WORLD DIABETES DAY AND THE RISK AMONG NIGERIANS

World Diabetes Day is celebrated every year on November 14. The Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat that diabetes poses. It became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. World Diabetes Day is celebrated worldwide by the over 200 member associations of the International Diabetes Federation in more than 160 countries and territories, all Member States of the United Nations, as well as by other associations and organizations, companies, healthcare professionals and people living with diabetes and their families.

The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its member associations. It engages millions of people worldwide in diabetes advocacy and awareness. The International Diabetes Federation chooses new theme by each year to address issues facing the global diabetes community. Diabetes Education and Prevention is the World Diabetes Day theme for the period 2009-2013. Activities organized each year include, Radio and television programmes, jingles and promos, Sports events, Free screenings for diabetes and its complications, Public information meetings, Poster and leaflet campaigns, Diabetes workshops and exhibitions, Press conferences, Newspaper and magazine articles, Events for children and adolescents, etc.

Diabetes is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Basically, there are three main types of diabetes. The first results from the body's failure to produce insulin, and requires the person to inject insulin or wear an insulin pump. The second results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. And the third form, occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level.

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes could also double the risk of health complications, which include affecting blood vessel formation in the retina of the eye that can lead to visual symptoms, reduced vision, and potentially blindness. Diabetes also has impact on the kidneys, which can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease that may lead to dialysis. It also impacts the nervous system, most commonly causing numbness, tingling and pain in the feet and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputation.

Causes of diabetes are partly inherited or due to lifestyle factors. The inherited diabetes is usually triggered by certain infections. A genetic element in individual susceptibility to some of these triggers has been traced to particular genotypes which are described as self" identifiers relied upon by the immune system. However, even in those who have inherited the susceptibility, the disease seems to require an environmental trigger. The second type is unrelated to genes but lifestyle factors due to obesity, diet, physical inactivity among others.

In recent years, there has been a dramatic increase in diabetic cases around the world, despite the intensified effort on education and preventive measures regularly promoted by the relevant associations to mitigate the scourge of the disease. According to Williams Textbook of Endocrinology survey, globally as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double, based on research findings released by Wild S, Roglic G, Green A, Sicree R, King H in 2004 in their research titled "Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030”. Even though this projection may pose some technical questions, but the fact remains that the global prevalence of Diabetes is on the increase. As at the end of 2011, the International Diabetes Federation (IDF) published that 366 million persons are living with this disorder and that if nothing is done, this figure could rise to 540 million in the near future.

The menace of Diabetes is more common and prevalent in the more developed countries. According to a survey in 2010, almost one Chinese adult in ten has diabetes. The study estimated that more than 92 million Chinese adults have the disease, with another 150 million showing early symptoms, based on a report broadcasted by BBC on March 25^th, 2010. Similarly, the report indicated that the incidence of the disease is increasing rapidly; a 2009 study found a 30% increase in 7 years. For at least 20 years, diabetes rates in North America have been increasing substantially. In 2010, nearly 26 million people have diabetes in the United States, of whom 7 million people remain undiagnosed. Another 57 million people are estimated to have prediabetes, based on a survey by the Centers for Disease Control and Prevention(CDCP).

According to other researches, the greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030. A research conducted by Gale, Jason in November, 2010 titled "India’s Diabetes Epidemic Cuts Down Millions Who Escape Poverty" and taken on Bloomberg, the disease affects more than 50 million Indians, equivalent to 7.1% of the nation's adults, and that the disease kills about 1 million Indians a year. The increase in incidence in developing countries may not be unconnected to the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet.

In Nigeria, Six million Nigerians are estimated to be living with diabetes while deaths associated with the disease are projected to increase by 52% by the year 2015. This statistics was revealed by Erdoo Apeh, who is the Brand Development Manager of DeeDoo Nigeria, Pharm. on Sunday 15^th November at a news conference, as part of the organization’s activities to mark this year’s World Diabetes Day Awareness Campaign. Apeh added that The World Health Organization (WHO) has estimated that about 6 million people are reported to be affected with diabetes while six in every 10 Nigerians are at risk of having the disease because of their life style, eating habits and nonchalant attitude towards comprehensive and routine medical checkups. Corroborating Mr., Apeh’s statistics, the Health Reform Foundation of Nigeria (HERFON), had also declared that diabetes is likely to cause more deaths than imagined in Nigeria. The body said it is a major cause of deaths arising from non-communicable diseases (NCDs). The foundation also declared in a projection that death through diabetes in Nigeria will account for 52 percent in 2015.

The good news however, is that all forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. But both types 1 and 2 are determined as chronic, which cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal as possible, without causing hypoglycemia is another form of treating the disease. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes, oral medications, as well as possibly insulin, in type 2 diabetes).

To be able to tackle the dangerous trend of this killer disease, patient education, understanding, and participation is very vital, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. Attention should also be paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. According to The Diabetes Prevention Program (DPP), a major federally funded study of 3,234 people at high risk for diabetes, showed that people can delay and possibly prevent the disease by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity 5 days a week and healthier eating.

As a preventive measure it is advised that anyone aged 45 years or older should consider getting tested for diabetes, especially if you are overweight. If you are younger than 45, but are overweight and have one or more additional risk factors (see below), you should consider getting tested. To reduce the spread of the disease, there are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. It is therefore important to intensify awareness creation among the public that every person should see it as a duty on their part to ensure responsible living and lifestyle modifications. This is a huge responsibility on the part of Government and individuals involved in Diabetes work to double effort.

Apart from awareness creation, governments and instituted authorities have other crucial roles to play in reducing the risk of the spread of diabetes in the world. Countries that are concerned about their citizens already have programmes and policies to that effect. For instance The United Kingdom has predicted that the National Health Service could be spending as much as 16.9 billion pounds on diabetes mellitus by 2035, a figure that means the NHS could be spending as much as 17% of its budget on diabetes treatment by 2035. Therefore, Nigeria among other countries should take cue from UK’s effort.

It would be recalled that in September of 2011, there was an extra ordinary meeting of the United Nations General Assembly where Diabetes was considered along with other non communicable diseases as a global challenge. The President of Nigeria was in attendance, but since then, we have not noticed any action being coordinated by the Government to address the challenges of diabetes in Nigeria.

Therefore, it is imperative for the government through the Ministry of Health to immediately collaborate with Diabetes Association of Nigeria (the umbrella body of all groups handling Diabetes) to implement some modern techniques introduced by International Diabetes Federation like Diabetes Conversation Map Education Program, which is currently in use in over 160 countries of the World who are members of IDF. Introduce Guidelines for Diabetes management to public and private hospitals in Nigeria in order to have uniform standards of practice and care. It is also important that all non-governmental organizations working in the area of Diabetes to complement such efforts so as to have documented evidence for statistical records, awareness creation, as well as bringing about effective networking among healthcare providers and persons living with Diabetes in Nigeria. The work ahead for everyone involved in Diabetes care and advocacy in Nigeria is enormous. Other Countries have gone far, we seem not to have started, but it is possible to still create an impact before the year 2020, to reduce our estimated prevalence rate.

NATIONAL ID CARD IN NIGERIA: WILL IT EVER BE POSSIBLE?

According to a recent figure released by the National Identity Management Commission (NIMC) in November, 2012, over 100 million out of the total population of the country do not own national identity card. The Director of Information Technology of the commission, Engr. Aliyu Aziz, who disclosed this at a Stakeholders’ Forum organized to sensitize the public on the operations of the Commission in Makurdi, further revealed that out of the few Nigerians that own the national ID card, 75% of the cards are fake.

Identity or identification is a proof of something or somebody is what he/she/it claims to be. This could take the form of a card or document. Identity card is therefore, a small piece pocket size card holding information sufficient enough to prove that a claim or description of somebody or something bearing it is accurate. It is usually an official document issued by government or organizations that identifies the bearer with a country or organization. It is also sometimes used to grant somebody access to something.

National Identity Card is sometimes used interchangeable with National Passport. However, National Identity Card is a piece of card or document issued by government of a country to a citizen that identifies the bearer as a citizen or national of the issuing country, and is entitled to privileges that international foreign policies warrant. While passport is both used as identification, protection as well as securing access to travel beyond the borders of a person’s country.

Historically, the origin of official national identity card could be traced back to the summer of 1939, just before the commencement of World War II, preparations were concluded in England to compile a national register in case of war, so that every person including children, would be given an identity card, as United Kingdom citizens. Shortly after that, many western countries followed suit in realization of the importance of the national register/database or national identity card as the war became more and more imminent. Here in Africa, however, one of the few countries that began to adopted the use of a national identity card was Mauritania, when a decree in March 1969 made national identity cards obligatory. Today, most of the western and developed world consider national identity card a necessity and compulsory. Many other African nations have also taken it very seriously.

In Nigeria, attempts to compile a national register or database that will avail all citizens of the country a national identity card like their counterparts around the world have exceeded 35 years, but all could be conveniently said to have ended in a woeful failure. Between late 1970s to date, hundreds of billions of dollar have been sunk by successive governments for the exercise, but despite that colossal amount of money in the span of over 35 years, today only a meager segment of the population own the national ID card, and as revealed by the NIMC, 75% of the cards are counterfeit.

Other constraints facing the commission includes sabotage and manipulation of the database or exercise by some unpatriotic elements in the society for the purpose of politics of population, because having a comprehensive, credible and reliable national database plays a significant role in determining national affairs, such as leverage of power, influencing public policies, revenue allocation, state creation, representation, and in terms of election. In realization of the significant role compiling a comprehensive national database plays in influencing the aforementioned national activities, one can conveniently say that some people with sinister political, economic or social agendas regularly frustrate the successful compilation of a comprehensive national database and the national identity card exercise. To further buttress this point, a probe conducted by the House of Representatives Committee on Internal Affairs, under the Chairmanship of Hon Ehogie in 2004, discovered a 204 million dollars fraud surrounding the national identity card exercise, implicating the former Internal Affairs Minister, Chief Sunday Afolabi and others.

Following the realization of the flagrant corruption that bedeviled the process, the Federal Government enacted the National Identity Management Commission (NIMC) Act in 2007, which provided for the establishment of a National database and the National Identity Management Commission under the Internal Affairs Ministry, charged with the responsibilities for maintenance of the National Database, registration individuals and the issuance of general multi-purpose identity cards and other related matters.

One major important mandate of the commission was providing the citizens through the ID card a National Identification Number (NIM), which is continually becoming a requirement in applying for and issuance of passport, operating a bank account, purchase of insurance policy, registration of voters, payment of services, vehicle registration, etc. It also captures biometric data which is an automatic method for identifying a person on the basis of some biological or behavioural characteristic of the person such as fingerprints, behavioural characteristics, and voice patterns, which are distinctive to each person.

The National Identity Management Commission (NIMC) operates in collaboration and shares information with some government institutions like the Independent National Electoral Commission (INEC), National Health Insurance Scheme (NHIS), Federal Road Safety Commission (FRSC), Corporate Affairs Commission (CAC), National Populations Commission (NPC), National Pensions Commission (NPC), the Central Bank of Nigeria (CBN), State Security Service (SSS), Economic and Financial Crimes Commission (EFCC), and other strategic agencies that would require a comprehensive national database for the purpose of planning, budgeting, and for security and investigative reasons.

Compiling a national database and issuance of of national ID card to citizens has so many advantages. It helps in gathering demographic and statistical data on the citizen that the government can use in making informed decisions in planning, budgeting and formulating sound policies and programmes that will benefit the citizens. It is important in tracking criminality and fraudulent activities. It can also be used too check the inflow of people from neighboring countries posing as Nigerians, as well as regulate Nigerians within and outside the country and protect the nation’s integrity abroad, by addressing the problem of imposters who commit crimes and claim to be Nigerian citizens. In addition, compiling an automated national database and issuance of National ID cards together with the National Identity Number (NMI) to citizens could help in checking economic and cyber crimes, just like the Automated Teller Machine (ATM) cards that have fool-proof mechanisms.

Other advantages of the scheme include assisting in checking insecurity by ensuring authenticity of citizens and in tracking criminals. It would also help in address the problem of overtaking scarce appointments and jobs by expatriates, when Nigerians need such opportunities and could even perform better among other advantages.

The Director of Information Technology of the NIMC, while had recently assured Nigerians that the commission has concluded arrangements to begin a new registration that would capture over 150 million Nigerians within the space of 40 months, adding that the new smart card would enable bearers to transact electronic payments, access ECOWAS countries without the regular use of travel documents among other things.. So let us hope and pray that the commission has learnt from the mistakes of the past and that this time around the exercise would not fail like other previous attempts. Similarly, the citizens should endeavour to corporate fully and participate actively with the commission when the new exercise begins for the overall success of the scheme.

WHEN A GENERAL SAYS HE IS AFRAID, THEN WHO IS SAFE?

Former President, General Olusegun Obasajo (rtd) has recently added his voice into the torrent of comments, concerns and fears expressed by many Nigerians about a dangerous and imminent revolution the nation is drifting towards, unless urgent steps and measures are taken both by government and the citizens. The former President and elder statesman stated that Nigeria will soon witness a revolution, the danger of which can only be imagined.

Obasanjo, who made the this statement at the weekend during the West African Regional Conference on Youth Employment, in Dakar, Senegal, said that he is afraid, adding that when a General says he is afraid, that means the danger ahead is real and potent. He added that the danger posed by an army of unemployed youth in Nigeria is an imminent threat to Nigeria’s nationhood.

This is not the first time this issue was raised. Many social and political analysts, public affairs commentators, journalists and indeed other well meaning Nigerians have been calling the attention of both the government and good people of Nigeria about many signs and indicators of an imminent danger facing the country that could lead to a dangerous revolution as a result of youth unemployment and abject poverty in the nations as outlined by, Obasanjo. There are also other factors that other contributors in the discourse emphasize. This include bad leadership, unprecedented level of corruption and abuse of public trust, ethno-religious  intolerance, unfair distribution of national resources, collapse of the civil service and the rise mediocrity, the spate of insecurity in the form of crimes, militancy, terrorism, etc.

Barely seven months before General Obasanjos’s warning against an imminent revolution in Nigeria, another General and former head of state, General Muhammadu Buhari had in April this year gave the same warning as long as things continue to remain the way they are or even worsen in Nigeria. Even though the two Generals based their assessments and judgments on different factors; such that Obasanjo sees growing youth unemployment and abject poverty as the driving force for the revolution, while in Buhari’s view, the continued rise in corruption and shortchanging of Nigerians by the ruling People’s Democratic Party (PDP) are the major factors that would lead to the inevitable revolution in the country in the near future.

Even though revolutions, which simply mean a forcible, pervasive and often violent change of a social or political order by a sizeable segment of a country’s population, which is usually spontaneous and not really planned, but for two military generals and former heads of state, who also lead the two major political parties in the country to warn the nation about an imminent revolution in Nigeria, is indeed something to take very seriously and not treated with kid-glove

In addition, taking into consideration the recent Arab spring that brought about revolutionary changes in many North-African and Middle-eastern states, the much talked about United States’ prediction that Nigeria would disintegrate in a couple of years, other historical revolutionary indicators and triggers such as alarming rise in societal ills, crimes, insecurity, deprivation, poverty, injustice, human rights violation and lack of basic amenities, such as healthcare, educate, housing and youth unemployment are all prevalent in Nigeria.

Although from the leadership point of view, a revolution might seem farfetched, it would be delusional not to reconcile history, old rhetoric and tired excuses, with the recent warnings by two military generals and former heads of state and the prevailing social, economic and political realities in Nigeria. Contrary to the perception of the nation’s leadership and others who see any kind of revolution in Nigeria as not feasible, current realities in the nation are strong indicators that Nigeria is indeed ripe for a revolution.

Those that have the notion that revolution in Nigeria is impossible, at least not in the near future, usually premise their judgments on some of the following reasons. One, Nigeria’s transition away from military rule since 1999 and successive democratic leadership in 2003, 2007 and 2011. So in their assumption, most of the revolutions in the Arab world were mostly triggered by long stay of undemocratic leaders and their attempt to perpetuate themselves or bequeath to their children after their demise. Two, some say that Nigeria’s ethnic diversity, sectarian, religious and regional sentiments are all mitigating factors against a successful revolution unlike in Egypt, Tunisia and Libya, where the people share the same language and ethnicity and have less or even no regional divides. Three, unlike Egyptians, Nigerians do not trust their security agencies, both the military and police, either because of their questionable conduct in quelling restiveness in different parts of the country, or for being partisan and government controlled institutions, who would not hesitate to crackdown, open fire and shoot revolutionary protesters, if directed to do so. Simply, Nigerians do not think or believe that the military or police would behave in the manner their Egyptian counterparts did.

Other obstacles in Nigeria, which the government and supporters of the status quo, capitalize on include, the people’s nonchalant attitude and unwillingness to make the required sacrifices, withstand pressure, go hungry, sleepless and bathless for days, as well as the so-called ‘on-your-own’ and ‘my hand no dey am-o’ syndrome. But more interestingly, many Nigerians are of the view that, all large number of those who advocate for a revolution, especially the elites are not sincere or advocating for the sake of good governance and ameliorating development challenges, rather they are only interested in using the people as stepping stones to upstage those in power, secure political powers, gain recognition, political appointments or for some other narrow personal interests. Nonetheless, revolutionary indicators are vividly evident and present in Nigeria today, and the grievance and suffering levels are high and continually resonant, therefore making it a likely candidate for a revolution, and possibly a violent one (God forbid).

Apparently, the nation today is in a serious turmoil. All the six geo-political zones of the counry are entangled in one form of social conflict and restiveness or the other, ranging from militancy, insecurity of kidnappings, organized crimes and armed robbery, sectarian violence and growth of fundamentalism that has both religious, terrorist and political undertones. These challenges combined with the general problems of bad governance, flagrant corruption, massive unemployment and abject poverty makes for a very explosive political landscape in Nigeria. It would therefore, not amount to an exaggeration to say that critical revolution markers and tripwires both exist in Nigeria, and the spark could start from anywhere and at anytime.

Therefore, the two generals and former heads of state, General Olusegun Obasanjo (rtd) and General Muhammadu Buhari (rtd), with their pedigree, experience and depth of understanding of the nation had both at different occasions and time warned the nation of an imminent revolution in the country pretty soon, and indeed these assertions by the two generals are indeed something to pay keen attention to. Both have their reasons and assessments for drawing such a conclusion, and that cannot be described as being alarmist, but acknowledging prevailing realities in the nation.

As desirable as a revolutionary change in Nigeria is, no one should pray for revolution, because no one knows what form it might take. Yet revolutionary change in Nigeria is very possible and imminent, it is only a matter of time when revolution becomes the only alternative to the people as long as things do not improve.