eye Worm)

• Causative Agent: The parasitic worm Loa loa.
• Vector: Deer flies or mango flies (Chrysops species).
• Significance in Nigeria: While a distinct disease, loiasis is important in the context of filariasis control in Nigeria because it is co-endemic with onchocerciasis in many areas. Treating loiasis-infected individuals with Ivermectin (the main drug for onchocerciasis) can lead to serious, sometimes life-threatening, side effects (encephalopathy) if the Loa loa microfilaria load is very high. This complicates mass drug administration strategies.
• Clinical Manifestations:
  • Calabar Swellings: Localized, temporary, non-tender subcutaneous swellings.
  • Eye Worm: The adult worm can be seen migrating across the surface of the eye.

Control and Elimination Efforts

Nigeria has a National Neglected Tropical Disease (NTD) Programme that coordinates mass drug administration (MDA) campaigns with support from international partners.

• Strategy: MDA involves giving an entire community or region a combination of antiparasitic drugs annually for several years to eliminate the microfilariae and stop transmission.
• Drugs Used:
  • Onchocerciasis: Ivermectin (Mectizan), donated by Merck.
  • Lymphatic Filariasis: A combination of Ivermectin and Albendazole.
• Progress: Years of sustained MDA have led to a significant reduction in the prevalence and morbidity of both LF and onchocerciasis in many endemic areas of Nigeria, with some Local Government Areas (LGAs) having successfully stopped treatment. The goal is to eliminate these diseases as public health problems.

Buruli Ulcer (Popularly known as (Ota-ere in Igboland)

Buruli ulcer (BU) is an infectious, non-contagious neglected tropical disease (NTD) caused by the bacterium Mycobacterium ulcerans. It is endemic in Nigeria, but it remains largely a neglected and underreported disease, often leading to delayed diagnosis, severe complications, and permanent disability.

The disease is characterized by chronic, painless, and progressively destructive skin ulcers.

Prevalence and Endemicity

Epidemiological data on Buruli ulcer in Nigeria is rare and incomplete, primarily due to poor surveillance, lack of public awareness, and late consultation by patients who may attribute the lesions to spiritual causes or witchcraft.

• Geographic Distribution: Confirmed cases have been reported in several states, predominantly in Southern Nigeria. Endemic states and areas mentioned in studies include:
  • South-West: Ogun and Oyo States.
  • South-South: Cross River, Akwa Ibom, Delta, and Rivers States.
  • South-East: Anambra, Enugu, and Ebonyi States.
• High-Risk Areas: The disease is strongly associated with humid tropical regions, particularly near swampy, marshy, or flood-prone areas and slow-flowing rivers.
• Vulnerable Population: Like other African endemic countries, BU disproportionately affects children under 15 years of age in Nigeria, though it can affect all age groups.

Clinical Presentation

Buruli ulcer is the third most common mycobacterial disease globally, after tuberculosis and leprosy. The bacteria produce a toxin called mycolactone which causes local immunosuppression and tissue destruction.

• Early Signs (Pre-ulcerative): The disease often begins as a painless, localized swelling (papule, nodule, or plaque) or a firm, painless area of edema (swelling).
• Late Signs (Ulcerative): If left untreated, the lesion progresses into a painless ulcer with a characteristic undermined edge.
  • Lesions are most commonly located on the lower limbs (legs and feet) due to the proximity to the suspected environmental source of the bacteria.
• Complications: Late diagnosis and treatment can lead to:
  • Extensive Ulcerations
  • Osteomyelitis (bone infection)
  • Contractures (permanent tightening of muscle/skin, limiting movement) and disfigurement.

Diagnosis and Treatment

Early diagnosis and treatment are crucial to preventing disability.

• Diagnosis:
  • Clinical Diagnosis: Often based on the characteristic appearance of a painless ulcer with undermined edges, especially in endemic areas.
  • Laboratory Confirmation: The gold standard is Polymerase Chain Reaction (PCR) targeting the IS2404 sequence specific to M.\ ulcerans. This is the most sensitive method, though access to PCR testing can be limited in rural areas.
• Treatment: The World Health Organization (WHO) recommends an 8-week course of combination antibiotic therapy:
  • Rifampicin (daily)
  • Clarithromycin (daily) or Streptomycin (daily, though a shift away from streptomycin is preferred due to injection requirements and side effects).
• Management: Antibiotic treatment is combined with:
  • Wound Care: Thorough cleaning and dressing of the wound.
  • Surgery: May be required for debridement, excision of necrotic tissue, skin grafting for large ulcers, or contracture release.
  • Physiotherapy: To prevent or manage functional impairment and disability.

The Federal Ministry of Health in Nigeria, through the National Tuberculosis & Leprosy Control Programme (NTBLCP) and in collaboration with WHO and partners, continues to work on integrating BU management into the primary healthcare system to improve early detection and treatment access.

Poverty in Nigeria

Poverty in Nigeria is a significant and escalating challenge, with the country estimated to have one of the world’s largest populations living in extreme poverty. Multiple economic shocks, high inflation, and structural issues have reversed previous gains and deepened the crisis.

Poverty Statistics and Scope

Nigeria faces a high rate of both monetary and multidimensional poverty:

• Monetary Poverty: The World Bank estimates that almost half of all Nigerians (47%) are living in poverty in 2024, with approximately 45 million people falling into poverty since 2018/19.
  • This is often measured against the international extreme poverty line of $2.15 per person per day (2017 PPP).
• Multidimensional Poverty: As of the 2022 Multidimensional Poverty Index (MPI) report, 63% of the population (133 million people) are considered multidimensionally poor, meaning they suffer deprivations across health, education, and living standards.
• Spatial Inequality: Poverty is significantly more prevalent in the Northern geopolitical zones compared to the South. Rural areas are also disproportionately affected, with poverty rates nearly double those of urban regions.
• Vulnerable Groups: Children (67.5% of children are multidimensionally poor) and individuals without formal education are the most vulnerable groups.

Major Causes of Poverty

The persistent and growing poverty in Nigeria is driven by a combination of economic, political, and social factors:

• High Inflation and Economic Shocks: Rapidly increasing prices, especially for food, coupled with economic reforms (like the removal of fuel subsidies) and the aftermath of the COVID-19 pandemic, have eroded the purchasing power of households.
• Structural Economic Issues:
  • Over-reliance on Oil: The economy remains heavily dependent on the oil sector, which provides limited jobs for the large, youthful population.
  • Low Economic Diversification and Job Creation: The economy struggles to create enough productive jobs to absorb the millions of Nigerians entering the labor force each year.
• Insecurity and Conflict: Persistent insurgency (North-East), banditry, and farmer-herder clashes destroy livelihoods, displace populations, disrupt agricultural output, and deter investment.
• Poor Governance and Corruption: Widespread corruption at all levels of government undermines effective resource distribution and limits the impact of poverty reduction programs.
• High Population Growth: A rapid population growth rate often outpaces economic growth, straining national resources and development gains.
• Income Inequality: The benefits of what economic growth occurs are often not equitably distributed, widening the gap between the rich and the poor.

Government Poverty Alleviation Programs

The Nigerian government, through various administrations, has initiated programs aimed at poverty reduction, most recently under the National Social Investment Program (NSIP) and subsequent initiatives:

• Expanded Conditional Cash Transfer (CCT): Provides direct financial support (monthly stipends) to extremely poor and vulnerable households to cushion the effect of economic shocks. The current administration has planned to expand this to 15 million households.
• N-Power Programme: Aims to provide training, job placements, and stipends for unemployed graduates and non-graduates (ages 18–35).
• Government Enterprise and Empowerment Program (GEEP): Provides interest-free micro-credit to small business owners, artisans, and farmers through platforms like TraderMoni and FarmerMoni.
• Home-Grown School Feeding Program (HGSFP): Provides one free meal a day to primary school children, aiming to boost school enrollment and support local farmers.
• Recent Initiatives (Under President Tinubu): These include the Student Loan Scheme to improve access to education and the Presidential Compressed Natural Gas (CNG) Initiative to provide affordable public transportation following the removal of the fuel subsidy.

Despite these efforts, many programs have been critiqued for issues related to poor implementation, limited coverage, and lack of sustainability, which restrict their overall impact on systemic poverty.

The video below discusses the inflation crisis and its impact on the 129 million Nigerians estimated to be living in poverty. 129 Million Nigerians Living in Poverty: The Inflation Crisis Explored

129 Million Nigerians Living in Poverty: The Inflation Crisis Explored – YouTube

News Central TV · 895 views

 

Skin Cancers

Skin cancers in Nigeria present a distinct pattern compared to Caucasian populations, with a higher prevalence of aggressive types and major challenges in early diagnosis and treatment. While the overall incidence is lower due to protective melanin, the cancers are often more deadly because they are caught late.

Pattern and Types of Skin Cancer

Unlike in fair-skinned populations where basal cell carcinoma (BCC) is the most common type, studies from Nigeria show a different hierarchy:

Rank	Cancer Type	Key Characteristics in Nigerian Population
1.	Squamous Cell Carcinoma (SCC)	Most common type. Often arises from chronic wounds, burns, scars, or long-standing ulcers (Marjolin’s ulcers), especially on the lower limbs. It is also a major cancer in people with albinism.
2.	Malignant Melanoma (MM)	The most lethal form of skin cancer. It is often found on non-sun-exposed areas, particularly the soles of the feet (acral lentiginous melanoma), and has a very high mortality rate due to late presentation.
3.	Basal Cell Carcinoma (BCC)	Least common among the three major types in the general dark-skinned population, but its incidence is higher in sun-exposed areas and in individuals with albinism.

Key Anatomical Site: The lower limbs (legs and feet) are the most frequent site for skin cancers, contrasting with the head and neck predominance often seen in Caucasians.

Major Risk Factors

The risk factors in the Nigerian population are largely influenced by underlying health conditions and local environmental factors:

• Albinism: Individuals with oculocutaneous albinism (OCA), who lack protective melanin, have an extremely high risk of developing skin cancer, often at a younger age. Studies indicate a majority of skin cancers in albinos are BCCs and SCCs, and skin cancer is a leading cause of death for this group.
• Chronic Wounds and Scars: Chronic ulcers, untreated burns, and non-healing wounds are significant predisposing factors, particularly for Squamous Cell Carcinoma. This is a major source of non-solar-induced skin cancer.
• Trauma and Irritation: Repeated trauma or irritation to certain body parts, including pre-existing benign moles (nevi), is a common precursor for cancer development.
• Prolonged Sun Exposure: While melanin offers protection, intense tropical sunlight combined with outdoor occupations (like farming) is still a factor, especially in conditions that compromise the skin’s defense.
• Immunosuppression: Conditions such as HIV/AIDS increase the risk of certain skin malignancies, including Kaposi’s Sarcoma.

Challenges in Diagnosis and Treatment

Skin cancer outcomes in Nigeria are often poor due to systemic challenges in the healthcare sector:

1. Late Presentation: Most patients present with locally advanced or metastatic (Stage 3 or 4) disease. This is due to low public awareness, a tendency to initially seek help from traditional healers, and a lack of suspicion for skin cancer among patients and general practitioners.
2. Lack of Specialists: There is a critical shortage of specialized personnel, including dermatologists and pathologists, leading to a dermatologist-to-population ratio that is extremely low, particularly in rural areas.
3. Inadequate Infrastructure: Many health facilities lack the necessary diagnostic equipment (like dermoscopy) and advanced treatment options (like radiotherapy) for comprehensive cancer care.
4. High Cost of Care: Cancer treatment is extremely expensive, and the lack of comprehensive national health insurance forces patients to pay high out-of-pocket costs, often delaying or completely abandoning treatment.
5. Focus on Communicable Diseases: The healthcare system’s resources and priorities are historically focused on managing infectious diseases, leaving cancer control programs under-resourced and underdeveloped.

Meningitis in Nigeria

Meningitis in Nigeria is a major public health concern, primarily due to the country’s location within the African Meningitis Belt, a region stretching across the Sahel from Senegal to Ethiopia that experiences recurrent, large-scale epidemics.

Geographic and Seasonal Context

• Meningitis Belt: All states in Northern Nigeria, including the Federal Capital Territory (FCT), lie within this belt. This region is highly prone to seasonal meningitis outbreaks.
• Epidemic Season: Outbreaks typically occur during the dry season (roughly December to June), peaking around March and April. The low humidity, high dust levels, and cold nights during this period are thought to facilitate the spread of the causative organisms.
• Vulnerable Population: Infants, children, and young adults are the most severely affected, and survivors often face permanent, debilitating complications like hearing loss, seizures, or other neurological disorders.

Causative Agents and Epidemiology

The most common causes of bacterial meningitis in Nigeria include:

1. Neisseria meningitidis (Meningococcus): The primary cause of large epidemics. Historically, Serogroup A (NmA) was dominant, but the introduction of the MenAfriVac® conjugate vaccine targeting NmA in the 2010s led to a dramatic reduction in NmA cases.
2. Serogroup Replacement: Following the NmA vaccination campaigns, there has been an emergence and increase in outbreaks caused by other serogroups, notably Serogroup C (NmC) and Serogroup W (NmW). For instance, recent outbreaks have been driven by NmC and NmW.
3. Streptococcus pneumoniae (Pneumococcus): This is a significant cause of Pediatric Bacterial Meningitis (PBM), with some surveillance data showing it to be the predominant pathogen in children under five years old.
4. Haemophilus influenzae: Also a major cause of PBM, although its incidence has declined in areas with routine use of the H. influenzae type b (Hib) vaccine.

Recent Outbreaks and Vaccination Efforts

Nigeria frequently mobilizes a national and international response to outbreaks, which highlights both progress and ongoing challenges:

• Recent Outbreaks (e.g., 2024-2025): The country has faced significant outbreaks, particularly in the Northwest (Kebbi, Sokoto) and other states, with the majority of confirmed cases often due to Serogroup C or W.
• New Vaccine Deployment: Nigeria was the first country to receive the Pentavalent Meningococcal Conjugate Vaccine (Men5CV) from the global stockpile in 2024 to combat the circulating serogroups C and W. This new generation of vaccine provides protection against five serogroups (A, C, W, Y, and X), offering a more comprehensive long-term solution.
• Reactive Campaigns: Most vaccination efforts are reactive, meaning they are implemented in response to a confirmed outbreak, often targeting the most affected age group (e.g., 1–29 years). The goal is to rapidly break the chain of transmission.

Challenges in Control

Despite significant efforts, controlling meningitis remains difficult due to several factors:

• Serogroup Replacement: The emergence of new dominant serogroups after mass vaccination against a single strain necessitates the rapid development and deployment of broader-spectrum vaccines.
• Vaccine Access and Cost: Multivalent conjugate vaccines can be expensive, and ensuring they are consistently available and equitably distributed, especially in rural areas, remains a hurdle.
• Diagnosis and Surveillance: There is an ongoing need to strengthen surveillance systems to detect outbreaks early, improve laboratory capacity for rapid pathogen identification, and address the underreporting of cases.
• Poor Health Seeking Behavior: Many community members initially mistake meningitis symptoms for other common illnesses like malaria (due to fever and headache), leading to a crucial delay in seeking specialized care, which is vital for survival.
• Infrastructure: Limited health infrastructure can complicate rapid response and case management during large-scale epidemics.