Health

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lack of clinical skills needed to appropriately discern acute febrile illnesses coupled with excessive reliance on the outdated Widal test is driving an alarming prevalence of this peculiar diagnosis.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 Bello Hussein Adoto

One, two, three. Every three seconds, someone somewhere is receiving blood, and they don’t know where it comes from. The person could be an accident victim with a broken leg, a woman bleeding after birth, a sickle cell patient hanging on to life, a man with haemophilia whose blood just won’t clot, or a snakebite victim whose cells are lysing away.

Three seconds. Someone is on the bed, being saved with another person’s blood. That blood could be yours—one pint drained from your body in ten minutes every three months (men can donate up to four times a year). Sometimes, it doesn’t take more than that to save a life.

Unfortunately, many people don’t donate blood because they frown at the idea that hospitals “sell” the blood they donate for free, so it is better that they don’t feed what they see as an unwholesome trade. Why should we donate blood for free if recipients have to pay for it? Let’s unpack the answer.

Blood is free. Hospitals—public ones, at least—don’t sell blood.

They collect service charges ranging from five to eight thousand naira in public hospitals to cover the cost of screening, collecting, bagging, storing, matching, and transfusing blood. The service charge is like revolving funds that keep the blood flowing from the donor to the patient.

Is it criminal? Not quite. Hospitals get blood from unpaid voluntary donors and relatives of transfusion recipients who donate to replace the blood their loved ones received. A third source is those who get paid for donating blood. However, getting blood from paid donors is discouraged for ethical and safety reasons. Whatever the source, blood recipients are required to pay processing fees to cover the cost of getting blood and transfusing it safely.

Let’s face it. Healthcare is subsidised, but it’s not free. The government can only pay for so much. Hospitals need facilities to receive donors and collect their blood. They need equipment, test kits, and reagents to screen the blood; bags and anticoagulants to keep the blood fluid and aseptic; storage units to keep the blood stable enough to be useful to the patient. These cost money and that’s the service charge that patients and their relatives pay.

The need for blood for voluntary blood donation is high in Nigeria. According to a recent National Blood Services Commission (NBSC) report, only 25% of blood transfusion demand is met in Nigeria. Unpaid voluntary donation closes the demand gap for blood donation. It makes blood available to patients, especially those with rare blood types and those needing many pints of blood.

While you are welcome to share your concerns about patients having to pay for blood, please don’t let that discourage you from donating. People need blood, and that need is critical. Malnourished children, pregnant women, people with severe malaria, and those with sickle cell disease are among the top groups in this category.

Your blood could be the difference between someone staying alive or dead. Imagine your younger sister or a parent desperately needs blood, but blood banks and reserves are depleted due to a lack of willing donors. What do we do then? Even if you worry that recipients will eventually have to pay for it, your blood gives them something to pay for.

Besides, your donation makes blood available so that desperate patients and their relatives don’t have to get it from the so-called black market, which is more expensive.

Beyond donating, you can raise awareness for other people to donate. As of 2022, only 8% of transfused blood in the country was voluntarily donated. We need more unpaid voluntary donations to make blood more accessible to those in need.

Transfusible blood is obtained only from humans. We can’t manufacture blood like normal saline or get it from animals like insulin. So, people need to donate blood.

We must also make the case for better investment in our health system. Many public hospitals across the country cannot collect or store blood. They often ask patients’ relatives to look for donors or collect and keep blood that may not be useful for transfusion. Better hospital facilities and more laboratory supplies will buffer these limitations and improve the quality of blood transfusion in Nigeria.

While I don’t deny that unscrupulous elements could profit from the blood trade, we need to see the bigger picture. Blood donors serve a great need. Your donation makes blood readily available and accessible to everyone. So, please, go out there and donate. You are saving a life.

Adoto, a researcher, writer, and journalist, writes via bellohussein210@gmail.com.

By Muhammad Suleiman Yobe.

Jigawa State Ministry of Health has confirmed 141 new cases of Cerebrospinal Meningitis that claimed eight lives in the state.

The ministry’s Permanent Secretary, Dr Salisu Mu’azu, confirmed the cases to Daily Reality in Dutse, the state capital.

The Permanent Secretary, who spoke through Dr Sabi’u Muhmmad of the disease control department in the ministry, outlined some areas in Kaugama, Birniwa, Gumel, and Maigatari Local Governments the cases were identified.

Dr Muhammad said 134 out of the 141 patients were infected by Neisseria Meningitis type C, and 6 contracted Strept pneumonia while one was identified with Neisseria Meningitis type X and among the cases identified, about eight death were recorded.

He said that all measures had been put in place to avert the pandemic. He further advised communities in the affected areas to be conscious and refer a suspected case to the nearest general hospital for all necessary action. The state government has procured free medication for patients with such cases.

By Aminah M. Abubakar

Sometimes last year, a Nigerian PhD student at Korean University named Abdulqaadir Yusif Maigoro tweeted about his PhD thesis research work. He talked about his findings on the relationship between gut health and autism spectrum conditions. During a presentation at the International Meeting for the Microbiological Society of Korea, Maigoro discussed how gram-negative bacteria endotoxins could travel from the gut to the brain and cause inflammation in people with an autism spectrum disorder.

The research sparked my interest, so I joined the conversation on his Tweet. I asked; if gastrointestinal issues, such as stomach aches, irritable bowel syndrome, constipation, and bloating, are commonly seen in individuals with autism and other neuro conditions. It is possible that these issues may be related to the gut-brain connection and the role that the gut plays in regulating the body’s immune response. How close are experts to getting a cure for the gut disease in Autistic individuals?

Abdulqaadir Maigoro (@Abdul_Y_Maigoro) responded that it’s true individuals with Autism condition have gastrointestinal problems, and further research is needed to fully understand the relationship between gut health and neuro conditions by exploring various mechanisms. But it is clear that the gut plays a significant role in overall physical and mental health.

Maigoro’s findings have prompted my interest in getting more information by exploring the connections between gut health and other neurological conditions, such as Autism, Depression, Anxiety, ADHD, Alzheimer’s disease, and Dementia.

Gut health has long been known to be connected to overall physical health, but recent research has also shown a link between the gut and mental health conditions such as depression and anxiety. The gut is home to the enteric nervous system, sometimes referred to as the “second brain,” which has a network of nerves, neurons, and neurotransmitters that extend throughout the digestive tract. The enteric nervous system communicates with the brain through the nervous system, hormones, and the immune system. This communication is especially important in regulating the body’s immune response, as 70% of the immune system is focused on the gut.

The gut, or “second brain”, is vital to overall human health and well-being. It breaks down food, absorbs nutrients, and eliminates waste through chemical and mechanical processes. It also has its own nervous system called the enteric nervous system, which is made up of nerves, neurons, and neurotransmitters and extends throughout the digestive tract – from the oesophagus, through the stomach and intestines, and down to the anus. Because it uses the same types of neurons and neurotransmitters as the central nervous system, some experts refer to the enteric nervous system as the “second brain.”

The enteric nervous system communicates with the brain in the head through the nervous system, hormones, and the immune system, and it plays a key role in certain diseases and mental health.

Researchers are beginning to examine the gut in people with conditions such as depression, Parkinson’s disease, Alzheimer’s disease, autism, ALS, multiple sclerosis, pain, anxiety, and other neurological disorders. They are also studying the role of the gut in gastrointestinal conditions like ulcers and constipation and how it affects brain function.

The gut is also home to microorganisms that help regulate the body’s immune response, and around 70% of the immune system is focused on the gut to fight off and eliminate foreign invaders. Research on how the gut, or “second brain,” mediates the body’s immune system is exploring ways to expand the treatment of psychiatric and other neurological conditions, including the gut’s nervous system.

Researchers are now exploring various mechanisms in an attempt to find a potential cure for neuro conditions through the gut. The medical breakthrough will surely transform the world and touch the lives of nearly every person on the planet.

Aminah M. Abubakar sent the article via mbubakar.minah@gmail.com. She can also be contacted via her Twitter handle: @MinahMbubakar11.

By  Abdullahi Yusuf

Globally, the health care system is governed by ethical principles guiding the professional conduct of different professions within the coordinated body of health care delivery. Those ethical principles regulate service delivery in every profession and safeguard the well-being of the patients handled by those professionals within the scope of their professional practice.

Nigeria, with no exception, has its own healthcare system encompassing three delivery levels, ranging from primary, secondary and tertiary healthcare. Each level has personnel that are professionally trained in the various fields of health practice to take care of patients according to their expertise and professional boundaries.

The relationship between a healthcare provider and his patients from a legal perspective is contractual. The healthcare provider owes his patient a duty of care, and the patient owes the healthcare provider a token as payment for the service rendered. A contract is known to be an agreement between two or more parties that is legally binding, but in some cases, the relationship between the health care provider and the patient is not mutual, as the patient might not be in the right state of mind to make decisions. Regardless, the relationship is contractual, as implied by law.

In every contractual relationship between parties, there is a legal obligation that is to be fulfilled. Failure to fulfil the obligation will be regarded as a breach of contract. Breach of contract, according to law, generally attracts damages and, in some exceptions, can attract restitution, quantum meruit or specific performance, as the case may be. Inadequate knowledge of the law leads to the exploitation of many patients by some healthcare providers, which usually slides without punishing the offenders.

A healthcare provider can exploit his patient through breach of contract, medical negligence that could give rise to tortious liability, violation of some specific fundamental rights or violation of the patient’s rights under the National Health Act 2014. A healthcare provider can be punished when he/she commits any action under the aforementioned through specific disciplinary mechanisms set aside by the law.

The disciplinary mechanisms could be a civil or tortious liability, where the offender will be required to pay for damages by the court; criminal liability, where the offender will be punished based on the intensity of his crime according to the penal code of the state; and professional punishment can be served by the professional body that the offender belongs to by demotion, revoking of license or dismissal as the case may be.

There are instances where the management of a health facility could be held responsible for an accident that occurred to the patient in the facility—it is referred to as “Occupier’s liability” in law. In this regard, the accident must be a result of the negligence of the management, caused by failure to provide something necessary in which its absence resulted in the accident, or there may be a lack of maintenance of some equipment or devices that might have led to an accident.

Vicarious liability is also a situation where the management of a health facility can be held responsible for an act committed by their employee. When a patient is maltreated in a health facility by any member of staff, be it a violation of the right, tortuous act or breach of contract, the patient can sue the whole management of the facility in court for justice to prevail.

Any health consumer in Nigeria that once in a while visits a health facility to patronise health care services should know his rights as stipulated under the National Health Act 2014.

Part III of the National Health Act 2014 (Rights and obligation of users and health care personnel) encompasses eleven sections, starting from section 20 to section 30. Eight of those sections (sections 20, 23, 24, 25, 26, 27, 29 and 30) directly state the right of patients in relation to the health care provider.

Section 20 is about “emergency treatment”, where the section mandates any healthcare provider on duty to attend to a patient in an emergency without any hesitation or formality.  Contravening the section can attract a fine of ₦100,000 or imprisonment of not more than six months, or even two, as the case may be.

“User (Patient) to have full knowledge” is what section 23 is all about. It explained the right of a patient to be well informed of his condition and the possible treatment that will be administered to him/her, unless in the case where informing the patient will cause more harm. Section 24 expatiates the “duty to disseminate information” by federal, state or local government health authorities. Facilities should make such information visible at the entrance. The information should include the services provided by the facility, operating schedule and visiting hours, processes for making complaints and the rights of the patients as well as the health care providers.

Section 25 explained the “obligation to keep records”. This record involves the demography, treatment as well as medical history of the patients. It is mandatory for any health facility to keep records of their patients for future reference. “Confidentiality” of the patients must be a priority for any health facility and its personnel, as stated in section 26 of the National Health Act 2014. Disclosure of a patient’s information without a genuine reason is an offence that can attract punishment if reported.

The health record of the patient can be disclosed in some cases where the disclosure is in the best interest of the patient or is required by the court of law for judgement. It is stated as “Assess Health Record” under section 27 of the National Health Act 2014. “Protection of health record” is stated under section 29. Negligence in handling the record of a patient or deliberately tampering with any information without legitimate authorisation is an offence that can attract conviction to imprisonment for not more than two years or a fine of ₦250,000.

The last section with respect to patient’s rights under the National Health Act 2014 is section 30, which expatiates on the “Laying of complaints”. Any patient that is maltreated by any health personnel has the right to complain. The complaint should be in accordance with procedures provided by the federal or state ministry of health.

As a citizen of Nigeria, knowledge of fundamental and specific rights is necessary regardless of one’s level of education. People are being oppressed and maltreated on a daily basis due to ignorance of their rights and how to seek justice. To have a just and egalitarian society, people need to be aware of their rights and what should be considered a violation of those rights.

Conclusively, the law is set aside for justice to prevail, and nobody has the authority to deprive you of your right to justice. To get justice, you have to find it by going through the right channel. Albert Einstein said, “In matters of truth and justice, there is no difference between large and small problems, for issues concerning the treatment of people are all the same”.

Abdullahi Yusuf wrote is a final year student of Health Education, Department of Human Kinetics and Health Education, Bayero University Kano. He can be contacted via abdoolphd@gmail.com.

By Muhammadu Sabiu 

Virginity testing is forbidden, Dr Oluwajimi Sodipo, a consultant family physician at the teaching hospital of Lagos State University, said in Ilorin on Wednesday.

He revealed to the News Agency of Nigeria that the WHO had ruled the practice to be unlawful while he was attending a session for primary healthcare professionals.

Aside from the WHO announcement, he said, the practice was antiquated.

The most common reasons for conducting the virginity test are requests from parents or suitors to see whether the girl is eligible for marriage or to determine her suitability for a job.

According to the WHO, a virginity test is a gynaecological exam done with the intent of determining if a woman or girl has had vaginal contact.

He added that the practice was frequently agonizing, embarrassing, and distressing, adding that the idea of a virginity test was false because a woman’s lack of a hymen did not necessarily indicate that she was promiscuous.

By Safiyanu Ladan

The National Health Insurance Scheme (NHIS), now Nigeria Health Insurance Authority (NHIA), was established under NHIS Act (2004) by the Federal Government of Nigeria to provide easy access to health care for all Nigerians.   

The central idea of the scheme is to enhance healthcare delivery to all Nigerians at affordable prices. Hence, easy access to health care installations for all Nigerians is consummate as it would drastically reduce, among other effects, neonatal and maternal deaths which have been the bottleneck of Nigeria’s development.  

According to World Health Organization (WHO), the maternal mortality rate in several low-income and middle-income countries is alarming. For example, Nigeria and India account for about 34% of global motherly deaths. 

Nigeria’s maternal mortality rate (MMR) is 814 per 100,000 live births. The lifetime threat of Nigerian women dying during gestation, childbirth, postpartum and post-abortion is 1 in 22, in contrast to developed countries, estimated at 1 in 4,900. 

Still, the WHO attributed the high prevalence of maternal deaths in Nigeria is inequality in access to health services.  

To contend with the challenges associated with maternal deaths in Nigeria, the studies by WHO suggested some modalities, one of which is perfecting the accessibility, availability, affordability and quality of health care in PHCs will most probably reduce the high rate of neonatal and maternal mortality in Nigeria.  

Upon assumption of duty in 2019, the selfless, diligent, and workaholic professor of family medicine unveiled a  novel 3 points agenda which includes, among other effects accelerating the scheme towards achieving universal health coverage for all Nigerians.  

In ascertaining that, the amiable and agile professor and his platoon worked round the clock, day in and day out, and sought out the legislation that changed the narratives in NHIS. A milestone that his forerunners failed to achieve. Therefore, the credit goes to him. 

On May 19, 2022, he made history, having successfully secured the signing of the National Health Insurance Act (NHIAA) 17 into law by the National Assembly. 

The signing of the National Health Insurance Act 17, which gave birth to the National Health Insurance Authority ( NHIA), is a breakthrough in the full implementation of all-inclusive access to health care.  

The legislation provided a legal framework for all Nigerians, including the most vulnerable, to have easy access to quality healthcare delivery through the National Health Insurance Authority.

 Professor Sambo said to ensure the effective perpetration of the scheme. The FG would spend a whopping 1.4 trillion for the Health Insurance premium of about 83 million Nigerians who fall within the vulnerable group of citizens of the country. 

His tireless efforts towards achieving the chivalrous change of NHIS clause “ May ” in section 16 of the NHIS to “Shall”, thereby making it all-inclusive, is greatly applaudable. 

The previous professor Sambo has set an unprecedented pace towards evolving NHIA to achieve its mandate of ensuring Universal Health Coverage for all by 2030. With Sambo at the helm of NHIA, it’s attainable. 

Safiyanu Ladan writes from Zaria.

By Aisha Musa Auyo

World Menopause Day (WMD) is held annually on the 18th of October. The purpose of the day is to raise awareness of menopause and the support options available for improving health and well-being. Professionals and women are encouraged to participate in this global awareness-raising campaign by printing and sharing these materials, organising events to engage their communities, and sharing WMD social media posts. The theme for the 2022 WMD is Cognition and Mood

Before going into this year’s theme, I’ll explain the basics of menopause as a reminder and enlightenment for those who do not know much about it.

Menopause happens to most women with an average age of 51 years, but it’s normal to have menopause anywhere between 45 and 55 years – although some women have it earlier or later. Perimenopause is the time leading up to menopause, and postmenopause is the time after the final period. So it’s likely that you have reached menopause if you haven’t had a period for 12 months.

What happens at menopause?

From about 35–40 years of age, a woman has fewer eggs left in the ovaries, so one often doesn’t ovulate (release an egg from your ovary) regularly. Menopause means ovulation and periods stop.

Hormones are chemicals in one’s body that relay messages through the bloodstream. For example, your hormones tell your body to eat and sleep. The three main hormones that change as one approaches menopause are oestrogen, progesterone, and testosterone; change in hormone levels leads to different menopausal symptoms and the menopause transition

1. Perimenopause is the stage before your final period (menopause). It’s when your body reaches the end of its reproductive years. Perimenopause is a natural part of a woman’s life, and it usually happens sometime in her 40s. On average, it lasts four to six years but can also last from one to 10 years.

During this time, your ovaries begin to run out of eggs. This causes hormone levels, particularly oestrogen, to fluctuate, causing different symptoms like hot flashes and mood swings. Changing hormones can also affect your menstrual cycle. For example, your periods may be irregular, shorter (or longer), lighter (or heavier), or they may not come for a few months.

Some months you may ovulate, and other months you may not. You may even ovulate twice in a cycle. Symptoms include: Irregular periods, vaginal dryness, hot flashes, chills, night sweats, sleep problems, mood changes, weight gain and slowed metabolism.

2. Menopause occurs when you’ve stopped producing the hormones that cause your menstrual period and have gone without a period for 12 months in a row. Once this has happened, you enter postmenopause.

3. Post-menopause is the time after menopause has occurred. Once this happens, you’re in post-menopause for the rest of your life. Your hormone levels will remain low, and you will no longer have a monthly period. You can’t get pregnant because your ovaries have stopped releasing eggs.

Most people in post-menopause feel lingering symptoms from menopause. However, the symptoms are less intense. In some cases, they almost disappear. Lingering symptoms are caused by low levels of reproductive hormones. Women in post-menopause can feel symptoms such as hot flashes and night sweats, vaginal dryness and sexual discomfort, depression, changes in sex drive, insomnia, dry skin, weight changes, hair loss and urinary incontinence.

Talk with your healthcare provider if your symptoms become more intense or interfere with your daily life. They may want to rule out any underlying condition causing these symptoms.

How do I manage symptoms of post-menopause on my own? Particular lifestyle or at-home changes can help you manage symptoms of postmenopause. Some of these include:

• Using a water-based vaginal lubricant during sex to make it more pleasurable. Lubricating the vagina helps with dryness and pain.

• Regular exercise, meditation and other relaxing activities can help with depression and other side effects of postmenopause.

• Eating a diet rich in phytoestrogens (plant-based sources of estrogen) such as whole-grain cereals, flaxseed, chickpeas and legumes. Reducing caffeine and alcohol intake has also been shown to help.

Cognition and mood in menopause

Cognition

During the menopausal transition, many women complain of memory problems such as difficulty with words, forgetfulness and “brain fog”, thus suggesting that hormonal changes related to menopause may be responsible for changes in cognition. This is due to the deep connection between estrogen and cognitive function. Still, some lifestyle changes one can make may ease symptoms and improve memory.

For example, you should eat a well-balanced diet; a diet high in low-density lipoprotein (LDL) cholesterol and fat may be bad for your heart and brain. Also, get enough rest, and exercise your body and mind.

Mood

Irritability and feelings of sadness are the most common emotional symptoms of menopause. Often, they can be managed through lifestyle changes, such as learning ways to relax and reduce stress. Here are some tips that may make it easier for you to handle your fluctuating emotions: Exercise and eat healthily; find a self-calming skill to practice, such as yoga, meditation, or rhythmic breathing; avoid tranquilisers and alcohol; engage in a creative outlet that fosters a sense of achievement; stay connected with your family and community; nurture your friendships.

Supporting someone through the menopause

Menopause can be associated with many physical and emotional changes for women, making it a challenging and complicated time.

If you know someone who might be going through menopause or perimenopause, it’s helpful to find out more about how you can support them. For example, some women will drop out of the workforce if not supported. Adapting working policies, such as providing access to flexible working, can help women remain in the workplace.

Learn more about menopause

Getting yourself and others informed is a significant step. It will give you an idea of what your partner, family member, friend or colleague might be going through.

A good first step would be to learn about all the various symptoms of menopause, the impact these symptoms may have on your loved one and others, and the potential treatments and support available.

Listen to them

Communication is key. Ask about how others feel or what they’re going through. It’s essential to keep in mind that not everyone might want to talk about specific symptoms or feelings. It is also important to remember that everyone’s menopause is different, so don’t make assumptions about what they are experiencing. However, letting them know you’re there if they need you will make them feel supported.

Encourage them

They might not feel like doing things they usually would, and their self-esteem might be low. Words of encouragement can help make them feel more uplifted and empowered. Inviting them to engage with various people or activities will also provide opportunities to feel good about themselves even when experiencing symptoms.

Help with their symptoms

An active, healthy lifestyle can ease some of the symptoms of menopause. For example, you can encourage them to go for a walk, swim or try a yoga class to get more active. In addition, changing the ways you spend time together, like cooking a healthy meal together.

Menopause and the workplace

Many women have said that they often find managing symptoms of menopause in the workplace very challenging. Coping with symptoms in the workplace can be hard, especially as many women find it difficult to talk about menopause at work.

Workplaces

It is vital that women feel supported to continue working throughout their menopause. Managers and organisations can make many small changes to ensure workplaces are healthy and welcoming places for women going through menopause.

Supporting staff

Menopause is a normal transition for many women. Thus, employers can contribute to a positive work environment by providing help and support for women who are managing menopause symptoms at work.

Menopausal symptoms can also be protected by employment law. Therefore, it is crucial that managers and colleagues feel informed and comfortable about the symptoms and impact of menopause.

Aisha Musa Auyo is a Doctorate researcher in Educational Psychology, a mother of three, a Home Maker, caterer and parenting/ relationship coach.

By Lawal Dahiru Mamman 

Noma, otherwise known as necrotising ulcerative stomatitis, gangrenous stomatitis, or cancrum oris, is a bacterial infectious but non-contagious infection; resulting from poor oral hygiene, lack of sanitation and malnutrition, affecting both soft and hard tissues of the mouth and face, rapidly progressive and more often than not fatal.

The most common sign and symptom is the development of an ulcer in the mucous membrane of the mouth before spreading to other parts of the face. If detected early, the condition can be arrested with antibiotics, proper nutrition and oral hygiene, while late diagnosis does not restore disfigured or damaged tissues even if treated.

Affecting children between 2 to 6 years of age, the disease is prevalent in impoverished communities in Asia and Africa. However, infection was also found decades ago in Europe and South America. This infection has since vanished with improved livelihood and healthcare.

Preventable but deadly, all over the world, Noma has been given the cold shoulder (neglected) over the years. The absence of current epidemiological data has made the data of the World Health Organisation (WHO) from 1998 the most frequently cited estimation of the disease, with a global estimate of 140,000 new cases recorded annually, with a majority in Sub-Saharan Africa and a mortality rate of 90% if not treated within two weeks.

The infection has not spared the children in Nigeria, falling under the countries in Sub-Saharan Africa, killing numbers and leaving survivors disfigured, coupled with the reality of leaving the rest of their lives under stigmatisation.

This informed the decision of the Federal Ministry of Health to call on the WHO at the 75th World Health Assembly to include Noma on the list of Neglected Tropical Diseases (NTDs) where it belongs.

The call was aimed at rallying global support to eliminate and start preventive and curative measures against the preventable but deadly disease.

Established in the year 1999, the Noma Children’s Hospital, Sokoto, up until May 2022, when Noma Aid Nigeria Initiative (NANI) began construction of a new 100-bed National Noma Treatment Centre within the National Hospital, Abuja, has been the only specialist hospital shouldering the burden of the debilitating disease in the country.

The Chief Medical Director of the hospital in Sokoto said, “what is lamentable is that the disease is curable and even preventable, but lack of awareness has made a good number of patients die at home without visiting the hospital, exacerbating knowledge gap.”

To create awareness on predisposing factors like malnutrition, vitamin (A and B) deficiency, contaminated drinking water, immunodeficiency and living in proximity to livestock, November 20th have been set aside as Annual Noma Day.

Before resting my case, let me advocate that the awareness campaign held annually on NOMA DAY be taken to people in rural areas. These people are most vulnerable and unaware. Therefore, it will be better than having the symposia in town or city halls where the inhabitants are most likely informed. Moreover, more specialists should be trained on the infection to establish more specialist hospitals in at least each geopolitical zones of the country to unburden that in Sokoto and the upcoming one in the Federal Capital Territory.

Furthermore, people should be encouraged to embrace oral hygiene and proper nutrition like a religious ritual. In suspected cases, patients should be taken to the hospital for appropriate treatment to prevent disfigurement. Routine vaccination for children ought to be taken as a priority of every parent, and individuals with any information on Noma are encouraged to carry out a personal campaign in their locality amongst family and friends because the little things we do can make a difference.

Lastly, I urge all to avoid stigmatisation of survivors because they were but victims of circumstance.

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

By Adam Mustapha, PhD

Floods are natural disasters that occur globally, destroying lives and property, especially in developing countries like ours. As a natural disaster, it is caused by climate changes and human activities which distort the balance of environment, hosts and pathogens. Factors such as high sea level rise, urbanization, destruction of river banks, and deforestation increase the risk of flood disasters.

Flood results in the disturbance of the epidemiological triangle; environment, host and infectious agent, and as such, it could result in the emergence of new agents or re-emergence of infectious agents that previously existed. Therefore, the potential outbreak of infectious diseases is a matter of great concern, and urgent intervention is needed to break the chains of transmission.

Flood is known to increase the global burden of various infectious diseases, mortality, social and economic disruptions and displacement of people, which can result in both physical and psychological trauma. Of great concern is how flood causes the outbreaks of infectious diseases, as germs can easily be transported and contaminate drinking water sources, which will provide a conducive environment for the completion of the vector life cycle.

Like other developing countries, flooding has become an annual event in Nigeria, and many towns and cities are vulnerable and susceptible to it. This year, the Nigerian meteorological agency (NiMet) warned some states that they were at high risk of flooding in its yearly prediction of rainfall. Therefore, it was unsurprising that flooding hit many such states, states like Jigawa and Yobe have significantly been hit. In contrast, others such as Borno, Adamawa, Gombe, Kebbi, Kano, Kaduna, Lagos, Kogi, Niger, Delta, Rivers, Zamfara, Taraba, Ogun, Osun, Ondo, some parts of Ekiti, Edo and FCT are affected from moderately to low levels.

Flooding can cause waterborne diseases such as cholera, non-specific diarrhoea, typhoid and viral diarrhoea caused by Rotavirus. These diseases are known to peak after flooding as the pathogens such as bacteria, viruses, and parasites can be transported. In addition, the crowded nature of displacement camps can potentially result in and aggravate the outbreak of respiratory diseases.

The crowded nature of displacement camps can potentially result in the outbreak of respiratory diseases of different etiological agents. Wastewater is a breeding ground and carrier of infectious diseases. For instance, wastewater has the potential of spreading viruses, as they are known to be good-chance takers of a flood, which take days after flooding to meet their incubation cycle. Viral diarrheal diseases, such as hepatitis A and E, vector-borne viral diseases such as Yellow fever, and many others are also some diseases that could potentially spread after the flood.

The genome of some viruses, such as SARS-CoV-2, are known to be detected in community wastewater and this call for concern as it can be disseminated during a flood. Another agent to worry about due to flood is Naegleria fowleri, a brain-eating amoeba causing primary amoebic meningoencephalitis (PAM). As water level and temperature rise, such a situation could fuel the growth of the agent. Environmental contribution to the development of infectious diseases is a significant public health concern that should not be ignored. Antibiotic-resistant bacteria and antibiotic-resistant genes are quickly disseminated in environmental wastewater, which could be further transported into the water system, which calls for concern.

Furthermore, the vector-borne disease can occur as a result of a flood because the development cycles of vectors are provided. For instance, mosquito-borne diseases such as malaria and West-Nile fever tend to increase after floods. Rodent-borne diseases also expand during flooding because the flood increases contact between rodents and humans, resulting in outbreaks of such diseases. Common rodent-borne infectious agents due to flooding include Leptospirosis, Hantavirus pulmonary syndrome, Hemorrhagic fever with renal syndrome etc.

Health interventions

 First, public health measures are essential in preventing infectious diseases due to floods. Therefore, preventive measures should be taken before, during and after the flooding.

Second, the provision of crucial intervention. The critical intervention is an active early warning system that can alert governments to prepare for possible outbreaks and send signals for evacuation of people at risk.

Third, the activation of rapid emergency response is also a necessity. This includes the provision of basic materials and health care services.

Fourth, after the flood, the activation of an effective surveillance method is mandatory for the early detection of an outbreak.

The key intervention is active early warning systems which can alert governments to prepare for possible outbreaks and send signals for evacuation of people at risk. At this stage, all stakeholders and the public must act on time. However, compliance is low due to a lack of an alert system or people refusing to abide by the warning system. Furthermore, risk assessment is needed to ensure that no basic amenities are disrupted due to floods.

Moreover, there is a need for vector control after the flood to break the chains of transmission. There is a need for collaboration among all public health stakeholders. Public enlightenment and outreaches are equally essential intervention measures.

Finally, provisions of clean water, sanitation and hygiene after the flooding to prevent infectious disease outbreaks are also very significant.

Adam Mustapha, PhD, is a clinical and medical microbiologist. He wrote from the Department of Microbiology, University of Maiduguri, via adadmustapha@unimaid.edu.ng.