The Lancet Nigeria Commission: investing in health and the future of the nation

Abubakar, Ibrahim; Dalglish, Sarah L; Angell, Blake; Sanuade, Olutobi Adekunle; Abimbola, Seye; Adamu, Aishatu L; Adetifa, Ifedayo; Colbourn, Tim; Ogunlesi, Afolabi Olaniyi; Onwujekwe, Obinna; Owoaje, Eme T.; Okeke, Iruka N.; Adeyemo, Adebowale; Aliyu, Gambo; Aliyu, Muktar H.; Aliyu, Sani H; Ameh, Emmanuel A.; Archibong, Belinda; Ezeh, Alex; Gadanya, Muktar A; Ihekweazu, Chikwe; Ihekweazu, Vivianne; Iliyasu, Zubairu; Chiroma, Aminatu Kwaku; Mabayoje, Diana Ayoola; Sambo, Mohammed Nasir; Obaro, Stephen K.; Yinka-Ogunleye, Adesola; Okonofua, Friday; Oni, Tolu; Onyimadu, Olu; Pate, Muhammad Ali; Salako, Babatunde Lawal; Shuaib, Faisal; Tsiga-Ahmed, Fatimah I.; Zanna, Fatima H

doi:10.1016/s0140-6736(21)02488-0

Cited by 167 publications

(135 citation statements)

References 158 publications

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“…[23][24][25] Widespread improvements in population health and system coverage will require a rebalancing of health-care financing in Nigeria away from out-of-pocket payments towards greater public investment into health. Although our estimates indicate that women experienced lower recommendations, 26 effective intersectoral action to prevent NCDs would improve outcomes, reduce demands on the health system, and avoid shifting scarce resources towards late-stage care for these conditions at the expense of interventions to prevent and reduce neonatal, child, and maternal mortality and infections. 26 Further investment needs to eliminate, rather than reinforce, existing inefficiencies and inequities in resource allocation across the system.…”

Section: Discussionmentioning

confidence: 73%

“…Although our estimates indicate that women experienced lower recommendations, 26 effective intersectoral action to prevent NCDs would improve outcomes, reduce demands on the health system, and avoid shifting scarce resources towards late-stage care for these conditions at the expense of interventions to prevent and reduce neonatal, child, and maternal mortality and infections. 26 Further investment needs to eliminate, rather than reinforce, existing inefficiencies and inequities in resource allocation across the system. Policy interventions will need to improve the effectiveness and resilience of the health system and specific recommendations have been outlined in The Lancet Nigeria Commission report to achieve better value and outcomes in Nigeria.…”

Section: Discussionmentioning

confidence: 73%

“…Policy interventions will need to improve the effectiveness and resilience of the health system and specific recommendations have been outlined in The Lancet Nigeria Commission report to achieve better value and outcomes in Nigeria. 26 Our analysis also suggests potential for large health gains through strategic investment outside the health system with nutrition-related, sanitation-related, and air pollution-related risk factors the most pressing drivers of disease burden in Nigeria and responsible for almost 90% of under-five mortality. The proportion of Nigerians with access to clean water (68•5%) and improved sanitation facilities (29%) is lower than many other west African nations and most nations globally, with some evidence of recent deterioration.…”

Section: Discussionmentioning

confidence: 81%

See 2 more Smart Citations

Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study

et al. 2022

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 81%

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Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study

et al. 2022

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“…The Nigerian health system, like many in Africa, struggles to deliver laboratory medicine in general and clinical diagnostic microbiology in particular [6–9]. Nonetheless, even with poor and fragmented access to diagnostic microbiology, clinical bacteriology does support patient care in at least some hospitals and thus can form the basis for AMR surveillance sentinels.…”

Section: Introduction: the Pressing Need For A Antimicrobial Resistan...mentioning

confidence: 99%

“…Nigeria is still in the early stages of building this AMR surveillance system, but it was imperative to establish a functioning initial system in that critical period between 2017 and 2020. The Nigerian health system, like many in Africa, struggles to deliver laboratory medicine in general and clinical diagnostic microbiology in particular [6][7][8][9]. Nonetheless, even with poor and fragmented access to diagnostic microbiology, clinical bacteriology does support patient care in at least some hospitals and thus can form the basis for AMR surveillance sentinels.…”

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confidence: 99%

Establishing a national reference laboratory for antimicrobial resistance using a whole-genome sequencing framework: Nigeria’s experience

et al. 2022

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Whole-genome sequencing (WGS) is finding important applications in the surveillance of antimicrobial resistance (AMR), providing the most granular data and broadening the scope of niches and locations that can be surveilled. A common but often overlooked application of WGS is to replace or augment reference laboratory services for AMR surveillance. WGS has supplanted traditional strain subtyping in many comprehensive reference laboratories and is now the gold standard for rapidly ruling isolates into or out of suspected outbreak clusters. These and other properties give WGS the potential to serve in AMR reference functioning where a reference laboratory did not hitherto exist. In this perspective, we describe how we have employed a WGS approach, and an academic–public health system collaboration, to provide AMR reference laboratory services in Nigeria, as a model for leapfrogging to national AMR surveillance.

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Maternal Characteristics and Prevalence of Infants Born Small for Gestational Age

Xiang,

Li,

et al. 2024

JAMA Netw Open

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ImportanceBeing born small for gestational age (SGA) is a risk factor for neonatal mortality and adverse outcomes in the short and long term. The maternal profile in China has substantially changed over the past decade, which may affect the risk of infants born SGA.ObjectivesTo analyze the prevalence of infants born SGA from 2012 through 2020 and explore the association of maternal sociodemographic characteristics and other factors with that prevalence.Design, Setting, and ParticipantsThis cross-sectional study examined data from the National Maternal Near Miss Surveillance System on women who delivered singleton live births at gestational ages of 28 to 42 weeks from January 1, 2012, through December 31, 2020, in China. Statistical analysis was performed from December 2022 to September 2023.ExposuresCharacteristics of delivery (year, region of country, and hospital level), mother (age, educational level, marital status, prenatal visits, parity, preexisting diseases, or prenatal complications), and newborn (birth weight, sex, and gestational age).Main Outcomes and MeasuresPrevalence of infants born SGA stratified by severity and by region of the country, changes in prevalence based on log-linear Poisson regression with robust variance, and association of maternal characteristics with changes in prevalence of infants born SGA between 2012 and 2020 based on the Fairlie nonlinear mean decomposition.ResultsAmong 12 643 962 births (6 572 548 [52.0%] male; median gestational age, 39 weeks [IQR, 38-40 weeks]), the overall weighted prevalence of infants born SGA was 6.4%, which decreased from 7.3% in 2012 to 5.3% in 2020, translating to a mean annual decrease rate of 3.9% (95% CI, 3.3%-4.5%). The prevalence of infants born SGA decreased from 2.0% to 1.2% for infants with severe SGA birth weight and from 5.3% to 4.1% for those with mild to moderate SGA birth weight. The mean annual rate of decrease was faster for infants with severe SGA birth weight than for those with mild to moderate SGA birth weight (5.9% [95% CI, 4.6%-7.1%] vs 3.2% [95% CI, 2.6%-3.8%]) and was faster for the less developed western (5.3% [95% CI, 4.4%-6.1%]) and central (3.9% [95% CI, 2.9%-4.8%]) regions compared with the eastern region (2.3% [95% CI, 1.1%-3.4%]). Two-thirds of the observed decrease in the prevalence of infants born SGA could be accounted for by changes in maternal characteristics, such as educational level (relative association, 19.7%), age (relative association, 18.8%), prenatal visits (relative association, 20.4%), and parity (relative association, 19.4%). Conversely, maternal preexisting diseases or prenatal complications counteracted the decrease in the prevalence of infants born SGA (−6.7%).Conclusions and RelevanceIn this cross-sectional study of births in China from 2012 to 2020, maternal characteristics changed and the prevalence of infants born SGA decreased. Future interventions to reduce the risk of infants born SGA should focus on primary prevention.

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The Lancet Nigeria Commission: investing in health and the future of the nation

Cited by 167 publications

References 158 publications

Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study

Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study

Establishing a national reference laboratory for antimicrobial resistance using a whole-genome sequencing framework: Nigeria’s experience

Maternal Characteristics and Prevalence of Infants Born Small for Gestational Age

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