Most infectious diseases endemic to Nigeria become more virulent during the dry season. Consequently, they leave high-level complications and deaths in their wake. This realisation questions the country’s preparedness to prevent, detect, and contain these diseases, as well as other emerging respiratory and infectious ailments emanating from other parts of the world. CHUKWUMA MUANYA and MUSA ADEKUNLE chronicle recommendations from experts and appropriate agencies on how to reduce the incidence, prevalence, and fatality of these diseases.
The impact of climate change on Nigeria and indeed other parts of the world is feasible, with extreme weather conditions affecting natural occurrences, and bringing about severe conditions that have an immense impact on the flora and fauna, including infectious diseases, which are soaring steadily.
This surge, experts say has a lot to do with the changing climate, where alterations in temperature and rainfall patterns create an ideal environment for the proliferation of disease-carrying vectors.
Extreme weather events like floods and droughts triggered by climate change further compound the issue, just as these events disrupt water and sanitation systems, heightening the risk of disease outbreaks.
The consequences of these are dire, as they affect the health of the population, particularly vulnerable groups such as young children, pregnant women, older adults, individuals with chronic illnesses or disabilities, and those with limited resources.
Medical experts note the importance of heightened awareness among vulnerable populations regarding the health risks associated with changing climatic conditions. The impact of climate change on human health in Nigeria, both direct and indirect, is a growing concern.
Research indicates a range of direct consequences, including cerebrospinal meningitis, cardiovascular and respiratory disorders in the elderly, skin cancer, high blood pressure, malaria, cholera, and issues related to child and maternal health.
As Nigeria grapples with these challenges, the urgent need for adaptive measures and resource allocation becomes increasingly evident in the face of a changing climate.
Therefore, as the dry season sets in, health officials stress that there is a compelling need for vigilance against a surge in Lassa fever, meningitis, cholera, meningitis, monkeypox (mpox), and other illnesses.
That notwithstanding, a haunting question lingers: Are we sufficiently armed to face the impending challenges that the season carries, especially as the arid conditions morph into fertile grounds, nurturing mosquitoes, ticks, rodents, and other insidious disease vectors?
While Nigerians are not alien to the dry season, climate change is making it longer and more intense. This means that more dangerous diseases could become even more virulent, especially in places that don’t have a lot of resources.
According to a virologist, Prof. Oyewale Tomori, the dry season is usually associated with high temperatures and low humidity, even though the early hours of the day are usually cold, especially in the North, close to the Sahel, and there is also a strong cold wind with a lot of dust.
Tomori, a consultant to the WHO added that climate change exacerbates these conditions, and also increases the likelihood of transmission of organisms that cause diseases such as cerebrospinal meningitis (CSM), conjunctivitis, measles, chickenpox, cholera, diarrhoea, cough, and catarrh.
Tomori, who is also the pioneer vice chancellor of Redeemers University, Ede, Osun State, said: “We must not forget, especially the yearly increase in the number of reported cases of Lassa fever transmitted by rodents. The source of food for rodents and other peri domestic animals is drastically refunded during the dry season, and these rodents which are the vectors for Lassa fever then invade our homes for food, thereby increasing contact between man and rodents, and exposure to rodents’ urine, faeces, and other droppings. One of the effects of climate change is an increase in the frequency of flooding and a higher incidence of waterborne diseases.”
Tomori added that “populations in our rural areas and urban slums are the ones at high risk of infection by these diseases. These groups in our society; the malnourished with poor access to affordable healthcare, and those living in areas of poor sanitation and environmental devastation are the most vulnerable to these diseases.
“The filthy and unsanitary environments are more attractive to rodents and other disease vectors. It is in such locations that you will find stagnant pools of water serving as breeding sites for mosquitoes, ready transmitters of malaria and other insect-borne viral diseases.”
Judging from whatever standpoint, Lassa fever, an acute viral zoonosis of the severe hemorrhagic fever type with manifestations of fever, muscle pain, sore throat, nausea, vomiting, and chest and abdominal pain, is one of the diseases that must be watched out for. The Lassa virus is an RNA virus belonging to the Arenaviridae family. It is endemic in West Africa, where the first case was reported in 1969 in Lassa, a town in Askira Uba, in Borno State, more than 50 years ago, and it is estimated that nearly 5,000 deaths occur in West Africa each year.
Re-emergence of endemic diseases
SHEDDING light on the cyclical nature of these diseases, the National Lassa Fever Technical Working Group’s Incident Manager at the Nigeria Centre for Disease Control (NCDC), Dr. Yetunde Abioye, said: “Lassa fever is endemic in Nigeria; it is one of those diseases that during the dry season, we have more cases. We are endemic in the sense that there is no month that We don’t have a confirmed case of Lassa fever but we have more cases than what we refer to as surge, there is always a surge from the beginning of the dry season and then towards the early rainy season period to like move to have an increase in number of Lassa fever cases. Another disease is also cerebrospinal meningitis. What we call meningitis. So, Nigeria is actually in the African meningitis belt, it’s also one of those diseases that we are always on alert for during the dry season.”
She stressed the need for appropriate authorities to trust and work with verified sources like the NCDC website, World Health Organisation (WHO), and health ministries for accurate updates, as well as how to combat the health challenge.
While emphasising the need for health officials to take seriously, personal protective measures, she also harped on the need to keep “your environment clean to deter rodents, and cook food thoroughly, avoid bush meats, and don’t eat dead animals.
“Health workers should raise their Lassa fever suspicion, protect themselves with proper personal protective equipment (PPE), and refer patients to designated treatment centres. Regular training on handling of infectious diseases, including meningitis and Lassa fever must be ensured for optimal patient care and healthcare workers’ safety.
Abioye’s position is corroborated by a study published in October 2023, in Health Science Reports titled, “Re-emergence of Lassa fever in Nigeria: A new challenge for public health authorities.”
The study by Aroma Naeem, Shafaq Zahid, Muhammad Hassan Hafeez, Arifa Bibi, Shehroze Tabassum, and Aymar Akilimali, noted that Nigeria is one of the endemic hotspots for the fever, and has experienced numerous recurrent outbreaks due to the increased multiplication of the host reservoir, Mastomys natalensis.
The researchers pointed out that for the Lassa epidemics in 2022 and January 2023 alone, Nigeria accounted for a quarter of the yearly deaths from this disease, adding that poor lifestyle and hygiene, difficulty in diagnosis due to non-specific symptomatology, lack of effective treatment based on clinical evidence, and ineffective human immunisation programme combined with a health system that is not adapted, or equipped to control and prevent recurrent deadly epidemics, as well as an outdated regional disease surveillance system in West Africa, are some of the challenges that must be overcome to rapidly and effectively eradicate this disease, whose area of spread is constantly expanding as a result of the movement of populations in the context of economic and socio-cultural activities.
They concluded: “The recent Lassa fever outbreak has exposed a deep-rooted mismanagement of the healthcare system and public safety sectors of Nigeria. The population most affected belongs to substandard living conditions and questionable hygiene practices. Amidst these overlying issues, social awareness should be raised to ensure preparedness to combat such outbreaks and health risks. Clinicians should keep updates on disease surveillance reporting and management guidelines to efficiently and effectively curb this outbreak. There is a need to ensure preparedness to respond to the epidemic and other public health events. Regular sensitisation of clinicians on disease surveillance and adherence to management protocols by healthcare personnel, empowerment of health facilities with a rapid and effective diagnosis of Lassa fever by ensuring that a national or state-level health system can lead the action plan proposed in this work.”
Anthrax outbreak amidst Lassa fever, diphtheria endemicity as multiple crises
IN a recent study titled, “Multiple Crises: Anthrax Outbreak Amidst Lassa Fever and Diphtheria Endemicity in Nigeria,”
researchers maintain that the re-emergence of these diseases, with the existing prevalence of Lassa fever in the country burdens the health system and could make the control of these multiple diseases difficult.
The study done by Jeremiah Omojuyigbe, Taiwo Sokunbi, and Esther Ogodo, and published in the Journal of Medicine, Surgery, and Public Health, also throws light on established multiple epidemics, current efforts, challenges, and potential crises in the country’s health system.
According to the study, some of the challenges with these multiple epidemics include a limited supply of Diphtheria Antitoxin, a lack of viable vaccine for Lassa fever prevention, and the cost of hospitalisation with the current economic crisis.
By way of recommendations to tackle multiple endemics in the country, they enumerated the allocation of sufficient funds to the health sector by the government, increasing the level of community awareness programmes, encouraging safety measures, and improving the uptake of vaccines in the community among others.
Government, citizenry must watch out for outbreaks of aboriginal diseases
THE President of the Nigerian Association of Resident Doctors (NARD), Dr Dele Abdullahi, said that with the onset of the dry season, both the government and the populace must brace up for outbreaks of endemic diseases like meningitis, etc.
“The populace must ensure that basic hygienic rituals are strictly adhered to. The use of nose masks is not just for COVID-19, as it would protect us all from the excessive dust in the atmosphere, washing of hands frequently must also be encouraged, the same as using appropriate clothing for the current weather, and indulging in early health-seeking behavior to ensure prompt intervention,” Abdullahi advised Nigerians.
“For the government,” he said, “We need to support our healthcare facilities to be prepared for receiving these patients. And to protect the healthcare workers, the needed alarms should start being sounded now, which is an action that we are also carrying out to remind the healthcare workers on the need to be extra careful and be more vigilant.”
Malaria fuelled by extreme weather conditions a major concern
WHILE the government, and the generality of Nigerians are being tasked to watch out for outbreaks of aboriginal diseases, the WHO in the broader context of global health is shedding light on the escalating threat posed by climate change to global malaria control efforts.
Despite advances in providing preventive measures, such as insecticide-treated nets and medications for young children and pregnant women, the 2023 World Malaria Report revealed a concerning rise in malaria cases. In 2022, for instance, the estimated global malaria cases reached 249 million, surpassing the pre-pandemic level of 233 million in 2019 by 16 million cases.
The global response to malaria faces challenges, including drug and insecticide resistance, humanitarian crises, resource constraints, and the direct impacts of climate change.
The 2023 World Malaria Report explored the intricate connection between climate change and malaria. Changes in temperature, humidity, and rainfall directly influence the behaviour and survival of the malaria-carrying Anopheles mosquito. Extreme weather events, like heatwaves and flooding also exacerbate the transmission and disease burdens. A striking example is the five-fold increase in malaria cases in Pakistan in 2022 due to catastrophic flooding.
The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, emphasised the substantial risk that climate change poses to malaria progress, particularly in vulnerable regions, calling for sustainable and resilient responses alongside urgent climate action.
Climate variability is expected to indirectly affect malaria trends by impeding access to essential services and disrupting the supply chain for preventive tools. Population displacement resulting from climate-induced factors may lead to increased malaria as individuals without immunity migrate to endemic areas.
“The changing climate poses a substantial risk to progress against malaria, particularly in vulnerable regions. Sustainable and resilient malaria responses are needed now more than ever, coupled with urgent actions to slow the pace of global warming and reduce its effects,” Ghebreyesus said.
Sexual transmission of monkeypox stirs fresh apprehension
RECENTLY, the WHO officially acknowledged the occurrence of sexual transmission of monkeypox in the Democratic Republic of Congo (DRC) during its most extensive outbreak.
This revelation, despite happening thousands of kilometres away from Nigeria adds a new layer of concern to an already alarming situation, especially with Africa grappling with a shortage of vaccines.
The confirmation, which emerged as the DRC faces its largest-ever monkeypox outbreak, has created challenges for scientists who fear that the disease may become more difficult to contain.
The WHO consultant, Tomori expressed concern over the potential underreporting of the health challenge and warned of the virus spreading to other regions of the continent, including Nigeria.
The virologist emphasised the need for serious attention, particularly in the face of strict anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ+) laws that might drive affected communities underground, hindering disease control efforts.
Despite the severity of the outbreak, Tomori highlighted the absence of mass immunisation campaigns in Africa, contrasting with responses in Europe and North America. He called for urgent action, stating that the confirmation of sexual transmission should serve as a signal for increased seriousness and immediate measures to address the monkeypox challenge in Africa.
Alleviate impact of climate change on prevalence of diseases
SPEAKING specifically on the potential consequences of disease burden in Nigeria as a result of climate change, the virologist said climate change can only worsen the diseases burden directly or indirectly.
He explained that the consequences of climate change on the environment include a reduction in available arable areas for farming, leading to a reduction in food production and attendant malnutrition, adding that the search for arable land in virgin forests for farming has the potential to increase human and animal contact and interactions.
On what proactive measures can be implemented to alleviate the impact of climate change on the prevalence of diseases, the virologist said there is an urgent need to reduce activities that enhance severe climate change.
He noted: “We must improve our disease surveillance activities, which promote and enhance our preparedness to prevent, detect, and respond to disease outbreaks. These include field surveillance, laboratory backup, and effective and timely response activities. We must fully engage and involve the community in our field surveillance activity.
“Additionally, we must decentralise disease surveillance activities by empowering states and local councils to carry out our surveillance activities, with the NCDC coordinating, rather than controlling these activities. In all of these, the NCDC must upgrade to a coordinating, and not controlling body. One other area that we need to urgently improve is public awareness through appropriate tailored communication.” Tomori said.
National action plan for health security
NIGERIA made substantial strides in bolstering its health security framework following the Joint External Evaluation (JEE) conducted in 2017. This progress can in part be attributed to the implementation of the National Action Plan for Health Security (NAPHS) and the adoption of a one-health approach that fostered collaboration among diverse stakeholders and channeled financial investments into addressing identified gaps.
The Director General, NCDC, Dr Ifedayo Adetifa, said that the 2023 JEE conducted in August 2023 marked a significant improvement in the country’s health security, with a commendable rise in its score from 39 per cent in 2017, to 54 per cent in 2023.
Also, worthy of note is the capacity strengthening at points of entry, evidenced by the eight Nigerian ports now included in the WHO’s list of authorised ports for ship inspections and health certificates, strengthening Nigeria’s role in global maritime health security, and enabling effective inspections of ships for safety and biosecurity.
Although substantial progress has been made in enhancing human health security in the country, public health physicians say that there remains a pressing need to include and promote the environment and animal sectors within the broader health security framework.
They maintained that the integration of these sectors is crucial for a comprehensive, one-health approach that addresses the interconnectedness of human, animal, and environmental health.
“Addressing this integration gap will bolster Nigeria’s ability to anticipate and respond effectively to emerging health threats that often originate at the human-animal-environment interface,” said a professor of public health at Lagos University Teaching Hospital (LUTH) Idi-Araba, Akin Osibogun.
