Lifestyle

By Suleiman Ahmed

1. When things are going well for you, remain humble. It’s not just about your hard work, intelligence, skills, or talents; factors like luck, good timing, opportunities, and privileges also play a role.

2. Conversely, when things are going bad for you, forgive yourself and avoid falling into despair. Some aspects are beyond your control. As long as you did what you had to, forgive yourself, learn from the outcome, correct your mistakes, and keep moving forward. 

3. You’re not as good as you think you are when you’re winning, and you’re not as bad as you think you are when things are going poorly. Take it easy.

4. Bad things will happen. It doesn’t matter if you’re a good person or not; bad things can happen to anyone. There are too many variables beyond your control. This is why it’s crucial to prepare for challenging days when things are going well. 

The Igala people have a wise saying: “In times of abundance, prepare for hardship.” Life isn’t all about feasting; there will be moments of famine. What you do during times of plenty determines how you cope during times of scarcity. A great year doesn’t guarantee the next one will be the same. Life is unpredictable. Another crisis might happen, or unexpected challenges may arise. 

Many things are beyond your control, so staying prepared is the best way to handle surprises. In essence, the Igala wisdom encourages prudence during prosperous times. It teaches us to resist the temptation to indulge in extravagant spending during good times and, finally, to adopt a sustainable life, diligently saving for unforeseen emergencies. 

A lack of preparation for the bad times exposes one to relying on charity from others for financial assistance when hard times eventually arrive. While this may not be wrong in and of itself, relying on people’s benevolence during emergencies is not only risky but also unfair to both yourself and the people you seek help from, especially if feelings of betrayal arise when they can’t rescue you. Numerous relationships have been strained due to one party’s inability to offer financial support during times of distress. It’s crucial to recognise that we don’t always know the challenges others are silently facing. Therefore, feeling offended or betrayed when they are unable to help is rather unkind. 

In summary, stay humble and frugal during good times, forgive yourself and remain patient during bad times, and stay prepared for the unexpected. While the future is unpredictable, being prepared helps you handle surprises better.

The path is long. 

The burden is heavy. 

May your arm be strong. 

May your sword be sharp.

Suleiman Ahmed is the author of TROUBLE IN VALHALLA. He is also a software engineer. He is available on X/Twitter via @sule365.

By Abubakar Aminu Ibrahim

Communication is vital to human interaction, influencing relationships, emotions, and outcomes. In all languages, the impact of communication skills is profound, especially in expressions of greetings, well-wishing, congratulations, condolences, and the like. While these expressions are often used to convey positive intentions and goodwill, how they are communicated can significantly affect the recipient’s feelings and perceptions.

In Hausa culture, for example, greetings are essential to daily interactions, reflecting respect, courtesy, and social harmony. Appropriations of greetings demonstrate politeness and establish a positive tone for communication. However, the impact of greetings goes beyond mere words; it encompasses the tone of voice, body language, and facial expressions. A warm and sincere greeting can make the recipient feel valued and respected, while a cold or indifferent greeting may convey disinterest or disrespect, leading to negative feelings.

Well-wishing is another crucial aspect of communication in our daily encounters, especially in the context of prayers for someone’s well-being or success. This is something that seems cordial yet can be volatile. Whether it is praying for someone to have a child, to get rid of poverty, or to find a job, how these wishes are expressed matters significantly. The spot where such utterances are made can make or mar the situation.

For example, when offering prayers for someone to have a child, it is quite unnecessary to say it to their face. It is often like reminding them and telling those around them how childless they are! Then, is it really necessary? Prayers can be both general or precise, thanks to the fact that Allah is always aware of our inner intentions. Thus, such prayers can be positively concealed in a more general term. “May Allah offer your wishes”, “May Allah reward you with Jannah/bless your family”, etc., cannot harm, I guess.

A similar reproach is often experienced when offering consolations. The manner, tone and words used can reflect civility and ensure privacy yet remain empathetic, hopeful, and positive. A well-expressed prayer can uplift the recipient’s spirits and strengthen their resolve. In contrast, a poorly articulated wish may appear insincere or lacking in empathy, potentially causing emotional distress. Consider a situation where an ill person (who needs support and encouragement) is constantly being told how he is wasting weight! Is that consoling or condemning? Instead of extending the tender support required, we often extend emotional pain and wash away the little drops of hope in the patient.

Similarly, congratulations are often extended to celebrate achievements or milestones in a person’s life. Whether congratulating someone on a promotion, a wedding, or any other accomplishment, the manner of expression can enhance or diminish the recipient’s joy. A heartfelt congratulatory message conveys genuine happiness and support, whereas a superficial or casual expression may undermine the significance of the achievement, leading to feelings of disappointment or devaluation.

In conclusion, the impact of communication skills is profound, especially in expressions of greetings, well-wishing, congratulations, condolences, and their likes. How these expressions are communicated can significantly affect the recipient’s feelings and perceptions, shaping the quality of interpersonal relationships. Without diplomacy and sensitivity in communication, even well-intentioned expressions can have unintended negative consequences. Therefore, it is essential to cultivate effective communication skills to convey goodwill and ensure that our words and actions do not inadvertently cause harm. Without diplomacy, we may do more harm than good despite our noble intentions.

Abubakar Aminu Ibrahim wrote from Katsina via matazu247@gmail.com.

By Ladi Ibrahim

Early marriage, also known as child marriage, remains a persistent issue in Nigeria, where cultural traditions, poverty, and limited access to education contribute to this harmful practice. Despite significant progress made in addressing child marriage globally, Nigeria still grapples with high rates of early marriage, adversely affecting the lives of countless young girls. This article aims to illuminate the causes, consequences, and potential solutions to this deeply rooted societal problem.

Several factors contribute to the prevalence of early marriage in Nigeria. Cultural norms and traditions play a pivotal role, with many communities believing that marrying off their daughters at a young age protects their honour and ensures their future safety. Poverty is another critical factor, as families with limited resources may see marrying their daughters off early as an economic relief or an attempt to secure a better life for them.

Furthermore, lack of access to quality education, especially for girls, perpetuates the cycle of early marriage. Limited educational opportunities deprive young girls of the chance to develop essential skills, pursue independent livelihoods, and gain awareness about their rights. Additionally, prevailing gender inequalities and discrimination further exacerbate the problem, limiting gender equality and social progress.

Early marriage has detrimental effects on the physical, mental, and emotional well-being of young girls. Firstly, it exposes them to serious health risks, as their bodies are often not fully developed to bear children, resulting in complications during pregnancy and childbirth. Early marriage also robs girls of their right to education, denying them the chance to reach their full potential and contribute meaningfully to society.

Moreover, young brides often face economic hardships, lacking the necessary skills or education to secure stable employment. This perpetuates the cycle of poverty, subsequently affecting future generations. Early marriage is also linked to a higher incidence of domestic violence, mental health issues, and limited decision-making power for girls and women within their households.

Addressing the issue of early marriage in Nigeria requires a holistic approach that involves multiple stakeholders, including the government, civil society organisations, religious leaders, and communities. 

 Enhancing access to quality education, particularly for girls, is pivotal to breaking the cycle of early marriage. This can be achieved by providing scholarships, building schools closer to rural communities, and promoting educational campaigns focused on child rights and gender equality.

Strengthening existing laws that criminalise child marriage is essential, accompanied by strict enforcement mechanisms to hold perpetrators accountable. Providing young girls with vocational training and economic opportunities can dismantle the economic rationale behind early marriage. Such initiatives can help them gain financial independence and empower them to make informed choices.

 Collaborating with religious and community leaders to change social norms and customs that perpetuate early marriage is crucial. Obtaining their support and involvement is vital for building awareness and changing mindsets.

Expanding healthcare facilities and services in rural areas, specifically aimed at addressing the unique needs of young brides, can contribute to reducing the health risks associated with early pregnancy and childbirth.

Early marriage continues to be a significant challenge in Nigeria, depriving countless young girls of their rights and potential. By addressing the root causes of this practice through education, legal reforms, economic empowerment, community engagement, and access to healthcare, Nigeria can pave the way for a brighter future for its girls. Efforts to end early marriage require synergy, collaboration, and a relentless commitment to ensuring that every child in Nigeria has the opportunity to grow, thrive, and determine their destiny.

Ladi Ibrahim wrote from the Department of Mass Communication, University of Maiduguri.

By Abdurrahman Muhammad

A call has gone to the Federal Government for a reform of Nigerian marriage laws that will allow married women to bear their fathers’ names. Making the call was an Islamic human rights advocacy group, the Muslim Rights Concern (MURIC). 

A statement signed by the group’s director, Professor Ishaq Akintola, on Monday, 18^th December 2023, described the current practice whereby married women are forced to bear their husbands’ surnames as gender discriminatory, archaic and oppressive. 

MURIC condemned the current practice for depriving women of their Allah-given fundamental human right to personal and parental identity in marriage. The group advocated the adoption of the women-friendly Islamic practice, which allows married women to bear their fathers’ surnames after marriage. 

The full statement reads:

“Our attention has been drawn to the plight of married Muslim women who are being disallowed by employers from bearing their fathers’ names. This amounts to forceful enslavement, denial of Allah-given fundamental human right to parental identity and wrongful dismissal of loco parentis.

“We condemn the current practice for three major reasons, namely, for generating confusion in the society, for creating a monumental identity crisis among married women and for depriving women of their Allah-given fundamental human right to personal as well as parental identity in marriage.

“Instead of this, we advocate the adoption of the women-friendly Islamic practice which allows married women to bear their fathers’ surnames after marriage. 

“No woman dropped suddenly from the sky, and even if some appear out of nowhere, they must have been born, bred, nurtured, buttered and marmaladed by certain parents before they grew up and matured into womanhood. Their education was also sponsored by their parents at a time when the future husband probably knew nothing about them and spent no kobo on their upbringing and their education.

“It therefore beats logic, fairness and natural justice that a husband appears out of nowhere to commandeer a woman’s parental identity simply by marrying her. Such identity robbery also has its advantages. 

“For instance, women who are educated are forced to advertise change of names to their husbands’ surnames after marriage in order to retain the validity of their documents and properties. It often becomes very difficult and sometimes impossible for married women to be located or to retain old friends due to such a change of name. 

“Those who want to be sincere among married women today will confirm the stress they have gone through from this experience. Islam sets women free from such stress by permitting married women to retain their original family names.

“Contrary to the general claim that Islam discriminates against women, Islamic liberation theology actually teaches respect for the dignity of women in all circumstances. One of such circumstances is the period when women are in wedlock. Whereas Western civilisation robs married women of their original family identity by insisting that they should bear their husbands’ surnames, the Shari’ah allows women to bear their own fathers’ names even after marriage. 

“We therefore invite the Federal Government and other relevant authorities to set the machinery in motion towards allowing married women to bear their fathers’ names. In particular, we charge both houses in the National Assembly, the Senate and the House of Representatives, to introduce the necessary bills that will set Nigerian women free from undue masculine domination.

“This advocacy is not for Muslim women alone. We are certain that Muslim women are not the only ones who feel the pinch. MURIC would love to see every married woman who desires to be identified by her father’s name enabled to do so. Our lawmakers should frame the clauses in such a way that all women can enjoy the freedom to choose between bearing their fathers’ names or their husbands’. It is time to set Nigerian women free. They are the mothers of our society.

“We contend that the whole gamut of women’s liberation struggle boils down to a sham and a mirage until this goal is achieved. A married woman is not a slave. She is not just a dot in social statistics. She has a soul, and that soul yearns for love. She covets to love and be loved, not only by her husband but also by her family and vice versa. Nigeria must not fail her. Parental identity is sacrosanct. Husbands can never replace fathers in matters of parental identity, and that is what the current system compels women to go through. Enough is enough.”

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

By Usman Muhammad Salihu

In our busy lives, we often overlook a fundamental truth: sharing what little we have can bring blessings to others and ourselves. It doesn’t require grand gestures or lavish gifts; sometimes, small acts of sharing can profoundly impact lives and illuminate the world.

Sharing fosters connections between people, whether it’s with a friend, a family member, or even a stranger. These bonds can be significant, reminding us of our shared humanity. Sharing brings joy, whether you’re offering your time, food, or old clothes. Giving, even in modest amounts, can bring immense happiness and contentment. Knowing you’ve made someone else’s day better is a joy.

What might seem insignificant to you could mean the world to someone in need. Your extra meal or a warm blanket could mean the difference between hunger and comfort for someone less fortunate. Sharing eases the burden of those in hardship and can inspire others to do the same, creating a cycle of kindness that brightens the world one act at a time. Moreover, it cultivates gratitude for the small blessings in your life, fostering a more positive outlook.

Across various cultures and beliefs, there’s a common understanding that what you give is what you receive or even more than that (givers never lack). The universe has a way of rewarding those who share, although not always in the same form. Sharing also minimises waste, putting resources to good use and contributing to a more efficient use of our planet’s resources.

Your act of sharing has a ripple effect, touching the lives of many. These blessings extend far beyond you, positively impacting the world. It’s not about the quantity you give but the quality of your heart when you give. A warm smile, a meal, or a helping hand – each act of sharing can change lives and enhance the world, one kindness at a time. Therefore, never underestimate the profound impact of sharing. It’s only in giving we receive the true blessings of life.

Usman Muhammad Salihu writes from Jos, Nigeria and can be reached via muhammadu5363@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.