In separate telephone conversations with President Bola Tinubu on Thursday evening in Abuja, United States Vice President Kamala Harris and United Nations’ Secretary-General Antonio Guterresexpressed strong support for Nigeria’s efforts toward the restoration of constitutional order in the Republic of Niger.
The two leaders also commended the Nigerian President, who is also the Chairman of ECOWAS Authority of Heads of State and Government, for spearheading the peace moves.
On Wednesday 26 July 2023, some soldiers from the Presidential Guard had moved to depose President Mohamed Bazoum.
President Tinubu had quickly rejected the threat to democracy in that country, sending a strong delegation to talk with all the parties with a view to restoring constitutional order in Niger.
Kamala Harris [PHOTO CREDIT: @KamalaHarris ]
In her telephone conversation with President Tinubu, at the instance of the US authorities, Ms Harris praised the reform initiatives of the Federal Government, urging the country to continue in that direction.
While pledging to support democracy in Africa including the West African sub region, Ms Harris also said the US would assist Nigeria in the battle against terrorism.
The US Vice President spoke on the need for Africa, including Nigeria to embrace energy transitions.
In his response, President Tinubu thanked Ms Harris for the telephone call and her words of encouragement on the efforts taken so far on the economy, but added that “the developments in Niger Republic dampen spirits.”
He said ECOWAS under his watch would do all that is necessary to restore democracy in Niger, while counting on the support of the US. He said ECOWAS under his watch would do all that is necessary to restore democracy in Niger, while counting on the support of the US.
“We would need the US to help push for investments that will help alleviate the effects of subsidy removal in Nigeria. We need foreign direct investment to come in.
“We have abundant gas resources in the country and not been able to fund gas pipelines to Europe and compete in that gas market is a handicap,” he said.
On climate change, the president said Nigeria would stay focused on alternate energy but he pleaded for the developed nations to understand the situation in developing countries including Africa.
The two leaders also spoke on strengthening relations between their two countries and on their shared work on global and regional issues. Other matters that featured in the discussions that lasted about 40 minutes are defending democracy in West Africa and The Sahel and digital inclusion.
Photo: Michael Gottschalk/Photothek via Getty Images.
Speaking with the UN Secretary- General Guterres, President Tinubu said he was doing everything possible to resolve the impasse in Niger.
While expressing the hope that the situation in Niger could still be reversed for better, he said ECOWAS would require UN’s support for restoring democracy and building institutions in that country.
Mr Guterres had earlier pledged the commitment of the UN for Tinubu’s peace efforts in Niger.
Dele Alake, Special Adviser, Special Duties, Communication & Strategy
The ongoing strike by Nigerian doctors under the aegis of the National Association of Resident Doctors (NARD) has disrupted activities across public tertiary hospitals in Nigeria.
PREMIUM TIMES’ reporters observed that health activities were skeletal on the second day of the strike in some hospitals in Nigeria’s capital city, Abuja, and Lagos State.
The doctors embarkedon an indefinite industrial action in the early hours of Wednesday following what they described as the failure of the Nigerian government to meet their demands.
This came after the expirationof a two-week ultimatum earlier issued to the government.
The association said the two-week ultimatum, which ended on 19 July, was to give the government adequate time to begin implementation of the resolutions of the Memorandum of Understanding (MoU) previously agreed on.
Doctors demands
The doctors, among other issues, are demanding the immediate payment of the 2023 Medical Residency Training Fund (MRTF), tangible steps on the “upward review” of the Consolidated Medical Salary Structure (CONMESS) and payment of all salary arrears owed its members, since 2015.
The doctors also want immediate massive recruitment of clinical staff in the hospitals and abolishment of the bureaucratic limitations to the immediate replacement of doctors and nurses who leave the system.
They also want the immediate review of hazard allowance by all the state governments as well as private tertiary health institutions where any form of residency training is done.
Doctors demands
The doctors, among other issues, are demanding the immediate payment of the 2023 Medical Residency Training Fund (MRTF), tangible steps on the “upward review” of the Consolidated Medical Salary Structure (CONMESS) and payment of all salary arrears owed its members, since 2015.
The doctors also want immediate massive recruitment of clinical staff in the hospitals and abolishment of the bureaucratic limitations to the immediate replacement of doctors and nurses who leave the system.
They also want the immediate review of hazard allowance by all the state governments as well as private tertiary health institutions where any form of residency training is done.
At the time PREMIUM TIMES visited the Asokoro district hospital, many patients were waiting to be attended to. Medical consultants, nurses and other healthcare workers were attending to some patients at the eye clinic department.
However, a family leaving the hospital at the time of the visit said the management directed them to vacate the premises because there are no doctors to attend to them.
“My son has been on admission since last week but they suddenly asked us to leave the hospital because doctors are on strike,” the mother identified as Mrs Joseph said.
At the Federal Medical Centre (FMC), Jabi, it was observed that only a few patients were at the General Outpatient Department (GOPD). A patient, Aisha Sani, said she and others have been waiting for long hours to be attended to.
Ms Sani said some people have been forced to go back home because they could not wait any longer.
A nurse on duty said the hospital was offering skeletal services, describing the workload as overwhelming “but all hands are on deck to ensure patients on ground are responded to.”
At the Wuse District Hospital, patients were stranded. One of the them, identified as simply as Benjamin, said he got to the hospital at 8 a.m. but that as of 12:30 p.m., he was yet to be attended to.
LASUTH
At the surgical outpatient department of the Lagos State University Teaching Hospital (LASUTH), PREMIUM TIMES observed that patients were being attended to but ongoing strike may have slowed the services.
A patient’s relative, identified simply as Mrs Aliu, said her son had been on admission at the facility before the strike.
Another patient’s relative at the LASUTH Medical emergency department, Susan Abraham, said they took her 18-year-old son to the hospital on Thursday morning as a result of a swollen leg but could only be attended to later in the afternoon.
Another woman who refused to mention her name said her daughter was admitted on Tuesday due to a sickle cell crisis and that she has been attended to by different doctors.
Demands from Lagos government
The president of ARD at LASUTH, Salmon Abeeb, confirmed that the branch had complied with the directive of the national body, adding that only the consultants and medical officers were working.
He disclosed that the leadership of NARD were as of the time engaged at a meeting with the representatives of the government in Abuja.
“We pray that it yields favourable results and I hope that the government does the needful,” he said.
“As regards Lagos State, we are yet to get any response from the government, despite the fact that the strike has commenced and we believe they are on it.
“By the end of this week, if we don’t receive any favourable response, it means the strike will continue.”
Mr Abeeb noted that if the Lagos State Government pays the medical residency training fund for 2023, “we can call ourselves together and deliberate on our position.”
“We want them to grant the most pressing of our demands,” he said.
Speaking to PREMIUM TIMES, a consultant family physician and resident doctor in LASUTH, Oluwajimi Sodipo, decried “the lackadaisical attitude of government” to issues that concern doctors’ welfare.
“We must realise that no health practitioner wants to go on strike, but unfortunately the government doesn’t react until people go on strike,” he said.
He said NARD had raised a number of issues over the past few months and there have been several meetings with the government “but nothing happens until a strike is declared.”
“The notification for strike action should be the trigger action for the government to prevent the industrial action.”
Way forward
Shortly after the strike commenced on Wednesday, the Speaker of the House of Representatives, Tajudeen Abbas, said the federal government was working towards ending the doctors strike.
Mr Abbas, who spoke after a meeting between the principal officers of the lower chamber and President Bola Tinubu, said there are plans to meet some of the demands of the doctors.
“It is a work in progress. I am sure with some of the issues that they have raised, if we can be able to meet some of their expectations; of which we are already working on that,” he said.
“We have already set up an ad-hoc committee chaired by the majority leader of the House to look at the issues they raised. I am sure one or two interventions in their areas of concern will prevail on them to come back to the negotiation table.”
“He said he is just coming on board and we should ask them to please give him more time as he is completely unaware of most of the things that they mentioned and he is yet to be briefed about the issues,” Mr Abass said.
At a corner of a crowded female hospital ward, Mabel Dauda groaned loudly in pain from where she lay. Nurses dressed in white and blue uniforms moved around the ward, pushing along with them trollies containing medications and other items, as they attended to the patients.
Ms Dauda, who appeared to be mid-30, had been diagnosed with liver disease. According to the medical official on duty, the disease had reached the end stage. The patient was surrounded by family members who were crying as they hoped and prayed for a miracle. But that did not happen.
Ms Dauda died right where she lay in a corner of the ward. The end came for her sooner than anticipated.
“If only her case was presented earlier. The infection had already caused serious damage to her liver before she was brought in,” the doctor assigned to Ms Dauda murmured as he stepped away from the ward.
The scenario was in 2016 at the Ekiti State University Teaching Hospital (EKSUTH) in Ado Ekiti, the state capital, where this reporter was also on admission at the time.
Although the doctor did not exactly mention the cause of Ms Dauda’s death, some of her wailing relations had mumbled the word “hepatitis,” after the doctor confided in them.
Hepatitis, a viral infection, is known as a major cause of liver disease, which leads to death if not promptly and properly managed.
A consultant gastroenterologist at the Lagos University Teaching Hospital, Emuobor Odeghe, said hepatitis B, one of the five strains of hepatitis virus, can infect the liver and cause liver damage, calling it the commonest cause of chronic liver disease and its complications in Nigeria.
A consultant gastroenterologist at the Lagos University Teaching Hospital (LUTH), Emuobor Odeghe
Ms Odeghe said hepatitis is an inflammation of the liver that can be self-limiting or can progress to cirrhosis or liver cancer.
The World Health Organisation (WHO) said approximately 296 million people were living with chronic hepatitis B in 2019, and that 1.5 million new infections are recorded each year.
The global health body also disclosed that hepatitis B resulted in an estimated 820,000 deaths in 2019, mostly from cirrhosis and primary liver cancer, also known as hepatocellular carcinoma.
Nigeria is one of the most affected countries. With an estimated population of over 200 million people, the country has a hepatitis B prevalence rate of 8.1 per cent and hepatitis C of 1.1 per cent, according to the 2018 Nigeria AIDS Indicator and Impact Survey (NAIIS) report.
The malignant nature of hepatitis may have informed the decision to set aside a day every year to raise awareness about the viral infection and share knowledge on how to halt its danger.
WHD 2023
World Hepatitis Day (WHD) is marked on 28 July every year to raise awareness about the global burden of viral hepatitis and to influence real change.
The themefor the 2023 WHD, “We are not waiting’ is a call to accelerate elimination efforts of viral hepatitis now and the urgent need for testing and treatment for the people who need it.
More about hepatitis
According to Ms Odeghe, the consultant gastroenterologist, hepatitis viruses are the most common cause of hepatitis in the world. She listed its five typesincluding hepatitis A, B, C, D, and E.ⓘ
Although all five strains are of great concern, because of the burden of illnesses and deaths they cause and the potential for outbreaks and epidemic spread, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are said to be the most common cause of long-term liver damage and cancer, accounting for about 90 per cent of deathsfrom viral hepatitis.
Ms Odeghe said while hepatitis A and E are caused by ingestion of contaminated food or water, B, C, and D usually occur as a result of contact with infected body fluids.
“Hepatitis B virus can be transmitted through contact with infected body fluids such as from mother to child, one child to another child through skin cuts or infections that get in contact with infected blood during play, sharing of sharps and personal items; unsafe sexual practices; using unsterilised instruments for surgeries and other medical procedures; unsafe blood and blood product transfusion and needle stick injuries sustained by health care workers,” she said.
A consultant paediatrician, infectious diseases, at Barau Dikko Teaching Hospital, Kaduna State, Shuaibu Musa, also reiterated that hepatitis B and C virus are transmitted through direct contact with infected blood or certain bodily fluids.
Mr Musa said hepatitis is a silent epidemic because most people do not have symptoms when they are newly infected or chronically infected, hence they unknowingly spread the virus to others.
He said most patients with hepatitis B and C remain asymptomatic until the liver is significantly damaged. “Some symptoms of the viral infection include loss of appetite, stomach pain, dark-coloured urine, nausea, yellowish eyes or skin, and vomiting.”
Global health threat
Of the five strains of hepatitis, B, and C have been described as global public health threats and the world’s most common causes of liver infection.
According to WHO, approximately 296 million people were living with chronic hepatitis B in 2019, and 1.5 million new infections each year. The health body also disclosed that hepatitis B resulted in an estimated 820,000 deaths in 2019, mostly from cirrhosis and primary liver cancer, also known as hepatocellular carcinoma.
Data also revealsthat about two billion people globally have been infected with the hepatitis B virus (one out of three people).
In Africa, more than 90 million people are living with hepatitis, representing 26 per cent of the global total.
A medical doctor at the Federal Medical Centre (FMC), Gusau, Zamfara State, Bashir Gusau, said hepatitis B has become a global threat that requires urgent attention.
A medical doctor at the Federal Medical Centre (FMC), Gusau, Zamfara State, Bashir Gusau
Mr Gusau said people are not presenting for hepatitis tests as often as they should, hence the continuous spread of the virus.
“There are many persons living with hepatitis for long and they are ignorant of their health status. This infection has become an epidemic that must be tackled quickly to prevent more deaths,” he said.
Meanwhile, in Nigeria, the NAIIS survey – a national household-based survey that assessed the prevalence of HIV and related health indicators including the national prevalence of two additional blood-borne viruses of HBV and HCV – gave an estimated number of about 19 million Nigerians living with Hepatitis B and or C.
Nigeria’s former health minister, Osagie Ehanire, also said that hepatitis is under-reported, under-diagnosed, and under-treated in the country.
Late case presentation
Although there is no cure for hepatitis B, health experts say cases can be well managed if presented early.
Mrs Odeghe, the consultant gastroenterologist, said early detection and treatment of hepatitis B will reduce the risk of complications including liver cirrhosis and cancer.
She explained that late case presentation has led many manageable cases to deaths, one of which was that of Ms Dauda.
“Being hepatitis B positive is not a death sentence. Anyone who is positive should immediately see his/her doctor for further evaluation because there is an effective and safe treatment for it,” she said.
Salma Abdulrasheed, a resident of Masaka in Nasarrawa State, said she is currently undergoing treatment for hepatitis B at the National Hospital, Abuja.
Ms Abdulrasheed said although she presented to the hospital at the chronic stage of the infection, the doctor said her condition can still be managed as hepatitis B has no cure.
Mr Musa, the infectious diseases consultant, said hepatitis B becomes chronic if it lasts more than six weeks in the human body, noting that 25 per cent of chronic hepatitis B infections progress to liver cancer.
“For people who are chronically infected but don’t have any symptoms, their liver is still being silently damaged which can develop into serious liver disease,” he said.
Sadly, most patients with hepatitis B and C infections are asymptomatic and can remain so until the liver is significantly damaged. According to WHO, only about 10.5 per cent and 19 per cent of patients with chronic HBV and HCV are aware of their status.
The case of Daniel Benjamin is not different from that of Ms Abdulrasheed. Mr Benjamin said he never experienced any symptoms associated with hepatitis B until he became very ill and was rushed to the hospital.
“In all honesty, I didn’t observe any unusual symptoms with my body, I was 100 per cent fine until one morning I suddenly fell ill and was rushed to Garki Hospital,” he said.
Preventable but not curable
Unlike its counterparts, hepatitis B has no cure but can be managed effectively.
Mr Musa explained that the treatment options available for hepatitis B infection include focusing on controlling the viral replication, reducing liver damage, and preventing the progression of the disease.
“For acute hepatitis B, supportive care is often sufficient. But chronic hepatitis B requires long-term management using drugs that can kill the virus which is prescribed to slow down the replication of the virus and reduce the liver damage,” he said.
He noted that these drugs can help control the infection, improve liver function, and lower the risk of complications.
Mr Musa, however, said the killer infection can be prevented with the use of approved vaccines which he said are highly effective and recommended for everyone especially those at high risk.
He said the vaccines provide long-lasting protection against the virus as some studies show that immunity will persist for at least 20 years.
“Some studies also indicate that complete doses last for a lifetime and also the duration of immunity can vary between individuals because of certain factors like the age the vaccine was administered, the dosage received, the individual’s immune response, and other underlying health issues of the individual,” he said.
Rukayya Muhammad, a nurse at the Specialist Hospital, Sokoto, said a full course of hepatitis B vaccine is given in three doses and it offers lifelong protection for some people.
Ms Muhammad said the recommended dose of vaccine for a child is at zero, one, and six months and for adults, zero, one, and two months.
She, however, said recommended doses vary based on countries and vaccine type.
Investigations carried out by our reporter show that the costs of hepatitis B vaccines and tests vary based on location, health facility, and the nurse and or medical practitioner on duty.
At Asokoro District Hospital, Abuja, a dose of the vaccine costs N2,000. Three doses are required for an adult to achieve full immunity against the virus, making a total of N6,000. A patient is also required to first undergo a hepatitis B test for N2,000. If negative, the patient can proceed with vaccination.
At Wuse District Hospital, Abuja, a dose of the vaccine costs N3,000 and the test is N2,000, according to one of the nurses. When the reporter approached another nurse for confirmation, she said one dose cost N2500.
At the National Hospital, Abuja, a dose is N4,200 while the test to confirm the patient’s status is N4,000.
Emmanuel Ishaku, a resident of Kabala Doki, in Kaduna North LGA of Kaduna State told PREMIUM TIMES that he received the vaccine free of charge at the primary health centre in his community.
Mr Ishaku, however, said he paid N500 to carry out the hepatitis B test.
Vaccines not free for adult
The Executive Director of the National Primary Health Care Development Agency (NPHCDA), Faisal Shuaib, said the Hepatitis B vaccine is given under the Expanded Programme on Immunisation (EPI) schedule in Nigeria.
Mr Shuaib in his response to an FOI sent to the agency said Hepatitis B vaccine is among the childhood vaccines given to infants to prevent the viral disease and that it is readily available for children in all public and private health facilities providing routine immunisation services across the country.
He, however, said the vaccine is not readily accessible for adults because the EPI policy is yet to include it as a routine vaccine for adults.
“Apart from the fact that the focus of routine immunisation is essential to ensure all children get all the antigens, it is also required that adults get tested for hepatitis disease before they take the vaccine,” he said.
“Once an adult tests positive for hepatitis, taking the vaccine is no more necessary.”
Mr Shuaib said adults are able to access the vaccine through arrangements by private health facilities and some NGOs who make special requests to the agency.
He noted that there are already ongoing efforts by the Nigerian government to make the vaccine more available and accessible for adults.
To increase vaccine uptake, Mrs Odeghe, the consultant gastroenterologist, said the government must ensure vaccine availability and make it affordable for average Nigerians.
She said the full course of vaccine costs at least N5,000 in major parts of the country, a cost that many people cannot afford.
Increased awareness, screening
Mr Musa, the infectious diseases consultant, reiterated the need for increased awareness, especially for those in rural communities where many people are ignorant of such diseases.
He said regular screening will also ensure more cases are captured and placed on treatment before the infection gets to the chronic stage.
“Hepatitis B cases are still on the increase due to ignorance and lack of awareness and that is because a lot of people don’t know the causes and ways to prevent the infections. They are unaware of the very potent vaccines against hepatitis B,” he said.
Ms Abdulrasheed and Mr Benjamin, currently managing the infection, said they were not aware of the vaccines until they were diagnosed.
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