Author Archives: Ebun Okunuga

No one Wants to Drink Salt and Water – the Struggle to Raise ORT Momentum

I remember being forced as a child to gurgle salt and water solution whenever I would get a mouth sore in Nigeria. The solution was never pleasant and I can’t imagine what drinking it must taste like. Even then, I always distrusted the potency of this “drug”, believing it to be an old wives’ tale and wondered why I simply wasn’t given a drug from the Pharmacy. 15 years later in New York and I often yearn for some of those “drugs” my grandmother would prescribe to me whenever I got a mild to moderate illness. It’s difficult to understand from a health specialist point-of-view why such a seemingly easy, and not to mention, effective remedy has such as slow uptake in developing countries. The Oral Rehydration Therapy (ORT) case study from Harvard Business School presents the facts, among which is the aforementioned example from my childhood, in hopes of stimulating discourse and innovative solutions.

The use of ORT as a first line treatment for diarrhea is not more widespread despite its proven effectiveness because of a myriad of interconnected issues which compound to create a negative synergistic effect that has resulted in slower than expected adoption and implementation of ORT. As is sometimes the case with global health recommendations, delivery from the country level and community/individual preferences and/or beliefs were overlooked during the first implementation stages.

I believe the first issue on the agenda for ORT scale up should be increasing demand for ORT. Currently, individuals and providers do not demand ORT because of a distrust of its effectiveness, lack of understanding of the severity of diarrhea and the challenging fact that ORT does not treat the symptoms of diarrhea (which caregivers observe), but simply prevents death from mortality (which is harder to observe unless a child is in that situation). Addressing demand issues will ensure that there will be sufficient demand in the population for ORT to be successful should the supply side issues be resolved as well. In terms of supply issues, pulling a script from the global response to tuberculosis, creating a supply committee to aid countries in understanding the logistics involved with ensuring adequate availability and distribution of ORT to those in need would help resolve some of the supply issues. Also, working with the pharmaceutical companies to create a solution that tastes better for children will ensure that children are willing and happy to use ORT.

Lastly, while encouraging homemade ORT solutions sounds appealing, there is a huge margin for error because of lack of standardization. Caregivers should be educated on the specific proportions for the solution and should be encouraged to use this first line response for when the symptoms first appear. It is not only enough to discover effective solutions to some of the world’s trying health issues, it is also important to understand what factors on the ground, sometimes health-related other times not, might affect implementation and scale up.


Polio, a disease of cultural and religious differences?: a look into polio in Nigeria

dancing african children

Northern Nigeria is plagued with many issues, one of them being Polio. Nigeria, along with Afghanistan and Pakistan are the only countries left in which Polio is still endemic. Considering that Polio has been eradicated in most of the world, this fact is quite disheartening and begs the question: Why hasn’t Polio been eradicated in these countries? Unfortunately, the answer to that question is more complicated than simply providing vaccines to the respective populations.

Interestingly, these marginalized populations are Muslim. An interesting fact that was also observed in Uttar Pradesh, India. That is not to say that Islam is a major factor affecting polio eradication. It simply is a commonality shared by different populations affected by the same disease and begs the question: Are these people being marginalized by their government as a result of other cultural and religious tensions? This is the question that I attempt to shed some light on.

Nigeria is arguably divided 50/50 by Christianity and Islam with the south being predominantly Christian and the north being predominantly Muslim. Data shows that northern Nigeria is disproportionately affected by poverty and health issues when compared to southern Nigeria (for instance, higher rates of malaria, cholera, poverty, malnutrition, hunger, etc). To combat these issues, national efforts have focused largely on vertical approaches to these public health issues, which was the approach taken to eradicate polio via the Global Polio Eradication Initiative (GPEI). However, there has been a current shift in global health trends to health systems strengthening as a new public health approach. Also, the failure to eradicate polio in countries such as Nigeria further heightens the need for this approach and the need to comprehend the underlying issues exacerbating the spread of polio.

As mentioned, northern Nigeria is plagued by many issues, most of which is intertwined with the recent insurgence of Boko Haram. It is difficult to use a strictly vertical approach to scale up polio efforts when a huge influence on the community, Boko Haram, continually thwarts these efforts. Due to the presence of Boko Haram, there has been an increase in distrust of the government and deteriorating security, compounded with low levels of education creating a melting pot that is ripe for continued spread of the disease.

Despite these set backs, the number of cases in Nigeria has dropped indicating that is it possible to eradicate the disease once and for all. Also, Nigeria’s successful elimination of Ebola shows that the government is capable is responding swiftly and effectively to public health issues. However in order to replicate this success in polio, Nigeria would need to scale up polio immunization efforts by increasing community engagement and use of community health workers and integrating polio vaccination to other immunization efforts and possibly maternal and child health treatment cascade as a whole.