By Dr. Aliyu U. Tilde

The stalemate between ECOWAS and Niger Republic needs to be broken urgently for humanitarian and strategic reasons. The decision should be taken tomorrow at the meeting of the Heads of State of the regional body to shorten the unnecessary suffering of 26 million ECOWAS citizens in Niger.

Humanity

The world is appalled by the ongoing starvation in Gaza, and it is rightly calling for its end. In a similar way, the humanity in us should trigger our conscience to open Niger’s borders and restore its electricity. There is just no reason why we should superintend over the death of African lives and the destruction of the economy of a member state in the name of democracy. It is no longer about Mohamed Bazoum or General Tchiani or the neo-colonial interest of France. It is about the people of Niger.

Democracy is not as important to Africans as it is to their lives and livelihoods. In a year or two, Niger can return to democracy, and heavens will not fall before then. However, the longer we strangulate Nigeriens now, the longer our guilt for the collective punishment we meted on them last later. On their part, the Nigeriens will retain—and recall—for generations the long memory of ECOWAS’ suffocating sanctions, and they will bring it to bear on every future association with Nigerians in particular.

A Shot in the Foot

Apart from the imperatives of history, DNA, culture and contiguity, the Niger Republic will, through River Niger and our future Europe-bound gas pipeline, continue to play a crucial role in our economy, not to mention the daily cross-border trade relations worth billions of Naira.

Our weaponization of electricity to Niger will seriously undermine future strategic cooperation with the Republic regarding River Niger. Nothing will stop it from damming the River in a big way to ensure its national electricity and food security, letting us get sufficient water in Kainji and Jebba Dams only when there is an overflow. We will be forced to rely solely on gas for power generation.

Our national security will also be at great risk when Niger inevitably develops cold feet, as a payback, on our strategic partnership against Boko Haram and Bandit terrorism. Niger is just a neighbour too important for Nigeria to call off. I am not sure if we haven’t shot ourselves in the foot already.

Forward

The July coup is now a standing reality. I suggest, as a way out, that ECOWAS demands two assurances from Niger, with a third party, say America, serving as a guarantor to the agreement: The release of Bazoum and a short timetable for a return to civilian rule in exchange for immediate removal of sanctions. This ‘Niger free, Bazoum free’ formula will immediately relieve the population of the horrendous difficulties it is undergoing and save the lives of the sick, including women and children, who are dying in Nigerien hospitals due to the blackout. It will also save the investments of hundreds of Nigerians whose loaded vehicles have been stranded at the borders for months now.

Bazoum’s government is spilt milk which cannot be recovered. ECOWAS should let this go and prepare for the future. It can consider establishing a standing force to immediately intervene in future incidents if necessary without procrastination. But how democracy is proving to be a conveyor of poverty and bad governance in Africa makes it a creed not worthy of such a financially heavy enterprise.

Instead, ECOWAS should develop mechanisms to promote good governance as the only assurance of stability and prosperity and a panacea against future coups. No matter the situation, in the future, measures that will bring hardship to citizens and ruin the economies of member states should be avoided as much as possible by ECOWAS. We cannot be Americans in Iraq. Otherwise, we will only be surrogates of colonial masters. So far in Niger, we have cut our nose to spite our face. Tomorrow, December 10th, is the date to start stitching it.

Dr. Aliyu U. Tilde can be reached on Twitter: @Dr_AliyuTilde.

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 Sabiu Abdullahi

In a strong stance against what they deem a failure of the federal government to provide adequate compensation for the victims of the Tudun Biri bombing in Kaduna state, lawyers representing the Concerned Northern Forum have issued a threat of legal action.

The tragic incident unfolded during the Maulud celebration last Sunday night, claiming the lives of over 80 villagers. 

Nafi’u Abubakar, the spokesperson for the lawyers’ forum, conveyed their unwavering commitment to securing justice for the families impacted by the regrettable event.

Speaking to reporters in Kaduna on Saturday, December 9, Abubakar stressed the urgent need for the federal government to take swift and decisive action, ensuring a comprehensive and unbiased inquiry into the incident. 

Abubakar notes, “It is imperative that those responsible are held accountable for their actions, and measures are put in place to prevent any recurrence of such incidents in the future.

“We also urge the Nigerian Army to reevaluate its rules of engagement and training procedures to prevent the loss of innocent lives during military operations.” 

The forum, comprising over 600 members, extended sincere sympathies to the grieving families, affirming solidarity in their grief.

Abubakar stated, “We stand united with them and pledge unwavering support in ensuring justice is served. The Concerned Northern Lawyers Forum will tirelessly pursue legal avenues to claim the compensation owed to the victims.”

By Aliyu Yakubu Yusuf

It is challenging for any group of players that has won all the available trophies on offer to maintain the same focus and motivation the following season. There’s only one way for any club to win a treble of league title: UCL and the domestic cup. That way is downwards. In this context, I am not overly surprised about Manchester City’s struggles so far this season.

Pep Guardiola is a gaffer who prioritises control and patient buildup in the middle of the park. The current Manchester City team lacks these attributes. Their matches are often chaotic end-to-end affairs that produce plenty of goalscoring chances. This isn’t a quintessential Guardiola team that routinely deprives their opposition of a sniff of the ball, let alone scoring opportunities. I attribute Manchester City’s recent travails to three critical factors:

1. Rodri’s frequent suspensions

Manchester City have lost four games so far this season. A common denominator in all these games is that Rodri missed ALL of them. Make that what you will.

2. Kevin De Bruyne’s Injury

Do I even need to mention the importance of the blond Belgian to this team? Julian Alvarez has deputised in the KDB role, often admirably. However, the Argentine is no midfielder and will never bring the same midfield control and assurance.

3. Gundogan’s Departure/Kovacic’s Poor Form

Pep Guardiola signed the Croatian as a direct replacement for Ilkay Gundogan, who left for a Bosman ruling in the summer. The German was a cornerstone for Manchester City for several years. True, Kovacic is no Gundogan. Still, he has often been poor whenever he steps onto the pitch. He was subsequently relegated to the bench. Guardiola and City surely expected more from the former Inter Milan, Real Madrid and Chelsea man.

There you have it. For the record, I still expect Guardiola to sort things out and mount a title challenge as usual. Come the end of the season, the Citizens will be there or thereabout. Write them off at your own peril.

Aliyu Yakubu Yusuf wrote from Kano, Nigeria. He can be contacted via aliyuyy@gmail.com.

The Nigeria Customs Service Management has given the green light for the promotion of 357 officers. 

This is contained in a statement released by Chief Superintendent of Customs Abdullahi Maiwada, the National Public Relations Officer of the anti-smuggling service.

The decision to elevate these officers from the rank of Customs Assistant I (CAI) to Inspector of Customs (IC) was officially approved during the 7th Management meeting of 2023, held on December 1, 2023.

The meeting, chaired by the Comptroller General of Customs, Bashir Adeniyi, MFR, underlined the commitment to fostering a motivated and excellence-driven workforce. 

The comprehensive promotion list encompasses both General Duty (GD) and Support Staff (SS) personnel who demonstrated exceptional performance in the 2023 promotion exercise.

The breakdown of the promoted officers is detailed as follows: AIC to IC (246) GD, AIC to IC (37) SS, CAI to AIC (39) GD, CAI to AIC (27) SS, CAII to CAI (7) SS, and CAIII to CAII (1) GD. 

This strategic move stands as a testament to the visionary leadership of the Comptroller-General, affirming the importance of motivation, recognising excellence, and rewarding diligence within the service.

Chief Superintendent of Customs Abdullahi Maiwada, serving as the National Public Relations Officer, extended heartfelt congratulations to the newly promoted officers.

In his statement, he conveyed the Comptroller General’s call for these men to redouble their efforts in fulfilling the service’s core mandates of Revenue Generation, Suppression of Smuggling, and Trade Facilitation. 

The Nigeria Customs Service looks forward to the continued dedication and enhanced contributions of its recently promoted officers, as they play a pivotal role in advancing the organisation’s mission and objectives.

By Kamal Alkasim

Atiku Abubakar, former vice president and perennial presidential candidate, has long styled himself as the “Unifier” of Nigeria. Yet, recent events raise questions about his ability to live up to this label.

Internal Divisions and G5 Exodus:

Atiku’s party, the People’s Democratic Party (PDP), has been plagued by internal divisions. The G5 group of five aggrieved governors, led by former Rivers State Governor Nyesom Wike, have publicly parted ways with Atiku and the party leadership. This exodus has significantly weakened the PDP’s chances in the 2027 presidential election.

Lost Allies and the Rise of New Political Alliances:

Further complicating the picture, two major figures who ran for president in 2023, Peter Obi and Rabiu Musa Kwankwaso, have left the PDP. These departures have deprived Atiku of potential allies and created a new political landscape with the emergence of a possible merger between the PDP, Labour Party, and New Nigeria People’s Party.

Unifying Action Needed:

While the details of this potential merger remain unclear, it presents a fresh challenge for Atiku. Should the merger materialise, it will demand exceptional unifying skills to navigate the competing ambitions of Obi, Kwankwaso, and other stakeholders within the new entity.

Unification Through Action, Not Words:

The question remains: when will Atiku be a “verified Unifier”? While words are persuasive, concrete action will ultimately determine his ability to bring together disparate political forces and forge a unified front.

Negotiations and the Struggle for Power:

Atiku faces a tough road ahead. He must navigate the complex negotiations with Obi, Kwankwaso, and other influential figures while overcoming internal party divisions. Ultimately, his success in securing the presidential candidacy and uniting the disparate political forces will be the true test of his unifying credentials. 

Kamal Alkasim is a freelance writer. He can be reached via kamalalkasim17@gmail.com.

By Abdelghaffar Amoka

I travelled home in 2012 after my PhD and one of my older cousins asked when I would become a Professor. I laughed and told him it would still take some years, and I jokingly told him I was not keen on becoming a Professor. He became angry at my response and said I should get the Professor for them even if I didn’t want it. After I left him, I began to wonder what is in that rank that some people want at all costs.

I can still remember the huge congratulatory messages I received after my friend and colleague shared on Facebook the news of my promotion to that rank. Sometimes I reflect on those messages and imagine how rich I would have been if those congratulatory messages could be transformed into cash. Here we are struggling, and some of us can’t even drive our cars any longer.

The Nigerian Professor

Becoming a Professor, the peak in academia, is something most academics look forward to. The title still comes with some prestige and perceived false benefits attached to it by outsiders. I once read a post on Facebook that said professors are stingy. Poor professors and the public want them to spend the money they don’t have. I went to buy a seat cover for my car a few years ago and the seller said lecturers have money but refused to spend it. I asked how much he thinks a professor is earning, and he said it can’t be less than N700,000. I laughed very hard.

I have written a lot on the remuneration of academics in Nigerian public universities, but many still don’t believe the figures. Yeah! Too bad to be true as compared with their perception. I had a discussion with one of our PG students, who is a lecturer in a state polytechnic, about salary disparity in the Nigerian public sector yesterday, and the salaries of university lecturers came into the discussion. I told him the figures, and the smile on his face showed that he didn’t believe it but couldn’t say I was lying. So, I logged in to the university portal and showed him my payslip. The gross, the deduction, and the net. We met again today, and he said that until yesterday, he never believed that a Professor on step 4 was earning less than N600,000.

Again this is the salary of academics in any federal government university in Nigeria. The quoted value is for step 2, the rank:

~The Assistant Lecturer’s net salary with all his allowances is N118,279 (105 USD).

~Lecturer II’s net salary with all his allowances is N129,724 (115 USD).

~Lecturer I net salary with all his allowances is: N160,809 (142 USD)

~Senior Lecturer’s net salary with all his allowances is: N222,229 (197 USD)

~Reader (Associate Professor) net salary with all his allowances is: N277,179 (245 USD)

~The professor’s net salary with all his allowances is N332,833 (294 USD).

The University workers are perhaps the only federal government workers whose salary is yet to be reviewed since 2009, that is for 14 years despite inflation. Those who were already professors in 2009 are still receiving the same salary since then. Your comfort is key to your output.

Aside from the academic work and the research and publication work that forms the bulk of your promotion criteria, you are loaded with administrative responsibilities without responsibility allowance. They call it ‘community services’. You can be denied promotion if you don’t have enough of the said “community services”.

If you happen to travel outside the University for a conference and you are lucky to be funded, the travel allowance is as follows:

~Duty Tour Allowance (DTA) for the professorial cadre is N16,000 per night.

~Duty Tour Allowance (DTA) for Senior Lecturer cadre and below is N12,000 per night.

~The transportation allowance is N20 per km.

If a Professor is to travel 200 km for an assignment that lasts for a day, he will get a DTA of N32,000 for 2 nights for his hotel accommodation for 2 nights and feeding and N8,000 for transportation. That is a total of N40,000. Despite the fact that FG has approved a new DTA for public service in September 2022, the universities can’t afford the new rate a year later. I applaud the patience of my colleagues, but the patient dogs are dying of hunger.

Meanwhile, education is said to be key to national development.

Dear prospective academics, I love academia. For me, it is not a job but a way of life. However, ask questions before you wish to join academia and become a Professor. The job as it is at the moment can’t pay your bills for a decent life.

Abdelghaffar Amoka Abdelmalik, PhD, wrote from Ahmadu Bello University, Zaria. He can be reached via aaabdelmalik@gmail.com.

By Ahmad Deedat Zakari 

The Sultan of Sokoto, Dr. Muhammad Sa’ad Abubakar, has insisted that the victims of the airstrike by the Nigerian Army must be properly compensated. 

The Sultan demanded justice at the Silver Anniversary of the 11th Emir of Jama’a, Alhaji Muhammad Isa Muhammad, on the throne at the Emir’s Palace in Kafanchan, Kaduna, on Friday. 

Recall that the Daily Reality earlier reported the bombardment of Muslim faithful celebrating Maulud in Tudun Biri Village in Kaduna State by the Nigerian Army. 

Commenting on their commitment to seeking justice for the Kaduna airstrike victims, the Sultan said, “We are here not only to celebrate the emir but to also pray for the emirate and the lives of those killed in Kaduna State. We are going to push for it until justice is served to the  people.” 

The Nigerian Army took responsibility for the massacre and described the situation as a ‘mistake’. 

However, replying to the Sultan, the Chief of Defence Staff, General Christopher Musa, described the incident in Kaduna as highly regrettable. 

“Our duty is to protect the citizens, we are going to take a serious action to make sure something like this is not going to happen again anywhere in the country. The president has ordered a thorough investigation on it,” he said.

By Sabiu Abdullahi 

The Central Bank of Nigeria (CBN) has issued a strong caution to the public regarding the surge in illegal Naira banknotes circulating in the country.

CBN’s Acting Director of Corporate Communications, Hakama Sidi Ali, noted the gravity of the issue in a statement released on Friday, particularly highlighting the prevalence of counterfeit higher denominations. 

“The CBN has observed the circulation of counterfeit banknotes, especially higher denominations by some individuals,” warned Mr. Sidi Ali. 

These fake Naira notes are reportedly being used for transactions in food markets and commercial centres across major cities in Nigeria.

The CBN expressed its commitment to collaborating with relevant security and financial agencies to combat the circulation of counterfeit currency. 

“The law provides severe sanctions, including a term of imprisonment of not less than five years, for any person found culpable of counterfeiting Naira notes or any other legal tender in Nigeria,” stated Sidi Ali. 

The public is urged to report suspected cases of counterfeit Naira notes to the nearest police station, CBN branch, or via email at contactcbn@cbn.gov.ng.

In response to the rising concerns, financial institutions and the general public are advised to exercise increased vigilance and adopt precautionary measures to prevent the acceptance and distribution of counterfeit notes.

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