$1Bn FRAUD IN NIGERIA’S HEALTH CARE, HMOs GO FREE

By Jereaghogho Efeturi Ukusare

Health Management (or Maintenance) Organisations (HMOs) are companies that provide or arrange managed care for health insurance, self-funded health care benefit plans, individuals and other entities, acting as a liaison with health care providers – hospitals, doctors et cetera – on a prepaid basis. 

In Nigeria, HMOs are expected to deliver quality health care to a designated population in a cost effective manner through health care providers that are paid either a fixed budget or discounted fees. The value-driven system is one of managed care, to provide affordable health services. The financial burden or the risks of over-using health services are borne by the HMO, it’s service providers or both. There exists various explicit and implicit rules which governs the risk-sharing. The member must receive health care from an HMO approved provider.

HMOs have exclusive provider networks. On certain occasions, they also use primary care providers (PCP) as gatekeepers. Gatekeepers are responsible for arranging a patient’s referral to a specialist or admission to a hospital.

In 2017, Nigeria’s House of Representatives’ Committee on Health Care Services organised a two-day investigative hearing where Nigeria’s Minister of Health Prof. Isaac Folorunsho Adewole revealed that the sum of N351 billion ($1Billion) had been expended on health management organisations (HMOs) so far without commensurate result. The Government of Nigeria pays 5% of consolidated salary as a premium to NHIS which in turn pays HMOs. By law, 70% of this fund is required to be paid immediately to health care services providers to provide care for those paid for. Failure to make immediate transfer is a punishable offence by law. It is pertinent to note that there is immense private sector participation in this scheme as there are 59 HMOs in this country. 

It is mind boggling that this revelation was made last year and up till now no action has been taken to punish offenders in the system. No HMO has been sanctioned. No service (care) provider sanctioned. This deliberate silence quickly brings to mind the pathetic nature of the corruption in Nigeria. More than 70 new born babies and over a 100 women die daily from avoidable mortality despite the fact that they are on the National Health Insurance Scheme.

It is still not clear what exactly is going on at this time. However, one thing is clear and it is the fact that it is only in a corrupt society that a huge amount of money as this will be  embezzled or mismanaged and the culprits will walk away free. The misery of the Nigerian masses will only be continually magnified by the mysteries of the disappearance of this money as justice is not served on the masterminds. 

RIVER BLINDNESS IS BLIND. DON’T BE!  

By Jereaghogho Efeturi Ukusare

Carrying out its God’s given assignment around a fast flowing river is the blackfly from the genus Simulium. This type of blackfly is usually found near rivers and streams. The bite of the infected female blackfly injects into the human body or animal the larvae of the worm known as Onchocerca volvulus. It is from this worm that the  disease gets its scientific name “Onchocerciasis”. This worm is a parasite. And because the fly that infects with this worm is found around rivers and streams, the disease is popularly called “River Blindness.”

Affecting approximately half a million people across sub saharan Aftica annually, in its early stages, an infected individual notices no symptoms. It could take up to a year for symptoms of this disease to appear and the infection to become apparent. Once the infection becomes severe, symptoms may include: 

skin rashes

extreme itching

bumps under the skin

loss of skin elasticity, which can make skin appear thin and brittle

itching of the eyes

changes to skin pigmentation

enlarged groin

cataracts

light sensitivity

loss of vision

In rare cases, you may also have swollen lymph glands. Obviously, this disease is “very blind.”

Adult worms can live for up to 10 to 15 years and produce millions of microfilariae within this period of time. Microfilariae are baby or larval worms. Symptoms appear when microfilariae die, so symptoms can continue to worsen the longer you are infected. The longer these organisms stay in you, the closer you are to blindness.

Several tests are currently in use in diagnosing onchocerciasis. The first thing the clinician does is to feel the skin to try to identify nodules. Your doctor will do a skin biopsy, known as a skin snip. During this procedure, they will remove a 2 to 5 milligram sample of the skin. The biopsy is then placed in a saline solution. This will make the larvae to emerge. Multiple snips, usually six are taken from different parts of the body. Other methods of diagnosis also exist. 

The most common treatment for onchocerciasis is ivermectin (Stromectol). It is considered to be safe for most people and it is administered once or twice a year to be effective. It also does not require refrigeration.

Amazingly, there is currently no vaccine to prevent onchocerciasis. For most people, the risk of contracting onchocerciasis is low. Those at the highest risk are residents of certain regions of Africa and Latin America. The best way to keep away from being blind, that is, preventing the disease from getting to you is to avoid being bitten by blackflies when you find yourself in its territory. Wear long sleeves and pants during the day, use insect repellant and wear permethrin-treated clothing. Make sure to visit a doctor if you suspect an infection so you can begin treatment before symptoms become severe. Do not go blind. It is hard. 

PRIMARY HEALTH CARE IN NIGERIA

By Jereaghogho Efeturi Ukusare

The 1% Consolidated Revenue Fund for Primary Healthcare included in the budget of Nigeria as part of the country’s 2018 Appropriation Bill that was recently passed into law is an example of responsive leadership in Africa.  The implication of this is that poor families in Nigeria will be able to get free health care. With the prevalence of malaria especially and other diseases in Nigeria that are usually quite expensive for poor Nigerian families, this is a boost not only to the health sector but also to the Nigerian economy. Nigeria looses millions of dollars in cost in the purchase of malaria drugs annually. A trend that this will not stop but take away the burden from poor families. 

The 1% of the national budget allocated to Primary Healthcare will also reduce the high rate of both maternal and infant mortality related deaths in the country. Statistics show that 10% of infant and maternal mortality in the world occurs in Nigeria.

While this seems to be one cheering news out of Africa, it is quite pertinent to place emphasis on the management of the fund. There must be prudence in  the administration of the fund for it to have any meaningful impact in the society. There was high level of corruption in the NHIS scheme, this fund is also susceptible to such. It is recommended that the Nigerian government sets in motion a mechanism that would prevent corrupt practices, mismanagement and diversion of the fund from its original purpose into the hands of individuals or for political purposes.

It is expected that there would be fiscal accountability in the management of this fund to the benefit of poor Nigerians.  

7  THINGS YOU MUST NOT DO AFTER A MEAL

1. Do not smoke after a meal!
Experiments from experts prove that smoking a cigarette after a meal is comparable to smoking TEN cigarettes (Chances of Cancer are higher).

2. Do not eat fruits immediately after meals. It will bloat your stomach. Therefore have your fruits one or two hours before or after your meal.

3. Do not drink tea after a meal as tea leaves contain a high content of acid. This substance will cause the protein content in the food you consume to be hardened, making it difficult to digest.

4. Do not loosen your belt after eating. Loosening the belt after a meal can cause intestinal problems.
5. Do not bathe after eating. Bathing will cause the increase of blood flow to the hands, legs and body thereby causing the amount of blood around the stomach to decrease. This will weaken the digestive system in your stomach.

6. Do not walk after a meal even though you have heard people say that after a meal, walking a hundred steps will make you live till 99. Walking immediately after a meal will make it difficult for the digestive system to absorb the nutrition from the food we eat. Wait at least an hour after your meal and then walk if you want to.

7. Do not sleep immediately after a meal. The food will not be able to digest properly thereby leading to gastro-intestinal problems.

IS MALARIA ELIMINATION IN AFRICA POSSIBLE?

By Jereaghogho Efeturi Ukusare

An infectious disease caused by a small flying insect known as mosquito is called Malaria. It affects humans and other animals as a result of parasitic protozoans deposited in the body by the female mosquito called Anopheles Mosquito. Symptoms of the disease begin ten to fifteen days after the mosquito’s infection and in a case where a preventive drug has been taken, it takes between 18 to 25 days. 

The disease is widespread in the tropical and subtropical regions of the world. This includes Sub-Saharan Africa, Asia and Latin America. In 2016 alone, 216 million cases of malaria was recorded worldwide and an estimated 731,000 deaths were recorded. Bulk of the cases and deaths occurred in Africa.

Malaria is commonly associated with poverty and has a major negative effect on economic development. In Africa, it is estimated to result in losses of US$12 billion a year due to increased healthcare costs, lost man hours and the negative effects it has on tourism on the continent. 

The disease is most commonly transmitted by an infected female mosquito. The mosquito bite introduces the parasites from the mosquito into an individual’s bloodstream.  The parasites move onto the liver where they mature and reproduce.

Malaria is usually diagnosed by the microscopic examination of blood using blood films or with antigen-based rapid diagnostic tests in a laboratory. The method of polymerase chain reaction to detect the parasite’s DNA have been developed. However, it is not widely in use in areas where malaria is common as a result of cost and complexity.

The treatment for malaria is a combination of antimalarial medications that includes an artemisinin and mefloquine or lumefantrine or sulfadoxine/pyrimethamine. Quinine and doxycycline could be used if an artemisinin is not available. The recommendation is that in areas where the disease is common, malaria is confirmed possibly before treatment starts as a result of increasing drug resistance of the disease. If it is not properly treated, people may have recurrences of the disease months later.

Mosquito bites could be prevented through the use of mosquito nets and insect repellents or with mosquito control measures such as spraying insecticides and draining standing water. Several medications are available to prevent malaria. Occasional doses of the combination medication sulfadoxine/pyrimethamine are recommended in infants and after the first trimester of pregnancy in areas with very high rates of malaria. 
Inspite of the fact that there is an urgent need, no effective vaccine exists and this brings to mind the essence of several meetings held by government agencies and ministries. Regional organisations and sub regional organisations have held conferences and meetings as well one of which was the “Technical Meeting on Malaria Vector Control in the Ecowas region” which was held in Cotonou in 2011. 

All of these activities have not yielded any positive results as to the elimination of malaria from the continent. Billions of dollars lost every year, lives lost every year as a consequence of the presence of the disease in Africa should ideally necessitate a joint action by African governments towards the elimination of this disease from Africa. It is strongly recommended that African Leaders make deliberate efforts by allocating sufficient funds and judiciously utilising these funds to eradicate malaria from the continent. 

THE HORRORS OF SLEEPING SICKNESS

By Jereaghogho Efeturi Ukusare

Sleeping sickness also known as African trypanosomiasis is an insect-borne parasitic disease of humans and other animals. It is caused by the protozoa of the species called Trypanosoma brucei. There are two known types that infect humans, Trypanosoma brucei gambiense (TbG) and Trypanosoma brucei rhodesiense (TbR). TbG is responsible for over 98% of cases that have been reported. 

The tsetse fly (genus Glossina) a large, brown, biting fly is both a host and vector for the trypanosome parasites. While taking blood from a mammalian host, an infected tsetse fly injects metacyclic trypomastigotes into the skin tissue. Parasites first enter the lymphatic system and then pass into the bloodstream. In the mammalian host, they transform into bloodstream trypomastigotes and conveyed to other sites throughout the body, reaching other body fluids — lymph, spinal fluid – and continuously replicates by binary fission. Rural areas are prone to this insect bite and reports on this mostly come from these areas. 

The disease can also be transmitted by:

Mother-to-child infection: the trypanosome can sometimes cross the placenta and infect the foetus. 

Accidental infections: through the handling of blood of an infected person in a laboratory and organ transplant; however, this is rare. Blood transfusion and Sex are possible ways the disease is transmitted. Horse-flies (Tabanidae ) and stable flies (Muscidae ) possibly play a role in transmission of nagana (the animal form of sleeping sickness) and the human disease form. 

African trypanosomiasis symptoms occur in two stages. The first stage, known as the hemolymphatic phase, is characterized by fever, headaches, joint pains, and itching. Fever is intermittent, with attacks lasting from a day to a week, separated by intervals of a few days to a month or longer. Invasion of the circulatory and lymphatic systems by the parasites is associated with severe swelling of lymph nodes, often to tremendous sizes. Winterbottom’s sign, the tell-tale swollen lymph nodes along the back of the neck, may appear. Occasionally, a chancre (red sore) will develop at the location of the tsetse fly bite. If left untreated, the disease overcomes the host’s defenses and can cause more extensive damage, broadening symptoms to include anemia, endocrine, cardiac and kidney dysfunctions.

The second phase of the disease, which is the neurological phase, begins with the parasite invading the central nervous system by passing through the blood–brain barrier. Disruption of the sleep cycle is a leading symptom of this stage and is the one that gave the disease the name ‘sleeping sickness.’ Infected individuals experience a disorganized and fragmented 24-hour rhythm of the sleep-wake cycle, resulting in daytime sleep episodes and night time periods of being awake.

Other neurological symptoms include: confusion , tremor, general muscle weakness, hemiparesis , and paralysis of a limb. Parkinson -like movements might arise due to non-specific movement disorders and speech disorders. The individual may also exhibit psychiatric symptoms such as irritability, psychotic reactions, aggressive behaviour or apathy which can sometimes dominate the clinical diagnosis. 

Without the administration of any treatment, the disease is invariably fatal. This manifests with progressive mental deterioration leading to coma, systemic organ failure and finally death. An untreated infection with T. b. rhodesiense will cause death within months whereas an untreated infection with T. b. gambiense will cause death after several years. Damage caused in the neurological phase is irreversible.

The standard for diagnosis is identification of trypanosomes in a patient sample by microscopic examination. Patient’s samples that can be used for diagnosis include chancre fluid, lymph node aspirates, blood, bone marrow and during the neurological stage, cerebrospinal fluid. Detection of trypanosome-specific antibodies can be used for diagnosis, but the sensitivity and specificity of these methods are too variable to be used alone for clinical diagnosis.

Trypanosomes can be detected from patient’s samples using two different preparations. A wet preparation can be used to look for the motile trypanosomes. Alternatively, a fixed (dried) smear can be stained using the Giemsa ‘s or Field ‘s technique and examined under a microscope. Often, the parasite is in relatively low abundance in the sample. Hence, techniques to concentrate the parasites should be used prior to microscopic examination. For blood samples, these include centrifugation followed by examination of the buffy coat; mini anion-exchange/centrifugation; and the quantitative buffy coat (QBC) technique. For other samples, such as spinal fluid, concentration techniques include centrifugation followed by examination of the sediment.

At the moment, there are few medically related prevention options for African Trypanosomiasis. That is, there exists no vaccine for immunity. Although the risk of infection from a tsetse fly bite is extremely low, the use of insect repellants, wearing long-sleeved clothing, avoiding tsetse-dense areas, implementing bush clearance methods and wild game culling are the best options to avoid infection available for local residents of affected areas.

During the 36th summit of the Organization for African Unity in Lome, Togo, in July 2000, a resolution was passed to form the Pan African Tsetse and Trypanosomiasis Eradication Campaign (PATTEC). The campaign works to eradicate the tsetse vector population levels and subsequently the protozoan disease by use of insecticide-impregnated targets, fly traps, insecticide-treated cattle, ultra-low dose aerial/ground spraying (SAT) of tsetse resting sites and the sterile insect technique (SIT). The use of SIT in Zanzibar proved effective in eliminating the entire population of tsetse flies but was expensive and is relatively impractical to use in many of the endemic countries afflicted with African trypanosomiasis.

Very frequent active surveillance which includes detecting and prompt treatment of new cases and tsetse fly control is the thrust of the strategy used to control sleeping sickness. Systematic screening of communities is the best approach to tackling this disease. 

Intravenous or intramuscular pentamidine for T. b. gambiense or intravenous suramin for T. b. rhodesiense is employed in treating the first stage of this disease. 

For the second stage of T. b. gambiense a regiment involving the combination of nifurtimox and eflornithine, nifurtimox-eflornithine combination treatment (NECT), or eflornithine alone is apparently more effective and results in fewer side effects. These treatments may replace melarsoprol when available with the combination being first line. NECT has the benefit of requiring less injections of eflornithine. Intravenous melarsoprol was previously the standard treatment for second stage which is the neurological phase of the disease and is effective for both types. Melarsoprol is the only treatment for second stage T. b. rhodesiense. There are cases of resistance to this treatment. Sadly, it causes death in 5% of patients who take it.

The disease has occurred in 37 countries in sub-Saharan Africa. It occurs regularly in southeast Uganda and western Kenya. It is recorded to have killed more than 48,000 Africans in 2008 alone. The Democratic Republic of the Congo is the worst hit country in the world accounting for 75% of the Trypanosoma brucei gambiense cases. 

African governments should step up their efforts at surveillance as this is the key to success in the fight against this disease.

THE HEALING POWERS OF WATER LEAF

 
Waterleaf, also known as Talinum triangulare is one of those underrated and undervalued plants in Africa. Some even regard it as a nuisance, a stubborn weed that grows all year round, though it flourished more during the rainy season. In many scientific studies and trails, waterleaf showed that it can inhibit proliferation of cancerous cells and shrink tumours. Other studies have been focused on its cerebral-protective potential and it indicates that consumption of waterleaf enhances brain activities and protect brain tissues.Waterleaf is also a good remedy for insomnia (sleeping disorder).

Water leaf contains more proteins than cashew nuts, more pectin (a food fiber that helps digestion) than apples, and also have high level of vitamin B, essential amino acids, omega3-fatty acids, resins, iron, calcium, copper, lead, manganese and zinc. It is also a rich source of carotenoids, vitamin C, A, thiamine, riboflavin, niacin, alpha and beta tocopherols.

The pounded waterleaf is applied to soothe inflammations. An infusion of the leaves is taken as a diuretic. For prostate enlargement, the roots are boiled. The dosage is half a glass twice daily. Waterleaf is good and safe for pregnant women and growing children, as it boosts their blood levels. Eating waterleaf regularly as soup helps to regulate hypertension and diabetes.
While waterleaf is very beneficial when it is taken as vegetable, dried herbs and infusion, juicing is the way to go if you want the best out of waterleaf. 

Juicing is a process whereby you extract vitamins, minerals and liquids from fruits and vegetables.
To juice waterleaf, simply chop waterleaf, both stem and leaves in the same way you do when you want to cook it. Put two or three handfuls in the blender and add one liter of water. Blend in same way as you blend your tomato or fruit. Sieve out the chaff and you will be left with a dark green liquid, packed with vitamins and minerals. Ensure you drink and finish the whole drink within 10 minutes. 

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