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Ihekweazu: No magic bullet for Lassa fever

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Dr. Chikwe Ihekweazu, is the Chief Executive Officer of the Nigeria Centre for Disease Control (NCDC). He talks about the intricacies surrounding Lassa fever in this interview with REGINA OTOKPA

 

What could be responsible for the reemergence of Lassa fever in some states?

We have always said keep your food covered from rats and it is still true but also, we need to think why are rats still coming into our neighborhoods?

For me, it is very important; if you go round our cities even Abuja, there are heaps of refuse everywhere. Some of the blame is on government but some of it too is us. If we see refuse in front of our houses and gutters are full on our streets, we can mobilise ourselves and clear it because it is those heaps of refuse, that attracts rats.

The first thing actually is to really intensify efforts across Nigeria and that is what we have been telling states and local governments; clear refuse and don’t put the things that will attract rats into our neighborhood in the first place. We really need to get the message out that we need to keep our environments clean as soon as possible and free from rats. It is bad enough that there are rats in our environment but we should not be inviting them into our homes by keeping a lot of dirt around.

Yes, our local government and states are making efforts to clear these away but we must not wait for them all together; we must also do our best to see that we keep our environment clean.

 

Is this part of the message the raid response team are taking into the field?

Absolutely, this is the main message directed at members of the public. The other message is directed at healthcare workers and it is the same thing we have been saying. Health care workers are really at the frontline of the work we are doing. It is just like when you are going into battle.

Have your soldiers in the health sector, you have your doctors and the doctors most at risk are those that provide the most care for patients while those who are at biggest risk are the doctors that are in Accident and Emergency Section (A&E). When you bring in patients that are severely ill initially to the hospital, most healthcare workers don’t protect themselves.

Our message to health care workers is to always remember especially when working in A&E where suddenly patients come in with fever, to remember to always be ready to wear gloves and gowns. Do not take that risk of managing, it means that you have to be prepared; you need to have the gloves and gowns there.

That means that you have to push your hospital to procure all those things and not when a patient comes you tell them to start going around to look for money to buy gloves. The key issue is use gloves. Think about it before patients come and make sure you have a stockpile of gloves and gowns available to provide healthcare to patients in a hurry.

 

The year just started and already about ten care givers have been affected. Do you see this demoralising the people working in the health sector?

I agree it has a big impact on people but most of these patients are actually from one facility. This is a particular circumstance in Abakaliki. I was in Abakaliki for two days in a hospital; everybody has come together to respond. They are going through re-education and training at the moment on infection prevention and control.

That was a particularly unfortunate event that happened in Abakaliki and, of course, for few days everybody was shaking. Health care workers were a little bit hesitant but everybody has gone back to work stronger. If you go to Abakalik now everybody is wearing gloves.

Everybody is washing hands but the issue is can we sustain it beyond the response and really that is the message that we keep sharing with Nigerians. It is just like the post-Ebola period. All of us were at it but we have to sustain these efforts over longer periods of time.

There was an outbreak of Lassa fever in Imo State. What is the NCDC doing to curb the spread to other states?

It is not spreading. Lassa fever is carried by rats in various parts of Nigeria and sometimes it jumps to humans and this is what we are having somewhere in Imo state. The first patient was in Orlu and because they haven’t been used to dealing with this kind of situation, there was a lot of panic but we have been in touch with the state.

 

We have provided them a lot of personal protective equipment (PPE). We are speaking to the Chief Medical Director (CMD) of the Federal Medical Centre (FMC) in Owerri and we have identified an isolation centre.

Owerri was in the press a lot because they are not used to dealing with this. There was a lot of panic in the state but we have worked with them and now there is calm. They are dealing with the situation and we helped them to respond. In a way, Lassa fever is not spreading.

It is emerging in different beats depending on how careful you are and how much you allow exposure from rats to humans. We are testing a lot more patients. So, we will find more. The same message goes across to everyone across the country.

 

Can infectious disease like Lassa fever be contacted during burials

? Absolutely, diseases can be contacted but really it is how you deal with your dead body that will make the difference. There are some cultures that allow us wash our dead bodies. We perform a lot of ceremonies touching and all of that but the dead body of people who died from Lassa fever are still very infectious.

Anyone touching such corpse is very much at risk. We have a process called safe and dignified burial which means you can do it safely and still give the person a dignified burial but it just means that you cannot have that level of contact with the dead body as is the norm in some cultures in Nigeria.

Is Lassa fever peculiar to Nigeria?

No, there are two regions in Africa where there is a lot of Lassa fever. Nigeria and part of Benin axis and the Sierra Leone and Liberia. For some reason, in between West Afrca, the extreme west and these parts, are not too many cases have been found but last year we confirmed more cases in Nigerian than in any other country in the world.

 

With the level of deaths being recorded, is there hope for those infected?

For some infectious diseases like Yellow fever for example, there is a big vaccination campaign; we have a very big tool for preventing cases. In Lassa fever we don’t have a vaccine yet.

There is no easy solution. However, there is a lot of research going on, but there is no vaccine yet. In a way we don’t have a tool that can provide that level of immunity.

So, we have to keep working with people, educating them, enlightening health care workers, trying to do prevention when we have found a few cases and trying to stop the spread to others but there is no magic bullet, especially not for Lassa fever. So, our approach is to continue with these strategies, continue pushing Nigerians to raise the bar to keep the environment clean and stop transmission from one person to the other.

 

Does that mean cleanliness is the only solution available at the moment?

When we say cleanliness, it is not the cleanliness in itself; it is to prevent the host animals which are rats, coming into our environment.

The cleaner your environment is, the less likely you will have rats running around but when you don’t keep your kitchen clean and there are food stuffs all over the place.

The gutters are full; your backyard is full of refuse and then rats come in and once they are in that environment, you don’t have to touch the rat itself. There are rats in our environment, but we should not be inviting them into our homes by keeping a lot of dirt around Implement basic health care provision fund, expert tells

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Scientists link western diet with kidney stones

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Scientists said western diet, widely acclaimed to be unhealthy, could be linked to high prevalence of kidney stones. A study by the Mayo Clinic found kidney stones increased more than 300 per cent in women and 100 per cent in men within 30 years.

 

Although, the increase in kidney stones can in part be explained by improvements in medical imaging technology, medical experts linked it to the same dietary factors driving increases in colon cancer, heart disease, diabetes and obesity.

Kidney stones (renal lithiasis, nephrolithiasis) are hard deposits made of minerals and salts that form inside your kidneys.

Kidney stones have many causes and can affect any part of the urinary tract — from kidneys to the bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallise and stick together.

 

Passing kidney stones are hard masses that form in the kidneys and take a painful route through the urinary tract when exiting the body. Passing out kidney stones can be quite painful, but the stones usually cause no permanent damage if they’re recognised in a timely fashion.

 

Depending on the situation, one may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract, are associated with a urinary infection or cause complications — surgery may be needed.

 

The Mayo study examined first-time presenters of kidney stones from residents in Olmsted County, Minnesota in the United States (US), from 1984 to 2012, focusing specifically on differences between gender and age group. Previous studies of kidney stones were less accurate because they relied on diagnostic codes or survey questions to identify patients with stones.

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‘30% of Nigerians suffer tooth decay’

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Dr. Olurotimi Olojede is the former President of the Nigerian Dental Association (NDA) and the Secretary General of the African Regional Organisagion of World Dental Federation. In this interview with APPOLONIA ADEYEMI, he discusses factors fueling tooth decay, mouth odour, teeth extraction and measures to improve oral health generally

 

What are the common tooth problems in Nigeria?
Basically, in Nigeria, we have two major tooth problems. One has to do with the hard tooth structure and the second is the soft tissue. The hard tooth structure has to do with any disease that will affect the enamel. We call it cavity conformation or dental caries and we have the disease of the soft tissues or supporting structures of the teeth. It may be the gum, which is the periodontal disease and other parts of the tooth.
Race and environmental factors tend to affect the prevalence or occurrence of these dental problems at a particular point in time in different environments.
There is also oral cancer. Some may be benign while some are malignant.

Are they very common?
They are common; the only challenge we have is that patients don’t come to the hospital because some of the oral cancers are not painful at the onset and the swelling is gradual.
Some people carry the swelling for between eight to ten years and sometimes fifteen years until when they start to have deformation or cosmetic embarrassment. That’s when they seek medical advice and by that time it’s almost late. In fact, a very serious damage must have been done and surgery to correct that is very expensive.

What is the burden of dental caries in terms of available data?
If we are to look at available data, we will be talking about 25 per cent to 30 per cent of our population that comes down with dental caries.
Dental caries or cavities, which are also known as tooth decay, is a breakdown of teeth due to acids made by bacteria.
The cavities may be a number of different colours from yellow to black. Symptoms may include pain and difficulty with eating.
It’s a cross-sectional thing; it cuts across male, female, children and adults. If children takes things that will lead to it, it will happen. If adults, too take some of those things that will lead to it, adults too will develop it.
Specifically, what are the causes?
The four major things interplay in the development of dental caries; if one is missing out of those four major things, dental caries will not occur.
Number one is that it is not the quantity, but the frequency of the intake of refined sugar that is behind it.
Secondly, a susceptible tooth could also develop caries; that is to say that some teeth are made to have caries because of some things happening in them.
Then, the immunity of the patients is also very important and finally, bacteria in the saliva is another major problem leading to caries. All of us have bacteria in our saliva. So, when there are those enabling environment in the patient’s mouth, the patient will develop caries. We all have different species of bacteria in our mouth. Those four factors are very germane to the development of caries.

How can people prevent developing caries?
That’s why I said, it is not the quantity of refined sugars consumed that causes it, but the frequency. Even if you are taking it in small quantity, but also taking it frequently, the refined sugar will increase your risk of developing tooth decay. If you engage in taking refined sugar from morning till night, under one month, you will develop carries. Whereas, I might just sit down before my wife’s refrigerator before my lunch and take all the cakes there. You will realize that I will not have dental caries while someone taking tom-tom on regular basis throughout the day will have dental caries.
So, it’s the frequency of the intake of sugary diet that fuels tooth decay. For example, if before you leave your house in the morning, you drank tea or coffee with sugar and milk; When you get to work, you had another coffee or at meeting, they served you meat pie and soft drinks.
Thereafter in the afternoon you say, “Oh!, I’m really hungry. Can I have soft drinks,” which also contains refined sugar. Similarly, before you go to bed, you say, “Oh! You must give me my coffee” with milk and sugar. Before you know it, you have challenged your mouth regularly, eight to twelve hours with sugary substances.
Therefore, if you do that consistently for one month, you will have to get a good deal with your dentist.

Prevention
One paramount method of prevention is, whether there is complaint or not, you must make sure you see your dentist every six months or twice a year.
You must also brush your teeth twice a day, first thing in the morning and last thing before you go to bed at night.
Similarly, you must make sure that you avoid what is called ‘in-between’ meals. You have taken breakfast, then you see somebody taking chin-chin, you take a little; someone is eating When you’ve taken your breakfast, you should relax. When you want to take snacks, take snacks and rinse your mouth and end it there.
Much more than that, you ought to involve in principles of hygiene; it’s very important and that is why I said that you shouldn’t wait until you a have a complaint before you visit your dentist.
In addition, you should use what is called medium toothbrush. In the market, there are trademarks, showing types of toothbrush; we have soft, medium and hard brushes.
Look on the packet, you will see medium for adults and then, you ask your dentist to teach you how to brush your teeth. It’s very important; we call it oral hygiene instruction.
If you do all that, you can keep your teeth for a lifetime, except you have trauma.

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Adelusi-Adeluyi: Use digital platforms to improve patient outcomes

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An appeal has gone out to healthcare professionals in the country to leverage communication and networking in order to improve the net worth of health service given to the patients.
To underscore this approach, they were urged to become early adopters in the use of digital health platforms that will positively improve patient outcomes.
This was the unequivocal submission of leading health practitioners at the launch in Nigeria of the IQVIA HCPSpace a digital healthcare platform by leading global provider of information, innovative technology solutions and human data science, IQVIA, formerly known as Quintiles IMS.
IQVIA HCPSpace is a web and mobile based platform designed to bring together all specialties and sub specialties of doctors, pharmacists, nurses, medical laboratory scientists, and all other healthcare professionals, where they can connect with peers, follow key opinion leaders (KOLs), discuss medical cases, establish public/private groups, view videos for increased knowledge, earn Continuing Professional Development, CPD points from content provided by approved bodies and KOLs, find jobs and career opportunities across multiple regions in Africa and the Middle East.
Chairman of the occasion and President, Nigerian Academy of Pharmacy, Prince Julius Adelusi-Adeluyi noted that IQVIA’s HCPSpace is a bridge-building tool that will encourage collaboration among healthcare providers whilst driving efficiency, performance and capacity utilisation as well as innovation in the nation’s health space as a whole.
“I would like to commend IQVIA for trying to crack a problem that has remained with Nigeria for quite a while given the numbers of government committees that had been set up in the past to solve the challenge of interprofessional collaboration and promote harmony in the health space. This tool will be a blessing to the nation as it will radically alter Nigeria’s health landscape for good and help to reduce unnecessary competition among professionals,” Adelusi-Adeluyi stated.
Chairman of the IQVIA HCPSpace Advisory Board, Dr. Femi Olugbile, pointed to the growing domestication of technology for personal and professional use across the world as well as creating a sense of team in community via multi-specialty task performance and problem solving tools.
“All over the world, there is an increasing awareness that communication and collaboration are essential ingredients for the creation of a thriving, high-achieving healthy work force.
Providing the reason for the platform’s existence, Country Manager, West Africa, IQVIA in General, Pharm. Remi Adeseun recalled that a communiqué was issued at the end of the Inter-Professional Collaboration Symposium organised by the Nigeria Academy of Pharmacy in collaboration with the Pharmaceutical Society of Nigeria, PSN. The event which held on May 11 2017 at the University of Lagos, encapsulated an 8-point resolution, and underscored the need to deepen the concept of universal communication and collaboration among healthcare professionals via tools that are yielding documented benefits and gains in the healthcare sector across the world.
“We are very confident that the

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