Neglected Tropical Diseases, NTDs, are silent destroyers of homes – Dr Olamiju

Dr Francisca Olamiju is the Executive Director of Mission to Save the Helpless (MITOSATH), a non-governmental development organisation committed to improving the quality of life of the poor and rural indigents through advocacy, raising awareness, resource mobilisation and energising the collective will of all stakeholders, all of which is aimed towards the control and elimination of Neglected Tropical Diseases (NTDs). In this interview with DANIEL ANAZIA, she examines the effect of the diseases and the successes recorded so far in the fight against the scourge.  

Not many Nigerians are aware of what Neglected Tropical Diseases (NTDs) are

FOR the purpose of simplicity and for people to understand, NTDs are a group of communicable diseases through parasitic and bacterial infections that prevail in tropical and subtropical countries and affect more than 1.5 billion people across the world. Children account for about 850 million of the affected population. It is called the disease of the poor because those affected are people who are socially and economically poor. They can be regarded as people living where there is no road. 40 percent of these diseases are concentrated in sub-Saharan Africa. They are caused by a variety of pathogens such as viruses, bacteria, protozoa and helminths. Though 20 of these NTDs are prioritized by the World Health Organization (WHO), Chromoblastomycosis and other deep mycoses, scabies and other ectoparasites and snakebite envenomation were added to the list in 2017. And like I said, these diseases are common in 149 countries, costing developing economies including Nigeria billions of dollars every year. Virtually all states in Nigeria including the Federal Capital Territory are affected by one form of NTD or the other.

These diseases include river blindness, which is scientifically called Onchocerciasis. You have bilharzia, which is also known as schistosomiasis; you also have elephantiasis, soil-transmitted helminthiasis, which is caused by three major worm species, which include Ascaris (roundworms), Trichuris (whipworm), the hookworms Necator americanus and Ancylostoma duodenale, and Strongyloides stercoralis. You also have Trachoma, which is an infectious disease caused by bacterium Chlamydia trachomatis. The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness. Like I said earlier, there are about 20 NTDs that have been prioritised by the WHO; however, Nigeria is currently focusing on five, which I had just mentioned. All 36 states and the FCT inclusive are affected and none is totally free from any of these NTDs mentioned. But for us at MITOSATH, we have six states that we have been assigned to focus our mission services on and these states are Taraba, where we started, Lagos, Ondo, Bauchi, Ekiti and Niger state respectively.

We are carrying out our mission services in these states through the support of the governments, partners and donors, and the people of these states. We have been in existence since 1996, so this year makes it 25 years of embarking on a mission to save the helpless in our society. People will want to ask what has been our achievement in these 25 years of our existence. Our achievements are out there in the open space and can be verified. We started with about 22,000 treatments in 1996 and by 2005; we had expanded to about 936,000. But over the years, we treated about 32 million people. It is good news to us because it was all started by General T. Y Danjuma, beginning with his home state, Taraba. Also, it is good news because it is one of the things I want to live to see because nobody should be blind due to river blindness. I say this with the utmost confidence because recently we went back to those communities where we have carried our MITOSATH activities and there is nobody, not even a child that has been affected by river blindness in the past 15 years. Prior to our visits, the communities were regarded as the village of the blind. As a matter of fact, we had two generations of blindness. What we did was administer Ivermectin, which is also known as Mectizan annually. These medications are free. But people would ask for how long. The pharmaceutical company says it is free and available for as much as it is required and as long as it is needed. So this commitment spurred us to resolve that there is no reason anybody should be blind as a result of river blindness.

What is the number of those affected by these diseases in the country?

As I mentioned earlier, every state in the country with the FCT inclusive is affected by one form of these NTDs or the other. In a 2009 analysis of the NTDs in sub-Saharan Africa, Nigeria was identified as one of the countries with the greatest number of cases of high prevalence NTDs such as intestinal helminth infections, schistosomiasis, and lymphatic filariasis (LF). Nigeria has the greatest number of cases of intestinal schistosomiasis caused by Schistosoma mansoni and urogenital schistosomiasis caused by Schistosoma haematobium. In terms of the high prevalence of vector-borne NTDs, Nigeria has the greatest number of cases of LF and onchocerciasis in Africa, ranking globally third and first, respectively, and accounting for one-fourth or more of the global disease burden from these two NTDs. 

Nigeria also has an estimated 18 million people at risk for trachoma, with nearly 1.3 million people living with trichiasis, and the third or fourth largest number of new cases of leprosy in Africa (behind Ethiopia and the Democratic Republic of Congo), in addition to some of the greatest number of cases of the lower prevalence NTDs, including yellow fever, rabies, and Buruli ulcer, which are high in prevalence in Africa. Despite these alarming statistics, the good news is that Nigeria has made some important strides in controlling and eliminating these NTDs. In 2018 alone, MITOSATH delivered about 32 million treatments covering the five areas of intervention.

How can these NTDs be totally eradicated in Nigeria?

The good news and what has been proven is that if people are treated annually with the donated medicine, and other donors take a cue from what those who have donated the medicine have done, like the Mectizan Donation Programme, which started this fight against NTDs, the high prevalence will reduce drastically. Mectizan is free for as long as it is needed, and for as many people that need it. Mectizan is for river blindness alone. A combination of Mectizan and Albendazole, which is donated by GSK takes care of onchocerciasis (river blindness) and lymphatic filariasis or what we all know as elephantiasis (swollen leg). For children or anyone urinating blood, which is scientifically called Hematuria, the drug is available. Pharmaceutical companies have formed a group and through the WHO they bring these drugs to Nigeria. On how to prevent and eradicate it totally, everyone that needs to take the drug should take it, and that is where MITOSATH plays a role.

  As said earlier, we have been assigned five states — Taraba, Lagos, Bauchi, Ekiti, Ondo, and Niger states. Other NGDOs have been assigned to other states. In Taraba, following the success recorded families that hitherto were separated are now back together, and the beneficiaries have become the goodwill ambassadors, as they now spread the good news around, encouraging other people who have similar problems to come forward for treatment. We have an 80-year-old woman, who is a beneficiary and has lost her husband. She wants corrugated zinc over her mud house, and we are working towards helping her fulfill that dream. We have so far carried out over 700 successful surgeries on lymphatic filariasis caused by elephantiasis and swollen scrotum. Today, the economic and socio-economic lives of those people are no longer the same. Some of them have remarried; those whose wives left due to the medical condition have returned; a majority of them are back to the farm because they are predominantly farmers.

Having helped and still helping these indigents of the society, what from your viewpoint is the economic and social impact of NTDs in their lives?

First off, NTD is a silent destroyer of homes, particularly lymphatic filariasis and I tell you why. When a man cannot manage his home because he can’t go to work, he cannot even dress up normally because he has to wear a flowing gown to cover the swollen genitalia, what do you expect such a man to do? He can’t bend down because he is in pain, he can’t go to where they pray; socially he is marginalized because people know he can’t satisfy his family. By this, I mean fulfilling his conjugal obligation. This has resulted in many of them losing their wives, because they abandoned them. Once a man is hit by NTD, he cannot be able to support his family. So the impact is really very difficult to measure but it is the daily adjusted life that we are saving. We are saving people from living that daily adjusted life of sub-optimal socially, economically, mentally, emotionally and otherwise; just anyhow you choose to look at it. The bottom line is that these NTDs are silent killers of homes. It is against this premise that we are now expanding awareness and advocacy through campaigns with leaflets, radio talks with phone-in programmes. Through this medium, we bring those whose lives have been turned around through surgeries and medical rehabilitation to testify of the impact of medical rehabilitation. Thus we encourage other people who are having similar ailments to come forward and access medical support.

Would you say that we have done enough in the fight against NTDs either through preventive control measures or elimination in our society?

I will say yes; in Yoro Local Government in Taraba State, we have about 800 people that had successful surgeries. I will say that quite a significant number given the population of Taraba State, which is estimated to be over two million people. So if we have 600 males that have benefited from the surgery programme initiative  by MITOSATH, and economically their life is better, I will say yes we have tried but because we still have the list of those requiring surgery stilled up as people their own success stories, there is a lot more that needs to be done. A lot of people used to be shy of talking about it but because people that have benefited from the surgery initiative have come out to testify and they are now goodwill ambassadors, more people are now coming out to access medical support. I’m also aware that in Taraba State, the intervention for Trachoma, of course, Taraba lies on the Trachoma belt of Nigeria, we have also carried out MDA with the support from our partners for three years and in the impact assessment we were greatly commended and applauded. So we have also controlled Trachoma in two LGAs to a point that it is no longer a public challenge. We are awaiting the assessment of our activities on schistosomiasis (deworming of children). Though we are excited with the success stories so far, we are not going to bed because we have some states and countries (Cameroun, Niger) bordering us, and due to the security challenge in that part of the country we are not able to do as much as we intend. The question now is, how are we going to ensure that where we have cleaned out are not infected again?

So there is a need to partner with these neighbouring countries and states to ensure that the places are intact. Also, we need to ensure that the drugs are released on time. Last year was an example, we had some bureaucratic delays and we could support our beneficiaries on time. That affected a lot of activities that we could have sorted out before the end of the year. So, we have done a lot, but as you know, Nigeria is a very big country; there is still a lot more to do. We have a gap in the area of sustainability. We are lucky in that we have donors to come to aid and support our activities. There are some things donors cannot do; things as measuring impact, announcing where we have cleaned out, things around the sustainability of the programme, and inviting the WHO to come to assess and certify us in certain areas; doing the paper works are strictly for the government. You cannot write an exam and mark it. There is a need to put surveillance in place to sustain the cleaned-out places. We know the impact of climate change around the world; we don’t want a comeback of these diseases. For example, where we have contained river blindness in Taraba State, we don’t want it to come back.

Talking about the government, how much support are you getting?

Yes, there have been some giant strides in the country, but the question is how we ensure they are sustained and make sure that whatever distance that is left the programme will be highly successful. I think that is why the idea of having World NTDs Day, is being celebrated every January 30. The whole essence of the celebration is to create more awareness about NTDs and the interventions that will help mitigate them. Since the inception of the fight against these diseases, people have not been mobilized to create awareness to talk about it. So, this is the reason the level of compliance among people is very low because they have their biases and myths. Some even believe it was caused by one ancestor or the other. So the celebration is to kind of engage those groups of people. Compliance is key; so in order to erase those biases and myths. Through the celebration of World NTDs Day we will be expanding awareness about the diseases and the various intervention programmes.        

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