Reducing Chronic Diseases in Nigerian Slums

To fortify themselves against the early morning cold and wind, the fishermen in the Makoko slum drink a strong home brew similar to gin for breakfast, and then set off in their boats across the trash-filled lagoon to the Atlantic. In those same waters, the some 10,000 residents of this crowded slum in Lagos, Nigeria, bathe, urinate, wash their clothes, and get their drinking water.

“In all my years in Lagos, I’ve never seen such poverty—no facilities, makeshift houses of wood and cardboard, their whole lives on the water,” says Adesola Musa. “Most children don’t go to school, there’s high unemployment, no health facilities, teen pregnancy and crime are high—especially rape.

NigeriaShe had passed by Makoko and other slums many times, but the lead statistician for the Nigerian Institute for Medical Research (NIMR) was shocked by the conditions she and her team found during recent site visits there. Musa helped design a study for data collection in three Nigerian slums, looking closely at lifestyle and the prevalence of noncommunicable diseases (NDCs). Results of the study of 2,400 slum dwellers will give policy makers a reliable baseline knowledge on how to make informed health policy decisions. 

NigeriaIn addition to the tuberculosis, pneumonia, diarrhea, malaria, HIV/AIDS and other infectious diseases rampant in Makoko, there are NCDs —liver disease, hypertension, diabetes, cardiovascular and lung diseases, cancer, mental health problems, and allergies—which are becoming large public health challenges in many of Nigeria’s urban slums. Lifestyle factors contribute to many of these chronic diseases, including tobacco, alcohol and drug abuse, diet, indoor pollution, obesity, and lack of exercise. One of the aims of the $56,000 research grant funded by IANPHI is to reduce such chronic disease in Lagos by promoting health lifestyles. 

Nigeria“Our main objective is to look at  lifestyle and the prevalence of non-communicable disease—what kind of food the people eat, their daily activities, and with this information design interventions to help improve the health condition of the communities,” Musa says. The team performed a series of simple diagnostic tests, such as weight and height to calculate the body mass index, blood glucose, and blood pressure that will help NIMR assess the effect of lifestyle on health. “The baseline data will help us plan intervention programs like health education, ICT materials and counseling so people can better understand the implications of their lifestyles. I believe if you educate one person, you educate many in the community. “ 

The study is one of three in Nigeria supported by the International Association of National Public Health Institutes (IANPHI)—a network of 76 CDC-like organizations in 72 countries that boosts capacity to identify and prevent health risks and ultimately save lives. Musa has been involved in all of those grants to NIMR, including pioneering efforts in Africa to combat multi-drug resistant TB. An additional project, which would be closely coordinated with CDC’s Nigeria office, is under discussion. 

Musa is also a third-year doctoral student at University College Hospital, the only place in Nigeria where biostatistics is offered at the PhD level. Recently she came to Emory University in Atlanta on an IANPHI fellowship to learn more about study designs, advanced statistical analysis, and modeling of infectious diseases to assist her in the completion of her PhD thesis on the “long-term effects of ARV drugs on HIV/AIDS patients: insights from mathematical models.” She’s looking at optimal times to start antiretroviral therapy and survival patterns in patients. 

“Because of high patient loads, there are so many issues of sustainability of programs back home,” she says. “For example, our AIDS programs have been funded by PEPFAR, but we can’t expect these to last forever, so my thesis focuses on how can we sustain such programs. We’re looking at ways to reduce costs of monitoring and the cost-effectiveness of drugs. Should we treat early or wait till later?” 
Currently, more than 15,000 HIV-positive people, from all over Nigeria flock to the NIMR clinic. Many come to Lagos where no one knows them to escape the stigma of AIDS in their own immediate communities.

Musa says her six-week fellowship in Atlanta better equipped her to complete her PhD, and enhance her job at NIMR, which touches virtually every department and project there.

“I learned so much from the faculty at Emory, and that’s going to change the way we design our studies—how we collect data and do our statistical analyses, what software we use, and how we provide policymakers evidence so they can set policy,” she notes. “For example, we now don’t have specific times for people to come in for treatment of AIDS, but I’ve learned that timing does affect outcomes so we’ll look closer at that.” 

Musa enthusiastically recalls her fellowship experience at Emory—a visit to Grady Memorial Hospital (“not that different” from hospitals back home), the Biostatistics and Bioinformatics Departmental Library, where she had access to books and journals that NIMR can’t afford to subscribe to, and most important, many helpful conversations with other biostatisticians and physicians from the Emory Center for AIDS Research (CFAR). 

At Emory, she was mentored by Lance Waller, who chairs the Biostatistics and Bioinformatics Department in the Rollins School of Public Health. He orchestrated her assignments, including meetings with faculty and CDC biostatisticians. The faculty in the department collaborates with researchers at the CDC, the Carter Center of Emory University, the Georgia Department of Human Resources, the Emory University School of Medicine, and other health-related organizations. The Biostatistics Consulting Center serves as a resource for advice on the design, conduct, and analysis of studies in the health sciences.

“A lot of what I’ve learned from my fellowship can’t be found in books,” Musa concludes. “It’s been very helpful and will have a great impact on my contributions to subsequent design, statistical analysis, and ultimately on the management of health of my people.” 

Sola Musa
One of Sola Musa’s favorite places at Emory during her IANPHI-funded fellowship was Emory’s Biostatistics and Bioinformatics Department Library where she had access to books and journals unavailable in Lagos. Her six-week fellowship in Atlanta better equipped her for her NIMR job which touches virtually every department and project there.