Principles of Public Health

Second Assessment Point

Topic

Health Needs Assessment for Rural Communities in Borno State, Nigeria

By

Ugochukwu Daniel Nwachukwu

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Principles of Public Health - UPGPBHM01-19391

August 20th 2020

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Health Needs Assessment is a prerequisite for proper health decision taking by relevant

stakeholders. it helps to identify the major causes of health problems within the area under

review and also decide on best steps to mitigate these risk factors while considering the culture,

age group distribution, gender issues, economic conditions and other factors within the

population. HNA involves a thorough identification of the target population, understanding

important health and demographic indices within the population, identifying most urgent actions

that needs to be taken based on the identified indices, planning, execution and assessment of the

impact of the programs executed.

Public Health Actions, decisions and programs will be of little or no impact to a greater

population if a thorough Health Needs Assessment is not carried out. HNA ensures that

resources are channeled to programs that has most impact to majority or people facing the

highest risk and most vulnerable within the area being reviewed.

A critical study of the health situation in Rural communities in Borno State just like most states

of Northern Nigeria shows an urgent need for attention and thoroughly planned response by

government and other relevant stakeholders. Borno State suffers the highest health risk (UNDP,

2017) of diseases like Cholera, Malaria, HIV, Meningitis and other diseases due to a

combination of factors like lower literacy, cultural beliefs, poor rural road network, next to no

electricity in villages, poorly equipped primary health centers and violence.

The lingering conflict in North Eastern Nigeria continues to devastate the lives of civilians,

resulting in a humanitarian crisis affecting 7.7 million women, men and children who are all in

acute need of help and protection. Since the start of the conflict in 2009, more than 20,000

people have been killed, more than 4,000 people abducted and 1.7 million remain displaced,

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most of them in Borno State. (UNICEF, 2020), In order to give the much needed support, a

thorough Health Needs Assessment has to be carried out.

Population and Ethnic Groups

Borno state is located at the North Eastern tip of Nigeria with international borders with Niger

Republic, Chad and Cameroon. She is home to various ethnic groups including the Kanuri,

Shuwa, Babur-Bura, Marghi, Gwoza, Higghi, Kanakuru, Kibabku and Hausa-Fulanis. The

State’s population grew from 2,536,003 in 1991 to 4,171,104 in 2006, which represents about

3% of the country’s population at the time, and a land mass of 72,609 Square Kilometers, (NBS,

2006).

Table 1: Population of Borno State by Local Government Areas 1991 and 2006

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Health Indices

According to Nigeria Bureau of Statistics (2017), Borno State has a life expectancy at birth of 42 years for

males and 48 years for females, with a fertility rate of 4.8. The state recorded an infant mortality rate of

42 deaths per 1000 live births and total under-five mortality rate of 82 deaths per 1000 live births (NBS,

2017), and a maternal mortality of 1,549 per 100,000 live births (BM Audu et al, 2010).

As at 2016, a total 59,410 person were living with HIV in the state, a decline from 62,642 recorded in

2013. 10,764 of these patients in 2016 had access to anti-retro viral treatment in 2016 against 20,329 in

2013 (NBS, 2017) – thus showing a decrease in HIV infections and a decrease in access to treatment.

Mobidity Data

Fig 1. Infectious Diseases prevalent in Borno State

Source: Borno State Health Sector Bulletin

According to a survey carried out by the state ministry of health, the leading cause of morbidities in the

state is Malaria which is responsible for about 53% of all morbidities, this is followed by Acute

Respiratory Infections (ARI) with 14%. 50% of ARI cases where reported among children 5 years and

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below.

Measles also recorded about 10% of all morbidities in the state. 58% of suspected measles cases had

recieved no dose of measles vaccination and 71% of all measles cases were children under 5 years of

age. Other causes of hospitalizations includes water diarrhea taking 8% of morbidities, Severe

malnutrition, bloody diarhoea, mental health and other causes.

Mortality Data

Fig 2. Leading causes of health-related deaths in Borno State

Source: Borno State Health Sector Bulletin

Neonatal disorders remains the leading cause of death in Borno State, causing over 13% of health

related deaths, other causes of death are lower respiratory infection with over 12% and malaria with

over 9%. Others are diarrheal diseases, HIV/AIDS, meningitis, tuberculosis, mal nutrition, iron deficiency

and measles.

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Behavioral Issues

Borno state just like most states has high percentage of young people who are given to cigarette

smoking and substance abuse. In a survey carried out by Hammagabdo et al (2018), 400 respondents

were interviewed on their use of cigarette and symptoms associated with cigarette smoking which they

feel (if any), The following results where obtained.

Table 2: Prevalence of cigarette smoking among the study population

Table 3: Knowledge of Symptoms Associated with Cigarette Smoking

Socio-economic issues

Borno state is has a high population of adults with little or no education, it has a literacy level lower than

the national average (NBS, 2006). Illetracy and resistance to western ideas makes people take wrong

decisions in health issues. Such decisions as refusal to have children immunized, refusal to attend

antenatal care when pregnant, etc.

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Table 4: Literacy Rate in Borno and 9 other states in Nigeria

Source: UNESCO

Health inequalities

Just as in other states, the rural communities in Borno state suffer intense inequality in health delivery.

Some areas have a rough terrain making it difficult to access, some have been ravaged by violence while

others have little or no basic amenity to live on, including but not limited to pipe borne water, Primary

Health Centres, electricity and motorable roads.

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Understanding the Information taken

According to the Borno State Ministry of Health (2016), the illness with most mortality is

neonatal disorders, followed by lower respiratory infection, malaria, diarrhea, HIV/AIDS among

others. Furthermore, 50% of all malaria cases were reported among children under 5 years.

Measles had 71% cases among children under 5 with 58% percent having no single dose of

measles vaccination.

From the reports gathered, it could be presumed that the risk factor leading to deaths in the state

include but not limited to poor maternal health for pregnant women, poor hygiene, mosquito

infested communities, unsafe drinking water, unsafe sex, poor nutrition, non-immunization

among other factors.

Setting Priorities

A large chunk of morbidities and mortalities in the state is reported among children. Care has to

be geared to protect the children in the state. It is also very important to ensure pregnant women

get all the needed care they need to curb the spate of neonatal disorders. Control of mosquitoes in

the environment is another important part of the response to be planned, ensuring children are

immunized, steady supply of Anti-retro viral drugs to designated clinics, water and sanitation

facilities.

Health care Program Planning

Health care program for the state should start by rebuilding and equipping Primary Health

Centers in villages and ensuring there is accessible road leading to Maduguri. This is to ensure

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that pregnant women get the care they need in good time, also communities should be educated

on the need for antenatal care during pregnancy so as to reduce the leading cause of death –

neonatal disorders. Health workers should be given incentives to live and work in rural

communities considering the harsh living conditions in those areas.

The health program will also be aimed at eradicating breeding places for malaria causing

mosquitoes. This can come in the form of fumigation, clearing of stagnant waters and

distribution of treated mosquito nets in communities. The federal and State governments should

also subsidize the most potent Anti-malaria drugs so as to make it affordable for the poorest of

the poor. Care for Cholera patients should also be provided and potable water provided in

communities with reported cases. The Water, Sanitation and Hygiene (WASH) Program in the

state should be re-activated to ensure every household and public facility has a functional toilet

and a total end to open defecation.

The reports on HIV/AIDS showed about 50% drop in the number of HIV patients who have

access to Anti-retro viral treatment from 2013 to 2016. This dangerous situation deserves speedy

response, more dangerous is the fact of the 59,410 recorded cases of HIV, only 10,764 have

access to ARV treatment. More funds should be disbursed for procurement of ARVs in the state

to meet the over 80% of HIV patients who do not have access to ARV treatment.

Part of the activities in the health program should be routine immunization for children under 5

years old. All the required vaccines should be made available for children especially in Internally

Displaced Persons (IDP) Camps.

Community and religious leaders should be lectured on the adverse effect of tobacco smoking

and substance abuse. Security agencies should also be motivated to follow the supply chain of

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these illegal commodities and clamp down on the purveyors. Sale and consumption of hard drugs

should be banned in communities, this does not only promote good health, it also reduces crime.

Most importantly, a Universal Health Insurance System which insures rural dwellers should be

put in place to reduce the financial burden of healthcare. This is because poverty remains the

leading cause of death in rural communities (Bolatito A, 2018). The rich can afford all the

diagnosis and healthcare they need, this is not the same for community dwellers, they should be

insured in some kind of arrangement where they can access healthcare from their community for

a fraction of the cost.

In conclusion, Borno State having been the epicenter of terror-related violence in Nigeria have

suffered huge civilian casualties, displacements all of which pose a major health risk to the

survivors. The government besides her duty to provide security of lives and property also owes

the people a well-articulated health care delivery. Infant and Maternal health should be

prioritized along with roll back malaria programs in the communities, WASH program which

ensure potable drinking water and toilets for communities. Anti-retroviral treatment should be

provided at subsidized rates, routine immunization should be continuous operation in

communities and community inclusion in health insurance will make healthcare available and

affordable in rural communities.

Word Count: 1730

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Reference List

Ahmed Hammangabdo et al. (2018), Prevalence and factors influencing cigarette smoking

among young adults in a tertiary institution in Borno State, Nigeria, Available at:

https://www.researchgate.net/publication/329477740_Prevalence_and_factors_influencing_cigar

ette_smoking_among_young_adults_in_a_tertiary_institution_in_Borno_State_Nigeria

(Accessed: 19 August 2020).

BM Audu et al. (2010), Trends in maternal mortality at University of Maiduguri teaching

hospital, Maiduguri, Nigeria - A five-year review, Available at:

http://www.nigeriamedj.com/article.asp?issn=0300-

1652;year=2010;volume=51;issue=4;spage=147;epage=151;aulast=Audu (Accessed: 19 August

2020).

Bolatito A. (2018), Poverty and maternal mortality in Nigeria: towards a more viable ethics of

modern medical practice, Available at:

https://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-7-11 (Accessed: 20 August

2020).

Borno State Government. (2016), Borno State Health Sector Bulletin # 04. Health Sector

Nigeria.

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Borno State Government. (2016), Borno State Health Sector Bulletin # 07. Health Sector

Nigeria.

Nigeria Bureau of Statistics (2017), Statistical Report On Women And Men In Nigeria,

Available at: https://nigerianstat.gov.ng/download/784 (Accessed: 19 August 2020).

UNDP. (2017), Accelerating Development Investments in Famine Response and

Prevention - Case Study North East Nigeria, Available at:

https://www.undp.org/content/undp/en/home/librarypage/crisis-prevention-and-recovery/

accelerating-development-investments-in-famine-response-and-prev.html (Accessed: 19 August

2020).

UNICEF (2017), how UNICEF is supporting the Government of Nigeria to respond to

emergencies especially in northeast Nigeria, Available at:

https://www.unicef.org/nigeria/emergencies (Accessed: 19 August 2020).

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