Attitudinal And Behavioural Aspects Of Epidemiology And Control Of Parasitic Diseases In Tropical Africa

Abstract

In my lecture to the College of Medical Sciences at the University of Benin last month (Ukoli, 1986), I made bold to propose that the prevalence of parasitic diseases (as well as other communicable diseases) should be included among the indicators for monitoring and evaluating progress made towards achieving health for all by the year 2000 in the less developed countries (LDCs) prescribed by the World Health Organization. In everyone of those indicators, Nigeria falls far short of expectation. Thus, as shown by Omene, the expenditure on health in Nigeria is way below the recommended 5% of the gross national product; the resources available are not equitably distributed and primary health care is not available to the entire population; owing to the poor nutritional status of the people, the incidence of low birth weight (LBW) in infants is still very high, double the recommended 10%; infant mortality at 150/1000 is still way above the prescribed limit of 50/1000, and life expectancy at birth is less than 50 years instead of rising above 60 years. When we add to this catalogue of woes the fact that the prevalence of all the most virulent parasitic diseases is still very high, and we have made very little progress towards eradicating, or in case this is not feasible, controlling or preventing them, the conclusion is inescapable that the attainment of the slogan “health for all by the year 2000” is a pipe-dream as far as Nigeria is concerned (Ukoli, 1986).

High prevalence of parasitic diseases, along with poverty, ignorance, and hunger are indisputable indices of under development. But just as explicit is the fact that these LDCs lack the material, manpower, and technological resources to grapple with and overcome these problems. Where such resources are available, they lack the capacity to mobilize them effectively or the will to formulate rational policies and the drive to ensure their successful implementation. Consequently in the case of parasitic diseases, rather than succeeding in minimizing their impact, the LDCs in tropical Africa are experiencing an increase in their prevalence and severity which thereby continue to constitute the greatest threat to the health and socio-economic status of the people (Ukoli, 1984).

But even more intriguing is the fact that control of these diseases is within our reach; in fact all that is needed to be known for the successful application of the various control measures is already common knowledge. Thus the salient features of the parasites and their intermediate hosts and vectors which enhance the spread of the diseases and whose manipulation will procure control have been known for decades, and have been successfully exploited in eradicating the diseases in the advanced countries. Admittedly, changes in the socio-economic status of the people in these countries, which find expression in improved sanitation, better nutrition, and increased awareness of the aetiology of the diseases, have contributed significantly towards their eradication and control. In tropical Africa, parasitologists have made significant contributions, through research, to knowledge about our environment and its parasitic fauna and their hosts. However, such research does not appear to have resulted in the development of fresh insights into the problems nor has it provided a new thrust for the generation of novel and original ideas for control. It is as if all our efforts have ended up merely characterizing our local conditions and at best corroborating, verifying, and reinforcing the already available knowledge forming the basis of well-established control strategies (Ukoli, 1988). Moreover, many studies conducted on problems of disease, whether they achieve breakthroughs or not, are likely to remain mere academic exercises with little practical or policy impact, for the simple reason that we are yet to evolve effective ways of managing and utilizing research findings