Epidemics and Burden of Inefficiency

Epidemics and Burden of Inefficiency

By Ibrahim Musa


The recent outbreak of the cerebrospinal meningitis in some part of Nigeria came with superimposed idiosyncrasies. The authorities are playing hide-and-seek with the situation in their desperate desire to protect the country’s hosting right of the next world youth football championship. This probably stemmed from their previous experience with the FIFA technical committee which stripped  Nigeria of the similar hosting right in 1995 due to reasons bordered on the poor handling of the worst ever outbreak of cholera and meningitis in the world at that period. The way some state Governments turn frantic in demolition any visible structures on the road sides, sending many small businesses packing without contingency arrangement; laboring hard in their desire to impress in vain smacks of carelessness. Who are we trying to impress when meningitis has already denuded our population defense barrier? This dreadful epidemics caused by an organism called Nesseria meningitides has a long history of unholy romance with the African continent. It tends to occur almost at an interval of ten years.

  Meningitis is endemic to Africa but actually it was not indigenous to Africa . It invaded the so called ‘ Dark Continent ’ during the Anglo Egyptian war. It came to places like Timbuktu , Kano , forming what is known today as ‘meningitis belt’, an area that stretches from the Senegal in the west coast to Ethiopia in the east with population of about 300 million. The disease which has a very high case fatality ratio and devastating residual neurological complications ought to have been nipped in the bud. Predictably the epidemics occur during the dry season, between November and June, peaks usually in April and may suddenly stop with the first or second rainfall. It has been argued that climate and social habits favor the transformation of a seemingly indolent organism that many people (10% to 25%) harbor in the nasopharynx, into a deadly infection which is spread through sneezing, coughing, kissing, sharing spoons or cigarettes, overcrowding in poorly ventilated rooms etc.

 

 The symptoms may include headache, fever, photophobia, convulsions and neck stiffness. The most subtle presentation is the one whereby the patient will complain of fever alone which may ordinarily be mistaken for malaria only for the patient to die few hours after taking the antimalarial medications as a result of misdiagnosis.

 

 The disturbing thing about all this unfortunate development is our recurrent near total failure as a nation and artificial lack of capacity to confront things of such magnitude squarely by the head. Understandably the global production of CSM vaccines is low due to rationing by the WHO, however, why would a serious country allow its people to be caught in the web of epidemics unawares? There were no genuine health education campaigns in the media at the outset of the present precarious situation. No any attempt for health promotions in the communities. Enhanced epidemiological surveillance and prompt case management was almost zero, talk less of mass immunization of the districts that are in an epidemic phase as well as the contiguous districts that are in the alert phase. What a government we have that can boast of securing only 1.5 million vaccines for population of 140 million!

 

Of course no one is in a doubt that the polysaccharide vaccine is not without shortcomings as it does not provide herd’s immunity and can not be used in children less than two years. If we can not provide enough vaccines because of logistics and our poor preparedness, what reason do we have not to distribute Rifampicin, a drug used as prophylaxis for the people at risk? This drug is cheap and relatively available. Some times I ask myself if all this could be a pointer to the fact that our leaders are seriously sick in the head. Health, they say, is wealth and needs to be treasured. Alas! the story is different with us; we always trivialize vital events and overemphasize useless things. I don’t know why we could not take advantage of the immunization plus days for polio to mass vaccinate the communities against meningococcal meningitis.  Media organizations do not consider it prime enough to deserve a front page caption when 5323 people have been reported to have had the disease with 333 deaths according to the official figures. Why should the media waste a page for news that is not value worthy in monetary gains? How do you expect broadcast outfits to devote a chunk of air time meant for entertaining audience with the latest tracts of ‘Tu Face’, p square or ‘sangaya’, to a boring health talk? They would rather allocate time for political jingles and brigandage. Do you expect something like this to happen even in Niger republic not to talk of developed nations? Wonders will never end in this country! While meningitis is ravaging our people daily, the ill-informed members of the Senate were busy debating Lassa fever. I am not saying Lassa is not important but why not debate the two cases together, because isolating one is tantamount to saying the other group should go to hell and die. Lassa fever is presently only in Abuja and Nassarawa state and the population at risk is the occupants of the high brow capital city; (dis)honorable members inclusive. Probably that was why they rushed to compel the Executive to pay serious attention to it for their selfish interest. It really sends a wrong signal.

 

  During periods like this, one would expect significant input from professional organizations like Nigeria Medical Association (NMA) and relevant sister associations. Their voice ought to be heard and they should utilize such period to display unwavering commitment to the nation. They should copy from the Nigerian Bar Association, which always take a stand on issues pertaining to elections and state of the nation. This battle can not be won just by prescribing drugs in the consulting rooms and ignoring much larger problem outside. At a stage like this complacency is akin to conspiracy. There is a need to be more proactive and vigilant.

Riga kafi yafi magani!

 

NB: This article was published in Dailytrust newspaper in May 2009.