A Brief History of Epidemic Meningitis in Nigeria

About a century ago, the first outbreak of epidemic meningitis in Nigeria occurred in Zungeru, a town in Northern Nigeria near the River Niger. This outbreak was reported by McGahey in 1905 in the Journal of Tropical Medicine and 32 cases were reviewed in that report (Greenwood, 2006). There are no detailed accounts of the extent of this epidemic, but it spread widely within that year and was recorded as reaching Yola, a town in North-Eastern Nigeria, 500 miles east of Zungeru (as shown in the figure below). This first epidemic accounted for an estimated 20,000 cases and many thousands of deaths.

It is widely thought that the disease described by McGahey was meningitis because of the wide age range affected and the characteristic signs and symptoms seen, which were similar to cases of meningitis described elsewhere. Further confirmation was obtained the next year (1906) when the disease spread to Ghana and the meningococcus was isolated by culture from cerebrospinal fluid (Greenwood, 2009). Even though it may not be certain if this meningitis epidemic was the first ever in Northern Nigeria, recorded discussions with traditional rulers at that time suggested that they recognized that this was a new illness (with strange signs and symptoms). In addition, the writings of early medical explorers in the 1700s and 1800s in Northern Nigeria (like Mungo Park, a surgeon), who had written on diseases like malaria in the region, made no mention of epidemic meningitis.

There are many theories that try to explain how epidemic meningitis got to Northern Nigeria (origin of the disease in the country). Greenwood (2009) outlines some of them in his review, but it is not exactly certain which of them is the most accurate. The first possible explanation is that a strain of the bacteria, which is usually non-pathogenic and lives in the human airway epithelium (commensals in the upper airway tract) acquired a virulent gene possibly by mutation and became pathogenic causing disease and spreading in the population. It is theorized that this same evolutionary process was responsible for the first epidemic in Europe a century earlier.

Other theories suggest that the disease was brought to Nigeria from Sudan; a large epidemic was recorded in Omdurman, Sudan in 1989. There are suggestions that the epidemic strain was brought into Northern Nigeria by West African pilgrims who had embarked on the Hajj (Muslim pilgrimage) and who travelled across Sudan before crossing the Red Sea to the Arabian Peninsula and returned by the same route. These journeys from West Africa across the Sudan could be completed, travelling by horse or camel, in a few months, which is well within the period in which the causative bacteria can persist in the upper airway tract. In modern times, the Hajj is still a place where international transmission of meningitis still occurs even though in recent years mandatory vaccinations have greatly reduced this risk.

In Northern Nigeria, major meningitis epidemics were recorded in the medical literature in 1949-1950, 1960-1962 and 1969-1970 (Blakebrough, et. al., 1982). The report (see picture below) by Vollum and Griffiths (1962) describes their efforts to control the epidemic of 1961 in the province of Katsina in Northern Nigeria. They used sulphadimidine snuffs, which was very effective at that time. They achieved this success by carefully coordinated plans involving the Emir of Katsina, district heads and the people of the community in carrying out the intervention in the districts where they worked. This is a good illustration of how to implement public health control strategies for an epidemic disease in a low resource setting even though this was almost half a century ago and public health efforts in Nigeria was still in the infancy stages.

REFERENCES

Blakebrough, I.S., et. al., 1982. The epidemiology of infections due to Neisseria meningitidis and Neisseria lactamica in a Northern Nigerian community. The Journal of Infectious Diseases, 146(2), pp.626-637.

Greenwood, B., 2006. 100 years of epidemic meningitis in West Africa – has anything changed? Tropical Medicine & International Health, 11, pp.773–780.

Vollum, R.L. and Griffiths, R.W., 1962. An experiment in the prevention of meningococcal meningitis in Nigeria. Journal of Clinical Pathology, 15, pp.50-53

A Firm Resolve...

‎...make a resolve today to do the right thing...if you don't have a conviction today, you won't suddenly get it by magic tomorrow when the temptation comes...


‎...we were discussing about the corruption in the National Assembly a few weeks ago...very sad...it seemed like everyone was corrupt in the country's leadership...executive, legislature and judiciary (the judges have let some top politicians and bankers of the hook in recent times even though there is overwhelming evidence that they stole billions)...


...but at that discussion, I begged to differ...I insisted that I am not corrupt...and I don't need a soothsayer to predict that I WILL NOT be corrupt in the future...this is not a boastful/proud declaration...this is simply a statement of fact from someone who has made a personal decision, who has defined his VALUES in life...I am not perfect, I actually have many flaws...and I'm working on them...but on this issue of being swayed by money, to do the wrong thing, I have made up my mind...


...I was shouted on during the discussion...and some of my friends looked at me in disbelief...but I truly meant every word I said...my friends had a point...they insisted that I haven't seen "big money" yet...they insisted that I haven't been in tough situations...I may agree that I have sort of had a sheltered life, but I have had my small challenges...and taking the right decisions in those circumstances didn't faze me one bit...I definitely know that in the future, I will succeed in doing the RIGHT THING...it may mean taking the harder way, or making difficult choices...but at least, it allows me to sleep well at night...


...I wish we all could make up our minds...I assure you that if we did, our country will change overnight...I wish we would become "the land of upright men"...just like Thomas Sankara dreamed for his own country...

Medical Outreach to Anka...

It's been a long while since my last blog post...many changes...new goals, new job, new continent...but still the same old, witty Kene - my Facebook posts bear me witness !!!

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Memories of my one-year service to my nation still come to my mind once in a while...those were truly simple times...living in simple circumstances...resources were limited, but I think it was truly an opportunity to serve, with a team of some very committed people...

In the bus we hired, getting ready to depart...

On Wednesday 9^th December 2009, the Association of Resident Doctors (ARD) at the Federal Medical Centre, Gusau embarked on a medical outreach to Anka Emirate. All clinical departments in the hospital were represented in the contingent made up of twenty doctors. I worked in the Internal Medicine department at the hospital and I was glad to be part of the outreach.

The journey to Anka from Gusau took two hours and it was a smooth ride. Anka is regarded as the ancestral home of the Zamfarawa, the indigenous people of Zamfara state. Our first port of call was at the Emir’s palace, but we were told that he had gone to Mecca for the annual pilgrimage. However, he was ably represented by his deputy and we were given a warm welcome by members of the Emirate Council and the people of Anka. At the reception point in a hall at the Emir’s palace, we were given an opportunity to state the purpose of our visit. We also gave the people some health promotion messages addressing the common public health problems in their area.

After the welcome reception, the contingent was split into three groups. The first group stayed behind at the Emir’s palace and attended to members of the community, running consultation clinics, treating minor illnesses like malaria and giving general health advice to those who needed it. The second group moved to the local government office in the town and carried out similar activities to that of the first group. In addition, the second group also shared donated insecticide-treated mosquito nets to pregnant women and women with children under the age of five years. The third group was involved in a community deworming exercise among children in the town-square.

The Deputy Emir giving his welcoming speech

The people of Anka later on treated the visiting health team to a sumptuous lunch, which was well received; and then it was time to close the curtain on the program. The outreach proved to be a resounding success and a fulfilling experience for all the participants as it gave members of the ARD an opportunity to contribute their personal quota to development in their immediate locality.

EDUCATION IN NIGERIA AND 2015...from an award winning essay...


We are finally at the end of the year and on a personal level, I have completed my post-graduate degree in Public Health. I will like to share with you in this post, my scholarship winning essay that made the MSc degree possible. It brings back great memories for me yet again. Firstly, writing the essay on the move. I was actually attending a conference in Abuja when the opportunity came up and I had to research and craft the essay on the go. Education has always been a passion for me and I already had some ideas on improving the educational sector, so when I saw the essay topic, it caught my fancy immediately. Next, the tension of the finals. Defending the essay before a panel was not easy. The panelists wanted to know the underlying premises and assumptions of the idea and they wanted you to prove the workability of your plan. I was glad that I was successful. Finally, announcing the winners. There were six scholarships up for grabs that night and twenty finalists. It was a wonderful feeling to be called up as a winner. Great memories indeed. Please enjoy the essay.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

In 2000, 192 United Nations member states agreed to achieve 8 international development goals by 2015. One of these Millennium Development goals is the achievement of Universal Basic education: “By 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling and free education for all.”

More than half way to the 2015 deadline, many African countries find themselves in a situation where this seems to be a far off dream. With the poor quality of classroom facilities, increase in school drop outs, poor teacher training and union strikes, most countries are at a loss about how to move from here to actualising the 2015 vision.

We need your help.

In 750 words or less using Nigeria as a case study, what ground-breaking ideas can you offer to turn this situation around?

The second Millennium Development Goal (MDG) which aims to achieve universal primary education is the only MDG that sets a 100% target for its goal. It targets that by 2015, all children everywhere will be able to complete a full course of primary schooling. This underscores the importance of education in national development and also its key relevance in realizing the other MDGs as it influences the efforts against poverty, gender inequality and maternal and child mortality. Sadly however, Nigeria seems to be far from this goal. The net enrolment ratio in primary education in Nigeria was 62% in 2000 when the MDGs were initially declared at the UN Millennium Summit and 65.2% in 2006. With the target in 2015 being 100%, it is clear that the country’s progress towards the goal is too slow. Other nations however have made good progress. Nigeria’s neighbour, Ghana had a net enrolment of 60.9% in 2000 and 71.9% in 2006 while Rwanda had a net enrolment of 68.6% in 2000 and an astonishing 94% in 2006. In Nigeria today, there are close to 30 million children of primary school age but 10 million of these children are not in school. There is clearly a lack of capacity – infrastructural and human resources, to place these children in primary school. At a recent forum, the current Nigerian Minister of Education, Dr. Sam Egwu was reported (in the Compass Newspaper of Aug 29 2009) as stating that there are 87, 941 primary schools of which 54, 434 are public primary schools (government owned). He also stated that there is an urgent need for 22,000 new primary schools. This will involve huge infrastructural and human resources to achieve the goal in 2015. This is especially difficult in the light of the prevailing global economic recession, dwindling revenues arising from crude oil and decreased influx of donor aid into the country. How can we increase this much needed capacity with just 6 years to go? My idea will involve a revolutionary paradigm shift where primary education is carried outside conventional classroom structures into the community and utilize existing physical and social structures in the community. Traditional schools presently do not have the capacity to enrol the large number of children presently without primary education and this idea will bypass the large infrastructural investment required to physically construct schools as well as save time which it would have taken to build those schools. Every community, rural and urban, has meeting places such as town halls, motor parks, mosques, churches, markets and traditional rulers’ palaces. These can be the new venues where knowledge is transferred to Nigerian children so that even in rural areas where there is a lack of access to primary education, schools can now exist. They may not be ideal places of learning but with some innovation and creativity, they could be made suitable as places of learning for a few hours every day. For example, if a primary school could be sited at a village market, it ensures that the children of the rural market women will receive an education daily and still assist their mother at the market. The shortfall in the number of school teachers needed to teach this massive number of new enrolees could be met by recruiting teachers from members of the National Youth Service Corps (NYSC) which mobilizes about 200,000 tertiary institution graduates annually for youth service. These “Corpers” could be given preliminary training in teacher education at the commencement of their orientation programme to enable them perform. For these ideas to work there must be a well-coordinated organisational structure to manage these large scale efforts across the three tiers of government. Seasoned and relevant technocrats need to be recruited to adapt the existing curriculum to achieve the stated objectives. There must also be sufficient motivation and an increased pay package especially for teachers serving in rural areas to serve as a matching incentive. Necessary textbooks, desks and chairs could be purchased from the savings generated from non-construction of new classrooms. In conclusion, it must be emphasized that for these community-driven efforts to yield fruit, effective community mobilisation needs to be carried out with full community participation in the project from initiation and planning, unto the implementation and evaluation phases of the project. Educating children outside conventional classrooms may be a radical idea but this may be a viable option in this season of scarce funds especially with 2015 around the corner.

...POPULATION...and the Nigerian...

Today is World Population Day. This date has been marked since July 11, 1987 when the world population reached 5 billion. The world is headed to 7 billion in a few months (On 31 October 2011, the world population will reach 7 billion, according to the United Nations Population Division) and Nigeria is front and centre in the bid to getting to that mark.

Nigeria’s population today is projected at 150 million people and this is almost double what it was two decades ago (1991 Census - 88.9 million, 2006 census - 140.4 million). Nigeria’s population is growing at the rate of 3.2% per annum. The total fertility rate of the country is estimated at 5.7, with some regions of the country having rates nearing 8.0 (National Population Commission, 2009). This population explosion in the country is virtually unsustainable given the fact that crude oil exports which are the mainstay of the economy are unstable and may even be declining. This growing population without a commensurate increase in the income and quality of life of the people is the basic problem with the health sector as people cannot afford healthcare, education, clean water and housing. The high birth rate in the country has been a hindrance to achieving the Millennium Development Goals (MDGs) particularly goals on reducing infant and maternal mortality rate and eradicating extreme poverty and hunger.

However, through extensive advocacy and with the support of traditional leaders and politicians, there is a possibility that the fertility rate can be markedly reduced by at least half, and this will bring improvements in those aforementioned indices. The reason for this improvement will be that families will probably have sufficient resources to seek healthcare and get their children educated simply because their families are smaller in size. Nigeria’s political structure and revenue distribution among states depends on the population distribution and this has undermined efforts at population control in the country. However, in the view of the obvious population crisis the country is facing, the government urgently needs to put in place policies to decrease the fertility rate by reducing early marriages, early childbearing, increasing the use of contraception and bringing the issues of the population explosion to light for frank political discourse.

Trying to fix public health problems like infant mortality and maternal mortality without addressing this population problem directly (especially the extra-high fecundity) is like trying to fill a basket with water under a running tap. And Nigeria has a great chance to actually start addressing the issue now that a respected Nigerian, Prof. Babatunde Osotimehin leads the United Nations Population Fund (UNFPA).


REFERENCE
National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro. Available online at < www.measuredhs.com/pubs/pdf/GF15/GF15.pdf> [Assessed on 3 Nov 2010].

ON EDUCATION AND THE NIGERIAN DREAM…

Once upon a time, there was a Nigerian Dream…

Knowledge is power was the motto of my primary school and the previous national emphasis on education and on its power to change earning potential and social circumstance, literally transformed people’s lives. Available data shows that 1 - 3 years of maternal schooling reduces child mortality by 15% (Abel-Smith, 1994). Houseboys and girls rose to become lawyers and doctors, people born in penury benefited from the free qualitative education policies of the past. And the vast majority of the past generation had great tales to tell of how hard work, perseverance and diligence brought them from rags to riches. That was the age of the 70s and 80s...

Unfortunately today, the story is different. Quality education in present times can only be afforded by the rich. At all levels, education has been bastardized and confused. An example in point is the recent policy by government to cancel Junior Secondary classes in all unity colleges. The Unity Colleges were previously one of the success stories of the Nigerian Educational System and fostered the ideals of the Nigerian Dream. Government sponsored quality education relieved the burden on struggling families...

The Nigerian Dream was that if you got educated, worked hard and persevered, you’ll make it. Unfortunately today, government policies have destroyed the educational system and the corruption is so dense and unemployment so high that even when one obtains the education at great personal cost and sacrifice, there is little hope of getting a job that can provide one with the tools to pursue his happiness.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness. That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed. THAT WHENEVER ANY FORM OF GOVERNMENT BECOMES DESTRUCTIVE OF THESE ENDS, IT IS THE RIGHT OF THE PEOPLE TO ALTER OR TO ABOLISH IT, AND TO INSTITUTE NEW GOVERNMENT, having its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness”.
- The American Declaration of Independence.

What is the function of Government with regards to education and the Nigerian dream? I think the passage above answers that question...


________________________________________________

Abel-Smith, B., 1994. An Introduction to Health Policy, Planning and Financing. New York, US: Longman Group Limited.

DREAMS OF MY BELOVED COUNTRY

Recently, someone said, "God wants us to dream great dreams". And I smiled to myself, because I've been dreaming for so long and the reality is nearer...

I've dreamt of the people of my beloved country, finally realizing that they have been shortchanged for in the last 12 years, demand for the CHANGE that they deserve.

I've dreamt of integrity returning to our schools, hospitals, police stations and courts.

I've dreamt of roads being built and awarded contracts being executed faithfully.

I've dreamt that those who stole in the past were caught, tried and convicted and stolen monies were returned to government coffers - and the new leaders willingly chose to steal no more.

I've dreamt that the weak and helpless, the children and the youth had hope returned to them.

I've dreamt that clean water ran from taps and water-borne diseases became a thing of the past.

I've dreamt that the gutters were cleaned up, proper sewage disposal systems were put in place and stagnant water for mosquitoes became a thing of the past.

I've dreamt that the electricity problem was finally fixed and children born in the coming days never knew what it signified to shout for joy when epileptic electricity was restored.

I have dreamt...

NOW IS THE TIME FOR ACTION...Don't you want these dreams to come true? Vote Wisely next month...

This is where the healing begins...This is where our healing starts...

Suffering Children

(I wrote this piece about 2 years ago when I was doing a rotation in Paediatrics...the pain the children face is REAL...like Michael Jackson said, "...let's make the world a better place..." and I would add, "...especially for the children")

He was supposed to be twelve but he looked more like six. He was obviously tired of life because of all the suffering. His eyes were a deep yellow and he wore a gross sigh that showed despair. He was in a lot of pain and had to sleep in a sitting position every night because if he lay down, his lungs will fill with fluid and threaten his very breath. He suffers from sickle cell anaemia and today he was having a clinical picture of acute kidney failure.

Suffering Children have done nothing to deserve all the pain they go through. It saddens my heart whenever I see a child with Paediatric HIV - suffering for a virus he knew nothing about, practically did nothing wrong to get and did not deserve. Children with severe malnutrition - brought into the world to literally die of hunger. Children with cancer - many of them not even marking their second birthday but yet doctors declaring that they can't possibly see the next one.

I feel sometimes the parents are to blame. For example, when a man and his wife decide to forgo family planning and start having numerous children for whom they provide little or nothing and these children fall victim to severe malnutition diseases (such as marasmus and kwashiokor, where the ribs stick out and the child is so weak that he can barely eat even when food is brought to him). Such parents are not being just and should not be allowed to allow innocents to suffer. Another example is when two couples in love who are carriers of the recessive sickle-cell gene forgo the reality of sickle cell, tie the nuptial knot and end up in misery two years later when they have a child with the sickle cell disease who has to endure so much pain and suffering for much of his usually short life span. I therefore plead with would-be-parents to please consider what it takes to bring up a child and make up their minds to give these ones the best and if they are not able to, please remain single and don't jeopardise another's future and bring someone into sorrows and anguish.

However it must be said that sometimes the parents and the child are not at fault and an example is the case of a six month old infant who has bilateral eye cancer and in the best case scenario is blind for life as both eyes must be removed by surgery and in the worst case scenario dies before the age of five after a protracted battle with the cancer. That is why a campaign must begin for childhood cancer to be treated for free in our hospitals. Both the government and the private sector must join hands to make this possible. I have seen children die of cancer because they couldn't buy the next course of cytotoxics that cost N20,000 ($150) that may have given them a chance - this is unjust and unfair. A bank recently gave away N50 million ($350,000) as prize money in a promotion and GSM companies give out millions in their numerous extravaganzas but a fraction of that sum will make a difference in the life of thousands of little children.

Make a difference today.

"...AND OF SOME HAVE COMPASSION, MAKING A DIFFERENCE" Jude vs 24

DEMANDS WE NEED TO START MAKING (Part 1)
Let "them" set an agenda...

In my last post, I tried to emphasize the fact that Tunisians knew they deserved more from their government and they rose to make their demands known. Nigerians on the other hand, even though being far more short-changed by their leaders and politicians (with a poorer quality of life compared to Tunisians) have failed to react to the gross under-performance of government. It is clear that this attitude needs to change and indeed, we need to start making demands of our leaders and would-be leaders. In this following series of articles, I would like to suggest practical demands we can start making from leadership in Nigeria at different levels.

The next few months are going to be full of activity as the political campaigns start since most parties have conducted primaries. Jingles will hit the airwaves, there will be political rallies in different towns and a lot of money will be spent on persuading would-be voters. However, this time, can we DEMAND that our would-be leaders tell us exactly what they want to do? Since my childhood, political manifestos have always seemed too good to be true...implausible and ridiculous even for my gullible mind. The politicians promise health for all, housing for all, free education, constant electricity (I wonder which countries in the world still promice their people electricity during elections? maybe somalia?), potable water for all, peace and prosperity, etc. (...they could as well promise heaven and streets paved with gold for all we care...). Of course when they get into power, they can't achieve any of these because they were not realistic targets; they were more like dreams or hallucinations.

We need the political campaigners to set out in a realistic manner what they intend to do with the given resources and the time span it will take to achieve these targets. Government income figures are available and they can show us how they intend to spend money in the first year of their government as well as subsequent years and the projects they intend to embark on. We don't need open blanket statements like, "I will work on the health sector"; No!!! What we need is specific, realistic, time-bound projects; like, "I will build a kidney transplant centre which will cost such and such within 18 months" or "I will generate 4000MW of electricity at a cost of such and such within 12 months". We want to see REALISTIC PLANS from the campaigners. We need them to tell us specifically what they intend to do for the Niger Delta. SPECIFICALLY. For example, "I will complete the abandoned East-West road to the tune of so and so amount within 12 months using so and so funds". We need them to tell us their strategies. Are they going to raise money from better taxation? The Federal Government revenue is about $30 billion every year depending on crude oil prices. How can they increase this with taxation? especially of the rich who do not pay taxes in Nigeria? What will import duties look like under their government? Defense spending (on the Army, Navy, etc) is a large part of the budget. Will they reduce it? What are they specifically going to do about the police? Are they going to increase funding and training? in which areas? We need specifics.

Unfortunately, elections in Nigeria have usually not been about substance, but about tribalism, sentiment, and emotional baggage. This time however, we have a right to make demands as the electorate. We can't be taken for a ride again. Mallam Nuhu Ribadu is the only candidate who has enunciated clearly his plans in a well written manifesto available online. However, his write up is not specific and he does not tell us how much he thinks the projects he has in mind will cost and how long they will take to be achieved. We need our candidates at all levels - Presidential aspirants, Governorship aspirants and Legislative aspirants to set out an agenda. They should tell us what they intend to do and how they intend to do it. This is necessary so that we can hold them accountable when they get into office. It also helps them to have a sense of direction when they get into government.

WHY WE NEED TO WAKE UP...TUNISIA SHOWS THE WAY...

This write up was inspired by my friend UO who said and I quote, “On every single measure of human development, every single one of them, Tunisia far outclasses Nigeria; yet Tunisians had INSIGHT-they knew they were getting less than they deserved from their government". Nigerians have been short-changed for years…and it seems like the kleptomaniac leaders got bolder and bolder as the years went by. In the 1970s, the issue was 10%...most contracts were inflated by 10% and the leaders got the action in collaboration with corrupt civil servants. Today, it’s more like 100% and annoyingly the work is not done. How many times have “they” awarded Railway contracts, and yet the railways are not working? Or contracts for roads like the Onitsha-Enugu expressway, the Lagos-Benin expressway, etc, and the roads are still not finished. The recent contract of billions for upgrading the Enugu airport, shut down air access to the East for almost a year and when the airport was opened, what a disappointment !!! Indeed, the only state in the country that seems to be getting value from its leadership seems to be Lagos state. The masses of most other states are being taken for a ride by the government.

The recent happenings in Tunisia should tell Nigerians that they should expect more from their government. It is not immoral to expect government to govern, or spend the people’s collective resources on the people and people based services and not on parties in London hotels and school fees for the governor’s children. Like the drafters of the US “Declaration of Independence” wrote, “… whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness”. Tunisians acted because their government had become destructive of the ends of its existence. Government exists for the people and not the reverse and realizing this (thanks in no small deal to Wikileaks) enabled the Tunisians to demand what was theirs. Here are some comparative indices between Tunisia and Nigeria (from the WHO statistics archive).

Development Index	Tunisia	Nigeria
Population (millions)	10.1	151.2
GDP Per Capita (US $)	$7460	$1980
Life Expectancy (years)	75	49
Poverty Levels (% living on less than US$1/day)	2.6%	64.4%
Complete Immunization Coverage	99%	41%
Under-5 Mortality Rate (per 1000 live births)	21	186
Maternal Mortality Rate (per 100,000 child births)	60	840
% of Population with access to Potable water	94%	58%
Net Primary School Enrollment (%)	97.4%	64.5%

Once again, the data is irrefutable. Tunisia is miles ahead of Nigeria in development, per capita income is 4 times that of Nigeria, poverty levels are 32 times higher in Nigeria, yet the people in Nigeria have refused to demand development from their government. My heart is so sad that things are getting worse and no one seems to be concerned. 2011 beckons a season of hope and change and I hope we decide to take our destiny in our hands and at most level of government demand some level of accountability.

________________________________________

REFERENCE

World Health Organization, 2011. Global Health Observatory. Online Available at http://www.who.int/gho/en/