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22 — Vanguard, TUESDAY, OCTOBER 18, 2022 ‘ Why immunisation coverage remains low in Nigeria • Falls short of GVAP goals with only 57% coverage By Chioma Obinna ONE of the major rea sons Nigeria is committed to the goals of the Global Vaccine Action Plan, GVAP, was not only to ensure that at least 90 per cent of children under the age of 5 are immunised with all the relevant and available vaccines for children but to put to an end or reduce to the barest minimum child killer diseases. Sadly, with the slow progress being made in immunisation coverage, Nigeria still falls short of the goal it set with only 57 per cent of children immunised in the last five years, according to the 2021 Multiple Indicator Cluster Survey, MICS, and the National Immunisation Coverage Survey, NICS, jointly released by the Nigerian Government, the United Nations Children’s Fund, UNICEF, in partnership with other partners. Findings by Good Health Weekly showed that many mothers and caregivers still have reservations about immunisation, leaving Nigeria with only 36 per cent of children aged between 12 and 23 months receiving all recommended vaccines, according to the 2021 MICS. Even though the benefits of vaccines are fully realised when children receive all recommended vaccine doses promptly, many of these children receive incomplete doses. A case in point is that of Abdul Abdul. At age 1, Ahmed received only one immunisation which was given to him a few days after his birth at one of the Lagos State Primary Healthcare Centres. Bola, Abdul's mother, said he was not himself after the first dose of BCG, which discouraged her from returning for the other immunisations. “I was afraid that my child would have more complications if I went back for another immunization. He had a fever for days. Although I tried to go back for measles the day I went to the PHC, we were told to come back and I have not been able to go back due to time and he is now more than nine months. I lost my first child I don’t want to lose another. ” she said Like Abdul, many children in Nigeria have either received one or two immunisations and some have not received any at all due to unsubstantiated reasons. Today, immunisation coverage in Nigeria is below GVAP goals, putting millions of children at risk of vaccinepreventable diseases all thanks to these unfounded factors. However, findings by The highest percentage of children who did not receive any vaccinations are in Sokoto with 51 per cent while the smallest proportions is found in Enugu with 1 per cent and Ebonyi 0 per cent. Courtesdy of MICS6. HEART ATTACKS: Okoye seeks improved attention on blood clots • As World Thrombosis Day Campaign steps up By Sola Ogundipe AS Nigeria joined the rest of the world to mark this year’s World Thrombosis Day, a medical expert and spokesperson for the World Thrombosis Day campaign, Dr Helen Okoye, has called for more attention towards curtailing the menace of blood clots and the risk of fatal heart attacks. Okoye who spoke on World Heart Day ahead of the World Thrombosis Day Campaign noted that it’s vitally important for people to understand the risks that could lead to having a fatal heart attack, and how to lessen them. Thrombosis, commonly known as blood clots, plays a significant role in people having heart attacks. To understand how this happens, she explains that coronary arteries – which are wrapped around the outside of the heart – supply blood to the entire heart muscle, which needs oxygen-rich blood to function. “These coronary arteries can develop plaques – a the MICS report, showed that gaps in routine immunisation in Nigeria. It shows that 64 per cent of children aged 12-23 months did not receive all routine immunisations, 46 per cent did receive but not all doses, 18 per cent did not receive any one, and 30 per cent build-up of cholesterol, fibrous tissue, and inflammatory cells – in a process called atherosclerosis. If these plaques become unstable and rupture, a blood clot can form at the site in a process called arterial thrombosis. If that blood clot blocks a coronary artery, blood can’t reach the heart, which leads to a heart attack,” she says. Signs of a heart attack include chest pain or pressure, shortness of breath, light-headedness, pain in the jaw, neck, and back, and pain in one or both arms or shoulders. If such an instance, seek immediate emergency medical help. Warning of a fatal link between blood clots and heart attacks, Okoye harped on the importance of reducing the risk of thrombosis, the often preventable underlying pathology of the top three cardiovascular killers – heart attack, thromboembolic stroke, and Venous Thromboembolism (VTE). She states that thrombosis can affect people of all ages, even though certain thought the child was fully immunised. Other reasons found by the survey showed that 51 per cent lack knowledge or information, while 7 per cent complained that the immunisation site was too far and 19 per cent was due to service delivery issues and 11 per cent reported that mothers or caregivers too were busy, 24 per cent lack of time or other family issues, 11 per cent had fear of side reactions and 26 per cent due to mistrust or fears. According to the report, a fully vaccinated child must have received all 1YL antigens including BCG, OPV0, HepB0, OPV1-3, IPV, Penta1-3, PCV1-3, YF, Meningitis A & MCV1. Sadly, even though the benefits of vaccines are fully realised when children receive all recommended vaccine doses promptly, only 36 per cent of children aged 12- 23 months received all recommended vaccines in Nigeria. The report also notes that more children were fully vaccinated in the southern zones compared to the northern zones. From the survey, nearly 2 of every 4 rural children received Penta3 and children in the richest quintile were more than twice as likely to receive Penta3 as those in the poorest quintile. “Immunisation coverage varies dramatically across Nigeria and improvements are needed in nearly every state,” the report stated. factors put one at higher risk. “Thrombosis is a significant public health issue, yet so many people are unaware of it. Risk factors for thrombosis include hospitalisation, surgery, cancer, prolonged immobility, family history, oestrogen-containing medications, and pregnancy or recent birth. It all comes back to prevention. “Understanding the risk factors and what you can do to lessen them enables you to be an active participant in your health and wellbeing and is the knowledge that could very well save your life or that of a loved one.” Meanwhile, World Thrombosis Day, a global awareness campaign led by the International Society on Thrombosis and Haemostasis (ISTH), recognized annually on October 13 to bring awareness to conditions caused by thrombosis, stepped up efforts against the preventable killer disorder. Ahead of its 10th anniversary in 2023, the World Thrombosis Day campaign, with the tagline “Eyes Open to Thrombosis,” is dedicated to spreading awareness of the signs, symptoms, and risk factors of blood clots with the help of more than 3,000 partner organisations who organizing upwards of 10,000 awareness activities worldwide Blood clots are the underlying cause of heart attacks, ischemic strokes, and venous thromboembolism (VTE), the top three cardiovascular killers. VTE occurs when one or more blood clots form in a deep vein, most often in the leg (deep vein thrombosis, DVT), and can travel in the bloodstream and lodge in the lungs (a condition known as pulmonary embolism). This year’s global campaign offers enhanced efforts to share personal stories from patients and survivors who have experienced life-threatening VTE to spotlight the prevalence of this often-overlooked condition. However, the report also found that two states - Ebonyi and Enugu have estimated leads among states with the lowest number of children not vaccinated. The two states have the highest number of Penta3 coverage above the 90 per cent goal. Penta3 coverage is notably higher in the southern zones than in the north. “Children are significantly less likely to have received 3 doses of pentavalent vaccine if they are from poor families or rural families or if the child’s mother is younger than 25 years of age or has a low level of education,” the report revealed. In the NICS 2021 survey, only 56 per cent of children showed a child health card and the availability of child health cards varied across states, with a high of 98 per cent in Ebonyi and a low of 16 per cent in Sokoto. States with low immunisation coverage also had low card availability. Child health cards are important health records critical for evaluating immunisation status. It also found that in 3 of 6 zones there are significant differences in zero dose prevalence between urban and rural households, with rural children more likely to be zero doses. In 4 of 6 zones, there are significant differences across one or more categories of maternal education, with less educated mothers likely to have zero-dose children. In 5 of 6 zones, there are significant differences between the poorest and richest wealth quintiles, with poorer households more likely to have zero dose children.” UNICEF’s Chief of Monitoring for Result (M4R), Mr Claes Johanson who traced most deaths of children to lack of immunization, told Good Health Weekly that, although the 2021 immunisation report showed a little improvement from the 44 per cent and now 57 percent, has a huge impact on child mortality. He said women’s education has a huge impact on immunisation. Johanson who said the smallest proportions of children who did not receive any vaccinations are found in Enugu with 1 per cent, Ebonyi, 0 per cent and Sokoto with 51 with r cent said the benefits of vaccines are fully realised when children receive all recommended vaccines doses promptly. Johanson said while there was a little progress, there was room for improvement, adding that, action should be a priority for the Nigerian government.
Despite huge advances in diabetes treatment, access remains challenging • Prevalence projected to hit 8m by 2045 in Nigeria Bolaji Babatunde DESPITE huge ad vances in diabetes treatments, people living with the disease in poorer countries still miss out on access to insulin and other treatment choices. Unfortunately, a report on diabetes care published by the Access to Medicine Foundation (ATMF), a Netherlands-based nonprofit Organisation showed that the number of people with diabetes worldwide is expected to reach 643 million by 2030, and 783 million by 2045. Findings by Vanguard have shown that in LMICs, many people who need insulin currently do not have access to this essential, lifesaving drug and many more do not have the choice of products that all patients deserve. According to medical experts, Insulin is a hormone made in the pancreas, a gland located behind the stomach. Insulin allows the body to use glucose for energy. Glucose is a type of sugar found in many carbohydrates. Injections of insulin can help manage both types of diabetes as it acts as a replacement for or a supplement to the body's natural Cancer diagnosis most traumatising step patients will go through — Oncologist A Consultant Clinical and Radiation Oncologist at Evercare Hospital, Lagos has said that a diagnosis of cancer is one of the most traumatising steps patients will have to go through. Okoro, multiple cancer specialists explained that the emotional and psychological burden of the disease is occasionally so much for patients to handle which may be the reason why cases of depression in patients with cancer are higher when compared with other non-communicable diseases. Okoro who is a specialist in malignancies of the breast, genitourinary tract, gastrointestinal tract tumours, gynaecological malignancies, prostate malignancy, and head and neck tumours, noted that such a diagnosis is expected to result in physical, emotional, financial, and spiritual changes in the individual, hence, strategies for coping with the condition necessary to improve treatment outcome. With cancer as one of the leading terminal illnesses today, he explained further that the most important first step for a patient diagnosed with cancer was understanding the diagnosis and disease process. "Discussions with the managing physician should provide information on the type of cancer, location of insulin. People living with type 1 diabetes can't make insulin, so they must inject insulin to control their blood glucose levels. Many people living with type 2 diabetes can manage their blood glucose levels with lifestyle changes and oral medication. However, experts say, if these treatments don't help control glucose levels, people living with type 2 diabetes may also need supplemental insulin. However, in Nigeria, the prevalence of the disease is projected to rise to 8 million by 2045. The rise, according to the ATMF report, will be most rapidly in low- and middleincome countries, LMICs, like Nigeria as the burden of non-communicable diseases continue to skyrocket. Reacting to the study, the Chief Executive of Officer of Access to Medicine Foundation, Dr Jayasree Iyer, the number of people living with diabetes is expected to grow by over 100 per cent in Africa by 2045. She said the current estimate of 3.5 million living with the disease in Nigeria may be underestimated due to poor diagnosis. To break these inequalities in treatment and ensure easy access to treatment, the World Health Organisation, WHO added several analogue insulins to its Model List of Essential Medicines, with analogues joining the human insulins that were already listed - demonstrating an increasing recognition by global health stakeholders that both types of insulin are needed for patients in all countries. Still in Nigeria and other low-income countries, the burden of treatment of diabetes remains significantly greater, according to the ATMF. The report also showed that the 3.5 million Nigerians living with diabetes are facing challenges accessing treatment. However, "costs associated with the prevalence of the disease are not only social but economic," says Iyar She said:" The health expenditure related to diabetes care in Africa is about $12.5 billion and this reflects the fact that most people pay for relatively expensive and unaffordable insulin treatment. For example, the average diabetes-related health expenditure per person amounts to approximately 500 dollars a year, which is a huge financial burden if the patient has to pay it all or partially out-ofpocket." The report also indicates that 35 per cent of patients in LMIC pay out-of-pocket for healthcare, compared to 13.6 per cent in high-income countries, where the public sector is more likely to be involved. However, to ensure access to insulin and treatment, organisations are seeking more sustainable, systemic approaches to expanding access to insulin in countries like Nigeria and other LMICs. The ATMF report examined the activities of three prominent pharmaceutical manufacturers. It showed that Eli Lilly, Novo Nordisk, and Sanofi, produce 83 per cent of the insulin sold in LMICs, where they also hold around 95 per cent of the market share. Insulin supplied by these firms is sold at higher median prices in LMICs than in high-income countries. According to the report, the reasons for this include the manufacturer's selling price, wholesale and retail mark-ups, taxes, and other tariffs. These companies are however taking action to address the inequity in access to this essential medicine. Members of Otu Osisioma Age Grade during a waqlk to mark this years cancer awarebness month in Lagos. cancer, stage of the disease, which could be institution comes. is the disease treatable or based or in form of a nonprofit organization, these Get enough rest and exer- "Choose a healthy diet. not, treatment options, side effects of treatment, cost of groups usually have members that have undergone can exercise during treatcise if you can. Patients who treatment, what happens if the patient declines any or undergoing treatment for ment not only deal better treatment and life changes similar illnesses and as with side effects but also to expect during and after such lots of coping strategies are discussed and Lifestyle changes will may live longer. treatment. "Having open-minded made available to members," he added. changes usually include need to be discussed; these conversations with your managing physician is of immense benefit as it creates maintaining a healthy terruptions should be ex- He further stated that work schedules as work in- the opportunity for both lifestyle was also important pected while on treatment, patient and physician to be for any patient being managed for cancer as it will not present may not include physical activities that form on the same page as regards treatment expectations only improve the energy cancer care. Hence most which makes tracking of level, manage the stress and patients will have to fund treatment progress easier. fatigue of cancer as well as cancer care out of pocket Patients are also encouraged to join support groups tively impact treatment out- are usually its treatment but will posi- even when such treatments expensive." Vanguard, TUESDAY, OCTOBER 18, 2022 — 23 Group offers free cancer screening for Lagos women By Deborah Ariyo and Bolaji Babatunde TO mark this year’s Breast Cancer Awareness Month, stakeholders have called for regular breast cancer screening and increased awareness of the disease as part of measures to prevent unnecessary deaths from the scourge of the disease. To this end, Osisioma Age Grade sociocultural group weekend in Lagos organised a walk/enlightenment and free cervical cancer screening for women in the Festac area of Lagos. Addressing the gathering, the Registrar, Dept of Surgery, Lagos University Teaching Hospital, LUTH, Dr Olaleye Emmanuel maintained that early detection and treatment were key to surviving breast cancer. Emmanuel who stressed the need for increased awareness of the scourge of cancer said breast cancer is a serious disease that requires awareness to go out to the rural areas. “There is a need to educate Nigerians on how cancer develops and how to curb it on time. Cancer can be cured if it is discovered and treated early. Foundation gives 101 eye glasses, vision devices to children with Albinism By Esther Onyegbula IN line with the vision of Re store Foundation For Child Sight, RFCS, to ensure attainment of full life potentials through optimization of eyesight in disadvantaged children, 101 eye spectacles and visual devices were presented at no cost to children living with albinism on Saturday in Lagos. The Executive Director of RFCS, Dr Halima Alimi revealed that children living with Albinism encounter challenges in attaining greater heights in their academic pursuit due to poor vision. She emphasised the need to support these group of children with a view to having a fair chance to perform optimally in life. She added that the Foundation is determined to reach out to them and provide restorative devices to enhance their vision. In achieving this mandate, Alimi disclosed that the Foundation is collaborating with the Lagos Albinism Awareness Society to organise eye outing days where preliminary vision tests can be carried out on the Albinism children and But people need to be aware of the disease and watch out for it.” According to the WHO 2021 report, breast cancer is currently the most common type of cancer worldwide, with 2.26 million cases recorded in 2020. In Nigeria, breast cancer cases were historically low but are now increasing as a result of urbanisation and lifestyle changes. He commended the group for organising such an event that seeks to create awareness of the disease. Speaking on cervical cancer, an Oncologist/ Gynaecologist from the Lagos University Teaching Hospital, Oluchi Ozonu who stated that the HPV virus that causes cervical cancer can be transmitted through sex urged parents to teach their young girls about sex education early in life. In his welcome address, the Lagos State Chairman of the Osisioma Age Grade, Pastor Chuks Nduka, who disclosed that a number of their wives and daughters have died due to cancer said the month of October is regarded as breast cancer awareness month, hence, the need for the sensitization programme. provide restorative devices that will be useful to them. She therefore called on the Federal Government to develop certain policies that will mandate publishers to print large and bold textbooks for children with low vision. Government should also ensure proper registration of children with Albinism at birth so that they easily be reached for quick intervention, she said. Alimi also urged school teachers to have bold handwriting and always put children living with albinism at the front rows in classrooms. The Convener of Lagos Albinism Awareness Society, Mrs. Josephine Omolola commended the laudable project being embarked upon by Restore Foundation for Child Sight. She admonished parents of children living with Albinism to visit qualified medical professionals such as Ophthalmologists for eye treatment and Dermatologists to take proper care of their skin. Mrs.Josephine also urged parents to keep their children away from the damaging rays of the sun to prevent skin cancer.
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