HEALTHCARE MANAGEMENT AHM-608-Further

Reading:

1. PREVENTION OF HIV AND CARE OF PEOPLE LIVING /AFFECTED BY HIV/AIDS

Learner Objectives
At the end of this session, participants would be able to:
1. Enumerate the basic preventive measures for the control of HIV/AIDS
2. Describe the ways to care for People living with HIV/AIDs (PLWHA) and
people affected by AIDS (PABA)
Introduction:
HIV stands for Human Immunodeficiency Virus, a germ which when it infects
human beings may lead to a condition known as AIDS. AIDS stands for Acquired
Immune Deficiency Syndrome, a disease condition associated with repeated
infections resulting from a totally weakened immune system. HIV is spread
through sexual intercourse with an infected person, infected blood and
instruments and from infected parents to their babies during pregnancy,
childbirth or breastfeeding. About 90% of HIV/AIDS cases in children are a result
of parent–to–child transmission.
This is increasingly becoming a challenge in this environment which threatens to
reverse the gains of child survival programmes. Although no cure is currently
available for HIV/AIDS, it can be prevented and managed. People living with
HIV/AIDS need care and support from their families and communities.

Key Messages – Prevention of HIV/AIDS

 HIV is human immune-deficiency virus.
 AIDS is Acquired Immune Deficiency Syndrome.
 HIV may be spread through sexual intercourse.
 HIV can also be spread through the sharing of infected objects e.g. blades,
needles.
 HIV can also be spread from a HIV positive parent to a baby during pregnancy,
childbirth and breastfeeding.
 HIV/AIDS can be prevented and managed but there is no cure yet.
 The increasing number of deaths of People Living with HIV/AIDS (PLWHA) has
resulted in increasing numbers of orphaned children.
Additional Information
 AIDS is a disease that occurs due to infection with HIV
 You can avoid HIV Infections through:
 Abstinence (not having sex).
 Having only one faithful sexual partner who is not infected.
 Proper and consistent use of condoms.
 Getting proper treatment for sexually transmitted infections
 Avoiding the use of non-sterile sharp objects e.g. use of blade for
scarification.
 Using disposable injection syringes and needles.
 Ensuring that blood for transfusion is screened for HIV.
 Prevention of HIV/AIDS is important. Depending on the stage of the infection,
HIV positive persons may not display any observable signs of infection but are
nevertheless capable of transmitting the virus.
 Parent to child transmission of HIV/AIDS can be prevented by:
 Ensuring that men and women of child bearing age avoid getting infected
with HIV. This can be achieved by giving HIV prevention messages to this
group of persons at appropriate fora.
 Encouraging people of child bearing age to know their HIV status
 Making sure that HIV positive pregnant women have adequate access to
services that limit transmission of HIV to babies such as the use of anti-
retroviral (ARV) drugs; caesarean section and providing access to ARV drugs
for babies within 48 hours of birth.
 Proper counselling of HIV positive pregnant women on infant feeding
options.
 HIV weakens the immune system of infected persons making them prone to
repeated infections which lead to the collapse of their immune systems and
full blown AIDS
 If preventive measures are not taken, HIV can infect a whole generation
 Appropriate advice regarding HIV/AIDS can be obtained through voluntary
counselling and testing in the community.
 It is advisable that everybody seeks voluntary and confidential counseling and
testing (VCCT) on HIV/AIDS since anybody can be infected. VCCT should be
provided within the community. It is important for individuals to visit the VCCT
centre to know their HIV status. HIV testing and counselling is especially
important for people who are preparing for marriage or for a baby.
Key messages – Care for people living with HIV/AIDS
 Provide adequate diet for PLWHA.
 Encourage PLWHA to seek proper health care when any symptom appears
 People living with HIV/AIDS can be helped with some known drugs.
 Families should care, love and support PLWHA (e.g. financial, moral, material
support.
Additional Information
 HIV/AIDS is not contracted by sharing plates or cutlery, eating or shaking
hands with an infected person. Neither can it be contracted through hugging,
or using the same toilet with PLWHA. HIV/AIDS is not transmitted through
mosquito bites.
 PLWHA need improved diet. Encourage them to take lots of fluids, and eat lots
of vegetables, fruits etc.
 Families and communities should discourage HIV/AIDS stigmatization and
should not discriminate against PLWHA.
 PLWHA can get drugs from designated places or centres.
 Families and communities should give support to orphans; especially those
whose parents died of HIV/AIDS and also children living with HIV/AIDS
 Couples that are infected (both partners) should still use condoms every time
they have set because:
  They may be infected with different types of the virus and cross infection
may occur.
 A larger dose of the virus can be transmitted which may accelerate the
onset of AIDS (Increase in viral load).

2.WHAT IS LASSA FEVER?

Lassa fever or Lassa hemorrhagic fever (LHF) is a viral haemorrhagic illness,
caused by contact with vector rodent (rat), food or household items contaminated
with rodent urine or faeces. It is an epidemic prone disease. Just a single case is
already an epidemic. The Lassa virus can be spread between humans through direct
contact with blood, urine, faeces, or other bodily secretions of a person infected
with Lassa fever.
Where is Lassa fever found?
The illness was discovered in 1969 when two missionary nurses died in Nigeria.
The cause of the illness was found to be Lassa virus, named after the town (in the
Yedseram River valley) Bornu State, North East Nigeria where the first cases
originated during a nosocomial (originating from a hospital) outbreak at a local
hospital.
Lassa fever is an endemic disease in portions of West Africa. It is recognized in
Guinea, Liberia, Sierra Leone, as well as Nigeria. However, because the rodent
species which carry the virus are found throughout West Africa, the actual
geographic range of the disease may extend to other countries in the region.
In areas of Africa where the disease is endemic (that is, constantly present), Lassa
fever is a significant cause of sickness and deaths.
In what animal host is Lassa virus maintained?
The rat species Mastomys, in particular, M. natalensis. This is a consistent host
reservoir for the Lassa virus because of congenital neonatal infection (infection at
birth), which results in rats with long-lasting and/or lifelong infection. Because of
the mechanism of infection, there is no break in the natural chain from virus to host
species. The rats themselves might show no symptoms of the disease, but they
shed the virus freely in urine and droppings, and secrete the virus in their saliva.
Mastomys rodents breed very frequently, produce large numbers of offspring, and
are numerous in the savannas and forests of West, Central, and East Africa. In
addition, Mastomys generally readily colonize human homes. All these factors
together contribute to the relatively efficient spread of Lassa virus from infected
rodents to humans.
How do humans get Lassa fever?
There are a number of ways in which the virus may be transmitted, or spread, to
humans.
The Mastomys rodents shed the virus in urine and droppings. Therefore, the virus
can be transmitted through direct contact with these materials, through touching
objects
or eating food contaminated with these materials, or through cuts or sores.
Because Mastomys rodents often live in and around homes and scavenge on
human food remains or poorly stored food, transmission of this sort is common.
Contact with the virus also may occur when a person inhales tiny particles in the
air contaminated with rodent excretions.
This is called aerosol or airborne transmission.
Finally, because Mastomys rodents are sometimes consumed as a food source,
infection may occur via direct contact when they are caught and prepared for food.
Lassa fever may also spread through person-to-person contact. This type of
transmission occurs when a person comes into contact with virus in the blood,
tissue, secretions, or excretions of an individual infected with the Lassa virus.
The virus cannot be spread through casual contact (including skin-to-skin contact
without exchange of body fluids). Person-to-person transmission is common in
both village and health care settings, where, along with the above-mentioned
modes of transmission, the virus also may be spread in contaminated medical
equipment, such as reused needles (this is nosocomial transmission).
What are the Signs and Symptoms of Lassa fever?
Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient
comes into contact with the virus. These include fever, retrosternal pain (pain
behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting,
diarrhoea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and in
the most severe cases, individuals may bleed from the mouth, nose, eyes or other
parts of the body. .
Neurological problems have also been described, including hearing loss, tremors,
and encephalitis (inflammation of the brain).
Because the symptoms of Lassa fever are so varied and nonspecific, clinical
diagnosis is often difficult.
How is Lassa fever treated?
There is yet no known vaccine against the fever. All persons suspected of Lassa
fever infection should be admitted to isolation facilities and their body fluids and
excreta properly disposed of. The WHO last year has stated that early
administration of Ribavirin helps in the management of Lass Fever. Once there is
a case, history is taken to find out if the person has been out of the state or not.
Such information is crucial in assisting epidemiologists about notification of the
disease outbreak. All persons that have had contact with the Lassa fever patients
are traced and placed under observation.
How is Lassa fever prevented?
Although there is no vaccine currently available for Lassa fever, the disease can be
prevented and is treatable. Adopt the following measures:
 Get the facts: Get the factual and correct information on Lassa fever from
social media, radio, television and newspapers. Be knowledgeable about
how to respond to outbreaks. This helps minimise fear.
 Avoiding contact with Mastomys rodents: Primary transmission of the
Lassa virus from its host to humans can be prevented by avoiding contact
with Mastomys rodents, especially in the geographic regions where
outbreaks occur. Infected rodents can spread Lassa fever through contact,
spitting, defecation or urination into foods or home utensils.
 Promoting and maintaining good community hygiene (clearing
surrounding, proper disposal of wastes and junks, etc.) serve as deterrent to
rodents. The house should be kept clean while grains and other foods should
be stored away in rodent-proof containers to discourage rodents from
entering homes. Washed but exposed plates in the kitchen should be
rewashed before use. Drying food, fish or meat at the roadside exposes them
to rodents. Using these rodents as a food (bush meat) source is should be
discouraged.
 Food hygiene & storage: Avoid consuming raw grains. Cook all grains
well before consumption. Safer methods should be adopted for food
processing and storage. Farmers in rural communities need to avoid sun-
drying farm produces on bare ground and/or road sides as these are
opportunities for rodents to perch on these products that will eventually be
processed into food.
 When caring for patients with Lassa fever, further transmission of the
disease through person-to-person contact or nosocomial routes can be
avoided by taking preventive precautions against contact with patient
secretions. Such precautions include wearing protective clothing, such as
 masks, gloves, gowns, and goggles; using infection control measures, such
as complete equipment sterilization; and isolating infected patients from
contact with unprotected persons until the disease has run its course.
 Early reporting: Familiarity with the structure of public health facilities is
advised. Be in possession of the contact numbers of Primary Healthcare
officers and their locations. If you encounter or observe fevers that are not
responding to anti-malarial and antibiotics, or fever associated with sore
throats or bleeding, report promptly to the local government health officers.

What needs to be done to further address the threat of Lassa fever?

 Nationwide sensitisation and health education campaigns should be
embarked on to educate people and ways to decrease rodent populations in
their homes and aid in the control prevention of Lassa fever.
 People should also be educated also on measure to adopt in the event of
suspected case of the disease.
 FMoH (NCDC) should strengthen it Surveillance Unit for quick and early
detection of future outbreaks.
 Provision of protective equipment such as masks, gloves, gowns, and
goggles to health centres
 Government should sponsor researches in developing more rapid diagnostic
tests and increasing the availability of the only known drug treatment,
ribavirin.
 Blocked drainages and refuse dumps should be promptly attended to.
Notification: It is very important to report to a health facility for early initiation of
treatment. Lassa fever should be suspected where common causes of fever, like
malaria have been ruled out. Health care workers, community pharmacists
inclusive, are advised to practice universal care precautions while handling patients
at all times, not just when Lassa is suspected. Every health worker should think
about Lassa fever and have a high index of suspicion.
For more information, contact NCDC toll-free number: 0800-970000-10, sms
08099555577. WhatsApp 07087110839. Twitter/Facebook: @NCDCgo
 3. PIW MAGAZINE Nov, 2017: MONKEYPOX DISEASE BY
Pharm.Aloy Idam
“Yenagoa, 20 October 2017-World Health Organization (WHO) is supporting
the Bayelsa State to scale-up response and rapidly contain further spread as well
as debunk rumours linking the Monkeypox outbreak to immunization activities.
Since the report of the index case in Yenagoa, Bayelsa state on 22 September
2017, 22 additional suspected cases have been reported. Results of samples taken
to WHO Regional Laboratory in Dakar, Senegal, confirmed Monkeypox from
three (3) of the suspected cases while 46 contacts are being followed-up at
present.”
The above statement from WHO office in Nigeria is a confirmation of the outbreak
of Monkeypox disease in Nigeria, and this prompted the Editorial Board of PIW
Magazine to step down and replace an already written article for the Health
Column with this potential epidemic. This is write-up therefore is to empower the
reader with basic knowledge that could help prevent the imminent spread of
Monkeypox disease. Please read on!

Five Cardinal Points to Know About Monkeypox

1) Monkeypox is a rare disease that occurs primarily in remote parts of Central
and West Africa, near tropical rainforests.
2) The monkeypox virus can cause a fatal illness in humans and, although it is
similar to human smallpox which has been eradicated, it is much milder.
3) The monkeypox virus is transmitted to people from various wild animals but
has limited secondary spread through human-to-human transmission.
4) Typically, case fatality in monkeypox outbreaks has been between 1% and
10%, with most deaths occurring in younger age groups.
5) There is no treatment or vaccine available although prior smallpox
vaccination was highly effective in preventing monkeypox as well.

What is Monkeypox virus?

Monkeypox is a rare viral zoonosis (a virus transmitted to humans from animals)
with symptoms in humans similar to those seen in the past in smallpox patients,
although less severe. Smallpox was eradicated in 1980.However, monkeypox still
occurs sporadically in some parts of Africa.
Monkeypox, smallpox, cowpox, and vaccinia viruses all belong to the same family
of viruses, the Poxviridae. Monkeypox belongs to same genus (Orthopoxvirus) as
smallpox.
The virus was first identified in the State Serum Institute in Copenhagen,
Denmark, in 1958 during an investigation into a pox-like disease among monkeys.

Outbreaks
Reports of an outbreak of monkeypox in Bayelsa State surfaced about one month
ago when a family in Agbura, Yenagoa, began experiencing symptoms of the virus
after eating a monkey.
Health workers in Bayelsa State and officials of the Nigerian Centre for Disease
Control (NCDC) collected and dispatched blood samples from the first 13
suspected patients of the virus to the World Health Organization (WHO) reference
laboratory in Dakar, Senegal for a confirmatory test following a clinical diagnosis
of monkeypox. World Health Organization (WHO) reference laboratory in Dakar,
Senegal, has confirmed the outbreak of monkeypox in Bayelsa State.
Unfortunately, one of the patients receiving treatment for the virus at the
quarantine centre in Bayelsa State reportedly committed suicide, state government
officials said on Monday.
Since the outbreak of monkeypox occurred in Bayelsa State on September 22,
2017,the NCDC has said that the virus has marched into Rivers,Ekiti,Akwa
Ibom,Lagos,Ogun,Cross River and five other states in Nigeria.

By Thursday 19, October, 2017, the Federal Ministry of Health announced that the
outbreak of monkeypox had spread to 11 states with 74 recorded cases. As would
be expected there is apprehension and concern amongst the Nigerian populace that
the outbreak may grow to epidemic level if the governments and citizenry do not
take steps to break chain of transmission.
Human monkeypox was first identified in humans in 1970 in the Democratic
Republic of Congo (then known as Zaire) in a 9 year old boy in a region where
smallpox had been eliminated in 1968. Since then, the majority of cases have been
reported in rural, rainforest regions of the Congo Basin and western Africa,
particularly in the Democratic Republic of Congo, where it is considered to be
222endemic. In 1996-97, a major outbreak occurred in the Democratic Republic of
Congo.
In the spring of 2003, monkeypox cases were confirmed in the Midwest of the
United States of America, marking the first reported occurrence of the disease
outside of the African continent. Most of the patients had had close contact with
pet prairie dogs.
In 2005, a monkeypox outbreak occurred in Unity, Sudan and sporadic cases have
been reported from other parts of Africa. In 2009, an outreach campaign among
refugees from the Democratic Republic of Congo into the Republic of Congo
identified and confirmed two cases of monkeypox. Between August and October
2016, a monkeypox outbreak in the Central African Republic was contained with
26 cases and two deaths.

Transmission
Infection of index cases results from direct contact with the blood, bodily fluids, or
cutaneous or mucosal lesions of infected animals. In Africa human infections have
been documented through the handling of infected monkeys, Gambian giant rats
and squirrels, with rodents being the major reservoir of the virus. Eating
inadequately cooked meat of infected animals is a possible risk factor.
Secondary, or human-to-human, transmission can result from close contact with
infected respiratory tract secretions, skin lesions of an infected person or objects
recently contaminated by patient fluids or lesion materials. Transmission occurs
primarily via droplet respiratory particles usually requiring prolonged face-to-face
contact, which puts household members of active cases at greater risk of infection.
Transmission can also occur by inoculation or via the placenta (congenital
monkeypox). There is no evidence, to date, that person-to-person transmission
alone can sustain monkeypox infections in the human population.
In recent animal studies of the prairie dog-human monkeypox model, two distinct
clades (related species) of the virus were identified – the Congo Basin and the
West African clades – with the former found to be more virulent.

Signs and symptoms

The incubation period (interval from infection to onset of symptoms) of
monkeypox is usually from 6 to 16 days but can range from 5 to 21 days.
The infection can be divided into two periods:
 the invasion period (0-5 days) characterized by fever, intense headache,
lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle
ache) and an intense asthenia (lack of energy);
 the skin eruption period (within 1-3 days after appearance of fever) where
the various stages of the rash appear, often beginning on the face and then
spreading elsewhere on the body. The face (in 95% of cases), and palms of
the hands and soles of the feet (75%) are most affected. Evolution of the rash
from maculopapules (lesions with a flat bases) to vesicles (small fluid-filled
blisters), pustules, followed by crusts occurs in approximately 10 days.
Three weeks might be necessary before the complete disappearance of the
crusts.

The number of the lesions varies from a few to several thousand, affecting oral
mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid)
(20%), as well as the cornea (eyeball).
Some patients develop severe lymphadenopathy (swollen lymph nodes) before the
appearance of the rash, which is a distinctive feature of monkeypox compared to
other similar diseases.
Monkeypox is usually a self-limited disease with the symptoms lasting from 14 to
21 days. Severe cases occur more commonly among children and are related to the
extent of virus exposure, patient health status and severity of complications.
People living in or near the forested areas may have indirect or low-level exposure
to infected animals, possibly leading to subclinical (asymptomatic) infection.
The case fatality has varied widely between epidemics but has been less than 10%
in documented events, mostly among young children. In general, younger age-
groups appear to be more susceptible to monkeypox.

Diagnosis
The differential diagnoses that must be considered include other rash illnesses,
such as, smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis,
and medication-associated allergies. Lymphadenopathy during the prodromal
(early) stage of illness can be a clinical feature to distinguish it from smallpox.
Monkeypox can only be diagnosed definitively in the laboratory where the virus
can be identified by a number of different advanced tests which at the moment are
not available in Nigeria.

Treatment and vaccine

There are no specific treatments or vaccines available for monkeypox infection,
but outbreaks can be controlled. Vaccination against smallpox has been proven to
be 85% effective in preventing monkeypox in the past but the vaccine is no longer
available to the general public after it was discontinued following global smallpox
eradication. Nevertheless, prior smallpox vaccination will likely result in a milder
disease course.

What is the prognosis of monkeypox?

The usual prognosis (course & outcome) of patients with monkeypox is good to
excellent. Many patients have mild symptoms. However, patients with immune or
other compromised health problems (malnutrition, lung problems) may develop
complications of secondary bacterial infections, pneumonia, and dehydration.
Older estimations of a 10% death rate were published, but in the last 10-15 years,
this has been revised to less than 2% of infected individuals, with the worst cases
originating from animal-to-human infection, not person to person.
Natural host of monkeypox virus
In Africa, monkeypox infection has been found in many animal species: rope
/squirrels, tree squirrels, Gambian rats, striped mice, dormice and primates. Doubts
persist on the natural history of the virus and further studies are needed to identify
the exact reservoir of the monkeypox virus and how it is maintained in nature.
In the USA, the virus is thought to have been transmitted from African animals to a
number of susceptible non-African species (like prairie dogs) with which they
were co-housed.

Prevention
 Preventing monkeypox expansion through restrictions on animal trade

Restricting or banning the movement of small African mammals and monkeys may
be effective in slowing the expansion of the virus outside Africa.
Captive animals should not be inoculated against smallpox. Instead, potentially
infected animals should be isolated from other animals and placed into immediate
quarantine. Any animals that might have come into contact with an infected animal
should be quarantined, handled with standard precautions and observed for
monkeypox symptoms for 30 days.

 Reducing the risk of infection in people

During human monkeypox outbreaks, close contact with other patients is the most
significant risk factor for monkeypox virus infection. In the absence of specific
treatment or vaccine, the only way to reduce infection in people is by raising
awareness of the risk factors and educating people about the measures they can
take to reduce exposure to the virus. Surveillance measures and rapid identification
of new cases is critical for outbreak containment.
Public health educational messages should focus on the following risks:
 Reducing the risk of human-to-human transmission.
Close physical contact with monkeypox infected people should be avoided.
Gloves and protective equipment should be worn when taking care of ill
people. Regular hand washing should be carried out after caring for or
visiting sick people.

 Reducing the risk of animal-to-human transmission.

Efforts to prevent transmission in endemic regions should focus on
thoroughly cooking all animal products (blood, meat) before eating. Gloves
and other appropriate protective clothing should be worn while handling sick
animals or their infected tissues, and during slaughtering procedures.
  Controlling infection in health-care settings

Health-care workers caring for patients with suspected or confirmed monkeypox

virus infection, or handling specimens from them, should implement standard
infection control precautions.
Healthcare workers and those treating or exposed to patients with monkeypox or
their samples should consider being immunized against smallpox via their national
health authorities. Older smallpox vaccines should not be administered to people
with comprised immune systems.
Samples taken from people and animals with suspected monkeypox virus infection
should be handled by trained staff working in suitably equipped laboratories.
What research is being done on monkeypox?
Like in any medical/health challenge, research is ongoing with monkeypox virus.
For example, prairie dogs are being used as animal models to test the effectiveness
of vaccinations. Several studies are using animal models to test the effectiveness of
several antiviral drugs to reduce or eliminate symptoms in experimental infections.
Because of the close relationship of smallpox to monkeypox, genetic comparison
and genetic alteration studies are likely to be available in the future, along with
more rapid detection tests.

4. Lifestyle Tips for Healthy Living

Being a Health Talk Delivered ATWA Lagos,7th Dec., 2014
by Pharm.IDAM ALOY OTI

Introduction
Life is good. Life is lovable.
Every living being loves to live and enjoy life.
But life is only enjoyable if the health of that life is good.
Good health is one of the greatest blessings of life. Many people who have it do
not give much thought as it is not a problem to them. We can take our good health
for granted when; in fact, it is truly a blessing from God.

The recipient of good health should cherish it, jealously guard it and dutifully
nourish it with proper nutrients.
God still heals people today and as Christians we turn to and look at Jesus as the
greatest Physician. Jesus heals completely and thoroughly.

The Question then is; does our faith in the healing power of God and our
acceptance that good health comes from Him license us to live our lives
recklessly?

The answer is NO! Though I am believer in divine healing, it is my considered

opinion that people need to take some personal responsibility for their health.
People need to make wise choices especially in their diets and other health-related
life styles.
For example, if a person has lung cancer and still smokes cigarettes, I think most
reasonably-minded people would agree that this person would not be healed.
Similarly, it smacks of irresponsibility for someone with a compromised kidney or
liver to near alcohol.
Ironically many people find it difficult to cut off certain habits in life even though
they have the knowledge of the health hazards such habits carry.
For instance, the hazardous consequences of cigarette smoking are common-
place knowledge, yet some people including some medics who should know better
choose to smoke.

The truth is that everyone knows that if you follow healthy lifestyle tips it is not
really hard to live healthy. It just takes the resolve and motivation to change our
bad habits into good, healthy ones.

There are many healthy lifestyle tips but here are a dozen and two top tips.

1. Your Food: To live healthy, it important that one eats adequate (balanced)
diet. Your meals should contain the five food classes of carbohydrates1,
Proteins2, Fats & Oils3, Vitamins &Minerals4 and Water5. Eat more grains,
nuts, fruits and vegetables and get rid of the high sugar, salt and processed
foods (junks).
2. Your Drink: Take healthy fresh fruit drinks with vitamins and minerals that
will nourish your body and help it work properly.
(Ref:OSGL-Juicing) Avoid carbonated mineral drinks with high sugar.
Water is the best and safest drink.
Love water- “Water no get enemy”.After air, water is the most free but
essential gift of God to life. Every living thing constitutes of and requires
 water to continue to live and survive. Human life, as with all animal and
plant lives on planet earth, is dependent upon water. Man can live without
food for up to 90 days but 7days without water may lead to disaster. Water is
the essence of life. Most body functions (transportation of solutes and
hormones, digestion and absorption of
nutrients and vitamins, homeostasis, detoxification, metabolism, even
respiration etc) require water and dehydration will cause them to
malfunction.
What is my daily water need?
Your body weight, activity, heat, and humidity influence your daily water
need. It was previously recommended that one consistently takes at least 8
glasses of water per day to maintain a healthy glow of the skin. Now thirst is
expected to determine the amount to be taken.
A more accurate calculation is to drink 30ml (1oz.) of water for every 1kg
(2lb) of body weight, (2.2lb=1kg).
3. Use Sunlight: Get outside in the sunshine for a natural boost. The sun's rays
on the skin help your body produce vitamin D, which has been shown to
fight heart disease, depression, osteoporosis and even some types of cancer.
We in the Tropics are blessed to have sunlight all the seasons of the year.
4. Need for Exercise: Today many health experts agree that a calculated
amount of daily exercise is a-do-without for good health and longevity.
Exercise makes you feel good and can motivate you to get other things done
as well. Try to exercise at least 30 minutes a day, at least five days a week.
Exercising includes all of the following activities: walking, running, cycling,
skipping, swimming, skating, dancing, aerobics, domestic chores (cleaning,
washing, gardening, etc) and any other sport activity.
5. Deep breathing: Inhale and count up to 5 seconds, hold it for a few
seconds, and release slowly. When you’ve got time – at your desk, driving
the car, cooking food – do some deep breathing. Exchange of oxygen and
carbon dioxide is one of the best things we can do for our blood and cells.
6. Recognize, Accept and Love Yourself: Know and accept yourself for the
unique individual you are. “Our best friends and our worst enemies are the
thoughts we have about ourselves. (Dr Frank Crane).As a man thinketh in
his heart, so he is. Be careful of your thoughts. They may become words and
any moment and actions very soon. You may succeed if nobody else
believes in you, but you will never succeed if you don’t believe in yourself.
There is something unique in you that the man or woman you envy does not
have, albeit to the same measure.
7. Have Positive Attitude to life. Your attitude towards issues of life can
prolong or shorten your life. See things in the positive perspective. Become
 a glass-half-full person! Studies have found that those with a positive
attitude suffer less from conditions such as hypertension and other heart
disease. Much worrying is a precursor to raised blood pressure. Sustained
elevated blood pressure is the disease known as hypertension, (a lethal silent
killer on its own which could equally invite other major health problems).
8. Quit Unhealthy habits: All nasty habits like smoking, much drinking or
drinking in an empty stomach, drugs, chewing tobacco, sex obsession or
whatever your vice, are injurious to your health. Quit them now! You are in
charge of your health and living a healthier lifestyle means getting rid of the
things that may kill you, albeit gradually.
9. Build Support Network: Surround yourself with a strong support network,
or a group of people who will be there for you and participate in a healthy
lifestyle as well. (Church/Village groups, clubs, e.t.c.)
10.Avoid Anger and Seek Laughter: Anger, malice and unforgiveness are
siblings of the same family, avoid them. They cause the release cortisol
hormone. High levels of cortisol have been linked to heart disease and other
conditions such as diabetes.
Find something to laugh at every day to boost the release your feel-good
hormones (endorphins).
Giving your partner a hug doesn't just warm the heart, it can protect it too.
A study by the University of North Carolina in 2005 found that hugging
your spouse for 20 seconds could lower blood pressure and reduce levels of
the stress hormone, cortisol.
11. Work, Play and Rest: Let your activities in life revolve around the three
sides of this triangle. Create a good balance between work, play and rest.
Your family and friends can cooperate and help you observe time to work,
play and rest.
12. Accept and Love your job: Your job is something you will be doing for
some time to come, so you should love it. If you don’t, keep looking until
you find something you do love that will give job satisfaction and rest of
mind.
13.Maintain Personal and Environmental Hygiene: Germs that cause
diseases thrive better in dirty bodies and environments. Devote time and
money to your personal and environmental hygiene.
14.Budget for Medicals: Do not wait until you are down before you see your
doctor. Make sure you see a doctor each year for annual medical checks
(blood sugar/cholesterol, BP, Pap smear, BSE, PCE, GM, etc.)
But seek medical advice or help anytime you feel abnormal.
As I conclude, let me leave you with these seven cardinal statements to
contemplate on:
 1. Life is good.
2. Life is lovable.
3. Every living being loves to live and enjoy life.
4. But life is only enjoyable if the health of that life is good.
5. Good health should be admired and cherished, jealously guarded and
dutifully nourished.
6. We must take personal responsibility of the business of our health, investing
generously in it; time, energy and money.
7. We must ‘listen’ to, understand our body and seek timely medical advice or
intervention that the body requires.

Thank you.
Pharm.Idam Aloy

OSGL= OPEN SECRETS TO GOOD HEALTH & LONGEVITY – By Pharm

Aloy Idam

5. EXCLUSIVE BREAST FEEDING FOR SIX MONTHS IS THE BEST

FOR THE CHILD

The Integrated Maternal, Newborn and Child Health Strategy of 2007;a publication
of the Nigerian Federal Ministry of Health, shows that in Nigeria today, one out of
every five children still dies before their fifth birthday.

Seventy percent (70%) of these deaths are due to one or a combination of five
major disease conditions namely: Malaria, Acute Respiratory Infection (ARI)
especially Pneumonia, Diarrhea, Measles and Malnutrition.

Some other countries in Africa and other developing worlds present grimmer
pictures.

Research has shown that one of the approaches to be adopted for the survival,
growth and development of the child is "Exclusive Breast Feeding”.

Considering the fundamental importance of the practice of exclusive breast

feeding, I want to devote a sizeable part of this chapter to this health-worthy
practice.
According to WHO, exclusive breast feeding means feeding a baby with only
breast milk from birth until the age of six months. Breastfeeding is fundamental to
the growth, development and health of the children and it also important for the
health of mothers.

Babies who are on exclusive breastfeeding do not need additional water since
80%-90% of breast milk is water.
When breast feeding a baby, good positioning and attachment are important for the
comfort of mother and child.

Good positioning will also elicit better yield of the breast milk to the satisfaction of
the mother and child.

Let us look at the suggested positioning and attachment for smooth and safe
breastfeeding.

1. Mother should be well positioned with her back supported to avoid

discomfort, which can cause premature termination of the breastfeeding
activity.
2. Baby should be brought to the breast and not breast to baby to avoid pulling
on the breasts which can cause cracking/blisters.
3. Head, back and buttocks of the baby should be in a straight line for the
baby's comfort and to avoid choking.
4. Baby's chin should make good contact with the breast with mouth wide open
and lower lip turned outward.
5. Most of the areola (the dark part of the breast) should be in baby's mouth.
This makes for maximal milk yield.
6. Continue feeding baby on one breast until it feels soft and empty before
moving him/her to the other breast. This is to ensure that the baby benefits
from the more concentrated and nutritious hind milk.
7. Breastfeeding can also be done while the mother is lying down so long as
she is awake and alive to the activity.

Note that the baby will come off the breast when satisfied.
Economic realities have compelled an exclusive breastfeeding mother to be at her
place of work during this period. All the same the baby could still be exclusively
breastfed with hand expressed breast milk.
Some mothers complain of pains while expressing breast milk and this could be as
a result of wrong procedure.
With proper education and demonstration mothers can learn the correct procedure
which is not painful. During antenatal visits, nurses and mid-wives should
demonstrate the correct procedure to expectant mothers.
Nonetheless let us go through the correct step by step technique for hand
expression of breast milk.

1. Wash hands thoroughly

2. Assume a comfortable position (sitting or standing) with a clean cup near the
breast.
3. Place the thumb on the areola (dark part of the breast) above the nipple with
the other four fingers under the breast for support.
4. Press the thumb inwards towards the chest wall with the other fingers still in
place.
5. Compress the areola behind the nipple, between the index (first) finger and
the thumb.
6. Continue the process of pressing and releasing the areola from all sides until
the milk is expressed from all the segments.
7. Start the expression on one breast until the flow slows and then change to
the other breast.
8. Avoid undue squeezing of the nipple; what is required is only a sliding
movement of the thumb and finger over the areola.
9. Keep the expressed milk covered inside a cup or plate in a bowl of water (to
avoid ants from entering) until the time to feed the baby.

It is important to note that:

 Properly expressed and stored milk can last up to 8 hours.

 You can put in a fridge if it is available but not in a freezer.
 The use of cup and spoon and not feeding bottles is encouraged
because of the hygienic demands to maintain the latter.
Excerpts from Open Secrets to Good Health & Longevity by Aloy Oti Idam

6. Dozen Ways to Eliminate Stress at Work

It's normal to have some stress. Stress releases hormones that speed up your heart, make you breathe
faster, and give you a burst of energy. Stress can be useful when you need to focus on or finish a big
project. But too much stress or being under stress for too long isn't good for you. Constant stress can
make you more likely to get sick more often. It can make chronic pain worse and can also lead to long-
term health problems such as heart disease, high blood pressure, back problems, and depression.

While some workplace stress is normal, excessive stress can interfere with your productivity and
impact your physical and emotional health. Your emotions are contagious, and stress has an
impact on the quality of your interactions with others. The better you are at managing your own
stress, the more you'll positively affect those around you, and the less other people's stress will
negatively affect you.

And your ability to deal with it can mean the difference between success or failure. You can’t
control everything in your work environment, but that doesn’t mean you’re powerless—even
when you’re stuck in a difficult situation. Finding ways to manage workplace stress isn’t about
making huge changes or rethinking career ambitions, but rather about focusing on the one thing
that’s always within your control: you.

1. Act Rather Than React

“We experience stress when we feel that situations are out of our control,” says Mel
nick. It activates the stress hormone and, if chronic, wears down confidence, concentration and
well-being. You are advised that you identify the aspects of the situation you can control and
aspects you can’t. Typically, you’re in control of your actions and responses, but not in control
of macro forces or someone else’s tone, for example. “Be impeccable for your 50%,” is the
advice. And try to let go of the rest.
2. Take A Deep Breath
If you’re feeling overwhelmed or are coming out of a tense meeting and need to clear your head,
a few minutes of deep breathing will restore balance you are advised. Simply inhale for five
seconds, hold and exhale in equal counts through the nose. “It’s like getting the calm and focus
of a 90-minute yoga class in three minutes or less at your desk,”
3. Eliminate Interruptions
“Most of us are bombarded during the day. Too many Emails, phone calls, pop ins, instant
messages and sudden, urgent deadlines conspire to make today’s workers more distracted than
ever. While you may not have control over the interrupters, you can control your response. You
are advised to respond in one of three ways: Accept the interruption, cut it off or diagnosis its
importance and make a plan. Many interruptions are recurring and can be anticipated. “You want
to have preset criteria for which response you want to make. You can also train those around you
by answering email during certain windows, setting up office hours to talk in person or closing
the door when you need to focus.
4. Schedule Your Day For Energy And Focus
Most of us go through the day using a “push, push, push” approach, thinking if we work the full
eight to 10 hours, we’ll get more done. Instead, productivity goes down, stress levels go up and
you have very little energy left over for your family. You are advised scheduling breaks
throughout the day to walk, stretch at your desk or do a breathing exercise. Studies shows that if
we have intense concentration for about 90 minutes, followed by a brief period of recovery, we
can clear the build-up of stress and rejuvenate ourselves,” she says.
 5. Eat Right and Sleep Well
Starving or eating badly will stress your system- eating a low-sugar, high-protein diet. And when
you’re not sleeping well, you’re not getting the rejuvenating effects. Most people do not get
sufficient sleep, which is a critical recovery period for the body. If racing thoughts keep you
from falling asleep or you wake up in the night and can’t get back to sleep try this simple
breathing trick that will knock you out fast: Cover your right nostril and breathe through your left
for three to five minutes.
6. Change Your Story
Your perspective of stressful office events is typically a subjective interpretation of the facts,
often seen through the filter of your own self-doubt. However, if you can step back and take a
more objective view, you’ll be more effective and less likely to take things personally. She
recalls one client who sent a request to human resources for more people on an important project.
When she was denied, she immediately got angry and defensive, thinking they didn’t trust her to
know what she needed. Yet she never stopped to even consider there might be budgetary issues
on their end. Once she was able to remove herself from the situation, she called the HR director
and said: Tell me where you’re coming from, I’ll tell you where I’m coming from and then let’s
see if we can find a solution. Ultimately, it worked
7. Cool Down Quickly
“When you feel frustrated or angry, it’s a heated feeling in your body that can cause you to
react. Instead of immediately reacting—and likely overreacting— I suggest trying a “cooling
breath” technique: Breathe in through your mouth as if you are sipping through a straw, and then
breathe out normally through your nose. Done right, you’ll feel a cooling, drying sensation over
the top of your tongue. It’s like hitting the “pause” button, giving you time to think about your
response. It’s so powerful it will even calm the other person down.
8. Identify Self-Imposed Stress
Learn to stop self imposing stress by building your own self-confidence rather than seeking
other’s approval. If you’re too caught up in others’ perceptions of you, which you can’t control,
you become stressed out by the minutia or participate in avoidance behaviours like
procrastination. Ironically, once you shift your focus from others’ perception of your work to the
work itself, you’re more likely to impress them.
9. Prioritize Your Priorities
With competing deadlines and fast-changing priorities, it’s critical to define what’s truly
important and why. That requires clarity. It’s important to understand your role in the
organization, the company’s strategic priorities, and your personal goals and strengths. Cull your
to-do list by focusing on those projects that will have the most impact and are best aligned with
your goals.
10. Reset the Panic Button
For those who become panic-y and short of breath before a presentation, you can quickly reduce
your anxiety with the right acupressure point. Positioning your thumb on the side of your middle
finger and applying pressure instantly helps regulate your blood pressure.
11. Influence Others
Even if you’re responsible for your behaviour and outlook, you’re still left dealing with other
people’s stressful behaviour. You advised confronting a problem co-worker or employee by
stating the bad behaviour in a respectful tone, describing the impact on the team and the
individual, and requesting a change. For example, constant negativity might be addressed in this
way: “When you speak in a critical tone, it makes others uncomfortable and less likely to see you
as a leader. I understand your frustration but request that you bring concerns directly to me, so
we can talk them through.” By transferring the ownership of the problem, you’re more likely to
resolve it.
12. Be Your Own Best Critic
Some 60,000 thoughts stream through your mind each day and internal negativity is just as likely
to stress you out as an external event. Instead of being harsh and critical of yourself, try pumping
yourself up. Encouraging thoughts will help motivate you to achieve and ultimately train you to
inspire others.

7. 10 Ways to Build Good Co-worker

Good office etiquette helps build the foundation for a healthy work environment.
Here are 10 tips to make the most of your interactions with coworkers.

After working in a variety of companies both small and large, I have learned how to
spot the difference between committed employees who are in it for the long haul and
temporary faces who will move on down the line. You can tell the "keepers" based
upon how they get along with others in the office: They engage people in a
professional and respectful manner that adheres to certain traits. This helps the
business's bottom line, since positive employee interaction drives the organization.

Building employee morale has been a common theme among management as of late.
Company socials and outings, promoting exercise through walk-a-thons or friendly
weight-loss contests, and other mood-boosting strategies are fine (although I felt a
mandatory high-school-style company rally at one business I worked was a bit
much).

But fancy plans aren't always needed. Sometimes the simple approach is the best.
So I've put together this list of 10 things I have found invaluable in maintaining
positive relations at work based on the traits I referred to above. Best of all, these
tips don't cost money!

1: Practice common courtesy

This one should be self-explanatory, but I live in New England, which can be known
for standoffish attitudes. Look, there's nothing creepier than walking down the hall
at work and greeting a coworker with a friendly "Hello" only to receive a stony stare
in response (or no acknowledgment at all). I'm not saying you should throw confetti
and hand out balloons, but a simple exchange of smiles and a "Hi" is the first step in
forming a constructive workplace. Make eye contact and refer to people by name.
This is the oil that keeps the engine of cooperation running smoothly. It doesn't
mean you have to chat over coffee for an hour and it certainly doesn't mean you have
to kiss anyone.

Furthermore, keep in mind office life is much like having roommates. Don't be the
guy (or girl) who left the fish sandwich in the fridge for two weeks, or finished the
last Keurig cup without opening another box. If your feet noticeably sweat, sandals
at work may be a bad idea. And so forth.

2: Use effective communications

Learn who works best through email, phone, instant messaging, or personal visits
and try to utilize these preferences when engaging your coworkers. Some people
prefer email since they like to keep a written record of their actions or responses to
questions (or they may be online late at night getting caught up). Others will value a
phone call more since it's a quicker medium of communication.

I have found email is usually the standard. When it comes to a powerful email
strategy, my four corners are:

1. Always make sure the subject line is helpful (e.g., "question about expiration of
paid time off" and not "question") and keep the email as concise and on-topic as
possible.
2. Leave people out of emails/meeting requests if they don't need to attend or be
kept in the loop on the topic, so they won't see your emails as meaningless spam.
3. If you bring others into a conversation, let them know why; don't just CC them on
a huge email trail. For instance, you might say, "Jeff, I'm including you because
you have some good insights on foreign exchange rates and I remember you just
got back from England."
4. Don't reply to previous emails to start a new conversation unless it has some
bearing on the current topic.

Sometimes we find we're not getting the results we need from coworkers. Emails
and voicemails may go ignored (or it can seem that way). Think before banging out a
huffy email and cc:ing someone's manager -- this latter tactic can be a disaster for
cordial relations unless other avenues have been tried first. Maybe it would make
more sense to politely ask your coworker in person about the issue? They may be
too tied up to check messages and can refer you to another resource in the
company. Unless you have a clear-cut reason to assume someone is blowing you off,
give them the benefit of the doubt. If they are dragging their feet deliberately, I
recommend approaching your own manager first for assistance.

3: Respect other people's time

Every job is a service job. Whether you work in IT, HR, Marketing, or Administration,
you have something other people need. It could be know-how in your job role or the
capability to perform certain business functions, like signing purchase orders.
Unless it's a genuine emergency, don't hover outside someone's cube/office while
they're busy with someone else, to "wait for them to get off the phone," or finish an
existing conversation; just come back later. They will see you and feel pressured to
get rid of the existing visitor or end the phone call. Similarly, don't hand off work
requests in the hall, kitchen, bathroom, or outside the office. (On one occasion, I
bumped into someone at the grocery store on Saturday who asked me to get a new
computer for her at the office and wanted an ETA on the spot!) The line between
work and personal lives should be respected.

Conduct business operations with others at times that are convenient for both
parties. Nobody should ever dread running into you, and they certainly shouldn't
depart a grocery store with more tasks on their list for Monday. The lunch break is
an area where people can really feel pinched. My rule if I approach a coworker with a
business-related question and find them eating lunch is to excuse myself and leave.
It doesn't do them any good to gobble a sandwich while looking something up for
you, and you probably won't be able to hear them talk with food in their mouth,
either.

4: Help yourself
I worked with a benefits coordinator years ago whose favorite gripe was about
people who asked simple questions about medical benefits that were right in the
manual. "Yes, it's my job to answer questions," she said, "but it's silly to have to
answer the same stuff that is right on page one of the book everyone already agreed
to review!"

If you need assistance from someone else at work or have a question, see if you can
look up the information/try the task before seeking help. Even if you can do this only
partially, it will help – and it will earn respect. For instance, if you need to submit a
request to your network group to open ports in the firewall, research the ports and
the IP addresses of the hosts involved instead of just emailing them to ask "Can you
allow remote desktop access from outside the company?" People will know you've
done the legwork and will appreciate that.

Some things are best left to the professionals, of course. If the other guy on your IT
team is responsible for making DNS changes you could easily perform yourself, you
shouldn't proceed on his turf unless he's given you permission to do so and is aware
of your action.

5: Proceed with caution on social media

A plethora of social media vehicles come and go; Facebook, Google+, LinkedIn --
anyone remember MySpace? However, there's really nothing different about
interacting with coworkers on social media as compared to the standard rules of real
life that have been around for decades. (Of course, you should review your
company's social media policy to be aware of the requirements.)

If you do connect with coworkers through social media, don't engage in

inappropriate relationships and don't present an unprofessional side of yourself.
We've all heard that it's dumb to post drunken Facebook photos, but a better rule
would be to keep any controversial interests or hobbies separate from your
coworkers. Don't share confidential information about the company or other workers.
Pretend the company president (or board of directors) is personally following your
every move on social media and act accordingly. Your job and maintaining the
operations and integrity of the company is the priority. A better option might be to
restrict work connections to LinkedIn and leave Facebook for "real-life friends,"
family, neighbors, and so forth.

6: Stay on the level

Treat everyone the same. Office politics can be deadly and sometimes even
unavoidable, but reduce your involvement in them wherever possible. Don't gossip or
get involved in it when others do. I've seen instances where bad blood developed
among employees who kept "whispering" rude things about people they didn't like
through instant messaging services. Guess what happened when one of them left
their computer unattended? Everyone got a free trip to see the VP of HR and all of
them were gone within a few months -- except the target of their discussions!

The person you hired might wind up being your boss one day, and your manager
might get transferred elsewhere then transferred back to become the one in charge
again. I have seen both instances happen in real life, proving that staying on a
friendly (or at the very least neutral) basis with everyone possible is always the best
policy.

7: Don't gripe about work at work

Everyone vents about the job at times. We are a vent-oriented society. Unless you're
an ice cream tester or a gourmet food critic, chances are your job produces stress.
Griping is okay -- so long as you do it to your significant other, relative, non-work
friend, or dog. Keep it outside the company if you can, though.

There's a line in the movie Saving Private Ryan where Tom Hanks, the captain of the
unit assigned to find and rescue Private Ryan, tells his subordinates, "Gripes go up,
not down. Always up. You gripe to me, I gripe to my superior officer, so on, so on,
and so on. I don't gripe to you. I don't gripe in front of you. You should know that as a
Ranger." That's excellent advice. Managers should never display frustration about
the company to their staff. It will trickle around; that's a guarantee.

Getting paid to complain about work while you're at work is a little over the top and
just fosters an unhealthy victimhood culture. If there's something you can do, do it. If
not, address it through the healthiest means possible.

8: Put out a welcome mat

Go out of your way to make new hires welcome. Don't act like you're part of the "Old
Timers" network and these young upstarts are trying to crash the party or intrude on
your home ground. You once lived through the first day on the job, too. It's not just
for the sake of being friendly and making people feel at home; remember tip #6 – that
new hire might be a VP in five years. I'm not saying this to suggest buttering people
up or acting like a conniving politician so you can maximize your advantages. Rather,
I'm emphasizing that everyone plays an important role in a business and even the
intern building workstations deserves a "Welcome to the company. Let me know if
there's anything I can help you with."

9: Don't pass the buck

Mistakes will always be made. In IT, they can be disastrous. I've seen routing loops
caused by two switches linked together twice, servers accidentally unplugged,
Active Directory OUs mistakenly dragged and dropped and thereby breaking group
policies, and so on and so forth.

It's not enough to acknowledge errors on your part -- but it can be tricky when you
know someone else caused the problem and management confronts you to explain
it. If your coworker Ted clicked Shut Down instead of Log Off when disconnecting
from the Exchange server and management wants to know why email is down, "Ted
did it!" is not the best response.

In those instances, I recommend asking Ted to talk to the boss and explain what
happened on his own. If he's unavailable (or perhaps tied up frantically mounting the
Exchange databases) and someone in charge presses you for more information, you
should describe exactly what happened. However, do so from the standpoint of an
impartial observer: "Mistakes were made. Ted can describe what happened better
than I, and I want to make it clear I'm not throwing him under the bus here, but the
server was shut down accidentally. Log Off is similar to Shut Down on that Start
Menu…." Don't respond like a participant trying to bail himself out.

I have found that a post-mortem analyzing disasters like this and what controls will
be put in place to prevent future occurrences can be extremely helpful in solving
tensions that erupt when things go awry.

10: Follow up with people

Believe me, this one goes a long way. When you've completed a task involving
others, it takes 20 seconds to bang out an email a couple of days later asking "Did
that work for you?" or "How are things going?" Every time I've done it this has
solidified relations by showing the other party I care how things turned out, and I
didn't just treat them like a hot potato to be tossed onto a plate and served to
someone else.

Conclusion
These strategies may be common sense, but they can complement an agenda-
oriented workplace (isn't that the purpose of business?) to help keep the wheels of
business turning in a healthy and productive fashion. If you have other tips and
suggestions, I'd love to hear more in the comments section!