Chiwuike Uba is the founder and chairman of the Board, Amaka Chiwuike-Uba Foundation (ACUF). In this interview with ANTHONIA OBOKOH of BusinessDay, Uba spoke about Asthma health condition and why it should be a top priory for intervention programs.
How can you describe asthma prevalence in Nigeria?
Asthma prevalence and incidence have been increasing worldwide in recent decades. This increase is not only attributable to genetic background but largely because of the effect of a wide number of environmental and lifestyle risk factors. Unfortunately, in many countries, asthma and other non-communicable diseases are yet to be considered a healthcare priority.
In Nigeria, more than 15million people are currently suffering from asthma with a projected increase to 100million by 2025. Globally, more than 300million people are currently with asthma and this is expected to increase by over 100million by 2025. It is also estimated that 14 per cent and 8.6 per cent of the world’s children and young adults’ experience asthma symptoms, while 4.5per cent of young adults have been diagnosed with asthma and/or are taking treatment for asthma. The burden of asthma is greatest for children aged 10-14 and the elderly aged 75-79. Currently, Asthma is the 14th most important disorder in the world in terms of the extent and duration of disability. Given the well-known under-diagnosis of asthma, the above quoted numbers may be an underestimation.
As a globalized and significant public health problem, which oftentimes, requires use of emergency care, hospital admission and can cause early permanent disability and premature death, asthma requires urgent policy and government attention to enhance the management of asthma in Nigeria.
What is the cost and social impact of asthma?
Asthma management comes with very huge costs. These costs are direct, indirect and intangible costs. In 2014, it was found that the annual out-of-pocket cost of asthma incurred by patients in Nigeria was US$368.4 per patient. Medication cost accounted for the majority (87%) of this cost. This cost does not include other direct, indirect and intangible costs and is not related to costs incurred by patients with exacerbation and differing severity of the disease. This shows that in Nigeria, the annual average out-of-pocket cost incurred by asthma patients is US$ 5.5 billion (N2trillion) as at 2014.
Asthma costs USA economy more than US$ 80 billion annually in medical expenses, days missed from work and school, and deaths. In Nigeria, asthma care imposes economic burden on affected patients; though, patients’ costs for asthma is not well documented in Nigeria and other African countries.
It is therefore important for Nigerian government, in addition to making asthma a health priority, should invest in asthma research, develop national strategies and guidelines and action plan to improve asthma management and reduce costs.
What is the way forward to managing asthma in Nigeria?
To achieve the objective of Better Breathing, Better Living for Nigerians requires collective efforts and commitment of everybody – the government, the citizens, and development partners.
Air pollution is responsible for more than 12 million deaths per year, notwithstanding the availability of different respiratory diseases drugs, significant numbers of patients are still suffering from respiratory diseases while a significant number still die from the disease. For instance, an estimated 75% hospital admissions for asthma and as many as, 90per cent of the asthma deaths are avoidable. Poor diagnosis is one of the reasons.
Therefore, continuous medical education is necessary for medical doctors. Interestingly, ACUF, in collaboration with other organisations, is already facilitating such specialised training for medical doctors. Asthma is already an epidemic! The global burden of asthma is already substantial in terms of mortality, morbidity and economic costs. According to the recent Global Burden of Disease (GBD) study, Asthma is estimated as the 14th most important disorder in terms of global years lived with disability. Asthma, therefore, should be among the top priorities of Ministries of Health, development partners and CSOs when assessing health priorities, allocating resources, and evaluating the potential costs and benefits of public health interventions.
We need continuous collaboration of the Nigeria Medical Association and other allied organisations and the Ministry of Health, as well as financial support from Nigerians, grant-making institutions and development partners, and finally, the collaboration of the National Assembly in putting in place, laws that will promote better breathing and better living in Nigeria. Nigerians also need to start visiting hospitals for proper diagnosis and management of their medical conditions.
Can you tell us what Annual National Asthma Conference all about?
First, we are faced with challenges ranging from being rated as one the most polluted countries in the word to a country grappling with a lot of problems associated with other governance issues. Most diseases are associated with environmental and governance issues. The 2019 Amaka Chiwuike-Uba Annual National Asthma Conference with the theme Better Breathing, Better Living: The Role of the Environment and Governance is unique and is coming at the right time.
The Annual Conference is a platform to discuss national issues, especially health and related matters in an evidenced-based approach. The 2019 Conference is, therefore, expected to X-ray the linkages between the environment and governance and its impacts on health management as well as make policy recommendations on ways to ‘deal’ with the identified challenges.
Why is ACUF talking about ‘Better Breathing, Better Living: The Role of the Environment and Governance’
The conference theme was chosen in consideration and recognition of the impact of environment and governance on the quality of life of people. Pollution is a major environmental health problem affecting everyone; contributing heavily to the burden of diseases from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma.
Whereas people may have a greater ability to modify indoor environmental exposures, in most cases, they do not have direct control over outdoor pollutant concentrations. A clear example is the continuous and continuing gas flaring in Nigeria as well Nigeria’s rating as one of the most polluted countries in the world. The control of both indoor and outdoor environment exposures, therefore, becomes the key ingredient and responsibility of government and outcome of governance (either good or bad).
According to the World Health Organisation (WHO), air pollution is responsible for more than 12million deaths per year. The achievement of the Sustainable Development Goals (SDGs) targets —SDG 3 (Good health and well-being), SDG 6 (Clean water and Sanitation), SDG 7 (Affordable clean energy), SDG 13 (Climate action), SDG 14 (Life below water) and SDG 16 (Peace, Security and Strong Institutions) is dependent on the environment and governance outcomes. In a nutshell, governance is core to a sustainable environment and development.