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2017: Same old story in healthcare

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      …as National Health Act, UHC remain in limbo

The health sector in 2017 was characterised by undue delays and hiccups in terms of policy formulation and implementations, resulting in only motion without concrete achievements, reports APPOLONIA ADEYEMI

 

As Nigerians prepare to bid farewell to 2017, key stakeholders in the health sector are concerned over the non-implantation of the National Health Act (NHA), which was passed into law in 2014. Seen largely as an instrument that could boost health care funding while easing the current burdensome out-of-pocket pocket payment by patients, how to make it operational has been a major concern in 2017.

Monkeypox
Although, the emergence and re-emergence of infectious diseases in the country had begun in 2016, the outbreak of Monkeypox remains the most dreadful, in terms of the impact of the disease of the pox family in the psyche of human beings .

Till date Nigeria aligns with the global community in finding lasting solution to the health challenge posed by Monkeypox. It’s known that death rate from the condition is near zero; the emergence of the medical condition is a sore point for the country’s disease surveillance system. This trend emerged in spite of expert projections in the past two years that infectious diseases of old could re-emerge.
Monkeypox is an infectious disease caused by the monkeypox virus. Symptoms begin with fever, headache, muscle pains, swollen lymph nodes, and feeling tired. This is then followed by a rash that forms blisters and crusts over.

Monkeypox is not the only disease that plagued Nigerians this year, many citizens similarly came down with Lassa fever, the most dreadful medical condition in the country presently on account of the high death rate arising from it. This is the disease that even medical doctors and other health workers dread most because of its highly contagious nature. Several health workers in the course of duty have been infected and died.

However, the Federal Ministry of Health (FMOH), the Nigerian Centre for Disease Control (NCDC) in partnership with international partners have increased surveillance to track both the old and new emerging diseases.
The FMOH and NCDC have however been providing free treatment for Nigerians that came down with these diseases including dengue fever, the outbreak of which did not reach epidemic level throughout the year. These are not the only diseases that troubled Nigerians in 2017.

Malaria
Malaria fight is another area where Nigeria recorded poor performance. The latest World Malaria Report 2017, issued by the World Health Organisation (WHO) in November, shows that after an unprecedented global success in malaria control, progress has stalled.

Going by details of the report, there were an estimated five million more malaria cases in 2016 than in 2015 and malaria deaths stood at around 445 000, a similar number to the previous year.
The Director-General of the World Health Organisation (WHO), Dr. Tedros Adhanom Ghebreyesus said, “In recent years, we have made major gains in the fight against malaria. We are now at a turning point. Without urgent action, we risk going backwards, and missing the global malaria targets for 2020 and beyond.”

Based on WHO’s Global Technical Strategy for Malaria which had called for reductions of at least 40 per cent in malaria case incidence and mortality rates by the year 2020, the WHO’s latest malaria report is an indication that the world community is not on track to reach these critical milestones.

However, at the centre of the problem is insufficient funding at both domestic and international levels, resulting in major gaps in coverage of insecticide-treated nets, medicines, and other life-saving tools.
An estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally in 2016. That is well below the US $6.5 billion annual investment required by 2020 to meet the 2030 targets of the WHO global malaria strategy.

In 2016, governments of endemic countries including Nigeria provided US$ 800 million, representing 31 per cent of total funding. The United States of America was the largest international funder of malaria control programmes in 2016, providing US$1 billion (38 per cent of all malaria funding), followed by other major donors, including the United Kingdom (UK) of Great Britain and Northern Ireland, France, Germany and Japan.
The report shows that, in 2016, there were an estimated 216 million cases of malaria in 91 countries, up from 211 million cases in 2015. The estimated global tally of malaria deaths reached 445 000 in 2016 compared to 446 000 the previous year.

The WHO estimates that the African Region continues to bear an estimated 90 per cent of all malaria cases and deaths worldwide. Fifteen countries – all but one in sub-Saharan Africa – carry 80 per cent of the global malaria burden.

“Clearly, if we are to get the global malaria response back on track, supporting the most heavily affected countries in the African Region including Nigeria must be the primary focus,” said Dr. Tedros.
According to the report, the African Region has seen a major increase in diagnostic testing in the public health sector: from 36 per cent of suspected cases in 2010 to 87 per cent in 2016. A majority of patients (70 per cent) who sought treatment for malaria in the public health sector received artemisinin-based combination therapies (ACTs) – the most effective antimalarial medicines.

However, in many areas, access to the public health system remains low. National-level surveys in the African region show that only about one third (34 per cent) of children with a fever are taken to a medical provider in the public health sector.

National Health Insurance Scheme (NHIS)
Similarly, another key aspect that could have facilitated wider access to care is the expansion of the National Health Insurance Scheme (NHIS). From the inception of the scheme 12 years ago, only about five per cent of the nation’s population was captured as enrollees, which has presently reduced to about three per cent following the exit of some that have outgrown the scheme. Instead of expanding the scheme to include more Nigerians, 2017 witnessed allegations of large scale fraud involving key operators of the NHIS all of which openly traded blames of fund misappropriation.

Among those named for alleged misappropriation are Prof. Usman Yusuf., the now suspended executive secretary of the NHIS, members of the Health and Managed Care Association of Nigeria (HMCAN), an umbrella body of Health Management Organisations (HMOs), lincensed operators of the NHIS. Yusuf, was appointed by President Muhammadu Buhari as the Executive Director of the NHIS.

In the heat of the allegations which drew numerous petitions against Yusuf, he was alleged to have misappropriated N292 million which he allegedly spent on health care training “without recourse to any appropriate approving authority.

The Mister of Health, Prof. Isaac Adewole subsequently suspended him in July, to pave way for fair and uninterrupted investigation of the panel constituted to probe him. After the committee found Mr. Yusuf “culpable in many areas” of his performance, the minister of health extended his suspension indefinitely pending the decision of President Buhari on the matter.
Subsequently, the Federal Government appointed Mallam Attahiru Ibrahim as acting executive secretary of the NHIS.

Counterfeit drugs
In the year under review, the menace of fake drug continued unabated. During their 90th 2017 Annual National Conference, the Pharmaceutical Society of Nigeria (PSN) which held in Umuahia, Abia State from November 6 to 11, the Chief Economist of PricewaterhouseCoopers (PwC), Andrew S. Nevin, in a keynote address, said that counterfeit medicines account for 17 per cent of the generic drugs in supply, noting that various sources have made varying claims at different times on this figures. What the true figures are is a very contentious issue.

While calling for the drug regulatory environment in the country to be strengthened, a National Chairman of the Association of Community Pharmacists of Nigeria (ACPN), Dr. Albert Kelong Alkali said all open drug markets should be closed down, while calling on Federal Government to support the Pharmacist Council of Nigeria (PCN), the National Agency for Food and Drug Administration and Control (NAFDAC) in this regard. According to him, a lot of Nigerians were either dying or being maimed as a result of ingesting fake medicines.

To this end, he called on the Federal Government to declare emergency on the issue of fake drugs, adding that the Federal Task Force on Fake and Counterfeit Drugs should be inaugurated and reinforced.
Although, a June 2017 timeline had been fixed to dismantle all open drug markets located in Onitsha, Aba, Sabongeri in Kano State, among others, the Federal Government and key partners did not meet that deadline due to lack of political will Alkali asserted.

Traditional Medicine
In spite of a United Nations (UN) declaration more than 10 years ago to adopt traditional Medicine as part of acceptable medications because their accessibility, affordability and local acceptance, several factors continue to hinder wider use of traditional medicine products. Key practitioners still lament the hindrance in including traditional medicine into mainstream health system as an alternative medicine, of choice for consumers of health. That lack of inclusion and practioners’ delay in modernising their production in terms of providing scientific backing for their claims and hinderance in adopting modern and up-to-date packaging, still limit the wider acceptance of the products throughout the year in review.

In 2017 the traditional medicine practitioners under the auspices of the National Association Of Nigerian Traditional Medicine Practitioners (NANTMP) partnered the Nigerian Institute of Medical Research (NIMR) which is doing clinical trials of their medications to standardise the products’ claims. Similarly, the Pax Herbal Laboratories similarly signed an MoU with NIMR this year in this regard. More practitioners are expected to key into this development with a view to enhance their practice.

In his assessment of how the health sector faired in 2017, President of the Nigeria Medical Association (NMA), Prof. Mike Ogirima said the country’s health indices were far from getting better. “We have had issues with government not implementing certain programmes that would have improved the indices of the health of Nigerians, particularly the NHA.

Highlighting those to benefit more from the rapid implementation of NHA and the of Universal Health Coverage (UHC), he said: “We thought the 2018 budget will capture certain privileges for the vulnerable population: The pregnant women, children under five and road accident victims.

“One per cent of the consolidated revenue should have been set aside from the NHA as basic health trust fund for such group of people.”
This is the third year since the NHA was enacted; so, we need constant advocacy not only from health practitioners but also from the people in the media to remind government to do the needful because, even if you have three per cent of our population captured under the NHIS as it is today, “Without extra funding, we cannot get it right. We can now talk of Universal Health Coverage (UHC), which means every Nigerian should be able to access health, no matter how little, from the comfort of his room and get better.”

Poor health Budget
Furthermore, the President of the NMA lamented continued poor budget allocated to health. Irrespective of African government’s Abuja Declaration in 2001 to budget 15 per cent of annual budgets to health, Ogirima lamented that Nigeria has continued to earmark between three to four per cent of its annual budget to health.

Brain Drain
The brain drain of medical doctors and other health care practitioners including nurses, pharmacists, among others rose to unprecedented levels in the year under review.
The NMA similarly urged governments at all levels to intervene to stem the tide. Ogirima noted that in two years – 2016 and 2017, over 600 Nigerian trained doctors dumped the country to take better paid employment abroad. All government must therefore prioritise the welfare of doctors and other health care workers to curb this unwarranted exodus, Ogirima said.

Marginalisation
On his part, President of the Joint Health Sector Unions (JOHESU), Biobelemoye Josiah said: “there is a bleak future in the area of industrial harmony due to Federal Government’s insensitivity and lack of will to address the demands of JOHESU, a cluster of health care workers constituting 95 per cent of professionals in the health system.

He noted that health workers operating under JOHESU have been seriously marginalised in the health sector without any sign of ending the ordeal of affected persons.
“Considering the bias of the Federal Government against our members since 2015, our patience has gotten to breaking level. “This year, there were some efforts to sit down and talk, but as I speak with you some of the cardinal issues arising since 2014, such as the adjustment of the Consolidated Medical Health Salary Scale (CONHESS), has not been resolved.

“We would have been on strike this festive season but we rejected that option because we have to keep the Holy period holy; hence we have restrained ourselves from resuming our strike action.”
However, Josiah noted that while the Federal Government has not implemented the key aspect of the agreement on adjusting CONHESS before the next minimum wage comes out, there were approvals for the demands from the National Association of Resident Doctors (NARD) on December 21 for which a circular was issued because of NARD’s strike action.

However whenever such demand involves JOHESU members, Josiah lamented that the Federal Government would say the economy was bad; there was recession; and that it takes time for President Buhari to approve the demand.
On the contrary, similar demand from NARD since 2014 has been approved. While a related demand from JOHESU was pending, the Federal Government has again approved another related demand for medical House Officers. “So, you can see the bias in the Health sector,” he lamented.

Lopsided appointments
Tracing the background of the marginalistion of health workers, Josiah blamed the development on political appointments which gives the positions of minister of Health, the Minister of State for Health and that of the Minister of Labour and Employment solely to medical doctors, a development that shuts out JOHESU members from being represented at the top managerial level of the health sector.

“Where the less than five per cent of health sector staff alone occupies all the decision-making level, he noted: “certainly JOHESU cannot get a fair deal from the system,” adding that sustaining this situation cannot promote peace in the health sector.”
President of JOHESU therefore called for fair treatment for all including professionals and the non-professionals.

Based on the deliberate delays in meeting the demands of JOHESU, which predates the administration of the current JOHESU executives, Josiah said the Federal Government was forcing health workers under JOHESU to make the forth-coming year a strike-infested 2018, adding, “We shall not shy away from that. Nigerians will understand our plight. If they push us that far, we will give it back to them because we are not slaves in the health sector.”

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Health benefits of cucumber (3)

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Cucumber is a creeping vine that roots in the ground and grows up trailing or other supporting frames, wrapping around supports with thin, spiraling tendrils. The plant has large leaves that form a canopy over the fruit. Face Mask: For oily skin – grate 1/2 cucumber into a bowl and add one tablespoon of honey.

Apply to the T-Zone, which is the forehead, nose and chin. To reduce pores and tighten skin – apply the mixture all over the face including under the eyes and eyelids. Leave on for 15 minutes and rinse with warm water, Pat dry with a clean towel.

 

Fighting cancers: Cucumber is known to contain lariciresinol, pinoresinol, and secoisolariciresinol which are linked to a reduced risk of several types of cancer. Controlling blood pressure: Cucumber juice contains a lot of potassium, magnesium, fiber, and phytonutrients that work effectively for regulating blood pressure.

 

Aiding digestion: Their high water and dietary fiber are very effective in driving away the toxins from the digestive system. Daily consumption of cucumbers can be regarded as a remedy for chronic constipation. Relieving gout and arthritis pain: Cucumbers are rich in vitamin A, B1, B6, C & D, Folate, Calcium, Magnesium, and Potassium.

 

When mixed with carrot juice, they can relieve gout and arthritis pain by lowering uric acid levels. Cucumbers also contain a substance needed by the cells of the pancreas for producing insulin. Researchers have found that sterols in cucumbers help reduce cholesterol levels. It is one of the very low calorie vegetables. It contains no saturated fats or cholesterol.

 

Cucumber peel is a good source of dietary fiber that helps reduce constipation, and offers some protection against colon cancers by eliminating toxic compounds from the gut. It is a very good source of  potassium, an important intracellular electrolyte.

 

Potassium is a heart friendly electrolyte that helps bring a reduction in total blood pressure and heart rates by countering effects of sodium. Cucumbers contain unique antioxidants in moderate ratios such as ß-carotene and a- carotene, Vitamin- C, vitamin-A, zea-xanthin and lutein.

 

These compounds help act as protective scavengers against oxygen derived free radicals and reactive oxygen species (ROS) that play a role in aging and various disease processes. Cucumbers have mild diuretic property, which perhaps attributed to their free-water, and potassium and low sodium content.

 

This helps in checking weight gain and high blood pressure. Ongoing research indicates that Cucumbers play a key role in the treatment of Alzheimer’s disease patients by limiting neuronal damage in their brain.

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Heavy drinking increases risk of dementia

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Scientists yesterday said people who drink enough to be hospitalised were at serious risk of dementia and Alzheimer’s disease.

 

According to findings published in the ‘Lancet Public Health’ journal, more than a third, 38 per cent of the 57,000 cases of early-onset; dementia were directly alcohol-related and 18 per cent had an additional diagnosis of alcohol use disorders. Overall, alcohol use disorders were associated with a three times greater risk of all types of dementia, the research showed.

 

To this end, lead author in the study, Dr. Michaël Schwarzinger, of the Translational Health Economics Network in France, said; “A variety of measures are needed, such as reducing availability, increasing taxation, and banning advertising and marketing of alcohol, alongside early detection and treatment of alcohol use disorders.”

 

Dementia, which is not  a specific disease, is an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 per cent of cases.

 

Previous studies consistently showed that, overall, heavy alcohol consumption was detrimental to health and was a leading preventable cause of death. When the body takes in more alcohol than it can metabolise, the excess builds up in the bloodstream.

 

The heart circulates the blood alcohol throughout the body, leading to changes in chemistry and normal body functions. It had been shown that even a single bingedrinking episode can result in significant bodily impairment, damage, or death. Over time, excessive alcohol use can lead to the development of many chronic diseases and other serious health problems.

 

However, the new study, which used the French National Hospital Discharge database, looked at more than a million people diagnosed with dementia between 2008 and 2013.

 

Although, the study was not conducted to look at the effects of moderate drinking on people’s dementia risk, Schwarzinger warned that the research showed damage done to the brain by alcohol was never repaired.

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Lifestyle, screening key to tackle colon cancer

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About 80 per cent of Nigerians who are diagnosed with colon cancer die from it, even though the disease is preventable. Experts said rectal bleeding, fresh blood in the stool, unexplained constipation, diarrhoea alternating with constipation are among the indicators of colon cancer. APPOLONI A ADEYEMI reports

 

News about the death of the Zimbabwean opposition leader Morgan Tsvangirai who died from colon cancer at the age of 65, is another indication of how late stage cancers could increase mortality.

 

Reports showed that Tsvangirai who was the president of the Movement for Democratic Change in Zimbabwe, had been suffering from colon cancer for at least two years, but his condition deteriorated rapidly shortly before his death, despite treatment in neighbouring South Africa.

 

The death of Tsvangirai on February 14 may have brought colon cancer death to the consciousness of Nigerians; sensitisation about this condition has been in the front burner. As far back as 2016, the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), had raised the alarm that Nigeria was contending with heavy burden of colon cancer. According to SOGHIN, “More Nigerians above 40 were coming down with colon cancer, which is also known as colorectal cancer and bowel cancer.”

 

In spite of this background, most Nigerians may not be aware of colon cancer; yet it is one of the most common cancers, globally. Colon cancer is the third most common cancer in Nigerian men, after prostate and liver cancer and the fourth most common cancer in Nigerian women, after breast, cervical and liver cancer. Colon cancer is the development of cancer from the colon or rectum (parts of the large intestine).

The human colon, or large intestine, is a muscular, tube-shaped organ measuring about four feet long. It extends from the end of the small bowel to the rectum.

 

Its functions include to digest and absorb nutrients from food, to concentrate fecal material by absorbing fluid (and dissolved salts, also called electrolytes) from it, and to store and control evacuation of fecal material. Most colon cancers develop slowly, over ten (10) to fifteen (15) years. It usually begins as a small non-cancerous growth, called polyp on the inner lining of the colon or rectum.

 

The World Health Organisation (WHO) estimates that every two hours a Nigerian is diagnosed of colon cancer.

 

The Chairman, National Consultative Committee on Cancer Control in Nigeria, Prof. Francis Abayomi Durosinmi-Etti told the New Telegraph that more Nigerians were coming down with colon cancer. “We are noticing an unusual increase in the incidence of colon cancer. “This last week alone, I saw three colon cancer patients at the clinic at the Lagos University Teaching Hospital (LUTH).”

 

 

“On what his clinical experience has been like Durosinmi-Etti said from the rate at which affected persons turn up in the clinics, we can conveniently say colon cancer ranks among the first five common cancers in both men and women in the country presently.”

 

Nigeria records an estimated 102,000 new cancer cases including colon cancer annually, according to data from the Federal Ministry of Health (FMOH). Similarly, cancer is responsible for 72,000 deaths in Nigeria every year.

 

Sadly about 80 per cent of all Nigerians who are diagnosed of colon cancer die from it, said Dr. Abia Nzelu, a fellow and consultant of the West African College of Surgeons and the National Postgraduate Medical College of Nigeria.

 

Nzelu who is also the Executive Secretary, Committee Encouraging Corporate Philanthropy (CECP-Nigeria), said, “This is very unfortunate given the fact that colon cancer is one of the cancers that is virtually 100 per cent preventable.” Examples of personalities that survived colon cancers are Justice Ruth Joan Ginsburg, the oldest and only female Justice of US Supreme Court who marked her 82nd birthday on March 15, 2015.

 

She developed colon cancer in 1999. During the treatment, she did not miss a day on the bench. In 2009, she again had successful treatment for pancreatic cancer and did not miss any oral arguments in court. Similarly, Queen Elizabeth the Queen mother, survived colon cancer and breast cancer at ages of 66 and 83 years respectively.

 

 

She died cancer-free at the age of 101. Furthermore, Pope John Paul II, the second longest serving pope in history, survived colon cancer and later became a patron of the Global Campaign for Prevention of Digestive Cancers.

 

These success stories are a result of availability of infrastructure for screening and treatment of cancer in the respective countries of the survivors. Symptoms On factors that indicate the existence of colon cancer in a person, Durosinmi-Etti said people who experience rectal bleeding must see the medical doctor urgently.

 

“If you see any sign of fresh blood in your stool you need to see a doctor,” he said, adding that it was important to have such fresh blood checked by the medical team to ensure that was not colon cancer.

 

He advised people that experience unexplained constipation, stooling that is excreted in very small, narrow form, rather than being excreted in bulk, unexplained weight loss or weight gain, to see the doctor urgently, adding “These are all indicators of colon cancer.”

 

Durosinmi-Etti asserted that experiencing all these does not necessarily mean that the one has colon cancer, but advised affected persons to see the doctor that would recommend necessary tests to determine the health status of the patient visà- vis colon cancer.

 

Other symptoms of colon cancer include change in bowel habit such as diarrhoea, constipation, or diarrhoea alternating with constipation that lasts for more than a few days, a feeling that one needs to pass stool that is not relieved by doing so (tenesmus).

 

Tenesmus is a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness. Other symptoms are blood in the stool, cramping or belly pain, weakness and fatigue.

 

“It is noteworthy that colon cancer may not have obvious signs and symptoms in the early stages. So, people should not wait for symptoms,” Nzelu advised. Risk factors Factors that can affect a person’s risk for developing colon cancer include several modifiable lifestyle habits such as diet, weight, exercise, smoking and heavy alcohol intake as well as non-modifiable factors like age, family history of colon cancer or polyp; type 2 diabetes.

 

Race and ethnicity also play a role. For example, in the United States (US), of all racial groups, African Americans have the highest incidence and mortality rates of colon cancer.

 

Of these risk factors, the link between diet, weight and exercise and colon cancer risk are some of the strongest for any other type of cancer. Prevention According to Nzelu, with lifestyle modification (including regular medical screening) most cases of colon cancer can be prevented.

 

The recommended measures include the intake of diet high in fibre such as fruits, vegetables and whole grains, diet low in red meat (such as beef, pork, lamb or liver) and processed meat (such as hot dogs and sausage) as well as liberal intake of water. She said, “It is important to note that fibre supplements have not been shown to be helpful in reducing risk of colon cancers. “Rather, the emphasis should be on dietary sources of fibre, such as oat bran, wheat bran, legumes (beans), green leafy vegetables, carrots, oranges, bananas and other fruits and vegetables.

 

“Avoidance of excessive weight, smoking and excessive alcohol intake while increasing the intensity and amount of physical activity, also helps to reduce colon cancer risk.”

 

Above all, eligible individuals, people who are 40 years and above, should undergo screening as recommended. Nzelu said regular colon screening is one of the most powerful weapons for preventing the cancer.

 

“This can in many cases, prevent colon cancer, altogether. This is because, with regular screening, most polyps can be found and removed before they become cancers.

 

Screening can also result in finding colon cancer early, when it is highly curable.” Available tests Screening tests for colon cancer include stool test, endoscopy (sigmoidoscopy, colonoscopy), as well as x-ray (double contrast barium enema and CT colonography).

 

According to Nzelu, an important advantage of colonoscopy is that polyps that are found during the procedure could be clipped off on the spot.

 

In addition, it only needs to be repeated every ten (10) years if the result was normal. “The recommended age for commencement of screening in the western world is 50 years.

 

However, anecdotal evidence shows that the peak age of diagnosis of colon cancer in Nigerians is about 44 years.

 

“This is highlighted by the relative youthfulness of some prominent Nigerians that have fallen victim to colon cancer, according to recent media reports.

 

For this reason, Nigerians should commence screening from the age of 40.” Those with a family history should commence screening ten (10) years before that age at which the affected family member was diagnosed.

 

On his part, Durosinmi- Etti said most of the patients diagnosed with this condition in the country presently were persons living sedentary lifestyles, for example people in jobs requiring them to sit down all day long.

 

“What is also significant, according to Durosinmi- Etti is that now there’s more non-governmental organisations involved in raising awareness about colon cancer as well as providing free screening for Nigerians. “This development paves way for more persons afflicted with the disease to be picked up early for medical attention,” he added.

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