Small Grants, Big Impact: Dr. Regina Ejemot-Nwadiaro, Cross River State, Nigeria

In May 2017,  ARNTD, USAID, and COR-NTD announced the first-ever grantees of the African Researchers' Small Grants program.

The six winners, selected from a pool of nearly 100 applicants, now receive support to conduct operational research to address issues facing efforts to control and eliminate neglected tropical diseases (NTDs) in their home countries of Cameroon, Nigeria, Tanzania, and Togo.

Regina Ejemot-Nwadiaro, a senior lecturer at the University of Calabar in Nigeria, was selected for her proposal, "Demand creation and services uptake push for onchocerciasis control in Cross River State, Nigeria."  In Nigeria, 32 out of the 36 states - including Cross River State - are endemic for the disease. Over the past two decades, global health leaders have worked to turn the tide on onchocerciasis by promoting interventions that reduce risk of infection, increase access to treatment and build capacity.

In this Q&A, Dr. Ejemot-Nwadiaro describes her work and her motivations to increase the priority of onchocerciasis control in her home country.

Regina Ejemot-Nwadiaro

 

When you applied for the African Researchers’ Small Grants Program, you stated that 10% was a gross underestimation for onchocerciasis in Cross River State.  What have you seen to suggest that this number should be much higher? How can it be lowered? 

Cross River State (CRS) is reported as one of the high onchoceriasis endemic states in Nigeria, with onchocerciasis endemicity reported in almost all the 18 LGA of the state. Umeh et al.(1), reported a 50% prevalence rate for ocular onchocerciasis (one of the advanced stages of onchocerciasis) higher than the two other regions in Nigeria they studied, implying that CRS may bear the highest onchocerciasis burden in Nigeria. That 10% was reported in 2012 with minimal requisite systematic reported interventions could have resulted from the sample used in estimating the prevalence being lower than would be expected in the general population. Thus, the sample used may not have been representative. Also, misclassification due probably to errors in measurement or in diagnosis is possible, since signs and manifestation of onchocerciasis are not specific.

Furthermore, onchocerciasis is replete with myths and misconceptions in this environment, and therefore poor health-seeking behavior is common and thus underreporting is likely. Lack of awareness in the communities on onchocerciasis continues to contribute to this underestimation due to attribution of the disease to ill luck, witchcraft, and punishment for ill deeds. The 10% reported could have also been estimated from facility-based records rather than population based. In this environment, health facility attendance and use are notoriously poor and thus could have resulted in this low estimation.

Onchocerciasis control should be driven within not without the population affected for solutions to be sustainable. Effective mobilization and engagement of communities at risk my hold the ace for onchocerciasis control and elimination. In addition, establishing a sentinel site nested in the existing Demographic Surveillance System (DSS) located in Ikot-Ansa and Akpabuyo to track the disease in CRS could help in developing location specific strategies for onchocerciasis control and elimination.

How did you get involved with the study of onchocerciasis?

Any illness or disease that affects the vision of an individual leads to serious dependence on others for survival. Such dependence especially in resource poor countries perpetuates the cycle of poverty. Onchocerciasis being one of such diseases ranks very high in my priority as a public health professional.  My interest in onchocerciasis was further strengthened by the pathetic personal story of my Master of Public Health student, whose family had experience living with onchocerciasis. Their treatment struggle included difficulty accessing treatment and cost – this is in spite of her family being of the upper income class. I was deeply moved and wondered how the very poor can cope with this preventable debilitating disease. These experiences imprinted the DNA for my suggested approaches in this grant project for control of onchocerciasis.

What does support from the African Researchers' Small Grants Program mean to you?

The burning question which always pops up is why we are not preventing onchocerciasis when there exist multitude of preventive and control measures? The African Researchers' Small Grants Program support couldn’t have come at a better time than now with respect to mitigating the disastrous impacts of onchocerciasis in endemic areas of CRS. The funds will be crucial in facilitating the achievement of the research objectives through evidence-based approaches as outlined in our methodology. This will ensure smooth implementation of activities and timely attainment of expected goals which hinge on the elimination of onchocerciasis in CRS.

With research dollars behind your proposal, what will be the main goal you want to accomplish throughout the grant?

Regardless of the presence of funds, every disciplined person and seasoned professional in any sector of life should be goal oriented in every activity planned and implemented. My main goal throughout this grant process is to achieve all set objectives as proposed prior to winning of the grant in record time. My main goal will be to assiduously to increase onchocerciasis treatment coverage and to optimize service delivery. I will derive utmost fulfillment in creating longstanding impacts through this project and contributing to the elimination of onchocerciasis, which is a crucial headway to restoring the pride and dignity of the affected populace and improving the social atmosphere of the community.

How will your research help the situation of onchocerciasis in Cross River State? How might it be applied in other settings?

This research will increase community participation and mobilization for the elimination of onchocerciasis in CRS. The efficacy of most interventions is predicated on active participation and ownership of it by the people. By identifying program implementation challenges militating against such program’s efficacy, we hope to further strengthen future program design to attain maximum results. Advocacy being key towards shaping attitudes and increasing awareness remains a major in this project that will yield far reaching results in improving awareness, clarifying perceptions and increasing compliance to preventive measures aimed at onchocerciasis elimination in the state. This research project will also act as significant cues to action towards eliciting massive interest in students and professionals in uptaking NTD research to further consolidate the gains of elimination. This research takes into consideration the existing diversity evident in endemic rural communities and will attempt to explore the influences of simple easily available and relatively affordable mobile phone technology (SMS messages) to enhance disease treatment coverage and uptake of other healthcare services. As such, application in other settings can easily be achieved. This research looks at promoting and intensifying evidence based actions which can be adapted in any setting of choice.

Sometimes professionals have setbacks to reach their goals.  Have you experienced these holdups? If so, what kept you motivated to keep going forward?

Setbacks might be short or long term depending on the peculiarities of the situation and I am no stranger to such, ranging from lack of material resources and to conflict in personal schedules. However, from personal experience, setbacks are more often than not part of the whole process in attainment of set goals. The greatest motivation involved in overseeing periods of setbacks is the positive attitude which springs from altruistic desire to achieve set goals and consequently have a sense of fulfillment. In addition, hard work is external while passion is internal. When both combine, the product is sheer determination and commitment. I strive to embody both, and that has constantly buoyed me through periods of holdups.

The Cross River State Government is committed to eliminating NTDs by 2020.  Year two of that plan is almost complete. As a recipient of the SGP, how can your research accelerate this initiative?

Eliminating NTDs by 2020 hinges on holistic multi-sectorial approach involving the government, NGOs and populations at risk in addressing factors which are salient in the NTD discourse.  Factors such as community mobilization, increasing treatment uptake, improving health-seeking behavior and training/capacity building – these are core strategies in my SGP research. Thus, the attainment of this research project objectives will be invaluable in accelerating the process of eliminating onchocerciasis in the state as it will contribute towards ending the perennial issues of low awareness, recommending sustainable strategies for effective program implementation, stimulate community leadership and participation to ensure responsibility and compliance towards all measures designed to eliminate NTDs in CRS by 2020.

Is there anything else you would like to add that I have not asked you about?

My passionate commitment is to change the drive and drive the change for placing onchocerciasis from neglected to priority disease for elimination in Cross River State, Nigeria.

 

(1)Umeh RE, Mahmoud AO, Hagan M, Wilson M, Okoye OI, Asana U, Biritwum R, Ogbu-Pearce P, Elhassan E, Yaméogo L, Braideo EI, Seketeli A. (2010). Prevalence and distribution of ocular onchocerciasis in three ecological zones in Nigeria. African Journal of Medical Sciences; 39(4): 267-275

 

 

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The African Research Network for Neglected Tropical Diseases (ARNTD) is the only African-based network, spear-headed by Africans that does not exclusively focus on a single NTD or theme and is composed of individuals from a variety of disciplines across health, social, and management sciences, including policymakers. The ARNTD secretariat is based in Kumasi, Ghana, with membership spread across 30 countries.

The U.S. Agency for International Development (USAID) is the lead U.S. Government agency that works to end extreme global poverty and enable resilient, democratic societies to realize their potential. Based in Washington, D.C., USAID extends help from the American people to achieve results for the poorest  and most vulnerable around the world. 

The Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) includes researchers, program implementers, and their supporters with the shared goal of optimizing the control and elimination of neglected tropical diseases. The COR-NTD secretariat is the Neglected Tropical Diseases Support Center, a program at The Task Force for Global Health in Decatur, GA, USA.