Honest leadership and transparency in Government is desirable, so that scarce resources can be evenly and meaningfully distributed. This is fundamental if we are to make meaningful progress. Governments at all levels must avoid misplacing priorities and invest wisely. Many projects and programmes are not designed to solve the problem of unemployment. Immunisation: The key to the reduction of childhood morbidity and mortality is to strengthen immunisation coverage. Marginalisation of key professionals in the implementation of the Current NPI must be stopped forthwith. Immunisation is serious business and not the duties of First Ladies. The current circus show must end. The Paediatrics Association of Nigeria (PAN) should be allowed to play an active role in policy formulation and execution. The recommendation of PAN with regard to the content and schedule of immunisation should be adopted.
The procurement and distribution and distribution of vaccines must be decentralised to guarantee availability. Local production must be encouraged. Recently, a new strain of measles virus was isolated in at least two different parts of Nigeria. This will explain the current epidemic as well as the severity of the illness. A significant number of previously immunised children were affected in the last epidemic. While a break in the cold chain may be blamed partly for the latter observation, it is quite likely that the measles vaccine currently in use does not confer adequate protection against these new strains of the virus because of antigenic differences. Further research is therefore necessary to monitor the strains prevalent in this environment. This should be done for all the vaccine-preventable diseases. Institutions of learning should be involved in the implementation of the NPI. For instance, it may be desirable for parents to produce a certificate of immunisation as evidence of satisfactory completion of immunisation at school entry. Such Certificates should however not be used to prevent unimmunised children from attending schools. Rather, it will provide an opportunity for those who have either missed or have not had the opportunity of being vaccinated to receive them. We must look inward and develop appropriate technology and devise local solutions to our problems where feasible.
As a response to the antimalaria drug resistance situation, the WHO recommends that treatment policies for falciparum malaria in all countries experiencing resistance to monotherapies should be combination therapies, preferably those containing an artemisinin derivative (artemisinin based combination therapy or ACT). Many countries in Africa which originally requested funding for Chloroquine have already re-evaluated their drug polices towards the use of ACT's. Examples are Senegal, Ghana, Mali, Chad, Kenya and the Gambia. Nigeria should follow suit today. In addition to prompt recognition and treatment of clinical cases, preventive measures need to be intensified. In this regard, local production of insecticide-treated nets need to be encouraged to significantly bring down the price. Intermittent presumptive treatment of pregnant mothers with SP needs to be intensified.
Over five million people are newly infected with HIV worldwide annually. Painstakingly accrued gains in human development have been rapidly eliminated in the hardest hit countries. When a mother becomes debilitated by AIDS, her children are more likely to miss immunisations against childhood diseases, eat fewer and less nutritious meals and be taken out of school, especially if they are girls, to assume domestic responsibilities. Controlling the spread of HIV will ensure that more girls stay in school. In the absence of a vaccine, EDUCATION is society's best defence against HIV/AIDS. Better educated people have lower rates of infection. Educated young people are more likely to protect themselves and those who are in school spend less time in risky situations.
Nigeria has the largest number of sufferers of Sickle Cell Anaemia in the world. The frequency of the S gene in Nigeria is 25 per cent that is, one out of every four Nigerians carries the S gene. The disease affects 2 per cent of all newborn babies. Similarly, one out of every four Nigerian males suffers from another genetic disorder known as Glucose-6-phosphate dehydrogenase deficiency. None of these disorders is currently routinely screened for. Rather, we wait for the patients to present to us when they are in crisis. Routine neonatal screening as is currently practiced in countries with lower incidence of these diseases will ensure early diagnosis and better chances of survival. Treatment should be provided free of charge for children with sickle cell disease and all other forms of chronic illness, to reduce the financial burden on their parents.
Specialised Paediatric Hospitals should be established in at least each of the six geopolitical zones. A shift in political will toward improving paediatric, especially neonatal services is fundamental. The present set-up has led to the marginalisation of children. At present it is difficult to carry out certain investigative and therapeutic procedures in paediatrics due to lack of appropriate components of available equipment. This is due to the fact that children are usually not considered when ordering these equipment.
The government should provide at least one balanced meal per day for every pupil in our public primary schools. After all, our prisoners are fed free three times a day seven days a week. This will reduce the incidence of stunting among our youths. Making education free and compulsory is the keystone of any national plan to eliminate gender disparity in education and achieve Universal education. Faced with an economically driven choice between sending sons or daughters to school, poor families often send their sons. Removing fees or offering financial support to families with daughters in school, as well as explaining the advantages of sending girls to school, can make a real difference.
The government should consider the imposition of sanctions on 'anti-school' parents. We can take a cue from a local council in Britain where the recent imposition of a 100 pound fine has led to a significant reduction in truancy. Budgetary allocation to education must be significantly increased. The sum of 94 billion Naira set aside for education in the 2004 budget, which represents 5.6 per cent of the total budget still falls far short of the 26 per cent recommended by UNESCO.
Education systems and programmes must (1) be efficiently managed and equitably financed. (2) assure that all students graduate with the essential skills, knowledge and values to succeed. (3) assure gender equity in access and quality. We should take urgent steps to prevent and halt inter-ethnic clashes in various parts of the country, particularly in the Niger Delta and the middle belt regions. According to the Human Rights Watch, 'all wars are wars against children'.
Provision of regular water and power supply will prevent the situation where life-saving equipment lie idle simply because of lack of electricity or water. It is not unusual for premature babies in the neonatal units to be hypothermic in the midst of idle incubators. This situation is unacceptable. Finally, private sector involvement through NGO and foundations to fund specific projects, similar to the Rockefeller foundation, will go a long way in complementing efforts of the Government.
Concluded
Olanrewaju is a Professor of Paediatrics at Olabisi Onabanjo University, Ago Iwoye, Ogun State.
