IN Kano state, some communities have been plagued with Diphtheria – an infection caused by strains of bacteria that can lead to difficulty breathing, heart rhythm problems, and even death. Advocacy through community leaders and improvement in epidemic preparedness are factors mitigating the spread of the disease in the state, Mustapha Usman reports.
Abdullahi Kabir’s family, in Tudun Fulani, is one of the families hit with diphtheria, as three of his children, including Umar, contracted the disease early this year. Despite medical attention, the youngest child passed away in February, while his eldest child is still hospitalised.
Umar, 6, who is the second child of Kabir has, however, been discharged and is currently on medication to treat the remnant of the disease.
Initially, Umar’s father wasn’t aware of the disease and didn’t see the need to immunise his children until his children were infected and had to take them to the nearest public health centre-Mongoro PHC. However, the medication given to Umar at the centre was ineffective, prompting him to seek treatment at another hospital, Dala Hospital, located a few kilometres away.
At Dala Hospital, Umar was admitted and was confirmed to have diphtheria.
The father said, “He (Umar) started with a fever, so I decided to take him to our PHC, Mongoro Hospital, they gave him some drugs which were ineffective, I further took him to Dala Hospital, where he got treated.
“At first, when I took him to Mongoro PHC, they confirmed that it was not diphtheria, but later when I went to Dala Hospital, they confirmed that my child has diphtheria.”
“He’s living together with his siblings now, but his sister is still on admission at Murtala Muhammad Hospital, while I lost my three-year-old child Hauwau Kabiru to diphtheria,” Kabir added.
Kano state is one of the few states which have been plagued with diphtheria-a disease, according to NCDC, is a serious bacterial infection caused by the bacterium called Corynebacterium species that affects the nose, throat and, sometimes, skin of an individual.
The disease has spread across five local government areas in Kano state, namely, Ndala, Gwale, Ungogo, Nasarawa and Tarauni. It has caused the deaths of at least 61 lives while hundreds of other residents were admitted to hospitals.
Data from NCDC showed that 783 patients were on admission, of which 360 were females and 423 were males, as of March 2, 2023.
The NCDC attributed the outbreak and the high fatality rate to delays in diagnosis and the absence of diphtheria antitoxin during the early stage of the outbreak.
While the factors for this may also be attributed to low vaccination across the country, Kano state is, however, an exception, according to sources and authorities who spoke to The ICIR, they recorded significant progress in vaccination since the outbreak this year.
Residents of these communities who spoke to The ICIR explained that advocacy and house-to-house immunisation efforts by the Kano State Government are mitigating the spread of diphtheria.
Government quick intervention
Although the diphtheria outbreak in Kano has claimed a few lives in the state this year, The ICIR gathered that Government’s quick intervention in some affected communities and provision of free and adequate health care is curbing the spread of the disease.
Haladu Muhammad, a resident of Tundun, is a parent to one of the children who contracted the disease in the state. His daughter, Haladu Hajara, who is four years old, was infected with diphtheria in January.
“It was just one sudden night, I met my daughter ill, so due to the awareness of the outbreak of diphtheria, I took her to Murtala Muhammad General Hospital, they ran a test and confirmed that she has diphtheria.”
Muhammad explained that the treatment fee for Diphtheria at the Murtala Muhammad General Hospital was free, adding that his other children were vaccinated with their mother.
“We didn’t spend a kobo at the hospital, all treatment was free of charge. After that other children were vaccinated, together with her mother.”
Other families of the survivors who spoke to The ICIR also shared the same testimony on the government’s quick response to their wards.
The Kano state Epidemiologist and Incident Manager, Abdullahi Issa while speaking to The ICIR stressed that the state emergency preparedness and response committee (EPR committee) has been reactivated to contain and control all public health emergencies and threats in the state.
Issa aligned their recent success and development to the creation and approval of budget lines for epidemic preparedness and response.
In 2020, Kano created a budget line for epidemic preparedness and response, totalling 300 million naira and allocating two million naira each toward strengthening preparedness in the 44 local government areas in the state.
“We are currently responding to the diphtheria, and evidence has shown that we have made a remarkable improvement and currently, the patients have been treated at the designated treatment centre and we have seen a significant reduction in the number of cases. Regarding the creation of budget ideas, we must commend the effort of the current government under the leadership of his excellency Governor Abdullahi Umar Gaduje for approving the creation of the budget line for emergency preparedness and response and also announced some amount of money is appropriated for EPR activity in the state.
“Not only that, the most welcome development in the EPR budgeting and financing is a recent approval by his excellency of a monthly stand in other that guarantees the monthly release of some amount of money to the state EPR committee under the Ministry of health, so that whenever there is any outbreak, there’s no need to wait and begin to write memo seeking for approval when there’s money in the ministry of health already,” Issa added.
The ICIR gathered that only Kano and Lagos states have created a budget line for the epidemic preparedness and response among Nigeria’s 36 states.
Although The ICIR could not ascertain if the actual amount budgeted for the EPR was released in 2022 by the state government, it was said that not less than 30 million was released for the project in 2022.
This was according to the Kano state Lisdel coordinator an NGO that focuses on advocacy initiatives for sustainable development goals – Shuaib Mohammed, who was part of the campaign on the state taking ownership of health and creating a budget line for epidemic preparedness.
He disclosed that the increased Health funding by the state government in recent years is reducing the rate at which some of these diseases spread across the state. He said, “The state has taken charge of the management of diphtheria like treatment, sensitisation, vaccination, etc. While partners such as: WHO, MSF, UNICEF are technically and financially supporting the state.”
Mohammed stated that a sum of N30 million was released out of the amount approved for preparedness.
Diphtheria vaccination coverage in the state
Misinformation, illiteracy and lack of proper sensitisation were some of the reasons why many people were reluctant to take vaccines in Kano state. The reluctance towards getting vaccinated might have originated from 1996, when some children were reported dead barely one month after receiving Trovafloxacin/Alatrofloxacin and Ceftriaxone, the standard vaccine for meningitis.
Nigeria faced one of Africa’s most severe Meningitis outbreaks during that period and was approached by a research team of six members from one of the biggest research-based pharmaceutical companies in the United States, Pfizer, who promised to combat the outbreak by conducting tests on the efficacy of their new antibiotic, ‘Trovan,’ on 200 young meningitis patients in Kano State.
Although Pfizer asserted that the drugs were not responsible for the children’s deaths, the company was found to have conducted human trials without obtaining informed consent during the investigations. The ICIR did a more detailed report on vaccine hesitancy and how religious clerics drove the vaccination coverage in Kano state, see report here.
The scenario has, however, changed as community leaders, health workers, and relevant non-government organisations are preaching the importance of receiving vaccines to people.
The Head of Tudun Fulani Barebari of the Ungogo LGA, Ado Isah, explained to The ICIR that after one of his children was discharged from the hospital, he met with healthcare workers and stakeholders to sensitise the other residents on the need to take vaccines.
“During the outbreak of diphtheria in my community, I have been relentlessly moving from one LGA to another and also engaging with different stakeholders. From there, the LGA took a step by sending health personnel and also drugs to the Mangoro Primary Health care, were they started vaccinating residents.
“As the village head, I have been trying my best to see that I curtail the widespread of the epidemic in my community by meeting with healthcare workers and also stakeholders. We used to sensitise the residents on how to protect themselves from contracting such viruses.”
Isah noted that he went to mosques and public gatherings with public healthcare workers to educate people on preventive measures, adding that the state government has done well in vaccination coverage in his LGA as “they spent almost a week administering the vaccination.”
He also confirmed that most people who contracted the disease in the village received free treatment at the Murtala Hospital.
We have vaccinated over 500,000 children on Diphtheria-Official
Over 500,000 children have been immunised against Diphtheria in Kano this year. The Kano state primary health care immunisation officer Shehu Abdullahi Muhammad said the state constituted a technical working group under the rapid response in January 2023, to tackle the outbreak.
According to him, the committee identifies the victims of the disease and the plagued areas and proceeds to take their samples to determine who has the disease and further isolate them from the population.
He stated that the state healthcare sector engages in outreach to every part of the state to provide vaccines for the people, especially in the five most affected LGAs.
“We have even concluded the second phase of vaccinations in five LGAs, Ndala, Gwale, Ungogo, Nasarawa and Tarauni, these are the five epic centres LGAs who have high burdens of transmission of these diseases and people were reached since February, and we did the second phase in March/April. We are now preparing for the third phase because the National body has planned for three consecutive months of RI intensification activities campaign in all 23 LGA and intensified the diphtheria activities in five LGA that I mentioned earlier.
“We have vaccinated over 500,000. The first concerning phase one is that the National will require one million doses of TD vaccine, and unfortunately National didn’t have this quantity, they gave us 500,000, and we were able to immunise more than 270,000. The recent conclusion of this RI intensification phase two, which we finished yesterday (April), is that over 350,000 (eligible from four years to fourteen years of age) were vaccinated. So if we sum it all up; 270,000 people plus 350,000 people, we were able to reach more than 600000 people who have benefited from the vaccine in the state.”
Muhammad further explained that the state target population for Diphtheria vaccination coverage is 1.5 million and has, however reached 50/60 per cent, adding that the third round of the exercise will start in May.
Strides in Kano state health budget
Aside from the creation of a budget line for Epidemic preparedness, the Kano state health budget has seen an increase in recent years.
The budgetary allocation for health increased from 27 billion in 2016 to 40.2 billion in 2023, and the health budget as a percentage of the total state budget has increased from 9.85 per cent in 2016 to 15.01 per cent in 2023. This demonstrates the state government’s efforts to comply with the Abuja declaration that requires FG, state, and local governments to allocate at least 15 per cent of their total budgets to health.
However, despite this positive development, the amount allocated for epidemic preparedness is still relatively low. Less than 1 per cent of the health budget was dedicated to epidemic preparedness in recent years. For instance, in 2019, only N50.7 million, which is 0.15 per cent of the total approved budget for the health sector, was approved for epidemics.
This amount remained almost the same in 2020, with N50 million (0.16 per cent of the total approved health budget) being spent on epidemics. In 2021, the allocation for epidemics dropped significantly to N20 million, which is only 0.07% of the state’s health budget for the year.
Meanwhile, in 2022 and 2023, the amount allocated for epidemic preparedness increased again, with N40 million allocated in both years.
Muhammad, the Kano state Lisdel coordinator, raised concerns over the issue of the state government not releasing the actual money budgeted for healthcare, noting that there would have been a more improved epidemic preparedness and disease control in the state.
According to him, sometimes, a single release takes a whole year of advocacy. He said, “Creating a new budget line is a good achievement and you know releasing funds is not something easy in the government. Budget is always a proposal of what’s expected from the revenue generation, at times it takes the whole year advocating for a single release. The Government mostly has some priorities from the physical structures and all that.”
Also, a report from a Civil Society Organisation working in Kano, the development Research and Projects Centre (dRPC) shows there were poor releases in 2018, 2019, and 2020. The report stressed that there were less than 50 per cent releases in all, far less than the required 75 per cent.
The released amounts for 2015 and 2016 were merely 7.3 per cent and 3 per cent, respectively, resulting in a substantial deficit of over 90 per cent in both years, according to the report.
However, the total health capital releases for 2018 and 2019 accounted for 25 per cent and 32 per cent, respectively, showing a significant increase from the previous years.
The report further stated that only 2 per cent was the total released for the health capital expenditure in 2020.
This report is supported by The Nigeria Health Watch.
Usman Mustapha is a solution journalist with International Centre for Investigative Reporting. You can easily reach him via: [email protected]. He tweets @UsmanMustapha_M