Non-communicable diseases as Nigeria’s grim reaper

BY EBENEZER OHWOVORIOLE

The Nigerian media have reported, in recent times, unexplained deaths of some prominent Nigerians. Not just that, the media have buffeted Nigerians with stories of harrowing pain of chronic and terminal illnesses afflicting some public officials in the limelight. Ordinary Nigerians have not been spared the menace of these scourges: they, too, are dying mysteriously and are plagued with ailments that gradually smother their lives without any remedy since Nigeria’s public health system is abysmal.

Those with the financial resources are able to flee the land in search of medical succor in countries like South Africa, India, Malaysia, the United Kingdom and the United States. Consequently, according to a May 2019 Voice of America report, Nigeria loses more than $1 billion (N351 billion) annually to medical tourism. Unfortunately, for the poor majority, their health remains moribund until these less privileged Nigerians wither and die, unannounced. However, the multitude of baffling sudden deaths and vexing sicknesses that have been robbing a noticeable number of Nigerian families a blissful life can be prevented because the underlying conditions that may have led to some of these morbid experiences are self-inflicted due to the harmful lifestyle most Nigerians have embraced.

Before engaging in a limited discourse on the many facets of this harmful lifestyle Nigerians might have embraced, it is pertinent to have a quick overview of what is generally believed to be the cause of Nigeria’s mortality situation.

According to the CIA World Factbook, as at last year, Nigeria’s crude death rate was put at 9.6 deaths / 1,000 population. In other words, Nigeria, a country of about 204 million people probably loses almost two million of her citizens at the midyear mark. The Nigeria Social Statistics Atlas attributes these deaths to the following causes: communicable diseases (66%), non-communicable diseases (24%), and injury (10%).

Communicable diseases are infectious diseases like waterborne diseases acquired through eating or drinking (Hepatitis A, Hepatitis E, and Typhoid fever), vectorborne diseases picked up through the bite of an infected insect or spider (Malaria, Dengue fever, and Yellow fever), water contact diseases acquired through swimming or wading in freshwater lakes, streams, and rivers (Leptospirosis and Schistosomiasis), aerosolized dust or soil contact disease acquired through inhalation of aerosols contaminated with rodent urine (Lassa Fever), and respiratory disease acquired through close contact with an infectious person (Meningococcal meningitis).

On the other hand, non-communicable diseases, which the World Health Organization (WHO) claims last July “kill 41 million people each year, equivalent to 71% of all deaths globally” are cardiovascular diseases (Coronary artery disease, Heart Attack, Stroke, and Abnormal heart rhythms or arrhythmias), cancers, respiratory diseases (Asthma, Pneumonia, and Tuberculosis) and diabetes.

If WHO argues that non-communicable diseases are accountable for a higher percentage of global death, then there is the likelihood that public health authorities in Nigeria are, statistically, misdiagnosing the major causes of death recorded in the country if just 24% of deaths are attributed to non-communicable diseases, which appear to be a silent killer ravaging the land; that is when juxtaposed with the 66% assigned to communicable diseases.

Of course, communicable diseases are the natural first choice killers in developing societies. The despicable social amenities that such communities possess and the total lack of functional public health practices in those societies unequivocally enunciate the reasons why these types of diseases are always within the radar of public health officials despite the fact that there may be other obvious killers lurking in unseen places. Nigeria, as a developing nation is a victim of her own excesses due to the absence of a political will that will enervate corruption and enhance the growth of social amenities including a veritable public health system.

Presently, majority of Nigerians live on less than $2 (N724) daily. This implies that an individual exists on financial resources below the current international poverty line. The debilitating effect of this reality cannot be lost on the people’s psyche even as they wrestle with non-existent social safety net programs in a country that is an entity in total rot. According to a Pew Research Center February 2019 report, a majority of Nigerians describe the Nigerian economy as bad. The report, which Christine Tamir authors, finds that “as of summer 2018, 54% of Nigerians described the economic situation as “bad,” down from a high of 71% in 2016.” Although there is a positive outlook, yet, significantly, this study affirms the degenerative condition of life in the Nigerian polity in monetary terms. An economy in miasma is likely going to pay less attention to the general health of a people. To this end, Africa Check confirms in February 2018 that Nigeria spends five times less per person on healthcare than South Africa – another leading country in Africa – following a report in Thisday Newspaper. Using a 2015 data, Africa Check reveals that Nigeria spent US$97 [N35, 114] per person whereas South Africa spent US$471 [N170, 502] per individual. These amounts, nonetheless, pale in comparison with what some developed countries spend on their populace.
In the United States, for instance, the Public Health Service is responsible for protecting the nation from infectious diseases. As The Gale Encyclopedia of Environmental Health points out, “the Service helps city and state health departments with health problems. Its responsibilities include controlling infectious diseases, immunizing children, controlling sexually transmitted diseases, preventing the spread of tuberculosis, and operating a quarantine program.” In prioritizing the health of the American public, the United States, as observed in a 2017 data, spent “$10,739 per person” which means “health spending accounted for 17.9 percent” of the country’s Gross Domestic Product during the period under review.

With the above data, it can be subsumed that poverty is at the heart of Nigeria’s health concerns. According to the American Heritage Dictionary, poverty is the “lack of the means of providing material needs or comfort.” Nigeria exemplifies this meaning: not just in the daily lives of the citizens of the country but, also, in the soul of the Nigerian state. And, if there is anything to be learned from studies, people who live in “low-income urban neighborhoods are exposed to a range of severe and chronic stressors” as Ilana Reife, Sophia Duffy, and Kathryn E. Grant affirm in their essay, “The Impact of Social Support on Adolescent Coping in the Context of Urban Poverty.” On the other hand, Efe Useh, in “Non-Invasive Approach in Lifestyle Diseases” asserts that stress has a negative effect on a person’s lifestyle choices, if not managed correctly. Consequently, some studies have shown that people respond to “emotional pressure suffered for a prolonged period of time in which an individual perceives they have little or no control” by seeking solace in comfort food.
Heather Scherschel Wagner, Britt Ahlstrom, Joseph P. Redden, Zata Vickers, and Traci Mann note in their study, “The Myth of Comfort Food” that “people seek out their own idiosyncratic comfort foods when in negative moods, and they believe that these foods rapidly improve their mood.” However, their research contradicts this claim. In their report, they state:

We found that comfort food was not significantly more effective at improving a negative mood than an equally liked food (Study 1), a neutral food (Study 2), or no food (Study 3). In addition, it is not the case that participants get comfort only when they eat a food that they believe will comfort them, as there was no correlation between participants’ confidence the food would comfort them and their change in mood …. The amount of food they consumed also did not correlate with the change in mood.

While the above declaration argues that comfort food is a myth, there is no denying the fact that the high-calorie foods people binge eat when stressed are dangerous to the human body.
High-calorie foods can cause people to be overweight or obese, and Nigeria’s staple foods are mostly high-calorie foods. Therefore, for people to over-indulge in these foods under any guise is a conscious attempt at producing a recipe for a health problem. Calorie is a unit of energy in food and two units produce one calorie. In essence, diets that have carbohydrates, fats, and protein, and drinks with alcohol provide food energy or calories.

The food that people eat have both caloric and nutrient densities. The former density is bad when high while the latter is good. Regrettably, most Nigerian mainstay foods have higher caloric density. For instance, jollof rice (868), white rice (693), super pack Indomie noodles (640), one cup of Semovita (600), one cup of beans with oil (520), one cup of Tuwo masara (450), one cup of Soybeans (446), Eba or one cup of garri (400), pounded yam (400), one wrap or fist size of Akpu/Fufu (330).

A number of these foods are high on carbohydrates as well. Medlineplus – a service of the U.S. National Library of Medicine (NLM) – describes this nutrient’s function as follows: “Your digestive system changes carbohydrates into glucose (blood sugar). Your body uses this sugar for energy for your cells, tissues and organs. It stores any extra sugar in your liver and muscles for when it is needed.” Definitely, this is not a bad process and purpose. The only problem is that an abuse of these foods including unchecked storage of excess calories and blood sugar in the body due to a sedentary lifestyle leads to obesity and diabetes.

A rotund body is priceless in Nigeria because it is assumed as a visible evidence of good living. In contrast, though, craving obesity as a sign of prosperity can expose people to several chronic diseases like cancer, heart disease, and diabetes. The insalubrious conditions that emanate from being overweight usually cause premature death. These ailments constitute the Grim Reaper that is silently killing Nigerians.

Death by cancer is on the rise in Nigeria, and WHO announced February this year that a “total of 41,000 Nigerians were killed by cancer in 2018.” Nonetheless, a study – “Cancer Incidence in Nigeria: A Report from Population-based Cancer Registries” – claims that in Nigeria “some 100 000 new cases of cancer occur every year, with high case fatality ratio.”

Away from cancer, more Nigerians are dying because of heart diseases. During the first week of this year’s last quarter, Nnenna Ezeigwe, the National Coordinator for Non-Communicable Diseases (NCD) in Nigeria’s Federal Ministry of Health (FMoH) said, “CVD [cardiovascular diseases] is a significant public health concern responsible for 11% of over 2 million NCD deaths in Nigeria annually. It is also responsible for a high burden of morbidity and disability. Most people with CVDs are not aware until catastrophes like stroke, heart attack or death occur.”

Too much sugar in the blood due to an inactive lifestyle can lead to diabetes type 2. Diabetes, if not properly managed, may lead to limb amputation, cause blindness or kidney failure, which is the consequence of a chronic kidney disease. Death by Diabetes mellitus (DM) is on the increase in Nigeria because “poverty … lack of tools and basic infrastructure … are responsible for much of the failure to detect DM” until its effect has become fatal since “a vast majority of patients are diagnosed late, at complication stages of the disease.” A 2016 study – “A review of population-based studies on diabetes mellitus in Nigeria” – claims “Nigeria is the leading country in Africa in terms of the number of people with diabetes, 3.9 million had diabetes with 105,091 diabetes-related deaths in 2013 which is estimated to increase annually by 125,000 between 2010 and 2030.”
The implication of the various findings is this: there is an epidemic in the horizon and a torrent of deaths is in Nigeria’s near future.

To checkmate a future rash of premature deaths in the country like the type that the family of Senator Benjamin Uwajumogu has just experienced, Nigerians should change their lifestyle and have regular medical checkup with a battery of blood tests. Lifestyle changes will, first, require Nigerians to limit their calorie intake to healthy portion sizes consisting of healthy balance of foods every day. However, decisions on the key elements of healthy eating patterns, according to the U.S. government dietary guidelines for 2015-2020, should take into consideration the fact that “calorie needs vary based on age, sex, height, weight, and level of physical activity.” Second, Nigerians should lead physically active lives that involve regular exercises, bodily movements done as part of working, playing or doing house chores. Being plump may be an evidence of good living in Nigeria. However, underneath the chubby façade are deadly weapons that can kill anyone anytime without any warning. For instance, high blood pressure, stroke and heart disease are the consequence of extra fat tissue in the body that will necessitate extra pressure on the walls of one’s arteries. However, since Nigeria’s staple foods are rich in fatty elements which consumers do not effectively manage, over time, arteries would have accumulated fatty deposits that would have narrowed them. Narrow arteries are precursors for heart attack and when there is a blood clot, stroke is unleashed. Finally, the Nigerian government should invest more in public health services and retool the dilapidated public health system so that the majority of Nigerians can have access to preventive healthcare.

With these, Nigerians of all social and economic shades will live longer thereby preventing myth induced mystery deaths and limiting the adverse effect of sudden deaths on the Nigerian polity.

Ohwovoriole, a medical doctor based in California, USA, can be reached via [email protected]