An ounce of prevention: Efforts to thwart diseases before contraction have increased

Disease prevention, a vital aspect of the health care sector’s development, has the ability to create enormous cost savings, as preventive health measures tend to be significantly less expensive when compared with disease treatment. HIV/AIDS provides an excellent example of an extremely difficult and costly disease to treat, yet an incredibly easy disease to prevent through education and preventive measures. In Nigeria disease prevention has the potential to significantly reduce the footprint of diseases, such as malaria, HIV/AIDS, polio, yellow fever, tuberculosis (TB) and meningitis, among others. While a large portion of donor funding goes toward disease prevention, in July 2012 the National Assembly reduced the Ministry of Health’s (MoH) budget proposal on prevention and surveillance from $3.72m to just $499,200.

ACTION PLANS: Apart from numerous private organisations and NGOs aiding in the fight against vaccines preventable diseases (VPDs), the federal government has several agencies leading the charge against disease control and prevention. The Nigerian Institute of Research Medicine (NIRM) was created in 1977 to combat infectious diseases and represents a significant resource in the fight to control and prevent the spread of communicable and non-communicable disease in the country. The NIRM conducts research on all major diseases and is currently working towards WHO accreditation for its HIV/AIDS virology lab.

While the NIRM focuses on research and development, the Department of Disease Control and Immunisation (DDCI), a branch of the National Primary Health Care Development Agency, is mainly responsible for ensuring children are vaccinated. Over the past two years the DDCI reported it increased the number of children vaccinated against VPDs by more than 30%, bringing its immunisation performance to over 70%.

MALARIA CONTROL: Malaria is arguably the most significant public health issue in the country, with over 90% of the population at risk and 50% contracting the disease at least once annually. According to the National Malaria Control Programme (NMCP), another MoH agency, the disease is responsible for 60% of outpatient visits, 30% of childhood deaths and 11% of maternal deaths. The financial loss caused by malaria has also been estimated by the NMCP to be $844.8m annually due to treatment costs and preventive efforts, while the World Health Organisation (WHO) assesses the economic loss to be as high as 1.3% of economic growth per year.

The NMCP, along with its partners in the World Bank Malaria programme, uses integrated vector management as its control scheme. The strategy involves various vector control methods, including long-lasting insecticidal nets (LLINs) and indoor residual spraying, to prevent or reduce vector populations and their contact with humans. Repellents, outdoor spraying, larviciding and the use of protective clothing are also used in the fight against malaria.

NET WORTH: The distribution of LLINs has become a popular method of malaria prevention across Africa due to its effectiveness and relatively cheap cost. In 2012 the NMCP reported distributing 1.1m LLINs to the Ondo State as part of its larger goal of ensuring at least two LLINs per household nationwide. At the beginning of 2011, an estimated 30m LLINs had been distributed nationwide. The NMCP is also signed into the voluntary pooled procurement programme of the Global Fund, a $22.9bn international fund designed to eliminate HIV/AIDS, TB and malaria, from which it procured large amounts of anti-malaria drugs. Other agencies contributing funding, facilities and organisation include the Society for Family Health (SFH), the US President’s Malaria Initiative (PMI) and UK Aid, a conglomerate of London-based non-governmental development organisations.

However, despite the best efforts of government and partner institutions, Nigeria still faces significant gaps in the procurement of anti-malaria preventive measures. According to the NMCP, there is a widening gap with respect to the distribution of prevention aids in the short term. The shortage of LLINs is expected to grow from 40.3m in 2012 to 45.1m in 2013.

Though HIV/AIDS leaves a much smaller footprint in Nigeria, its more deadly and transmittable nature makes it a formidable obstacle to health care development. HIV/AIDS prevalence in 15-49 year olds has been reduced from 3.9% of the population in 2000 to 3.6% in 2010, according to the World Bank. Improvements have also been made in the use of condoms among 15- to 24-year-olds who reported sexual intercourse with multiple partners, which despite remaining low, nearly doubled from 2005 to 2010, jumping from 29% to 56%, according to the UN’s Millennium Development Goals Report 2012.

The National Agency for the Control of AIDS (NACA) manages national policy with regard to AIDS prevention and treatment. One of NACA’s primary goals is to ensure that 60% of Nigerians have comprehensive knowledge of HIV/AIDS and that 60% of the sexually active population uses condoms consistently and correctly with non-regular partners by 2015. In total NACA reported a 4.1% prevalence of HIV in the adult population in 2011, along with 56,681 HIV-positive births and a total of 281,180 new HIV infections each year. In 2010 NACA reported distributing 93.8m condoms, however, in a country with population of 152.6m, that equates to less than one condom per person.

TUBERCULOSIS: The number-one killer of people living with HIV/AIDS in Nigeria is, in fact, TB. Though the UNDP expects TB to be a minor health burden by 2015, new forms of drug-resistant TB threaten to halt the country’s progress in this area. After decreasing each year from 180 incidents per year per 100,000 people in 2004 to 130 in 2009 the number of incidents climbed again to 133 in 2010, according to data from the WHO. Multi-drug resistant forms of TB (MDRTB) have cropped up, though efforts to counter the new forms of TB were officially begun with the opening of Nigeria’s first MDRTB treatment centre at the Jericho Chest Hospital in Ibadan.

In order to improve children’s health, in 2012 the government introduced a pentavalent vaccine – which combines five vaccines to prevent diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza B in a single dose. Once the vaccination programme is fully operational, it is expected to reduce child mortality by 17%, prevent nearly 400,000 cases of influenza and save roughly 27,000 lives per year. Ado Muhammed, the executive director of the National Primary Health Care Development Agency, stated at the launch of the vaccine that the federal government spent over $6.4m in the past two years simply preparing infrastructure for the arrival of the vaccine and that more than 10m doses had already been paid for.

There is a major shortage of funding, awareness and treatment infrastructure to combat and prevent disease. The political will to combat disease is strong, despite the recent budget decrease, as evidenced by the federal government’s success in bringing polio (see analysis) to the point of eradication and significantly reducing incidents of TB over the past decade.