Archives for July2015


WORLD HEPATITIS DAY – ACTING NOW TO PREVENT LIVER CANCER

WELCOME TO CECP-NIGERIA'S BLOG

WELCOME TO CECP-NIGERIA’S BLOG

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Every year, July 28 is marked as World Hepatitis Day (WHD). It is a day dedicated to increase the global awareness and understanding of viral hepatitis and the diseases that it causes. The theme of this year’s WHD is “Prevent Hepatitis. Act Now”.

world hepatitis day poster

Viral hepatitis is inflammation of the liver caused by a group of virus known as hepatitis A, B, C, D, and E. The liver is the largest internal organ. It is shaped like a pyramid and lies under the right ribs just beneath the right lung. The liver is an indispensible organ. It has several important functions including: break down and storage of many of the nutrients absorbed from the intestine; production of most of the clotting factors that prevent excessive bleeding from cuts or injuries; release of bile into the intestines to help absorb nutrients (especially fats) as well as removal of harmful substances from the blood.

liver

Annually, viral hepatitis affects 400 million people worldwide, causing acute and chronic liver disease and killing 1.4 million people (4,000 people daily), mostly from hepatitis B and C (HBV & HCV). Yet, it is entirely preventable. With better awareness and application of its preventive measures, this life-threatening disease could be eliminated and 4,000 lives could be saved daily, underscoring the importance of the theme of WHD 2015.

Viral hepatitis is one of the most communicable diseases in the world. It is spread through contaminated blood, intravenous drug abuse and sexual contact with an infected person. In highly endemic areas like sub-Saharan Africa and Asia, hepatitis B is most commonly spread from mother to child at birth (perinatal transmission). In addition, infection can occur during medical, surgical and dental procedures, tattooing, or through the use of razors and similar objects that are contaminated with infected blood.

Infection with HBV or HCV is the main cause of liver cancer; viral Hepatitis causes 80% of liver cancer deaths. This fact makes hepatitis a target disease of the Big War Against Cancer in Nigeria, the current focal cause of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria). The first phase of the Big War is aimed at “Taking holistic health care to the Grassroots” by raising funds to acquire and deploy 37 Mobile Cancer Centres (MCC), one for each state and Abuja.

 WHD poster-1

Over 83% of cases of liver cancer occur in developing countries. In Nigeria, liver cancer is the second leading cause of cancer death, accounting for over 11,000 deaths yearly and 32 deaths every day. Liver cancer is rare in children and teenagers. The average age of occurrence in Nigeria is about 46 years compared to the developed world where the average age of occurrence is in the mid 60s. Liver cancer is more common in men with a male : female ratio of about 2 in 1.A recent well- known male Nigerian casualty is Senator Khalifa Zanna, a recently re-elected Senator of Borno State, who died at the age of 60 on May 16, 2015. On that same day, 31 other Nigerians also died of liver cancer, unknown and unsung, but not unloved. Liver cancer is also the second leading cause of cancer deaths worldwide, accounting for more than 700,000 deaths each year.

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The leading cause of liver cancer is cirrhosis (damage of liver cells and replacement with scar tissue) due to either HBV, HCV, or chronic alcoholism. In 2013, 300,000 deaths from liver cancer were due to hepatitis B, 343,000 to hepatitis C and 92,000 to alcohol.

Aflatoxin exposure is another important cause of liver cancer especially in developing countries in Africa, South-East Asia and China. The aflatoxins are a group of chemicals produced by a fungus Aspergillus. Ingestion of food contaminated by the fungus is very toxic to the liver. Common foodstuffs contaminated with the toxins are tree nut (almonds, cashews, and walnuts), peanut, rice, dried fruits and cereals and other vegetables. Concurrent HBV infection and aflatoxin exposure increases the risk of liver cancer to over three times that seen in HBV infected individuals without aflatoxin exposure. Other risk factors include: obesity, diabetes, and smoking.

AFLATOXIN- ASPEGILLUS   aflatoxin-CORN  AFLATOXIN- GROUNDNUT

Signs and symptoms of liver cancer often do not show up until the later stages of the disease. Some of the most common symptoms of liver cancer are: weight loss (without trying), loss of appetite, feeling very full after a small meal, nausea or vomiting,        liver and spleen enlargement, belly pain or pain near the right shoulder blade, swelling or fluid build-up in the belly, itching, yellowing of the skin and eyes (jaundice).  Other symptoms can include fever, enlarged veins on the belly that can be seen through the skin, and abnormal bruising or bleeding. For people who have chronic hepatitis or cirrhosis, worsening of their usual symptoms or just changes in laboratory test results may indicate progression to cancer.

The survival rate from liver cancer is generally poor because liver cancer progresses rapidly, and treatment options are limited. Thus, prevention is the key to reducing liver cancer deaths.

One of the most successful ways of preventing liver cancer is vaccination against hepatitis B. This vaccine has been available since 1982 and the first dose is now being given at birth. The vaccine is safe and effective, protecting from HBV infection for life and the development of chronic disease and liver cancer due to HBV. Vaccination for HCV is currently unavailable. However, antiviral medicines can cure HCV infection. Other ways of preventing hepatitis include limiting transmission of these viruses by avoiding sharing of needles and other items such as toothbrushes, razors or nail scissors. Avoid getting tattoos or body piercings from unlicensed facilities and screening of blood donation products. Furthermore, safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission. Reducing alcohol abuse, obesity, and diabetes would also reduce rates of liver cancer.

Aflatoxin exposure can be avoided by post-harvest intervention to discourage mold. These include storing food in dry places, refrigeration of food, avoiding contact between foods and insects, throwing away any moldy, discoloured or shriveled food. Roasting, baking, frying, X-radiation, and pressure cooking also help to reduce aflatoxin levels in food. Aflatoxin prone foods should not be stored for months unless frozen.

Screening and early diagnosis can prevent health problems that may result from viral hepatitis infection and prevent transmission of the virus. Treatment with drugs, including oral antiviral agents can decrease the risk of liver cancer.

To significantly reduce the current hepatitis and liver cancer epidemic, there is need for massive awareness and widespread availability of these interventions. In Nigeria, the Mobile Cancer Centre (MCC) being championed by the CECP-Nigeria would be an excellent means of facilitating health education, screening as well as vaccination against hepatitis at the grassroots.

mobile cancer centre

An MCC is much more than a Mobile Mammogram. Rather, it is a clinic on wheels, in which cancer screening, follow-up and treatment (including surgeries), can take place. It also contains facilities for screening against most common diseases, including the Ten Major Cancer-related killer diseases (Diabetes, Renal Disease, Obesity, Malaria, Schistosomiasis, Helicobacter pylori, Hepatitis, HIV/AIDS, Human Papillomavirus (HPV) and Hypertension).

The MCC is perhaps one of the most important means of raising the life expectancy of Nigeria which is currently the 12th lowest globally. Cancer and these ten disease conditions are the main culprits responsible for this low life expectancy. A single MCC in a state of Nigeria could make a huge positive difference. That state would be divided into smaller units such that every community would be reached by the Mobile Cancer Centre at least once a year.

In line with the theme of this year’s World Hepatitis Day, the CECP- Nigeria hereby invites all Nigerians to ACT! (Attack Cancer Together! Attack Cancer Today!! Attack Cancer Totally!!!). This could be done through advocacy and by donating towards the acquisition and deployment of the MCC. Be a voice for the 1,800 lives that will be lost to hepatitis – related liver cancer on WHD this year and every other day!

 

“By moving forward together we have the potential to show Cancer: It is not beyond us.”- UICC 2015

 

BANQUET OF STARS AGAINST CANCER (BOSAC) 2015

 

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BOSAC- DEPUTY GOV AND DR KOLADE

 

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CANCER SURVIVORS AT BOSAC 2015

 

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BOSAC- PRESENTATION TO DEPUTY GOV BY CONVENER

 

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AYO AT BOSAC 2015

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BLADDER CANCER IN NIGERIA: WHY SNAILS MATTER

WELCOME TO CECP-NIGERIA'S BLOG

WELCOME TO CECP-NIGERIA’S BLOG

bladder cancer awareness

July is Bladder Cancer Awareness Month. The bladder is a balloon-shaped organ in the lower belly that stores urine.

bladder

Bladder cancer is the second most common urogenital cancer after prostate cancer. Globally, there were about 430,000 new cases of bladder cancer and about 165,000 deaths from bladder cancer in 2012. In Nigeria, there are about 1000 new cases of bladder cancer and over 600 deaths annually. This implies that Bladder cancer kills 2 Nigerians every day. This number excludes so many victims who die of the ailment undiagnosed, due to poor diagnostic facilities especially in rural areas where it is prevalent.  A recent well-known casualty was Rt. Hon Samuel Ajayi Adesina, Speaker, Ondo State House of Assembly who died in February, 2014, at the age of 56.

Unlike the western world where tobacco smoking is the main contributor to bladder cancer, the major risk factor in Nigeria is infection with a parasitic flatworm called Schistosoma hematobium. This infection is known as schistosomiasis (bilharziasis) or “snail fever”. The infection usually occurs in childhood. Prevalence and intensity of infection increase with age, peaking in the 5 to 14 year age group. If untreated it could result in bladder cancer in adulthood with a peak age incidence in the late 40s and 50s. The majority of bladder cancer cases occur in farmers and fishermen living in regions along the river.

This relationship between schistosomiasis and bladder cancer explains why schistosomiasis is one of the targeted diseases of the Big War Against Cancer in Nigeria, the flagship focal cause of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria). The first phase of the Big War is aimed at “Taking holistic health care to the Grassroots” by raising funds to acquire and deploy 37 Mobile Cancer Centres (MCC), one for each state and Abuja.

Schistosomiasis ranks second only to malaria as the most common parasitic disease. However, it is the most deadly Neglected Tropical Disease (NTD) – the so-called forgotten diseases of forgotten people – killing an estimated 280,000 people globally, each year. About 700 million people are at risk of schistosomiasis in 78 countries, with almost 240 million people infected worldwide. The infection is prevalent in tropical and sub-tropical areas, in poor communities without potable water and adequate sanitation, with 90% of the burden occurring in Africa. Sadly, Nigeria is thought to have the greatest number of people infected with schistosomiasis in the world, with approximately 20 million sufferers — mostly children.  Delta, Edo, Plateau and Nasarawa states have the highest incidence. The effect of schistosomiasis is especially devastating, for communities already burdened by poverty and ravaged by scourges such as malaria and tuberculosis. It weakens the body’s resistance to other infections and prevents children from reaching their full potential.

 snail- swimming  swimming

Schistosomiasis is transmitted by contact with contaminated fresh water (lakes and ponds, rivers, dams) inhabited by snails carrying the Schistosoma parasite. Swimming, bathing, fishing and domestic chores such as laundry can put people at risk of contracting the disease. Hygiene and play habits make children especially vulnerable to infection. Larvae emerge from the snails and swim in the water until they come into contact with and penetrate human skin. Once inside the body, the larvae develop into worms which live together in the blood vessels for years. Female worms release thousands of eggs which are passed out of the body in the urine and feces. If people urinate or defecate in bodies of freshwater, the eggs migrate to snails where they eventually hatch and begin the cycle again.

snail- life cycle

Some Schistosoma eggs, however, remain trapped in the body and migrate to specific organs where they can inflict major damage. Urinary schistosomiasis causes scarring of the bladder and kidneys, and can lead to bladder cancer.

For the avoidance of doubt, it is important to stress that neither snail farming nor snail consumption puts a person or community at risk of schistosomiasis or bladder cancer.

Symptoms of urinary schistosomiasis include: initial itching and rash at infection site (“swimmer’s itch”), frequent, painful or bloody urine and Lymph node enlargement. Ironically, the incidence of schistosomiasis is so high in some communities in Nigeria that youths regard the bloody urine passed at some stage of the disease as a sign of attainment of maturity, a rite of passage from adolescence to adulthood. Therefore, they do not seek medical advice or treatment.  Symptoms of bladder cancer are similar to that of schistosomiasis. The most common symptom of bladder cancer is blood in the urine; which can be sudden in onset and may be intermittent.

bloody urine

 The mainstay of schistosomiasis control is treatment with a single dose of a tablet known as Praziquantel. Other control measures include improved sanitation, health education and control of freshwater snails.

Early and regular administration of Praziquantel reduces the occurrence, extent, severity, and long-term consequences of the disease. Schistosomiasis outbreaks can be identified by mapping the rates of blood in the urine of school-age children.  If the rates are high, the drug is distributed to the entire community at risk. Annual dosing of Praziquantel is recommended for areas at high risk for re-infection, and to help reduce the severity of symptoms in chronic sufferers. The goal should be to achieve a minimum target of regular administration of Praziquantel to at least 75% of all school-age children and at risk special groups.

indexpraziquantel

 Merck (the manufacturer of Praziquantel) has committed to donate 250 million tablets of praziquantel annually, at a cost of US$ 23 million per year. So far, over 100 million tablets have been donated, and over 28 million children have been treated.

The major control effort in Nigeria has been through the Carter Centre, an American-based organization, which has been working in Delta, Nasarawa, Edo, and Plateau state since 1999. The current coverage of the schistosomiasis control programme in Nigeria is less than 6% in spite of the fact that the drug has been donated free of charge by Merck. According to data released by WHO, Nigeria has one of the worst coverage in the world and compares unfavourably with better coverage in countries like Burkina Faso (96.4%), Togo (94.80%), among others.

Praziquantel distribution

 Little wonder then, a study in Nigeria, showed nearly 5 fold increase in the number of bladder cancer cases between 1999 and 2004. On the other hand, the use of this drug, as well as lower infection rates due to urbanization, is thought to have led to a substantial decrease in incidence of schistosoma-associated bladder cancer in Egypt over the past few decades.

According to data from the National Cancer Institute (NCI) of Egypt, with the control of schistosomiasis in Egypt, the frequency of bladder cancer dropped over a period of 10–15 years. In late 1980s and early 1990s, bladder cancer accounted for about 27% of all cancers seen at the NCI. In more recent years, the data of the population based National Cancer registry in Egypt, showed a frequency rate range of less than 10%. Clearly, changes in the incidence of schistosomiasis reflect on the changing incidence of bladder cancer.

In Nigeria, the Mobile Cancer Centre (MCC) being championed by the CECP-Nigeria  would be an excellent means of taking health education, screening as well as the Praziquantel  therapy to the grassroots thereby, improving the coverage of praziquantel in Nigeria, and reducing the devastating effect of schistosomiasis especially bladder cancer.

An MCC is much more than a Mobile Mammogram. Rather, it is a clinic on wheels, in which screening, follow-up and treatment (including surgeries), can take place. It includes facilities for mammography, sonology, colonoscopy, colposcopy and cryotherapy, as well as a surgical theatre. It is also equipped with a laboratory for screening against most common diseases, including the Ten Major Cancer-related killer diseases (Diabetes, Renal Disease, Obesity, Malaria, Schistosomiasis, Helicobacter pylori, Hepatitis, HIV/AIDS, Human Papillomavirus (HPV) and Hypertension).  Thus the MCC would tackle the double burden of disease, i.e. Communicable & Non-Communicable.

mobile cancer centre

The MCC is perhaps the single most important means of raising the life expectancy of Nigeria which is currently the 12th lowest globally. Cancer and these ten disease conditions are the main culprits responsible for this low life expectancy. A single MCC in a state of Nigeria could make a huge positive difference. That state would be divided into smaller units such that every community would be reached by the Mobile Cancer Centre at least once a year.

The cost of one MCC is $600,000 only (about N 120,000,000 at the current exchange rate) and ots operational cast for one year (including cost of personnel, supplies and maintenance( is USD 685,000).

To actualize its vision, the CECP -Nigeria is involved in a fund-raising campaign, known as the #GivingTide. A highpoint of the #GivingTide is the National Cancer Week (NCW). At the just concluded Banquet Of Stars Against Cancer, the climax of the NCW 2015) the Lagos State Governor, H.E. Mr. Akinwunmi Ambode, FCA, dedicated his birthday to the Big War Against Cancer, thus setting the tone for the CECP -Nigeria MoreLife initiative.

morelife logo

MoreLife is a subtheme of #GivingTide, aimed at encouraging the use of individual and corporate milestones to promote the focal cause of CECP -Nigeria. These milestones include birthdays, wedding anniversaries, memorials or corporate annual general meetings/corporate anniversaries.

‘MoreLife’ is so-named because the event is an opportunity for the celebrant / honoree to add life to the less privileged in society in gratitude for one more year added to his/her life. Everyone is encouraged to enlist as a MoreLifer in support of the Big War Against Cancer in Nigeria. Further information on the MoreLife initiative could be obtained at www.givingtide.org.

“By moving forward together we have the potential to show Cancer: It is not beyond us.”- UICC 2015

This article was published in July 14 and 15 Guardian Newspaper

  © 2015 Committee Encouraging Corporate Philanthropy (CECP- Nigeria)