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Nigerians’ life expectancy shortened by malaria, others

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Nigerians are living 7.55 years longer at average life expectancy of 65 years but are still battling with communicable diseases such as Human Immuno-deficiency Virus (HIV), malaria, diarrhoea and neonatal ailments like sepsis and encephalopathy.

Sepsis is a rare but serious complication of an infection. Encephalopathy is a general term that means brain disease, damage, or malfunction.

Also, according to the 2017 Annual Global Burden of Diseases Study (GBD), composed of five peer-reviewed papers, and published yesterday in the international medical journal The Lancet, obesity, conflict, mental illness and substance use disorders are preventing further progress in death reduction.

According to the report, a Nigerian man born in 2016 can expect to live 63.7 years, an increase in life expectancy of seven years over the past decade. A woman has a life expectancy of 66.4 years, up 8.1 years from 2006.

The report, however, noted that illness and injuries take away years of healthy life and that a Nigerian male born in 2016 will live approximately 55.5 years in good health; a female only 57.2 years.

The GBD study is the world’s largest scientific collaboration on population health, which reveals new trends in illnesses, deaths, and risk factors leading to poor health. It draws on the work of over 2,500 collaborators from more than 130 countries and territories. The Institute for Health Metrics and Evaluation (IHME), an independent global health research centre at the University of Washington in Seattle, United States (US), coordinates the study. This year, more than 13 billion data points are included; the papers comprise a complete edition of The Lancet.

Established in 2007, the IHME provides rigorous and comparable measurement of the world’s most important health problems and evaluates strategies to address them. IHME makes this information available so that policymakers, donors, practitioners, researchers, and local and global decision-makers have the evidence they need to make informed decisions about how to allocate resources for improving population health.

This year’s GBD improves upon the previous annual update through new data, improvements in methodology, and a measure for tracking completeness of vital registration information.

According to The Lancet report, Nigeria has a higher life expectancy than South Africa, Niger, or Cameroon, but it lags behind Kenya, Rwanda, and Ethiopia; and the top five causes of premature death in Nigeria are malaria, diarrheal diseases, HIV, neonatal encephalopathy, and lower respiratory infection.

The report noted that the ailments that cause illness can be very different and that iron-deficiency anemia, back pain, and migraines are the top causes of years that people live with disability in Nigeria.

According to the report, deaths of children under five are a persistent health challenge and for every 1,000 live births, 46.6 Nigerian children under the age of five die. That far exceeds the global figure of 38.4, and the regional average of countries in western sub-Saharan Africa, which is 40.7. Only a few countries in the region – such as Niger, Mali, and Chad – have higher rates of under-five mortality.

The five papers provide in-depth analyses of life expectancy and mortality, causes of death, overall disease burden, years lived with disability, and risk factors that lead to health loss.

Moreover, in 2016, for the first time in modern history, fewer than five million children under age five died in one year, as compared to 1990 when 11 million died.

According to the report, globally, countries have saved more lives over the past decade, especially among children under age five, but persistent health problems, such as obesity, conflict, and mental illness, comprise a “triad of troubles,” and prevent people from living long, healthy lives, according to a new scientific study.

Director, Center for Healthy Start Initiative (HIS-Centre), Jacob Olusanya, said: “Life expectancy in Nigeria is growing, but people in many other sub-Saharan African countries are living longer, healthier lives. Communicable diseases like malaria, diarrhea, lower respiratory diseases, and HIV are still taking the lives of far too many Nigerians. Infants and children are at particular risk from these diseases, and neonatal ailments like sepsis and encephalopathy kill thousands of infants. We have much more work to do.”

HIS-Centre is an organisation in special consultative status with the United Nations Economic and Social Council (ECOSOC). The formal establishment of the Centre for Healthy Start Initiative (HSI-Centre) in March 2011 was the product of an extensive research work on childhood disability in Nigeria since 1993 by its Principal Promoter, Dr. Bolajoko Olusanya, a developmental paediatrician by training.

Researchers attribute this global health landmark to improvements in increased educational levels of mothers, rising per capita incomes, declining levels of fertility, increased vaccination programs, mass distribution of insecticide-treated bed nets, improved water and sanitation, and a wide array of other health programs funded by development funding for health.

Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, United States, Dr. Christopher Murray, said: “Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates. But, we’re been much less motivated to address issues leading to illnesses. A ‘triad of troubles’ – obesity, conflict, and mental illness, including substance use disorders – poses a stubborn and persistent barrier to active and vigorous lifestyles.”

Despite progress on reducing deaths, this “triad of troubles” – obesity, conflict, and mental illness, including substance use disorders – is preventing further progress.

According the report, one of the most alarming risks in the GBD is excess body weight. The rate of illness related to people being too heavy is rising quickly, and the disease burden can be found in all socio-demographic levels. High body mass index (BMI) is the fourth largest contributor to the loss of healthy life, after high blood pressure, smoking, and high blood sugar.

The Lancet report noted that deaths over the past decade due to conflict and terrorism more than doubled and recent conflicts, such as those in Nigeria, Syria, Yemen, South Sudan, and Libya, are major public health threats, both in regard to casualties and because they lead to long-term physical and mental consequences.

According to the report, mental illness and substance use disorders continued to contribute substantially to the loss of healthy life in 2016, affecting all countries regardless of their socioeconomic status. Treatment rates for mental and substance use disorders remain low. Even in high-income countries where treatment coverage has increased, the prevalence of the most common disorders has not changed.

The study’s other findings include:
· Poor diet is associated with one in five deaths globally.
· Non-communicable diseases were responsible for 72 per cent of all deaths worldwide in 2016, in contrast to 58 per cent in 1990. Within the past decade, diabetes rose in rank order from 17th to 9th leading cause of death in low-middle income countries.
· Tobacco is linked to 7.1 million deaths, and in more than 100 countries, smoking was among the leading risk factors for loss of healthy life.
· The leading causes of premature death globally included: ischemic heart disease, stroke, lower respiratory infections, diarrhea-related diseases, and road injuries. Ischemic heart disease was the leading cause of premature death for men in 113 countries and for women in 97 countries.
· Only four of the leading 20 causes of disability in 2016 – stroke, COPD, diabetes, and falls –were also leading causes of death.

In addition, the top conditions in 2016 that made people sick, but were not necessarily fatal were: low back pain, migraine headaches, hearing loss, iron-deficiency anemia, and major depressive disorders.

Director, Center for Healthy Start Initiative (HIS-Centre), Jacob Olusanya, told The Guardian why cancer and kidney damage where not captured as major causes of death in Nigeria.

Olusanya said: “First, it is important to clarify that some 264 causes of death worldwide were considered by the GBD team based on the International Classification of Diseases published by the World Health Organisation. These included cancer and kidney damage. However, of the approximately 1.4 million deaths in all ages which occurred in 2016, about 60 per cent occurred in children below the age of 15 years. Cancer and kidney damage are more prevalent in adults, especially in Nigeria. It is therefore, not surprising that these conditions were not among the top five leading causes of all estimated deaths in Nigeria. Of course, if we exclude the children, these conditions may feature more prominently.”

On why malaria is a major cause of death and affects life expectancy in Nigeria, he said: “In science, you must provide published evidence to support your position. There is unequivocal evidence in the literature that malaria is a major cause of premature death in all malaria endemic regions of the world including Nigeria. The finding reported by GBD was derived from available data on the burden of malaria in Nigeria and the rest of the world. The establishment of the National Malaria Control Programme under the Federal Ministry of Health in partnership with the Global Fund for example, is a clear recognition of the significance of malaria burden in Nigeria. Rather than disagree with the GBD finding, we should unite to explore ways of eradicating malaria related deaths in Nigeria.”

Reacting to the specific populations in Nigeria that were used for the study, Olusanya said: “GBD does not conduct surveys. Rather, it analyses representative and population-based data on Nigeria obtained from various sources. For example, the data used by the GBD were derived from over 700 sources including Ministries of Health, Nigerian Population Commission, WHO, World Bank and their partners. This information is available on the GBD website.”

On what Nigeria has done well or has been doing well to record this improvement on life expectancy, Olusanya said: “The GBD did not set out to describe activities in various countries. Rather, its focus is simply to report global and national health status based on the analysis of available data. You and I are in a better position to identify possible reasons that has led to this improvement. From my observations, one possible reason is improved health consciousness in the general populace. In my neighbourhood, I find an increasing number of people engage in physical exercises especially on weekends. People want to live long and they are taking steps that can help them to achieve this desire. It is also possible that the improved life expectancy can be attributed to the increasing investment into healthcare services by the government and donor organisations.”

On why the impact of poor funding for health in Nigeria not captured in the study, the HIS-Centre Director said: “The GBD report released so far is devoted to reporting the burden of disease based on mortality and disability associated with various health conditions. The issue of health funding will be addressed separately at a later stage.”

Olusanya said the report is very credible and has the backing of the United Nation (UN) and her sister organisations including the WHO and the World Bank. In fact, the GBD project was midwifed by WHO and the World Bank. “Moreover, the GBD findings are increasingly being relied upon by major international funding organisations like Bill & Melinda Gates Foundation in setting priorities for resource allocation to developing countries,” he said.



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