The Pediatric Association: Millions of Nigerian Children are dying from Preventable Diseases

The Pediatrics Association of Nigeria on Tuesday pledged to support efforts of government and other stakeholders to drastically reduce the high rate of death among children in Nigeria, put at one million annually.

President of the Association, Dr. Ngozi Ibeziaku, made the pledge at a press conference in Kaduna to herald the commencement of the association’s 48th Annual Conference.

She said the focus of the conference would be on child health and evolving strategies to encourage mothers and other stakeholders access health services to ensure the survival of the Nigerian child.

“Children can’t speak for themselves, so we are their voices”, she said, adding that the association would also support policies and programmes to tackle high child death in the country.

She stressed that most of the deaths were preventable, and could be tackled through exclusive breastfeeding, accessing antenatal care, vaccination against killer diseases, environmental cleanliness, use of treated mosquito nets, and hand washing.

Ibeziaku added that the association would continue its advocacy for the provision of safe drinking water, protecting children against child labor, drug abuse and patronage of health facilities for medication.

She noted that Nigeria’s indices on child death were alarming, and every Nigerian needed to contribute towards safe motherhood and the upbringing of children.

“Everywhere in the world, it is the health indicators concerning children especially those under-5, that they use to determine the state of development of nations.

“Unfortunately for us in Nigeria with our large population, our prenatal and neonatal mortality and morbidity rates is one of the highest in the world.

“The same for our under-5 mortality rate, that is children aged under-5. Many of our children don’t live to celebrate their first birthday and even those that did, don’t live to celebrate their fifth birthday, which is a landmark in the life of any child.

“When we look at the under-5 figures, we find that children in the first one month of life contribute more than 45 percent of the deaths of children in the country. So the great problem is in the first month of life,” the president noted.

The News Agency of Nigeria reports that the theme of the four-day conference is “Consolidating child health development in Nigeria through SDGs; Gains and Gaps of the MDGs.”


REFERENCES:
http://punchng.com/one-million-nigerian-children-die-preventable-diseases-annually-paediatrics-association/

Public Health Challenges In Africa

In 2005, out of 58.03 million people who died globally, an estimate of 10.9 million (18.8%) were from the WHO African region [1]. HIV/AIDS (19%) was responsible for the majority of the deaths (64%) that occurred in the region, lower respiratory infections (10%), malaria (8%), diarrhoeal diseases (7%), cerebrovascular disease (4%), ischaemic heart disease (3%), tuberculosis (3%), measles (3%), low birth weight (2%), birth asphyxia and birth trauma (2%) and maternal conditions (2%). Although there are effective public health interventions that can prevent most of the deaths, the coverage is insufficient due to weak and under-resourced health systems. Some of the weakness can be generated from the challenges related to leadership and governance; health workforce; medical products; vaccines and technologies. Information, financing and service delivery [2].

Firstly, the leadership and governance is inefficient, which includes weak public health leadership and management [3]; inadequate health-related legislation and their enforcement; limited community participation in planning, management and monitoring of health services; weak inter-sectoral action; horizontal and vertical inequities in health systems [4]; inefficiency in resource allocation and use [5]; and weak national health information and research systems [6].

Secondly, extreme shortages of health workers exist in 57 countries of which 36 are in Africa [8]. The crisis has been exacerbated by inequities in workforce distribution and brain drain. Thus, the delivery of effective public health interventions to people in need is compromised particularly in remote rural areas.

Thirdly, there is rampant corruption in medical products and technologies procurement systems, unreliable supply systems, unaffordable prices, irrational use, the wide variance in quality and safety [2]. This has contributed to the current situation where 50% the population in the Region lack of access to essential medicines [6].

Fourthly, there is a dearth of information and communications technology (ICT) and mass Internet connectivity, compounded by a paucity of ICT-related knowledge and skills limiting capacities of national health management information systems (HMIS) to generate, analyze and disseminate information for use in decision-making [7].

REFERENCES:

• http://www.who.int/healthinfo/bod/en/index.html
• WHO Strengthening health systems to improve health outcomes: WHO's framework for action Geneva. 2007.
• Brinkerhoff DW, Bossert TJ. Health Governance: Concepts, Experience, and Programming Options.Bethesda: Abt Associates Inc; 2008.
• McIntyre D, Mooney G. The economics of health equity. Cambridge: Cambridge University Press; 2007.
• Kirigia JM, Asbu Z, Greene W, Emrouznejad A. Technical efficiency, efficiency change, technical progress and productivity growth in the national health systems of continental African countries. Eastern Africa Social Science Research Review. 2007;23:19–40. doi: 10.1353/eas.2007.0008.[Cross Ref]
• Kirigia JM, Wambebe C. Status of resources for health research in ten African countries. BMC Health Services Research. 2006;6:135. doi: 10.1186/1472-6963-6-135. [PMC free article] [PubMed][Cross Ref]
• Gething PW, Noor AM, Gikandi PW, Ogara E, Hay SI, Nixon MS, Snow RW, Atkinson PM. Improving imperfect data from health management information systems in Africa using space-time geostatistics. PLoS Med. 2006;3:e271. doi: 10.1371/journal.pmed.0030271. [PMC free article][PubMed] [Cross Ref]

Lead Poisoning in Children

Lead poisoning is responsible for the mortality rate of childhood diseases in a toxic environment. Today, children across the world are at risk of exposure to lead from several sources. Lead poisoning is accounted for 0.6% of the burden of diseases worldwide (WHO, 2009). Traces of lead exposure, prevalence rates of lead poisoning and the severity of its impact varies greatly from country to country, and from place to place within countries. Countries also vary greatly in their degree of recognition of the problem and in the strength and effectiveness of their lead poisoning prevention programmes.


Most countries have programs for monitoring the degree of lead exposure in the blood and the environment. They also have programs for primary and secondary prevention of childhood lead poisoning. Some of these have restricted the use of lead, they have established an environmental standard and developed screening programs. They also have lead hot spots, such as battery recycling plants, smelters, refineries, mines, hazardous waste sites and sites where waste is burned in the open.


Although childhood lead poisoning in relation to exposure to certain substances has been recognized as a public health problem in some countries, they are yet to implement assessment and exposure prevention programs. In some countries, where there is no recognition of lead poisoning as a potential health hazard, there is no existence of screening or surveillance programs. As a result, the public health authorities have little or no knowledge of the magnitude of the exposure towards children.
Because of this heterogeneous situation, the true picture of global and regional lead poisoning in children is not yet fully defined. The contribution of lead poisoning to the global burden of disease and its effect on the global economy and human development is probably still underestimated.


There are multiple international conferences and declarations which have recognized the importance of childhood lead poisoning and the need to intervene to prevent it (see Annex for examples). The 1989 Convention on the Rights of the Child and the 1992 Agenda 21 adopted by the United Nations Conference on Environment and Development both addressed the need to protect children from toxic chemicals. The 1997 Declaration of the Environment Leaders of the Eight on Children’s Environmental Health World Health Organization 14 acknowledged the importance of lead poisoning as a major environmental hazard and called for action to reduce children’s blood lead levels and to fulfill the Organisation for Economic Co-operation and Development Declaration on Lead Risk Reduction. The 2002 Bangkok Statement on Children’s Health and the Environment called for the removal of lead from gasoline (Suk, 2002). In 2005, the Health and Environment Ministers of the Americas agreed in the Declaration of Mar del Plata to “strengthen sub-regional and national actions to achieve a complete elimination of lead in gasoline and its reduction from other sources” (OAS, 2005). The 2006 Declaration of Brescia on Prevention of the Neurotoxicity of Metals recommended: the immediate elimination of tetra-ethyl lead from the gasoline supplies of all nations; the review of all uses of lead, including recycling, in all nations; and urgent reduction of current exposure standards (Landrigan et al., 2007). The 2009 Busan Pledge for Action on Children’s Health and Environment further affirmed the commitment of the global community to end childhood lead poisoning.


REFERENCES

Akesson A et al. (2005). Tubular and glomerular kidney effects in Swedish women with low environmental cadmium exposure. Environmental Health Perspectives, 113:1627–1631.

Al-Saleh I et al. (1999). Determinants of blood lead levels in Saudi Arabian schoolgirls. International Journal of Occupational and Environmental Health, 5(2):107–114.

American Academy of Pediatrics Committee on Environmental Health (2003). Pediatric environmental health, 2nd ed. Elk Grove Village, IL, American Academy of Pediatrics. Amitai Y et al. (1987). Hazards of ‘deleading’ homes of children with lead poisoning. American Journal of Diseases of Children, 141:758–760.

 Amitai Y et al. (1991). Residential deleading: effects on the blood lead levels of lead-poisoned children. Pediatrics, 88:893–897. Baker EL et al. (1977). Lead poisoning in children of lead workers: home contamination with industrial dust. New England Journal of Medicine, 296(5):260–261.

Basha MR et al. (2005). The fetal basis of amyloidogenesis: exposure to lead and latent overexpression of amyloid precursor protein and ß-amyloid in the aging brain. Journal of Neuroscience, 25:823–829. Beattie AD et al. (1972). Environmental lead pollution in an urban softwater area.

British Medical Journal, 2(5812):491–493. Bellinger DC, Stiles KM, Needleman HL (1992). Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study. Pediatrics, 90(6):855–861.

Social Determinants of Mental Health Among Adolescents

In recent years, depression in childhood has increased attention for awareness among adolescence.^1- 3 Although it was believed that depression did not occur in children before the 1970s, recent studies ^1,4- 7  have proven that about 2%-8% of young adults experience their first symptoms at the age of 16.

For example, Hankin et al⁵ discovered that approximately, 6% of young adults in  the Dunedin study cohort met DSM-III⁸ diagnostic criteria for depression on at least one occasion by age 15. A similar rate was reported by Fergusson et al,⁴ who found that almost7% of 15-year-olds met DSM-III-R diagnostic criteria for depression.

The increase in the presence of depression among adolescences has led to a growing interest in the etiology, comorbities, and consequences of early-onset depression. For example; there has been evidence suggesting that young people showing signs of early depression or depressive symptoms are at high risk for several adverse outcomes, including further depressive episode,^9- 11 impaired social functioning,^9,12- 16 low academic achievement,^{9,10,12,15,17,18} and a range of other mental health problems, such as anxiety disorders, substance abuse, and suicidal behaviors.^{12,15,19- 21} These linkages between early depression and later outcomes are thought to reflect the effects of early-onset depression on normal development and the continuities of depressed mood across time.⁹

REFERENCES

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/206141

Prevalence of Mental Illness in Austrlia

Every year, there is an estimate that one of every five Australians experience mental illness. Mental illness is the third leading cause of disability burden in Australia, approximately 27% of the total years lost due to disability. 4% of people who experience depressive episode in 12-month are accounted to effected by mental illness, with 5% of women and 3% of men. 14% of Australians are affected by anxiety disorder within a 12-month period. While 3% of the Australian population are affected by psychotic illness; such as schizophrenia, where is loss of contact with reality during the episode of the illness.

2% of the population with mental illness experience eating disorder, which may occur during their life with women 9 times more than men. 5% experience substance abuse disorder in any 12-month period, men more than twice as likely as women to have substance abuse.

Prevalence of mental disorder decreases with age. The most affected age is between 18-24 years. Women are more prone in developing anxiety disorders (18% compared with 11%), and mood disorders (7.1% compared with 5.3%). A national survey proves that 35% of people with mental disorder have used mental health services and 29% consulted a GP within the 12 months before the survey. Women are more likely than men to receive medical services. In Australia, the prevalence of mental or behavioral disorders among people born abroad is similar to those born in Australia. May violent people have no history of mental disorder and most people with mental disorder (90%) have no history of violence. 

REFERENCES:

http://www.mindframe-media.info/for-mental-health-and-suicide-prevention/talking-to-media-about-mental-illness/facts-and-stats

The Effects of Economic Challenges on the Health Sector in Nigeria

It has come to a period where the Federal Government of Nigeria is to declare a state of emergency in health sector of the country. The Nigerian economy has decelerated, especially after the declaration in July 2016 of the Nigerian economic recession by the Finance Minister for the Federal Government because of the increased inflation to 17.1% higher than the previous years (Alloh F. T, 2017). The lead to a decrease in the price of crude oil from $115 in 2014, to $35 per barrel (World's Economic Forum, 2016).

The crude oil accounts for 75% of the country’s economy, therefore, having a significant impact on all sectors of the country. In addition, Nigeria is battling with one of the most dangerous terrorist group in the world known as book haram. Also, the pipelines in the south-south region of Nigeria is being attacked by the Niger-Delta militants. This is an unrest against the Nigerian government for disrupting the crude oil production among the area.

The Nigerian government has considered the healthcare of the people as a low priority. According to the United Nation Children’s Fund (UNICEF) in July 2016, the withdrawal of healthcare workers in Borno state has resulted to an increase of health victims due to the threat imposed on the lives of the health workers. UNICEF has estimated that more than 2 million crisis victims need health care services, leaving more than 1.2 million people internally disabled (Burki T, 2016). This has increased the rate of malnutrition among children with an estimate of over 244,00 children. 49,000 are at risk of dying if healthcare services are not provided in the areas most affected by the insurgency. The level of acute malnutrition recorded between July and August (2016) was well above the 15% threshold and classified critical with some cases higher than 50% representing about half of children affected.

In the northern states of Nigeria, more than 72% of health care facilities in Yobe, and 60% in Borno state have been destroyed because of the insurgency. The challenges confronted by Nigeria has led to a high poor rate of health outcomes. According to the African Health Observatory report by WHO, Nigeria has the fourth highest maternal death among African countries; leading to over 820/100,00 deaths per live births, and 109/100,00 death among children under the age of five per live births resulting to 58,00 women and 750,000 children dying in 2015 (WHO, 2016).

The life expectancy in Nigeria among men and women is 53years(males), and 56(females) which Is among the lowest in the world. Less than half (49%) of the children in Nigeria received DPT/Penta dose of immunization, which was below the target percentage (90%) in the goal of Millennium Development to decrease the child mortality rate. In 2015, half of the children were unable to receive vaccinations against measles and rubella, thereby raising the health risks. WHO reported three cases of polio crisis in Borno state; after the country stated that there were no existing cases of polio within the state (WHO, 2014).  

After the 2001 benchmark declaration in Abuja where 15% of yearly budget was allocated to the health sector, Nigeria has failed to reach the target in every given year. During the recession in Nigeria, the impact of poor funding on the health sector has risen. The federal ministry of health reported that the budget allocated to the health sector is reduced as a gradual decrease from N264.64 billion ($839 million), equivalent to 6.0% of the national budget in 2014, to N257.38 billion ($816 million) equivalent to 4.23% of the annual budget in 2016 6. This was because of the economic recession, causing the GDP to drop by -2.06% in 2016 according to the National Bureau of Statistics (National Bureau of statistics, 2016).  

Due to the lack of funding in Nigeria, the health sector is unable to address the health issues confronted by the country. This increases the poor framework of the health sector, and coordination with variation of fragmented services, scarcity of medical supplies, and medical pills, old and decaying infrastructure, lack of healthcare services, poor quality of health care delivery, and increase in health inequality gap between the rich and the poor.

REFERENCES

1.      Alloh F. T, a. R. (2017). Effect of economic and security challenges on the Nigerian Health Sector. Retrieved from http://eprints.bournemouth.ac.uk/29580/1/Effect%20of%20economic%20and%20security%20challenges%20on%20the%20Nigerian%20Health%20Sector.pdf

2.       Burki T. (2016). Health crisis intensifying in Nigeria. Borno State, Nigeria.

3.       National Bureau of statistics. (2016). Nigerian gross Domestic product report.

4.       WHO. (2014, july). Government of Nigeria reports 2 wild polio cases,. Retrieved from http://www.who.int/mediacentre/news/releases/2016/nigeria-polio/en/

5.       WHO. (2016). Atlas of African Health Statistics 2016 - Health situation analysis of the African Region. Retrieved from http://www.aho.afro.who.int/en/atlas/atlas-african-health-statistics-2016-health-situation-analysis-of-the-african-region

6.       World's Economic Forum. (2016, March 2). Retrieved from What’s behind the drop in oil prices?: https://www.weforum.org/agenda/2016/03/what-s-behind-the-drop-in-oil-prices/

The Public Health Challenges in Nigeria: Lack of Government Revenue

According to the 2011 WHO statistics, the overall life expectancy at birth is 54 years, infant mortality rate is 86 per 1000 birth while maternal mortality ratio is 840 per 100,000 live births.  Nigeria is confronted with major public health problems such as infectious diseases, sewage disposal, health insurance, water supply, air pollution, noise pollution, environmental radiation, housing, solid waste disposal, disaster management, control of vector some diseases, doctor-population ratio, population-bed ratio, population per health facility, payment system/methods, utilization of care, access to care, improper co-ordination of donor funds, material mortality, infant mortality, health financing, poor sanitation and hygiene, incessant doctors strike, disease surveillance, smoking of tobacco, brain drain, rapid urbanization, non-communicable diseases, alcohol abuse, environment degradation, road traffic injuries.

The death rate in Nigeria will continuously increase if there are no interventions to address the public health problems in Nigeria. According to the WHO Global Status Report on non-communicable diseases, Nigeria, together with other developing countries have the highest death rate caused by non-communicable diseases, such as cardiovascular disease, cancer, diabetes, chronic respiratory diseases, sickle cell disease, asthma, coronary heart disease, obesity, stroke, hypertension, road traffic injuries and mental disorders.

The World Health Statistics have reported that the malaria mortality rate in Nigeria is 156 per 100,000 population. Nigeria has one of the highest Tuberculosis burden in the world (311 per 100,000) resulting in the largest burden in Africa. This is according to USAID. The proper design of programs to address the public health problems in Nigeria will no doubt go a long way in improving the health status of the people. Though there are programs designed to address some of the health issues, there is a need to solve many other health problems.

The Nigerian primary health care has not been helpful in solving the numerous health problems effectively. Equity, accessibility, affordability, quality, effectiveness and efficiency remains a problem in Nigeria. Cost effective interventions for priority public health issues such as non-communicable diseases, injuries, maternal and child health are hardly being used.

According to 2010 UNAIDS reports, the inter-sectoral cooperation and collaboration between the different health-related ministries remains a major issue. And, also, there are about 1000 new infections of HIV in each day in Nigeria. WHO statistic has shown that the number of reported cases of malaria increased from 2, 834, 174 in 2008, to 4,295,689 in 2009. The government has done nothing to improve the health status in Nigeria. The national health system is weak, its management is ineffective and inefficient. The human resources between urban and rural area remains undistributed. Over 70 percent of doctors are in urban areas where only 48 percent of the population live, leaving 52 percent of the population who live in the rural area at the mercy of inadequate health personnel.

There is inadequate supply of health workers. Also, there is limited opportunities for career advancement and continuing education for health workers. Governments at all levels are yet to review their allocation of resources to health sector in line with internationally recommended standards. Only 1 percent of the health budget is allocated to preventive services while over 70% is allocated to curative services. Additional avenues for financing the health system such as community financing and donor/partner funds have not been fully explored and utilized. The national health insurance scheme (NHIS) which is over six years old cover less than 10 percent of Nigerians. The construction and institutionalization of a National health account is still in the works. There is insufficient evidence on the number of girls who die from female genital mutilation in Nigeria.

REFERENCES:

https://www.inigerian.com/addressing-the-public-health-challenges-nigeria-faces/

The Act of Ethical Injustice Against Biafra: The Nigerian Military Kills Unarmed Pro-Biafra Supporters

An investigation conducted by the Amnesty International confirmed that the Nigerian army gunned down civilian’s months ahead of the Pro-Biafra commemoration event which took place last month in Onitsha Anambra state.

Testimonials of eye witness, morgues and hospitals proved that in the month of May 2016, between 29-30, the Military of Nigeria opened fire on the member of the Indigenous people of Biafra (IPOB). According to M.K Ibrahim, Country Director of Amnesty International Nigeria, “a person was shot to death after the authorities burst in on them while they slept”.
The supporters of IPOB impose no threat or harm to anyone. The shooting towards them was the use of unnecessary power, and force that resulted to multiple deaths and injuries.

The number of deaths is yet to be identified, because the Nigerian army took away corpses and the Injured. However, the Amnesty International reported via various sources that the estimate number of those who were 40, and those who were injured in the cross fire were 50.

The leadership of IPOB declared that more than 50 of their members were killed. The Nigerian army stated that they acted based on self-defense, and they claimed that the actual number of IPOB members who died were 5. The amnesty international has no proof of evidence that the killings were done necessarily for the safety of the civilians because some of the dead and injured IPOB supporters were shot in the back as an indicator or evacuating the scene. Although the police authority also claimed that IPOB members killed two of their officers, the claim remains to be confirmed.
Such act of genocide would not be supported by the motion of the army’s argument which claims to be an act of self-defense.

A joint investigation was conducted by the Nigeria rmy, police and navybetween the night of 29^th May, which was intended to prevent a rally march organized by the IPOB in Nkpor motor park. The military raided homes, and churches where the IPOB members sought for shelter, right before the rally.

The following are the testimonials of the civilians:

IPOB supporters told Amnesty International that hundreds of people who had come from neighbouring states, were asleep in the St Edmunds Catholic church when soldiers stormed the compound on 29 May.

I saw one boy trying to answer a question. He immediately raised his hands, but the soldiers opened fire…He lay down, lifeless. I saw this myself

A 32-year-old hair dresser who was in the church told Amnesty International: “At about midnight we heard someone banging the door. We refused to open the door but they forced the door open and started throwing teargas. They also started shooting inside the compound. People were running to escape. I saw one guy shot in the stomach. He fell down but the teargas could not allow people to help him. I did not know what happened to the guy as I escaped and ran away.”

Another witness told Amnesty International that on the morning of 30 Mayhe saw soldiers open fire on a group of around 20 men and boys aged between 15 and 45 at the Nkpor Motor Park on the morning of 30 May. He says that five of them were killed.“I stood about two poles [approximately 100 metres] away from where the men were being shot and killed. I couldn’t quite hear what they were asking the boys, but I saw one boy trying to answer a question. He immediately raised his hands, but the soldiers opened fire…He lay down, lifeless. I saw this myself.”

The witness described how military officers loaded men with gunshot wounds into one van, and what appeared to be corpses into another.

Later that morning, another witness described how police shot a child bystander as a group of young men protested the shootings, blocking a road and burning tyres along the Eke-Nkpor junction.

He told Amnesty International: “I heard a police siren and everybody started running helter-skelter. I ran away with other people, but before we left, the police fired tear gas at us and shot a boy in my presence. He was just hawking in the street. He wasn’t even there to protest,” he said.An investigation conducted by the Amnesty International confirmed that the Nigerian army gunned down civilian’s months ahead of the Pro-Biafra commemoration event which took place last month in Onitsha Anambra state.

Testimonials of eye witness, morgues and hospitals proved that in the month of May 2016, between 29-30, the Military of Nigeria opened fire on the member of the Indigenous people of Biafra (IPOB). According to M.K Ibrahim, Country Director of Amnesty International Nigeria, “a person was shot to death after the authorities burst in on them while they slept”.
The supporters of IPOB impose no threat or harm to anyone. The shooting towards them was the use of unnecessary power, and force that resulted to multiple deaths and injuries.

REFERENCES:

https://www.amnesty.org/en/latest/news/2016/06/nigeria-killing-of-unarmed-pro-biafra-supporters-by-military-must-be-urgently-investigated/

Neuro Blastoma Cancer among Infant Babies

Chris Jr Strong,  an infant  who was diagnosed with stage  4 neuroblastoma.

Neuroblastoma is cancer that begins in the early stage of nerve cells (also known as neuroblasts) of the sympathetic nervous system, therefore, they are found anywhere along this system.  1 out 3 neuroblastomas start in the adrenal glands. About 1 out of 4 begin in sympathetic nerve ganglia in the abdomen while the rest start in sympathetic ganglia near the spine in the chest or neck or in the pelvis (The American Cancer Society , 2014). 

Neuroblastoma often begins in infancy and are diagnosed within the first month of life. It is found when the tumor begins to grow and cause signs of symptoms. Sometimes it forms before birth and is found during a fetal ultrasound.

By the time is diagnosed the cancer cells must have matured (spread). and this most often spreads usually to the lymph nodes, bones, bone marrow, and liver among infants. It also spreads to the skin (NATIONAL CANCER INSTITUTE, 2017). 

SIGNS AND SYMPTOMS:

Lump in the abdomen, neck, or chest.

Bulging eyes.

Dark circles around the eyes ("black eyes").

Bone pain.

Swollen stomach and trouble breathing (in infants).

Painless, bluish lumps under the skin (in infants).

Weakness or paralysis (loss of ability to move a body part).

PREVALENCE OF NEUROBLASTOMA:

This is a common extracranial solid tumor among children under the age of five years. It affects 1 in 7000 children. 40% of cases were diagnosed in children younger than 1 year of age. These infants have extremely favorable prognosis even in the presence of metastatic disease. The observation has contributed to screening infants with the aid of a specific catecholamine markers that are easily measured in the urine in order to identify the disease in preclinical stage, although it is unknown whether this approach can reduce mortality rate of neuroblastoma (William G. Woods, 2002). 

REFERENCES:

1.      NATIONAL CANCER INSTITUTE. (2017, OCTOBER 16). NATIONAL CANCER INSTITUTE.

2.       The American Cancer Society . (2014, March 14). What Is Neuroblastoma? Retrieved from The American Cancer Society : https://www.cancer.org/cancer/neuroblastoma/about/what-is-neuroblastoma.html#written_by

3.       William G. Woods, M. R.-N. (2002, April 04). Screening of Infants and Mortality Due to Neuroblastoma. NEW ENGLAND JOURNAL OF MEDICINE. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa012387#t=article

Exposure to Generator Fumes in Nigeria

Indoor air pollution (IAP) is an increased public health concern over the past years. This is a result of high amount of time people spend indoors (Ismail Adefeso, Jacob Sonibare, Funso Akeredolu and AdemolaRabiu, 2012). According to World Health Organization Constitution, people are entitled to the humanrights of healthy indoor environment. They defined air quality as “thermal comfort, and visual healthand comfort” (R. Kosonen, and F. Tan, 2004). Due to insufficient funds, the Nigerian government hascancelled all power projects, there reducing the supply of electricity within the country. As a result, thedemand of generators increased.

Portable electric power generator (PPG) is a gasoline or diesel-powered device which provides
temporary supply of electric power upto a certain wattage in homes (Debbie J. Jarvis, Gary Adamkiewicz,Marie-Eve Heroux, Regula Rapp, and Frank J. Kelly). This is designed for only outdoor purposes.Generator owners often place their power generator near, or in their homes due to generator theft,noise to neighbors, and the design of the home (depending if the individual is an apartment tenant or ahouse tenant) (M. R. Ashmore, and C. Dimitroulopoulou, 2009). The exposure to generator fumes is associated with the combustion design of diesel/fuel engines.
The quality of air in homes, offices, schools and other institutions, is required to be clean because 80% of people spend, or perform their daily activities indoors. The National Health and Medical Research
Council (NHMRC) defines indoor air as air within a building occupied by people within a specific period of time (Godson Rowland Ana, Oyewale Mayowa Morakinyo and Gregory Adekunle Fakunle).

The US Consumer Product Saftety Commission reported five out of 104 deaths caused by generator
carbon monoxide (CO) poisoning is associated with generator placed outside the home towards open
windows or, doors or vents (N. E. Marcy and D. S. Ascon, 1990-2004). In 2008, over 60 people suffocated
to death in Nigeria as a result of exposure to high concentration of CO.

REFERENCES:

1. Debbie J. Jarvis, Gary Adamkiewicz, Marie-Eve Heroux, Regula Rapp, and Frank J. Kelly. (n.d.).
WHO Guidelines for Indoor Air Quality: Selected Pollutants. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK138707/
2. Godson Rowland Ana, Oyewale Mayowa Morakinyo and Gregory Adekunle Fakunle. (n.d.).
Indoor Air Quality and Risk Factors Associated with Respiratory Conditions in Nigeria. World's
largest Science, Technology & Medicine. Retrieved from https://cdn.intechopen.com/pdfs-
wm/48283.pdf
3. Ismail Adefeso, Jacob Sonibare, Funso Akeredolu and Ademola Rabiu. (2012). Environmental
Impact of Portable Power Generator on Indoor Air Quality. International Conference on
Environment, Energy and Biotechnology. Retrieved from http://www.ipcbee.com/vol33/012-
ICEEB2012-B031.pdf
4. M. R. Ashmore, and C. Dimitroulopoulou. (2009). Personal exposure of children to air pollution.
Atmospheric. 43, 128-141.
5. N. E. Marcy and D. S. Ascon. (1990-2004). Memorandum: Incidents, deaths, and in-depth
investigations associated with carbon monoxide from engine-driven generators and other
engine-driven tools. United States Consumer Product Safety Commission.
6. R. Kosonen, and F. Tan. (2004). The effect of perceived indoor air quality on productivity loss.
36, 981–986.

Discrimination and Health Effects

THE SOCIO-ECONOMIC DETEREMINANTS OF ROMA HEALTH STATUS IN COMPARISON WITH NON-ROMA IN BULGARIA, HUNGARY AND ROMANIA:

The welfare of the Roma population has been an interest of case studies over the recent years. It has been estimated that 12-15million (Program, Open Society Institute Network Public Health, 2005)Roma minorities live in Europe. This has reflected decades of Roma Inclusion’ (2005-15), harmonizing with the entry of several Central and Eastern European (CEE) countries into the European Union.  The Roma minorities within the CEE countries are subjected to poor living conditions. They live in poor regions with lack or no access to education (Centre for Documentation and Research, 1994).

Historically, the Roma have been perceived and often discriminated as a source of contamination in Central and Eastern European countries (Martin McKee, 2004). This was a result of the health literacy of the Roma population which focused on infectious diseases, and genetic disorders as the main caused of Roma health differences (Steve Hajioff). Although many studies have failed to state the extent of the Roma inequalities and its association to health (Jeremiah A. Barondess, 1998), multiple data have indicated that the Roma population are limited to health literacy and access to medical care. Among most of the population in Central, and Eastern Europe, it is estimated that the Roma has 10 years of life expectancy (Braham M, 1993). It was concluded by a rare study which was conducted in 1989, that in Czechoslovakia, the Roma men and women have a life span of 12.1 and 14.4 years lower than the country’s entire population (Ferák V, 1987).

Recent studies have proven that there is an increased rate of chronic diseases and related risk factors compared to most population among the Roma minorities. High levels of insulin, hypertension and obesity were found among the Roma’s than the majority population in Slovakia. Due to the lifestyle and low level of education among the young Roma population, there is a higher prevalence rate of cardiovascular diseases risk factors and metabolic syndrome (Krajcovicova-Kudlackova M, 2004).

Studies have shown a decrease in Vitamin C, and other antioxidant vitamins and higher levels of inadequate nutrition, and smoking among the Roma minority groups in Czech (Jan Dejmek, 2013) and Slovakia republics (Philipa Mladovsky, 2007). The prevalence of underweight among the Roma population was high than that of the entire population in Croatia (Domagoj Šegregur, 2017). The sanitary conditions pose to be a policy objective and initiatives to improve sanitation of the Roma society. Policies on Roma health should be multi-sectoral, considering the economic, social and cultural crisis. The main determinants of inequalities in health status among the Roma population in Bulgari, Romania and Hungary were education and wealth. The study indicated that the Roma population experienced specific health inequalities after determining for education, expenditure and wealth.

The Romanian society has one of the worst cases of social stigma in Europe. This resulted from the reluctance and refusal of important public personalities of Romani origin to declare their membership or links to Romania’s Romani minority (Valeriu Nicolae and Hannah Slavik, 2003). Even though the Roma population has the biggest minority groups in Europe, they face extreme negligence and racism. Discrimination among the Roma population started from the 16^th century of nationalism, which rendered them one of the most socially and financially excluded groups in Europe (Wilkin A, Derrington C, Foster B, 2009).

The significance of identifying the health inequalities among Roma and Non-Roma communities is reflected by a huge difference in their hygienic lifestyle (Hajioff S, 2000). According to WHO, sanitation is the provision of facilities and services for the safe removal of human faeces (WHO, 2010). Different backgrounds in cultures play a significant role in health inequalities. For example; since the Roma population are situated in poorer regions, with low access to medical care, the non-Roma are more likely to perform a chronic illness diagnosis just simply because they have access to medical care than the Roma. 

THE STRUCTURE OF ETHNIC INEQUALITIES IN HEALTH: ECONOMIC POSITION, RACIAL DISCRIMINATION, AND RACISM:

According to a US study, the nature of racial prejudice changes over time in such a way that experience of discrimination maybe hard to recognize. Davidio and Gaertner defined “aversive racism”, as people characterized by “endorse egalitarian values, who consider themselves as non-prejudiced, yet discriminate in a rationalized way. Thus, making it hard to measure the health effects (Dovidio JF, Gaertner S, 2000).

The Forth National Survey of Ethnic Minorities discovered an association between racial discrimination experience, perceptions of racial harassment, and different health risks across ethnic groups (Cooper RS, 1993). The study shows that racial discrimination experience against minority groups were independently linked to the likelihood of reporting fair or poor health, and the socioeconomic effects on occupational class which includes; economic disadvantage, the feeling of low self-esteem or devalued, minor status group, and personal insult and stress of being a victim of racism (Kaufman JS, 1998).

Although, data have shown that socioeconomic inequalities cannot explain the ethnic inequalities in health, it has proven that it contributes to health inequalities among different ethnic groups across different countries. Forth National Survey of Ethnic Minorities have illustrated that ethnic differences differed from each ethnic group. Example, the minority people had a smaller income compared to the whites (James Y. Nazroo and Saffron Karlsen, 1997).  Similar study in the US, according to Oliver and Shapiro, white people have more income than black peoples and, the black are most likely to remain in that situation among those below the poverty line (James SA, 1987). Black people are unlikely to own houses due to their low level of wealth (Melvin L, 1997).

Studies conducted in the US have indicated the relationship between self-reported experiences of racial discrimination and different health outcomes such as, hypertension, psychological distress, poorer self-rated health, and days spent ill in bed (Krieger N, 1990).

According to the National Survey of Ethnic Minorities in the UK, ethnic inequalities increase with age, with slight differences in younger age, and huge differences surfacing from mid-30s and above (Nazroo J, 2001). Increase in health inequalities among ethnic minorities at a certain age reflects on the range of health risks over the life span, and long-term outcomes of exposure to health hazards at an early age.

 

REFERENCES:

1.      Braham M. (1993). A Survey of the Roma People of Central and Eastern Europe: A Report to the Office of the United Nations High Commissioner for Refugees; Office of the United Nations High Commissioner for Refugees (UNHCR): Geneva, Switzerland. Retrieved from http://www.oalib.com/references/9318027

2.       Centre for Documentation and Research. (1994, NOVEMBER 1). UNHCR CDR Background Paper on Refugees and Asylum Seekers from Romania. REFWORLD. Retrieved from http://www.refworld.org/docid/3ae6a6414.html

3.       Cooper RS. (1993, MARCH 03). Health and the social status of blacks in the United States. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8269065

4.       Domagoj Šegregur, a. J. (2017, MARCH). Antenatal characteristics of Roma female population in Virovitica-Podravina County, Croatia. 56(1). Retrieved from https://www.degruyter.com/view/j/sjph.2017.56.issue-1/sjph-2017-0007/sjph-2017-0007.xml

5.       Dovidio JF, Gaertner S. (2000, JULY 11). Aversive racism and selection decisions: 1989 and 1999. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11273391

6.       Ferák V, S. D. (1987, FEB 08). The Slovak gypsies (Romany)--a population with the highest coefficient of inbreeding in Europe. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3580917?access_num=3580917&link_type=MED&dopt=Abstract

7.       Hajioff S, M. M. (2000, November). The health of the Roma people: a review of the published literature. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11027202

8.       James SA, S. D. (1987, OCTOBER 12). Socioeconomic status, John Henryism, and hypertension in blacks and whites. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3631056

9.       James Y. Nazroo and Saffron Karlsen. (1997). Ethnic inequalities in health: social class, racism and identity. RESERACH FINDINGS. Retrieved from http://www.lancaster.ac.uk/fass/projects/hvp/pdf/fd10.pdf

10.   Jan Dejmek, E. G. (2013, March 14). Vitamin C, E and A Levels in Maternal and Fetal Blood for Czech and Gypsy Ethnic Groups in the Czech Republic. International Journal for Vitamin and Nutrition Research. Retrieved from http://econtent.hogrefe.com/doi/abs/10.1024/0300-9831.72.3.183

11.   Jeremiah A. Barondess. (1998, December 1). Care of the Medical Ethos: Reflections on Social Darwinism, Racial Hygiene, and the Holocaust. Retrieved from http://annals.org/aim/article/712357/care-medical-ethos-reflections-social-darwinism-racial-hygiene-holocaust

12.   Kaufman JS, L. A. (1998, MARCH 08). The relation between income and mortality in U.S. blacks and whites. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9504282

13.   Krajcovicova-Kudlackova M, B. P. (2004). Cardiovascular Risk Factors amon Young Gypsy Population. 256-259. Retrieved from http://bmj.fmed.uniba.sk/2004/10578-03.pdf

14.   Krieger N. (1990). Racial and gender discrimination: risk factors for high blood pressure? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2367873

15.   Martin McKee, E. N. (2004). HEALTH POLICY AND EUROPEAN UNION ENLARGEMENT. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0004/98392/E82999.pdf

16.   Melvin L, O. a. (1997). BLACK WEALTH/WHITE WEALTH. Retrieved from http://ross.mayfirst.org/files/oliver-shapiro-black-white-wealth.pdf

17.   Nazroo J. (2001). Ethnicity, Class and Health. POLICY STUDIES INSTITUTE. Retrieved from http://www.psi.org.uk/site/publication_detail/1276/

18.   Philipa Mladovsky, P. (2007, JUNE). To what extent are Roma disadvantaged in terms of health and access to health care? What policies have been introduced to foster health and social inclusion? THE LONDON SCHOOL OF ECONOMICS AND POLITICAL SCIENCE. Retrieved from http://academos.ro/sites/default/files/biblio-docs/241/135.mladrom.pdf

19.   Program, Open Society Institute Network Public Health. (2005, DECEMBER). Mediating Romani Health: Policy and Program Opportunities. Open Society Institute Network Public Health Program. Retrieved from https://www.opensocietyfoundations.org/sites/default/files/roma_health_mediators.pdf

20.   Steve Hajioff, M. M. (n.d.). The health of the Roma people: a review of the published literature. BMJ JOURNALS . Retrieved from http://jech.bmj.com/content/54/11/864

21.   WHO. (2010, JULY 16). SANITATION. Retrieved from http://www.who.int/topics/sanitation/en/