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New Height Pharmaceuticals partners DIC on hypertension campaign
As Nigeria joined the rest of the world to mark the 2013 World Hypertension Day, on May 17th, themed: “Healthy Heart Beat-Healthy Blood Pressure”, New Height Pharmaceuticals, official business partner for Omron healthcare in Nigeria, has called on all health practitioners, including pharmacists to be part of the campaign against hypertension.
Speaking to Pharmanews in an exclusive interview at the weekend, during a one-day workshop organised by Drug Information Centre (DIC), for community pharmacists on hypertension, pharm. Omaruaye Ogheneochuko, managing pharmacist, New Heights Pharmaceutical s, urged pharmacists to be actively involved in the creation of awareness on high blood pressure, by providing their clients with information on how to measure their blood pressures at homes.
According to him, “we decided to partner with ACPN to educate and to inform pharmacists on the need for them to join in the advocacy, to create more awareness on hypertension”.
“Aside drug dispensing; we want pharmacists to know that they can also make available more information to their patients on the need for them to be actively involved in measuring and managing their blood pressures at home. As a leading marketer of Omron blood pressure monitors in Nigeria, we felt we should do something to instigate and encourage pharmacists to be involved in increasing the rate of hypertension awareness in the society”.
He further stated that about 70 per cent of the Nigerian population is hypertensive, quoting from a WHO’s information, adding that this is an unfortunate situation, because most of these people are not aware that they are hypertensive, owing to the simple fact that they do not know that they can check their blood pressures at home using an Omron BP monitor.

Asthmatic? How can it be effectively managed?
As Nigeria, on May 7, joined the rest of the world to mark the 2013 World Asthma Day, experts have unanimously asserted that asthmatics can live their normal lives without experiencing frequent crisis, if they always take their inhalers along with them.
The experts who spoke at a symposium organised by the Elias Nelson Oyedokun Foundation, ENOF, a foundation established in the year 2012, in memory of late Nelson Oyedokun, a 13-year-year-old boy who died from asthma, said asthma is one of the conditions that can be easily managed if the suffers comply with the rules of the condition, by taking their inhalers along with them always to control any attack.
Speaking on the theme for this year’s world asthma day being: “You Can Control Your Asthma,” the commissioner for health, Lagos State, Dr. Jide Idris said asthma deaths are ultimate tragic evidence of uncontrolled asthma and these were mostly preventable if control measures are effectively instituted.
The commissioner, who was represented by Dr. Jemilade Longe, director of disease control, for health in Lagos has also urged parents and guardians to cooperate with healthcare professionals on improved knowledge, awareness and management of childhood asthma to check the chronic condition that is most commonly responsible for absence of pupils from schools across the federation.
He also called on both the public and private sectors to create a conducive work environment devoid of sensitisers that could trigger occupational asthma, as well as contribute to already high incidence of asthma in Nigeria.
Also, operators of companies dealing in strong chemicals that can trigger asthma in adults have also been advised to ensure adequate protection of their staff to prevent them from developing the condition.
According to the commissioner, the prevalence of asthma is increasing throughout the world, especially as communities adopt western lifestyles and become urbanised. “An estimated 300 million people worldwide have asthma according to the Global Burden of Asthma Report, a compilation of public data on the prevalence and impact of asthma around the world. “Children constitute a reasonable percentage of those afflicted”.
Medical Director of Massey Children Hospital, Dr. Abieyuwa Emokpae while noting that strong chemicals like paints can trigger asthma in adults, advised persons at risk of asthma to avoid strong fume, perfume, insecticide, mentholatum, smoke, among others.
In his presentation, a professor of paediatrics, James Renner advised parents to first get a proper diagnosis of asthma and prevent living in denial of the condition.
Secondly, he noted that affected persons should stick to the health plan regarding when to use drug and when not to use the drug. “They should know which drug to use and for what situation. There should be no fears for mother to manage asthmatic children,” said Renner.
In her remarks, Lola Ilaka and founder of the ENOF said the objective of the organisation is to create awareness about asthma and to touch lives, adding that ENOF will train health care providers on improved asthma care and create avenue for people to learn about asthma.
Nigeria health system defective – Dr. Godfrey O. Achilihu
Hypertension already affects one billion people worldwide and kills nine million people every year. Prevalence of high blood pressure is highest in some low-income countries in Africa, with over 40 per cent of adults in many African countries thought to be affected. Hypertension is a silent, invisible killer that rarely causes symptoms. A United State Fellowship Trained Cardiologist, Dr. Godfrey O. Achilihu, in an interview with Gracia Obi, x-rays measures in which the government health system can provide these services to the less privileged, with emphasis on women and children.
What would you say of the various problems facing the health care sector in this country?
There are issues, but the problems are not insurmountable. It starts with the decision of the government to address the problems. It also starts with the decision of the medical practitioners to address their part.
Individuals and government can invest in health, because they are spending as much money as they spend abroad. If they do, it will save a lot of capital flight which happens when Nigerian patients go abroad. In fact, it will improve the economic situation of the country.
Considering the high cost of services of medical specialists, don’t you think it is important that a trust fund be established to meet the needs of people who are unable to afford the cost?
Yes, there should be a system that caters for the less privileged. Government should have a fund that caters for the poor in such a manner that no one is left out. It is the case abroad where government caters for the less privileged. In Medicare or Medicaid, government pays for health care. In the United States, Medicare actually pays for it. It seems to me that we are running a system that is defective. In such a defective system, people that work for government are the ones that benefit from the defects of the system. It shouldn’t be the case because this country belongs to all of us. Those in government have access to health care, including the option of going abroad at the expense of the country. But if you don’t work for government, oil companies or banks, you may not get the health care you need, as you are likely unable to afford it.
Government should be able to get corporations to buy into health care provision. For example, a family should be able to afford health insurance, in which you pay a certain level of deduction from you earning. The idea is that it will be very difficult to get someone to pay several millions at a time because he was not expecting the problem. But insurance can help give some equivalent of their health care, when they are sick. This is because the insurance company will offset some of your bills when you are sick. I think that system can be established here in Nigeria.
How can professionals help to create awareness about the availability of these services in this country?
The level of awareness can be raised. Not just about what can be done to help patients but also about the disease symptoms itself. Nigeria should create a system such as “Calling 911” as is the case abroad. An emergency help line should be established. When someone has passed-out in front of you, you can just call 911 and the appropriate authorities will swing into action. When you dial that number, it rings at a central station which will then tell the ambulance where you are. Then help will reach you.
It is true that we, the professionals, have a lot to do. But apart from that, there are certain technologies that are required to make it work. We need consistent power supply. If for example, I want to call someone in Asokoro and there is no electricity supply, how do I get that done? Many factors are involved. Raising awareness can also be done through the churches, mosques, schools and local associations, while the doctors are able to provided intermittent and consistent information about disease processes and symptoms. If somebody tells you they should be able to do something, it is not wise to dismiss it. Or when they say they get out of breath when they do some work, or when their legs get swollen; those are symptoms of heart disease and it should not be dismissed. Particularly when someone complains of chest pain or tiredness, or when they break out in sweat. That is a sign of blockage of an artery in the heart that could lead to massive heart attack that can cause sudden death.
So, awareness can be raised in so many ways and we should all be involved in it. There should be seminars on the soccer field, and everywhere. Everyone should know what a defibrillator is. We all should know what should be done when someone collapses. It should be taught in school.
How expensive are some of the corrective measures, like the implanting devices?
Some of the things we do in the area of cardiology are expensive and cannot be afforded to most people. Economic problems can prevent a patient from getting the health care he needs. If we have enough resources and get enough people to pay for some of these things, the prices will reduce and become affordable to more people. The cost of health care in the United States and India is not very high.
However, some people may claim that they cannot afford health care, but they will build a hundred million naira home. Some patients come and they say “Oh, doctor, we cannot afford the cost,” but you find that the following week, they are in India. That is sometimes the problem. I don’t see how going to India will reduce what the cost could have been in Nigeria. When you put the cost of flight together and a few other things, you will find that it cannot be cheaper in India than it is in Nigeria. For many reasons, the best place to get your health care is in Nigeria. If there is an emergency, your family can be reached. More so, knowledge of the patient’s medical history matters. If you bring someone to me from India, I don’t know what the history of his sickness is, and it may be difficult to treat.
Is that different from what the National Health Insurance Scheme (NHIS) is doing in this country?
NHIS is a very low level insurance scheme. However, private individuals or corporations can run higher levels of health insurance that would also accessible to people who are not necessarily in that corporation. For example, everybody that is working in some area can cater for their health through that system. A corporation can have a health insurance department that is open to the public. When you need health care, insurance comes into play. NHIS that you spoke of is a low level scheme that makes provision for only primary health care issues. When it comes to funding for ailments that require a lot of money, I don’t think NHIS is positioned for that.
However, that kind of job shouldn’t just be the job of government alone. Health insurance should be run like any other business. If I want to buy insurance, I will buy into that kind of insurance.
Government should be able to provide these services to the less privileged. These should be with emphasis on women and child health because there is no society without women and children. The bedrock of a healthy society is the child. However, opportunities exists to do things right.
Group sensitises villagers on malaria
In order to curb the menace of malaria in the rural areas, Women for Peace (WP), a non-governmental organisation (NGO) in the Federal Capital Territory (FCT), is currently visiting villages in the FCT, educating them on how to shield their environments from mosquitoes, the main cause of the disease.
The NGO visited Anagada, Giri, Kabusa, Sheda and Yangozhirecently, and held 45-minute sentitisation sessions with the people of each village, especially women.
Mosquito nets, insecticides, soaps, broom, cutlasses and drugs were shared in each of the villages.
Speaking to Pharmanews, the scribe of the NGO, Rebecca Madami said, “Malaria is a deadly disease.”
She said: “Because of the bushes that edge many villages, it is very prevalent there, yet they don’t know how to prevent its attack. Everybody knows that it is caused by mosquitoes, so the best way of stoping it is through shielding our environments from mosquitoes.”
“So, we are here to sensitise people on how to keep their homes away from mosquitoes. We have taught them how to clean and ensure that their houses are always neat, so that mosquitoes cannot come in; we taught them how to dispose sewages, cut the bushes around their houses and other measures. We also brought materials which we shared to them.”
Obono decries huge amount spent tackling adverse drug reaction
Pharm. Margaret Obono, incumbent treasurer of the Pharmaceutical Society of Nigeria (PSN), has declared that the bulk of annual budget earmarked for the health sector is being spent on hospitalization, due to reported cases of adverse drug reaction (ADR).
Speaking on Essentials of Pharmacovigilance at a workshop organised for pharmacists by Pharmanews Limited on 4th April, 2013, Obono attributed this report to recent studies, saying that in addition to ADR, drug induced morbidity and mortality have also become a major problem for the health care professionals and the populace.
In defining adverse drug reaction, the former chairman of the Association of Lady Pharmacists (ALPS) described it as any response to a drug which is noxious and unintended and which occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease or the modification of physiological function.
“Other issues relevant to this science include substandard medicines, medication errors, lack of efficacy reports, use of medicines for indications that are not approved and for which there is inadequate scientific basis, as well as case reports of acute and chronic poisoning,” she said.
In her presentation, Obono noted that it was on the legal basis for Pharmacovigilance that the National Agency for Food and Drug Administration and Control (NAFDAC), which was established by Decree 15 of 1993 (as amended), came into existence.
NAFDAC as Act Cap N1 laws of the Federal Republic of Nigeria 2004 was placed with the mandate to “to control and regulate the manufacture, importation, exportation, distribution, advertisement, sale and use of food, drugs, cosmetics, chemicals/detergents, medical devices and all drinks, including packaged water.”
“This mandate further requires NAFDAC to ensure quality, safety and efficacy of the above named regulated products, hence, pharmacovigilance.Thus the National Pharmacovigilance Centre (NPC) was set up in September 2004,” she said.
The PSN treasurer further explained that since no active drug is entirely free from adverse effects, the introduction of an adverse drug reaction reporting system is an essential component of a national health care delivery system. Government shall, therefore, encourage the establishment of adequately equipped pharmacovigilanceunits nation-wide, to collect, evaluate and disseminate relevant information on adverse drug reactions and poisoning.
While discussing pharmacovigilance regulatory system in Nigeria, Pharm Obono opined that it shall be voluntary for the reporting health professionals and traditional herbal medicine practitioners or healthcare providers working in establishments other than the manufacturing or importing/distributing companies.
“ADR reporting is voluntary with no remuneration. It is a professional ethical obligation. In fact, it shall be mandatory for all manufacturers of pharmaceutical products and traditional herbal medicinal products, their local agents in Nigeria, importers, including those of public health medicines, to report to the National Pharmacovigilance Centre any adverse reaction associated with their products in Nigeria or anywhere in the world,’ she emphasised.
The pharmacist declared, among other things, that report on ADR should include response to medicines used in humans which are noxious (harmful) and unintended, lack of efficacy, overdose, misuse and/or abuse of a medicine, medication error and counterfeit or substandard medicine.
FG reviews national plan for tuberculosis and leprosy control – By Gracia Obi
Towards improving efficiency in combating two deadly diseases, the Federal Government has announced that it is currently reviewing the National Strategic Plan for Tuberculosis and Leprosy Control.
The outcome of the evaluation, which is being conducted by teams of international experts, with the support of TB experts in Nigeria, is expected to be used in re-strategising interventions and efforts towards reaching the Millennium Development Goals target by 2015.
It also said the National Strategic Plan for Tuberculosis and Leprosy has, so far, provided services to over 4,000 hospitals and health facilities across the country.
The Minister of Health, Prof. Onyebuchi Chukwu,said recently at the mid-term evaluation of the plan in Abuja that the review would facilitate the emergence of an adjusted and reviewed National Tuberculosis and Leprosy Strategic Plan Suitable for funding from government Global Fund, USAID, Centre for Disease Control (CDC) and other partners.
The Director of Family Health at the Ministry, Dr. Bridge Okoegbule, represented the Minister at the occasion.
National Coordinator of the National Tuberculosis and Leprosy Control Programme, Dr. Olusegun Obasanya, stated that the programme has so far provided health services in some 4,000 health facilities across the country.
“We have gone midway, though yearly we have been looking at our progress, but midway, we need to stop to look at what we have done, look at our achievements, our challenges and from there, re-strategies to say okay, let’s look at how we have been doing and see how we can improve our situation.”
All health-related Millennium Development Goals to be achieved by 2015 – Minister (By Gracia Obi)
Minister of State for Federal Capital Territory (FCT), OlajumokeAkinjide, said the Federal Capital Territory Administration (FCTA) was determined to achieve all health-related Millennium Development Goals in FCT by 2015.
She said: “The FCT Administration is committed to ensuring that the residents of the territory have the best quality of healthcare at the various levels of care.
“The administration is determined to achieve all of the health related Millennium Development Goals (MDGs) in FCT by 2015 and the transformation agenda of Mr. President.”
She assured that FCTA was committed to ensuring a world-class healthcare delivery in the territory, adding that the provision of quality and affordable healthcare delivery remained a top priority of the administration.
Akinjide gave this assurance during a training organised for biomedical technicians and engineers by the FCTA, in collaboration with a non-profit organisation based in the United States of America, Medshare.
She stressed that the training was in line with the administration’s transformation agenda of providing world-class and affordable healthcare delivery, from primary to tertiary healthcare facilities.
“Effective and efficient medical practice is dependent on availability of skilful human resources, functional diagnostic medical equipment and hygienic working environment.
“It is my utmost belief that this capacity building programme will generate ripples of change among biomedical technicians and engineers in handling and maintenance of our medical equipment and ensure their optimal functionality,” she added.
How to manage hypertension
Are you hypertensive and do not know the way out of it? The good news is that lifestyle management is key in living with hypertension. You are sure to get ample guidelines that will help you manage your condition effectively from this article.
Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body.
Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses, such as heart attack, stroke, heart failure, aneurysm, or renal failure.
According to Medilexicon’s medical dictionary, hypertension means “High blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences.”
The normal level for blood pressure is below 120/80, where 120 represents the systolic measurement (peak pressure in the arteries) and 80 represents the diastolic measurement (minimum pressure in the arteries). Blood pressure between 120/80 and 139/89 is called prehypertension (to denote increased risk of hypertension), and a blood pressure of 140/90 or above is considered hypertension.
Hypertension may be classified as essential or secondary. Essential hypertension is the term for high blood pressure, with unknown cause. It accounts for about 95 per cent of cases. Secondary hypertension is the term for high blood pressure with a known direct cause, such as kidney disease, tumors, or birth control pills.
Some 73 million adults in the United States are affected by hypertension. The condition also affects about two million teens and children.
What causes hypertension?
Though the exact causes of hypertension are usually unknown, there are several factors that have been highly associated with the condition. These include:
Smoking
Obesity or being overweight
Diabetes
Sedentary lifestyle
Lack of physical activity
High levels of salt intake (sodium sensitivity)
Insufficient calcium, potassium, and magnesium consumption
Vitamin D deficiency
High levels of alcohol consumption
Stress
Ageing
Medicines such as birth control pills
Genetics and a family history of hypertension
Chronic kidney disease
Adrenal and thyroid problems or tumors
Statistics indicate that African Americans have a higher incidence of hypertension than other ethnicities.
What are symptoms of hypertension?
There is no guarantee that a person with hypertension will present any symptoms of the condition. About 33 per cent of people actually do not know that they have high blood pressure, and this ignorance can last for years. For this reason, it is advisable to undergo periodic blood pressure screenings even when no symptoms are present.
Extremely high blood pressure may lead to some symptoms, however, and these include:
Severe headaches
Fatigue or confusion
Dizziness
Nausea
Problems with vision
Chest pains
Breathing problems
Irregular heartbeat
Blood in the urine
How is hypertension diagnosed?
Hypertension may be diagnosed by a health professional who measures blood pressure with a device called a sphygmomanometer – the device with the arm cuff, dial, pump, and valve. The systolic and diastolic numbers will be recorded and compared to a chart of values. If the pressure is greater than 140/90, you will be considered to have hypertension.
A high blood pressure measurement, however, may be spurious or the result of stress at the time of the exam. In order to perform a more thorough diagnosis, physicians usually conduct a physical exam and ask for the medical history of you and your family. Doctors will need to know if you have any of the risk factors for hypertension, such as smoking, high cholesterol, or diabetes.
If hypertension seems reasonable, tests such as electrocardiograms (ECG) and echocardiograms will be used in order to measure electrical activity of the heart and to assess the physical structure of the heart. Additional blood tests will also be required to identify possible causes of secondary hypertension and to measure renal function, electrolyte levels, sugar levels, and cholesterol levels.
How is hypertension treated?
The main goal of treatment for hypertension is to lower blood pressure to less than 140/90 – or even lower in some groups such as people with diabetes, and people with chronic kidney diseases. Treating hypertension is important for reducing the risk of stroke, heart attack, and heart failure.
High blood pressure may be treated medically, by changing lifestyle factors, or a combination of the two. Important lifestyle changes include losing weight, quitting smoking, eating a healthful diet, reducing sodium intake, exercising regularly, and limiting alcohol consumption.
Medical options to treat hypertension include several classes of drugs. ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators are the primary drugs used in treatment. These medications may be used alone or in combination, and some are only used in combination. In addition, some of these drugs are preferred to others, depending on the characteristics of the patient (diabetic, pregnant, etc.).
If blood pressure is successfully lowered, it is wise to have frequent checkups and to take preventive measures to avoid a relapse of hypertension.
How can hypertension be prevented?
Hypertension can best be prevented by adjusting your lifestyle so that proper diet and exercise are key components. It is important to maintain a healthy weight, reduce salt intake, reduce alcohol intake, and reduce stress.
In order to prevent damage to critical organs and conditions such as stroke, heart attack, and kidney failure that may be caused by high blood pressure, it is important to screen, diagnose, treat, and control hypertension in its earliest stages. This can also be accomplished by increasing public awareness and increasing the frequency of screenings for the condition.
Exams and tests
Your health care provider will check your blood pressure several times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different, depending on the time of day.
Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your doctor’s office. Make sure you get a good quality, well-fitting home device. It should have the proper sized cuff and a digital readout.
Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly.
Your doctor will perform a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.
Tests may be done to look for:
•High cholesterol levels
•Heart disease, such as an echocardiogram or electrocardiogram
•Kidney disease, such as a basic metabolic panel and urinalysis or ultrasound of the kidneys
Treatment
The goal of treatment is to reduce blood pressure, so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you.
If you have pre-hypertension, your health care provider will recommend lifestyle changes to bring your blood pressure down to a normal range. Medicines are rarely used for pre-hypertension.
You can do many things to help control your blood pressure, including:
•Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. See: High blood pressure and diet
•Exercise regularly – atleast 30 minutes of aerobic exercise a day.
•If you smoke, quit – finda programme that will help you stop.
•Limit how much alcohol you drink – onedrink a day for women, two a day for men.
•Limit the amount of sodium (salt) you eat – aimfor less than 1,500 mg per day.
•Reduce stress – tryto avoid things that cause you stress. You can also try meditation or yoga.
•Stay at a healthy body weight – finda weight-loss programme to help you, if you need it.
Your health care provider can help you find programmes for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietician, who can help you plan a diet that is healthy for you.
There are many different medicines that can be used to treat high blood pressure. See: High blood pressure medicines
Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.
Possible complications
When blood pressure is not well controlled, you are at risk for:
•Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs
•Chronic kidney disease
•Heart attack and heart failure
•Poor blood supply to the legs
•Stroke
•Problems with your vision.
When to contact a medical professional
If you have high blood pressure, you will have regular appointments with your doctor.
Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.
Call your health care provider right away, if home monitoring shows that your blood pressure is still high.
Prevention
Adults over 18 should have their blood pressure checked regularly.
Lifestyle changes may help control your blood pressure.
Follow your health care provider’s recommendations to modify, treat, or control possible causes of high blood pressure.
Compiled by Adebayo Folorunsho-Francis with additional reports from the American Heart Association/American Stroke Association and Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine
Coffee, caffeine and headaches: Exploring the relationship between Caffeine and headaches
The consumption of coffee has been linked to reduction of headaches. This article seeks to explain some common terms often associated with coffee and headaches i.e. withdrawal headaches, weekend headaches and fasting headaches, and their possible association with caffeine use.
What is meant by the term “withdrawal headaches”?
Caffeine withdrawal headaches are headaches that occur when regular coffee drinkers discontinue coffee intake abruptly. This sudden cessation of regular caffeine consumption may result in headaches among sensitive individuals. The headache generally resolves within a few days or at most one week after consumption has stopped. In addition, the headache disappears when caffeine consumption is resumed. It is important to note that caffeine withdrawal headaches are not experienced by all individuals; prevalence figures vary between 0.4 per cent and 50 per cent. Caffeine withdrawal headaches can easily be prevented by reducing caffeine consumption gradually in the days before cessation of consumption, for instance in the case of religious fasting or a surgical procedure.
Are “fasting headaches” related to caffeine consumption?
Fasting of food is an important precipitating factor of headaches, generally, and the probability of onset increases directly with the duration of fasting. In fact, some authors have mentioned the use of terms like “hunger” headaches often used when individuals have not had any food for some time and experience headaches associated with their hunger. Fasting headaches are one of the most common forms of secondary headaches, but much remains to be explained about the underlying patho-physiological mechanisms. Hypoglycaemia and caffeine withdrawal are suggested as potential triggers although fasting headaches may occur even when there is no hypoglycaemia and in individuals who do not normally consume coffee. Other factors like abstinence from water, genetic makeup or cultural factors may also contribute to fasting induced headaches.
Are “weekend” headaches related to coffee consumption?
Some individuals may experience headaches particularly on weekend mornings. Different explanations are proposed for this so called weekend headaches. It might be related to the changes in stress levels, or sudden disappearance of stress during the weekend. Changes in the pattern of sleep have also been suggested as an important cause or missing the usual early breakfast on weekend mornings or avoidance of caffeine on weekend mornings.
Does the occurrence of weekend headaches indicate that coffee is addictive?
The common sense use of the term addiction is that regular consumption of a substance becomes irresistible and that using it creates problems. Caffeine use does not fit this profile. Its intake does no harm to the individual or society and caffeine users are not compelled to consume it. Though cessation of regular caffeine use may result in symptoms such as headaches and lethargy, these are very moderate, compared to those induced by drugs of abuse. In addition, they are easily and reliably reversible or wane with time.
In summary, coffee has many beneficial health effects and has been shown to reduce symptoms in certain kinds of headaches. Understanding the science behind some types of headaches that had been hitherto associated with regular coffee intake will help individuals prevent some of these symptoms and fully enjoy the health benefits of coffee consumption.
References:
Coffee and health information bureau.Coffee and the brain.Stmiocommunicatie&presentiatieTiel, Netherlands. April 2011.
Nehlig A. Caffeine and headache: Relationship with the effects of caffeine on cerebral blood flow. In Nehlig A (ed) Coffee, Tea, Chocolate and the brain;CRC Press LLC, Boca Raton, floroda: 2004;175-186
ScherA Caffeine as a risk factor for chronic daily headaches. A population based study. Neurology, 2004; 63: 2022-2027
Shapiro RE.Caffeine and headaches. Current pain headache rep. 2008 12:311-315
Torelli P et al Fasting headache: a review of the literature and new hypothesis. Headache, 2009; 49:744-752
Coutorier EGM Weekend attacks in migraine patients: caused by caffeine withdrawal? Cephalaga, 1992; 12:99-100
SKG pharma rewards trade partners, launches Novalyn Linctus
As part of its activities to retain customers’ loyalty, SKG Pharma Limited organised a trade partners conference, to celebrate the patronage of all their customers across the country, as well as reward them for the businesses transacted with the company for the year 2012.
The conference, which was held at the De-renaissance Hotel, Ikeja, Lagos, also witnessed the launch of a new product, Novalyn Linctus, a herbal cough medicine for both adults and children.
Speaking with the managing director, Mr. Okey Akpa, in an exclusive interview at the event, he said the trade partners’ forum is an annual event where they appreciate their clients for being in business with SKG Pharma, and also get reasonable feedback from them about the performance of the company, as well as that of its field force.
“The first thing we gain from this conference is customers’ loyalty; celebrating our customers every year is part of our scheme to retain loyalty. For us, loyalty is a two-way thing; we remain loyal to them, and they are loyal to us.”
“The second thing is quality feedback because they are the bridge between us and the rest of the channels, right down to the consumers. Speaking to them enables us get quality feedback, without which the business is at risk. So, we see this as a very important occasion where we interact, and chart the way forward for the organization.”
Speaking on the launched product, the SKG boss said the cough syrup has natural ingredients, which contain honey, purified natural oil, lime oil, lemon oil and glycerol. Another advantage it has over competitive products is its non drowsiness.
“As a company, we don’t want to be seen in one mode, either as a herbal company or anti-herbal company. We are a holistic pharmaceutical company, and we are involved in research and development. At any time we are able to get a product that is going to get all the therapeutic values, and meet all the scientific standards, that allow it to be registered by NAFDAC and other regulatory agencies, we will be very happy to present it.”
The workshop facilitator, Mr. Lere Baale of Howes Consulting Limited, took the participants on the topic: “Accelerating Business Growth”. He said, for a business to survive in a global economic recession, it must see advertising and marketing as an investment, and not a luxury. Also, he noted that the organisation must keep away from pitfalls that can run the company aground, such as price reduction, let’s wait and see approach, withdrawal of advertisements, and non training of staff.
He further submitted that there is the possibility of growth through expertise, by recruiting the right kind of people, passing the values and cultures of the organisation to the staff, focusing on productivity and teamwork, and ensuring involvement and participation of staff.
The trainer urged the company and its partners to see opportunity in the health care industry, stating that if the health care delivery is not efficient enough, it is an opportunity to sell quality products to the patients, who are seeking quality health care services.
In his own contribution, the national president of the PSN, Pharm. Olumide Akintayo, who was the special guest of honour of the occasion, tasked the company on continuous improvement, in the face of new drug distribution guidelines, and the need to put in place a drug distribution system that will be respected all over the country.
The president also advised the customers of SKG to remain loyal and committed to the organisation, saying that since they have been promoted from the level of customers to partners, they should abide by the values of the company, in all ramifications.
KCI embarks on solidarity walk to raise awareness for renal disease
As part of events lined up to mark World Kidney Day, Kidney Consultants International (KCI), a not-for-profit organization, in conjunction with Leadway Assurance, National Orientation Agency, Abeokuta and Ogun State Ministry of Health, commenced on a long walk through the city of Abeokuta to draw attention to the plight of people living with renal problems.
The walk, which started at 10.30 am on 14th March, 2013, also had in attendance representatives of Federal Road Safety Corps, Abeokuta, Nigerian Police, Super Foods Abeokuta, Rotary Club, Nigerian Association of Nephrology and Pathcare Nigeria, a Lagos-based diagnostic laboratory, as well as members of National Youth Service Corps.
According to Mr. Adebayo Sokunbi, operations director of KCI, the purpose of the day is to educate the public about kidney disease and to call attention of health authorities, all over the world,to the rising burden of the disease and the need to make policies to reduce the incidence.
During the walk, fliers were distributed which contained educative/preventive information on kidney disease made for the occasion by the National Orientation Agency,Ogun State branch. There was a brief stop-over at the Olubara of Ibara’s palace, along the Omida axis, to pay homage.
After the walk, which lasted for about 1 hour 30 minutes, the participants were all seated at the garden of the Abeokuta sports club for the educative/preventive health talk on kidney disease and free screening that followed.
This segment of the World Kidney Day activities was flagged off by the operations director of the Kidney Consultants International, Mr. Adebayo Sokunbi, who gave a welcome address.
During his keynote address,Ogun State commissioner for health encouraged guests on healthy living and the need for use of drugs, based on prescription.
The lecture for the day on the theme:Kidneys for life stop acute kidney injury was taken by Dr. Osagie Otasowie, medical officer at the Kidney Clinics, Abeokuta Dialysis Centre. He spoke broadly on the human kidney, its functions, problems, treatment and prevention, as well as the health and financial burden on the patient, relatives and the society at large.
Bringing home the point, in relation to the theme, he emphasised that acute kidney injury is treatable and,in fact, reversible when detected on time and medical attention is sought. He therefore advised the audience on the need for regular medical checkups, healthy living and most importantly, to seek medical help as soon as symptoms are noticed.
After the lecture, one of the chronic kidney patients, a 22-year-old, who is currently having his dialysis sessions at the Abeokuta dialysis centre, relived his experience to a bewildered audience.
This was followed by a free screening by a team of Pathcare Nigeria and Abeokuta dialysis officials. The tests conducted include urinalysis and random blood sugar, as well as measurement of blood pressure and body mass index.
A total number of 68 persons were screened and those with abnormal values were seen instantly by the doctor for referral.
GlaxoSmithKline unveils New Sensodyne Toothpaste Variant
In addressing recurring cases of sensitive teeth, GlaxoSmithKline Consumer Nigeria Plc has launched a new variant of its Sensodyne Toothpaste – Sensodyne Rapid Action into the Nigerian market.
The unveiling of the product, which was held at Eko Hotel and Suites, Victoria Island, Lagos on 28th March, 2013 had several dentists, including Dr. A. C. Olojede (president of the Nigerian Dental Association), academic professors such as Prof. K. O. Savage (past dean of Faculty of Sciences in LUTH) and community pharmacists in attendance.
Speaking at the launch, Chidi Okoro, GSK Consumer’s managing director, explained that so many people are unaware of the available treatment options and are also under the perception that treating sensitive teeth can be a time consuming process.
“But with this Sensodyne rapid action variant, many will immediately experience quick and effective teeth sensitivity relief in the most practical way. This is because the product is formulated to offer relief within 60 seconds,” he observed.
According to him, dentine hypersensitivity is a common problem affecting 1 out of 3 people, yet many do not actively address it. People develop sensitive teeth when the soft, inner core of the teeth, becomes exposed. This can happen due to factors such as abrasion from tooth-brushing, acid erosion which dissolves the enamel or tooth grinding that causes the enamel to be worn away, leading to sensitivity.
Buttressing his view, Dr. Steve Mason, GSK’s global clinical director for Sensitivity and Acid Erosion, stressed that Sensodyne toothpaste has been clinically proven to relieve the pain of teeth sensitivity with continuous use.
While expatiating on symptoms associated with dentine sensitivity, Mason explained that sensitive teeth may be experienced by people aged 20 and above, and if left untreated, can infringe on the enjoyment of certain food and drinks.
“That is why people adopt all sorts of methods to avoid the pain of sensitivity, but the simplest solution is to use a brand of toothpaste such as Sensodyne Rapid Action that is specially designed for sensitive teeth,” he remarked.
Following a complaint made by one of the participants on the difficulty experienced in accessing the product in Osun State, Dr Bode Adesoji, GSK’s medical director for Anglophone West Africa, said that the organisation plans to set up warehouses in some of the affected states, to facilitate smooth distribution.
“I can reassure you that GSK will never promote quackery. Before any of our adverts hit the press, it is made to undergo rigorous scrutiny. Besides, we have a well structured distribution channel,” he enthused.
Sensodyne was first marketed in 1961 as the first desensitising toothpaste based on a strontium chloride formulation.
In addition to being a global brand, with over 52 years of proven pain relief heritage, Sensodyne is the first brand with its core equity built on dentist’s recommendation and it is the most frequently recommended in the desensitising toothpaste category.
Presently, other variants of Sensodyne toothpaste available in Nigeria include: Sensodyne Extra Fresh, Sensodyne Total Care F and Sensodyne Gentle Whitening.
In addressing recurring cases of sensitive teeth, GlaxoSmithKline Consumer Nigeria Plc has launched a new variant of its Sensodyne Toothpaste – Sensodyne Rapid Action into the Nigerian market.
The unveiling of the product, which was held at Eko Hotel and Suites, Victoria Island, Lagos on 28th March, 2013 had several dentists, including Dr. A. C. Olojede (president of the Nigerian Dental Association), academic professors such as Prof. K. O. Savage (past dean of Faculty of Sciences in LUTH) and community pharmacists in attendance.
Speaking at the launch, Chidi Okoro, GSK Consumer’s managing director, explained that so many people are unaware of the available treatment options and are also under the perception that treating sensitive teeth can be a time consuming process.
“But with this Sensodyne rapid action variant, many will immediately experience quick and effective teeth sensitivity relief in the most practical way. This is because the product is formulated to offer relief within 60 seconds,” he observed.
According to him, dentine hypersensitivity is a common problem affecting 1 out of 3 people, yet many do not actively address it. People develop sensitive teeth when the soft, inner core of the teeth, becomes exposed. This can happen due to factors such as abrasion from tooth-brushing, acid erosion which dissolves the enamel or tooth grinding that causes the enamel to be worn away, leading to sensitivity.
Buttressing his view, Dr. Steve Mason, GSK’s global clinical director for Sensitivity and Acid Erosion, stressed that Sensodyne toothpaste has been clinically proven to relieve the pain of teeth sensitivity with continuous use.
While expatiating on symptoms associated with dentine sensitivity, Mason explained that sensitive teeth may be experienced by people aged 20 and above, and if left untreated, can infringe on the enjoyment of certain food and drinks.
“That is why people adopt all sorts of methods to avoid the pain of sensitivity, but the simplest solution is to use a brand of toothpaste such as Sensodyne Rapid Action that is specially designed for sensitive teeth,” he remarked.
Following a complaint made by one of the participants on the difficulty experienced in accessing the product in Osun State, Dr Bode Adesoji, GSK’s medical director for Anglophone West Africa, said that the organisation plans to set up warehouses in some of the affected states, to facilitate smooth distribution.
“I can reassure you that GSK will never promote quackery. Before any of our adverts hit the press, it is made to undergo rigorous scrutiny. Besides, we have a well structured distribution channel,” he enthused.
Sensodyne was first marketed in 1961 as the first desensitising toothpaste based on a strontium chloride formulation.
In addition to being a global brand, with over 52 years of proven pain relief heritage, Sensodyne is the first brand with its core equity built on dentist’s recommendation and it is the most frequently recommended in the desensitising toothpaste category.
Presently, other variants of Sensodyne toothpaste available in Nigeria include: Sensodyne Extra Fresh, Sensodyne Total Care F and Sensodyne Gentle Whitening.
OAU inducts 98 pharmacy graduates,17 bag distinctions
It was a carnival like arena as parents, guardians, friends and dignitaries in their hundreds trooped into to the prestigious Oduduwa Hall of the Obafemi Awolowo University (OAU), Ile-Ife, Osun State, to witness the professional induction and oath-taking ceremony for the ninety-eight pharmacy graduates for the 2011/2012 set. The ninety-eight about to be inducted graduands, who were brimming with smiles, were already seated with their colourful academic gowns as early as 10am, when the programme commenced.
The induction ceremony, which was under the chairmanship of the vice-chancellor of Obafemi Awolowo University (OAU), Professor Bamitale Omole, who was represented by dean, Faculty of Arts, Design and Management and chairman, Committee of Deans, Prof Fadare, also had in attendance several eminent guests, such as Pharm. (Sir) Ifeanyi Atueyi, publisher, Pharmanews; HRM Oba Pharm. OlatundeFalabi, who was represented by Chief Falana, the Aremo of Ikireland; Pharm. Ade Popoola, chairman, Board of Fellows and group managing director, Reals Specialties, Lagos;Pharm. (Dr). Lolu Ojo, national chairman, National Association of Industrial Pharmacists and the managing director, Merit Healthcare Limited, Lagos, who was also the keynote address speaker; Pharm Olumide Akintayo, president, Pharmaceutical Society of Nigeria, who was represented by the chairman, PSN, Oyo State, Pharm Lekan Fashesin; Prof O. O. Bolaji, dean, Faculty of Pharmacy, OAU; Mrs. Oluwatayo Omotoyinbo, director of Pharmaceutical Science, Federal Medical Centre, Owo, Ondo State; Pharm A. L. Akinbile, chairman, PSN, Osun State; Prof Adio Ogunbona; Prof Omolara Orafidiya; Prof Mrs.Ajarat Ibrahim, among others.
While delivering his speech, the vice-chancellor, Prof Bamitale Omole, disclosed that he was delighted that the programme came at a time when the institution and the faculty are still celebrating 50th year anniversary. “In the first instance, I am happy because it is the 50th anniversary of starting pharmacy graduate programme in the institution and I am also very happy to be identified with you people because you belong to a profession that is very important, because they are life savers. Without pharmacists, the whole world would have been upside down and a lot of people would have died of treatable sicknesses.”
He therefore urged the graduating students to always strive to live beyond mediocrity in their day to day activities and trust their instincts, when facing challenges. He also advised that they should continuously strive to work hard, as the scope of pharmacy profession has changed from what it used to be to an advanced level, hence the need for them to continuously learn and upgrade themselves, so as to give the best service in their field.
“I urge you to be compassionate at all time and also listen to people’s needs and concerns. As you become members of a distinguished profession like pharmacy, I urge you to learn more on how to improve parental care. Aim very high; after all, you graduated from the premier school of pharmacy in the country. Feel compelled to lead in your chosen profession. As you are inducted today, OAU is ranked among the ten best universities in Africa and presently, the number one in Nigeria, and we are ready to sustain this development.”
Continuing, he said, “We have quite a lot of challenges, especially in the aspect of funding. We need funds for research and infrastructural development, so we solicit for financial assistance from our alumni present. Meanwhile, the new pharmacy building would be handed over to the faculty in the next six months and contracts for the roofing of the old faculty building and purchase of a thirty-seater bus for the faculty has been awarded. This shows how much we value pharmacy profession in OAU, and we hope to do more.”
In his goodwill message to the inductees, Pharm. (Sir) Ifeanyi Atueyi appreciated the institution for extending invitation to him to witness such an occasion and to visit his alma mater once again, which according to him, makes him look younger. “Pharmacy is not easy and this is evident in the fact that it is not all that start that finish. Let me state that my experience is unique. No two persons are identical and so their experiences will not be expected to be the same. Our destinies are different; therefore, our routes in life are also different.
“This is my advice to you, before you engage in the practice of different aspects of the pharmacy profession, when you do what you love to do, money will definitely follow you. I also urge you to work in the area of your strength or competence, and as well aim at being and doing your best in all you do. It is also important for you to embrace integrity and honesty, which can move you faster than connections, influence and intelligence, and as well focus and concentrate on what you love to do.
“It is also important to demonstrate diligence in your work and also persevere, especially when facing with oppositions or difficulties. Your initial work may not be what God wants you to be doing. If so, you will not truly prosper. You may have to change jobs, when necessary, until you are in the area of your calling; endeavour to ask God for direction. It is also advisable that you maintain eating and drinking. Cut down your consumption of salt, sugar and products made with white flour, junk food and fats. These have been implicated in degenerative diseases like hypertension, diabetes, heart diseases, kidney diseases, cancer, etc which manifest towards old age. Finally, you shouldn’t make the mistake of leaving God out of your life or business. All your intelligence, money and accomplishments amount to nothing, without God’s blessing.”
Dr Lolu Ojo, in his keynote address titled “Professional Character, Relevance and Integrity” defined a professional as the one who willingly adopts and consistently applies the knowledge, skills, and values of a chosen profession; while he defined character as the combination of qualities or features that distinguish moral or ethical strength, capacity, position or status; also adding that it is a characteristic property that defines the apparent individual nature of something.
He explained that there is no reason why pharmacists should be inferior to other healthcare practitioners, especially doctors; adding that pharmacy is a precision science and any mistake from a pharmacist could lead to the death of so many people at a time. He also added that without pharmacy, healthcare has no substance and credibility.
He however lamented the drop in the education standard and low quality of university graduates. “When we were in school, they made us believe that, as pharmacy students, we have no time for social activities, and we adhered strictly to that; but the question begging for an answer is: what is the quality of the university graduates that we turn out today? Under what environment is the teaching taking place? What tools are we using to teach? How is the knowledge impacted and what do we teach?”
Speaking further, Lolu Ojo, who was one-time president of the Pharmaceutical Association of Nigerian Students (PANS), OAU, chapter during his university days, while congratulating the graduating students, also advised them that success in life is not about fame or acclaim, but a venture tried, a challenge met, and a future that they embrace, which is successful only if it makes the world a better place to live in.
“To the new pharmacists, these are the few success tips that I have for you: If you do not go after what you want or desire, you will never have it. If you do not ask, the answer will always sound like a no. If you do not step forward, you will always be in the same place. If you remain in the same place, you will never see what lies ahead of you. And if you do not know what lies ahead, you will never aspire.”
Earlier in her remarks, Pharm. (Mrs) G.O Abumere, the acting registrar, Pharmacists Council of Nigeria (PCN), disclosed to the graduands that the attainment of a university degree in pharmacy by a student is the beginning of a great and bright future, as they would still have to undertake twelve months internship training, to expose them to practical applications of the theories they were taught and now equipped with. She added that they would now be provisionally registered by the Pharmacists Council of Nigeria, the agency of the Federal Republic of Nigeria, charged with the responsibility of regulating the training and practice of the pharmacy profession, so as to allow them practise.
She noted that the production of additional ninety-eight pharmacy graduates from the institution would again help to address the paucity of pharmacists in the healthcare delivery system of the country. “This number of pharmacists would definitely increase the circle of influence of the pharmacy profession. It is also hoped that these young graduates will go out there to halt the declining trend in the health indices of our dear country, Nigeria. I enjoin you to be good team players with other healthcare professionals, in the best interest of the patients and the society at large.
“I wish to bring to your notice that pharmacists have the obligation in ensuring the rational use of medicine and health commodities, helping patients achieve and maintain good health by optimising prescribed medications. The increasing availability of medicine and their de-classification from Prescription Only Medicine (POM) to over the Counter (OTCs) medicines bring to the fore the need to monitor, not only the efficacy of medicines, but their safety as well. This can be done by no other than the pharmacy professional. The work of the pharmacist includes but is not limited to: dispensing of medicines, patient counselling, education and information of patients, adviser to the medical practitioners, promoting rational and safe use of medicine, detection of known and unknown adverse drug reactions (ADRs), identification of predisposing risk factors to use of medicines, pharmacovigilance, molecular synthesis and development, drug discovery and research.”
While lauding the institution’s efforts so far, as the premier school of pharmacy, Pharm. Abumere further urged the graduands to set good examples of moral behaviour in their profession, home and social life, and as well discharge their jobs with sincerity and with all their hearts, adding that the code of ethics is indispensable for the practice of the pharmacy profession.
Is the provider reimbursement mechanism under the NHIS adequate? By Dr. Chidi Ukandu
Introduction
The launching of the NHIS in 2005 heralded a change in the method providers are reimbursed in Nigeria. Prior to this time, providers were mainly reimbursed on a fee-for-service basis and salaries.
The NHIS employs capitation, fee-for-service and per diem as the major methods for reimbursing health care providers. The new reimbursement method has been raising a lot of furore, since its introduction. Providers (hospitals and clinics) with small numbers of lives have often complained that the capitation fee is too small, whilst other providers such as pharmacists, and laboratory scientists, insist that they should be capitated directly, instead of receiving payments from hospital and clinics (for primary care services).
This article examines various methods for reimbursing health care providers and recommends reforms, if necessary (in the context of the advantages and disadvantages of alternative methods of doctor’s reimbursement).
To arrive at conclusions, firstly, an overview of payment systems is carried out, the predicted impact of the various systems on quality, quantity and efficiency of healthcare services is enunciated, and suggestions are made regarding possible reimbursement systems.
Overview of payment systems
There are seven main ways of paying providers: Fee-for-service (FFS), Salaries, Capitation, Daily Payment or Per Diem (for hospital stay), Case Payment (per visit or admissions), Budget, and Bonus (performance based) payment.
The FFS System
This involves the remuneration of doctors per unit of service rendered. It rewards doctors according to the amount of work carried out. It is commonly used in Belgium, France, Germany, U.S.A. and Canada.
Advantages
- Enhancement of Productivity or Internal Efficiency
- Promotion of cost-effectiveness
Disadvantages
- Provision of unnecessary services (particularly when the workload is low, treatment options are ambiguous, and the fees are set at a profitable level)
- Reduction in quality of health care services
- Relatively high cost of administration
Capitation
This is a method of paying health care providers or insurers in which a fixed amount is paid per enrollee to cover a defined set of services over a specified period, regardless of actual services provided. Capitation payment is used in Denmark, Italy, the Netherlands, United Kingdom, Costa Rica, Indonesia, and in HMOs in the United States.
Advantages
- Reduction in health care costs
- Incentive to promote use of preventive services
- Lower administrative costs
Disadvantages
- Risk selection
- Reduction in quality of care
Salary
Under this system, the physician is paid for units of time. Remuneration is independent of the volume of services and independent of the number of patients. The salary payment to doctors is common in planned health care systems. For example, all hospital-based doctors in China and the United Kingdom are salaried. Doctors who take care of patients in outpatient health centers are often salaried in Finland, Greece, India, Indonesia, Israel, Portugal, Spain, Sweden, the former Soviet republics, Turkey, and many countries in Latin America.
Advantages
- No incentive for over or under provision of services.
- Makes health care planning easier. This is because the doctor’s salary is known in advance.
- Lower monitoring and administrative cost.
Disadvantages
- Low incentive for productivity and cost effective care
- Poor morale
- Low quality care
Despite its many disadvantages, the salary payment is still the most popular payment method around the world.
Budget
The budget is a prospective payment method in which health care providers are paid an amount per given period (usually a year) for specified service provision responsibilities. It is presently used in Germany, U.K., China, Hungary, Israel and Canada, and is increasingly becoming popular. Budgets vary in their structure and implementation modalities amongst various countries.
Advantages
- Makes cost of health care predictable
- Increases internal efficiency
Disadvantage
- Reduces quality of care due to transfer of all risks to providers
Bonus
The bonus is a payment that awards the payee extra money for achievement in association with established indicators of objectives. Various types of bonus systems exist in U.K., U.S.A., Indonesia, Canada and China. Although bonus systems are becoming increasingly popular, few studies in the health sector have analyzed the theoretical and practical effectiveness of the system.
Implications
From the above, it is clear that Provider Payment systems have their advantages and disadvantages. The choice of the ideal payment method for any health care system will depend on the historical, socio-cultural, economic and healthcare structure within which they are applied.
Conclusion
Incentives through provider payment systems influence provider behaviour and ultimately healthcare outcomes. The current provider reimbursement systems adopted by the NHIS appears adequate.
But it may be necessary to introduce some minor reforms, such as setting a minimum enrolee panel size, where capitation payment will commence for some providers. For example, providers with a panel size of 49 and below may be reimbursed on fee-for-service basis only and capitation introduced, when the enrolee panel rises to 50 and above. In addition, the bonus system may need to be added and tied to providers meeting health prevention objectives such as compulsory annual physicals for all enrolees.
FACULTY OF PHARMACY OBAFEMI AWOLOWO UNIVERSITY, ILE- IFE INDUCTION CEREMONY, 4TH APRIL, 2013. Comments by Pharm. Ifeanyi Atueyi, KSC, FPSN, FPCPharm.
I really do appreciate your invitation to this induction ceremony. It is an opportunity to visit my alma mater once again.
May I congratulate the graduands and their teachers; you have all done well. As graduands, you now have the freedom to embark on a new phase of life for which you’ve been adequately prepared.
I know you would like me to share some thoughts and experiences with you on this occasion. Let me state that my experience is unique. No two persons are identical and so their experiences will not be expected to be the same.
Our destinies are different; therefore, our routes in life are also different.
My Uncle’s counsel
My uncle had groomed me for Medicine but I preferred Pharmacy. I quote here an extract from his letter to me dated March 3, 1961, before I entered this university in September of the same year.
‘… What I would have advised is Medicine, as first choice. But if you definitely dislike it … Many young people, in choosing a profession, look for that which brings most wealth or the highest social status, and they usually imagine that Medicine gives both. I hope you are aware that that is not my aim in recommending Medicine. As a matter of fact, I would strongly advise you not to place material wealth and social pomp in the forefront. Rather, you should pray to God to find you a profession in which you will be a good Christian and, if possible, one that you will enjoy, not for the money or position it brings but simply for its own sake…’ (Emphasis mine).
After 52 years of my uncle’s counsel and 49 years of my practice as a pharmacist, I wish to pass on my own advice to you before you engage in the practice of different aspects of the Pharmacy profession.
- Do what you love to do. Do not look for where you will make more money. Look for what you will enjoy doing. Money will definitely follow you.
- Work in the area of your strength or competence. This is where your talents, gifts, skills and abilities can be fully utilised.
- Aim at being and doing your best in all you do. Cultivate the spirit of excellence. Aim at winning a prize, even if it is imaginary. It could be real. Realise that you are working for God and He demands high standards of performance.
- Integrity/Honesty: This can move you faster in life than your connections, influence and intelligence. Let your yes be yes and your no be no. Shun cheating and stealing. They will destroy your character and reputation.
- Focus and Concentrate: Nobody is created to be an expert in everything. There are other people to handle other things. Therefore, focus and concentrate on what you love to do as your major. Any other thing will be ancillary.
- Diligence: Demonstrate diligence in your work. Work hard but also know your limits. Slack hand leads to poverty.
- Perseverance: Many ventures fail because the owners lack the spirit of perseverance. Don’t give up at the slightest opposition or difficulty. Persevere.
- Your initial work may not be what God wants you to be doing. If so, you will not truly prosper. You may have to change jobs (when necessary) until you are in the area of your calling. This is where you have fulfilment, peace of mind and success. Ask God for direction.
- Maintain discipline in eating and drinking. I believe that cigarettes and strong alcohol are not for you. While still young, cut down your consumption of salt, sugar and products made with white flour, junk food and fats. These have been implicated in degenerative diseases like hypertension, diabetes, heart disease, kidney disease, arthritis, diabetes, cancer etc which manifest towards old age. Consume fresh fruits and vegetables which can keep away various diseases including cancer.
- Depend on God: Don’t make the mistake of leaving God out of your life or business. Make God your priority always. All your intelligence, money and accomplishments amount to nothing without God’s blessing.
- Thanks.
De-worm the children, De-worm the nation (By Adebayo Oladejo)
According to the World Health Organisation, nearly 2 billion people worldwide are infected with soil-transmitted helminthes (intestinal worms) or water-borne trematode worms called schistosomes. Many of those affected by worms live in low-income countries and do not have access to clean water and functional sanitation systems. Worm infections, while not immediately life-threatening, can have a significant negative impact on a child’s cognitive ability and general health. For example, children who have worms are more likely to become seriously ill and less likely to attend school on a regular basis. Worms also present a barrier to increased economic development since children who have worms are less likely to be productive, as adults.
A number of prominent health organisations and experts have promoted the deworming of children in the developing world as a potentially effective public health and development strategy. Because of the relatively low cost of intervention, deworming has attracted the attention of public health officials, development experts, and others concerned with global health, with early studies suggesting positive effects.
Helminths or worm infestations refer to worms that live as parasites in the human body and are fundamental cause of disease associated with health and nutrition problems beyond gastrointestinal tract disturbances. Globally, over 3.5 billion people are infected with intestinal worms, of which 1.47billion are with roundworm, 1.3 billion people with hookworm and 1.05 billion with whipworm. School children aged 5 – 15 years suffer the highest infection rate and worm burden that attributes to poor sanitation and hygiene.
According to Pharm. Adeshina Bashir, head, sales and marketing, Shalina Healthcare, worms are very dangerous for children because its manifestation and symptoms often takes time before it become evident. Bashir further advised that every child must be dewormed at least once in every six months as worms consume nutrients from children they infect, thus retarding their physical development.
“Worm affects children basically the normal way they live their lives. Children, especially those from poor background likes playing on the ground, eating without washing and eating of uncooked food and these are the avenue through which they get infected by worms. Meanwhile, worm infection is totally different from other diseases like malaria and others because it is basically asymptomatic.”
Bashir however advised that, people should not only look at de–worming exercise from the aspect of de-worming once in six months alone, but rather find ways to prevent it as well. “To do these, parents should always ensure that their children eat well cooked food, they don’t walk about bare footed and they wash their hands whenever they want to eat.
Also speaking in the same vein, Pharm.PemiOladipupo, the Association of Community Pharmacists of Nigeria (ACPN), Lagos State chapter’s coordinator for Ketu/Ojota/Ogudu/Magodo zone disclosed that one of the advantages of school based de worming exercise for primary school children is to enable those who do not have access to good health care and proper sanitation to benefit from what the children of the rich are enjoying.
According to him, it has been discovered that majority of children who attend public schools and few private schools do not have access to proper healthcare. “In accordance with UNICEF and WHO standard, children and even adults should be de-wormed once in every six months, but due to poverty and other limitations, you would discover that majority of those children may not be de-wormed even once in three years.”
“De-worming is very important, especially at the early years of pupils. If there is worm in their system, it can lead to their immune system being reduced, infection can also come in, such a pupil would also experience malnutrition, it destroy tissues and organs, causeabdominal pain, diarrhoea, intestinal obstruction, anaemia, ulcers and other health problems. All ofthese consequences of infection can slow cognitive development and thus impair learning.
He also added that de-wormingschool children by anthelmintic drug treatment is a curative approach for expelling the heavy wormload. However, drug therapy alone is only a short-term measure of reducing worm infection and reinfectionis frequent. Control measures through improved sanitation, hygiene and de-worming areneeded to prevent infection and re-infection.
Speaking further on the dangers inherent in not de-worming children, he disclosed that there are a number of measures being taken to prevent infections caused due to the human parasites viz., hookworm, pinworm, roundworm, tapeworm and whipworm. He added that worm infestations often cause serious health problems and impact a child’s ability to attend and perform well in school.
Meanwhile, according to UNICEF report, researches have shown that regular de-worming can substantially increase school attendance and significantly improve a child’s ability to learn in school. Eventually the growth rate and weight gain of children who are regularly de-wormed is higher than those who aren’t. Hence regular de-worming is the best solution for many of the childhood illnesses.
The report further revealed that in most cases, de-worming once every six months is sufficient for children and adult. But, if one suspect that a child is getting worms more frequently, de-worming such a child or the whole family more frequently as deemed appropriate by one physician may be necessary. Except tapeworms (as in the case of pinworm or whipworm infection), a second dose may be necessary after two weeks or 73-75 days after the first dose to break the life cycle/to kill the migrating larval forms of these parasites. In any case, de-worming the whole family twice a year is important.
However in Nigeria, 45 percents of school-age children, totalling nearly 12 million, are estimated to be infected with parasitic worms. Nigeria has an integrated Neglected Tropical Disease (NTD) control policy and plan, a school health policy and school feeding guidelines that all include school-based deworming, and within these frameworks, the federal ministries of health and education have all agreed to work in collaboration specifically on school-based deworming.
In respect to this, in 2011, Ogun State was identified by the Federal Ministries as an area of very high prevalence where pills were available and the State Government would benefit from a comprehensive technical assistance package to enable them to act on the federal policies related to school-based deworming. In response, a group called Deworm the World (DTW) assisted with high level advocacy within the State, which led to the convening of a school-based deworming working group. This group, in close partnership with DTW developed a program plan, targeting strategy and budget.
The State Government was then able to leverage funding for a pilot program that reached three Local Government Areas, trained over 500 teachers, community workers and health workers, and targeted over 100,000 children for treatment for STH and schistosomiasis. The pilot was carried out with financial support from UNICEF and was collaboration between State and Federal Ministries of Education, State and Federal Ministries of Health, the State Universal Basic Education Board, and the Rural Water and Sanitation Agency. While, DtW provided technical assistance and catalytic funding throughout, helping to lead the master training and supporting key components of the training and pill distribution cascade.
Also in November last year, over 23,025 million tablets of Praziquantel were donated through World Health Organization (WHO) by Merck to support the scale-up of treatment of Schistosomiasis, a widespread Neglected Tropical Diseases (NTD). This was acknowledged at a ceremony in Abuja on 8th, November 2012 to highlight the collaborative efforts of Merck, the government of Nigeria and the WHO in the control of schistosomiasis in Nigeria. Schistosomiasis is a worm-like disease stunts growth and cognitive development that causes anaemia, and in pregnant women, and can lead to an increased risk of delivering underweight babies. In Nigeria, more than 30 million people, mainly children, were said to be at risk of schistosomiasis.
Speaking at the event, the Officer in Charge of the WHO Country Office in Nigeria, Dr Alex Gasasira said, the life-saving drugs will be used to treat school-aged children and adults who are most at risk, such as those in endemic areas, and with occupations involving contact with infested water – such as fishermen, farmers, irrigation workers – and women whose domestic tasks bring them into contact with infested water. He added that the treatment will also be complemented with health education. According to WHO, the therapy is considered the most effective intervention in the fight against the parasitic worm disease.
The Commissioner of Health in Ogun State, Dr.Olaokun Soyinka, last year at a deworming exercise programme in the state noted that the most disadvantaged children, such as girls and the poor, often suffer most from ill health and malnutrition, and gain the most benefit from deworming. “Regular desparasitation (deworming) will help children avoid the worst effects of infection, especially where there is no improvement in sanitation; with the overall effects on physical growth, cognitive performance, and improved school attendance,” Soyinka said in a statement signed by the Information Officer in the State Ministry of Health, Miss SeunOyelade.
It is therefore suffice to say that the benefits of deworming the children are immediate and enduring. It has been proven to reduce school absenteeism by 25 per cent, and with the low cost of treatment, regular deworming of children can also prevent the parents from spending unnecessarily on the health and wellbeing of their children.
Also, regular deworming of children can also leads to higher income and literacy as these children grow to adults. Children regularly dewormed are shown to earn over 20 per cents more and work 12 per cent more hours as adults, while those who remain persistently infected are 13 per cent less likely to be literate.
The effects of deworming the children are not limited to just those children who receive treatment. It also positively impacts their siblings and other children who live nearby. Children who were less than one year old at the time of being dewormed in their communities are shown to have large cognitive improvements equivalent to half a year of schooling.
Regular deworming also contributes to good health and nutrition for school-age children, which in turn leads to increased enrolment and attendance, reduced class repetition, and increased educational attainment. It also leads to greater earnings and workforce participation when these children grow to be adults. The most disadvantaged children often suffer most from poor health and malnutrition, and gain the most benefit from deworming.
Education crucial in diabetics prevention, treatment – Dr. Solana-Sodeinde
The best way to enhance the prevention and treatment of diabetes in Nigeria is to properly educate the care givers and patients on the symptoms, risk factors and diet issues as it relates to the health condition, Dr. Diana Solana-Sodeinde, has said.
Dr. Solana-Sodeinde, a regulatory management officer at the Food Drug Agency (FDA) Office of Generic Drugs spoke with Pharmanews in an exclusive interview during the 85th Annual National Conference of the PSN, held in Abeokuta, Ogun State, last November.
Solana-Sodeine, a member of the Nigerian Association of Pharmacists and Pharmaceutical Scientists in The Americas (NAPPSA) who presented a paper on the topic: “Living sweet with diabetes – the role of Nigerian Pharmacists in diabetes management” at the conference said that proper education is crucial to diabetes control and management.
“People need to know how to take menu that are low in calorie and less in carbohydrates. People also need to know the health benefits of consumption of less alcohol, quitting smoking and doing regular exercises, she said.
She stressed that proper education is therefore crucial to enhance lifestyle medication that will ensure that Nigerians eat the right diet and do regular exercise.
Dr. Solana-Sodeinde lamented that Nigeria currently have about 3 million people living with diabetes, which makes the country the most populous African country with diabetes, adding that the WHO has projected that by 2030, the figure will increase to four million, three hundred thousand people. These figures, she said are very high.
She urged the government to get the mass media involved in educating Nigerians on this medical disorder. “Just like it is being done for HIV/AIDS, people need to be informed and educated about diabetes and the government should do more an enlightenment,” she said.
She said that NAPPSA is desirous of doing more to help improve health care in Nigeria, adding that the association will continue to help in any way possible to curtail the spread of diabetes and other non-communicable disease and even communicable diseases like HIV/AIDS, malaria and TB. “We will try and help our country,” she said.
Human Resource Management, our major challenge in community pharmacy –Pharm Afolabi
Pharm. Adetutu Afolabi, the managing director, Wellness Pharmacy and the financial secretary, Association of Community Pharmacists of Nigeria (ACPN), Ketu/Ojota/Magodo/Ogudu/Shangisha Zone is a reporter’s delight, any day. However, fixing an appointment with her is very difficult. She has such a busy schedule that one wonders how she copes with other things, aside from professional calls. In an interview with Pharmanews in her office at Ketu Alapere, Lagos, Pharm Afolabi spoke on some of the major challenges facing community pharmacists in Nigeria and equally addressed the challenges facing the practice as a whole.
Below is the excerpt:
Can you tell us what led to the establishment of Wellness Pharmacy?
We established Wellness Pharmacy because, aside being a pharmacist, there was a need to be available for our kids. Glaxo Smithkline was my former employer and my husband then was a staff member of Nestle Nigeria. There was a year we had to attend a sales conference at the same time. Meanwhile, we had a baby of about four to five months old and there was no one to leave the baby with.We had to find somewhere eventually to take the baby to. When we came back, we thought about it and concluded that we owe our children our time, so we thought about starting a business. That was how Wellness Pharmacy was established in 2007. But it became fully operational in 2008, when I resigned fully to manage the business.
Do you have so much money to start this business?
Except someone is giving you a lot of money to start your business, most of the time, what you have is never enough, and you just need to move on, follow your dream. We paid the rent in instalments, borrowed money from family and friends, collected stock from colleagues and wholesalers, paid the man that made the shelves in instalments. We are happy we had the guts to start and we have been able to add value to peoples’ lives.
Tell us some of the challenges you have faced, as a community pharmacist?
One of the challenges that amazed me so much in Nigeria is that we have lost our moral value system. People come to your outlet to make dirty deals, to steal and to do all sorts of illegal things. You keep changing staff, not only because they are lazy or rude to your customers, but because most of them steal. In an outlet, where you have four to five staff, they could conspire to steal your money or the stock. Other colleagues could conspire with your staff to sell their products. Sometimes, they collect phone numbers of your customers to service them outside your pharmacy. So, one of my major challenges, as an employer of labour, is lack of human resources that are dedicated, honest and that have integrity. Gone are the days when females are preferred over the males because they don’t steal, but now everything has changed. Another major challenge is that we have some people, who registered as wholesalers and who are not supposed to sell to individuals, irrespective of the quantity. You would realise that an average person would rather prefer to patronise them because they sell at a very low price. Some would even come to you for consultation and still go back to those places to buy, so it is worrisome. But we thank God that those who value our products and services,because they know that they always get value for their money, do patronise us and we have been moving from strength to strength.
How lucrative is it being a community pharmacist?
Some people come in to community pharmacy practice and they get a shocker of their lives. However, if you are doing a business that affords you opportunities to live your dream, enjoy the basic things of lives and be a blessing to others, such a business is definitely lucrative. In community pharmacy practice, your needs can be met and the satisfaction you get saving lives of others is significant. What you want to achieve before you start your business is crucial.
How many outlets do you have now?
We have four outlets across the state and we are becoming a household name in the state. The most important thing I enjoy most in this community practice is service to humanity.
How would you assess pharmacy practice in Nigeria?
I will say pharmacy practice in Nigeria is still developing. We are not doing enough, in terms of manufacturing and effective distribution of pharmaceutical products. We still have a lot we are battling with. I wonder why we are still unable to curtail the activities of the charlatans and the drug fakers. Our school system too is another major factor; we have so many pharmacy graduates who don’t know the intricacies of pharmacy practice. They do a lot of cramming while in school and when they graduate, they find it difficult to answer basic pharmacological questions.
How do you see pharmacy profession today, compared to when you started?
I will say we have only recorded a little improvement. I discovered that anytime issues concerning pharmacy are being discussed, those issues would still be those that have been discussed about eleven years ago. It is disheartening that those eleven years after I left pharmacy school, we still could not proffer solution to those issues. I am talking about issues like wholesalers and patent medicine dealer activities not being regulated, drug markets that are fake and substandard drugs are being sold. They are the same issues over and over and we are unable to find solutions to them.
Invest in the future, defeat malaria
Malaria is caused by parasites from the genus Plasmodium, which are spread to people by infected mosquitoes. There are five species of Plasmodium that can infect humans.
Statistics show that there are 250 million to 500 million cases of malaria each year in the world, causing up to 1 million deaths. Deaths are more common in children.
Although North America, Western Europe, and Russia are free of malaria, transmission still occurs in many other tropical and subtropical countries of the world. Disease rates are highest in sub-Saharan Africa.
The hallmark of malaria is fever. Initially, symptoms may mimic the flu. Fever may be accompanied by shaking chills and muscle aches. Anemia is common.
Severe cases may cause organ failure or death.
Causes of Malaria
Malaria is caused by protozoan of the genus Plasmodium. There are several stages in the life cycle of Plasmodium, including sporozoites, merozoites, and gametocytes. Sporozoites are the form that is injected by the mosquito into humans. Infection begins with a bite from an infected mosquito. After being injected into the human host by the mosquito, the parasite travels into the bloodstream and eventually makes its way to the liver, where the parasite begins to reproduce and develop into merozoites. The merozoites leave the liver and enter red blood cells to reproduce. Soon, new parasites burst out in search of new red blood cells to infect.
Sometimes, the reproducing Plasmodia will create a form known as a gametocyte in the human bloodstream, which is infectious to mosquitoes. If a mosquito takes a blood meal when gametocytes are present, the parasite begins to reproduce in the insect and create sporozite forms that are infectious to people, completing the life cycle.
There are five species of Plasmodium that infect humans:
P. vivax: Though it is most common in India and Central and South America, it’s found worldwide. Infections can sometimes lead to life-threatening rupture of the spleen. This type of malaria can hide in the liver and return later to cause a relapse years after the first infection. Special medications are used to eradicate P. vivax from the liver.
P. ovale: It is rarely found outside Africa. Symptoms are similar to those of P. vivax. Like P. vivax, P. ovale can hide in the liver for years before bursting out again to cause symptoms.
P. malariae: It’s found worldwide but is less common than the other forms. This form of malaria is hard to diagnose because there are usually very few parasites in the blood. If untreated, the infection can last many years.
P. falciparum: This is the most life-threatening species of malaria. Although present throughout much of the tropical and subtropical world, it is particularly common in sub-Saharan Africa. P. falciparum is resistant to many of the older drugs used to treat or prevent malaria.
P. knowlesi: Found in Malaysia, this species can cause high levels of parasites in the blood, leading to organ failure or death.
Common symptoms of malaria
In the early stages, malaria symptoms are sometimes similar to those of many other infections caused by bacteria, viruses, or parasites.
Symptoms may include:
Fever
Chills
Headache
Sweats
Fatigue
Nausea and vomiting
Symptoms may appear in cycles and may come and go at different intensities and for different lengths of time. But, especially at the beginning of the illness, the symptoms may not follow this typical pattern.
The cyclic pattern of malaria symptoms is due to the life cycle of malaria parasites camera as they develop, reproduce, and are released from the red blood cells and liver cells in the human body. This cycle of symptoms is also one of the major indicators that you are infected with malaria.
Other common symptoms of malaria include:
Dry (nonproductive) cough
Muscle and/or back pain
Enlarged spleen
In rare cases, malaria can lead to impaired function of the brain or spinal cord, seizures, or loss of consciousness.
Infection with the P. falciparum parasite is usually more serious and may become life-threatening.
Malaria Diagnosis
Many diseases cause fever in the tropical and subtropical world, including malaria, tuberculosis, yellow fever, dengue fever, typhoid, and cholera. Each of these is managed differently. Thus it is very important to make a specific diagnosis.
Malaria is diagnosed by seeing the parasite under the microscope. Blood taken from the patient is smeared on a slide for examination. Special stains are used to help highlight the parasite. Sometimes, it is possible to identify the species of Plasmodium by the shape of the parasite, especially if gametocytes are seen. Whenever possible, smears should be reviewed by someone with expertise in the diagnosis of malaria. If the smears are negative, they can be repeated every 12 hours. Smears that are repeatedly negative suggest another diagnosis.
Two types of other tests are available for diagnosis of malaria. Rapid tests can detect proteins called antigens that are present in Plasmodium. These tests take less than 30 minutes to perform. However, the Food and Drug Administration and the Centers for Disease Control and Prevention recommend that these new tests be used in conjunction with microscopy. A second type of test that is newly available is the polymerase chain reaction (PCR), which detects malaria DNA. Because this test is not widely available, it is important not to delay treatment while waiting for results.
Malaria recurrences
Malaria caused by P. falciparum may come back (reocur) at irregular intervals for up to 2 years if treatment is not complete.
Malaria caused by P. vivax and P. ovale may reocur at irregular intervals for up to 3 to 4 years, but medicine can prevent relapses.
P. malariae can remain in the blood of an infected person for more than 30 years, usually without causing any symptoms.
Factors that increase your risk of getting malaria include:
Living or traveling in a country or region where malaria is present.
Traveling in an area where malaria is common and:
Not taking medicine to prevent malaria before, during, and after travel, or failing to take the medicine correctly.
Being outdoors, especially in rural areas, between dusk and dawn (nighttime), when the mosquitoes that transmit malaria are most active.
Not taking steps to protect yourself from mosquito bites.
Your risk of getting malaria depends on your age, history of exposure to malaria, and whether you are pregnant. Most adults who have lived in areas where malaria is present have developed partial immunity to malaria because of previous infections and so almost never develop severe disease. But young children who live in these areas and travelers to these areas are especially at risk for malaria because they have not developed this immunity.
Pregnant women are more likely than non-pregnant women to get severe malaria, because the immune system is suppressed during pregnancy.
In addition, pregnant women, young children, older adults, and people with other health problems are more likely to have serious complications if they get malaria.
Complications of malaria
Malaria is a very serious illness which can be fatal if not diagnosed and treated quickly.
The falciparum parasite causes the most severe malaria symptoms and most deaths.
Anaemia
The destruction of red blood cells by the malaria parasite can cause severe anaemia.
Anaemia is a condition where the red blood cells are unable to carry enough oxygen to the body’s muscles and organs, leaving you feeling drowsy, weak and faint.
Cerebral malaria
Some rare cases of malaria can affect the brain. This is known as cerebral malaria and it can cause your brain to swell, sometimes leading to permanent brain damage. It can also cause seizures (fits) or coma (a state of unconsciousness).
Other complications
Other complications that can arise due to severe malaria include:
- breathing problems, such as fluid in your lungs
- liver failure and jaundice (yellowing of the skin and whites of the eyes)
- shock (a sudden drop in blood flow)
- spontaneous bleeding
- abnormally low blood sugar
- kidney failure
- swelling and rupturing of the spleen
- dehydration (a lack of water in the body)
As complications of severe malaria can occur within hours or days of the first symptoms, it is important to seek urgent medical help as soon as possible.
The effects of malaria are usually more severe in pregnant women, babies, young children and the elderly.
Malaria in Pregnancy
Malaria in pregnancy is a major cause of maternal morbidity worldwide and leads to poor birth outcomes. Pregnant women are more prone to complications of malaria infection than nongravid women. Treatment involves antimalarial drugs and supportive measures. Prevention involves chemoprophylaxis and mosquito avoidance.
Record has it that each year, 50 million women living in malaria-endemic areas become pregnant; one-half of these women live in Africa. It is estimated that 10,000 women and 200,000 infants die as a result of malaria infection during pregnancy; severe maternal anemia, prematurity, and low birth weight contribute to more than half of these deaths.
Malaria in pregnancy increases the risk of:
- maternal anaemia
- stillbirth
- spontaneous abortion
- low birth weight
- neonatal death
WHO recommends a package of interventions for the prevention and control of malaria during pregnancy.
- The use of insecticide treated nets (ITNs) to prevent infection;
- Intermittent Preventive Treatment (IPT) to prevent asymptomatic infections among pregnant women living in areas of moderate or high transmission of P. falciparum;
- Effective case management for malaria illness and anaemia.
TREATMENT
Malaria in pregnancy is dangerous for both the mother and the fetus. Therefore, pregnant women with malaria must be treated promptly with an effective antimalarial agent to clear parasites rapidly. Safety and efficacy data to guide management are limited . In general, the newer the drug, the more likely it is to be effective (in part because there has been insufficient time for resistance to emerge), but fewer data will be available on safety in pregnancy. Clinicians therefore have to make treatment decisions based on the clinical severity of infection, epidemiologic resistance patterns, and available data regarding safety of the drug or class of drug in pregnancy.
P. falciparum — Pregnant women with severe P. falciparum malaria should receive parenteral therapy; the intravenous route is preferred over the intramuscular route. Options for therapy include artesunate or quinine (plus clindamycin) . In nonpregnant adults and children with severe malaria, a mortality benefit has been demonstrated with artesunate over quinine. No trials have compared the efficacy of these agents in pregnant women.
Malaria in infants
Of the estimated one million annual deaths from malaria, approximately 80% occur in young African children.
Infants are vulnerable to malaria from approximately 3 months of age, when immunity acquired from the mother starts to wane.
In areas of intense malaria transmission, most cases of severe malarial anaemia, blood transfusions, and deaths occur in infants and young children. Severe anaemia probably accounts for more than half of all childhood deaths from malaria in Africa, with case fatality rates in hospital of between 8-18%.
Prevention is clearly of critical importance, and the targeted delivery of interventions to prevent malaria and anaemia in high-risk groups (pregnant women, infants and young children) would be an appropriate use of limited financial and human resources.
Malaria Prevention
To prevent malaria, there is the need to avoid mosquito bites.
Guidelines to prevent mosquito bites include:
Stay inside when it is dark outside, preferably in a screened or air-conditioned room.
Wear protective clothing (long pants and long-sleeved shirts).
Use insect repellent with DEET (N,N diethylmetatoluamide). The repellent is available in varying strengths up to 100%. In young children, use a preparation containing less than 24% strength, because too much of the chemical can be absorbed through the skin.
Use bed nets (mosquito netting) sprayed with or soaked in an insecticide such as permethrin or deltamethrin.
Use flying-insect spray indoors around sleeping areas.
Avoid areas where malaria and mosquitoes are present if you are at higher risk (for example, if you are pregnant, very young, or very old).
Other steps that may be helpful in reducing the risk of malaria include using air conditioning and electric fans, wearing protective clothing, using aerosol insecticides in your house, and taking certain antimalarial medicines.
Compiled by Temitope Obayendo with additional materials from emedicinehealth; bodyandhealth.canada and www.who.int
Improving primary health care centres in Nigeria
The Minister of State for Health, Dr Mohammed Pate, recently announced that the running of Primary Health Centres in Nigeria will soon become the responsibility of the State Governments.
The minister, who made the announcement during a one-day sensitisation meeting organised for commissioners of health and directors of Primary Health Centre (PHC) on Subsidy Re-investment and Empowerment Programme (SURE-P) and maternal and child held in Abuja, said that Primary Health Centres, which have been under the care of local government authorities have not been doing well, hence, the need to leave them under the care of state government.
To say that the primary health centres are not doing well is to say the obvious. In some states, they (PHC) only exist in name because nobody visits the centres for treatment.
Granted that the local government administration is the closest to the people and having the PHC managed by the local government should transform them to properly monitored, coordinated and efficient service delivery centres.The fact that the local government is the weakest tier of government with limited resources makes it incapable of managing the PHC.
The attendant result of this is that, arguably the most important level of care, the first point of call for majority of Nigerians that are ill or/and in need of medical intervention cannot provide the expected succour.
Consequently, most Nigerians ignore the primary health care facilities. While some people,especially at the grassroots, resort to consulting quacks, majority of Nigerians go directly to the secondary or tertiary institutions for their health challenges, hencemaking nonsense of the referral system. The effect of this is that the secondary and tertiary institutions are burdened by conditions that can and should be treated by the PHCs.
It must also be said that a major reason we have the unacceptably high incidence of infant and maternal morbidity and mortality is because of the poor state of the PHC. Most cases of infant/maternal health challenges get to these centres first and because of the inability of the PHC to provide immediate quality remedy and/or interventions, more complications sets in.
To improve the quality of care at the PHC, the federal government has established the National Primary Health Care Developing Agency (NPHCDA). The agency, however, has not succeeded much because it is not constitutionally empowered to implement programmes or policies at the state and local government levels. The NPHCDA requires the cooperation of state and local governments to achieve its mandate. Thus, it is our view that resolving some constitutional logjam is necessary to unleash the NPHCDA to perform and improve service delivery at the PHC.
We also agree that the local governments in Nigeria right now lack the capacity to ensure that PHCs deliver quality health care services to Nigerians and in full support of the state government taking over. However, the involvement of the state government must be to ensure that the PHCs have the necessary financial, technical and political capacity to effectively provide basic quality health care delivery expected from the level. Also, while managing the PHC, the state government must equally find a way to involve the local government, which is a very important stakeholder that the community can easily relate with. This is because with community involvement, the PHC stands a better chance of meeting the needs of the people at the grassroots.
However, beyond just transferring the management of the PHC to the state government, all tiers of government must recognise the importance of these centres and accordingly ensure they have the capacity to provide quality health care services to Nigerians.
How Medication Pollute Our Consuming Water
We count on our ingesting water to be germ free, however what about drug free? You most likely have not given it a lot thought…however new analysis is displaying our water is teeming with every kind of medication! Hint appears to be like at what that is doing to our our bodies and the setting.
Learn Extra:
“Feminized to Extinction”
http://information.sciencemag.org/sciencenow/2007/05/21-01.html
“All internationally, persons are polluting waterways with estrogen.”
“Exterior Drugs: Discarded Medication Could Contaminate 40 Million People’ Consuming Water”
http://www.scientificamerican.com/article.cfm?id=pharmaceuticals-in-the-water
“Though thousands and thousands of individuals flush unused drugs down the bathroom and discharge them in bodily waste, sewage remedy vegetation and septic methods should not required to take care of such contaminants.”
“Drugged Fish Lose Their Inhibitions, Get the Munchies”
http://information.sciencemag.org/sciencenow/2013/02/drugged-fish-lose-their-inhibiti.html?ref=hp
“Dude, take a look at these European perch.”
“Medication Are within the Water. Does It Matter?”
“Residues of contraception tablets, antidepressants, painkillers, shampoos and a bunch of different compounds are discovering their manner into the nation’s waterways, and so they have public well being and environmental officers in a regulatory quandary.”
“Flushed Medication Could Threaten Stream Ecologies”
http://www.wired.com/wiredscience/2013/04/drugs-and-streams/
“Most streams that move close to cities and cities are laced with medicine that escape from sewage remedy vegetation or pharmaceutical factories.”
“One thing within the water”
http://www.rsc.org/chemistryworld/Points/2008/September/SomethingInTheWater.asp
“Medication have been discovering their manner into our water provides for so long as they’ve been in use, so ought to we fear?”
“Intersex fish Endocrine disruption in smallmouth bass”
http://www.fws.gov/chesapeakebay/pdf/endocrine.pdf
“Intersex and irregular vitellogenin in smallmouth bass from parts of the Potomac watershed pose a menace to fish assets.”
“How one can Eliminate Unused Medicines”
http://www.fda.gov/downloads/Medication/ResourcesForYou/Customers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm107163.pdf
“Most medicine might be thrown within the family trash, however customers ought to take sure precautions earlier than tossing them out, in response to the Meals and Drug Administration (FDA).”
DNews is a present in regards to the science of on a regular basis life. We put up two new movies on daily basis of the week.
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supply
Embassy launches low sodium chloride salt, “Lo Sodum”
To ensure Nigerians continue to enjoy their favourite delicacies with enough salt taste and yet avoid harm to their hearts through ingestion of high sodium chloride present in common salt, Embassy Pharmaceutical and Chemicals Ltd, has launched a low sodium salt, Lo Sodum into the Nigerian market.
The launch of Lo Sodum salt, which has less than 50 per cent sodium chloride compared to the common salt in the Nigerian market took place at a colourful ceremony, attended by top cardiologists and other top health care practitioners. The event was held at Westown Hotel, Ikeja, Lagos, recently.
The event chaired by Prof. D. A. Oke, consultant cardiologist/CMD, Lagos State University Teaching Hospital (LASUTH), Ikeja, was also graced by the DG, NAFDAC, Dr. Paul Orhii, President of the PSN, Pharm. Olumide Akintayo; President, Nigerian Cardiac Society/Consultant Cardiologist, Prof. Solomon Danbauchi and other eminent personalities.
In his opening remarks at the occasion, the chairman, Prof. D. A. Oke, commended Embassy for introducing Lo Sodum salt. He said that with the introduction of the low sodium salt, Embassy was playing a pivotal role in helping to solve the problem of hypertension.
He said that there is sodium chloride in the staple foods aside the other processed adding that the fact that the new salt from Embassy has half sodium chloride compared to the common salt in the market makes it quite beneficial for people living with hypertension.
While making his presentation, Prof. Solomon Danbauchi, the guest speaker said that studies have shown a relationship between salt intake and blood pressure, adding that health professionals have always look for a way to ensure that people eat diet with low salt.
He noted that Low Sodum salt can thus help people with hypertension to ensure they consume low sodium chloride while still enjoying their food.
He stated that it is impossible to tell people to avoid salt consumption completely, adding that reduction in salt consumption is a easier gospel to preach.
He said that the low sodium chloride, Low Sodium can thus help both in prevention of hypertension and management of the condition.
In his presentation, Dr. C. Amadi, the keynote speaker said that man was programmed to take low sodium chloride, adding that there is a direct relationship between ingestion of sodium chloride in salt and blood pressure.
He noted that even though there is a genetic basis for salt sensitivity, studies have shown that the more salt we take, the more the blood pressure rises.
Dr. Amam C. Mbakwem, an associate professor/consultant physician and cardiologist, in her presentation, noted that hypertension remains a very high risk cardiovascular factor. She said that what perhaps should be done is to balance the sodium chloride and potassium content in salt.
The DG NAFDAC while also speaking at the event commended Embassy for introducing the low sodium salt. He said that Embassy has always been at the forefront of bringing in good products to Nigeria.
He also commended the company for bringing eminent physicians to educate guests present at the occasion on the issue of salt and health, adding that with his presence at the event, he is confirming that the product has been evaluated and approved by NAFDAC.
The PSN president, Pharm. Olumide Akintayo, while also speaking at the occasion noted that Lo Sodum salt with its low sodium chloride is good news for Nigerians.
He said that he is not surprised with the giant stride of Embassy because the company is one of the leading lights of the profession in Nigeria.
Also speaking at the event, Pharm. (Sir) Ifeanyi Atueyi, managing director of Pharmanews Limited, commended and congratulated Embassy for introducing the product, which he described as first of its kind in Nigeria and perhaps in the whole of Africa.
Pharm. (Sir) Nnamdi Obi, MD/CEO of Embassy while thanking dignitaries at the occasion for their presence and support, said that there is a nexus between what we eat and our state of health.
He said that his company decided to bring in the product, having seen the need for it in this clime.
He noted that based on the submissions of eminent health professionals at the event, it is very clear that salt is a very serious health issue.
Pharm. (Sir) Nnamdi Obi, MD/CEO, Embassy Pharm. & Chem. Ltd., speaking at the event.
Prof. Solomon Danbauchi, president, Nigerian Cardiac Society and guest speaker, speaking with journalists at the event.
PMG-MAN, APIN, others call for partnership between Nigeria and Indian pharmaceutical manufacturers
PMG-MAN, APIN, others call for partnership between Nigeria and Indian pharmaceutical manufacturers
The need for a mutually beneficial arrangement between the Nigerian Government and Indian pharmaceutical manufacturers has been voiced again by some concerned pharmaceutical bodies at the just concluded Grand Pharma Expo.
The two-day exhibition, which was organised by India’s Pharmaceutical Export Promotion Council (Pharmexcil), in conjunction with the High Commission of India, took place at Federal Palace Hotel from 7th March.
In his address, Pharm. Ade Popoola, chairman of PSN Board of Fellows (BOF), explained that the Nigerian Government can learn from the grand exhibition by doing the same in Africa and beyond.
“However, everything still boils down to funding. Therefore, I will call for a partnership of sorts between the Government of India and Nigerian pharmaceutical manufacturers. We want a situation where our graduates can be recruited and intensively trained, so that they can, in turn add, value to our economy,” he said.
Buttressing this view, Pharm. Bunmi Olaopa, chairman of Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN), reminisced that the collaboration between the Indian Government and the Nigerian Pharmaceutical sector dates back to many decades. This has been growing in leaps and bounds, since the exit of the giant multinational companies in the 1980s, he said.
“It would not be wrong to say that at least 40 per cent of the dosage formulations and active pharmaceutical ingredients (API) in Nigeria today have their origin from India,” he said.
According to Olaopa, the balance of trade in the pharma sector is overwhelmingly in favour of India.
“This is not surprising and unexpected, bearing in mind the level of development of the Indian pharmaceutical sector. Therefore, we are privy to the fact that, today, many Indian pharmaceutical companies are showing greater interest than before in establishing their presence in Nigeria,” he noted.
Dr Lolu Ojo, chairman of Association of Industrial Pharmaceutical of Nigeria (AIPN), lauded the successful launch of the expo, adding that it was a welcome development.
He however lamented that rather than promote the cause of pharma manufacturing in Nigeria, what most pharmacists have concentrated on these days is strictly pharmaceutical trading.
While lauding NAFDAC efforts so far on the war against counterfeiting, the AIPN chairman opined that the quality of people handling the pharmaceutical distribution is part of the problem of counterfeiting.
Pharm. Nnamdi Obi, chairman of the Association of Pharmaceutical Importers of Nigeria (APIN), seems to equally have the same notion.
“Most Nigerians are alive today, owing to the integrity behind Indian drugs. Imagine running on generator in your home and business for 24 hours. Tell me, what will a manufacturer produce that can give him something in return?” he queried.
A record of 62 Indian companies displayed some of the latest range of pharmaceuticals products, including bulk-drugs, formulations, biotech products as well as herbals. This is the third time Pharmexil, in association with the High Commission of India in Nigeria, will be organizing the expo.
Exercise can reduce high blood pressure, obesity – Dr Awopetu
Dr. Adeyemi Awopetu, the associate professor of physiology at the department of Human Kinetics and Health Education, University of Lagos (UNILAG), has said that people who are inactive are more susceptible to hypertension and obesity.
Awopetu, who spoke at the breakfast Wellbeing Interaction Programme held at the MUSON Centre, Lagos, recently, recommended regular exercise for everybody, especially top corporate executives and high profile civil servants, who hardly have time because of their busy schedule.
Awopetu said sedentary lifestyle or physical inactivity, which comes with occupying high office, has been confirmed to be the reason for several ailments such as high blood pressure and obesity, which constitute health hazards. He recommended what he called ‘Desk exercises’.
This, according to him, are exercises that could be done while sitting. “Desk exercise can be used for transportation purposes, while at the same time used to keep fit. Apart from that, the other form of exercise is stretching. Stretching is a natural exercise.”
Director, First Cardiology Consultant, Ikoyi, Dr Kofo Ogunyankin, who took the guests on wellbeing talk, listed a few health hazards such as tobacco intake, physical inactivity; alcohol abuse, which he added poses danger to the genetic encoded life expectancy of 125 year, as against what is obtainable in the country.
Chief Executive Officer, Corporate/Leisure, Biodun Jaji appealed to the guests to take out time to recreate.
He said: “What Nigerians do when they travel abroad is not leisure. Going to stay in a sister’s house, brother’s house; that’s not leisure. Corporate/Leisure are the people who give leisure experience, so you just need to work with us. Please take some time out to recreate. You can go on tour, cruising, safari.”
Ms Inge Cross, an international cruise consultant, CI Services Africa, representative of Royal Carribean and Celebrity Cruises for Africa, said a cruise is great way of holidaying.
She said: “It’s about relaxation and there is no better way to do this than cruising. It is ideal for family, couple, children and all ages. It’s full of great benefit. And you can cruise all year round”.
She identified misconceptions about cruising such as being stuck in one place for the duration, sea sickness, nothing to do, too expensive, dress code and too formal.
Mrs Cross gave a surprise cruising package to one of the lucky guests, Dr. Charles Akindayo.
At the event was the special guest of honour, Deputy Governor of Lagos State, Mrs Adejoke Orelope Adefulire, who was represented by Permanent Secretary, Ministry of Health, Femi Olugbile; Head of Civil Service, Lagos State, Mr. Segun Ogunlewe; permanent secretaries from Ministry of Women Affairs, and Youth and Development; Chairman, Lagos Pension Commission, Tunde Dabiri, among others.
Fish oil, aspirin are cure for arthritis, says study
Fish oil and aspirin could be the key to beating a host of devastating chronic diseases, according to new research.
Researchers from the Brigham and Women’s Hospital and Harvard Medical School in Boston found that the two work together to combat the inflammation responsible for a host of illnesses, including heart disease, cancer, arthritis and Alzheimer’s.
Both aspirin and omega-3 fatty acids from fish are known to have an anti-inflammatory effect on their own, but the research shows that, when taken together, they can control the overactive immune responses associated with long-term illnesses.
Inflammation is the body’s natural response to injury and foreign bodies.
When something harmful or irritating affects a part of the body, there is a biological response to try to remove it, and the symptoms of inflammation show that the body is trying to heal itself.
But if the person suffering has a high-fat diet, too much body fat or is a smoker, for example, they may not be a break from the irritants, so the immune system can lose control, increasing risk of disease.
Long-term, inflammation can become chronic, which can then damage heart valves and brain cells, causing strokes and promoting resistance to insulin, which leads to diabetes.
It is also associated with the development of cancer.
Aspirin is used by millions of people to keep heart attacks and strokes at bay. The drug is used to thin the blood, which reduces the risk of clots.
It works by helping to trigger the production of molecules called resolvins that are made naturally by the body from omega-3 fatty acids.
Fish oils have long been heralded for their beneficial effects on the brain, bones and heart
These resolvins ‘resolve’ the inflammation that underlies the health conditions which blight the lives of millions.
Omega-3 is found in oily fish, particularly salmon and sardines, as well as chicken, nuts, kale and spinach as well as vegetable oils.
One resolvin called D3 was found to have an especially long-lasting anti-inflammatory effect.
The researchers said: ‘In this report, we found that one resolvin, termed D3 and from omega-3 fatty acid, persists longer at sites of inflammation than either resolvin D1 or resolvin D2 in the natural resolution of inflammation in mice.
‘This finding suggests that this late resolution phase resolvin D3 might display unique properties in fighting uncontrolled inflammation.’
The researchers also confirmed that aspirin triggered the production of a longer-acting form of resolvin D3 through a different pathway.
The team were able to produce a pure form of both resolvin D3 and aspirin-triggered resolvin D3.
When administered to human cells, both of these showed highly potent anti-inflammatory actions.
The research was published in the journal Chemistry & Biology.
PASSION AND YOUR DESTINY
It is a truism that everyone created by God has a destiny. In our life’s journey there aredestinations but when we travel along the direction God has planned for us, even before we were born,our destination becomes our destiny. Lack of knowledge, indolence, wrong choices and decisions can cause us to pass through life without achieving the God-given destiny. It implies that we have not been fully utilised for mankind. Our potential has not been exploited.
Your greatest discovery is to know God’s purpose and plan for your life. Knowing your gifts and calling will keep you on the right track. This knowledge will enable you get into a career or vocation that will please God and give you satisfaction and peace of mind. Ignorance of these truths is responsible for most of the crises we experience in life –poverty, unhappiness, lack of job satisfaction, selfishness, greed, corruption, fear, lack of progress, bitterness, envy, criminal tendencies, crazy accumulation of wealth, disease, premature death and so on. These are definitely not the plans and promises for God’s children.
Jeremiah 29:11 says, “For I know the plan Ihave for you,” says the Lord. “They are plans for good and not for disaster, to give you a future and a hope.”Fulfilment of this promise, like other promises, is subject to your personal choices, decisions and will power. Promises are not imposed on anybody. You are free to accept or reject and damn the consequences.
It is God’s pleasure to have you discover your own destiny so that you can walk along it. If you actually desire to know it and ask God, He will help you. After all, the Word of God says that everyone who asks receives; everyone who seeks finds; to everyone who knocks, the door will be opened. Jeremiah 33:3 says, “Call on me, and I will answer thee, and shew thee great and mighty things, which thou knowest not.”One major clue to your destiny is the desiresof your heart.
Do you have a burning desire? Your desire is what you long for. It is where your heart is and your greatest treasure.God places desires for certain things in your heart to make you know and serve Him. When your desires are godly, you are on the right track to your destiny.“Take delight in the Lord, and he will give you your heart’s desires”(Psalm 37:4). Your divine desires are pointing towards God’s purpose for your life.
Desires are not mere fantasies or wishes. At one time or the other, some thoughts flash across your mind. You see a beautiful car and you just wish it belongs to you.Your friend receives a free ticket and hotel coupon to enjoy a vacation in Hawaii Islands and you just imagine yourself receiving such a gift, too. Your neighbour completes his residential building and invites you to the house-warming ceremony. Your own project is still on-going and you visualise your own house being completed. These are good thoughts and wishes which vanish soon after.
With desire is passion. Passion is the excitement and zeal you have for something important to you. Passion is a positive power. Parents should always watch out for passion in their children. They are good pointers to where destiny is taking them. Students that have passion for figures and numbers must be moving towards mathematics and accountancy. Some people are always ready to help others. They hate to see other people in difficulty and are always ready to give a helping hand. Such persons will perform well as social workers and nurses.
In my working life, I never experienced passion for my work until I started my own publishing business. Before then, I did a bit of selling and thereafter spent 5 years in a production department. During that period, I was not particularly satisfied with my work and did not see myself prospering in that area. Then I moved to a marketing company. Despite all the training programmes on sales and marketing which I was exposed to, I was still asking myself where I was heading to. Inside me, I knew the job was not fulfilling and I was wondering how my colleagues were enjoying their work. I thought that the reason I did not derive joy in my work was that, as the marketing manager, I did not sufficiently appreciate the principles and concepts of marketing. Therefore, in order to find pleasure in my work, I attended a 6-week marketing programme of the International Marketing Institute in Cambridge, Mass. USA, in 1978. This programmereally expanded my scope in marketing but it brought disappointment to my boss since he did not willingly approve it for me, neither did he give me any financial support. The breakdown in our relationship caused me to resign my appointment to start publishing Pharmanews in 1979. It was then that I became aware of what God planned for my life. Today,I know I am in the right direction because the passion for my work has continued to intensify.
There is no doubt thatvery many people are in the wrong jobs which cannot offer them any satisfaction. They cannot shine and excel in those jobs because their hearts are not in what they are doing. Many young graduates accept whatever jobs are available, just to be engaged. Their spirits must be witnessing to them that they are only in transit to their calling. Their present jobs are just like bus stops on their route to their destination. They must be praying for God’s plan for their lives to manifest at the appointed time. God’s willis done on earth when everyone operates at their stations.
It is a truism that everyone created by God has a destiny. In our life’s journey there aredestinations but when we travel along the direction God has planned for us, even before we were born,our destination becomes our destiny. Lack of knowledge, indolence, wrong choices and decisions can cause us to pass through life without achieving the God-given destiny. It implies that we have not been fully utilised for mankind. Our potential has not been exploited.
Your greatest discovery is to know God’s purpose and plan for your life. Knowing your gifts and calling will keep you on the right track. This knowledge will enable you get into a career or vocation that will please God and give you satisfaction and peace of mind. Ignorance of these truths is responsible for most of the crises we experience in life –poverty, unhappiness, lack of job satisfaction, selfishness, greed, corruption, fear, lack of progress, bitterness, envy, criminal tendencies, crazy accumulation of wealth, disease, premature death and so on. These are definitely not the plans and promises for God’s children.
Jeremiah 29:11 says, “For I know the plan Ihave for you,” says the Lord. “They are plans for good and not for disaster, to give you a future and a hope.”Fulfilment of this promise, like other promises, is subject to your personal choices, decisions and will power. Promises are not imposed on anybody. You are free to accept or reject and damn the consequences.
It is God’s pleasure to have you discover your own destiny so that you can walk along it. If you actually desire to know it and ask God, He will help you. After all, the Word of God says that everyone who asks receives; everyone who seeks finds; to everyone who knocks, the door will be opened. Jeremiah 33:3 says, “Call on me, and I will answer thee, and shew thee great and mighty things, which thou knowest not.”One major clue to your destiny is the desiresof your heart.
Do you have a burning desire? Your desire is what you long for. It is where your heart is and your greatest treasure.God places desires for certain things in your heart to make you know and serve Him. When your desires are godly, you are on the right track to your destiny.“Take delight in the Lord, and he will give you your heart’s desires”(Psalm 37:4). Your divine desires are pointing towards God’s purpose for your life.
Desires are not mere fantasies or wishes. At one time or the other, some thoughts flash across your mind. You see a beautiful car and you just wish it belongs to you.Your friend receives a free ticket and hotel coupon to enjoy a vacation in Hawaii Islands and you just imagine yourself receiving such a gift, too. Your neighbour completes his residential building and invites you to the house-warming ceremony. Your own project is still on-going and you visualise your own house being completed. These are good thoughts and wishes which vanish soon after.
With desire is passion. Passion is the excitement and zeal you have for something important to you. Passion is a positive power. Parents should always watch out for passion in their children. They are good pointers to where destiny is taking them. Students that have passion for figures and numbers must be moving towards mathematics and accountancy. Some people are always ready to help others. They hate to see other people in difficulty and are always ready to give a helping hand. Such persons will perform well as social workers and nurses.
In my working life, I never experienced passion for my work until I started my own publishing business. Before then, I did a bit of selling and thereafter spent 5 years in a production department. During that period, I was not particularly satisfied with my work and did not see myself prospering in that area. Then I moved to a marketing company. Despite all the training programmes on sales and marketing which I was exposed to, I was still asking myself where I was heading to. Inside me, I knew the job was not fulfilling and I was wondering how my colleagues were enjoying their work. I thought that the reason I did not derive joy in my work was that, as the marketing manager, I did not sufficiently appreciate the principles and concepts of marketing. Therefore, in order to find pleasure in my work, I attended a 6-week marketing programme of the International Marketing Institute in Cambridge, Mass. USA, in 1978. This programmereally expanded my scope in marketing but it brought disappointment to my boss since he did not willingly approve it for me, neither did he give me any financial support. The breakdown in our relationship caused me to resign my appointment to start publishing Pharmanews in 1979. It was then that I became aware of what God planned for my life. Today,I know I am in the right direction because the passion for my work has continued to intensify.
There is no doubt thatvery many people are in the wrong jobs which cannot offer them any satisfaction. They cannot shine and excel in those jobs because their hearts are not in what they are doing. Many young graduates accept whatever jobs are available, just to be engaged. Their spirits must be witnessing to them that they are only in transit to their calling. Their present jobs are just like bus stops on their route to their destination. They must be praying for God’s plan for their lives to manifest at the appointed time. God’s willis done on earth when everyone operates at their stations.
The role of ageing and Health by NMA
In the face of enormous challenges facing the health sector, the Nigeria Medical Association (NMA) recently marked ‘the Physicians’, a week when doctors appraise the medical profession and Nigeria’s health care system, among other things. The week enabled doctors in the country to offer humanitarian services and, as part of its corporate social responsibility, the association specifically charged its members to focus on strengthening health care services in medical clinics established in the various camps set up for displaced flood victims. At present, a good number of Nigerians have been rendered homeless by floods, with stories emanating from the camps that several pregnant women had delivered babies while in camp. As such, NMA deems it necessary to offer such women and other displaced persons adequate health care services.
The theme of this year’s week is: “Prescription Rights – Its Abuse and Implications for the Health of Nigerians,” while subthemes include: “Medical Tourism and Investment in Nigeria’s Healthcare System; Role of NMA and other stakeholders and Ageing and “Health – the Role of Doctors.”
While other subthemes are of paramount importance, the subtheme on ageing and health has come at an apt time, owing to the fact that elderly persons and also a larger percentage of Nigerians are being faced with high level of poverty and neglect by the government. At present, 70 per cent of Nigerians are living below the poverty line, with about 60 million unemployed persons in the country. Government at the local level, which is supposed to cater for majority of Nigerians, has collapsed and as such there are no facilities, infrastructures or social amenities to cater for rural dwellers. There is no social security system in the country, while there are no homes for the elderly in the country and pension is not being paid as and when due. This state of affairs has resulted in the untimely death of many elder citizens and, as such, the focus of the NMA on ageing and health is a welcome development.
While speaking at the flag off of the physicians’ week, the President of NMA, Dr. Osahon Enabulele, said, “It is the progressive, universal decline in functional reserve in organisms over time and that the populations worldwide are ageing, with the number of older adults expected to increase to 974 million by 2030. Currently, about 59 per cent of older adults live in the developing countries, which also have the largest absolute number and largest percentage increase of older adults.”
The global age distribution of populations is rapidly changing, due to long term declines in fertility rates and worldwide improvements in mortality rates. This demographic transition/transformation is accompanied by an epidemiological transition in which non-communicable diseases are becoming major causes of death and contributors to disease burden and disability.
In Nigeria, though the life expectancy at birth is put at 47.3 for males and 48.3 for females, the population of older adults aged 60 and above is on the increase. The population of this age group of Nigerians currently put at 7.6 million is predicted to increase to 27.7 million by 2050.
According to Enabulele “it is imperative that short, medium and long term plans be instituted to adequately cater for this age group of Nigerians and that anything short of this may lead to catastrophic consequences on health care expenditure, as well as the mortality and morbidity indices of Nigeria.” This is due to the fact that chronic and non-communicable diseases, which afflict most elderly people are major contributors to mortality and morbidity and cause increased utilization of health care facilities and resources.
In Nigeria, not much emphasis has been devoted to the care of the aged in terms of medical, psychosocial and functional needs, while there is a dearth of trained medical personnel dedicated to the care of the elderly.
It is against this backdrop that the association recommended that government at all levels to institute and enforce a policy of free medical care for elderly people. In addition, committed efforts should be made to address the socio-economic and functional needs of the elderly, particularly the prompt payment of pensions.
According to the NMA leader, the association shall partner with relevant government agencies and ministries to intensify the promotion of lifestyle medicine/health promotion campaigns to empower elderly people to live healthier lives. The association also recommended that government should also provide for the health promotional needs of elderly people in Nigeria and to create district and neighbourhood recreation/sports centres for them.
Dr. Enabulele called for training of more doctors in geriatric medicine and that geriatric comprehensive assessment is made a standard practice in all hospitals. The association appealed to government at all levels, corporate and non-governmental organisations and private entrepreneurs to massively invest in hospice care rather that old peoples’ homes. NMA also called on the National Postgraduate College of Nigeria to give greater emphasis to geriatric care and establish subspecialties of geriatric medicine domiciled in the departments of family medicine and internal medicine.
On the controversial issue of prescription rights, which has set it up against the pharmaceutical association, the doctors association called for prescription and enforcement of sanctions for violators of the framework guiding the prescription of drugs and medicines in Nigeria. According to the president, one of the problems plaguing Nigeria’s health care system is the gross abuse of prescription rights facilitated by factors such as poor regulatory and legal framework, poverty and out of pocket financing of health care, poor governance, high level of illiteracy and a weak health system.
The need for a collaborative effort between doctors and other professionals within the health sector was clamoured for by the doctors. For the patients to enjoy uninterrupted services, everyone must be ready to serve and render such service willingly and satisfactory.
The need to have unfiltered service base on approved practices was also echoed by the conference, which must be implemented by the relevance authorities.
An Overview of Health Financing by Dr. ChidiUkandu
The World Health Organization (WHO) defines health financing as the way in which money is raised to fund health activities, as well as how it is used.It is important to note that the way a health system is financed is a key determinant of population health and well being. More than 1.3 billion people worldwide do not have access to essential health interventions, due to weaknesses in health financing and delivery systems. As many as 44 million households worldwide, or more than 150 million individuals, face catastrophic health care expenditures every year; of these, about 25 million households or more than 100 million people are pushed into poverty by health care costs. Health financing thus aims to achieve three goals: generate sufficient and sustainable financial resources; ensure optimal use of such resources; and protect individuals from financial embarrassment, in the process of seeking health care. The attainment of these objectives depends on how effectively the health financing functions of revenue collection, pooling and purchasing are performed.
Revenue collection
Revenue collection is the process by which the health system receives money from households and organisations or companies, as well as from donors. Common methods for revenue collection include general taxation, mandated social health insurance contributions, voluntary private health insurance contributions, community-based health insurance contributions, out-of-pocket payments and donations.
Fig 2.1: Health financing functions
Source: {Schieber,G. 2005}
The mix of collection methods adopted by a country will influence how much money can be mobilised and the patterns of equity, efficiency and the cost of health care services. Countries often use more than one of these methods to raise funds for the health system but the best mix depends on a country’s income level and its technical and administrative capacity. Literature indicates that many high income countries rely on general taxation or mandated social health insurance contributions, in contrast to low-income countries that depend far more on out-of-pocket payments or donor funding.
Pooling
Pooling refers to the accumulation and management of revenues in such a way as to ensure that the risk of having to pay for health is borne by all members of the pool rather than each contributor individually. Pooling performs the ‘’insurance function’ by sharing the financial risk that is associated with health interventions for which the need is uncertain. Pooling can be explicit, as with social health insurance, community-based health insurance and private health insurance, where people knowingly subscribe to the scheme, or it is implicit, as with tax based health systems. In either case, pooling enables health services to be received, based on need, rather than ability to pay and removes the need to pay for health services at the point of care, and thus reduces the possibility of individuals failing to receive care because of financial constraints. For pooling to occur, there has to be prepayment. Prepayment allows individuals to pay for health costs in advance, thus relieving them of uncertainty and ensuring compensation should a loss occur. Pooling coupled with prepayment enables the establishment of insurance and the redistribution of health spending between high and low-risk individuals and between high and low-income individuals.
Purchasing
Purchasing is the process by which pooled funds are paid to providers, in order to deliver a specified set of health interventions. The principal methods for paying providers are fee-for-service, per diem or daily payment, case payment, capitation, budget and salaries. The type of method used has implications for cost, access, quality and consumer satisfaction. Purchasing is therefore very important for achieving the health financing goals of universal access, optimum use of resources and financial protection for all.
Social health insurance (SHI)
SHI is a method of health financing where contributions for health services are collected from workers, self-employed people, enterprises and the government. Collections through SHI are often mandatory and backed by a legal act. It is sometimes referred to as national health insurance, when it covers the entire population within a country. In this case, SHI may be combined with voluntary schemes, such as community-based health insurance schemes, to cover the self-employed or informal populations.
Literature indicates that about 60 countries all over the world are using SHI as the predominant method for raising money for health services.27 countries have achieved universal coverage for their populations through this method.
In recent times, multilateral and bilateral organisations, such as the WHO, World Bank, German Agency for Technical Cooperation, have been promoting social health insurance as an alternative way to mobilise additional funds for the health system, especially in developing countries. They suggest that social health insurance is a suitable alternative when low-income countries do not have adequate tax revenues to fund health care of reasonable quality for everybody. In fact in 2005, the World Health Assembly adopted a resolution recommending social health insurance as an effective strategy for financing health systems.
Community-Based Health Insurance (CBHI)
CBHI has, in recent times, been advocated as complementary method for mobilising funds for the health system especially, in low-income countries. However, evaluations by the World Bank, the International Labour Organization and others conclude that in low-income settings CBHI schemes make only modest contributions to overall coverage and only as a complement to other formal schemes. Literature indicates that coverage with CBHI rarely exceeds 10 per cent of the population because voluntary contributions of poor people are usually insufficient to make it viable. Other researchers and scholars however argue that, in situations where government taxation is weak, formal mechanisms for social protection for vulnerable populations absent, and government oversight of the informal sector lacking, community health financing provides the first step towards improved financial protection against the cost of illness and improved access to priority health services.
Donor funding
This refers to international financial assistance from other countries, bilateral and multilateral organisations and NGOs. Literature indicates that financial assistance from donors is a major source of funding for health services in low-income countries. In 48per cent of the 46 countries in Africa, donor funding accounted for more than 20per cent of the total health expenditure. In 2004, external sources accounted for 6.25per cent or US$2.23 billion of the US$35.53 billion expended on health in Africa.It is recognised that current health expenditure in Africa are unlikely to meet the required funding to achieve universal access and, as such, increased donor assistance is being canvassed for many African countries.
Out-of-pocket payments
Out-of-pocket payments refer to payments that are made at the point of accessing health services and could be in the form of direct payments to health providers, user fees or co-payments. Out-of-pocket payments in the form of user fees and direct payments represent a major method for financing health services in low-income countries. Out-of-pocket payments imply the absence of pooling, are not sustainable and are therefore regarded as the most ineffective method for financing health services. Indeed, there is a distinct correlation between the amount of out-of-pocket-payments and the share of people exposed to catastrophic expenditure.
Living with diabetes is not a death sentence – Fasanmade …urges strict adherence to glucose control guidelines
An endocrinologist and specialist in the study and management of the gland and related area, Dr. Femi Fasanmade, has urged people living with diabetes not to see the ailment as a death sentence, but rather something they can live with and enjoy good life.
Speaking at the launch of the ten steps to better glucose control, developed by the Global Partnership for Effective Diabetes Management in Lagos, Fasanmade said a strict adherence to the glucose control guidelines could be all a patient would require to live with the condition in good health.
According to him, the steps to better glucose control helps create awareness on the disease and acquaint patients, doctors and health workers on the best way to achieve a control of the disease through the new guidelines.
Explaining the ten steps, Fasanmade said diabetic patients could reduce the risk of diabetes-related complications and thus improve their quality of life by following the recommendations of the ten steps.
These, he said, require among other things that the patient should strive to monitor his condition regularly and aggressively manage his blood sugar level, as well as blood fat (hyperglycaemia, hypertension and dyslipidemia); and every new diabetes patient should see a specialist, who should initiate appropriate management procedure before referring the patient to a general practice practitioner.
The patient and his/her doctor should not spear any management method to achieve a control. Such methods should include diet, drugs and exercise. “If you can combine these, you will not see any case of stroke, erectile dysfunction, blindness and many other complications diabetes often come with,” he said.
Professor Augustine Ohwovoriole, while launching the ten steps, described the state of the nation’s health care delivery system as too difficult and burdened with a lot of challenges, and could make it difficult for diabetes patients in Nigeria to achieve control. He said, to be able to follow the ten steps, laboratories must be available and well organised to offer necessary monitoring checks for diabetes.
He noted that a few laboratories in Nigeria could provide the HbAIc test recommended in the ten steps, adding that this and other tests were rather too expensive for Nigerian diabetics, who will strive to follow the guidelines effectively.
According to him, diabetes treatment is not as it should be in the country. He therefore, urged the government to, as a matter of urgency, include diabetes among the diseases covered by the National Health Insurance Scheme (NHIS).
The steps to better glucose control, as developed by Global Partnership, aimed at good glycaemia control include monitoring HbAIc every three months, in addition to regular glucose self-examination, manage hyperperglycaemia, dyslipidemia and hypertension with the same intensity, to obtain the best patient outcome.