MEDICAL PRACTICE IN DEVELOPING COUNTRIES, PAST, PRESENT & FUTURE.

Some 40 years ago, there were many diseases in the developing countries like Nigeria that were prevalent.

Malaria, for instance, has stayed with us through the years and still very prevalent today and does not seem for be ready to leave us in the near future, despite the various advances in research, diagnosis, treatment and prevention. It was a top killer and a major morbidity factor as well as a principal work/school hour loss entity and unfortunately, it still is today! 430,000 deaths due to malaria is reported yearly, 90% in sub-Saharan African countries.

The economic cost of dealing with malaria in a country like Nigeria can be very intimidating if projected realistically to the nearest available level of accuracy. In the  past as well as at present, the efforts in prevention, diagnosis and treatment, money wise are colossal. Yet there is nothing to show for it on the ground. I also very much doubt that the situation will change positively in the nearest future. It is reported that in Nigeria, the National Malaria Elimination Program costs the Nigerian economy N132billion ($660billion) annually.

With the hundreds of thousands of imported insecticide treated mosquito nets, available mainly to Government Hospitals and agencies who are responsible for caring for less than 20% of the population while the private Hospitals and institutions are responsible for over 80% of the care and preventive activities. The private hospitals and institutions are technically side lined in the distribution of these seemingly very important commodity in virtually all the areas of the country Nigeria. Hence the desired impact is not being made.

In addition, with the great heat being experienced in a season like the current one, complicated by the electricity power outage in most places, some for days, the statistics looks somehow like this -

Less than 0.o1% of the population has access to the insecticide treated mosquito nets.

Less than 0.01% of these use their net every night.

Hence the protection percentage this brings to the community is very negligible. As a result, malaria thrives with impunity.

Can this be better? I am not so sure.

Even if the nets are free and get to be distributed to every household, and all are reminded to use it every night, the statistics cannot improve more than a few numbers, Why? Because about 10% of Nigerians do not live in houses, huts or enclosures! They live and sleep in the open, where insecticide treated mosquito nets are nowhere on their mind, thought or agenda. Check the urban population and what you will see shall surprise you!

Mosquito repellants/Killers. These abound in many shops and supermarkets and pharmacies. Yet few can afford to buy them - less than 0.01% of the population. Most of them are actually not effective due to resistant strains of the mosquitoes and also due to fake products, many like the nets are being imported.

Preventive drugs - are not only expensive to get but also have a lot of fakes.  Coupled with this is the policy problem that changes almost every year, recommending this and that today and reversing the same tomorrow, confusing not only the physicians, not to talk of the populace.

Early diagnosis - is a form of preventive tool. Yet despite the available technologies and resources, this is scarcely applicable since less than 0.001% of the malaria diagnosis are ever made in the country.

Where do we go from here? The answer is very difficult to imagine not to talk of being given, because non of the parameters are getting better, except with those who are dealing with doctored and incomplete figures emanating from the Government Ministries, excluding the 80% private practice figures and the other huge percentage of self medications and patent medicine stores and numerous quacks, to me, they are rather getting worse on daily basis.

To be continued.

You input and contributions are welcome and will be appreciated.

Continuation.......

The issue of Malaria in Nigeria for example can be looked at from these perspectives

1. The Anopheles mosquitoes - to reduce or eliminate this notorious vector must be part of a sensible approach to reduce and possibly eliminate Malaria. Apart from the environmental sanitation to discourage the active breeding of the mosquitoes, major periodic drives at pesticide control in specific areas of high concentration as well as in living houses and public and private buildings and fields, a genetic approach, proven scientifically to make the mosquitoes sterile should also be used actively.

2. To prevent the Mosquito bites, the insecticide treated mosquito nets is a very important weapon. But why import the nets into Nigeria for example when Nigeria and Nigerians have all it takes to manufacture the nets and the insecticides? An investment of about 25% of the cost of monthly importation of this item in a space of one year is more than enough to make Nigeria self sufficient in the production of the insecticide mosquito nets it will need continually, while saving costs, ensuring a world acclaimed production standard, improving gainful employment and helping the locals to gain extensively in the marketing chain and make profits until Nigeria can export and possibly donate them.

The issue of Diagnosis - There is a lot of interesting policy statements and approach to this and they tend to vary every few months, signifying the complexity as well as the great scope and misunderstanding of the Malaria Endemic in a country like Nigeria.

For instance, you (WHO) recommend that before treating Malaria, the client must be tested and confirmed to have Malaria. As good as this is, how practical can it be? Imagine a General hospital in my neighborhood in Kubwa for example, has about two Doctors in the Medical out patient to attend to about 200 clients and 50% of them have symptoms related to Malaria. 100 clients in one day will be sent to the Laboratory manned by two medical laboratory Technicians and a Laboratory Scientist to be tested for Malaria using the imported rapid test kits. When you look at the cost implication as well as the work load and the materials needed to make this work, you will shake your head and realize that it is probably much cheaper, faster and less wasteful to treat those with high level clinical diagnosis outright and then send the doubtful cases for the test. Remember, the clients will still come back for review with the test results and the Laboratory staff have many other tests to do apart from malaria test some of which are more complex and more time consuming. A very interesting issue indeed!

Moreover, the test kits are all imported, whereas Nigeria for example have all it takes in manpower and resources to manufacture these kits and use the at a much cheaper rate and high international standard. Doing this will not only make the country richer, better, healthier and more self reliant than the import all approach we have been using and are still using today!

90% of the drugs used in treating Malaria in Nigeria today are imported. Why should that be in country of over 165 million people? Do we not have any vision of self sufficiency nor the basic joy of being a manufacturing nation with the great economic as well as employment gains? We have the resources, we have the manpower yet all we do is sit down and import and import. This should not continue! There must be a change for Malaria to be put under control.

To be continued.....

(Thank you very much for finding time to read this post and the update. Your opinion and contributions are highly welcome. Remain blessed. Amen.)

Continuation ...

 In the nearest future in Nigeria for example, the burden of Malaria can be reduced drastically if the following steps are taken - and seriously too. Other developing Countries can do the same too.

1. In-Country manufacturing of the insecticide treated mosquito nets in adequate quantity and continually with a comprehensive distribution network that is appropriate, fair and not wasteful and its effective use.

2. Serious efforts in reduction of mosquitoes all over the country including environmental sanitation and biological elimination.

3. Serious and continual research on mosquitoes, malaria diagnosis and treatments in both public as well as private institutions and making use of these findings in a timely and scientific manner.

4. Serious and continual training of all Medical and all health workers and annual certification on all the basic aspects of Malaria prevention, diagnosis and treatment.

5. In-Country manufacturing of diagnostic kits, anti-malaria drugs in adequate quantity and continually.

6. Review of cheaper drugs like Chloroquine which are being discarded on non adequate research and truly proven verdict of inefficiency and resistance.

7. Propping up support for the private sectors, in terms of funding, training and research as well as documentation and reports to make the overall statistics more meaningful and a truer reflection of the incidence all over the nation.

8. Self Medications, patent medicine store treatments and quackery as well as fake drugs must be discouraged and possibly eliminated in order to make the right diagnosis and treatment to be the standard all over the country.

These measures are in no wise exhaustive.

Conclusion - But depending on external grants, importations and poor personnel training and poorly conducted researches and concentration on Governmental institutional activities while neglecting the private hospitals and clinics caring for 80% of relevant cases will not help the developing Countries in their fight against malaria.

Kindly feel free to add and correct as you deem fit.

Thank you for you attention.