Thursday, 8 August 2013

Health- Charts path to detection,treatment in Nigeria



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Terseer adamu (Review)




They are silent killers. They cut down Nigerians in their prime. They are the major causes of sudden deaths in the country. Hypertension, diabetes, heart diseases or rather cardiovascular diseases and their attendant consequences of stroke, heart attack, and kidney failure are here to stay. CHUKWUMA MUANYA examines recent efforts towards finding solutions to the menace.


AZUBUIKE Mba was a 40-year-old banker with one of the old generation banks in Lagos. Azubuike stood at five feet six inches, weighed 130 kilogrammes with waist circumference of 46 centimetres.

  Azubuike was married for 12 years to Ngozi, also a banker, without children. He drank at least four bottles of beer daily with sticks of cigarette to cap the habit.   

  He rarely exercised, but moved from his air-conditioned house into his factory fitted air-conditioned car then the office with equally cooler conditions, and back the same route after work.

  Azubuike slumped and died in his office last month. Autopsy showed that he died of heart attack. 

   Azubuike represents millions of Nigerians with high risk of developing complications of non-communicable diseases (NCDs), chronic or rather degenerative diseases such as heart attack, stroke, kidney failure, diabetic leg ulcer, limb amputations, cancer, arthritis, among others.

  According to the World Health Organisation (WHO), an estimated 17.3 million people died from cardiovascular diseases in 2008, representing 30 per cent of all global deaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke. 

  However, medical experts, assembled by Pfizer Nigeria & East Africa Region (Pfizer NEAR), have identified hypertension, diabetes mellitus, hyperlipidaemia (high fat/cholesterol level), cigarette smoking, obesity and sedentary living as modifiable risk; while family history, age and gender as the non-modifiable risk factors. 

  The team of medical experts led by Consultant Nephrologist and Medical Director of Ibadan Hypertension Clinic, Emeritus Professor Oladipo Akinkugbe, at the Cardiovascular Summit organised recently by Pfizer Nigeria, Ghana and East Africa Region recommended preventive strategies, which include control of high cholesterol levels and high blood pressure through the modification of dietary habits and government‘s support especially in the discouragement of western dietary habits through its food and health regulatory agencies.

  The aim of the sixth Pfizer Cardiovascular Summit was improve awareness and management of common cardiovascular risk factors such as raised blood pressure, raised cholesterol, obesity and lifestyle by stimulating debate, discussion and education.

  The Cardiovascular Summit provided a forum for the advancement of medical knowledge and patient care. The summit brought together international and local healthcare professionals to deliberate on the new and emerging trends in the nature, diagnosis and management of cardiovascular diseases in Nigeria.

  Other members of the team included Chief Consultant Nephrologist at the National Hospital, Abuja, Professor Sunday Bwala, Chief of the Division of Endocrinology, Diabetes and Metabolism at the University of Tennessee Health Science Centre, Memphis, United States, Professor Sam Dagogo Jack, Medical Director/Chairman of the Country Medical Council, CMC of Pfizer Worldwide Bio-Pharmaceutical Businesses, Dr. Kodjo Soroh and Country Manager Pfizer Nigeria & East Africa Region, Carl Engleman.

  The team predicted an imminent health tsunami in Nigeria if nothing was done urgently to address the rising cases of NCDs and their complications.

  To address the situation, the medical experts called for a nationwide epidemiological mapping of NCDs such as diabetes, hypertension, stroke, kidney failure, arthritis among others and national programmes that would encourage physical activities like walking and sports.

  They also called for integration of the fight against NCDs into Vision 20:2020 with establishment of set targets as well as timeframes in resemblance of the Millennium Development Goals (MDGs).

  Dagogo –Jack said: “The ravages of hypertension and diabetes on the African continent can be seen daily in the faces of our people who have suffered a stroke or heart failure or developed kidney failure or lost a leg from amputation. These dreaded consequences could be avoided by preventing and effectively managing diabetes and hypertension. We have the knowledge to do both; the question is - do our leaders and society have the awareness and will to harness resources to tame the scourge of hypertension, diabetes, heart disease and stroke in our land?”

  Engleman reiterated Pfizer’s continuous commitment to education of physicians and the general public. “As the world’s largest pharmaceutical company, Pfizer is committed to working in partnership with healthcare providers, governments and stakeholders to improve patient care. Cardiovascular disease is a major threat to public health in Nigeria with significant impact on people and communities. The aim of the CV Summit is improve awareness and management of common CV risk factors such as raised blood pressure, raised cholesterol, obesity and lifestyle by stimulating debate, discussion and education,” he said.

 Soroh, said: “The Cardiovascular Summit is part of Pfizer’s contribution to the advancement of medical knowledge and patient care in the region. This further exemplifies the commitment of Pfizer to world-class medical education, capacity building and excellence in service to the Nigerian health sector.  This platform will provide healthcare practitioners an avenue to engage in robust discussions on the latest trends in cardiovascular disease, its management, encourage use of general treatment guidelines and recommendations for the management of patients with cardiovascular disease.”

  Akinkugbe said: “As night follows day, the so called NCDs are going to set in. A wise country is going to be proactive. It is already knocking at the door. It is going to be a health tsunami if we don’t take concrete steps to prevent it, because the wherewithal to prosecute medical remedy is often not there. The after events like kidney failure is often beyond the reach of developing countries even the developed ones are struggling. Therefore if we can put measures to prevent these diseases, then we will be saving hundreds of millions….

  “Adequate detection is extremely important. It is not just going to the teaching hospital and checking blood pressure but you have to go round the country, to the rural areas. That was what we tried to do 20 years ago. We went round the country to see 20,000 persons selected from rural, semi urban areas and we had a map of hypertension, diabetes. But the parameters today have changed. We use 160/95mmHg for hypertension mapping and we found that four million Nigerians were hypertensive.

  “The situation will certainly be worse today because lifestyles of the average Nigeria have changed. We are living more sedentary lifestyles and Western diets. Our own future must be in our own hands and the preventive measures are quite cheap.

  “The risk factors are the same. One of the things we could do will be to set some targets even tie it to Vision 20:2020 that by a certain date we will be able to reduce cardiovascular diseases by a certain percentage. It is achievable and measurable.”

  Akinkugbe said that detection was critical and the country needed to update the epidemiological studies done 20 years ago. “We need to define the situation and do it through a proper epidemiological study. Once you do that, then you begin to put in place measures. Four million Nigerians as at that time were with hypertension. Any measures to detect must be accompanied with measures to treat. Setting targets is important because there is need to update in detection and get to definite recommendations and the primary health centres ate the Local Government Areas are the major engine rooms towards achieving this,” Akinkugbe said.

  Bwala said: “We need to have some king of national policy on the part of government. The Federal Ministry of Health (FMOH) in fact came out with some kind of document in December last year that is the National Programme for the Prevention of Stroke, but it never saw the light of the day because of the way it was approached and it was earlier said that the technology already existed with the GSM companies. 

  “In fact the driver that took me to the airport gave a result he got from MTN in partnership with Nigerian Society of Nephrology. Just a single page with his bio-data, his blood pressures, sugar, lipids, family history of diabetes and high blood pressure and I told him what to do and what not to do. That sort of partnership is needed because the outreach of the GSM is incredible right into the nook and crannies of this country. So we should exploit it to the fore because these things are very easy to detect. 

  “We are trying to influence the FMOH to come out with a policy and partner with the major multinational Pfizer for instance. That way we can really address the problem holistically. Screening the members of the National Assembly and Ministries Departments and Agencies (MDAs) is just an individual thing, it doesn’t cover the society but it is useful, because they are the policy makers and they are already scared now that their members are dropping dead. So they are in a very receptive frame of mind for proposals. 

  “I think we should make some kind of submission to the National Assembly and the FMOH to include their decision of broad coverage of the society. That way we can begin to address the problem before the ‘Tsunami’.”

  Jack added: “What you cannot measure, you cannot tackle. There is need to make the LGAs operate as bureau of health statistics where they can train people with template from medical experts. There is also need to partner with industries because most of the drugs are not manufactured locally and are very costly. The type of hypertension we have here tend to be salt sensitive so we need to watch our salt intake.”


Source: http://www.ngrguardiannews.com

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