Health

By Umar Sani Adamu

Poverty has far-reaching consequences on various aspects of society, including health, education, and social structure. Understanding these repercussions is crucial for addressing the root causes and developing effective strategies to alleviate poverty and its associated issues.

1. Health

Poverty significantly impacts health outcomes. Limited access to nutritious food, clean water, and adequate healthcare services contributes to a higher prevalence of malnutrition, infectious diseases, and chronic conditions among the impoverished. Lack of resources often results in substandard living conditions, exposing individuals to environmental hazards. Additionally, stressors associated with financial insecurity can lead to mental health issues, further exacerbating the overall health burden.

2. Education

Poverty creates barriers to educational attainment. Families struggling with economic hardships may prioritise immediate needs over investing in education. Children from impoverished backgrounds often face challenges such as inadequate access to quality schools, resources, and educational support. Limited access to books, technology, and extracurricular activities hinders their development. As a result, the cycle of poverty continues, as these individuals may find it challenging to break free from their circumstances through education.

3. Social Structure

The social fabric of a community is intricately linked to economic well-being. Poverty can contribute to the fragmentation of social ties as individuals grapple with the stress and uncertainty of their circumstances. Communities with high poverty rates may experience increased social inequality and a lack of social cohesion. This can manifest as reduced community engagement, weakened support networks, and a diminished sense of belonging.

4. Crime

Poverty is often identified as a significant factor contributing to crime. Several mechanisms explain this relationship. Firstly, individuals in poverty may resort to criminal activities as a means of economic survival. Limited opportunities for legitimate employment can lead some to engage in illegal activities to meet basic needs. Additionally, impoverished communities may experience higher rates of substance abuse, which can further contribute to criminal behaviour.

Furthermore, the lack of access to quality education and limited social support in impoverished areas can result in a higher prevalence of delinquency. The frustration and hopelessness stemming from persistent poverty may lead individuals, particularly young people, towards criminal behaviour as an alternative to breaking free from their challenging circumstances.

Addressing the Link Between Poverty and Crime

A multi-faceted approach is necessary to mitigate poverty’s impact on crime. Policies to reduce poverty through economic empowerment, education, and healthcare access are crucial. Investments in education, vocational training, and job creation can provide individuals with opportunities to escape the cycle of poverty and reduce the likelihood of resorting to criminal activities.

Social support programs that strengthen community bonds, mental health services, and addiction rehabilitation can address some of the root causes of criminal behaviour associated with poverty. Additionally, targeted efforts to improve law enforcement-community relations and reduce systemic inequalities can contribute to crime prevention.

In conclusion, poverty has profound consequences on health, education, and social structure, with a direct link to increased crime rates. Breaking this cycle requires comprehensive strategies that address the systemic issues contributing to poverty and simultaneously provide individuals and communities with the tools and resources needed for positive transformation.

Umar Sani Adamu (Kawun Baba) wrote via umarhashidu1994@gmail.com.

By Uzair Adam Imam 

Dr. Tosan Erhabor, the Registrar of the Medical Laboratory Science Council of Nigeria (MLSCN), disclosed that a staggering 10,697 medical laboratory scientists have left the country, with 4,504 departing in 2023 alone. 

The brain drain, attributed to various factors, has prompted the Federal Ministry of Health to devise a policy aimed at regulating the migration of Nigerian health workers. 

Dr. Tosan Erhabor expressed his concern about the exodus of medical laboratory scientists during an interview with the News Agency of Nigeria (NAN).  

He highlighted the urgent need for a comprehensive policy to address the root causes of migration and establish regulatory measures. 

“The total number of medical laboratory scientists that have migrated is 10,697,” Dr. Erhabor stated.  

He further revealed that the Federal Ministry of Health is actively working on a policy framework that would govern the migration of health professionals and potentially curb the alarming trend. 

To alleviate some of the challenges faced by health professionals, Dr. Erhabor shared that the government has initiated a review of the hazard allowance for health workers.  

Additionally, considerations are being made to review the minimum wage and other allowances specific to health professionals. Dr. Erhabor underscored the importance of creating a safe and conducive work environment as a crucial factor in stemming the tide of brain drain within the medical laboratory science field. 

The reasons behind the migration, as outlined by Dr. Erhabor, are multifaceted. He cited poor remuneration, uncertainties in career progression within teaching hospitals, the pursuit of education abroad, the desire to acquire new skills, and enhanced professional status as contributing factors. 

Moreover, the security situation in the country, inadequate infrastructure, and a lack of modern equipment have prompted many professionals to seek opportunities abroad. 

The rising cost of living emerged as a critical factor, with Dr. Erhabor noting that it has become practically impossible for the average medical laboratory scientist to provide basic care and quality education for their children. 

The preferred destinations for these migrating scientists are reportedly the United Kingdom, the United States, and Canada, reflecting the global appeal of these nations for professionals seeking opportunities and a conducive working environment. 

As the healthcare sector grapples with this significant challenge, the MLSCN and relevant authorities are urgently working towards implementing effective policies to retain and incentivize medical laboratory scientists within Nigeria. 

The alarming departure of over 10,000 medical laboratory scientists from Nigeria in 2023 has prompted the MLSCN to call for swift policy interventions.  

With a multitude of factors contributing to the brain drain, the urgency to address remuneration, career uncertainties, and infrastructural challenges is crucial to retaining and attracting skilled health professionals within the country.

By Aliyu Nuhu

I saw a post by a friend advising people not to check their symptoms on internet and should go to hospitals for all their complaints. He was partially correct, but wrong in underestimating the power and importance of internet-based knowledge.

Medicine recognizes home treatment for non emergency medical conditions. But there is a caveat that you should consult a doctor if symptoms persist or get worse.

Always remember that doctors themselves know a lot about their speciality, but they also know little in a vast ocean of knowledge in other fields of medicine. You can know better than them if you choose to read.

My son was given about fifteen medications to take after heart surgery. But because I have knowledge of the disease and drug options,I was able to engage the doctor and at the end the drugs were reduced to four. Take note that I did not reduce the medication on my own. I only used my knowledge of pharmacy to engage the doctor and get him to reduce them himself. Some of the drugs were to be taken for few weeks and to be discontinued. Some were doing the same job and one of them has to go. Some were to alleviate symptoms, and if the child didn’t have the symptoms what was the need for them? Some were for pains from surgery and if the wound was healed there was no need for them. I once educated a doctor for asking a child to take calcium for bone strength, but he obviously didn’t know that the body would need vitamin D to successfully process calcium. Medicine is so vast that doctors must also read the internet to keep abreast.

There are treat-at-home symptoms you can learn from internet. I successfully treated myself for common illnesses through internet and over the counter medications. Why should I for instance go to hospital to treat nail fungus? You are your own best doctor. Arm yourself with knowledge before approaching your doctor.

There are symptoms that you know you need professional help. You know the red flags for potentially life threatening symptoms. When you can’t breathe you don’t need anyone to tell you to rush to get medical help at the hospital. When you have severe headache and other symptoms you never had before you should know that you need an immediate medical emergency.

I know when to see a doctor. The important thing for you is to also know when to see your own doctor. Even when meeting with my doctor, my vast knowledge of medicine prepares me for drug options and procedural choices. Internet makes you even choose the right doctor. If you have blood in your urine check for the possible causes. The regular GP may not detect if your condition is postate cancer. Oncologist knows what other tests to do and confirm if you have the condition. If you have shortness of breath, painful arm, etc, the cardiologist is the person that will know that you need angiogram to know if there is blockage in the circulatory system.

We have good doctors no doubt but always know that we have imposters, some that did not even read medicine in the university. Our hospitals are populated with half-baked professionals that only knowledge could save you from their deadly mistakes.

A whole teaching hospital treated a relative of mine for cerebral malaria when she actually had tuberculosis of the spine. My son was diagnosed with truncus ateriosis when in actual fact he had tetralogy of fallot. Without internet I would have been lost. However, a careful check gave me better understanding of the symptoms and led me to the right laboratory that identified the right disease. Internet led me to the right doctors abroad.

It will be suicidal just to rely on doctors without having elementary knowledge of your symptoms and treatment options. Drugs have side effects and also, interaction issues with other drugs or foods. If you don’t read you won’t know. Your doctor is human and has many patients and will not have time to educate you. Educate yourself. Knowledge is not only power, but in medicine it can be a life-saver.

Aliyu Nuhu writes from Abuja, Nigeria.

By Alhaji Musa Muhammad 

The more you have been infected with kidney failure, the more you will come to the mind of the people: “You are finished”. Others take you as a corpse just walking before its last breath.

Hadejia, the area with a number of such cases, is still facing the problem without knowing its root causes. However, there was a time when one of the presenters (name withheld), during a campaign awareness, warned vegetable/fish farmers to avoid using pesticides and herbicides on direct fruits, for example, eggplants.

He said there was a time when he saw a  farmer spraying his eggplant farm and asked him why he was pouring it. The farmer replied yes, I’m spreading it for every fruit to rip simultaneously. The Dr said are you not afraid the chemical will affect the consumers? The farmer replied, ‘I’m not the one who consumed it”.

Efforts have been made by some politicians, especially former senator Ibrahim Hassan, to take urgent action to tackle the spread of the disease. Unfortunately, there is no remarkable feedback about the different gatherings held on the kidney problem in the area.

Community-based organisations have done a lot in organising sensitisation meetings in collaboration with health practitioners, but the community members are still witnessing the increase in the problem.

One thing to be done regarding the kidney problem is the need for the government to take urgent action and mobilise the environment on the causes of the disease.

I must commend the effort and struggle of Dr Isah Billami during his tenure as chairman of Hadejia Ina Mafita to organise a town meeting to learn the solution to the problem. However, there was no positive feedback on the issue.

Our politicians range from the council chairman, members representing Hadejia at the state House of Assembly, senators representing Jigawa Northeast and the Governor at large; your response is highly needed now.

Allah ya kawo mana dauki , Ameem .

Alhaji Musa Muhammad wrote from Hadejia, Jigawa State.

By Lawal Dahiru Mamman

It is not uncommon to see destitute in motor parks, religious centres, T-junctions and other places that pull crowds clutching a doctor’s prescription, soliciting public support to purchase drugs.

Others plead not to be offered money but instead be accompanied by any good samaritan to the nearest pharmaceutical outlet to purchase the medication on their behalf. This is to free them from the accusation of preying on public emotion to beg for money without any justifiable reason.

These are indications that a number of Nigerians cannot afford drugs to treat themselves owing to the fact that healthcare is predominantly financed by households, without government support. According to pundits, this, among other factors, has been instrumental in pushing many citizens into poverty.

In 2021, the World Health Organization (WHO) said, “Up to 90 per cent of all households incurring impoverishing out-of-pocket health spending are already at or below the poverty line – underscoring the need to exempt poor people from out-of-pocket health spending, backing such measures with health financing policies that enable good intentions to be realised in practice.

“Besides the prioritising of services for poor and vulnerable populations, supported through targeted public spending and policies that protect individuals from financial hardship, it will also be crucial to improve the collection, timeliness and disaggregation of data on access, service coverage, out-of-pocket health spending and total expenditure.

“Only when countries have an accurate picture of the way that their health system is performing can they effectively target action to improve the way it meets the needs of all people.”

WHO revealed during the 6th Annual Conference of the Association of Nigeria Health Journalists (ANHEJ) last year in Akwanga, Nasarawa State, that “With healthcare out-of-pocket expenditure at 70.5 per cent of the Current Health Expenditure (CHE) in 2019, general government health expenditure as a percentage of the GDP was 0.6 per cent while government expenditure per capita was $14.6 compared with WHO’s $86 benchmark for universal health coverage (UHC).”

Nigeria currently bears the highest burden of tuberculosis and paediatric HIV while accounting for 50 per cent of neglected tropical diseases (NTD) in Africa, contributing 27 per cent of global malaria cases and 24 per cent of global deaths with Non-communicable Diseases (NCDs) accounting for 29 per cent of all deaths in Nigeria with premature mortality from the four main NCDs (Hypertension, Diabetes, Cancers, Malnutrition) accounting for 22 per cent of all deaths.

On account of the high disease burden, high out-of-pocket health expenditure and low enrollment into the NHIS, now National Health Insurance Authority (NHIA), the Federal Ministry of Health and Social Welfare has unveiled operational guidelines for the NHIA to ensure financial access to quality healthcare in line with Sustainable Development Goals, (SDGs), consequently putting the country on track of attaining Universal Health Coverage (UHC).

The Ministry said, “High out-of-pocket payment for health care services is not good enough, and it is not sustainable. Only 9 per cent of Nigerians have insurance coverage, and 90 per cent don’t.

“Ill health is pushing many Nigerians into poverty. We must, therefore, change the trajectory of healthcare delivery in Nigeria.

“Many people have wondered why the President added social welfare to the Ministry of Health. The answer is health insurance. Health insurance is the key to the Renewed Hope Agenda, and it is the reason the President added social welfare to the Ministry. This is because the President is aware that we need social protection for our people.”

The guideline, which harmonised crucial provisions of the old operational guidelines with the new Act, provided a legal basis for mandatory participation by all Nigerians, the Vulnerable Group Fund (VGF) for citizens who are able to service their insurance after keying-in and empowered the NHIA to promote, regulate and integrate health insurance schemes in the country among other provisions of the Act so as to contribute to poverty reduction as well as socioeconomic development.

The review expanded the operational guidelines from four to five. The first section, Governance and Stewardship, provides, which was not part of the previous guideline, a broad overview of the roles and responsibilities of the NHIA and stakeholders within the insurance ecosystem.

The second section, schemes and programs, identified contributory, non-contributory and supplementary/complementary schemes to ensure the capturing of public and private sector employees, a vulnerable group including those not captured in the National Social Register (NSR) by pooling resources from government, private sector, philanthropist and even international organisations.

Standards and accreditation, which is the third section, will focus on bringing health workers, health facilities and equipment, and patients under one roof for the meticulous running of the NHIA.

The fourth section of the operational guidelines, data management, allows the NHIA to provide and maintain information for the integration of data health schemes in Nigeria. Such data will allow collaboration data sharing between facilities, medical audits, and research and aid seamless decision-making for the authority.

Offences, penalties and legal proceedings, which is the last of the guidelines, ensures stakeholders’ compliance with the provision of the NHIA and provide a legal instrument for the investigation of grievances and disputes between stakeholder in accordance with protocols of the NHIA.

Implementation of this effort by the Health Ministry will make Nigerians worry less about the financial consequences of seeking medical care, providing avenues for early detection and treatment of diseases, which in turn will guarantee a healthy citizenry and increase population health outcomes for national growth and sustainable development.

Lawal Dahiru Mamman writes from Abuja and can be reached via dahirulawal90@gmail.com.

By Abdullahi Adamu

THE rot in federal and state institutions is taking a toll on the hostels and most especially in the national ivory towers.

Besides being overcrowded, many of the hostels lack basic amenities. Investigation in some public high
institution across the country revealed that many of the hostels were filthy as the taps in the toilets and
bathrooms were dry. Most of the taps are only there as decorations, and some of them have never worked for once. They never dropped a single drop of water since their installation.

As an undergraduate, back then, taking one’s bath in the bathroom or even easing oneself in the toilet
was usually a hurdle because of the sanitary conditions of the facilities. Even though there were porters
who came daily (apart from Sundays) to clean, the high number of persons using the facilities coupled
with the water situation was a major challenge. Also, some of the few staff, who sometimes do their best, leave the place at the hands of the killer viruses and bacteria around.

“Due to the limited number of students which the available hostel spaces could cater for, we found ourselves in a situation where a room that is originally meant for four students was being shared by eight students – that is to say, each of the legal and bonafide occupants had a “squatter”. This is in addition to students living off campus who also had to share the same facilities as there were none (toilets) around the lecture theatres – a number that is far beyond the projection at the inception – effectively making it almost impossible for the toilets to be neat.” in many tertiary institutions across the country. The nasty situation in hostels in many tertiary institutions leaves a sour taste in the mouth.

A student in IMO state University said the situation has worsened to the extent that some students take
their bath outside the bathrooms due to long queues and the ugly scene inside.

Another factor which leads to this unhygienic and ugly conditions of the toilet facilities in our public high institutions is the crude and improper usage by the students. Most of the students in Nigeria campuses throw away their internal dirt and defecate like uncivilized people.

For the girls’ hostel, it is also another nightmare. Most girls defecate and urinate in plastic or rubber containers, then empty it into the toilet to avoid contracting infections. Even at that, the toilets are not a place to even visit for any reason, unless when it is the last and only option.

It is more comfortable for me to defecate inside the bush along the post-graduate school to avoid
contracting any disease or foul smell of the school’s toilets.”, one postgraduate student said. Despite fee increasing and enormous internally generated revenues (IGR), including subventions from the
federal and state government amounting to billions of Naira, sanitary conditions of toilets across hostels
in Nigeria universities is appalling. May be this is why almost all our toilets across the country look so bad and unkempt. This is place where knowledge and morals are expected to be, but even the basics of a healthy and decent life are completely absent. No wonder!

Abdullahi Adamu can be reached via; nasabooyoyo@gmail.com

Dr. Ismail Muhammad Bello

Beyond hospital settings, harmful practices persist, particularly in developing countries where obtaining drugs over the counter is prevalent, and drug vendors may lack comprehensive knowledge of medications and diseases. From Penicillin to Ceftriaxone, these precious drugs, which require protection, can be obtained without prescriptions, posing a significant threat.

The ease of access to drugs has paved the way for self-treatment or “chemist” consultations, fostering malpractices. Again, a frequent occurrence is the prescription of antibiotics for the common cold. Research indicates that the common cold is predominantly caused by viruses, which are not responsive to antibiotics. It is a self-limiting condition that can be managed with measures such as steam inhalation, antihistamines like loratadine, and decongestants.

Similar to the common cold, most cases of sudden onset of watery stool, not stained with blood or mucus, with or without vomiting, are often of viral origin. This is typically a self-limiting condition that usually does not require antibiotics. In the management of diarrhoea, especially in children, the primary focus is on fluid therapy using Oral Rehydration Solution (ORS). Drug treatment is seldom beneficial, and antidiarrheal (antimotility) drugs can be harmful. Unfortunately, many individuals quickly resort to taking Flagyl, Loperamide, or Lomotil at the onset of diarrhoea.

However, bloody or mucoid stool, high fever, severe abdominal pain and prolonged diarrhoea are pointers to more serious conditions that may warrant antimicrobial use and should be quickly evaluated by a qualified doctor. In such instances, the use of antimotility agents is highly discouraged as it could lead to catastrophic outcomes like bowel perforation.

Another problem that continues to fuel this issue is the widespread and perplexing “Malaria-Typhoid diagnosis.” The lack of clinical skills needed to appropriately discern acute febrile illnesses coupled with excessive reliance on the outdated Widal test is driving an alarming prevalence of this peculiar diagnosis. 

Most cases exhibit a sudden onset of high-grade intermittent fever with chills and rigours, particularly worsening in the evening. This is usually associated with generalized body weakness and pain, with no symptoms attributable to the gastrointestinal system (abdomen). In a region and time where malaria is quite prevalent, this most likely suggests a simple case of Uncomplicated Malaria that should be managed as such. Strangely in our setting such cases are quickly subjected to not only Malaria but also Widal (Typhoid) tests at the request of a healthcare worker or even on self-referral.

Numerous studies have consistently demonstrated that the Widal test lacks high specificity, particularly in endemic zones such as ours, where repeated exposure to the bacteria is prevalent. Cross-reactivity with various diseases, including Malaria—a frequent cause of fever in Nigeria—and challenges in interpretation further restrict its reliability as a diagnostic indicator. 

It is therefore evident that the indiscriminate demand for the Widal test is causing the over-diagnosis of Typhoid fever, leading to the inappropriate use of antibiotics. 

This practice has also led to the wrong notion of “chronic symptomatic typhoid” among gullible persons. Typhoid fever is not in the league of HIV & Hepatitis B. Infection in typhoid does not endure indefinitely but could recur, especially when the underlying risk factors like unsafe water and poor hygiene persist. 

Chronic carriers do exist but are typically asymptomatic, holding more significance for public health due to their ongoing shedding of bacteria in their stool, a phenomenon reminiscent of the famous story of Typhoid Mary. Hence, statements like “Typhoid dina ne ya tashi” (I have a flare of a longstanding typhoid infection) and “Typhoid dina ne ya zama chronic” (I have a chronic typhoid infection) are grossly inaccurate.

While not antibiotics, antimalarials, unfortunately, face their fair share of misuse. A prevalent mispractice involves the irrational use of injectable antimalarial drugs such as IM Arthemeter and even the almighty Artesunate. Nowadays, individuals often opt for injections, citing reasons like “I prefer not to swallow pills” or the perception of faster and more effective results. The most concerning scenario occurs when the condition is misdiagnosed as Malaria, especially in many “chemist” settings. This not only entails misuse but also results in economic waste, unnecessary stress, and the potential risks associated with injections.

Regrettably, injectable antimalarials are meant for treating severe forms of malaria, which someone walking into a chemist likely does not have. This is akin to deploying elite special forces for a minor crime. These forces should be mobilized only for significantly heightened threats or when the situation surpasses the capacity of initial responders.

Recommendations: The government plays a crucial role in this battle. Policies and regulations must be established to ensure the optimal utilization of these drugs. To address our persistent issue, these policies should not remain mere documents in offices but must be strictly enforced, with penalties imposed on those who violate them. These regulations should encompass various aspects, including the use of antibiotics in veterinary practice and food production, as well as proper oversight of the opening and operation of patent medicine stores.

Prevention is certainly better than cure. Tackling infectious diseases at the primary level is more impactful and cost-effective. The COVID-19 pandemic has underscored the significance of Water, Sanitation and Hygiene (WASH) in disease transmission & control. Hand hygiene, a practice widely adopted in 2020, stands out as the most crucial measure to prevent the spread of infections. Therefore it is crucial to provide communities with access to potable water and sufficient sanitary infrastructure to forestall the spread of these diseases in our society.

In managing most infections, a standardized treatment guideline outlines the specific drugs, their timing, and proper usage. You might be intrigued to discover that many practitioners may not even be aware of a specific Nigeria Standard Treatment Guideline document or other guidelines for various medical conditions.

In the absence of a local protocol, variations in management may arise among colleagues due to diverse backgrounds and training. Nowadays, particularly in secondary healthcare, many learn primarily through apprenticeship without referring to standards or understanding the rationale behind certain “innovative” practices. Unfortunately, what one is accustomed to may be incorrect and potentially harmful, or at best suitable only within the constraints commonly found at lower levels of healthcare.

Therefore, despite the challenges in our setting, doctors must prioritize continuous medical education to stay updated on global trends and standards while navigating the complexities of our setting. These innovations should not only be embraced as centre-specific practices or based on individual preferences like “this is how we do it in our centre” or “this is how Prof XYZ does it,” but they should also serve as opportunities for research and scientific validation.

Also, hospitals should formulate treatment protocols tailored to their unique circumstances, disseminate them widely, offer them as job aids at points of care, and ensure strict adherence by practitioners.

Furthermore, healthcare practitioners should dedicate time to counsel patients about the significance and potential risks associated with adhering to the prescribed dosage and duration of treatment. In well-established hospitals, it is imperative to institutionalize antimicrobial stewardship to ensure effective utilisation and surveillance of resistance patterns. 

Ultimately, this is a battle declared by the microbial world on humanity, and everyone has a crucial role to play. Individuals should actively seek sound medical advice regarding diseases and treatments, avoiding the inclination to resort to self-help or patronize quacks. So when you take antibiotics for a simple common cold, know that you may be endangering humanity. When you fail to complete your antibiotics for the duration prescribed, you are surely endangering humanity. When you continue to treat typhoid when it is not the culprit, you are harming the patient and the world at large. Even you the medical practitioner, if you prescribe inappropriately, you are hurting the system.

Lastly, I encourage everyone to be advocates for responsible antibiotic use. Let’s utilize these valuable and endangered assets judiciously to avert a future where no drugs can cure pneumonia, syphilis, or meningitis – a potential regression to the 19th century. Remember, this is natural selection in action – it is not a lost battle but a fight for survival, one that we must undoubtedly triumph in. Dr. Ismail Muhammad Bello is a proud graduate of ABU Zaria. He is a Malnutrition Inpatient Care trainer and currently serves as a Medical Officer at both Khalifa Sheikh Isyaka Rabiu Paediatric Hospital in Kano and Yobe State Specialists Hospital in Damaturu. He can be reached at ismobello@gmail.com

By Dr. Ismail Muhammad Bello

Abuse of Antibiotics: Abuse of antibiotics entails both overuse and misuse. Medical professionals, veterinary practitioners, drug vendors, animal farmers and individuals in the community are all culpable in this detrimental practice. 

Antibiotics Abuse in Veterinary Practice and Animal Husbandry: In humans, antibiotics are primarily utilized for therapeutic purposes, but in veterinary practice, they are extensively employed for non-therapeutic reasons, such as promoting growth to meet the rising global demand for animal protein. Even for therapeutic purposes, a common practice involves administering antibiotics, sometimes even below the therapeutic dose, to entire herds for “disease prevention” when only some animals are ill.

The environment plays a crucial role in the evolution and dissemination of antibiotic resistance. Major sources of antibiotic resistance genes and antibiotic pollution in the environment include waste from large-scale animal and aquaculture farms, wastewater from antibiotic manufacturing, as well as from hospitals and municipalities. A portion of the antibiotics administered to humans and animals is excreted unaltered in faeces and urine.  Such animal waste is rich in nutrients and commonly used as fertilizer on crop fields, resulting in direct environmental contamination with both antibiotic residues and resistant bacteria.

Antibiotics Abuse in Human Medicine: In human medical practice, the lack of adherence to standard treatment guidelines has led to unwarranted prescriptions of antibiotics by medical professionals. A common occurrence is the prescription of antibiotics for non-bacterial conditions like the common cold (viral rhinitis).

Antibiotics Abuse in Hospitals: Moreover, medical professionals are also guilty of prescribing these drugs below the standard treatment dosage or for a shorter duration, particularly at the primary level of healthcare. This is particularly important because correct dosing is pivotal in drug therapeutics and serves as a significant distinction between orthodox and traditional practitioners. Paracelsus succinctly captures this in his renowned toxicology maxim: “All drugs are poisons; the benefit depends on the dosage.”

A common scenario in pediatric practice involves practitioners prescribing drugs based on volume rather than the calculated amount per child’s body weight. For instance, it’s not uncommon for a child to receive a prescription for 5mls of Amoxiclav Suspension to be taken twice daily. This practice poses a challenge for pharmacists during dispensing, as Amoxiclav Suspension is available in various strengths, ranging from 125mg to as high as 600mg of Amoxicillin in a 5ml dose.

A related situation arises when patients are instructed to take 1, 2, or 3 tablets of medications with varying dosage forms and strengths. For instance, Amoxiclav is available in tablets with 250mg, 500mg, 875mg, and 1000mg of Amoxicillin. This leaves the patient reliant on the drug vendor to select and dispense from his catalog, potentially leading to under-dosage or over-dosage, unless fortunate enough to be attended by a skilled pharmacist.

Another related practice involves the management of children with fever and multiple convulsions. In our setting, top among the list of differentials are severe malaria and acute bacterial meningitis. These conditions can be effectively distinguished through thorough good history-taking, physical examinations and investigations such as malaria parasite test (MP), cerebrospinal fluid (CSF) analysis and full blood count. Despite evidence favouring one treatment over the other, some practitioners often combine parenteral antibiotics and anti-malarials. While simultaneous severe infections are not impossible, they are typically uncommon, emphasizing the merciful nature of God.

The repercussions of this lack of precision extend beyond medical concerns to economic ones, particularly in our context. An unnecessary 7-10 day antibiotic course can result in an additional estimated bill of approximately N40,000 ($50.66). A good brand of Ceftriaxone nowadays costs about N2500-N6000 ($3.2-$7.6) per vial, varying by location. This is a significant expenditure for a country with the highest level of poverty globally compounded by a poor health insurance scheme and a paltry minimum wage of N33,000 ($41.8).

Such harmful practices may result in under-dosing, subjecting organisms to sub-therapeutic drug levels which are nonlethal, promoting drug resistance. It’s comparable to confronting a machine gun-wielding terrorist with a tiny stick, eliciting a reaction that can only be better imagined.

In this regard, health professionals should undergo continuous training on the proper use of antibiotics and adhere to standard treatment guidelines in disease management. Health institutions should also implement antibiotic stewardship programs to systematically educate and guide practitioners in the effective utilization of these drugs.

Job aids should be provided to assist in the accurate prescription of medicines. In this context, both healthcare workers and patients should recognize that medical practice is guided by the principle of “Primum Non-nocere” – First, do no harm – underscoring the importance of patient safety. Both patients and practitioners must understand that cross-checking when uncertain is not a sign of incompetence but a commitment to due diligence. Patient safety surpasses individual egos, as it’s wiser to be safe than sorry. Physicians’ reactions to patients’ treatment expectations contribute significantly to inappropriate antibiotic use. This often occurs when a patient arrives with preconceived notions about their condition and preferred medications. Emphasis should be placed on educating the patient rather than yielding to their requests and pressure. Patients need to be adequately counselled on their condition and the reasons why prescribed medication may not be necessary. Additionally, physicians should be mindful that non-drug therapies can be as effective, or even superior, in certain conditions.

Dr. Ismail Muhammad Bello is a proud graduate of ABU Zaria. He is a Malnutrition Inpatient Care trainer and currently serves as a Medical Officer at both Khalifa Sheikh Isyaka Rabiu Paediatric Hospital in Kano and Yobe State Specialists Hospital in Damaturu. He can be reached at ismobello@gmail.com

Bello Hussein Adoto

Last week, the world marked Antimicrobial Resistance Awareness (AMR) Week. The goal was to raise awareness about  AMR—a phenomenon where antimicrobials no longer kill or prevent the growth of the microbes they used to kill.

Our bodies do an excellent job of containing viral, bacterial, or fungal infections before a doctor chips in with a drug or two to kill the germs and bring us back to good health. These drugs include antibiotics for bacterial infections, antifungals for fungal infections, and antivirals for viral infections.

Unfortunately, some of us don’t go to—or wait for—the doctor to treat actual or presumed infections. We dash to the nearest chemist to buy ampicillin over-the-counter for boils (skin abscesses) and amoxil for typhoid. Patients who can’t tell the difference between dysentery and diarrhoea would buy branded Ciprofloxacin or Amoxiclav to resolve prolonged toilet troubles and stomach pain. Those who are not that buoyant would manage metronidazole.

Our health practitioners also contribute to the problem. A survey of 12 countries shows that Nigeria has the third-highest percentage of antibiotic prescriptions. Three out of every five patients on admission at our hospitals are on antibiotics. This heavy use of antibiotics contributes to Nigeria’s AMR burden.

The consequence of our use, abuse, and misuse of antibiotics is that the viruses, the bacteria, and the fungi have grown tough—they no longer fear us and our drugs. Our pills and creams are no longer as effective. Regular bacterial infections that were once treatable with first-line antibiotics have become stubborn. You may need a second or third line to treat them. Diseases that needed only Ciprotab now call for Ceftriazone and Imepenem. Diseases that were once tolerable have become debilitating, if not deadly.

The WHO recently spotlighted the story of a woman who had reconstructive facial surgery following an accident. The wound got infected and they treated the infection only for it to rebound and eat away at her face. Gradually, her facial muscles turned to cheese. Further tests showed she had MRSA, the dreaded methicillin-resistant Staphylococcus aureus. Luckily, the woman survived. “If I’d known earlier, maybe I wouldn’t have lost huge portions of my face,” she said years later.

Our ignorance about AMR doesn’t make it any less deadly. About five million people died from drug-resistant infections in 2019. More than one million of these deaths were linked directly to AMR.

Aside from being deadly, AMR is expensive. Infections with drug-resistant bacteria, for instance, mean that patients spend more on higher and more effective antibiotics. These antibiotics don’t come cheap. Augmentin, one of the go-to drugs for severe infections, is now 13,000 naira. That’s more than one-third of the minimum wage.

The task before us is to stem the tide this menace. The government is playing its part. It has drawn up a national action plan for AMR. The plan seeks to increase awareness about the problem

, promote surveillance and research, and improve access to genuine antibiotics. Doctors also have concepts like delayed prescription and antimicrobial stewardship to guide their prescriptions. You can join the fight too.

One, don’t use antibiotics without prescriptions. Trust your doctors when they say you don’t need antibiotics. Some viral infections like cold can resolve without drugs.

Secondly, complete your doses when using prescribed antibiotics. It could be tempting to abandon your drugs at the first sign of relief. It could be valid even: some research has shown that extended use of antibiotics after symptomatic relief doesn’t make any significant difference in recovery. Still, don’t discontinue your drugs at a whim. Speak with your doctor.

Thirdly, don’t share antibiotics or prescribe them to others. This should go without saying, but our desire to help friends and loved ones often pushes us to share drugs like antibiotics with them. You can do better by directing your friend or relative see a doctor. Antibiotics are not emergency drugs that can’t wait for a prescription.

Good hygienic practices can help, too. They limit the spread of infections, and the consequent antibiotics (ab)use. Wash your hands regularly. Adopt proper etiquette when you are in a hospital or laboratory environment. Doing otherwise increases your risk of contracting or transmitting new infections to your loved ones.

Five, get vaccinated. Vaccines protect you from contracting potentially resistant infections or spreading them to others. Moreover, viral infections that can be prevented with vaccines, like measles and influenza, are some of the reasons people abuse antibiotics. When you don’t contract influenza or measles, you won’t feel a need to abuse antibiotics.

The AMR Awareness Week has come and gone, but the problem and its consequences remain. They affect us all; everyone can and should contribute to the solution. You can be a part of the fight by not abusing antibiotics or demanding that your doctor prescribe antibiotics for you when you don’t need them. You can join in by not abandoning your treatment or sharing your drugs. You can get vaccinated too. Start now. Start today. Join the fight against AMR.

Hussein can be reached via bellohussein210@gmail.com.

By Dr. Ismail Muhammad Bello

You have likely heard about climate change, a pressing existential threat demanding global collaboration. However, it is not the sole concern. Antibiotic resistance is another rapidly emerging issue that demands urgent attention.

Not too long ago, the pathological basis of diseases was shrouded in mystery, often attributed to superstitions. About four hundred (400) years back, the role of microbes in disease causation was still unknown. It took the discovery of the microscope and the works of Antoni Van Leeuwenhoek to open our eyes to the unseen world – the realm of microbes – surrounding and inhabiting us.

Microbes, omnipresent and adaptable, have evolved significantly to thrive in a constantly changing world. The human connection with microbes is extensive and intriguing. Thanks to their versatility, microorganisms are instrumental in driving human technological advances through their varying applications in agriculture, environmental protection, medicine and industrial production. From drug discovery and development to their role in bioremediation, biotechnology, and the emerging field of genetic engineering, microorganisms have played a monumental role in the survival and progress of life forms on Earth, even shaping civilizations.

Nevertheless, despite their crucial role in the earth’s functions, microbes also contribute to human misery as pathogens. Despite global efforts to combat them, infectious diseases persist as a challenge, particularly in Sub-Saharan Africa where the existing weak health system grapples with a double burden of diseases – an increasing prevalence of non-communicable diseases alongside prevailing communicable diseases.

Apart from the substantial morbidity and mortality resulting from infectious diseases, the burden encompasses economic losses due to healthcare expenses and disabilities, as well as a decline in productivity. In a broader sense, infectious diseases hinder human development by adversely affecting education, income, life expectancy, and other health indicators.

While current morbidity and mortality rates remain notably high, the situation contrasts significantly with the past where certain infections, now easily treatable, were once considered death sentences or challenging to address. The serendipitous discovery of Penicillin by Alexander Fleming stands out as a pivotal moment in medical history. “Antibiotics” not only transformed the curability of many diseases but, coupled with advancements in anaesthesia, also enhanced the safety and feasibility of major surgeries.

While the term “antibiotics” holds a more specific meaning in pharmacology, commonly it refers to a category of drugs utilized in treating “bacterial” infections. Bacteria, while a significant group, represents just one class of microorganisms; others include viruses, fungi, parasites, and even prions. Antibiotics function by disrupting vital processes in microbes leading to a loss of structural integrity or functional capacity, ultimately causing them to die or halt their replication.

Antibiotics encompass a diverse group of drugs, belonging to various classes, each effective against specific types of organisms. They include the well-known Amoxicillin (Amoxil), Ampicillin-Cloxacillin (Ampiclox), Metronidazole (Flagyl), Ciprofloxacin, Amoxicillin-Clavulanate (Augmentin) and numerous others easily accessible over-the-counter in our setting. Antibiotics have played crucial roles in combatting menacing diseases like Tuberculosis, Leprosy, Gonorrhoea, Syphilis, bacterial pneumonia, acute bacterial meningitis, and many others.

The introduction of these drugs came as a huge blow to the pathogenic microbes that previously had a field day. However, in line with natural selection, they didn’t succumb passively and perceived the development as a declaration of war. Over the years, these microbes evolved, becoming insensitive to many of these drugs—a phenomenon known as antibiotic resistance.

In response, scientists discovered new drugs, tweaked some of the existing drugs or synthesized novel ones. This led to a vicious cycle, whereas new drugs are developed, these organisms adapt and become resistant. This trend persists to our present day, leading to the emergence of highly resistant strains of microorganisms that are not susceptible to most of the antibiotics used in treating the kind of infections they cause – the so-called Superbugs. 

Unfortunately, this cycle is not sustainable for mankind. The rate at which microbes adapt to our drugs is faster than the turnout of our drugs. It takes about 10-15 years to develop a new antibiotic. Not only that, studies have shown that the estimated global cost of developing a new, targeted antibiotic will cost over a billion USD ($1 Billion), making it a highly expensive and risky venture for pharmaceutical companies.

The combination of these factors has impeded innovation in the field of antibiotics. Notably, the latest discovery of a new “class of antibiotics” that has reached the market was back in 1987. Since then we have been in a “discovery void” era, and currently, there are few novel antibiotic classes in the drug development pipeline. 

In 2022, the World Health Organization (WHO) identified twenty-eight (28) antibiotics in clinical development that address the WHO list of priority pathogens, of which only six (6) were classified as innovative. The repercussions are felt globally as an increasing number of bacterial infections are becoming hard to treat, once again posing a threat to global health and development.

Undoubtedly, resistance is a natural phenomenon and will eventually develop against some antibiotics. However, the accelerated rate at which it is occurring is aided by our irrational use of these drugs. Therefore, prudent use will surely slow down the process. 

Key determinants of antibiotic resistance include antibiotic abuse in veterinary and medical practice, inadequate provision of Water, Sanitation and hygiene (WASH) infrastructure, and the effectiveness of policy development and enforcement.

Dr. Ismail is a Medical Officer at Khalifa Sheikh Isyaka Rabiu Paediatric Hospital, Zoo Road, Tarauni, Kano State.