By: Chiwuike Uba
It is no longer news that Nigeria is currently classified as one of the most polluted countries in the world. Despite the poor environmental condition, the Government has no clear road map and ‘will-power’ to reduce and manage our environment for better breathing and better living. According to World Health Organisation (WHO), outdoor air pollution is a major environmental health problem affecting everyone in developed and developing countries and consequently, by reducing air pollution levels, countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma.
Overall asthma management framework therefore requires great attention to the environmental exposures (indoors and outdoors) and control practices. The indoors environment exposures which contain both pollutants (e.g, particulate matter, nitrogen dioxide, secondhand smoke, and ozone) and allergens from furred pets, dust mites, cockroaches, rodents, and molds have been associated with decreased lung function, greater respiratory symptoms, and more frequent use of rescue medications among children with asthma. In addition, indoor environment exposures have been linked to inflammation in asthma—elevated exhaled nitric oxide concentration (a marker of airway inflammation) associated with an elevated PM2.5 concentration.
Outdoor environment exposures include particulate matter, ozone, nitrogen oxide, sulphur dioxide, pollen allergens, and air pollution. These environment exposures have been associated with higher mortality in the general population. In addition, the outdoor environment exposures have been linked to exacerbations, chronic symptoms, and decline in lung function; this includes greater risk of hospitalizations for childhood asthma.
Specifically, the ozone which is generated by the chemical sunlight on mixtures of Nitrogen oxide and hydrocarbons from fossil fuel combustion arising from vehicular traffic, power plants and industrial operations increase airway inflammation and hyper-responsiveness. These are associated with reduced lung function; increased symptoms, increased rescue medication use, and increased risk of asthma exacerbation. Second hand smoke caused primarily by automobile exhaust, local industry, power plants, and forest fires is associated with increased asthma symptoms, exacerbations, and hospitalizations, and with lower lung function, particularly in vulnerable populations, including young children and the elderly. A reduction of traffic density in a geographic region is also associated with reduced asthma morbidity, which may be partially mediated by the lowering of NO2exposure.
Furthermore, sulfur dioxide (SO2) mainly formed by the combustion of high-sulfur coal or oil has been allowed to continue in Nigeria for so long. Experimental studies suggest that SO2 can decrease lung function in exercising adults with asthma. A clear example of this is the continuous and continuing gas flaring in Nigeria. It is worrisome that currently, there is no well-articulated and followed-through government policy in Nigeria to reduce the level of pollution in Nigeria, even when Nigeria was rated as the most polluted country in the world as at 2015.
Whereas people may have a greater ability to modify indoor environmental exposures, in most cases, they do not have direct control over outdoor pollutant concentrations. The control of both indoors and outdoors environment exposures therefore become the key ingredient and responsibility of government and outcome of governance (either good or bad).
According to WHO, air pollution is responsible for more than 12million deaths per year. Painfully, deaths due to non-communicable diseases, such as asthma, stroke, heart disease, cancer and other respiratory illness is about 8.2 million or nearly two-thirds of the deaths resulting from unhealthy environments. Currently, it is estimated that more than 15 million Nigerians have asthma with about 5-10% of children in any given community suffering from asthma and this is expected to increase to more than 100 million in year 2025. Asthma as one of the world’s most common long-term conditions is currently affecting over 300 million people worldwide and projected to increase by another 100 million people by the year 2025. As a non-curable disease, management strategies are geared towards controlling the disease to reduce the associated morbidity and mortality.
Notwithstanding the availability of different asthma drugs, significant numbers of patients are still suffering from asthma while a significant number still dies from the disease. More so, an estimated 75% hospital admissions for asthma and as many as, 90% of the asthma deaths are avoidable. Painfully, in Nigeria, the estimated proportion of registered respiratory physicians to national population is 1 per 2.3 million individuals. This actually lends credence to the fact that part of the causes of increased mortality and morbidity is poor diagnosis traceable to poor governance and environmental management. In addition to other poor infrastructural issues, 13 States with an estimated combined population of 57.7million offer no specialist respiratory services. Nigeria has lost many illustrious people through asthma already and we need to stem the tide. Asthma is already an epidemic! The global burden of asthma is already substantial in terms of mortality, morbidity and economic costs. According to the recent Global Burden of Disease (GBD) study, Asthma is estimated as the 14th most important disorder in terms of global years lived with disability. Asthma, therefore, should be among the top priorities of Ministries of Health, development partners and CSOs when assessing health priorities, allocating resources, and evaluating the potential costs and benefits of public health interventions.
Most environmental failures are linked to governance failures. The inability of the Nigerian government to effectively enforce the anti-tobacco laws and other environmental laws lend credence to how poor governance leads to poor environmental outcomes. In addition, our development planning rarely takes into consideration the environmental goods and services–their benefits and the risks associated with environmental hazards. This, on the other hand, breaches environmental limits and who suffers as a result. Furthermore, there is an inherent weakness in the institutions responsible for natural resources and environment to keep up with development dynamics and to identify necessary investments in environmental information and management.
In conclusion, the problem of air pollution in Nigeria brings to fore lack of proper coordination between the administrative levels, political, legislative and economic interests and the citizens sensibilities. Painfully, the national and sub-national politics in Nigeria has not encouraged consolidated environmental governance. The governments are deeply divided along ethnic, religious and electoral lines.
Chiwuike Uba is the Chairman, Board of Trustees, Amaka Chiwuike-Uba Foundation (ACUF), and a Policy Analyst, PFM and Governance Expert. Mr. Chiwuike Uba can be reached at [email protected]