Country Introduction 　

      Nigeria is the most populous country in Africa and is one-third larger than Texas. It is in West Africa on the Gulf of Guinea. The Niger River flows into the gulf on the west side of the country. Terrain includes: plains in the north, mountains in the southeast, lowlands, rainforests in the south, hills and plateaus centrally. Lagos is the largest city. Abuja is the capital city. The government has been transitioning to civilian rule from military since 1999. President elected in 2007 is Goodluck Jonathan. Major industries include crude oil (12th largest producer worldwide), coal, tin, palm oil, peanuts, rubber. Agriculture includes cocoa, peanuts, palm oil, corn. Islam religion is practiced by about 50% of the population, Christianity is about 40%. Official language is English, however other cultures in the country have their own dialect. More than 250 ethnic groups here. HealthCare System 　In principle, the Nigerian system of health care is a decentralized, three-tiered system that includes: the federal government, the state government, and the local government. All three tiers have involvement in all of the major healthcare functions of the government including: financing, stewardship, and the distribution of services. At the federal level, the Federal Ministry of Health is responsible for policy writing for the entire healthcare system of the country and information distribution/collection. At the state level, the State Ministry of Health is responsible for secondary level hospitals and the regulation of primary health care services. The local governments are ultimately responsible for the primary care services distributed throughout the country and organized through districts or wards. Wards can have population sizes ranging anywhere between 150,000 – 2,000,000 people serviced ("The Nigerian Health System", 2012). One major flaw with the Nigeria system of health care organization is a duplication of services and a confusion of roles between the different levels of government; bringing about coordination weaknesses and a difficulty in benchmarking/performance tracking. There is one further "unofficial" tier: the community level. At the community level, there is further distribution/implementation of primary health care services and education. Committees are established at this level to implement changes and educate the local population. One major problem with these committees is not the forming of these committees, but the function of the committees to serve Nigerians in meaningful ways ("The Nigerian Health System", 2012).

 

Expenditure per Capita  　 

• Gross national income per capita (PPP international $, 2013) was 5,360 in Nigeria ("Nigeria", 2015). 
• Nigerian total expenditure on health per capita (Intl $, 2012) was 161 according to http://www.who.int/countries/nga/en/ ("Nigeria", 2015). 
• The total expenditure on health as a percentage of the gross domestic product in 2012 was 6.1 ("Nigeria", 2015). 
• PPP International $ = Purchasing parity rates to international dollars ("GDP, PPP (current international $)", 2015). 
• International dollars = Have the same purchasing power over GDP as the U.S. dollar has in the United States ("GDP, PPP (current international $)", 2015).

 

Top 3 Non-communicable Diseases

1.Cardiovascular Disease (including stroke, peripheral vascular disease, hypertension)

2.Cancers (especially cervical, breast, prostate, skin, gastric)

3.Diabetes Mellitus (Type 2)

Top 3 Communicable Diseases

1.HIV/AIDS

2.Malaria

3.Tuberculosis

 

WHO Ranking

 The last WHO world health system report was published in the year 2000. It used five independent variables called “attainment goals” to yardstick a country’s healthcare system. The five attainment goals were as follows: Disability-adjusted life expectancy (DALE) which measures the equivalent number of years of life expected to be lived in full health and its distribution, level of health care responsiveness and distribution, fairness in financial contribution, overall goal attainment and health expenditure per capita in international dollars. When all variables were tabulated Nigeria was ranked by the WHO as 187 out of 191 followed by the Democratic Republic of the Congo, Central African Republic, Myanmar, and Sierra Leone respectfully.

The WHO no longer publishes this consolidated “world health system report”. Instead the WHO currently publishes a World Health Statistics manual annually and uses “health-related Millennium Development Goals (MDGs) and associated targets” instead of attainment goals. Additionally, it should be noted that much has not changed in Nigeria’s WHO ranked status in these newer evaluation guidelines, as Nigeria has been consistently ranking in the lower 10 % of all current global MDG categories and associated health targets. Thus making their progress unremarkable to date.

 

 Life Expectancy Years (LEY) & Probability of Mortality (POM)

LEY at birth m/f (2012) = 53/55

POM between the ages 15 to 60 y m/f (per 1000 pop., 2012) = 371/346

A protuberant factor effecting both the LEY and POM statistics is the prevalence of edictally unresolved lower respiratory infections. This is evidenced by a recent WHO report that found “Lower respiratory infections were the leading cause of death, killing 290.2 thousand and accounted for 13.9% of all reported deaths in 2012.” A close second factor effecting overall life expectancy rates within the Nigerian population was found to be death by HIV/AIDS claiming 217.4 thousand people in 2012, with the majority of those inside the POM range.

 

Unique Health Practices

 Positive Health Promoting Activities

In Igbo society mothers breastfed their children for extended periods of time. Breast feeding promotes immunity through colostrum and antibodies. Breast milk is the best food a child can receive in the first 6 months to a year of life. During the postpartum period, called Omugwo, women are assisted by their own mother, elder sister, or grandmother for a period of 28 days and they assume responsibility of the household. During the Omugwo, it is believed that mothers need to follow a special diet in order to restore energy, promote milk flow and healing of wounds. The grandmother has a central role in this period, which entails sponge bathing the new mother and the baby, and she teaches housekeeping lessons (e.g. childcare, conflict management, knitting, sewing).

The Igbos commonly practice sexual abstinence during lactation due to the belief that a woman is not fully pure during this period; this practice contributes to child-spacing and family planning.

    Wrestling is promoted when it is not farming season amongst the Igbos, the Binis, the Ijaws and several other ethnic groups in the southern Nigeria. It is believed that wrestling promotes physical activity and health.

In most Nigerian cultures, environmental sanitation is practiced with both men and women performing early morning sweeping of the house and compound.

 

Harmful Cultural Practices

In western Nigeria, it is common to use cow-dung to clean the umbilical cord. This can lead to infection and disease. Also, in rural Nigerian cultural, children are usually not given eggs for fear of becoming a thief. Eggs are a good source of amino acids and proteins. Also some Nigerian groups believe in restricting snail meat for pregnant women for fear of having a drooling child, this is detrimental to maternal and fetal development when snail meat is the major protein source in the diet..

Female and male circumcision is practiced not only in Nigerian but also in at least 26 countries of Africa. These practices are not performed by medical professionals and lead to infections, deaths, and disfigurement. Moreover, female circumcision robs Nigerian women of the pleasure of sexual experiences by removing the clitoris.

Scarification and tribal marks are practiced commonly all over Nigeria but especially in the southwest and Northern Nigeria; these practices lead to infection and spread of communicable diseases such as HIV.

Many teenagers and young adults lack sexual health education and information as sex is traditionally seen as a private subject. The discussion of sex with teenagers, especially girls, is seen as indecent, unhealthy and unacceptable. Harmful marriage practices also contribute immensely to the increasing HIV rates especially among women. Early marriage is practiced in much of the country. Some families see it as a way of protecting their girls and maintaining their chastity, however, young married girls cannot negotiate condom use to protect themselves against HIV and other STIs.

In the majority of Nigerian society, it is acceptable for men to have concubines outside marriage especially when wives are pregnant or have just had birth, this further contributes to the rates of HIV and STIs.

In Nigeria, many houses are built with thatch and mud with openings that mosquitoes easily enter through. It is a common practice to store water in pots and other containers after rainfall and this encourages mosquito breeding around houses and the spread of Malaria.

In Ondon, located in the Western part of the country, the villagers believe that diarrhea is associated with the appearance of the anterior fontanelle and teething. Many believe that every child has to experience one or two episodes of diarrhea as a sign of survival and it is unnecessary for one to seek medical care when a child is having diarrhea, thus contributing to child morbidity and mortality.

Traditional Birth Attendants (TBA) oversee between 60-85 per cent of births delivered in the country and especially in the rural communities. TBAs are usually experienced women in pregnancy and birth that take much of their knowledge from traditional or cultural practices. Complicated pregnancy and emergency cessarens are often overlooked or not attended to by a medical professional and therefore increase the rates of both infant and mother mortality.

 

References:

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