Rural health in Northern Nigeria: Some recent developments and problems

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Abstract
Sleeping sickness, despite the steady decline in cases diagnosed, is in a highly active state. Frequent outbreaks are associated with a variety of circumstances:- population overspill into unfarmed land; migration of infected people eastwards from the Benue zone; redistribution of habitations along roads; vegetation regrowth in previously cleared areas; man-made transmission points; and factors unknown. Control of the disease needs careful tailoring to each circumstance—and enough cloth. Tsetse may be difficult to control, but modern man can be a determined rover, fickle of fancy, and we dare not risk blunting the weapon of pentamidine prophylaxis—which alone protects the minefield labourers of Jema'a and Wamba—by use on mobile or unenthusiastic populations. Some outbreaks respond well to medical surveys and treatment alone, others but slowly to the most intensive efforts of medical and entomological control teams; in some cases the part played by each is difficult to determine. Large-scale tsetse eradication efforts in the far north give early promise of success in a vast fertile area; elsewhere fly control problems have often still to be solved, and the large trypanosome reservoir of the Tiv shows in the meantime little sign of upsurge or of drying up. The slow eastward extension of this zone along the Benue, and along new roads further south, has been closely watched, treated, and for the present controlled; but quite incontinently, 2 outbreaks to the north-east have now spotted our maps, extending the known limits of human trypanosomiasis and throwing down the gauntlet to our surveillance system. The need for fundamental research on the use of insecticides against Glossina , and on the detection of low fly densities, is as urgent as ever. For the present we can improve the diagnosis of the different stages of sleeping sickness, in order that treatment with existing drugs can be more favourably manipulated to reduce the incidence of relapses; selected staff have shown good promise of being able to achieve this, and have shown a most intelligent response to the need for more selective surveys. Schistosomiasis is so common that we need not fear its increased prevalence in local people near irrigation schemes, and so mild in manifestation that we do not certainly know whether it is much to be feared at all. Reports of severe visceral damage in East Africa, with as little clinical effect as in Nigeria, are watched with growing wonder, while we try to detect any rise in mean S. mansoni egg output at Bacita—regretting the inconstancy of worms in their relationships with man. Ancylostomiasis is another common infection which is not a proved cause of mass morbidity in most of Northern Nigeria. Meningitis morbidity is easily measurable in terms of death, which comes to a minority probably of about 11% of sufferers; little else can be certain about the majority of cases notified from rural areas during non-epidemic periods, especially, when the meningococcus is responsible for only a minority of properly diagnosed hospital cases. In between major outbreaks, meningitis seems now to persist at a higher level than formerly, and its behaviour is less predictable. Of the Mass Campaigns, malaria control shows no immediate prospect of proceeding to eradication but it is probably achieving a significant effect on health; the leprosy campaign probably embraces about half the sufferers in the Region—and in certain areas a much higher proportion; and yaws, after 12 years of constant endeavour by the major part of the medical field units, appears to have been brought to the verge of extinction. Circumscribed outbreaks of two unidentified diseases, each with a high mortality, are described.

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