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NIMR probes rise in sudden deaths

By Chukwuma Muanya
07 July 2016   |   2:28 am
I came to the Institute six years ago with my vision to restructure and repositioning NIMR because before now little was known about NIMR and also little was known about what the institute does.
Prof. Innocent Ujah

Prof. Innocent Ujah

• Tracks AIDS drug resistance, efficacy of malaria medicines
• Identifies area in Nigeria where Zika, Dengue, Yellow fever carrying mosquitoes, Aedes aegyptica, are replete
• Sets up two commercial ventures to increase bridge funding gap, increase internally generated revenue
• Calls for amendment of TETFUND law to enable medical research institutes access it

Prof. Innocent Ujah is the Director General of the Nigerian Institute of Medical Research (NIMR) will on Tuesday July 12, 2016, mark his sixth year as the Chief Executive Officer (CEO) of the foremost medical research institute in the country. The event will be capped with a seminar titled “Post MDGs: Maternal and Child Health in Nigeria”, which will be delivered by a Professor of Obstetrics and Gynaecology from the Ahmadu Bello University (ABU) Zaria, Kaduna State, Dr. Oladapo Shittu. Ujah in an exclusive interview with The Guardian said NIMR is concluding a nationwide study on the causes of the recent rise in sudden deaths that has claimed some notable Nigerians as well as a study on Anti Retro Viral (ARV) drug resistance that the Institute got over N300 million grants from the United States Centres for Disease Control and Prevention (CDC). The consultant obstetrician and gynaecologist said the Institute is planning a national stakeholders meeting by October to disseminate its findings. Ujah said another research conducted by the Institute showed that lots of Nigerian women take alcohol in pregnancy, which is not safe and causes fetal alcohol syndrome.Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Problems may include an abnormal appearance, short height, low body weight, small head size, poor coordination, low intelligence, behavior problems, and problems with hearing or seeing. Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and have trouble with alcohol or other drugs. The most severe form of the condition is known as fetal alcohol syndrome (FAS). Other types include partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD).He said no level of alcohol in pregnancy is safe and NIMR plans to carry the campaign further to communities for woman who are pregnant to desist from taking alcohol.
Ujah said the Malaria Research group at NIMR has identified areas in the country where Zika virus, Yellow fever and Dengue fever carrying mosquitoes, Aedes aegyptica, are replete and plans to go there and find out the type of diseases they carry. To address the obvious shortfall in funding for health institutions in the 2016 national budget, Ujah said the research institute has set up two companies- NIMR Consult Pharmacy Limited and NIMR Global Ventures- to increase internally generated revenue. Ujah also called for the amendment of the law establishing the Tertiary Education Trust Fund (TETFUND) National Research Fund so that NIMR, as other tertiary institutions, can access it.
CHUKWUMA MUANYA writes. Excerpts:

Basically, most institute in Nigeria now just exist to pay salary, they are not doing anything. Six years at the Institute, would you say you have done something different and not just existing to pay salaries?
I came to the Institute six years ago with my vision to restructure and repositioning NIMR because before now little was known about NIMR and also little was known about what the institute does. That was why I came in with a vision to restructure and largely I can say I have achieved that objective.
When I came here I can tell you that sign post to direct people were not there, there was nothing like. People come to the research institute and do not know where to go. That was my first observation and I did that.

Secondly I felt we must instill discipline, law and order. When I came, I found that act of lawlessness was the order of the day in the Institute but I can say with humility that we have restored some level of orderliness.

Most importantly was our mandate, our mandate is to carry research on public health importance and impact in restructuring. It is during my time we were able to form nine research groups that never existed. When I came some researchers and fellows came to me and said ‘we were just given letter of appointments but we do not know what our jobs are.’ So I was actually motivated and through a strategic plan we were able to form nine research groups and they are functioning very well irrespective of the fact we may not be getting a lot of financial support from government, but we are not relenting.Therefore I can say we largely have done some repositioning and restructurings. It is also true that when I came there was nothing like Information and Communication Technology (ICT) and you could not carry out research without having ICT unit. So I emerged ICT from the library to ensure that it stood on its own and they are doing well.

So the whole of the Institute now has Internet service both within and without, and Internet is an asset for any researcher, because we must communicate with the world and am happy we have been able to do that.

The issue of Electronic or e library is almost finished, despite issues of funds; we have been able to go very far. I must say the remaining period of my tenure is to consolidate on whatever achievement we have had and that is coming in.

The human virology lab was given a boost and it is working very well. The special clinic, what we call AIDS Prevention Initiative in Nigeria (APIN) clinic, which deals with the treatment, and research of Human Immuno-deficiency Virus (HIV), is working very well.

As a matter of fact when I came on board, I was prevailed by some people in this place that the clinic should be closed down and I argued and said, ‘as a research institute we need to have clinical cases from which we will research and improve the quality of life of our people.’ And I am proud to say today that that clinic for HIV treatment is doing very well. As a matter of fact, we have got four or five pharmacists and a doctor to consolidate further the clinic so that the waiting time of our patients would reduce.

The quality of care, despite the pull out of the United States President Emergency Fund for AIDS Relief (PEPFAR) programme, has dwindled. We are not relenting, and the quality as remained as good as ever before, and it is a confirmation that we can own the programme. Previously I thought it was difficult to own it.

On the issue of your mandate of research, have you been able to bring out any research findings of international and national benefits and importance and how far have you gone in that area?
Well, I must tell you that in area of research we have done very well, in that at the moment we are concluding our research on common causes of sudden death, no body gave us that idea. We found out that suddenly people are dying, they would sleep and would not wake up, and they would just slump.
That is a research question, we call it Implementation research, we need to know the causes and find solutions. Even before the tragedies that happened recently as you know in the last one-month we have lost three important Nigerians who have died suddenly, I would not name them, we are concluding the study. It is a national research that includes the six geo political zone. It is not just in the southwest and I am happy to say that the initiative is working for us. So many cases of sudden death and we must respond to the health needs of our people.

We also almost finishing the study on Anti Retro Viral (ARV) drug resistance that we got over N300 million grants for the United States Centres for Disease Control and Prevention (CDC). We are almost completing the study and we have to have a national stakeholders meeting to disseminate our finding by September or October for this country, and we expect all researcher and stakeholders to participate in dissemination of this study.

Can we have an insight into the results of the study?
It would be too early to do that, you the press you need to be informed and know what we are doing. You know the issue of AIV drug resistance and drug failure is something that is of concern to us, and I must say that is a major achievement. I must also say we are doing well in area of malaria and drug resistance studies. In fact the head of malaria research group has written proposals and got grants from the World Health Organisation (WHO) in areas of malaria. So we are looking at tracking resistance to Artemisinin Combination Therapy (ACT). So in that wise we are doing well.

We have also done studies on maternal and child mortality and we found the level and pattern and trend of alcohol use in pregnancy. We found out that lots of women take alcohol in pregnancy, which is not safe. We have what we call fetal alcohol syndrome, we do not encourage alcohol in pregnancy because no level of alcohol in pregnancy is safe and that is the message. And we carry the campaign further to communities for woman who are pregnant to desist from taking alcohol, it is very important.

It is also important we promoted scholarship, lot of capacity development; we have been able to improve the knowledge of some of our junior colleagues to be able to do scientific writings for publications and also capacity development for grants. One of our vey junior colleagues got a grant from WHO and I think that is an achievement in that regards. We are also partnering with international communities, international association of public health institute, is a great partner with us and they are doing very well. They are training our staff; they are supporting us in the institute and supporting our conferences.

But for international partnership, we would not be able to attend any conferences and as you know part of our job is to disseminate our research findings, so that helps us to disseminate our research findings.

Another big concept now is the issue of malaria vaccine. There is a new vaccine now, which has been tried in several African countries. But the new publication says now that the vaccine is not effective and that it has a kind of passive effect, that over the years it might become harmful. What is the situation as regards to malaria vaccine in Nigeria?
I am aware that the paediatric department of the Jos University Teaching Hospital (JUTH) is involved in that trail, but NIMR is not directly involved. But we also know that issue of vaccine production or clinical trial for vaccine production is not an easy thing. It will go on for a very long time, just like HIV, up till about thirty something years.

But is there a possibility of getting an effective malaria vaccine?
In science you can never say never, what we never knew before is now possible. As time goes on may be some other generations would find something. Technology is improving at a very fast rate, many of the tests we could never did are now being done, and so we can never say never.

Another issue that has come up is that of mosquito borne diseases, they are increasing, from malaria now we have gone to Zika, Dengue and others. In the light of that as a research institute, what are you doing about this?
Well, you know the mosquito, Aedes aegyptica, carries Zika, Yellow fever and Dengue fever. We are doing our in house study here and we have identified a place in Nigeria where this type of mosquito is quite common, and we are planning to go to the place. I would not name the place but we are planning to go there and from there we would be able to find out the type of diseases they carry. So the malaria research group is doing well in this regard, we have met and discussed Zika and Dengue and Yellow fever. We need to do a study on it, but you see a study is not just done extempore, it is planned, the literature has to be reviewed, look at what has happened.

There are huge concerns on the issue of funding and the budget for health. Certainly there is a shortfall and predictions by analysts is that very soon NIMR and other research institutes under the ministry of health might not be able to pay salaries based on what is provided for in health in 2016. Are you worried about? What are your plans to forestall this?
Well naturally any normal human being should be worried about the dwindling funding. First of all research funding have never been sufficient, not adequate, it is nothing to write home about not to talk about the situation where we find our selves today. But you see there are other opportunities. Let me tell you that as a research institute we are always thinking about the future, that is what research is all about. We have to visionalise. Now let me say that in this institute we are looking at the commercial arm, I have registered two companies, one is NIMR Consult Pharmacy Limited and the other one is NIMR Global Ventures.

If we are to do business, that would help us to generate some revenue instead of depending wholly on government. We have to look inward and that is what we are doing, and in that case I can tell you we have appointed a general manager for the NIMR consults. We do not want to depend on government alone, in Europe and America look at what happens with the Medical Research Councils (MRC). What the medical research council of the United Kingdom (UK) get out of these services is far more that what their government budget for them. You also know that even in the universities they do consultation and all that. So NIMR Global Ventures would now compete for contracts and the rest with other organization both in NIMR and outside.

NIMR pharmacy apart from the fact that it would generate revenue, it would also provide service for our people. We need to have a pharmacy that is credible and NIMR pharmacy would stand for that. Before October it would start functioning, we are in the process of registration with the Pharmacy Council of Nigeria (PCN), so we are thinking ahead.

Another issue is those living with AIDS, the issue they had with their treatment after the pull out of PEPFAR. So are they paying for the drugs now?
No, they are not paying, all anti retroviral drugs are free, nobody pays for it, they are still free. Now what we are doing is we do not want the quality of service to go down because PEPFAR is no longer there, they are not a Nigerian government and we must device our own ways. What we have done is that little is paid for service charge so that we can keep on with the services especially the use of generator and the Internet.

Like how much do they pay?
For instance to pick up drugs is just N500. If you go for cancer, they pay for it. If you go for Magnetic Resonance Imaging (MRI), you pay for the investigation. If you have diabetes you pay for it, hypertension, you pay for it. Now AIDS is a chronic disease, it is no longer like a disease of a death sentence. We want to appeal to people living with HIV, fortunately the incidence coming down and we want to appeal to those who are positive to accept the reality something must be given. If I just pay N500 or N1000 for a visit to stay alive, I would do that. Previously when the cost of a one-month drug was N50, 000 it was acceptable that nobody could afford it, I could not have afforded it. So to pay N 1000 and if you go to buy anti malaria, which is about the same amount.

So why would coming to clinic, and being seen by specialist and you would not pay N500 any problem? In my opinion, I think we must be fair, the money is not there and we must device innovative ways, we have decided to keep them alive. If the clinic was have closed down, but I didn’t and we were able to absorbed all the staff that were here. There were about 70 staff and the government is paying their salaries to ensure the clinic remains open; we have Internet service to ensure the drugs they take are still intact. So ownership is key, let people come and learn ownership of treatment of HIV from NIMR. In 2010, we had a conference on ownership and sustainability, I brought it to NIMR, and therefore we have a sustainable way of treating our patients.

On a final note I have raise the profile of NIMR both nationally and internationally, I was the chairman and still the co chairman of Ebola treatment research group and it is a great thing we have done for Nigeria, not only me but people who participated, even the press. Also, I am a member the Lassa fever control committee, and that is an acceptance of the good things we are doing in NIMR. The welfare of our staff is also taken into consideration and we would continue to build capacity, we can never do enough but we would continue to do what ever we can do.

The most important thing I can tell you I achieved is when I came here, equipment break down was a common thing and I realize we didn’t have an electrical engineer and today we have employed one. Today many of our equipment breaks down have been reduced to barest minimum. We have what we call preventive maintenance; we have been able to maintain our equipment. One of the things we did was that is to ensure we are prudent in our spending, we do not want frivolous spending, people are more committed now than before our research profile has increased, our international acceptance has improved. The government recognizes the role we are playing in this place and all we need to do is to get support from government and private sector and all other philanthropies and in that case we would be able to improve on what ever we are doing. We believe that when we put our e library in functional state the whole of Lagos and other interested scientists can access the service.

Considering the importance of medical research, do you have plans to establish outstations in the other geopolitical zones?
Our activities were restricted to the southwest, even the staff. But when I came, I opened the scope and ensured that anybody from anywhere in this country that is qualified should be employed in this place.

Our research activities are now nationwide and we have now got an out station in Asabi for the south, which was given and furnished by the Governor of Delta State, Senator Ifeayi Okowa, and we thank him a lot. If you see the building you would be surprised. I think those are major achievement of the institute, but that is not to say we have enough fund. We believe that NIMR should access the Tertiary Education Trust Fund (TETFUND) National Research Fund, because we are a tertiary institute and we think we should access it. The law must be modified to ensure that we access it. It does not make sense that we are research institute and they say because we are located in the ministry of health we cannot access research fund, it is not normal and must be corrected. We believe we are qualified and the law should be amended.