An Overview of the Nigerian Health Policy

The Nigeria health system

Bombarded with quality health policies both mental and physical health provision for its citizenry, the Nigerian health system has for years seek to improve through awareness, prompt emergency response and free treatment amongst other measures, the lifestyle and other factors that facilitate the wellbeing of Nigerians. The primary health care being the third tier on the ladder of the health sector, serve as the avenue through which all and sundry can run to in times of health crises with the assurance of receiving if not comprehensive but at least first-hand medical attention and treatment. Most evident in this case is the diagnosis and treatment of malaria. Across the century, in virtually every pharmacy store and primary health centre, boldly written on posters are the words “not every fever is malaria” advocating for a “Rapid malaria test” usually done within 3 minutes or less and if confirmed, malaria drug (ACT) is prescribed/given at affordable price.

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According to the foreword in the revised health policy by the then honourable minister of health in 2004, Professor Eyitayo Lambo, who stated the relationship between the health policy and the health care system nationwide “the national health policy represents the collective will of the government and people of this country to provide a comprehensive health care system that is based on primary health care”. The health policies which provide the foundation for the planning, organization and management of the nation’s overall health system.

The national health policy encompasses major intention program as setup by the ministry of health at the federal level including HIV/AID, roll back malaria, Immunization, control of onchocerciasis, control of tuberculosis and leprosy, blood transfusion, elimination of female genital mutilation; others include reproductive health, adolescent health, food and nutrition, child health policy, drug policy and food and hygiene policy. With each providing overall goals and strategies for their implementation.

Over the years, such measures taken by the government in the form of interventions have yielded positive results across the nation as incident cases of some disease have been properly handed as reported in some quarters.

To be continued….

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Inability to cope with stress indicates lack of cortisol

Addison’s Disease and Its Presentation

After a long break due to the Christmas and New Year holiday, group 7 finally had a day to present on Addison’s disease.
Virtually, everyone undergoes stress be it mental or physical and how come they recover soon, that’s because there is a secretion of cortisol by glucocortisol the Zona fasciculate, a layer of the adrenal cortex. So what happens if this secretion stops and how does the body respond to stress?

Addison disease result in the inability or the deficiency of the adrenal cortex to secrete its hormone. (Adrenocortical hormone). The adrenal cortex is sub-divided into three layers namely
*Zona glomerulosa which is responsible for the secretion of mineralocorticoid aldosterone which utilizes cholesterol to synthesis sex hormones including estrogen, progesterone, testosterone amongst others
Zona fasciculate, which secrete glucocortisol, the cortisol. Their secretion is controlled by the hypothalamic pituitary axis via adrenocorticotropic hormone (ACTH)
Zona Reticularis which secretes the adrenal androgens dehydroepinandrosterone (DHEA) and androstenedione
It is important to state that all human steroid hormone including those produced by the adrenal cortex are synthesized from cholesterol. What happens when these hormones are not secreted due to certain factors i.e. adrenalism result of Addison disease.

Causes of Addison Disease
Atrophy or injury if the adrenal cortex autoimmunity against the cortices in about 80% cases resulting in atrophy.
Tuberculosis causes the destruction of the adrenal glands or invasion of the adrenal cortices by cancer
Another case could be adrenal insufficiency due to impaired function of the pituitary gland which fails to produce sufficient ACTH, low ACTH causes decrease production of cortisol; and aldosterone.

Symptoms of Addison’s Diseases
Deficiency in mineralocorticoid results in reduction of renal tubular Na+ reabsorption and consequently loss of Na+, Cl- and water into urine resulting in decrease ECF volume other consequences includes hyponatremia, hyperkalemia and mild acidosis which can result in shock. This is due to the failure of potassium and hydrogen ion exchange for sodium  reabsorption
Glucocorticoid deficiency results in lack of cortisol causing decrease in the mobilization of both proteins and fats from tissues thus depressing many other metabolic functions resulting in weak muscles; deficiency of cortisol also makes the patients highly susceptible to the deteriorating effects of different types of stress.
Melanin pigmentation: there is pigmentation of mucous and skin melanin appears as blotches on the skin. Due to decrease in cortisol secretion, there is no feedback to the hypothalamus thus there is increased secretion of ACTH by the hypothalamus as well as simultaneous increase in the secretion of Melanocytes Stimulating Hormone. Increased ACTH in the blood causes pigmenting effect.

Treatment Replacement
The possible way of correcting Addison disease is hormonal replacement, small quantities of mineralocorticoids and glucocorticoids are administered.

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Air Force Commissions Cancer Screening Centre In Kaduna.

Source: Channels Television

The project, which is an initiative of the Chief of Air Staff, Air Marshal Sadique Abubakar is part of the efforts to pay significant attention to the general well-being of Nigerian Air Force personnel, their relatives and members of the host communities.

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Photo credit: Channels Tv

Speaking during the commissioning of the centre located inside the NAF Hospital in Mando, Kaduna, the Air Force boss, represented by the Air Officer Commanding Training Command, Air Vice Marshal Nurudeen Balogun, said that the aim is to provide personnel of the Nigerian Air Force, their families and members of the host communities the opportunity to carry out routine medical checks in order to detect cancers early enough and commence treatment.

It was built to fill the gap, complement government healthcare delivery programmes and help in reducing the devastating effect of diseases in the country.
Records have shown that cancer, especially cervical cancer, has led to early and untimely death of women in recent time.

This, the Air Force acknowledged, is being occasioned by inadequate screening centre for early detection and treatment.
While expressing worry over the prevalent rate of cancer, especially among women, Air Vice Marshal Nurudeen Balogun urged officers and men of the service and their families to take advantage of the facilities provided in order to remain cancer free.

The Director of Medical Services, Nigerian Air Force Headquarters, Air Vice Marshal Saleh Shinkafi, said that the centre has been equipped with modern facilities for the screening of all types of cancer for early detection and treatment.

He also highlighted the importance of the cancer registry to provide a reliable database for research and planning for public health intervention programmes.
According to statistics, over half a million people globally die from breast cancer annually while over six million people are living with the disease worldwide.

In Nigeria, about 71,600 deaths are recorded annually from cervical cancer with many yet to be detected.

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Lassa fever reemerges in Nigeria

by PAUL ADEPOJU on DECEMBER 20, 2016
Source: HealthNewsNg

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Panic as Lassa fever reemerges in Nigeria

Lassa fever has reemerged in Nigeria with the official announcement by the Federal Medical Centre (FMC) Abeokuta today (Tuesday) of the death of a nursing staff to Lassa fever, the hospital also announced that two others have been placed observation.

According to the hospital management, the nurse died last week after battling with the sickness, which is also known as Lassa hemorrhagic fever (LHF). The hospital’s Head of Information, Segun Orisajo confirmed the development to
Daily Trust , but assured that the management has put up necessary measures to curtail the situation.

He said the name of the victim is Adebusuyi Bolanle, she died from complications which arose from contacting the fever.
“Yes, I can confirmed that we lost a staff Nurse to the Lassa fever and two others are undergoing observation as I speak with you. The immediate families of the deceased have been contacted and they were here today (Tuesday) for observation.

“The state commissioner for health, Dr. Babatunde Ipaye has been here too to carry out the necessary steps to stop the spread. The management can assure staff and patients that everything is under checks,” Orisajo said.

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Non-communicable Diseases Take over Africa

Non-Communicable Disease arm of World Health Organization report that over 1.7 million people die in Africa due to preventable and manageable diseases (NCD), the highest prevalence in the world.

Non-Communicable Disease also known as chronic diseases are slow progressive and long duration diseases not passed from person to person, they include cardiovascular diseases (like heart attack and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and Diabetes. Children, adults and the elderly are vulnerable to the risk factors (unhealthy diets, physical inactivity, exposure to tobacco smoke or effects of the harmful use of alcohol) contributing to NCD chiefly low and middle income earners.

According to report, all age group and all regions are affected by NCDs but about 82% occurred in low and middle income countries. Forces including ageing, rapid unplanned urbanization and the globalization of unhealthy lifestyles help facilitate the advance of these diseases leading to death e.g. globalization of unhealthy lifestyles like unhealthy diets might show up in individuals as raised blood pressure, increased blood glucose, elevated blood lipids and obesity referred to as ‘intermediate risk factors’ leading to cardiovascular diseases, a NCDs.

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Risk factors-modifiable behavioural risk factors
Behaviours such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol are the risk factors of NCDs. Below are statistics as provided on WHO website.
*Tobacco accounts for around 6 million death every year (including from the effects if exposure to second hand smoke) and is projected to increase to 8 million by 2030
*About 3.2 million deaths annually can be attributed to insufficient physical activity.
*More than half of the 3.3 million annual deaths from harmful drinking are from NCDs
*In 3020, 1.7 million annual deaths from cardiovascular cases have been attributed to excess salt/sodium intake.

The above risk factors leads to metabolic/physiological changes hiking the risk of NCDs and eventually death. These metabolic changes includes raised blood pressure, overweight/obesity, hyperglycaemia (high blood glucose levels) and hyperlipidaemia (high levels of fat in the blood)

Prevention and control of NCDs
*A comprehensive approach towards all sectors including health, finance, foreign affairs, education, agriculture, planning and others to work together to reduce the risks associated with NCDs and also the promotion in the interventions to both prevent and control them.
*Lessening the risk factors associated with these diseases is an important way to reduce NCDs
*High impact essential NCD interventions delivered through a primary health centre approach to strengthen early detection and timely treatment. Creation of healthy public policies that promote NCD prevention and control and reorienting health systems to address the needs of people with such disease.

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Source: WHO report on NCDs

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The Physiology of Stress

“Group 6 it’s your turn” as Dr. Davies took his seat at the beginning of his lectures. Hospital practice-course title, has been that platform for all students offering it to display their skills in research and lecture delivery. “We’ll be discussing cortisol and it effect on stress” the group leader said by way of introduction. Sit back, take your time as I bring you bit by bit information on the physiology of stress, causes and management.

Dr. Davies Kofrey defined stress as the condition capable of unbalancing homeostasis in the body. Stress is an inevitable part of life ranging from physical stress which includes change in weather conditions, increase in body temperature; emotional stress: anger, fear; to bacteria invasion in the body causing infection and sickness.
Stress can be both beneficial-physiological or destructive. A good example physiological stress is muscular exercise with its attendant imbalance in the body for example mild hypoxia with might result in the production of ketone in the body. And of course, worry and anxiety could be classified as negative stress.

Stress of any kind whether it be physical or neurologic can cause an immediate and marked increase in ACTH secretion by the anterior pituitary followed within minutes by adrenocorticotropic secretion of cortisol. Cortisol is an emergency-stress response hormone secreted at any incidence of stress (listed below). It mobilizes labile proteins and make amino acids available to needy cells in the synthesize of essential substance need for life. Various stressor of the body includes: Infections, intense mild/heat, surgery, almost any debilitating disease including schizophrenia, rheumatoid arthritis and poliomyelitis amongst others.

Short and Long Term Effects of Stress
During periods of increased stress, the immune cells which produces antibodies are bathed (immersed) in molecules which essentially tell them to stop fighting. These molecules which are cortisol molecules suppresses the immune system and inflammatory pathways rendering the body more susceptible to disease (Onyinyechi, 2016). Other significant effects of stress include prolonged healing time as a result of increased blood clotting time, reduction in ability to cope with vaccinations and heightened vulnerability to viral infection.
Onn a long time scale, effects of stress are seen in impaired cognition-trouble in remembering and learning; decreased thyroid function amongst others.

Managing stress: Simple both effective way of combating stress includes Exercise, relaxation, deep breathing, consulting a specialist say a psychologist, etc.

Remember, stress is a normal part of life but at times it may be too much and feels out of control.

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Pain Sensation, Its Benefit and Response

Pain Sensation

Pain is the unpleasant and emotional experience associated with or without actual tissue damage. It could be sharp or slow, acute or chronic. It is expressed in terms of injury for example, pain produced by fire is expressed as burning sensation; pain produced by severe sustained contraction of skeletal muscles is expresed as cramps.

Benefits of Pain Sensation
Within the skin is found in ‘free nerve ending’- a kind of receptor for pain-an important sensory system.
It protective as well as survival benefits are listed below.
1. It gives warning signal about the existence of a problem or threat; it aslo creates the awareness of injury
2. It prevents further damage by causing reflex withdrawal of the body from the source of injury.
3. It forces the person to rest or to minimize the activities thus enabling the rapid healing of the injured part.
4. It urges the person to take required treatment to prevent major damage.

There are three significant reactions besides the distinct sensation of hurt when a lesion is inflicted on the body. They are:
1. Motor reactions: pain sensation leads to withdrawal, a reflex which remove part or all the body from the painful stimulus e.g withdrawal reflex.
2. Emotional reactions: pain has an unpleasant effect with reactions seen as those of anxiety, anguish, crying, depression, etc
3. Autonomic reaction: Rise in blood pressure, peripheral vasoconstriction (reduction in the diameter of blood vessel), tachycardia (increase in the heart rate above 100/minute due to emotional response such as anxiety) and sweating.

Subdivisions of Pain
Pain can be subdivided into major types: Acute and Slow pain
1. Acute pain: This type of pain is felt when a needle is struck into the skin or when the skin is cut with a knife. It is usually not fleet in most parts of the deep tissues of the body. It occurs with about 0.2 second when a pain stimulus is applied. Type A delta fibers which are myelinated conduct pain at a rate of 6-30m/s.
2. Slow pain: This type of pain is associted with tissue destruction. It can also lead to prolonged unbearable suffering and can occur both in the skin and in almost any internal tissue or organ of the body. It occurs after a adecond or more, and increases slowly over a period of many seconds and sometimes, even in minute. Type ‘ fibers which are unmyelinated conduct at a rate of about 1m/s.

The receptors of both the components of pain are the same I.e the free nerve endings but the afferent nerve fibers are different. The first pain sensation are carried by A delta fibers and slow pain is conducted by C type of nerve fibers.

It is important to note-The non-adapting nature of pain.
Pain receptors adapt very little compare to other sensory receptors which include Meissner’s for touch, Merkel’s disk (touch), Pacinnian corpuscle (for pressure), Krause’s end bulb (cold), Raffinis end organ (warmth).

In some conditions, excitation of pain fibers increase as long as the stimulus persists especially for slow aching pain. This increases in sensitivity is termed hyperalgasia. The importance of this is that it keeps us aaware of the tissue damaging stimulus ad long as it is there, prompting us to take action.

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