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A Nation In The Jaws Of Neglected Tropical Diseases

A man walks through the teeming traffic at Banex, Abuja holding a blue bowl and a wooden stick. He is led by another wearing red shorts and a blue kaftan shirt. They both look young although it is difficult to tell seeing the strain the hardship of their lives has placed on them. The first man is wearing a formerly white but now brownish robe which speaks of the dirt that might be a daily companion.

With his bowl, he collects whatever is deemed okay to give by those he begs from which is sometimes nothing. A car squeals as the brakes are pulled so as to avoid running into these men. The sun is up and bright, it is 5 pm in Abuja and the rest of the world is hurriedly going about their business unaided except by machines like phones and cars but these two must remain indivisible for each to survive, especially the first who is blind. It is hard to imagine what their actual story might be, maybe the white kaftan man was once the breadwinner of his family who prided in his ability to navigate the world with little or no help.

Maybe he was someone who enjoyed playing football once the sun sets and the ball was there, but now he is reduced to being that unacceptable term “beggar” eagerly dependent on what others had to spare, praying wholeheartedly for who gave him the time of day. One wonders if he feels sorry for himself. This sight is not uncommon in Nigeria, in almost every street in cities, towns and villages there is the man or woman who seeks alms from passing stranger, some are with gaping wounds that seem like a shallow lake of blood that only runs deeper and never seems to heal. Some have lost their sight, others have excessively swollen body parts, they are part of the victims of Neglected Tropical Diseases (NTD) which have been nicknamed ‘diseases of poverty’.

The Division of Neglected Tropical Diseases (NTDs) under the Department of Public Health of the Federal Ministry of Health put the number of these members of the population at 100 million. The World Health Organisation puts the number of people affected globally at one billion.

“NTDs are a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries,” the World Health Organisation reports. WHO also reports a total of 20 NTDs which is corroborated by the department of NTDs of the FMOH. When Dr. Chukwuma Anyaike resumed office as the Director and National Coordinator of the Neglected Tropical Diseases Department of the Federal Ministry of Health, it was to a raging endemic of 12 neglected diseases ravaging the Nigerian population especially in lower-income and rural areas. He said that between 39 to 40 per cent of the 1 billion aggregate given by WHO live in Nigeria.

“The full scale of the disease cannot be fully known owing to lack of attention paid to the disease,” he said, adding, “It is not like Ebola or coronavirus or HIV but the effects are just as devastating to the individual, community and the country.”

Bilharziasis (also known as Schistosomiasis), Buruli ulcer which is characterised by a huge gaping wound, hookworm and guinea worm infections, leprosy, trachoma, river blindness, elephantiasis and snake bites are the most common of these diseases of poverty, the cause of the effect we come across each day. A heavy veil of misinformation covers these diseases, Dr. Anyaike stressed.

“You’ll see someone who just returned from the village with swollen legs or scrotum or breast and people will say it was caused by a relative who harbours ill-will towards the person in question. Others will say the man or woman committed adultery and is being punished for his/her sins. Meanwhile, that is elephantiasis caused by mosquitoes that bite some people and give malaria.”

Elephantiasis also called lymphatic filariasis is caused when infected mosquitoes (infected by microfilariae) bite a person who did not formally have the virus. It impairs the lymphatic system and causes abnormal enlargement of some body parts. The larvae migrate to the lymphatic vessels where they develop into adult worms, thus continuing a cycle of transmission. Elephantiasis is present in 583 local governments in Nigeria. River blindness is caused when hosts are bitten by black flies which are found where the river runs at a high current, when the worm deposited by the black fly crawls into the eyes it causes blindness. It mostly affects fishermen and farmers who own farms around these areas. Buruli ulcer is usually characterised by huge gaping wounds. Trachoma infection spreads from person to person, particularly from child to child and from child to mother to child.

The disease thrives especially in crowded living conditions where there are shortages of water, inadequate sanitation and where numerous eye-seeking flies are present. In affected communities, infection is often first encountered in infancy or childhood. Leprosy is an infectious disease caused by mycobacterium leprae, an acid-fast, rod-shaped bacillus.

The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Guinea worm and hookworm infections result in severe malnutrition in children, the worm lives in the body, particularly the liver and swallows up nutrition depleting the child’s strength and gradually killing them.

NTDs disrupt the economy, perpetuates poverty, keep family in the circle of poverty and leave victims disabled and unable to provide for themselves. “It works like this: the individual problem becomes a community problem and then it becomes national poverty. Combating NTDs is combating poverty.” By causing disabilities among a population that could otherwise provide for themselves, it becomes dangerous to the failing economy of Nigeria and makes it all the more important to eradicate. Those formerly gallant enough to care for themselves become a burden to others unable to provide and unable to do basic things such as bathing. NTDs’ patients also suffer from stigmatization caused by misinformation and mystification of the illness.

“Somebody might want to marry from a family where another person has trachoma but will be discouraged because of the fear of it been hereditary or a curse.” NTDs can be dealt with by installing a fully functional primary health care system, continuous campaigns for awareness and destigmatization. The world has a target of eliminating NTDs by 2030 which is quite ambitious but not impossible. Dr. Anyaike emphasized the effort of the government in achieving this task. “The input of the government is sub-optimal but creating a primary health care system that works and removing import duties on drugs given by donors will improve our response.”

Presently, river blindness has been interrupted in Plateau, Nasarawa and Kaduna States and elephantiasis has been interrupted in Nasarawa and Plateau States. Dr. Anyaike said the war against the endemic of NTDs is being won but more support is needed. To victims and patients of the diseases, he advises that they take personal hygiene seriously, protect themselves, and use drugs when available.

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