More than one-third of Nigerian adults suffer from hypertension, a leading risk factor for heart disease, stroke, and kidney failure. Excess salt intake contributes significantly to these conditions. Credit: Shutterstock

By Ifeanyi Nsofor
WASHINGTON DC, May 14 2025 (IPS)

In Nigeria, salt is deeply woven into the fabric of food and culture. It brings out flavor, preserves ingredients, and enhances tradition. But recently, salt has become the centerpiece of dangerous misinformation promoted by one of Nigeria’s most powerful spiritual leaders.

During a now-viral sermon, Pastor Chris Oyakhilome, founder of the global megachurch Christ Embassy, declared that warnings about excess salt are part of a broader conspiracy to harm Africans. He said, “They told you salt is not good so you won’t take salt anymore and then you get sodium deficiency and need their sodium tablets and sodium medication. Wake up, Africa!”

Within days, Nigeria’s Federal Ministry of Health issued a formal advisory contradicting his claims and reinforcing the risks of high salt intake. The ministry emphasized the well-known risks: high blood pressure, heart failure, stroke, and kidney disease. WHO recommends adults consume less than 5 grams of salt daily (about one teaspoon).

But what happens when millions believe the pulpit over public health policy?

A Pattern of Misinformation by Pastor Oyakhilome

Pastor Oyakhilome’s salt remarks are not an isolated incident. He has a troubling record of promoting health-related conspiracy theories that put his followers and the larger Christian community at risk.

During the COVID-19 pandemic, he falsely claimed that 5G technology was responsible for the spread of the virus. Though he later walked it back, the damage was done, fueling confusion and mistrust.

He has also repeatedly mischaracterized COVID-19 vaccines, describing them as tools of genetic manipulation. In one broadcast, he suggested that they alter human DNA, a claim unequivocally refuted by scientists and fact-checkers.

In April 2025, Oyakhilome falsely claimed that Pope Francis had died due to the COVID-19 vaccine. The Vatican quickly debunked this falsehood and confirmed that the 88-year-old pontiff passed away due to complications from a stroke, which led to a coma and heart failure.

Such statements have drawn regulatory action. In 2021, the UK’s broadcasting regulator, Ofcom, fined Oyakhilome’s television channel £25,000 for airing COVID-19 conspiracy theories and unsubstantiated medical claims.

Why Salt Misinformation Matters

The impact of misinformation is compounded in countries like Nigeria, where religious leaders wield enormous influence. According to a 2022 Afrobarometer survey, 60% of Nigerians said they trust religious leaders ‘somewhat’ or ‘a lot’. This is far higher than the trust shown for political leaders or public institutions: the president (27%); members of the National Assembly (19%); and political parties (15%).

Misinformation from the pulpit has real consequences

More than one-third of Nigerian adults suffer from hypertension, a leading risk factor for heart disease, stroke, and kidney failure. Excess salt intake contributes significantly to these conditions, as documented across multiple global health studies.

When salt enters the body in excess, its effects ripple silently across vital organs, often without early warning signs.

It starts with the heart, which must work harder to pump the increased volume of blood retained by the sodium. Over time, this sustained pressure can lead to hypertension and eventually heart failure, with the slow thickening of the heart’s walls and the quiet exhaustion of a vital muscle.

The kidneys, too, struggle under the weight of too much salt. These delicate filters are tasked with removing excess sodium, but when overwhelmed, they begin to break down. This can lead to chronic kidney disease, protein leaking into the urine, and the painful formation of kidney stones. Furthermore, reduced kidney function results in less excess water being removed, which increases blood pressure levels.

The brain is especially vulnerable. Prolonged high blood pressure caused by excess salt can rupture or block these vessels, leading to strokes. Even when no stroke occurs, the reduced blood flow can gradually impair memory and cognitive function.

Meanwhile, the arteries harden. Once elastic and responsive, they lose their ability to expand and contract. The result is a narrowed highway for blood, increasing the risk of heart attacks and peripheral artery disease.

High salt levels irritate the lining of the stomach and may contribute to the growth of Helicobacter pylori, a bacterium strongly linked to gastric cancer. What begins as seasoning at the table may, over years, become fuel for malignancy.

These are not speculative concerns. They are well-established scientific facts. When a high-profile pastor tells millions to increase their salt consumption, it risks undoing years of public health education and investment.

The Role of Faith Leaders in Health Communication

As a public health physician, I understand the importance of cultural context and trusted messengers. Faith leaders can, and often do play powerful roles in promoting healthy behaviors. For instance, during the COVID-19 pandemic, Pastor Enoch Adeboye (General Overseer of Redeemed Christian Church of God) encouraged christians to receive the COVID-19 vaccine. He said, “It is foolish to keep having faith that God will protect you from an infection when He has made provision for vaccines that can provide a high percentage of protection. I have taken the jab. I prayed about it and got a clear direction from God to go and receive it.”

But when spiritual authority is used to promote pseudoscience, it becomes a dangerous betrayal of trust. We must challenge misinformation, especially when it comes from influential voices. Public health officials must collaborate with faith communities to train leaders on evidence-based health communication. And regulatory agencies must be empowered to hold repeat offenders accountable.

Conclusion: Let Salt Season Food, Not Falsehood

Salt should enhance flavor. Not endanger lives. It is not a cure, and it certainly is not a conspiracy. Leaders with influence, especially in matters of faith, have a duty to uphold truth, not distort it.

As Nigeria and other countries navigate the growing burden of noncommunicable diseases (NCDs), we cannot afford sermons that sacrifice science for spectacle. NCDs cause about 29% of all deaths in Nigeria — over 684,000 annually.

Let’s preach health. Let’s defend the truth. Let’s keep misinformation out of our kitchens, and out of our pulpits.

Dr. Ifeanyi M. Nsofor, a public-health physician, global health equity advocate and behavioral-science researcher, serves on the Global Fellows Advisory Board at the Atlantic Institute, Oxford, United Kingdom. You can follow him @Ifeanyi Nsofor, MD on LinkedIn

Martin Luther King Jr. rightly identified health inequity as the worst form of social injustice. Credit: bswise

By Ifeanyi Nsofor
WASHINGTON DC, Jan 20 2025 (IPS)

Every year, January 20 is celebrated as Martin Luther King Jr. Day. He was a leader in the Civil Rights Movement who fought for equality and justice, especially for Black people, through peaceful protests and powerful speeches. The day is observed annually on the third Monday of January, close to his birthday on January 15. It is a time to remember his work, reflect on his message of fairness and nonviolence, and engage in acts of service to help others in our communities.

As a global health equity advocate, MLK Day holds special significance for me as a day to remember him as a health equity champion. He rightly identified health inequity as the worst form of social injustice. In his 1966 speech at the Second National Convention of the Medical Committee for Human Rights, MLK stated, “Of all the forms of inequality, injustice in health is the most shocking and inhuman”. I couldn’t agree more.

Globally, health inequities are numerous and mostly preventable. Neglected Tropical Diseases, maternal deaths, and malnutrition vividly reflect the global health injustices MLK foresaw

Growing up in Nigeria as a high school student in the 1980s, I was introduced to MLK through reading editions of Ebony magazine. I remember with nostalgia how I walked to roadside book sellers to buy old copies of the magazine.

These magazines introduced me to Black American social justice debates, including the works of MLK and Thurgood Marshall. It was an opportunity to connect spiritually with Africans in the diaspora – Black Americans – and their struggles. What struck me most as a child was MLK’s nonviolent demand for racial justice.

After high school, I went on to medical school in Nigeria to begin my training as a doctor. By the time I graduated in 1998, it was clear to me that patients’ rights must be respected in healthcare delivery. As health workers, we must prioritize preventive care while providing the care our patients need.

At the time, I did not know the right term for my convictions. Decades into my work in global health, I came to understand the term for my beliefs: health equity. In 2018, I delivered my first TEDx talk titled “Without Health We Have Nothing”. This is why MLK’s assertion that health injustice is the worst form of inequality resonates deeply with me. Healthcare – or its absence – is truly a matter of life and death.

Globally, health inequities are numerous and mostly preventable. Neglected Tropical Diseases, maternal deaths, and malnutrition vividly reflect the global health injustices MLK foresaw.

Neglected Tropical Diseases

Want to see a perfect example of diseases that disproportionately affect poor people? Look no further than Neglected Tropical Diseases (NTDs). These diseases affect 1.6 billion people globally, primarily in Africa and Asia. Many people do not realize some, like those mentioned in the Bible, still exist today.

A prime example is leprosy – a slow-growing bacterial infection that affects the skin, nerves, and sometimes the eyes and nose. Surprisingly, in 2024, the U.S. saw a significant rise in leprosy cases, particularly in the southeastern region, with central Florida identified as a hotspot.

Data reveals that approximately 34% of new cases reported between 2015 and 2020 were locally acquired. Without treatment, leprosy causes numb patches and potential deformities. Fortunately, leprosy is completely curable with antibiotics when caught early.

Other NTDs include river blindness, trachoma, and noma. Noma, in particular, is heartbreaking – it predominantly affects children between and six years who are malnourished, live in unhygienic conditions, or have weak immune systems.

Noma starts as a sore in the mouth but can destroy facial tissues, leaving severe deformities if untreated. Proper hygiene, nutrition, and healthcare can prevent noma, but it remains a reality in the poorest parts of the world.

Maternal Mortality

The United Nations Population Fund (UNFPA) captures the essence of safe motherhood with its statement: “No woman should die while giving life”. Tragically, for many women in low- and middle-income countries, and even wealthier nations, this isn’t the case.

In Nigeria alone, over 80,000 women die annually during pregnancy, childbirth, or shortly afterward. A professor once likened Nigeria’s high maternal mortality to filling a commercial jet with pregnant women every day and letting it crash – a haunting image. This huge injustice should not be allowed to continue.

In contrast, the United States of America has a higher maternal mortality rate compared to other wealthy countries, largely due to the disproportionately high maternal death rate among Black women. Black women are still 2 to 3 times more likely to die from pregnancy and childbirth than White women, regardless of their education level or socioeconomic status.

The solutions to stopping maternal deaths are not rocket science. Prenatal care must identify high-risk pregnancies, and women need access to proper nutrition to reduce the risks of postpartum hemorrhage, the leading cause of maternal deaths. With proper planning and preparation, including access to cesarean sections and emergency services, these deaths are preventable. Addressing these gaps would save countless lives.

Malnutrition

Malnutrition is a double-edged sword – it manifests as undernutrition (not enough nutrients) or overnutrition (eating too much). Both forms can be deadly, especially for children under five. Undernourished children fail to grow properly (wasting) and suffer impaired brain development, leading to stunting.

Globally, 22% of children are stunted, with 90% of cases occurring in Africa and Asia. On the other hand, overnutrition causes obesity, increasing the risk of non-communicable diseases like diabetes.

The solutions are simple: Support mothers to breastfeed exclusively for six months, educate communities on using affordable, local foods to prepare nutritious meals, and invest in school feeding programs. These steps would dramatically reduce malnutrition’s toll.

MLK’s vision for health justice shapes my global health equity journey. On MLK Day, let us reflect on global health injustices and commit to ending them. Identify one health issue you are passionate about and take meaningful action to address it.

MLK was right – health injustice is the worst form of inequality because without health we have nothing.

Happy MLK Day!

Dr. Ifeanyi M. Nsofor, a public-health physician, global health equity advocate and behavioral-science researcher, serves on the Global Fellows Advisory Board at the Atlantic Institute, Oxford, United Kingdom. You can follow him @Ifeanyi Nsofor, MD on LinkedIn

Will this free cesarean section policy truly deliver for them? Only time will tell, but much more needs to be done to make it work for all women in Nigeria. Credit: Shutterstock

By Ifeanyi Nsofor and Thelma C. Thomas-Abeku
WASHINGTON DC, Nov 25 2024 (IPS)

In Nigeria, over 80,000 women die each year from pregnancy and childbirth complications. Recently, Nigeria’s coordinating minister of health and social welfare, Muhammad Pate, announced the Maternal Mortality Reduction Initiative. It aims to provide free cesarean section (CS) and essential maternal care to poor women nationwide, ensuring safer childbirth and improved maternal health outcomes. Free CS is a life-saving solution. But while the idea is great, let’s take a closer look to unpack how it can really help Nigerian women.

To access the free CS, pregnant women must be enrolled in the country’s National Health Insurance Scheme, which covers pregnancy-related emergencies. Social welfare units in public hospitals will check if women qualify and can’t afford the procedure. But is this enough?

For a policy like this to work, it must be well-planned, involve many stakeholders, and take into account the rising cost of living, widespread poverty, and the large number of women in informal jobs who are not routinely covered by health insurance

The survival of women at childbirth hinges on availability of expertise to provide cesarean section when needed. A study found a national cesarean section prevalence of 17.6%, with a significantly higher prevalence in facilities in the south (25.5%) compared to the north (10.6%). The authors also identified higher prevalence of emergency cesarean section (75.9%) compared to elective CS (24.3%).

The Reality of Maternal Deaths in Nigeria

An unacceptable number of women in Nigeria die before, during, and after childbirth. Those 80,000 annual deaths are equivalent to 80% of the population of Seychelles.

This reaffirms Nigeria as a large country with an estimated population of more than 200 million; covering 36 states, the federal capital territory, and 774 local government areas.

For a policy like this to work, it must be well-planned, involve many stakeholders, and take into account the rising cost of living, widespread poverty, and the large number of women in informal jobs who are not routinely covered by health insurance.

Poverty is a big issue. Many women cannot afford hospital births and instead deliver in places like faith homes (run by churches) or with traditional birth attendants. If this policy is to work, women’s preference for health facility-based deliveries must improve significantly.

These are five ways to make the free CS policy truly equitable.

Does Nigeria Have Enough Obstetricians?

A CS is a life-saving surgery for high-risk pregnancies, like those with large babies, breech positions, or obstructed labor. But Nigeria faces a shortage of healthcare workers. Many doctors are leaving the country for better opportunities abroad.

As of 2021, Nigeria had only 84,277 doctors—about 3.95 per 10,000 people, far below the global recommendation. Who will perform these surgeries if our skilled workers are gone? The government needs to retain healthcare workers by offering better pay, housing, and improved working conditions. Training and career development programs are also crucial to ensure enough professionals are available for this initiative.

Bridging the Health Insurance Gap

Healthcare costs continue to hinder timely access to essential services, especially for marginalized and low-income populations, including women. To improve women’s health outcomes and realize the right to health, it’s imperative to address these inequities in healthcare delivery.

One effective strategy is to adopt the Health Equity Funds (HEF) model, a proven approach used in various countries. HEFs are third-party mechanisms that cover user fees at public health facilities for eligible low-income individuals.

By establishing and operationalizing a functional equity account, governments can facilitate the enrollment of more women from the informal sector into health insurance schemes, enhancing access and inclusivity.

Fighting Stigma and Myths About Cesarean Sections

Another challenge is the negative perception of CS. In some instances, women who undergo CS are stigmatized and labeled as ‘’weak’’. A study reveals that factors such as fear, lack of spousal consent, and poor education contribute to its underutilization.

Addressing these gaps requires intensified public education campaigns to inform women and dispel myths about CS, leveraging platforms like radio, TV, and social media to reach a wider audience. Additionally, integrating accurate information about CS as a normal and safe form of childbirth into school health education curricula is essential for long-term impact.

Federal, State, and Local Governments Cooperation

Healthcare in Nigeria is on the concurrent list, which means that federal, state and local councils have core responsibilities for healthcare delivery. How is this policy going to work within states and local government areas? Who is going to cover the costs for women in these sub-national areas?

For this policy to work, all three levels must collaborate. It is not enough for the federal government to announce the policy. State and local governments must also step up to implement it properly. The Federal Ministry of Health and Social Welfare through the National Health Insurance Scheme must collaborate with states through existing State Health insurance Schemes.

Will This Policy Truly Save Lives?

Women enrolled in the National Health Insurance Scheme might benefit immediately, but the majority—those poor, uninsured, and vulnerable—are left out. These are the women who need this policy the most. To deliver real change, the government must address these gaps.

Conclusion

In the end, every pregnant woman in Nigeria wants the same thing: to deliver safely and not die at childbirth. Will this free cesarean section policy truly deliver for them? Only time will tell, but much more needs to be done to make it work for all women in Nigeria.

About the Authors

Dr. Ifeanyi M. Nsofor, a public-health physician, global health equity advocate and behavioral-science researcher, serves on the Global Fellows Advisory Board at the Atlantic Institute, Oxford, United Kingdom. You can follow him @Ifeanyi Nsofor, MD on LinkedIn.

Thelma Chioma Thomas-Abeku is a seasoned communications specialist with a decade-long experience in public health advocacy and communications. She is a graduate of Liverpool John Moores University and University of Abuja. You can follow her @Thelma Thomas-Abeku on LinkedIn.

The three most important perspectives to consider in improving healthcare are social support, place of residence, and genetics. These factors are all critical for predicting health disorders and ensuring the delivery of quality healthcare. Credit: Kristin Palitza/IPS

By Ifeanyi Nsofor
ABUJA, Sep 12 2024 (IPS)

A recent study published in Journal Communications Medicine explores how people from different income levels and urban or rural backgrounds view the factors that influence health across eight countries: Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States.

It found that those with higher incomes are more likely to think genetics are the most important factor for health, while those with lower incomes value social support more. In contrast, urban residents prioritize healthcare, while those in non-urban areas place more importance on social support. This information can influence public health messaging.

Indeed, this study shows what the three most important perspectives are to consider in improving healthcare – social support, place of residence and genetics.

They are all important in predicting health disorders as well as providing quality healthcare. None should be viewed in isolation. Genetics helps predicts health conditions before birth or years before their occurrence, some health conditions are more prevalent in certain locations, and lack of social support can worsen the severity of different health conditions.

Genetics helps predicts health conditions before birth or years before their occurrence, some health conditions are more prevalent in certain locations, and lack of social support can worsen the severity of different health conditions

The three perspectives should also be interconnected when creating public health messaging around a disorder like sickle cell disease. This is why.

Genetics

Sickle cell disease is a genetic disorder that affects only Blackpeople. AS is the genotype for the sickle cell trait. It is an inherited disease, meaning one gets it from their parents if both carry the gene for sickle cell. A male and a female couple who have the AS genotype have a 25% chance of giving birth to a child with sickle cell disease (SS) in each pregnancy.

In sickle cell disease, the red blood cells that are usually round are shaped like sickles. This makes them sticky and makes it harder for them to move through blood vessels. They can get stuck, block blood flow, and cause pain, infections, and damage to organs. Caring for sickle cell disease warriors is very expensive because of the frequent pain crises and hospitalizations that could occur.

Public health messaging around sickle cell disease should focus on prevention, keeping in mind it is difficult to appeal to people’s emotions when they are in love. The messaging should be informed by families already caring for people living with sickle cell disease. It is the responsibility of health officials. However, there is an ecosystem of health advocate that can support.

In the event that a woman with the AS genotype becomes pregnant with a man who does too, the disease can be diagnosedin a fetus by sampling some of the amniotic fluid.

This test can help prepare parents for the birth of the child, learn more about sickle cell disease, its complications, how to prevent the complications to enable the child to live a life free from pains and the best way to care for the child.

It would also enable them to prepare financially to care for a sickle cell warrior. As heartbreaking as it may be, a couple knowing their genotype sometimes leads them to call off their wedding or decide not to have children of their own but instead opt for adoption. They need all the information necessary to make an informed decision for themselves.

Social Support

Family members are the primary and most important caregivers of sickle cell disease warriors. They are often not paid for their services; some give up their dreams while caring for sickle cell warriors and it takes a toll on their mental health too.

Government and non-profit organizations should push for policies on caring for caregivers. Such policies should provide financial compensation for carers, offer opportunities for continuous professional development for carers, provide paid alternate carers enabling family carers to get some rest.

Other social connections include organizations such as the Sickle Cell Foundation of Nigeria and the Sickle Cell Disease Association of America. These organizations contribute infundraising for care of warriors, research, policy development and advocacy. These organizations routinely host public awareness campaigns, working closely with public health authorities and healthcare providers. Families of sickle cell warriors can reach them by asking their healthcare providers and contacting these organizations via their websites.

Place of Residence 

Sickle cell disease is common in low- and middle-incomecountries. In those countries, there can be more severe complications because of widespread poverty, poor diagnostic capacities, and limited access to healthcare. Even in high income countries, poorer families bear a disproportionate burden of sickle cell disease.

A study in the U.S. found that 98% of cases with sickle cell disease are African-Americans and 42% had a family income at near federal poverty level. People in higher socioeconomic class also suffer from sickle cell disease though. Therefore, messaging must target everyone irrespective of social class.

To be sure, public health messages should be tailored to address the perspectives of different demographics. However, we should not lose sight of how interconnected they are. Indeed, it is crucial to understand the roles of genetics, social connections, and socio-economic status to design effective messaging strategies. That is how the findings of this research can benefit everyone.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is a member of the Global Fellows Advisory Board at the Atlantic Institute, Rhodes Trust, Oxford

Urban Farm gardening project in New York City. Urban agriculture is a sustainable way of growing food and local economies and meeting food security needs for urban dwellers. Credit: Shutterstock

By Ifeanyi Nsofor and Esther Ngumbi
SILVER SPRING, Maryland / URBANA, Illinois, USA, Feb 15 2024 (IPS)

Recently, a group of non-profit organizations launched the Inaugural Souper Bowl of Caring – a nationwide movement to address hunger-related challenges. It was an opportunity for VIP guests to engage and lend their support to end food insecurity as part of the Super Bowl. The goal is to encourage every viewer of the Super Bowl to contribute $1 or one can of soup.

Initiatives such as the one launched by NGOs are important since they tackle a pressing challenge: ending food insecurity in the US.

Urban agriculture leads to efficient utilization of unused urban spaces such as empty parking lots, rooftops, and vacant plots of land. Such spaces can be used to grow a range of crops, including tomatoes, potatoes, lettuces, carrots, herbs, and even edible flowers

Currently, over 10% of Americans are food insecure. But while donations can help in the short-term, they need to be accompanied with other long-term solutions. Among the long-term solutions that Super Bowl 2024 VIPs, investors, companies that spent $7 million for 30-second spots of commercial time, and viewers can do is to invest in and support urban agriculture and urban farmers.

Why are urban farms worthy of this attention?

Urban agriculture is a sustainable way of growing food and local economies and meeting food security needs for urban dwellers. On the global level, 15% – 20% of the world’s food supply is sourced from urban areas. Urban farming is growing across many U.S. cities too – from Chicago to Urbana to Kansas to Washington DC to Minneapolis to Atlanta to New York to Los Angeles to Las Vegas where the 2024 Super Bowl championship is taking place.

Urban agriculture leads to efficient utilization of unused urban spaces such as empty parking lots, rooftops, and vacant plots of land. Such spaces can be used to grow a range of crops, including tomatoes, potatoes, lettuces, carrots, herbs, and even edible flowers.  Growing crops within urban centers makes them close to markets and it becomes easy for urban farm produce to be transported to markets. It is also seamless for urban residents to walk to urban farms and buy directly from the source. The proximity of foods to markets considerably contributes to fewer emissions and helps mitigate the impacts of climate change.

Urban agriculture can bring about several social, cultural and community benefits. For example, urban farms can serve as a community space, where different events including workshops, training, farm to dinner, you pick, and weddings happen.

They can help create food secure and resilient urban communities and serve as lifelines for urban dwelling citizens when the food supply chain is disrupted by weather events, pandemics such as covid19, cyber security attacks or plant diseases and pests outbreaks.

In the United States, urban farms can build up the workforce. By venturing into urban farming, communities build their local economies and provide job opportunities for people living in those communities. City Councils can support the creation of urban food hubs.

An example is the University of the District of Columbia food hubs located in food desert neighborhoods of Washington, D.C. Food hubs comprise of food production, food preparation, food distribution, and waste and water recovery. These processes contribute to increasing the workforce in cities and overall economic growth.

Of course, urban farming cannot beat rural agriculture, nor take its place. But it offers an important way for people living in urban areas to gain access to local, fresh and culturally relevant foods.

Further, urban farming comes with its challenges. Soils in urban regions are particularly contaminated with heavy metals such as lead, arsenic, and copper. For example, Chicago’s soil lead concentrations are high.

Therefore, it is imperative to pay attention to the land’s history, especially soil history. Furthermore, a new study found that food from urban agriculture has a carbon footprint six times larger than conventionally grown produce. To mitigate this, urban agriculture practitioners can cultivate crops that are typically greenhouse-grown or air-freighted, in addition to making changes in site design and management.

Ultimately, there are economic, environmental, and social benefits that accrue from urban farming. The Super Bowl, with its huge viewership, could be an important platform to support urban farmers.

In preparation for the 2025 Super Bowl, Americans should consider contributing to the ‘Super Bowl of Caring’. Moving forward, it would be great to see urban farms take the center stage at the Super Bowl.

Food insecurity and food waste create a paradox that necessitates us to creatively address these two interlinked issues. Credit: Claudia Ciobanu / IPS

By Ifeanyi Nsofor and Esther Ngumbi
SILVER SPRING, Maryland / URBANA, Illinois, USA, Jan 25 2024 (IPS)

Ten percent of Americans live in food-insecure households. At the same time, the average U.S. family of four spends $1,500 each year on food that ends up uneaten. Food is the single most common material found in landfills; and food waste is responsible for 58% of landfill methane emissions released to the atmosphere. Food insecurity and food waste create a paradox that necessitates us to creatively address these two interlinked issues.

Both these issues are not just American problems, they are global. According to the Food and Agriculture Organization of the United Nations, up to one third of all food produced goes to waste. And in a cruel twist, even as so much food goes to waste, more than one billion people are food insecure globally.

On the issue of food insecurity, countries have taken several approaches to address it, including policy level interventions. The White House, for example, created a task force to investigate the issue of hunger and food insecurity. It included it as a social determinant of health.

According to the Food and Agriculture Organization of the United Nations, up to one third of all food produced goes to waste. And in a cruel twist, even as so much food goes to waste, more than one billion people are food insecure globally

In Kenya, the government in collaboration with the World Bank through initiatives such as the Kenya Climate Smart Agriculture and the National Agriculture Rural Inclusive Growth Project project is addressing food insecurity by deploying multiple strategies including providing farmers with inputs, offering them extension and climate advisory services, and facilitating market access.

It is important for governments to address these issues, but we must all do more. Here are five more ideas for tackling food insecurity and food waste.

First, tackle food waste at the production level. A recent study showed that inefficiencies in agricultural supply chains contribute 1.3 billion tons of food waste as it moves along to stores, restaurants and homes.

The U.S. government can promote a range of technological advancements to address this, including utilizing drones and cell phones and other technologies to accurately map what is being produced where and when including the expected yields, and timeframes.

Doing so would facilitate ensuring that all produced food can be marketed. Start-ups focused on ensuring all food that is produced is sold to consumers including through gleaning are at the forefront, championing these kinds of initiatives of urban gleaning programs in the US.

For example, there is a national map of gleaning, that rescues foods that would otherwise go to waste. These gleaning innovations serve a dual purpose – tackling hunger and food waste. Such innovations deserve to be promoted and invested in.

Second, farmers must develop innovative new crops that are resilient to climate change, easy to cultivate and packed with nutrients. An example is the biofortified orange-fleshed sweet potato developed at the International Potato Center and funded by the Bill and Melinda Gates Foundation.

This species of potato grows with less water, can withstand disease and contains nutrients necessary for growth and development. For example, it is fortified with vitamin A to protect children from vitamin A deficiency, which typically causes blindness, diarrhea, and immune disorders.

Research published in the International Journal for Vitamin and Nutrition Research shows that orange-fleshed sweet potato improves vitamin A status, increases the availability of different micronutrients and reduces vitamin A deficiency, and therefore reduces child mortality rates.

Third, introduce marketing innovations that encourage consumers to not only focus on buying better looking products, but also ensure that consumers can still buy not so perfect foods.

For instance, Asda recently introduced the UK’s first supermarket ‘wonky vegetable’ box. It contains enough ugly potatoes and knobbly carrots to feed a family of four for an entire week for just £3.50. The ‘wonky vegetable’ box contains in-season winter vegetables and salad ingredients at a price that is 30% cheaper than standard lines. Customers love wonky fruit and veg and sales have steadily increased.

Fourth, integrate artificial intelligence and big data analytics and support these recent innovations. To date, artificial intelligence has been utilized in the modern day to help tackle several challenges and it could be utilized to facilitate tackling this dual challenge.

These technologies can be used to forecast disruptions in the supply chain by using historical data that’s combined with real time data. In so doing, companies involved in food distribution can proactively anticipate and prepare for any logistical and weather-related challenges that may disrupt scheduled food supply and distribution channels.

Lastly, celebrate the use of innovative ways to address food waste in order to inspire others.

In Ghana, Elijah Amoo Adoo, founder of Food for all Africa – West Africa’s largest food bank found that 46% of the food produced on farms in the country goes to waste because of poor logistics and inefficient marketing.

Consequently, Food for all Africa collects leftover food close to its expiry date from local restaurants, supermarkets, food distribution companies, and rural small-hold farmers, and redistributes to disadvantaged children in orphanages, hospitals and lower-income schools. This is significant in a country where 28% of all children aged five years and below are stunted.

Of course, it will be important to consider barriers to innovations that address the dual challenge of food waste and food insecurity. These barriers range from availability of incentives to consumer willingness to accept and pay for these innovations as well as the relevance of these innovations to specific regions and cultures. But the tradeoff is worth the work – reduced hunger and reduced waste, and millions of lives improved.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow.

Esther Ngumbi, PhD is Assistant Professor, Department of Entomology, African American Studies Department, University of Illinois at Urbana-Champaign

Categorizing countries into “low- and middle-income countries” and “high income countries” is not appropriate for studying healthcare systems and population health. It is misleading to categorize countries for convenience of data analysis and interpretation. Credit: Charles Mpaka/IPS

By Ifeanyi Nsofor and Sowmya R Rao
ABUJA, Aug 11 2023 (IPS)

A recent publication in the journal PLOS Medicine reviewed the relationship between COVID-19 and mental health in eight low- and middle-income countries, collectively referred to as LMICs. As important as this publication is, we are appalled by the widespread use of the term “low- and middle-income countries” utilized in this article, and indeed in the majority of the global health literature and discourse.

This term vastly oversimplifies the relationship both between individual LMICs, and between LMICs and High-income countries (HICs). It isn’t an exaggeration to say that the term is colonial and racist. It divides rather than unites. It is time to change the narrative and use an equitable term to describe countries in the Global South.

Terms such as “low- and middle-income countries” perpetuate these inequities and use the same brush to paint 85% of the world’s population as the same. The Global South has almost six times the population of the Global North, is incredibly diverse, and has pockets of high-, middle- and low-income communities. Even within a single LMIC there is incredible diversity

We are both from the Global South and now work in the Global North. Sowmya is from India while Ifeanyi is from Nigeria. We both live in the U.S. Indeed, Sowmya has lived there for more than 30 years. In our global health careers, we have experienced inequities meted to us and people like us simply because of where we are from.

Terms such as “low- and middle-income countries” perpetuate these inequities and use the same brush to paint 85% of the world’s population as the same. The Global South has almost six times the population of the Global North, is incredibly diverse, and has pockets of high-, middle- and low-income communities. Even within a single LMIC there is incredible diversity.

Without a doubt, categorizing countries into “low- and middle-income countries” and “high income countries” is not appropriate for studying healthcare systems and population health. It is misleading to categorize countries for convenience of data analysis and interpretation.

According to Google Scholar, so far in 2023, over 12,100 publications have used “low-and-middle income countries ” in their titles or in the text. A couple of editorials calling for a change in the classification were published in 2022 and yet, the same journal has over 15,000 publications since 2022 (more than 6000 in 2023) using these terms. Is this classification appropriate for healthcare-related research? We also do not believe that World Bank classification of countries using the gross national income (GNI) is appropriate in this scenario.

Furthermore, funding agencies and peer-reviewed journals perpetuate this problem by requiring the investigators to generalize studies conducted in one country (even one city/town/village) to not only the entire country but beyond that to other “low- and middle-income countries”.

Countries vary in their population sizes, demography, cultures, type of governments, education systems, health care policies, health care access, diseases, and socio-economic problems. Summarizing data across these countries and studying them as a unit to find a one-size-fits-all solution undermines the problems.

For instance, Nigeria has an estimated population of more than 200 million, more than 250 ethnicities that speak over 500 languages. On the other hand, India is the most populous country in the world, with a population of over 1.4 billion. It has more than 2000 ethnic groups that speak over 19,000 languages or dialects.

First, begin to rectify this issue by ensuring that studies are customized to each country so appropriate policies can be implemented to improve healthcare in the country being studied. Most problems and solutions are local and must be studied in this context.

Second, funding institutions and peer-reviewed journals should not insist on generalizability of the results beyond the targeted populations but focus on the possibility of the solutions being adaptable to different populations and situations.

Studies that can positively impact these populations even if small are worth being conducted and published. It may then be further researched and adapted as necessary in different settings but that should not be a condition for funding or publishing.

Third, knowledge transfer should be bi-directional and not unidirectional as is currently done. Therefore, countries in the Global North should be open to learning from solutions found in the Global South (what are also termed as “resource-limited or resource-poor” countries).

There are many lessons in this regard: African Union’s coordination of country COVID-19 responses through the Africa Centre for Disease Control, and diverse experiences on managing epidemics in the Global South.

Finally, researchers must tap into the power of local knowledge. This means including Ministries of Health and local investigators to identify the main problems that need studying and finding solutions to mitigate them – another step towards creating equity.

Having countries from the Global South involved with setting study priorities and also funding portions of studies will ensure that they are vested in the process and are equal partners in studies that impact their own populations. Indeed, no country has infinite resources as was seen during the recent COVID-19 pandemic and any solution that uses the available resources efficiently should be welcomed.

LMICs and HICs are vestiges of colonialism. They divide instead of unite by making the most populous parts of the global community inferior to the least populous. Most importantly, they perpetuate inequities which pose serious consequences for global solidarity.

Using ‘Global South’ versus ‘Global North’ to refer to LMICs and HICs respectively in global research vocabulary is the most equitable thing to do.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow.

Dr. Sowmya R Rao is a Senior Research Scientist with the Department of Global Health at Boston University School of Public Health (BUSPH), a Fellow of the American Statistical Association and a biostatistician primarily interested in global health disparities.

While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend. Credit: Ernest Ankomah/IPS

By Ifeanyi Nsofor
ABUJA, Jun 2 2023 (IPS)

New research shows that Black mothers in the United States disproportionately live in counties with higher maternal vulnerability and face greater risk of preterm death for the fetus, greater risk of low birth weight for a baby, and a higher number of maternal deaths.

While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend.

The problem of poor maternal health for Black women in the U.S. is dire. Too many Black women die during pregnancy and childbirth due to preventable causes. For instance, the 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 – 2020).

The 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 - 2020). To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.

To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.

Further, according to the Kaiser Family Foundation, maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination.

In a previous piece, I wrote about the way that institutionalized racism is keeping Black Americans sick. Therefore, healthcare providers and policymakers across the U.S. must ensure respectful maternity care for all women during pregnancy, childbirth and afterwards.

The United Nations Office of the High Commissioner for Human Rights says respectful maternity care“encompasses respect for women’s basic human rights, including recognition of and support for women’s autonomy, dignity, feelings, choices, and preferences, such as choice of companionship wherever possible”.

Unfortunately, there is overwhelming evidence that Black American women face disrespect and profound indignity during pregnancy and childbirth. Tennis player and businesswoman Serena Williams almost died due to blood clots after giving birth because her nurse refused to listen to her cry for help. That clot could have led to a stroke. Her doctor eventually listened to her, and this saved her. If one of the most influential and most powerful women can have such a near-death experience, what is the fate of other Black American women who are not as privileged? Respectful maternity care is a way to ensure equity irrespective of class and race.

These are three lessons American policymakers can learn from successful maternal health projects across countries in sub-Saharan Africa as they try to save Black American lives.

First, is the continuum of care – prevention of postpartum hemorrhage project, implemented by Pathfinder International in Nigeria. It was a novel project that deployed several evidence-based interventions to prevent excessive bleeding after childbirth across the country.

These included the use of misoprostol to ensure adequate uterine contraction after the delivery of the baby; use of a plastic sheet with a pouch for blood loss estimation and active management of the third stage of labor to ensure the placenta is properly separated after the baby is delivered. These interventions led to a reduction in women who bled excessively after childbirth and improved the overall survival of women in participating health facilities.

For example, a new study on the efficacy of the plastic sheet carried out in 80 hospitals across 4 African countries, showed a reduction in the number of women experiencing severe bleeding by 60%.

A second example is the maternal nutrition program, implemented by Garden Health International in Rwanda. Adequate nutrition during pregnancy is imperative for the wellbeing of the unborn child.

The first 1000 days of life are even more crucial. Through the Maternal Nutrition curriculum, pregnant women are encouraged to attend antenatal classes at least four times in health facilities where they are educated on how to address the factors that can contribute to malnutrition. Women are taught how to prepare a balanced meal, the importance of hygiene and food safety in preventing malnutrition, the importance of the timely introduction of breastfeeding and complementary feeding, and postnatal care.

For instance, through the “one pot, one hour” cooking initiative, families are taught to use readily available foods to prepare nutritious meals is a core component of this program. Its success led to its adoption by the Rwandan Ministry of Health and it was implemented by 44,000 community health workers across the country.

A last example is the Kangaroo Mother Care for very low birth weight infants in South Africa. Very low birth weight infants are prone to hypothermia – a significant and potentially dangerous drop in body temperature.

According to the WHO, Kangaroo Mother Care involves infants being carried, usually by the mother, with skin-to-skin contact. If the mother is unable to fulfill the role, the father or other members of the family can take on the responsibility of skin-to-skin contact and provide warmth for the infant. A study of Kangaroo mother care of 981 very low birth weight infants admitted at Charlotte Maxeke Johannesburg Academic Hospital over a six-year period showed increased weight gain, lower rates of complications of prematurity and low overall mortality.

A multi-country study by the World Health Organization showed that in Ethiopia, government leadership; an understanding by health workers that kangaroo mother care is the standard of care; and acceptance of the practice from women and families helped improve the implementation of kangaroo mother care.

Institutionalized racism over many decades has put Black Americans in the most vulnerable counties in the U.S. Health policymakers, healthcare providers, donors, non-profit organisations and all stakeholders involved in maternal healthcare in the U.S. must implement interventions that are shown to save lives. The African continent is a great place to look.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow

It is imperative to identify symptoms when they are present and provide timely care. Asking routine questions at primary care visits is an effective way to achieve this. Credit: Unsplash /Melanie Wasser.

By Ifeanyi Nsofor
ABUJA, Feb 9 2023 (IPS)

Patients who visit public clinics in Abu Dhabi, United Arab Emirates, are asked mental health questions to detect signs of stress and depression early. The process starts with a basic checklist, with patients referred to a nurse, doctor, or specialist. Asking these questions at primary care not only can identify issues early on, but it also helps decrease the stigma often associated with mental health while maintaining anonymity.

This initiative is praiseworthy and should be replicated in all health facilities – both public and private. To ensure continuum of care, mental health services should also be provided in communities.

Globally, there are millions of unmet needs for mental health care. Globally, more than 970 million people are living with a mental disorder, with anxiety and depressive disorders the most common. According to the U.S. Centers for Disease Control, more than 50% of Americans will be diagnosed with a mental disorder at some point in their lifetime.

Globally, more than 970 million people are living with a mental disorder, with anxiety and depressive disorders the most common. According to the U.S. Centers for Disease Control, more than 50% of Americans will be diagnosed with a mental disorder at some point in their lifetime

Without a doubt mental health is important. However, just like physical health, it fluctuates. In an episode of my public health advocacy project, ‘Public Health for Everyone’, Victor Ugo – global mental health advocate and founder of Nigeria’s leading mental health not-for-profit, Mentally Aware Initiative said, “mental health is a continuum – sometimes we experience good mental health and other times, bad mental health”.

Therefore, it is imperative to identify symptoms when they are present and provide timely care. Asking routine questions at primary care visits is an effective way to achieve this.

Sadly, poor perception and stigma associated with mental health vary. For instance, the 2018 mental health in Nigeria survey, which I co-led, revealed shocking results. More than 5,300 respondents were interviewed in all 774 local councils across the country.

Seventy percent of Nigerians believe mental health disease is, “When someone starts running around naked”; and 54% said “possession by evil spirits as a cause of mental health disease”.

Furthermore, 18% said they will take someone with mental health disease to a prayer house for deliverance; traditional medicine healer (8%); locking up the person (4%) and beating the disease out of the person (2%). These shocking results underpin how difficult it can be to change behaviors to improve mental health.

As mental health is a continuum, so should mental health care. It is important to provide care not just at medical facilities but at community levels too. Community members may not be aware that primary care facilities provide mental health care but people they know in the community reach out to them.

Other reasons that community efforts are important include the reality that in many regions, health facilities may be far away from where people live or there may be unattainable costs associated with accessing care at health facilities. These are two examples of successful community-based mental health care services.

First is the Fellowship Bench, which began in Zimbabwe and was founded by Psychiatrist and Aspen Institute Senior New Voices Fellow Dixon Chibanda. Dixon lost a 26 year old patient to suicide because her family could not afford the $15 bus fare from her village to his clinic in Harare, Zimbabwe, for a follow-up visit.

It was a turning point for him, and this sad experience birthed The Friendship Bench. The Fellowship Bench deploys grandmothers, an ever-present human resource in communities, to provide mental healthcare. Grandmothers are trained on evidence-based talk therapy delivered on a park bench. In 2006, the first group of grandmothers went to work.

Chibanda believes that depression is treatable and suicide preventable. However, in low- and middle-income countries, there are not enough psychiatrists. Consequently, 90% of those needing mental health care do not get it, he said in his TED Talk. Therefore, innovative solutions such as The Friendship Bench are necessary to bridge the mental health care gap by providing care right in communities where people live.

Another effort is Mentally Aware Nigeria Initiative (MANI). It provides virtual mental health care to a large community by disseminating mental health information to its more than 180,000 followers on Facebook, Twitter, Instagram, TikTok and LinkedIn.

MANI reaches more than 3 million people (mostly young people) monthly through these social media platforms. MANI’s services are needed in a country of more than 200 million people with less than 250 psychiatrists. This translates to one psychiatrist servicing one million Nigerians. MANI provided mental health care during Nigeria’s 2020 EndSARS campaign against police brutality. Young people protested police brutality but were still brutalized and killed during the protest. Many people needed mental health care and MANI was there to provide it by offering calls.

One of the major challenges to providing mental health is the cost. More funding is required to support and scale more community-based mental health interventions. In 2022, the U.S. Department of Health and Human Services announced nearly $35 million in funding opportunities to strengthen and expand community mental health services and suicide prevention programs for America’s children and young adults.

In Europe, there is a €3,355,000 grant for large-scale implementation of community-based mental health care for people with severe and enduring mental ill health. In Nigeria, the TY Danjuma Foundation recently awarded a grant to Jela’s Development Initiatives to train 200 teachers about basic mental healthcare and create awareness for effective curriculum delivery.

Jela’s Development Initiatives also hosts ‘unburden’ – a group therapy session supervised by a mental health expert, which enables participants to speak about issues affecting their mental health within a safe and confidential space. These kinds of funds are important and need to continue regularly.

Providing mental health services at primary care and community levels can help millions of people. Supporting these efforts is the equitable thing to do.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow

With the rise in COVID-19 cases fueled by new variants, the number of long COVID cases will keep increasing. Credit: Unsplash/Ivan Diaz

By Ifeanyi Nsofor
ABUJA, Sep 1 2022 (IPS)

More than two-years in, the COVID-19 pandemic rages on with rising cases and deaths every day.  A silent and more long-term pandemic occurring simultaneously is long COVID. The impact of long COVID has serious consequences for the future of humanity and should worry us all.

The recent Household Pulse Survey by the U.S. Centres for Disease Control shows that an average of 14% of US adults report long COVID symptoms. This is staggering because 93 million cases have been reported in the U.S. This implies that 13 million people in the U.S. have long COVID. Long COVID is also a global phenomenon: 2 million people in the United Kingdom, half million in Australia, and more than 100 million people globally.

13 million people in the U.S. have long COVID - Long COVID is also a global phenomenon: 2 million people in the United Kingdom, half million in Australia, and more than 100 million people globally

Long COVID is a group of symptoms which some have who, on the surface, recover from COVID-19 infection. Its occurrence is more frequent in those who had severe illnesses and in people who are not vaccinated. However, even those without COVID-19 symptoms when infected could have long COVID too.

Examples of long COVID include loss of smell, loss of taste, brain fog, difficulty in remembering past events, tiredness on exertion, chest pain, shortness of breath, headache, heart palpitations, muscle pain, change in skin and hair color and lots more.

Long COVID varies in duration. It could last for as short as 2 weeks and as long as many months after recovery from COVID-19 infection.

Research published in the British Medical Journal even documents a female patient with persistent loss in smell 27 months after the initial COVID-19 infection.  Therefore, it is unsurprising that some long COVID sufferers are unable to work. According to the Brookings Institution, long COVID could account for 15% of the  10.6 million unfilled jobs in the U.S.

With the rise in COVID-19 cases fueled by new variants, the number of long COVID cases will keep increasing. This is a wake-up call for global and country-level efforts to mitigate the impacts of long COVID. These are five ways to do so.

First, all global COVID-19 funds replenishment efforts must include plans to support long COVID interventions. These should go beyond COVID-19 prevention activities such as wearing of face masks, washing of hands with soap under running water and COVID vaccination.

Unfortunately, the 2022 “Break COVID Now Summit” co-hosted by Gavi only focused on replenishing funds to enable poorer countries to buy COVID-19 vaccines. Another way to ensure availability of funds for long COVID interventions before the next round of funds replenishment is ensuring that all COVID-19-related funding should include a component on long COVID. Such funding should cover local research on long COVID to determine the burden at country-levels, treatment and care for sufferers.

Second, some long COVID symptoms should be classified as disabilities. The U.S. Department of Health and Human Services recognises that long COVID can be a disability under the Americans with Disabilities Act if it substantially limits one or more major life activities. Other countries should do likewise.

Classifying long COVID symptoms as disabilities would enable sufferers to fully recover while being supported by the government or their employer. It would also protect the rights of sufferers from discriminations and stigmatization. For instance, a worker who has brain fog and difficulty in recalling past events requires time off work and mental health therapy to recover.

Third, update mental health care to include care of those living with long COVID. This should include updating standards of practice for mental health practitioners, mental health policies and laws. In addition, doctors should refer people with long COVID to mental health specialists.

This is relevant globally, especially in low and middle countries with poor awareness and services for mental health care. For example, in Nigeria, public perception of mental health is poor, qualified personnel are few, the law regulating mental health is from colonial times and care of those suffering from mental health disorders is mostly provided by unqualified personnel.

In 2019, I co-led the mental health in Nigeria surgery – the largest mental health survey in the country within the last 20 years. Our result showed that 70% of Nigerians say that mental health disorder is when the sufferer starts running around naked. Such wrong perception delays care and stigmatizes sufferers. One can imagine how long COVID sufferers with mental health disorders could be neglected in Nigeria.

Fourth, prioritise long COVID interventions in children because they are our future and long COVID could tamper with their abilities to be successful in life.

A systematic review of long COVID in children and adolescents shows a prevalence rate of 25.24%. The top five long COVID symptoms in children and adolescents are mood symptoms (16.50%), fatigue (9.66%), sleep disorders (8.42%), headache (7.84%), and respiratory symptoms (7.62%).

The thought of children and adolescents dealing with such conditions is disheartening. Their development and productivity are stifled. Therefore, paediatricians, parents and child social workers should be trained on providing the best long COVID care for children and adolescents.

Lastly, invest in nonprofits providing long COVID interventions because governments alone cannot cater for the huge backlog of sufferers. COVIDAid – the first long COVID Charity in the United Kingdom — has brought long COVID to the front burners of national discuss in the UK. It has provided support to more than 125,000 people via a web hub, held live events on the mental health impacts of COVID-19, launched new free long COVID courses and encourages voluntarism for long COVID.

Nonprofits play important roles in bridging gaps in social development. Having more of these types of long COVID nonprofits would ensure these achievements are replicated in other countries.

Long COVID is an existential threat to humanity. Globally, the 100 million long COVID sufferers are more than the population of Germany. There is fire on the mountain. We must consolidate global efforts to quench the fire.

A polio vaccinator administers the oral polio vaccine to a child in Pakistan. Credit: Ashfaq Yusufzai/IPS

By Ifeanyi Nsofor
ABUJA, Jun 22 2022 (IPS)

For forty days, Kunle Adeyanju – a Nigerian, Rotarian, polio eradication advocate and biker – rode for more than 12,500km from London to Lagos to raise funds for polio eradication.

Adeyanju documented his journey on Twitter, where his handle is appropriately named @lionheart1759. Indeed, it takes one with a lion’s heart to embark on such a bold adventure. People like philanthropist Bill Gates, who works on polio eradication, and the CEO of Twitter, Parag Agrawal, tweeted out their support and admiration.

Even in the face of dwindling resources and competing demands, the push for the total eradication of polio must continue because as long as even a few people have polio, it could spread widely again

I also followed Adeyanju’s journey on Twitter, and I applaud him too, including because I love to see individuals pursue their dreams, no matter how terrifying it seems. Ellen Johnson Sirleaf, Africa’s first female President and former President of Liberia, aptly captures this sentiment, “The size of your dreams must always exceed your current capacity to achieve them. If your dreams do not scare you, they are not big enough.”

I also support his cause. Polio is a serious infectious disease – it causes paralysis of muscles and also kills if the respiratory muscles are affected. In the past, polio victims who were unable to breathe on their own were placed in iron lung machines to enable them to breathe. Thanks to the efficacy of the polio vaccine, this is now history.

I am a proud alumnus of polio eradication. It was my first experience in global health. As a young monitoring, evaluation and surveillance officer at Nigeria’s National Programme on Immunization, I was involved in the global polio reaction initiative supporting advocacy, training of health workers and supervising routine and polio vaccinations across Nigeria.

We’ve seen in recent years how the global community has come a long way in almost making polio the second infectious disease (after smallpox) to be eradicated. Without a doubt, Rotary International has been a major partner and funder on this journey. I am part of the Rotary International family and was the president of the Rotaract Club at the Nnamdi Azikiwe University College of Medicine, Nnewi, southeast Nigeria. Rotary International launched a global polio vaccination campaign in 1985.

Three years later, the Global Polio Eradication Initiative (GPEI) was established. At that time, polio paralysed more than 1000 children globally daily. Since then, more than 2.5 billion children have been immunized against polio. Consequently, global incidence of polio cases has decreased by 99%. Currently, wild poliovirus continues to circulate in Afghanistan and Pakistan. Nigeria interrupted polio transmission in 2019.

Even in the face of dwindling resources and competing demands, the push for the total eradication of polio must continue because as long as even a few people have polio, it could spread widely again. The final five-year push to eradicate polio would cost an estimated less than $1 billion per year.

Like Adeyanju, Gates, and others, I want to see polio completely eradicated. These are four areas where those $5 billion funds could make that possible.

First, polio vaccine is needed to vaccinate all eligible children. To be fully protected for life, children need four doses of polio vaccines. Polio vaccines come in two forms – oral and injectable. Based on UNICEF estimates, cost per fully vaccinated child is $0.42 for oral polio vaccine. In contrast, it is $2.78 for an injectable polio vaccine.

Second, polio surveillance is a continuous process necessary for prevention and detection of the virus. The polio virus is passed out in stool. That’s why polio transmission is faeco-oral.

This makes polio transmission common in communities with poor sanitation and widespread public stooling. Surveillance activities involve collecting and screening stools of children who have quick onset paralysis after episodes of fever. Further, environmental surveillance of polio involves collecting and testing sewage water for the polio virus.

Third, vaccine storage via modern cold chain equipment. Maintaining the right cold chain for vaccines requires constant electricity, which is lacking across communities in sub-Saharan Africa. For example, only 48% of sub-Saharan Africa has access to electricity, according to the World Bank.

Therefore, clean renewable energy such as solar is a sustainable way to provide the right cold chain for vaccines. Across African countries, some primary health centers already use solar freezers for vaccine storage. Solar freezers don’t come cheap. A Solar Direct Drive Freezer sold on the African Union’s “Africa Medical Supplies Platform” costs $5,797.56.

Lastly, public health education is imperative to achieve equity in complete polio eradication and to continue to see successful vaccination campaigns in countries without polio. Indeed, the University of Global Health Equity, Rwanda captures this succinctly, “to achieve equity in healthcare, depends on equity in health education”.

Polio education is delivered in communities using community health workers, community leaders and community based organisations. Other means include use of radio, TV, print media and electronic media. More polio education should be delivered via social media. Adeyanju has made polio topical among youths on social media by following his heart and pursuing his dream

Adeyanju’s bold ride from London to Lagos has put polio on the front burners of international discourse, especially in these times of covidization of everything.

Through his action, he has answered in the affirmative Rotary International’s four-way test of what people say, think or do:

Is it the truth? – Yes

Is it fair to all concerned? – Yes

Will it build good will and better friendships? – Yes

Will it be beneficial to all concerned? – Yes

Thank you, Kunle Adeyanju. Your boldness will save lives and stop children from being paralysed. You are a hero.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University.

Nigerians should not be pushing against global COVID-19 vaccine inequity amid widespread looting of the national treasury. Credit: UNICEF/Nahom Tesfaye

By Ifeanyi Nsofor
ABUJA, May 24 2022 (IPS)

Nigeria’s accountant-general, the administrative head of the country’s treasury, has been arrested by the Economic and Financial Crimes Commission for allegedly stealing 80 billion naira ($134 million). This is a staggering theft in a country that has an estimated poverty rate of 95 million (48% of the population) and some of the worst health indices in the world.

As a universal health coverage and global health equity advocate, I know that Nigeria’s health system would be stronger and work better by blocking these leakages and channeling the funds to provide universal health coverage for every Nigerian.

Indeed, the stealing of public funds denies millions of people healthcare, which comes with severe health consequences. These include citizens living with chronic debilitating illnesses, loss of productivity, worsening poverty and even death. In our country, about 58,000 women die during pregnancy and childbirth yearly; and 1 in 8 children do not live to witness their 5th birthday. Simply put, corruption is a matter of life and death.

These are five examples of how the missing 80 billion naira could improve the health of Nigerians if rechanneled.

First, 80 billion naira would fund President Muhammadu Buhari’s plan to provide health insurance for 83 million poor Nigerians, as part of his implementation of the new National Health Insurance Authority Act that he recently signed into law.

Further, the missing 80 billion naira is 114 times the 701 million naira budgeted for the defunct National Health Insurance Scheme in 2022. It is unsurprising that the Scheme did not achieve a national health insurance coverage of up to 5% for the past 18 years.

A mandatory health insurance program is a way to achieve universal health coverage for Nigerians because out-of-pocket spending at the point of healthcare pushes people into poverty. Isn’t it ironic that millions of Nigerians are pushed into poverty when they access healthcare and the accountant-general is alleged to have stolen 80 billion naira? This is a classic case of suffering in the midst of plenty.

Second, the stolen 80 billion naira can fund tertiary healthcare for millions of Nigerians who access care at teaching hospitals. Lagos University Teaching Hospital, University of Nigeria Teaching Hospital, University of Ibadan Teaching Hospital, Aminu Kano Teaching Hospital and Jos University teaching Hospital collectively have a budget of 78 billion naira for 2022.

Teaching hospitals do not just provide tertiary healthcare. They also provide primary and secondary healthcare services. In addition, they train medical students and other health professionals. They are also training institutions for doctors specialising to become consultants.

Third, the stolen 80 billion naira is 13 times the 6 billion naira collectively budgeted for National Obstetric Fistula Centres at Abakaliki, Bauchi and Katsina states in 2022. The World Health Organization describes obstetric fistula as an abnormal opening between a woman’s genital tract and her urinary tract or rectum.

It is caused by long obstructed labor and affects more than 2 million young women globally. The abnormal opening leads to leakage of urine and/or faeces from the vagina. Obstetric fistulas destroy the dignity of women. Victims are ostracized, stigmatized and lose economic power. It said that you smell victims before you see them.

That is the huge burden that victims carry. In Nigeria, prevalence of obstetric fistula is 3.2 per 1000 births. There are 13,000 new cases yearly. A review of obstetric fistula in Nigeria showed that the backlog of cases could take 83 years to clear.

In contrast, the stolen 80 billion naira would shorten the time it takes to clear this backlog. I know from my experience as a grantmaker. In 2012, I led the community health initiatives at the TY Danjuma Foundation. A one-year grant of 11 million naira awarded to a grantee in Kano state, northwest Nigeria provided surgical repairs of obstetric fistulas; training of health workers on repair and care of patients; economic empowerment of patients; and advocacy to communities to discourage early marriage and encourage health-facility-based deliveries.

Fourth, the missing 80 billion naira if allocated to the National Primary health Care Development Agency would improve COVID-19 vaccines procurement, distribution and administration in Nigeria. Indeed, that amount is more than 3 times the 24 billion naira budgeted for the NPHCDA in 2022.

So far, Nigeria is mostly depending on the generosity of vaccines donated by rich countries such as the U.S. through the COVAX facility. This is not sustainable. Recent news out of South Africa reveals that Aspen Pharmacare could shut down production of Johnson & Johnson COVID-19 vaccine because African countries are not placing orders as expected.

At a cost of $7.50 per dose of Johnson & Johnson COVID-19 vaccine, $134 million would buy 18 million doses to vaccinate Nigerians and help the country achieve herd immunity as quickly as possible. Nigerians should not be pushing against global COVID-19 vaccine inequity amid widespread looting of the national treasury.

Lastly, the stolen 80 billion naira is 1.5 times the amount budgeted for the 54-billion-naira Basic Health Care Provision Fund. According to the National Primary Health Care Development Agency, the fund is to improve access to primary health care by making provision for routine costs of running primary health centres, and ensure access to health care for all, particularly the poor, by contributing to national productivity. Eighty billion naira increases the number of poor and vulnerable Nigerians who could access healthcare through the Basic Health Care Provision Fund.

Sadly, while still trying to come to terms with the allegation against the accountant-general, there is more news of fraud in Nigeria. A former Managing Director of the Niger Delta Development Commission was arrested for allegedly stealing 47 billion naira. Also, the only female to have served as the speaker of Nigeria’s federal House of Representatives was also arrested for 130 million naira fraud.

These thefts must stop, and the funds should be put where they are most needed: funding healthcare. Without health, we have nothing.

Sub Saharan Africa has a population of 1.14 billion, yet just 24% of the population has access to safe drinking water. Credit: Stella Paul/IPS

By Ifeanyi Nsofor
ABUJA, Mar 2 2022 (IPS)

Paul Farmer, the legendary global health equity warrior, recently died in his sleep from heart-related complications at the University of Global Health Equity (UGHE) in Butaro, Rwanda, the university he co-founded.

So many tributes have been written to Paul Farmer, and he deserves all the accolades bestowed on him posthumously. My tribute to Farmer is to amplify his teachings on the social determinants of health. It is crucial for health workers and health planners to take these on board to create comprehensive strategies for planning and delivering healthcare.

One of Farmer’s famous quotes aptly describes this, “You have to look at what’s happening to the patient in front of you and think about ways to address social disparities. If there’s food insecurity, then you provide food when you provide care. Or if patients drop out of treatment, you provide transportation to the clinic, or you send community health workers to the patient”.

I wholeheartedly agree. In 2019, I was at UGHE as part of an executive education for my cohort of the Atlantic Fellows for Health Equity at George Washington University. After our 10-day study at the university and the surrounding Butaro communities, I became even more convinced that healthcare without social determinants of health is inefficient.

In honor of Farmer, here are four examples of social determinants of health that health care workers and governments should consider.

Access to clean water

Sub Saharan Africa has a population of 1.14 billion, yet just 24% of the population has access to safe drinking water, according to the United Nations. This means that a whopping 912 million do not have access to drinking water (more than 120% the population of Europe). Therefore, it is unsurprising that infectious diseases are rife in the region.

Here’s a common possible scenario that illustrates the problem: A child is treated for diarrhea at a health facility and is about to be sent home. The parents are told to ensure the baby drinks clean water. They must use clean water to wash cooking utensils.

However, the family’s only source of water is a contaminated river. Although they want to adhere to the advice of health workers, they are constrained in how limited their choices are. Two weeks later, the child has diarrhea again and is also vomiting. The family is unlucky this time. The current episode is very severe. The child dies before they get back to the health facility. The solution to this is simple – sub Saharan Africa governments must provide clean water in every community.

Availability of uninterrupted electricity 

A survey of 13 health facilities in 11 sub-Saharan African countries showed that 26% had no access to electricity. Furthermore, 28% of health facilities had reliable electricity among the 8 countries reporting data. Let me make the impact of this clearer.

Imagine a woman who is in labor in one of these health facilities without access to electricity. She has labored for a long time and now is unable to push out her baby. She needs a suction machine to help pull out the baby.

The suction machine is available. However, there is no electricity to power the machine. The woman is weak, her family is in tears and the midwife is helpless. Referring her to another health facility is out of the question because of long distance, poor roads and lack of transportation. The woman dies. Her unborn baby dies. These tragedies could have been avoided with electricity. To mitigate such tragedies, governments must invest in clean renewable energy such as solar power.

Access to clean cooking stoves 

Across communities in sub-Saharan Africa, families use woods and even cow dung for cooking. Sometimes, cooking using both materials is done indoors, where there is poor ventilation. In the process of cooking for their families, women inhale smoke.

Being caregivers, their children are mostly with them. Sadly, mother and child are exposed to smoke particles which are injurious to their health. Having these materials as their only fuel for cooking means that they are always at risk of respiratory conditions such as asthma and other chronic obstructive lung diseases.

Although they may have access to treatment of their chest conditions, as long as the source of smoke inhalation is not removed, they will keep needing healthcare. This is why use of clean cooking stoves is a way to end this inequity.

In Kenya, the Clean Cooking Alliance is leading an initiative to develop clean efficient-burning cook stoves to improve health, the environment, and save families money in East Africa.

Mitigating the Impacts of Climate Change 

Climate Change is a defining health inequity of our time. Its impacts on health vary. For example, Climate Change leads to flooding, droughts, population displacement, forced migration and lots more. When there is drought, families walk long distances in search of water.

Women, girls and children are the most vulnerable. Some sources of water are rivers. Fetching water from these rivers expose them to different neglected tropical diseases (NTDs) including river blindness, schistosomiasis and others.

Treating these infections through mass drug administration in their communities is a short-term measure as long as there are no plans to mitigate the impacts of climate change. Therefore, ending the scourge of NTDs affecting about 1.5 billion of the world’s poorest people is not achievable without addressing Climate Change.

Farmer’s death at only 62 is untimely. However, his death at UGHE is symbolic, for he watches over a world-class institution that is training the next generation of health equity warriors. Africans believe that death is not an end. It is a transition to a new world.

We are consoled that Farmer has joined our ancestors, watching over us. We must not despair. We must keep putting the social determinants of health at the center of healthcare delivery and planning. That is what he would do, and it is the most equitable thing to do.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch.

There are calls to include migrants and other vulnerable groups in the vaccine rollout programmes in the Southern Africa region. Credit: UNICEF/Nahom Tesfaye

By Ifeanyi Nsofor
ABUJA, Jul 30 2021 (IPS)

A new survey on public awareness of long COVID by ‘Resolve to Save Lives” showed that among the 40% of Americans who were not vaccinated, seeing testimonials of those who suffer from long COVID inspired nearly two-thirds to consider the vaccine. A representative sample of nearly 2,000 Americans 18 and older took the survey between May 21 and June 10, 2021.

While most people who recover from COVID-19 get better within a few weeks, some people have health problems for a long time. Even people who were initially asymptomatic can start exhibiting them. Examples of the symptoms include difficulty thinking or concentrating, headache, difficulty breathing, cough, joint or muscle pain, fatigue, loss of smell, lightheadedness, and depression or anxiety.

Trying to avoid long COVID is a good reason to try to not catch COVID-19. This is especially true with the emergence and spread of the highly infectious Delta variant. Long COVID devastates lives, occupations, and incomes

Even though some people may not take precautions or get vaccinated because they think COVID symptoms would be mild if they contract it, long COVID shows that even people with mild or asymptomatic cases can suffer long-term. Trying to avoid long COVID, then, is a good reason to try to not catch COVID-19. This is especially true with the emergence and spread of the highly infectious Delta variant.

Long COVID devastates lives, occupations, and incomes. For instance, Paul Garner, a professor at the Liverpool School of Tropical Medicine and Co-ordinating Editor of the Cochrane Infectious Diseases Group has documented his long COVID experience for the British Medical Journal.

After being diagnosed with COVID-19, receiving treatment and recovering, he had bouts of long COVID symptoms. His symptoms included acutely painful calf, upset stomach, tinnitus, pins and needles, aching all over, breathlessness, dizziness, arthritis in the hands.

A breakdown of the recent survey result shows that learning about these kinds of stories can motivate unvaccinated Americans. In the long COVID survey, 64% of Americans became more concerned about contracting COVID-19 from watching the testimonials.

Thirty-nine percent of those who were unvaccinated, including 31% who were vaccine hesitant, were motivated to consider getting the vaccine. The testimonials were most effective among 18 to 29-year-olds, Hispanics and urbanites.

Fifty percent of vaccine-hesitant Americans believe the message that “Getting the COVID-19 vaccine is the best way to prevent COVID-19 and its potential long-term complications”.

As a public health physician and COVID-19 vaccine advocate, I found the survey findings promising. They provide the evidence base to increase vaccine uptake and counter misinformation. What can public health officials do with this information? Here are four steps.

First, engage willing long COVID sufferers and survivors as vaccine advocates. A misleading aspect of this pandemic is that about 80% of those infected do not have any symptoms. This gives the false impression that COVID-19 is not as infectious, harmful or as fatal as it actually is.

Moreover, even those who are asymptomatic can still develop long COVID and that fact needs to be better publicized. The long COVID survey has shown the power of testimonies by sufferers. Governments, national public health institutes, civil society organizations, community-based organizations should leverage this.

This should begin by identifying long COVID sufferers willing to share their testimonies. COVID:Aid, the UK-based long COVID Charity set up to support and give a voice to individuals affected by Covid-19 across the UK, is a great organization to work with. Partnering with COVID:Aid will help identify sufferers and support them to share their stories.

Second, use findings of this survey to create targeted advocacy messaging for all demographics. Such messaging must be aspirational. It should not be designed to make the target groups feel unworthy. Rather, the messaging should be to make them aspire to be vaccinated. It should make the unvaccinated know the importance of being vaccinated and ending the pandemic. Health advocates must seize this opportunity to end the pandemic.

Third, prioritize social media as the medium for communicating the testimonials and targeted advocacy messaging. Vaccine hesitancy is quite common among the youths who use social media since they do not think they will suffer much if they contract it. Using social media in this way should involve working closely with social media firms and involving them in designing the messaging.

Already Facebook, Twitter, Instagram are involved in countering COVID-19-related misinformation and disinformation. Their involvement should include sharing videos of long COVID sufferers talking about their symptoms, how they cope and the benefits of being vaccinated.

Fourth, and related, use influencers to deliver long COVID social media testimonials. Globally, there are billions of social media users ruled by influencers. There are examples of social media influencers countering misinformation.

In Nigeria, the FactsMatterNG used Nollywood celebrity Actor Kate Henshaw (2.3 million Instagram followers). In Indonesia, social media influencers were among the first to receive COVID-19 vaccine. The Indonesian government took this route in world’s largest Muslim country due to the belief that influencers will post their experience online and help convey that vaccines are safe, effective, and allowed under Islamic law.

Celebrity TV star, Raffi Ahmad (54 million Instagram followers) shared his video of being vaccinated and it has been viewed more than 3.7 million times. In the U.S., American pop star Olivia Rodrigo (14.4 million Instagram followers) is supporting the plan by President Biden’s Administration to encourage young people to get vaccinated.

In a White House video, Olivia and Dr. Fauci read tweets and answered questions by young people on COVID-19 vaccination.  The first tweet they read was, “If Olivia Rodrigo tells you to get vaccinated, you get vaccinated“. This tweet shows the power of social media influencers.

Long COVID will be around for a long time. The survey shows that hearing testimonials from sufferers and survivors can help reduce vaccine hesitancy, so we must capitalize on that and work to reduce the likelihood of more people suffering from long COVID.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch.

There is no health without mental health. Credit: Unsplash /Melanie Wasser.

By Ifeanyi Nsofor
ABUJA, Jun 2 2021 (IPS)

Recently, Naomi Osaka, the number 2 ranked women’s tennis player in the world, said she would not participate in the press conference at the French Open (Rolland-Garros) because she wanted to protect her mental health.

The organizers of the tournament were incensed, imposed a fine on her and threatened to disqualify her.  Would the organizers have reacted differently if Naomi Osaka said she could not participate in the tournament’s press briefing because of a physical illness, such as abdominal pain? Your guess is as good as mine, but I believe the organizers would have been more empathetic and would have provided her with the best medical treatment. The same should happen for mental health.

Osaka was stigmatized because people do not understand mental health and feel she should “man up” and attend a press conference. Further, athletes like her are all too often viewed as superhuman and incapable of showing weakness

It is wrong for the organizers to impose a fine of $15,000 on Osaka and threaten to suspend her for missing the press conference. Such reactions contribute to why mental health is still so widely misunderstood, shrouded in mystery and stigmatized.

There is no other way to put this. Osaka was stigmatized because people do not understand mental health and feel she should “man up” and attend a press conference. Further, athletes like her are all too often viewed as superhuman and incapable of showing weakness.

Due to the backlash, Osaka has withdrawn from the French Open, apologized and the French Tennis Federation President has also apologized for the way this episode was handled. However, as regrettable as the events are, it can serve as a teachable moment for everyone.

Here are five ways to ensure mental health illnesses receives the same prominence as physical illnesses.

First, there is no health without mental health. The World Health Organization defines mental health as a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

Surely, from this definition, Osaka could not handle the stress which comes with participating in press conferences. She said so. She mentioned her experience with depression. Participating in the tournament press conference could have worsened her health and well-being. She was right to have withdrawn from the press conference and the tournament. Her health trumps all other concerns.

Second, revealing one’s mental health challenge is a strength and not a weakness. This wrong perception of mental health is ubiquitous.

For instance, EpiAFRIC and Africa Polling Institute interviewed more than 5,000 in a nationwide mental health survey in Nigeria. Some respondents said they will use force and other extreme measures on sufferers of mental health illness.

For example, 4% said they would lock up the sufferer while 2% said they will beat the disease out of the person. The way the French Open organizers responded to Osaka’s cry for help is wrong and must be condemned by all. It is great to see the support extended to Osaka by other Black elite athletes, Serena Williams and Stephen Curry.

Third, sports tournaments must develop a comprehensive mental health support policy for athletes. This is not the first time a major athlete cried out for help in dealing with a mental health challenge.

Naomi Osaka October 28th 2020 during the semi-final match of the women’s Cincinnati Masters played at the USTA Billie Jean King National Tennis Center’s Grandstand court. Credit: AndrewHenkelman / Creative Commons.

According to Athletes for Hope, 35% of elite professional athletes suffer from a mental health crisis which may manifest as stress, eating disorders, burnout, or depression and anxiety. Too many athletes are suffering in silence.

Due to their achievements and celebrity status, they are being shamed into silence. To help deal with this silent pandemic, sports tournaments must develop comprehensive mental health support policy. Elite athletes such as Osaka should have mental health counsellors as part of their medical teams. No athlete should have to suffer in silence because the consequences of that could be fatal.

Fourth, we must stop viewing Black women as having higher pain threshold. It is a common misconception for Blacks to be seen to tolerate pain better than other races. According to Proceedings of the National Academies of Science, 40% of first- and second-year medical students were of the belief that “Black people’s skin is thicker than white people’s.”

Even at childbirth, Black women are sometimes refused pain medications because of this wrong belief. This leads to verbal and physical abuse of someone dealing with a debilitating health condition. When Osaka said speaking at the press conference would negatively impact her mental health, she should have been believed. She is dealing with the pain of depression and needs all the support she can get.

Finally, media outlets must train reporters on writing about mental health with empathy. The Daily Mail UK article, in which the writer accused Osaka for “cynical exploitation of mental health to silence the media” is harsh and not the way to describe someone who is dealing with depression. Such articles worsen Osaka’s battle with depression and discourages other athletes from speaking out about mental health challenges they face.

Osaka is 23 years old. At such a young age, she should be celebrated for her boldness in confronting depression and being vocal about it. I hope she gets all the recuperation she needs. I pray she becomes stronger and can play in her next tennis tournament.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch.

A local cemetery working running on the ground collecting logs for funeral pyres, to perform the last rites for patients who died of Covid, on 29 April at the Ghazipur cremation ground in New Delhi. (Ghazipur Cremation Ground/File-Amit Sharma)

By Shubha Nagesh and Ifeanyi Nsofor
DEHRADUN, India/ABUJA, May 12 2021 (IPS)

The media is awash with the devastating news of deaths and sufferings due to COVID-19 coming out of India. What most media outlets overlook is the way Indian communities are rallying to save lives, reduce sufferings and stop the current wave of the pandemic.

As of May 11, 2021, India’s COVID-19 case total is about 23 million – with above 19 million recoveries, while total deaths are 250,025, according to the health ministry. All levels of hospitals and health facilities are full, after optimising their beds and staff, oxygen is almost not available, medicines are being bought in the black market and crematoriums have been inundated, forcing them to use nearby open spaces and parking lots to deal with the surge. Despite being the world’s largest producer of vaccines, India does not have enough for its own people.

Communities have to be acknowledged as the true heroes in this second wave of COVID-19 outbreak in India. Without support however, even they cannot flatten the COVID-19 curve

Shubha lives in Dehradun, in North India- with a population of one million, Dehradun is no different from anywhere else in India, but for the lack of much media attention. The Kumbh Mela, (a major pilgrimage and festival in Hinduism) did bring some focus to the state of Uttarakhand as a super-spreader event in the last month.

The past week has been consumed with calls all day around beds, medicines, oxygen and plasma. It all got really intense when someone in her own family got really serious and her condition scared the family tremendously. That was when the reality actually hit home – the scarcity, the fear, and the unrelenting nature of the virus.

While institutional care has taken priority in the conversation around COVID, from what is evident on the ground, it is the people who are enabling each other to seek appropriate care. Communities are coming together to maximise the resources they have, to promote preventive care and support post-hospital care. Mahatma Gandhi captured this sense of community aptly;

“a nation’s culture resides in the heart and in the soul of the people”.

This quote by Gandhi describes an important truth – one that still inspires us to believe the tremendous strength and courage that the people of India show in coming to the aid of sick people.

The current situation in India is clearly demonstrating the inequity in access to care, utilisation of care and showcases how institutions are catering to the privileged while the less-privileged suffer. As India attempts to rebuild, one good starting point is strengthening community supports and networks between the community and healthcare facilities.

Communities are the heart and soul of India. They have the potential to make or break the health of its people and impacts the determinants that drive health. It is important for us to understand its might and do all to meet the potential, now.

We give five examples of communities taking leadership to stem this second wave of COVID-19 in India:

First, religion unites. Religious communities have come forward to do their bit for patients and their families. The Sikh community in India and abroad has come forward to support families by distributing food, creating helplines, distributing oxygen, converting gurudwara premises into makeshift health facilities, and so much more.

Second, the power of celebrity. In India’s Covid-19 response, while most of the celebrities chose to stay quiet, one celebrity has been helping all along, including transportation for the migrant workers to return home, arrangement for hospital beds and oxygen cylinders, etc- Sonu Sood has been phenomenal in his relief efforts, and as he admits, “This was sheer teamwork and the will to help our fellow countrymen”.

Third, the Indian community knows no boundaries. Within the country and the Indian diaspora communities, the people are providing support. Nothing is too small to give. It all eventually adds up. For instance, the India COVID SOS is less than two weeks old.

However, it now has more than 500 members donating funds, equipment and expertise to stem the outbreak. In Dehradun, the number of people who have connected to share information about beds, oxygen, medicines and tests is unbelievable. It will take all of us, each of us, to get through this difficult time.

Fourth, heroic efforts of good samaritans, men, women and many others have ensured food for families through the pandemic. Pushkar Sinha of South Delhi collected details of all the elderly living in his building, collaborated with a nearby hospital and registered them for getting Covid-19 vaccination through the government’s Co-WIN app.

When some of the people said they were unable to get to the hospital, he arranged cars to ferry them. Deshna Krupa and her mom Ahalya from Chennai have been cooking free meals for Covid-19 patients who are quarantined at home.

Two sisters from Patna, Bihar, Anupama Singh and Neelima Singh along with their mother, Kundan Devi prepare and deliver food to homes.

Within days, groups all over India emerged to help support those in need.

Finally, the power of youths. Young people becoming volunteers to create resources for those in need of services. When Arushi Chaddha asked for help on Instagram, Suhail Shetty came forward to arrange for an oxygen concentrator. Nupur and Rahul Agarwal started “Mission Oxygen” to track oxygen concentrators and supplies, when they found a shortage of 3000.

With the help of social media, youth developed digital covid helplines to support affected families with testing, treatment, hospitalisation, oxygen support facilities, mental health, counselling and food services. Youth volunteers have created mobile apps to track bed situations in hospitals across the country.

India is really struggling with Covid-19 and needs global support. Importantly, communities have to be acknowledged as the true heroes in this second wave of COVID-19 outbreak in India. Without support however, even they cannot flatten the COVID-19 curve. The government must show responsibility to ensure that these community efforts are amplified.

Women informal cross-border traders. Credit: Trevor Davies/IPS

By Ifeanyi Nsofor, Adaeze Oreh, and John Lazame Tindabil
May 6 2021 (IPS)

Recently, both Republics of Benin and Chad held their 2021 national elections. These countries are among thirteen countries on the continent billed to elect new political leaders in 2021 alone. This is a good opportunity to improve conditions on the continent. Indeed, the COVID-19 pandemic has magnified other issues on the continent like youth unemployment that better leadership could help improve.

These are three ways West African leaders can better help their nations at this time of COVID-19 and beyond.

First, the rate of youth unemployment must be effectively tackled.

Younger nationals must be encouraged and supported to enter politics at all levels, vying for not only executive office, but also parliamentary seats in local, state and national elections

According to the United Nations, about 64% of the population in West and Central Africa are aged below 24. Although these young people are a huge resource for the region, unemployment, and a failure to invest and develop such as agriculture, education, health, and industry have led to an under-utilisation of this vital resource.

Sadly, the World Bank reports youths account for 60% of all of Africa’s jobless. For a continent with more than 200 million people aged between 15 and 24, the continent is home to the world’s youngest population whose level of unemployment is twice that of older adults.

Most electioneering and campaign messaging encourage violence, and with an astonishing number of unemployed and “working poor” amongst youth in the sub-region, these young people are ready tools to be used for violence, election fraud and social unrest, not to mention communal conflict and gang violence.

With informal employment being the default at up to 89% of jobs in sub-Saharan Africa, social safety nets and workers’ rights are inaccessible to most youths.  Last year, Ghanaian President Nana Addo Akufo-Addo announced that his country would cease to export cocoa to Switzerland, its largest trade partner, to increase cocoa processing and chocolate manufacturing for export.

This bold move which speaks to a focus on innovation could however change the status quo for Ghana and the West African sub-region. Harnessing the country’s youthful population into innovation-led agricultural and value-adding industrial processes medical equipment and vaccines will attract new and improved business ventures, which would lead to the creation of more jobs and economic growth.

Secondly, we must involve youths in elective offices.

United Nations projections reveal that over the next twenty-five years, the population of sub-Saharan Africa is projected to double (in what constitutes a 99% increase). For the youngest continent in the world, there is a vast disconnect between its people and its leaders – age, as the region plays host to some of the “oldest and longest-serving political leaders”.

Changing the political narrative will require Africa’s youth to throw their hats in the ring and defy entrenched systems of elder deference to bring about political change. Younger nationals must be encouraged and supported to enter politics at all levels, vying for not only executive office, but also parliamentary seats in local, state and national elections.

Lastly, there must be gender balance in elective offices.

There is no current female West African leader. Liberia’s Ellen Johnson Sirleaf was the first elected female leader in Africa, while Nigeria’s Patricia Etteh and Joyce Adeline Bamford-Addo of Ghana were two female Speakers of Parliament in a list of elected female West African leaders that is still too short.

Experience from the COVID-19 pandemic illustrated that nations that were successful in containing the virus were mostly women-led. There have been suggestions that women leaders are more diverse and inclusive in the perspectives brought to bear in their exercise of leadership, and prioritise the protection of their citizens over risk.

Ellen Johnson Sirleaf’s leadership in the eye of the storm of the West African Ebola outbreak of 2014 is a case in point. Madam Sirleaf herself has stated that the success of women leaders in addressing the COVID-19 pandemic has been borne out of their readiness to “draw on informal networks, ingenious partnerships, community support and alternative resources to solve problems.”

COVID-19 has affected all aspects of governance – economy, businesses, healthcare, education etc. Consequently, it will take a long time for economies to recover to pre-pandemic levels.

To quote Ellen Johnson Sirleaf: “Now is the time to recognize that developmental transformation and true peace cannot come without fundamental change in who is leading and the ways of leading.”

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch. You can follow him on Twitter @ekemma.

Dr Adaeze Oreh is a Consultant Family Physician and Country Head of Planning, Research and Statistics for Nigeria’s National Blood Transfusion Service. She is also an Amujae Leader and Senior Fellow for Global Health with the Aspen Institute in Washington D.C. You can follow her on Twitter at @Adaeze_Oreh

John Lazame Tindanbil  is a public health practitioner working to provide quality reproductive healthcare, including safe abortion services. He leads MABIA-Ghana and is a Senior New Voices Fellow at the Aspen Institute. You can follow him on Twitter @JLazame_5090

Continued inequity in COVID-19 vaccination means virus mutations occur and newer variants emerge that may be resistant to currently available vaccines. Credit: United Nations.

By Ifeanyi Nsofor
ABUJA, Apr 2 2021 (IPS)

As richer western nations continue hoarding COVID-19 vaccines to the detriment of poorer nations, there is some light on the horizon. On April 15, 2021, the U.S. will join the Global Vaccine Alliance (GAVI) and co-host the launch of the Investment Opportunity for COVAX Advance Market Commitment.
The aim of the event is to raise more funds to ensure at least 1.8 million doses of COVID-19 vaccines are available to 92 low-income nations. The U.S. recently donated $4 billion to COVAX and this new leadership role is highly commendable.

“The more the virus that causes COVID-19 is out there in the world, the more opportunities it has to evolve—and to develop new ways of fighting our defenses against it. If we don’t get the vaccine out to every corner of the planet, we’ll have to live with the possibility that a much worse strain of the virus will emerge.” 
Bill Gates

However, even if all the commitments are met from the launch, only 20% of people in poorer nations would be vaccinated. Furthermore, it could take until late 2022 for that population to be vaccinated.

Continued inequity in COVID-19 vaccination means virus mutations occur and newer variants emerge that may be resistant to currently available vaccines. Therefore, it is in the interest of every nation (both rich and poor) that everyone everywhere has a fair chance of being vaccinated simultaneously.

Bill Gates alluded to this in his recent Gates Notes: “The more the virus that causes COVID-19 is out there in the world, the more opportunities it has to evolve—and to develop new ways of fighting our defenses against it. If we don’t get the vaccine out to every corner of the planet, we’ll have to live with the possibility that a much worse strain of the virus will emerge.”

Simply put, to end this pandemic, we must vaccinate everyone, everywhere.

As the COVAX investment commitment launch approaches, these are three ways the U.S. especially can ensure more equity in ending the COVID-19 pandemic globally:

First, support the push by the World Trade Organization for temporary COVID-19 vaccine patent waivers so that vaccines can be manufactured locally in Africa and other parts of Asia. Recently, the U.S. Chamber of Commerce opposed calls for the World Trade Organization to back a temporary waiver of intellectual property rights to speed coronavirus vaccine production in poor countries.

If this continues, it could take until late 2023 or even early 2024 to vaccinate all those eligible across Africa. President Joe Biden has to intervene to authorise these waivers so that vaccine production can take place simultaneously in rich and poor countries.

Local production of vaccine in African countries will also lead to reduction in logistics costs and waiting times in transporting the vaccines from the west to African countries. Egypt has concluded preclinical trial and would soon begin clinical trial for a vaccine locally.

Likewise, Johnson and Johnson pharmaceutical has pledged 400 million of their single-dose vaccine to the Africa Vaccine Acquisition Task Team. Most of the supplies would be manufactured locally by Aspen Pharma in South Africa The U.S. should support more local production across African countries to speed up COVID-19 vaccination on the continent.

Second, block capital flight via corruption from poorer nations. Africa loses an estimated $50 billion yearly due to illicit financial flows. This theft amounts to a staggering $800 billion stolen from 1970 to 2008. These funds are stolen via electronic transfers.

Surely, banks and other agencies are aware as the theft is happening. The U.S. can work with banks and national anti-corruption agencies to stop funds being stolen. We do not have to wait for funds to be stolen and then go through all manners of legal and regulatory bottlenecks to repatriate the funds.

For example, no one really knows how much Nigeria’s former military dictator, General Abacha stole from the country. Twenty-three years after his death, funds he stole are still being repatriated back to the country.

The U.S. should also impose sanctions on banks, bank executives, politicians and civil servants who aid these thefts. With $50 billion yearly, Africa will not be dependent on richer western nations to vaccinate her people. Indeed, at $10 per dose, $50 billion will buy 5 billion doses of the Johnson and Johnson Covid-19 vaccine – more than enough to vaccinate all Africans three times over.

Third, ending the pandemic is not just about vaccines. Therapeutics, personal protective equipment and other commodities are essential. Sadly, the U.S. hoarded these at the beginning of the pandemic in 2020. These hoardings must stop.

The African Union’s Africa Medical Supplies Platform (AMSP) chaired by Zimbabwean billionaire, Strive Masiyiwa has succeeded in creating a platform for linking manufacturers with African nations especially for pre-ordering of COVID-19 commodities, including vaccines. The AMSP is an innovative idea to make Africa self-sufficient in COVID-19 response. This should be supported by the U.S.

All lives are created equal. The U.S. government should deepen its global health leadership by ensuring that this COVAX launch is an opportunity to demonstrate the sanctity of lives everywhere. It is the equitable thing to do to end this global pandemic for everyone.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch.

Credit: Unsplash /Melanie Wasser.

By Ifeanyi Nsofor and Shubha Nagesh
ABUJA, Jan 22 2021 (IPS)

Dealing with COVID-19-related city lockdowns has been exceptionally stressful, particularly for those parents who have had to balance work, personal life, children and elderly, providing home schooling or facilitating virtual learning, managing infection control within the home, and more, all while being disconnected from support services.

Beyond all this, other mediators and moderators play a key role in outcomes for parents and children, including their function and adaptation – sociodemographic, exposure, negative events, personality traits, and the experience of death among close family and friends.

It is therefore unsurprising the results of C.S. Mott Children’s Hospital National Poll on Children’s Health 2020 survey of child health concerns.

Clear links exist between mental health indicators and child-parent conflict and closeness, with anxious parents being particularly vigilant to responding to cues of children’s distress by encouraging them to express their opinions and providing support and acceptance of their decisions
The poll is a national sample of parents to rate the top health concerns for U.S. children and teens aged 0-18 years. A breakdown of the results shows the top ten concerns as follows: overuse of social media/screen time (72%); bullying/cyberbullying (62%); Internet safety (62%); unhealthy eating (59%); depression/suicide (54%); lack of physical activity (54%); stress/anxiety (54%); smoking/vaping (52%); drinking or using drugs (50%); and COVID-19 (48%).

The findings also show that parents’ biggest concerns for young people are associated with changes in lifestyle and mental health consequences of the pandemic.

There are fewer similar studies from the Global South; one study from China showed that the quarantine’s impact on children’s emotion and behaviour is mediated by the parents’ individual and group stress, with a stronger effect from the latter.

Parents who reported more difficulties in dealing with quarantine showed more stress, which in turn, increased the children’s problems. A study from Singapore explored work-family balance and social support and their links with parental stress. It revealed that lockdowns can be detrimental to parenting and marital harmony, especially for parents with poor work family balance and weak social support.

Clear links exist between mental health indicators and child-parent conflict and closeness, with anxious parents being particularly vigilant to responding to cues of children’s distress by encouraging them to express their opinions and providing support and acceptance of their decisions.

Previous studies have revealed that family structures who hold on their own in difficult times will best thrive and get past pandemic and other similar situations.

India’s lockdown declared without advance notice, saw many nuclear families from cities shift back to their ancestral towns for economic reasons. The lack of jobs, particularly in the informal sector, lack of resources to enroll children in online schooling and being cut off from health services and public transport made families shift back into joint family structures to support one another in times of uncertainties.

In Nigeria, the most severe impact of the pandemic on parenting is the loss of livelihoods among low-income families who earn daily within the informal economy – 65% of economic activities are within the informal sector. Most of them do not own bank accounts and may not have savings. The lockdown impacted these informal sector workers the most and consequently their ability to parent effectively.

Thus, the impact of pandemics on the mental health outcomes of children and their families must be explored as a distinct phenomenon. We suggest three ways to enable this:

Improve access to psycho-social support for families, parents and children during lockdowns in pandemic situations. Globally, there is second wave of the pandemic. In the United Kingdom, the country is in total lockdown. This implies that families continue to deal with the challenges identified by the C.S. Mott Children’s Hospital National Poll.

Governments, civil society organisations, public health administrators must begin to assign social workers to visit families and help them deal with the mental health consequences of lockdowns. Conduct outreaches to provide emotional and mental health support for children and families in low-income communities with poor internet access.

An example from India is the The Mental Health Action Trust (MHAT) in Northern Kerala, that developed a unique mental health initiative that has a strong focus on empowering local communities and implementing mental health services through more than a thousand volunteers who run the community service.

Use technology to provide remote to support to parents and children. When families are informed on how lockdowns could affect them, they are better prepared to deal with such challenges. Nigeria’s leading non-profit organization providing mental health support, Mentally Aware Nigeria Initiative, has been reaching out to individuals through social media to help them deal with mental health consequences of the pandemic.

They do this via the Project COVID-19. Services provided include mental health assessment and linkage to counsellors, monthly virtual conversation café using WhatsApp to discuss coping skills and providing support to keep isolation journals. Such organisations are few in the global south and should be supported by government, international donors and the private sector to take their services to scale.

Finally, COVID-19 has changed the workplace and it is no longer business as usual. A significant amount of stress is attributed to juggling work life and home, employers should better support their employees to ease some of the pressure.

Companies should promote frequent check-ins and flexibility, more relaxed patterns of work schedules, incorporate breaks between intense work meetings, encourage recreational online family gatherings, time offs and financial incentives etc. Company health plans should include mental health care. Connecting families to mental health services is another great way to support parents, and therefore families.

COVID-19 is a reminder that countries must invest in epidemic preparedness. These investments should be family-centred to ensure that parents and caregivers are equipped to provide the best parenting possible.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch.

Dr Shubha Nagesh works for the Latika Roy Foundation in Dehradun, India. She is a senior Atlantic Fellow for Health Equity at George Washington University. Shubha strives to make childhood disabilities a global health priority.

Miscarriage is the most common reason for losing a baby during pregnancy. It happens for up to 15% of women who knew they were pregnant.. Credit: UNSPLASH/Claudia Wolff.

By Ifeanyi Nsofor
ABUJA, Dec 29 2020 (IPS)

Recently, Meghan Markle, the Duchess of Sussex, wrote a piece sharing about her miscarriage. I knew, as I clutched my firstborn child, that I was losing my second, she wrote. She is part of a growing list of celebrities who have publicly shared their experiences with miscarriages.

Model Chrissy Teigen also recently shared the pain she and her husband singer John Legend felt about the miscarriage of her third pregnancy. While celebrities may make news for sharing their personal grief, they are not alone in experiencing it.

Miscarriage is the most common reason for losing a baby during pregnancy. It happens for up to 15% of women who knew they were pregnant. According to World Health Organization, a baby who dies before 28 weeks of pregnancy is referred to as a miscarriage, and babies who die at or after 28 weeks are stillbirths. Most miscarriages are due to chromosomal anomalies. The risk of miscarriages increases with age.

No matter when it occurs, however, nor how old the pregnant woman is, a miscarriage exerts huge mental stress on the women and their families.

"This is one part many women who have gone through loss are never asked or speak of. Reading hers, I remember mine. We all just learn to live with it. If I will ever write a book, I will of mine"

When I tweeted about Markle’s piece,  Abuja-based Martha Ngodoo responded to my tweet – “This is one part many women who have gone through loss are never asked or speak of. Reading hers, I remember mine. We all just learn to live with it. If I will ever write a book, I will of mine”.

After reading Ngodoo’s tweet, I was compelled to reach out and hear her story. She said she experienced both miscarriage and stillbirth. She is now a 40-year-old mother of three.

Her first experience was a stillbirth that happened 16 years ago during her first pregnancy when she was 24 years old. This was a case of a poorly managed preeclampsia (high blood pressure in pregnancy). She went into labor and was rushed to the hospital. She was in labour for 72 hours. The medical team tried to induce labour using oxytocin but was unsuccessful. Her dead baby was eventually pulled out by hand in an assisted delivery.

Her second experience was a miscarriage which happened five years after. She was aged 29 years then and the miscarriage took place at her twenty-second week in pregnancy. She had a fever during this pregnancy. One night, she woke up with the urge to urinate. When she attempted, her baby came out in bits. She was then rushed to the hospital and the baby was completely expelled. It was a horrible experience, she said.

Both experiences made Ngodoo wonder what she had done to deserve such pain, twice. Though her husband was very supportive, she was worried about giving him dead babies from her pregnancies. Some cultural beliefs made this more difficult. Her husband suggested they move into his parent’s home so she could get additional support. However, this turned out to be very unhelpful. For instance, her father-in-law wanted her to continue life as if nothing happened after the stillbirth.

Ngodoo is stronger now and after many years and three successful pregnancies, she is able to talk about her experiences without feeling sad. When I asked her what she recommended for helping women deal with the pain of miscarriages and stillbirth, she shared three suggestions.

First, don’t tell a woman that it is “okay” when she loses a pregnancy and dismiss what she’s been through. Women undergo physical and psychological changes during pregnancy. They develop deep attachments to their unborn babies and losing one is painful. It is okay for a woman who has lost a pregnancy not to feel okay.

Fourteen years after, Ngodoo still wonders what her daughter would be like now if the pregnancy did not end in a stillbirth.  She still does not know where her daughter was buried. These are thought that still plague her mind, even though she is not as devastated as she once was. She has learnt that talking about such experiences allows victims to exhale and then allow the healing process to begin.

Second, women that lose pregnancies need mental health support. Ngodoo wants more women to receive the kind of mental health support that would enable them to speak about their experiences.  A way to achieve this is through training counsellors to lead support groups for victims.

These support groups could be at communities, health facilities or embedded within professional associations. There are lessons from the UK-based Miscarriage Association. The association has a network of support volunteers, who have been through the experience of pregnancy loss themselves and can offer real understanding and a listening ear. This is done physically or virtually, through Zoom meetings.

Third, families of victims of miscarriage should be safe havens, especially when others may not have even known about the pregnancy, let alone the loss. Sadly, this is not always the case.

Ngodoo lived with her in-laws (in the family house) after her wedding. She feels her in-laws should have understood her loss better and not attempted to get her to resume normal activities immediately. She wishes visitors to the house wouldn’t have told her that she should carry on with her life because she is not the first woman to lose a pregnancy.

Ngodoo is now a mother to a daughter and two sons. Her daughter is 7 years old and her sons are 13 years and 10 years respectively. She describes her two sons as rainbow babies – born immediately after miscarriages. They are the sunshine that we are blessed with after a loss, she said.

With support, women can begin to heal after miscarriage. When women feel strong enough to share their miscarriage stories, it inspires others. The Duchess of Sussex is inspiring women by sharing her story. This should be the norm.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch.

We never imagined that we would witness food insecurity being an issue in developed countries such as the US. Credit: Stephen Leahy/IPS.

By Esther Ngumbi and Ifeanyi Nsofor
URBANA, Illinois / ABUJA, Dec 17 2020 (IPS)

Food insecurity across the U.S. continues to be on the rise because of the effects of COVID-19. According to Feeding America, over 50 million Americans will experience food insecurity, including 17 million children. 

We both grew up in countries referred to as “developing countries,” Ifeanyi in Nigeria and Esther in Kenya. At the time, we never imagined that we would witness food insecurity being an issue in developed countries such as the U.S. like we are now. As thought leaders in global health and food security, we are compelled to amplify this inequity in the world’s richest country.

The last few months, clearly, have changed our perception of food insecurity and the narrative around it is changing.

COVID-19 is very well linked with food insecurity and failing to have a food security expert working alongside the other advisory council members would undermine the ability of the country to effectively tackle these tightly linked issues

Moreover, even as we celebrate the arrival of the vaccine, COVID-19 continues to claim the lives of many Americans, while bringing the possibilities of new lockdowns, hence, we can certainly expect food insecurity to continue to be a problem.

Impressively, measures that were in existence before the pandemic in the U.S. such as foodbanks and other Federal benefits such as SNAP and WIC that Americans have access to in order to assist with food insecurity have helped to make a difference.

Through the pandemic months, we have also witnessed a rise in resources available to citizens who at one point or another need help with finding food. From the U.S. Department of Agriculture hotline that can connect citizens to available pantries, interactive maps that reveal where help and your local food bank is, to databases of pantries and non-profit subsidized grocery to food finder apps.  But the truth is these resources were designed to be supplemental.

Much more needs to be done. Here’s where to start.

First, President Joe Biden and Vice President Kamala Harris should include a food security expert in the COVID-19 Advisory Council. The responsibility of the expert should be to provide advice on ways to address the current COVID-19 food insecurity in the U.S.

COVID-19 is very well linked with food insecurity and failing to have a food security expert working alongside the other advisory council members would undermine the ability of the country to effectively tackle these tightly linked issues. Moreover, this person should preferably be a person of color, the population that has been impacted most by food insecurity.

Second, develop a multi-stakeholder comprehensive food security plan as part of epidemic preparedness plans for the next pandemic.

This is imperative because no one knows when the next pandemic could occur. A major lesson from COVID-19 and the city lockdowns which followed is that during pandemics there would be life losses, job losses, schools will be closed, and some families would need food support.

The major idea is to use lessons from COVID-19 to estimate those who may be in need of food support and group them based on ethnicities, postcodes, states etc. This plan should involve government agencies, food banks, non-profit organizations, faith-based organizations, schools, university institutions and other community groups.

Third, food banks should improve their process to enable long-term storage of nutritious foods such as green vegetables, fruits, proteins, milk etc. According to Feeding America, these classes of nutritious foods are the most requested at food banks. However, due to challenges with storage, those in need hardly have these requirements met.

Fourth, prioritize the needs of under-five children and women of child-bearing age. Worryingly, science and available evidence from a comprehensive review of 120 studies done by the UN FAO suggests a correlation between food insecurity and malnutrition.

Furthermore, according to World Health Organization, and available scientific data evidence, mostly obtained from studies done in developing countries, childhood malnutrition is considered a major public health concern with long lasting impacts including impaired cognitive development, enhanced risks of acquiring other diseases, and suboptimal economic productivity.

With the risk of irreversible stunting in children and its consequences on school performance, future earning capacity and contributions to the economy, children must receive the right nutrition at the right time.

Likewise, women of child-bearing age require to be well nourished to ensure they have adequate blood, healthy milk and not anemic. Anemia in women who plan to get pregnant has adverse consequences such as intrauterine growth retardation of the fetus, low birth of their babies and more likelihood of going into shock from bleeding after birth or even death.

Lastly, encourage families to form groups and run all seasons sustainable community gardens. There is a need to have community greenhouses that can be used to grow food past summer months. This would enable them grow fresh vegetables, poultry (for proteins) and cows (for milk).

At this time, many US States are going through the winter season, and food gardens that millions of Americans relied upon during summer have no sustainability during cold seasons.

A recent UNICEF report on the persistence of child poverty above pre-COVID levels in high income countries highlights why all year around community gardens should be an alternative source of fresh foods as the country recovers from this pandemic.

COVID-related food insecurity is widening health and social inequities in the U.S. The in-coming Biden-Harris administration should make this a priority. It is an ethical thing to do.

Credit: Unsplash / David Clode

By Ifeanyi Nsofor and Lolo Cynthia
ABUJA, Dec 4 2020 (IPS)

Every year, the global 16 Days of Activism against Gender-Based Violence begins on November 25 and ends December 10. The theme of this year’s activism is “Orange the World: Fund, Respond, Prevent, Collect!”

The 16 Days is very important this year. Data from several countries show rising cases of gender-based violence due to city lockdowns which have placed victims and oppressors in close proximity. A report by Voice of America shows that COVID-19 is increasing the incidence of gender-based violence in the U.S.; Russia; Mexico; and Malawi.

The situation in Nigeria is not different – a COVID-19 lockdown leads to an increase in sexual and gender violence, according to investigations by the Pulitzer Centre. Sadly, the United Nations documentedmore than 3600 cases of rapes during the COVID-19 lockdown in Nigeria.

The work of the Women’s Crisis Centre in Umuaka community, southeast Nigeria, reveals new information on gender-based violence and factors which perpetuate these brutal acts. In her role as the Program Manager at the Women Crisis Centre, Lolo conducted focus group discussions to learn the attitudes, beliefs, and behaviors around violence against women.

Women leaders said that mothers choose to sell their daughters into marriages because they are full-time housewives who are unable to financially take care of their children. They also view the act as a show of love and concern – means one less mouth to feed and the married daughter even contributes to the upkeep of her siblings

The result shows abuse of cultural practices, use of child marriage as a means to escape poverty, and husbands’ use of threat of divorce to perpetuate violence against women. Indeed, it is clear that violence against women and girls continued during and after the COVID-19 lockdown in Nigeria.

One topic that came up was around masquerades which are a very important part of the Igbo culture for men as they are regarded as an extension of Igbo ancestors. Even during COVID-19 restrictions, such festivals continued occurring in villages.

During them, females are forbidden from so much as looking masquerades in the face while the men are given the liberty to dance, flog, and demand money from the observers. Some young men who wear the masquerade costumes use its sacred nature to intimidate females who had previously refused their advances.

‘I was flogged and cut with a cutlass by one of the masquerades. He threatened me a few days before the festival because I refused his sexual advances… He told me that he would deal with me in due time… My body was heavily bruised’, said one focus group participant.

Much of the violence relayed during the focus group is related to poverty as Nigeria is the world’s poverty capital. Eighty-seven million Nigerians live in extreme poverty. The difficulty for families to care for their children pushes them to give away their daughters as minors in marriages.

Women leaders said that mothers choose to sell their daughters into marriages because they are full-time housewives who are unable to financially take care of their children. They also view the act as a show of love and concern – means one less mouth to feed and the married daughter even contributes to the upkeep of her siblings. Shockingly men are absolved from being complicit in this act. Instead, girls and their mothers are to blame by community members.

‘These small small girls – 13 and 14 year old’s……..they are so spoilt nowadays. All they want is money and fancy things. I see them on motorcycles with these 19-year old boys. They are always rubbing each other in public”, said one focus group participant.

At Umuaka Village, the pride of a woman is her husband. Indeed, marital status dictates how she is treated in the community. Women leaders said domestic violence cases are “resolved” at homes because if the victim reports to the police, she is viewed as bringing shame to her family.

‘You can see a woman with bruises in the station today reporting her husband …when the husband is arrested, he threatens to divorce her and she immediately drops the case’, said a police officer in the focus group.

‘The men are afraid of the law and their crimes, so they know what to say to make the women powerless… because she knows that men are scarce. Who wants to be divorced or have a husband in prison because his wife sent him there? It’s a big shame’, the police officer explained further.

These acts of violence should not be allowed to continue, even if some people seem resigned to them. These are four ways the Women Crisis Centre is intervening to reduce the incidence of violence against women based on the focus group findings:

First, government and civil society organisations must begin to engage with the traditional leaders at Umuaka to remove flogging as part of Owoh masquerade celebrations. Victims of violence should be encouraged to report to authorities when their rights are violated.

Second, ensure women are economically empowered and can earn their wages. Already, Women Crisis Centre is providing unconditional cash grants for women to start their own businesses.  In addition, they are taught financial literacy with a focus on how to save and open their personal bank accounts, as most of the women rely on their children or husband’s bank account.

Third, it takes a community to prevent violence against women. Therefore, the Women Crisis Centre is already working with traditional leaders, churches and the private sector to educate women of their rights and how to seek redress when their rights are violated.

Fourth, engage with the Umuaka community to consider girl-child education as a form of poverty alleviation. Every girl-child must be enrolled in school.

COVID-19 has worsened violence against women and girls. It also provides a good opportunity to push for reforms to end it. Talking to the community directly can provide guidance on where to start.

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. 

Lolo Cynthia is a Nigerian Sexuality and Reproductive educator who advocates for sexually empowered and liberated women and men through sex-education and access to contraceptives. She is the founder of LoloTalks and Program Manager at the Women Crisis Centre.

Protesters hold up their placards in front of the Lagos State House. Credit: TobiJamesCandids/Wikimedia Commons.

By Ifeanyi Nsofor
ABUJA, Oct 28 2020 (IPS)

On October 20, 2020, young Nigerians who were protesting against police brutality were shot by men in Nigerian military uniforms. Unarmed, peaceful citizens were massacred at the Lekki Toll Gate in Lagos, southwest Nigeria.

The Governor of Lagos state, Jide Sanwo-Olu earlier in the day had announced a 24-hour curfew to curb violence that erupted following the #EndSARS Campaign. SARS is Special Anti-Robbery Squad, established in 1984 to combat armed robbery which was rife then. However, SARS has been on a killing spree of young Nigerians. Protesters are demanding for the disbanding of SARS, prosecution of indicted officers and total reform of the Nigerian Police Force.

I do not know how long this campaign against police brutality will last. However, one thing I am sure of is the mental health consequences of the pre-meditated massacre of young Nigerians at the Lekki Toll Gate will be with us for a long time

Governor Sanwo-Olu’s announcement for curfew to begin at 4pm was made at 11:49am on the same day. This meant that a city of more than 20 million people was somehow supposed to magically beat the notorious Lagos traffic, get off the streets and be at home within 4 hours. I do not live in Lagos. However, I am aware of the confusion that arose as residents scampered home. My sister-in-law drove through the Lagos traffic from Apapa to Ojuelegba to make sure she was home for her three daughters aged 7 years and below.

There were complaints on social media about the short time available for people to get home before the curfew began. Human rights advocates urged residents to do everything possible to obey the directives. However, it is understandable that not all would be able to. Some peaceful protesters stayed back to continue pushing their message of disbanding SARS, at the Lekki Toll Gate, Lagos.

I followed the protest over Twitter while preparing dinner for my wife and daughters. My wife was tracking it too, and soon she called to me in tears that these peaceful protesters were being shot. Coincidentally, one of Nigeria’s celebrity Disc Jockeys (DJ Switch) was a protester at Lekki Toll Gate and live streamed the shooting.

When I viewed it, it was pure chaos hearing the sounds of multiple gunshots and the screams. It was like a war zone. It was also pitch dark because lights were off at the usually well-lit area. Sadly, these young protesters assumed they would be safe if they sat on the ground while singing Nigeria’s national anthem and waving Nigeria’s flag. It was a fatal assumption.

This experience has negatively affected my mental health. I am completely overwhelmed with feelings of helplessness and apathy. I could not sleep that night. I kept turning and tossing. I was edgy and jumpy for days. For instance, not long after daybreak, I heard loud sounds and I thought they were gunshots. It turned out to be sounds made by masons at a construction site next to my house. A week later, I am still trying to make sense of this massacre.

I am not alone in my reaction to the horrible events. Indeed, there is fear and apprehension in the land. All over social media, Nigerians are sharing how depressed they are by this massacre:

Nigerian public health physician, Dr. Chijioke Kaduru tweeted:

For someone who is used to being angry, and channeling that anger, today feels very different. It’s anger. Heartbreak. A sense of helplessness. And for the first time, doubt. This is 2020.

For someone who is used to being angry, and channeling that anger, today feels very different. It’s anger. Heart break. A sense of helplessness. And for the first time, doubt.

This is 2020.

— Chijioke Kaduru, MD (@cj_kaduru) October 21, 2020

In response to his tweet, my friend and laboratory scientist Celestina Obiekea responded:

Today, I can’t even channel any anger… I’m just numb… and when I think my heart can’t break any more than it has already, it breaks all over again.

For someone who is used to being angry, and channeling that anger, today feels very different. It’s anger. Heart break. A sense of helplessness. And for the first time, doubt.

This is 2020.

— Chijioke Kaduru, MD (@cj_kaduru) October 21, 2020

With such strong emotions, Nigerians are searching for answers and mental health support. I am not surprised that Nigeria’s top mental health advocacy organization, Mentally Aware Nigeria Initiative (MANI) is inundated by calls and have now extended their usual service hours.

With these increased requests for mental health therapy by Nigerians, my friend and MANI founder, Dr. Victor Ugo sent out this this message for international mental health support volunteers. 

Reaching out for help to all my friends in the international #mentalhealth community. We’ve just had the most overwhelming day since Mentally Aware Nigeria Initiative (MANI) started providing crisis support services in Nigeria, way beyond what we experienced during the months of #COVID19 lockdown. We are very much overwhelmed and need your help. If you have Mental Health and Psychosocial Support experience and can provide remote support, please fill this form. If you aren’t able to help, please do share across your networks.

The mental health services provided by MANI are very important in a country like Nigeria with poor knowledge of mental health and inadequate human resources for mental health. In 2019, EpiAFRIC and Africa Polling Institute conducted the mental health in Nigeria survey that found most people know little about it or how to help.

For instance, 54% say it is caused by evil spirits, and when someone has a mental health illness, 18% say they will take the person to a prayer house. For a country of about 200 million people, Nigeria has only 250 psychiatrists, according to the Association of Psychiatrists of Nigeria. This means that approximately one psychiatrist provides mental health services to 800,000 Nigerians.

Nigerians currently feel like sheep under attack without a shepherd. President Buhari made a national broadcast without acknowledging the massacre at Lekki Toll Gate. Initially, the Lagos State Governor had alluded that those responsible were forces beyond his control. However, at a recent interview, he mentioned that it was indeed the Nigerian military that is responsible for the massacre.

I do not know how long this campaign against police brutality will last. However, one thing I am sure of is the mental health consequences of the pre-meditated massacre of young Nigerians at the Lekki Toll Gate will be with us for a long time.

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. 

Unless diversity is accepted and inclusion becomes everyone’s business, it will be impossible to achieve the goal of universal health coverage because 15% of the global population who have some form of disability will be left behind. Credit: Bigstock.

By Shubha Nagesh and Ifeanyi Nsofor
Jul 30 2020 (IPS)

Over the next seven years, Google will invest a whopping $10 billion in India to improve technology, health and education, according to CEO Sundar Pichai. This is unprecedented and could be a game changer that could improve health, education and economic empowerment. 

While Google should be commended for such foresight, it is also pertinent to note that there was no mention of how this investment would benefit India’s 26 million persons living with disabilities. Without a doubt, investments in the Indian economy must be all-inclusive. This means including persons living with disabilities, particularly women and children.

For long, disability has been neglected to the detriment of millions of Indians who live with various forms of it. The plight of persons living with disabilities in India is not unique. In the global south, efforts to improve the health and wellbeing of persons with disabilities are usually led by individuals with disabilities, civil society and disabled persons organisations.

In the global south, efforts to improve the health and wellbeing of persons with disabilities are usually led by individuals with disabilities, civil society and disabled persons organisations

Unless diversity is accepted and inclusion becomes everyone’s business, it will be impossible to achieve the goal of universal health coverage because 15% of the global population who have some form of disability will be left behind.

Indeed,  inequities faced by persons living with disabilities have been magnified at this time of COVID-19. These challenges include unprecedented number of deaths, lack of access to finances, people-centered healthcare, home–based caregivers etc. Furthermore, closure of intervention centres and special schools, have postponed assessments and therapy sessions for children with developmental disabilities.

Education is also a major challenge as most schools turned online, without working on accessibility and barriers to inclusion, and so left out thousands of children.

There are many non-profits and government organisations in India that provide services to persons with disabilities, and most have been closed since April 2020, but staff are working overtime to provide the best services through online mediums thereby avoiding disruption of services and ensuring continued developmental progress in children.

So far, feedback from families are varied: from increased involvement of parents to no progress because such parents do not have access to digital technology.

This is the time to build a new era with accessibility as its key feature in India. However, to realise this, the private sector must play a key role as a funder and incubator of ideas.

These are five ways Google could ensure that its $10 billion investment in India is inclusive of persons living with disabilities.

First, involve persons living with disabilities in any plans to discuss the investment. This involvement must be from the beginning when plans are developed to when impact is evaluated. New initiatives must actively seek inputs from persons living with disabilities with different kinds of impairment. If this diverse representation is pursued, the inputs would be inclusive and could mitigate some challenges that may arise.

Second, ensure at least 20% of all roles are reserved for persons living with disabilities, to be well distributed along gender and age groups. Women are needed in leadership positions as the impact they make are phenomenal, with valuable indices like empathy, wellbeing and happiness. Also, children living with disabilities should not be left out.

Third, improve healthcare delivery by training health workers on providing care that is respectful and meets the needs of persons living with disabilities. Health facilities must be obligated to provide services without discrimination.

To achieve this, the investment should include partnerships with schools where health workers are trained to make the curriculum disability-friendly. Health workers already in service should also be trained and retrained on disability-centered care. Disability competencies for health professionals adopted by medical schools in India, should be used to train students, as well as train and retrain health professionals.

Fourth, ensure provision of social determinants of health such access to education, economic empowerment, access to clean water and sanitation for persons living with disabilities. For instance, access to clean water and sanitation helps reduce the incidence of infectious diseases.

Indeed, one of the most important public health interventions to reduce the spread of COVID-19 is frequent hand washing with soap under running water. Moreover, the more educated people are, the better their health-seeking behaviours.

Also, providing economic empowerment interventions would empower persons living with disabilities to pay for their healthcare themselves when the need arises.

Lastly, such a huge investment requires regular monitoring and evaluation. Persons living with disabilities should be included in monitoring teams. No one better than persons living with disabilities can evaluate the impact and the influence of programs that create change and transformation to improve the quality of life of members of the community. Also, lessons learnt can help others know how to cater for the needs of persons living with disabilities.

To be sure, Google is a private business and is entitled to deploy its corporate social responsibility however it deems fit. However, as one of its biggest markets, India is deserving of this investment.

It would amount to perpetuating gross inequities in India if persons living with disabilities are left behind again.

Dr Shubha Nagesh is a medical doctor and works with the Latika Roy Foundation, Dehradun India

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. 

Credit: Jeffrey Moyo/IPS.

By Ifeanyi Nsofor
ABUJA, Jul 8 2020 (IPS)

Recently, Barcelona’s Liceu opera opened its 2020-2021 season by serenading a full house of plants with classical music. The plants will then be given to over 2,200 health workers who serve at the frontlines to battle the pandemic. The performance was both an appreciation for the workers and it also celebrated the return to normalcy following the devastations caused by COVID-19.

It is commendable that health workers are being celebrated this way. However, from the beginning of this pandemic, health workers have been victims. For instance, Li Wenliang, who first raised an alarm about a serious infectious disease in Wuhan, China was hounded by Chinese authorities for inciting fear. This caused a delay in China accepting and reporting the occurrence of a new deadly disease.

In the heat of the pandemic, NHS workers wore bin bags as protection. Shockingly, personal protective equipment were fashioned out of clinical waste bags, plastic aprons and borrowed skiing goggles

Consequently, there are currently more than 9 million cases of COVID-19, above 5 million recoveries and almost 500,000 deaths globally. Unfortunately, Li Wenliang caught the virus and died from COVID-19.

All over the world, health workers continue to suffer a great deal during this pandemic. This is shocking because health workers save lives. In the U.S., more than 400 health workers have died from COVID-19, according to the Centres for Disease Control.

In the United Kingdom, more than 200 health workers have died from COVID-19. Sixty percent of the U.K. deaths are among Black, Asian, and minority ethnic groups. In Nigeria, over 800 health workers have been infected with COVID-19 and 10 doctors have died. This led to Nigerian doctors embarking on a national strike recently.  These deaths are attributed to lack of Personal Protective Equipment (PPE) for health workers.

As cities begin to reopen globally, the world must reflect on this pandemic and how it has claimed the lives of hundreds of thousands of people, including health workers.

These three lessons, which ensure safety of health workers should guide preparedness for the next infectious disease outbreak.

First, Infection, prevention and control protocols must be put in place in all health facilities and should be strictly adhered to. Infection, prevention and control measures include provision of clean running water, availability of soaps in health facilities and provision of personal protective equipment for health workers.

As common as these seem, they are not available in most health facilities in both low- and middle-income countries and high-income countries. A World Health Organization report on water, sanitation and hygiene from 54 low- and middle-income countries, shows that 38% lack access to even basic levels of water, 19% lack sanitation and 35% do not have water and soap for handwashing.

High-income countries have not done well with regards to infection, prevention and control during this pandemic. Reports from the United Kingdom revealed that in the heat of the pandemic, NHS workers wore bin bags as protection. Shockingly, personal protective equipment were fashioned out of clinical waste bags, plastic aprons and borrowed skiing goggles.

Second, improve salaries and conditions of service for health workers everywhere, especially in developing countries. These are ways to show health workers that they are appreciated. Poor salaries and poor conditions of service are major reasons for emigration of health workers from low to high income countries.

A 2017 study on emigration of Nigerian doctors conducted by Nigeria Health Watch and NOI Polls explored reasons for emigration. More than 700 medical doctors were interviewed. The result revealed that improved remuneration (18%), upgrade of all hospital facilities and equipment (16%), increased healthcare funding (13%), and improved working conditions for health workers as major reasons for reducing emigration of doctors.

Furthermore, it is mind-boggling that medical doctors in Nigeria are paid a monthly hazard allowance of less than $13. If this poor remuneration continues, emigration would persist and will adversely affect response to pandemics in poor countries.

Third, build regional coalitions for epidemic preparedness because epidemics will always happen. One lesson from COVID-19 is that epidemics do not respect borders and therefore, no country is safe as far as one country is at risk of epidemics. Going forward, countries should no longer operate in silos.

The African continent is leading in this regard through the Africa Medical Supplies Platform. This is an African Union initiative which enables African governments to join forces in bulk buying and transportation of COVID-19 commodities.

This would help countries procure and supply infection, prevention and control commodities needed by health workers, such as personal protective equipment and sanitizers. Furthermore, this should be taken to scale to cover other healthcare needs necessary to make health facilities safer for health workers in the post-COVID-19 period.

Pulling forces together is an important way to ensure sustainable funding for epidemic preparedness and protect health workers.

It is gratifying that all the plants serenaded with classical music by the Barcelona Opera will be donated to 2,292 health workers at the Hospital Clínic of Barcelona.

When health workers are appreciated, properly salaried and protected, the world would be healthier and safer.

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. 

Credit: UN

By Ifeanyi Nsofor and Adaeze Oreh
ABUJA, Mar 30 2020 (IPS)

As COVID-19 surges globally and leaves fear and panic in its wake, global efforts are underway to find a cure. Yet, the same level of response is lacking for several other infectious diseases that kill millions annually. These kinds of neglected tropical diseases (NTDs) are a broad group of communicable diseases which affect more than two billion people and cost developing economies billions of dollars every year.

Lassa Fever is an example and is endemic in Nigeria and other West African countries such as Benin, Ghana, Guinea, Liberia, Mali and Sierra Leone. At present, it kills about 17.8 percent of those infected in Nigeria. In 2020 alone, there have been nearly 4,000 suspected Lassa fever cases and more than 160 deaths.

First reported in 1969, there is still no viable vaccine to prevent it. An acute viral haemorrhagic illness that is similar to Ebola, the infection could last anywhere from two days to twenty-one days and is spread to humans through contact with food or household items that have been contaminated with rodent urine or faeces or from person-to-person.

Given the drive from the global north for a safe and effective vaccine and treatment for COVID-19, it is evident that for as long as diseases like tuberculosis, Lassa fever, as well as others like trachoma and sleeping sickness are limited to poor and marginalised populations, persistent underfunding will continue

Tuberculosis is another neglected disease. According to the World Health Organization, about 10 million people globally were infected with tuberculosis in 2018 including over one million children. India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa accounted for two thirds of all TB cases.

In same year, more than one and a half million people infected died, and over 200,000 of these deaths were recorded in children. What is most astonishing is that for decades TB has been both treatable and preventable. In fact, for the millions across the world living with TB, they are especially susceptible to COVID-19 with a likelihood of millions of deaths. This, according to Médecins Sans Frontières would be a “second tragedy”.

Collectively, while NTDs can lead to complications such as heart and kidney failure, visual impairment, seizures and in several cases death, they do not enjoy the attention of the global health community.

Perhaps because they are often limited to populations that are poor, live in remote locations and lack adequate sanitation. Recent scientific breakthroughs have led to the roll-out of effective drugs for diseases such as sleeping sickness and lymphatic filariasis with new rapid tests for sleeping sickness and leishmaniasis. However, these conditions have not attracted enough domestic and international donor support.

In contrast, between first report of COVID-19 in December 2019 and the first week in March 2020, more than eight billion US dollars has been raised for relief and response efforts worldwide and that figure is steadily rising.

A quick online search for mentions on COVID-19 research yielded over 3.6 billion results in less than half a second, whereas research on Lassa fever yielded only 1.2 million results. Given the global concern and commitment to advancing research, it is estimated that by the end of 2020 there could be a viable vaccine and effective treatment to protect the world and treat this infection; the race to the finish line is now a global competition and major biotechnology companies and the countries behind them all want in.

Given the drive from the global north for a safe and effective vaccine and treatment for COVID-19, it is evident that for as long as diseases like tuberculosis, Lassa fever, as well as others like trachoma and sleeping sickness are limited to poor and marginalised populations, persistent underfunding will continue.

This means that viable vaccines will remain a pipe dream and effective tests and treatments where they exist will not be made widely available and, in enough quantities, to wipe out these diseases.

In light of this reality, these are the steps that must be taken to address these neglected diseases.

First, developing countries that bear the greatest burden of these “neglected diseases” must develop local financing mechanism for healthcare. For too long, these countries have been passive recipients of donor assistance from western countries.

This aid is almost always conditional and tied to certain disease areas. These developing countries as a matter of priority need to shore up domestic finances to make effective interventions against these conditions widely available.

For example, in 2016, about 44 percent of current health expenditures in Africa was financed through domestic government funds and 37 percent from out-of-pocket payments creating significant burdens on African households with no appreciable improvements in healthcare delivery.

Second, countries in the global south must actively develop their research capabilities. A near-total reliance on research from the global north will continue to leave massive gaps in healthcare delivery simply because research is always driven from a perception of need and priority.

For as long as many of these diseases continue to be domiciled in developing countries in sub-Saharan Africa, Asia and Latin America, these continents must become the hubs of research into these conditions.

Third, corporate organisations in developing countries must begin to fund healthcare and health research. Already the private sector in Nigeria is partnering in the response to COVID-19. For instance, the United Bank for Africa is supporting African governments with $14 million for the outbreak response.

Other Nigerian private businesses have also joined in. However, these corporations should also fund epidemic preparedness because it is more cost-effective to prevent a disease outbreak. When pandemics such as COVID-19 happen, their returns on investments suffer.

As the push for decolonising global health continues, governments and the private sector in developing countries must also show leadership and fund the health of their people. It is the ethical and common-sense thing to do.

Dr Adaeze Oreh is a family physician, Senior Health Policy Adviser with Nigeria’s Federal Ministry of Health and Fellow of the West African College of Physicians.  She is also a Senior New Voices Fellow for Global Health with the Aspen Institute.

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. 

By Ifeanyi Nsofor
ABUJA, Mar 20 2020 (IPS)

Coronavirus is now a pandemic and the World Health Organization considers Europe as its new epicenter. Italy, Spain and France are on lockdown and several nations are banning travelers from countries where cases are on the rise.

But it’s a problem beyond Europe too, and governments in 61 countries have closed schools to slow the spread of the virus. In the U.S., President Trump recently declared a national emergency after the virus had spread to nearly every U.S. state, and he urged state governments to set up emergency operation centers immediately.

Most of these measures occurred after a significant number of cases were documented. In contrast, Nigeria, where I am based, has shown a remarkable level of preparedness and response to the Coronavirus pandemic even with just 12 cases diagnosed.

These efforts are led by the Nigeria Centre for Disease Control (NCDC). Nigeria’s past experiences of quickly responding to the 2014 Ebola outbreak and continuously responding to other infectious diseases such as Lassa fever, have strengthened its health security capacity. Consequently, there are lessons that other countries can learn from Nigeria’s response to Coronavirus.

Nigeria’s past experiences of quickly responding to the 2014 Ebola outbreak and continuously responding to other infectious diseases such as Lassa fever, have strengthened its health security capacity. Consequently, there are lessons that other countries can learn from Nigeria’s response to Coronavirus

First, invest in epidemic preparedness before an outbreak occurs. The Director-General of NCDC, Chikwe Ihekweazu believes that nations should build systems in ‘peace time’ that can be used during outbreaks. Working with subnational governments and partners, the NCDC since 2017 have been supporting Nigerian States to set up Public Health Emergency Operations Centre (PHEOCs).

At the last count, 23 States in Nigeria have set up PHEOCs. The PHEOCs serve as an epidemic intelligent hub for effective communication and efficient resource management during any outbreak. Therefore, the U.S. should have set up PHEOCs long before this Coronavirus pandemic.

Second, be open and transparent about Coronavirus cases. The index Coronavirus case recorded in Nigeria was reported within 48 hours of the Italian arriving Nigeria. The federal minister of health, NCDC and the Lagos state commissioner of health did not waste time informing Nigerians.

They have also continuously followed that with regular updates. The NCDC now has a microsite to provide regular updates to Nigerians and the international community. Other information available on the microsite are videos on risk reduction and summaries of the global Coronavirus situation report.

Third, invest in laboratory diagnoses of Coronavirus. Within weeks after the Coronavirus outbreak began, NCDC, with the support of partners, upgraded four of its reference laboratories to diagnose Coronavirus.

This led to quick diagnosis of the Italian despite his falling ill in a neighboring state to Lagos. These reference laboratories are located strategically around the country, so that delays in moving samples are reduced.

Fourth, the highest political will is imperative for epidemic preparedness. In 2018, after 7 years of operating without a legal backing, the NCDC was legalized through a bill signed into law by President Buhari.

This action puts NCDC in its rightful place as the national public health institute, with the mandate to lead the preparedness, detection and response to infectious disease outbreaks and public health emergencies. President Buhari backed the legal mandate with an approval for NCDC to receive 2.5% of the Basic Health Care Provision Fund – a funding mechanism designed to improve primary health care in Nigeria. This is unprecedented in the history of health security in Nigeria.

Likewise, some Nigerian legislators are advocating for increased funding for epidemic preparedness. For instance, the chairpersons of Nigeria’s senate committees on health and primary health care/communicable diseases have been advocating for increased budgetary allocation to NCDC.

Without a doubt, health security is an area that Nigeria’s executive and legislature agree. With hindsight, the U.S. should not have cut its Centres for Disease Control’s budget by 20% in 2018.

Fifth, pay attention to what is happening outside of one’s own country. Infectious diseases do not respect borders. Perhaps the most important lesson we should learn from Nigeria’s response to the Coronavirus is what Chikwe Ihekweazu said when he was interviewed by an international media outlet; “The concept of every country trying to look only within its own borders is completely, mindbogglingly, a waste of everybody’s time”.

To be sure, Nigeria is currently dealing with its largest Lassa fever outbreak, attempting to rebuild its health system and still requires more funds to prepare for the next epidemic. However, NCDC has shown what is possible in reducing the impact of a virus with accountable leadership, use of science for decision-making and ensuring value for money in epidemic preparedness.

Chikwe Ihekweazu’s admonition on borderless approach in responding to infectious disease outbreaks is very important because as far as global health security is concerned, the world is as prepared as its weakest link.

Other countries do not have to reinvent the wheel in managing this Coronavirus pandemic. Nigeria has succeeded in containing Coronavirus and is willing to share lessons learnt.

Excerpt:

Credit: UN News/Li Zhang

By Ifeanyi Nsofor
ABUJA, Mar 9 2020 (IPS)

Recently, New York Governor Andrew Cuomo said, “We have an epidemic caused by Coronavirus, but we have a pandemic caused by fear “.

This fear is worsened by how news agencies report the outbreak. These are some examples.

“Bodies ‘pile up’ in morgue as Iran feels strain of coronavirus” – CNN

“First UK death from coronavirus confirmed as cases surge to 115” – The Guardian UK

“Coronavirus: Global death toll exceeds 3,000” – Premium Times Nigeria

“Death toll from coronavirus in Italy rises to 148: Live updates” – Aljazeera

“Coronavirus update, map as death toll reaches 3,200. Infections soar in Italy, Iran and South Korea” – Newsweek

News outlets are often quick to report the number of infected and deaths due to Coronavirus. However, they do not highlight as prominently the number of Coronavirus survivors. Yet, there are many survivors.

Reporting the complete picture of the outbreak gives hope and builds confidence in people that being infected is not a death sentence. In contrast, continuing the negative reporting of COVID-19 increases hysteria, fear and panic associated with the outbreak

There are currently 110,624 reported cases; 62,397 have recovered, 44,396 are currently infected, with 3,831 deaths. herefore, there are 16 times as many people who have survived Coronavirus as those who have died from it. A breakdown of Coronavirus survivors in some countries are as follows, China: 58,721, Iran: 2,134, Italy: 622 and South Korea: 166. The much-reported Diamond Princess Ship has 245 survivors, and this is hardly reported.

The Nigerian writer, Chimamanda Adichie describes this act of only focusing on one side of a story as the danger of the single story. In her TEDGlobal Talk, Chimamanda affirms that we are vulnerable and impressionable in the face of a story. She went further to say that, show a people as one thing, as only one thing, over and over again, and that is what they become.

These Coronavirus headlines by major news agencies spell death, gloom and despair. Unconsciously, people are only associating deaths with the Coronavirus outbreak. They are taking extreme measures, closing businesses and schools. Currently, nearly 300 million children are out of school because of fear.

On the extreme end, the National Association of Funeral Directors in the United Kingdom  have indicated that if Coronavirus is declared a Pandemic, they would consider streaming funeral services online. According to the Association, this is to prevent the spread of the infection and give the bereaved a chance to mourn their loss. However, this could be counterproductive because internet trolls may use such videos to propagate fear and panic.

This must change.  Indeed, reporting the complete picture of the outbreak gives hope and builds confidence in people that being infected is not a death sentence. In contrast, continuing the negative reporting of COVID-19 increases hysteria, fear and panic associated with the outbreak. It perpetuates the narrative that people do not survive the infection. Fortunately, the data show the contrary.

Henceforth, these are four ways to ensure balanced reporting by news organisation:

First, news agencies must begin to write the complete story and always mention numbers of survivors in their headlines. Their articles on the Coronavirus outbreak should be aspirational as well as factual. Leaving out the thousands of people who survive the infection is a great disservice to survivors and paints an incomplete picture.

Second, we need to hear Coronavirus survivors speak about their experiences. Journalists should interview these survivors and document their journeys. There is a great lesson in this regard from the CNN Global Town Hall on Coronavirus. During the townhall meeting, Carl Goldman, a survivor at the Nebraska University Teaching Hospital was interviewed. He got infected while aboard the Diamond Princess Cruise Ship. Watching him share the symptoms he experienced, how he was treated by health workers and his recovery was liberating. More of such interviews should be done with survivors to encourage us all.

Third, news agencies must keep reiterating preventative measures in their reporting. People should know that doing these would reduce their risks of getting infected. Avoid touching their eyes, nose and mouth with unwashed hands; wash their hands with soap under running water; cough/sneeze into a tissue paper or the curve of the elbows, maintain a distance of at least 5 feet from anyone coughing or sneezing, and contact their healthcare providers when in doubt.

Fourth, news agencies should be cautious about the types of information they share with the public. The World Health Organisation acknowledges that there is currently an infodemic – an overwhelming amount of true and false information on social media and websites. When the public is overloaded with only news of death, it could lead to internet trolls using such to create misinformation.

To keep fear from spreading faster than the actual virus, organizations must self-regulate and report the Coronavirus outbreak in a complete manner. It is the ethical thing to do. It is for public good and public health.

Excerpt:

Credit: Patrick Burnett/IPS

By Ifeanyi Nsofor
ABUJA, Feb 25 2020 (IPS)

Recently, Nigerian feminist author Ukamaka Olisakwe spoke about her post-partum depression after giving birth in the city of Aba, southeast Nigeria. This follows her 2019 Longreads essay, in which she narrated painful details of her experience. 

In 2007, Olisakwe was 24 years old when she had her first encounter with post-partum depression. She had just given birth to her first child of three – a daughter.

Olisakwe’s experience convinced her that, No one really cares about how the women feel, if they are still haunted by the memories of childbirth, how they are coping with the immense bodily changes, if they are emotionally ready to have sex, if they even want to go through pregnancy ever again. They are expected to perform their roles as virtuous wives and good mothers, or they’ll fall short of societal expectations, of which the consequences are grave.

Post-partum depression is a mental health disorder. It is much more than baby blues. Globally, 13% of women who give birth experience post-partum depression. In some U.S. states, prevalence can be as high as 20%. In South Africa, up to 40% of women suffer from post-partum depression.

Post-partum depression is a neglected part of mental health. It is hardly spoken about. In most cultures, women who suffer post-partum depression are stigmatized and made to feel unworthy

According to the U.S. Centres for Disease Control, symptoms of post-partum depression include; crying more often than usual, feelings of anger, withdrawing from loved ones, feeling numb or disconnected from your baby, worrying that you will hurt the baby and feeling guilty about not being a good mom or doubting your ability to care for the baby.

It could also present with other symptoms of depression such as, thoughts of suicide or suicide attempts, difficulty falling asleep or sleeping too much and overeating or loss of appetite.

On the extreme end,  a few women have harmed themselves and their loved ones. In 2014, for instance, a woman named Carol suffering from post-partum psychosis stabbed and killed her three children aged 2 years, 1 year and 3 months. In 2016, another woman named Elizabeth committed suicide, after months of battling post-partum depression.

Without a doubt, post-partum depression is a neglected part of mental health. It is hardly spoken about. In most cultures, women who suffer post-partum depression are stigmatized and made to feel unworthy.

They are made to keep caring for their children, husbands and families despite suffering a serious disability, which dangerously impacts their quality of life. Women who suffer post-partum depression suffer in silence. When they cry out for help, society and health systems don’t listen.

It’s’ time to listen. We must help prevent post-partum depression and provide care to sufferers. These are ways to achieve both.

Post-partum depression diagnoses and treatment must be included in Maternal, Newborn and Child Health (MNCH) projects. Right now, it is hard to find a project with treatment of post-partum depression as a core component.

Between 2008 to 2010, for instance, I was part of a MNCH project in Nigeria, which focused on managing excessive bleeding after birth in communities and health facilities. Post-partum depression was not a part of that project. With hindsight, I can imagine the number of women who gave birth, looked “okay” but could have been battling post-partum depression. This makes me feel bad. A decade later, these kinds of services are still lacking.

Donors that fund MNCH programs should work with governments and ensure that such services are available to pregnant women and mothers. It is no longer a question of whether post-depression would happen, we know up to 40% of women who give birth will suffer this mental health disorder.

Community education to improve awareness on post-partum depression must be redesigned to show how serious it is. Governments, donors, private sector and community based organisations should work with communities, religious and traditional leaders to dismantle patriarchal cultures that perpetuate this mental disorder. As Olisakwe mentioned in her recent interview, “I think not discussing postpartum depression is the legacy of patriarchy, not the illness itself”.

There should be open non-judgmental discussions about post-partum depression and sufferers should not be shamed but supported to heal. Referral systems for mental health treatment should be established to cater for the women who would require such specialized care.

Communities must understand that not all women have same birth experiences. Therefore, every woman deserves individualized support during pregnancy, birth and afterwards.

Male involvement in pregnancy, childbirth and after birth should be institutionalized. Involving men leads to better outcomes for women. In Nigeria, Tolu Adeleke, popularly known as “Tolu the Midwife” champions male involvement.

Through her interventions, she organizes couples antenatal classes and dads’ antenatal classes. Topics covered during these classes include, what to expect when you are expecting, partner’s role in pregnancy, partner’s role at birth, breastfeeding and partner roles, postnatal recovery and adjusting to life with a newborn.

Parental leave should be non-negotiable. After 9 months of pregnancy, women and their partners need time off work to recover while caring for their newborns. All countries should emulate Finland’s parental leave laws which give each parent 7 months of leave after a child’s birth. This is a good way to involve men in caring for new mothers and newborn.

There is no time to waste, too many women are suffering in silence and crying out for help. It took Ukamaka 17 years of suffering in silence before she was able to write and speak about her experience.

Post-partum depression is a mental health disorder. It should be accorded the recognition it deserves. Period.

Excerpt:

Colorized scanning electron micrograph of MERS virus particles (yellow) both budding and attached to the surface of infected VERO E6 cells (blue). Credit: NIAID

By Ifeanyi Nsofor
ABUJA, Jan 21 2020 (IPS)

The coronavirus outbreak — which began in Wuhan, China, and causes a pneumonia-like illness — is raging across Asia, infecting close to 300 people and killing four. It was initially known to be transmitted from animals to human, and was just confirmed to be transmitted from human to human.

The rapid nature of its origin and speed in transmission reminds us that national security is threatened when a pathogen can travel from a remote village to major cities on all continents in 36 hours. Therefore, global health security should be given the same priority as national security.

The history of infectious disease outbreak is not new. In 1918, the Spanish flu pandemic infected about 500 million people globally (a third of world’s population then) and caused the death of 20 million to 50 million victims.

The 2014 -2015 Ebola outbreak in Liberia, Guinea and Sierra Leone infected 28,000 and killed over 11,000. By the end of the West Africa Ebola outbreak, the three nations lost a combined GDP of $2.8 billion.

Infectious diseases continue to be a huge problem. Of recent, Ebola and measles outbreaks in DRC have killed 2236 and over 6,000 respectively.

This Corona virus outbreak is happening during the Chinese Lunar New Year holiday as millions travel to visit with loved ones in country and travel abroad, making the current threat a global one. Most urgently, all countries must collaborate to contain this outbreak now

The ease of travel in today’s global community means the world must always be prepared for disease outbreaks. It is no longer whether an infectious disease outbreak would happen but when.

Globally, 100,000 aircraft carry millions of passengers from one city to the other daily. A visit to flightradar24.com puts this in perspective and shows how interconnected countries are.

International borders really do not protect against infectious disease outbreaks. This is why governments, national public health institutes, communities, private sector and global health actors must act rapidly to contain this outbreak and others happening elsewhere.

Also, processes must be put in place to prevent future outbreaks. These are four interventions to ensure response and prevention happen.

First, increased screening at international borders using computerized thermal cameras should be intensified. No one should be exempt from this screening no matter how highly placed they are.

In 2015, the global health community learnt the hard way the dangers of giving preference to diplomats in the way Patrick Sawyer moved freely from Monrovia to Lagos despite being already infected with Ebola.

That oversight led to a short Ebola outbreak in Nigeria which could have gotten out of hand if not for quick response mounted by Nigerian authorities and other global health organisations. Beyond international air borders, most countries have very porous and poorly manned land borders.

To overcome this challenge, communities along these borders must be properly informed about this current outbreak, its presenting symptoms and who to call when they suspect individual have symptoms.

Second, prepare for the spread of fake news on infectious diseases and be proactive about pushing out the right information to counter it. Community education is very important, especially at this time when the infection is raging. People are scared and can easily fall prey to fake news.

National public health institutes must take charge and disseminate the right information through different channels including TV, radio, Facebook, Twitter, Instagram, WhatsApp and community engagements.

The experience with the spread of fake news during the Ebola outbreak in Nigeria in 2015 led to people bathing with salt water because they believed it would stop them from getting infected with Ebola. That fake news led to deaths of two victims.

Third, governments in consultation with national public health institutes should designate specialized centers for handling suspected cases. At the same time, they should provide the necessary drugs for treatment too.

These must be coordinated with staff at ports of entry. There should be no confusion about where to take a suspect case. If a suspected case presents at hospitals, there must be plans to immediately direct the individual to the right part of the hospital to prevent the spread of the infection.

In 2015, while evaluating the African Union response to Ebola in West Africa, I heard firsthand the harmful effect of having hospital security workers who are not well informed. At Saint John of God Hospital in Port Loko District, Sierra Leone, the wrong handling of an Ebola case by a security officer led to deaths of 10 health workers.

Fourth, all governments must invest in epidemic preparedness. Although it is not cheap, it is cost effective. For instance, Nigeria Centre for Disease Control estimates that it would cost 40 cents per person for Nigeria to be prepared for epidemics.

This amounts to $80 million for a population of 200 million. Not doing this and a pandemic occurs, Nigeria would lose $9.6 billion in GDP annually, according to the International Working Group on Financing Preparedness.

Every country must have a financed plan and ensure that their national public health institute gets the required funds to lead prevention, detection and response to infectious diseases. Infectious diseases spare no one.

As the World Economic Forum holds in Davos, Switzerland, business leaders must discuss ways of supporting governments to fund epidemic preparedness. It makes business sense and will protect their investments.

This Corona virus outbreak is happening during the Chinese Lunar New Year holiday as millions travel to visit with loved ones in country and travel abroad, making the current threat a global one. Most urgently, all countries must collaborate to contain this outbreak now.

Excerpt:

An eight-month-old boy is examined by a doctor in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Ifeanyi Nsofor and Shubha Nagesh
ABUJA, Dec 16 2019 (IPS)

Recently, Madhukar Pai, the Director of McGill University Global Health Program wrote about the inequity in global health research. He observed that researches are skewed in favor of the global north. We agree that this inequity exists. However, we also have found that global fellowships such as the Atlantic Fellowship, of which we are both Senior Fellows, are platforms to reverse this inequity, foster international partnerships and amplify voices of development practitioners from the global south. 

Shubha Nagesh is a medical doctor by training and thereafter specialised in Global Health from Karolinska Instituet, Sweden as an Erasmus Mundus Fellow. She presently works with children with developmental disabilities in the foothills of the Indian Himalayas.

Ifeanyi Nsofor is a Nigerian medical doctor and a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and 2006 Ford Foundation International Fellow. Ifeanyi is a leading advocate for universal health coverage in Nigeria.

The world must realise that fostering a global village requires that different geographical locations do not attempt to solve problems alone. There must be a sense of community in all efforts to improve health

The Atlantic fellowship is funded by the Atlantic Institute and connects the seven Atlantic fellows programmes spread across six countries. The goal of the Atlantic Institute is to advance fairer, healthier societies. Fellows have diverse backgrounds and are united by their commitment to a more inclusive world.

As Senior Fellows of the Atlantic Fellowship for Health Equity at George Washington University, both authors have benefitted from an enriching fellowship year. This experience has led to convenings in the U.S., Rwanda and other locations and have been great learning opportunities to understand the local health systems and the benefits of international collaborations.

The mid-year convening at the University of Global Health Equity in Rwanda, allowed both authors to witness firsthand the partnership between the government of Rwanda and Partners in Health, which has led to significant improvements in mental health through the Mario Pagenel Fellowship in Global Mental Health Delivery. In previous opinion pieces, Shubha wrote about her Rwanda experience and Ifeanyi did the same.

From our combined experiences of benefiting Erasmus Mundus Fellowship, Ford Foundation International Fellowship, Aspen New Voices Fellowship and Atlantic Fellowship, there are four lessons that the global health community can learn to gradually reverse the inequity in global health workforce.

First, talent is universal, but opportunities are not. Opportunities for development experts from the global south are limited, especially those that demand leadership positions. Fellowships help create platforms for development experts from different countries to interact, get to know each other and learn about the capacities that everyone brings to the table.

For instance, the 2019 Atlantic Fellows for Health Equity at George Washington University comprises of 18 Fellows from 7 countries – Ghana, Malawi, Nigeria, US, Philippines, India and Iraq. Over a period of one year, the Fellows exchanged ideas and supported each in pushing for health equity in their different countries.

Second, prioritise women in global health workforce appointments because women face more inequities than men. Out of the 18 Fellows mentioned above, 15 are females. This was intentional on the part of the organizers in order to ensure that the gap between men and women will gradually be reduced. While women form the bulk of the health workforce, . key decision makers in the health sector are usually men. The recent appointment of Winnie Byanyima as the Executive Director of UNAIDS, after serving a successful 6-year tenure as the Executive Director of Oxfam, should be replicated across more global health agencies.

Third, Fellowships can amplify global south voices on the global stage. This is the core aim of the Aspen Institute’s New Voices Fellowship. It has trained more than 100 senior fellows from many countries from the global south.

These fellows have written more than 1,000 opinion pieces published on different platforms and have been interviewed on radio, TV and other platforms sharing their ideas. Ifeanyi is a Senior New Voices Fellow and has within the past 2 years written and published 33 opinion pieces on platforms such as Devex, The Hill, Scientific American, Biomed Central, All Africa, Inter Press News Service etc.

Therefore, this opinion piece is another case of amplifying voices of Indian and Nigerian development experts on the global stage.

Fourth, collaborations are for life and reduce inequities. The agenda of most fellowships is to nurture collaboration and not competition. Collaboration beats competition, every single time. Mentorships created within the boundaries of Fellowships can be transformed to collaborations that could prove beneficial for a long time.

The world must realise that fostering a global village requires that different geographical locations do not attempt to solve problems alone. There must be a sense of community in all efforts to improve health. This African proverb captures our thoughts succinctly; “If you want to go quickly, go alone. If you want to go far, go together.”

To be sure, Fellowships will not stamp out the global health workforce inequity overnight. However, fellowship should be used as platforms to systematically work to reverse the inequities articulated by Madhui Pai.

As Senior Fellows for health equity at the Atlantic Institute, we will collaboratively continue to advance fairer, healthier and more inclusive societies.

Credit: WHO/ F. Tanggol.

By Ifeanyi Nsofor
ABUJA, Nov 30 2019 (IPS)

Three years ago, I led an evaluation of an HIV project that focused on increasing access to quality care and supporting services for people living with HIV in Nigeria. It also aimed to reduce HIV-related stigma and discrimination.

The project achieved these goals by strengthening support groups, using homebased care services for sick persons and providing Savings and Loans Association membership to improve the livelihoods of persons living with HIV. These outcomes point to the power of community in managing HIV.

The first of December is celebrated globally as World AIDS Day. The theme of the 2019 celebration is, “communities make the difference“. This reminds us to re-focus on the power of community as we try to end the HIV pandemic.

Based UNAIDS 2018 global data, 37.9 million people were living with HIV/AIDS. There were 1.7 million new HIV infections. Fifty-four percent of these new infections occurred among key populations such as men who have sex with men, transgender folks and sex workers.

The first of December is celebrated globally as World AIDS Day. The theme of the 2019 celebration is, "communities make the difference". This reminds us to re-focus on the power of community as we try to end the HIV pandemic

The risk of acquiring HIV was 22 times higher among men who have sex with men; 22 times higher among people who inject drugs; 21 times higher for sex workers and 12 times higher for transgender people.

Weekly, about 6,000 young women aged 15–24 years become infected with HIV. In sub-Saharan Africa, 80% of new infections among adolescents aged 15–19 years are in girls. Young women aged 15–24 years are twice as likely to be living with HIV than men. Eighteen percent of pregnant women living with HIV did not have access to drugs that would prevent transmission of HIV to their newborns.

People living with HIV face many forms of discrimination when they try to get help. In Southwest Georgia in the U.S., people living with HIV travel long distances out of the area to access their HIV care for fear of being stigmatized.

In the United Arab Emirates, while citizens have free access to HIV treatment, non-nationals prisoners are denied HIV treatment and kept in isolation.  However, some face more inequities than others. Key populations, adolescent girls and pregnant women are examples. These communities should be prioritized in the addressing HIV.

Here are four ways to bolster community efforts to ensure equity.

First, eliminate mother-to-child transmission of HIV through peer programs. Governments, UNAIDS and all partners working in HIV should draw lessons from a country such as Cuba that has eliminated mother-to-child transmission of HIV and Syphilis.

For instance, Cuba’s achievement is based on a universal healthcare system which integrates maternal and child health programs with programs for HIV and sexually transmitted infections. In addition, community of mothers living with HIV called Mentor Mothers can improve uptake of PMTCT services.

Mentor Mothers provide peer support to pregnant women who have HIV. A study in Zimbabwe showed that Mentor Mothers improved retention in PMTCT services and led to positive behaviour change among HIV-positive pregnant women.

Second, integrate HIV/AIDS programming into youth-friendly clinics that provide reproductive health services to women aged 15-24 years. These youth-friendly clinics should be safe spaces, non-judgmental and without discrimination.

South Africa has high burdens of women living with HIV -above 62% of adults living with HIV in South Africa are women, or 4.7 million people. In South Africa, mobile technology locally known as Ringa Nathi (talk to us in Zulu) is used to provide confidential youth-friendly HIV services through WhatsApp-based support groups of 10 youths.

It is a platform for judgement-free discussions while improving knowledge on importance of adherence to HIV treatment and living positively with HIV.

Third, prioritise HIV services for high-risk populations such as men who have sex with men, transgender people, sex workers and injection drug users. Too often, they face barriers and discrimination to receiving help and this must end.

In this light, South Africa has established its first transgender healthcare facility at the Wits Reproductive Health Institute.

In Malawi, a country with one of world’s highest HIV prevalence rates, sex workers are stigmatized and often experience violence. International NGO Médecins Sans Frontières (MSF) provides HIV counselling and testing services to sex workers.

Fourth, communities must protect the rights of high-risk populations, period. Throughout the 40 years of the HIV pandemic, these populations have faced discrimination and at times been removed from the mainstream of HIV programming.

Stringent homophobic laws across Africa prevent gay men from accessing life-saving antiretroviral drugs. A study of 45,000 gay men in 28 African countries including Kenya, Malawi and Nigeria found that only 25% were taking their HIV drugs.

Therefore, the courts must rise to the occasion and protect the rights of key populations. Consequently, a High Court in Zimbabwe recently ordered the Minister of Home Affairs and the police to pay a trans woman $400,000 as compensation for her unlawful arrest in 2004.

One key lesson I learnt from leading the evaluation of the HIV intervention in Nigeria is that, “If you want to go quickly, go alone. If you want to go far, go together”. Therefore, no community of people living with HIV should be left behind. However, to ensure equity, some communities should be brought to the same level as others and the journey continued.

Excerpt:

Credit: S. Oka/WHO

By Ifeanyi Nsofor
ABUJA, Nov 27 2019 (IPS)

Dr. Wouter, a Dutch doctor who helped perform surgeries and train colleagues in surgical skills in underserved areas of Sierra Leone died of Lassa Fever. He was infected as a result of performing a Caesarean section on an infected pregnant woman. 

This was a very painful and avoidable death. I mourn with his family and the Dutch people over this loss. No health worker should die while trying to save lives. Sadly, every year 5,000 West Africans die from Lassa fever.

Lassa fever is a viral disease of inequity and disproportionately affects poor people. There are an estimated 100,000 – 300,000 annual cases of Lassa fever across West Africa, according to the U.S. Centres for Disease Control. Countries endemic for Lassa fever include Guinea, Liberia, Sierra Leone and Nigeria.

Lassa fever is a viral disease of inequity and disproportionately affects poor people. There are an estimated 100,000 - 300,000 annual cases of Lassa fever across West Africa, according to the U.S. Centres for Disease Control. Countries endemic for Lassa fever include Guinea, Liberia, Sierra Leone and Nigeria

The infection is a type of hemorrhagic fever, which is transmitted via contamination of foods and water by poop of a species of rats that are common across the region. Poor sanitation is a predisposing factor to multiplication of these rats.

Without a doubt, Lassa fever is common. For instance, based on recent epidemiological report by the Nigeria center for disease control, there are 101 suspected cases of Lassa fever, 11 confirmed cases and one reported death across 40 local councils in 11 States, including Nigeria’s federal capital city Abuja.

Based on November 2019 records, there were seven cases of Lassa fever and 2 deaths in Sierra Leone. While in Liberia, Lassa fever killed 21 as at September 2019.

Due to poor health systems across endemic countries, health workers in the line of duty are also at risk of Lassa fever. In a previous opinion piece, I wrote about Idowu, a young Nigerian Doctor who contracted Lassa fever after treating an infected 7-month old baby in north-central Nigeria in 2018. Dr. Idowu died less than a month later.

Another victim, Dr. Emeka got infected after treating a newborn that was bleeding profusely on admission. Dr. Emeka was abandoned by his colleagues and had to pay for his treatment in one of Nigeria’s Lassa fever reference hospitals. Although Dr. Emeka survived, he lives with Lassa fever complications.

Why should a disease whose causative organism, mode of transmission and treatment are known still be killing thousands every year? The answer to this question underscores the inequity around Lassa fever.

These are ways to ensure Dr. Wouter’s death is not in vain.

First, the international community must invest in producing a Lassa fever vaccine. This would be beneficial to endemic communities as well as protect health workers who work in such communities.

It is commendable that the Coalition for Epidemic Preparedness Innovations (CEPI) has put out an advert for grants to develop a vaccine against Lassa fever. The total grant amount is $44 million. This initiative is a good one and should be supported by governments, ministries of health, communities, civil society organisations and the private sector.

Second, governments must prioritise other social issues that have huge influence on health and health-seeking behaviours. These are called social determinants of health and include access to clean water, availability of community sanitation, provision of education for all and promotion of healthy behaviours.

Poor sanitation is implicated in the spread of Lassa fever. As long as communities in endemic countries keep lacking access to clean water and are not educated about the benefits of keeping their environs clean, Lassa fever would continue to be endemic.

Third, governments should provide universal access to healthcare. No one should be denied care because of their inability to pay at the point of need. The World Health Organization’s definition of universal health coverage includes a spectrum of prevention, promotion, treatment, rehabilitation and palliation. All five components are important to stop Lassa fever.

Specifically, prevention of Lassa fever entails that countries also invest in epidemic preparedness. As it stands, no country in Africa is prepared for epidemics based on scoring by preventepidemics.org. This has to change to save lives and improve economic wellbeing on the continent.

Fourth, health workers must adhere to strict Infection, Prevention and Control (IPC) protocols at all times when attending to patients. As committed as health workers are to saving lives, they must realise that they need to be alive to do so.

The Lassa fever public health advisory for health workers by the Nigeria centre for Disease Control strongly advises health workers to observe these protocols regardless of patients’ presumed diagnoses.

The IPC protocols include proper wearing and removal of face masks, hand gloves, gowns, and goggles before and after entering the patient’s room; washing of hands with soap under running water always; limiting invasive procedures such as injections; and appropriate disposal and disinfection of items used by Lassa fever patients etc.

As we mourn Dr. Wouter, the global health community should be reminded that no one should die of Lassa fever in the 21^st century; not health workers and definitely not poor people in endemic communities.

Excerpt:

An eight-month-old boy is examined by a doctor in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Ifeanyi Nsofor
ABUJA, Nov 7 2019 (IPS)

Free movement of people and goods across Africa increases the risk of transmission of infectious diseases. The continent must realise that it is no longer a question of if disease outbreaks will occur, but instead, of when, and how fast.

The U.S. Centres for Disease Control says that within 36 hours, a disease outbreak can spread from a remote village to major urban cities of the world.

According to preventepidemics.org, a website which ranks countries’ levels of epidemic preparedness, no country in Africa is ready for the next epidemic. The African Union must act now to increase the capacity of member countries to detect, respond and manage disease outbreaks. Managing disease outbreaks is not cheap but it is cost-effective.

There cannot be global health security if there are still poor underserved communities where people do not have access to healthcare or are unable to pay for the healthcare they need

The current Ebola and measles outbreaks in DRC have killed 2185 and more than 3,000 respectively. In Nigeria, recent weekly epidemiological reports by the Nigeria Centre for Disease Control show there are suspected cases of Lassa fever, cerebrospinal meningitis and yellow fever. In Zimbabwe, there is fear of another cholera outbreak. The 2018 cholera outbreak killed 26 people.

In this context, the recent increment in the capital base of the African Development Bank by $125 billion to $208 billion, should be commended as it could support improved health security across the continent.

It is also timely with the Africa Continental Free Trade Area (AfCFTA) agreement going into effect this year as AfCFTA requires a coordinated effort to put a stop to the frequent outbreaks of infectious diseases on the continent. Funds from the Bank can help.

Specifically, with its increased capital base, these are four ways the African Development Bank can support a more secure Africa.

First, provide grants to the Africa Centre for Disease Control and national public health institutes to increase laboratory diagnostic capacities. The first step to detecting any outbreak is knowing the cause as fast as possible, but laboratory equipment is expensive.

So, the Bank should give grants to national public health institutes to procure diagnostic equipment and upgrade laboratories. A way to achieve this is to partner with laboratory equipment manufacturers to reduce cost and work out favorable payment plans.

For instance, during the 2014-2015 Ebola outbreak across West Africa, an Ebola screening machine, which reduced specimen turn-around times in Sierra Leone, was brought from Nigeria. However, it was donated by the European Union. Africa must begin to take leadership in such areas, without depending on international donors for support.

Second, work in partnership with the African Union to train the local health workforce and increase local African capacity to prevent, detect, respond to and manage disease outbreaks.

The African Union’s deployment of more than 800 African volunteers to support the 2014-2015 Ebola intervention in Guinea, Liberia and Sierra Leone was instrumental in managing that outbreak and restoring health systems across the region.

I was a co-lead of the EpiAFRIC team which evaluated the African Union’s intervention. Traveling with my colleagues across the three countries and interviewing community members, volunteers, international partners and national ministries of health, it was apparent that it needed local expertise to stem the outbreak.

Third, improve infectious disease detection between borders. All African countries have ratified AfCFTA. When fully implemented, it would come with increased movement of Africans across borders.

The continent must be ready to prevent cross-border spread of infections. The ease with which Mr. Patrick Sawyer, the Liberian who brought Ebola from Liberia to Nigeria, threatened the health security of the continent, led to deaths of 8 health workers and Nigeria’s loss of $186 million in GDP.

To achieve this, the Bank should work with national public health institutes and ministries of health to ramp up epidemic preparedness at land, sea and air international borders.

Fourth, work with national governments and support their efforts for universal health coverage. Too many Africans pay out-of-pocket for healthcare.

This is not equitable and sustainable. According to the Director-General of the World Health Organization, universal health coverage and health security are two sides of the same coin.

Ultimately, there cannot be global health security if there are still poor underserved communities where people do not have access to healthcare or are unable to pay for the healthcare they need.

Needs are infinite and resources are limited. So, the African Development Bank should prioritize the health security of Africa, because a healthy continent would be more prosperous and then attractive to investors.

Excerpt:

Credit: Busani Bafana/IPS

By Esther Ngumbi and Ifeanyi Nsofor
ILLINOIS, United States / ABUJA, Oct 16 2019 (IPS)

United Nations World Food Day is celebrated around the world on October 16 under the theme: “Our Actions ARE Our Future. Healthy Diets for a Zero Hunger World”. This theme is timely, especially, because across Africa and around the world, there has been a gradual rise in malnutrition and diet-related non communicable diseases, as highlighted in The Lancet study and a United Nations Report published earlier this year.

While 45 percent of deaths in children are from nutrition-related causes, mainly malnutrition, diet-related non communicable diseases like obesity is a fast-growing problem across the world causing low- and middle-income countries to face a double burden of malnutrition.

Globally, non-communicable diseases kill the most people every year. Based on 2016 data, out of 56.9 million deaths, 40.5 million were due to non-communicable diseases (30.5 million were in developing countries). Diabetes, one of the complications of obesity led to 1.6 million deaths.

While 45 percent of deaths in children are from nutrition-related causes, mainly malnutrition, diet-related non communicable diseases like obesity is a fast-growing problem across the world causing low- and middle-income countries to face a double burden of malnutrition

Obesity is ubiquitous – every country is dealing with this pandemic in one form or another. Rates of obesity among females aged 5-19 years is 59%, 42% 36%, 8% in U.S., South Africa, Brazil and India respectively.

Research in Ghana shows that children from poorer backgrounds are more vulnerable to food insecurity and narrow dietary diversity. In contrast, consumption of processed foods rich in sugar but poor in nutrients is common among all socioeconomic classes. Showing that obesity does not respect boundaries. In Scotland, about 30% of adults and 13% of children are obese – this is attributable to foods and drinks high in fat, sugar and salt.

It is said that; the youths are the future. However, if the present trends of diet-related non communicable diseases like obesity among youths fueled by unhealthy foods continue, the future would be unhealthy. This is how to make the future healthy.

First, focus on consumption of plant-based nutritious meals among women of child-bearing age. One way to achieve this is by civil society organisations working with government to identify locally available nutritious meals and training families on how best to prepare these meals.

Data shows that most important time for using nutrition to improve cognition and physical development of a child is the first 1000 days of life (from when the woman becomes pregnant, through-out pregnancy, birth and until the baby is 2 years old).

In addition to the woman eating nutritious meals, there are several nutritional interventions to achieving these, including – exclusive breastfeeding within one hour after birth until the baby is 6 months old; introduction of nutritious complementary meals at 6 months and continuing of breastfeeding until the baby is 2 years old.

The good news is that, the African continent is endowed with indigenous vegetable plant varieties such as amaranth greens, African nightshade, Ethiopian mustard and fluted pumpkins that are affordable, and highly nutritious and dense in essential micronutrients that are lacking in many of the foods African.

In addition, many of these vegetable plants are highly adapted to the African climate and can endure drought and pests. Further, women that grow these crops for consumption can also earn income by selling the excess vegetables.

In Nigeria, for example, women farmers growing these indigenous highly nutritious indigenous African vegetable plant varieties are reaping several benefits including earning income and boosting food security. Similar success stories are documented in several African countries such as Kenya and Ethiopia.

Second, all nations should ban artificial trans-fat production and use. Globally, consumption of trans fat accounts for more than 500,0000 deaths due to heart disease every year, according to the World Health Organization.

The harmful effects of trans fat is by raising bad cholesterol and lower good cholesterol levels. Therefore, increasing risk of heart disease, stroke and insulin-dependent diabetes. Already there are lessons from countries that have policies on artificial trans fats.

For instance, South Africa limits industrially produced trans-fat in foods, fats and oils; and U.S. and Canada bans the source of industrially-produced trans-fat and require trans-fat to be labeled on packaged food.

Third, reduce daily consumption of salt to less than one teaspoonful a day because the sodium contained in salt increases blood pressure.

Hypertension in turn, is implicated in 7.5 million deaths every year.  According to the U.S. Centres for Disease control, more than 70% of the sodium Americans consume comes from processed and restaurant foods. There are several ways to reduce salt consumption such as public education, front-of-package labelling, promotion of salt substitutes, industry reformulation of packaged foods, and intervention for restaurants.

The United Kingdom salt reduction program led to lower slat content in processed foods, resulting in a 15% reduction in population salt intake.

Lastly, countries must come up with comprehensive policy approaches or revise already existing national nutrition policies to address this growing diet-related non communicable diseases. Once they’re set, governments must place high priority on them to ensure that nutrition policies are implemented and followed and that citizens are aware of them.

The complex, widespread and global rise of diet-related health diseases demand that we re-assess the foods we eat every day. Doing so will pave the way to a world where people are healthy.

Dr. Esther Ngumbi is an Assistant Professor at the Entomology Department, University of Illinois at Urbana Champaign. She is a Senior Food security fellow with the Aspen Institute and has written opinion pieces for various outlets including NPR, CNN, Los Angeles Times, Aljazeera and New York Times. You can follow Esther on Twitter @EstherNgumbi.

Dr. Ifeanyi M. Nsofor, a medical doctor, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. I am a 2019 Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. You can follow me on Twitter @ekemma.