Onecommon pathway by which contaminated water and food spread resistant strains of bacteria is by acting as superhighways that spread the resistant bacteria and the genes that make them resistant. It is important to understand that contaminated water or food do not create resistance, but they are able to cause resistance to develop in one of four main ways or via a combination of ways.The first step is by providing pollution sources. One example of this is farms, which use antibiotics in animals. The other aspect is that humans excrete drugs. Both of these end up in wastewater, soil, and as surface runoff. This surface runoff ends up in larger basins of water that eventually become the main sources of potable water for domestic use.In the end, these trace antibiotics in water resulting from manufacturing or urine will be unable to kill bacteria. Instead, they just select for the survivors, making resistance the new normal. By so doing, the surviving bacteria learn how to escape from the deleterious effects of the antibiotics sent after them.One real-world example of this is a situation in whichEscherichia coli (E. coli)from poultry farms contaminates irrigation water, which in turn infects lettuce that is consumed in soup and thereafter causes gastroenteritis in a patient who eventually fails ciprofloxacin treatment.The second scenario is created by mutation among these bacteria and the information sharing that occurs among them. In these contaminated environments, bacteria are constantly exposed to low doses of antibiotics. This stress triggers mutations and what is described as horizontal gene transfer among themselves, which sees such bacteria sharing resistance DNA basically like people trading cards.By engaging among each other in this way, they learn the tricks of surviving such antibiotics even when they are now unleashed upon them at much higher doses. This is the greatest disservice done to ordinary Nigerians when medications that bear substantially less chemotherapeutic value than what they are touted to contain are made available for use through the basic channels of trade with profit-making as the ultimate aim.The damage does not end there, because when you eat produce rinsed with tainted water, or you consume undercooked meat or fish or even these vegetables such as lettuce, you ingest these resistant organisms. Therein lies the real danger in consuming such contaminated food. Once these bacteria get into your gut, they can cause infections that do not respond to first-line drugs, which are the simple antibiotics that people usually consume. Among these are medicines such as Ampiclox, Flagyl, Tetracycline and Septrin, to mention a few.In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. The first step is by providing pollution sources. One example of this is farms, which use antibiotics in animals. The other aspect is that humans excrete drugs. Both of these end up in wastewater, soil, and as surface runoff. This surface runoff ends up in larger basins of water that eventually become the main sources of potable water for domestic use.In the end, these trace antibiotics in water resulting from manufacturing or urine will be unable to kill bacteria. Instead, they just select for the survivors, making resistance the new normal. By so doing, the surviving bacteria learn how to escape from the deleterious effects of the antibiotics sent after them.One real-world example of this is a situation in whichEscherichia coli (E. coli)from poultry farms contaminates irrigation water, which in turn infects lettuce that is consumed in soup and thereafter causes gastroenteritis in a patient who eventually fails ciprofloxacin treatment.The second scenario is created by mutation among these bacteria and the information sharing that occurs among them. In these contaminated environments, bacteria are constantly exposed to low doses of antibiotics. This stress triggers mutations and what is described as horizontal gene transfer among themselves, which sees such bacteria sharing resistance DNA basically like people trading cards.By engaging among each other in this way, they learn the tricks of surviving such antibiotics even when they are now unleashed upon them at much higher doses. This is the greatest disservice done to ordinary Nigerians when medications that bear substantially less chemotherapeutic value than what they are touted to contain are made available for use through the basic channels of trade with profit-making as the ultimate aim.The damage does not end there, because when you eat produce rinsed with tainted water, or you consume undercooked meat or fish or even these vegetables such as lettuce, you ingest these resistant organisms. Therein lies the real danger in consuming such contaminated food. Once these bacteria get into your gut, they can cause infections that do not respond to first-line drugs, which are the simple antibiotics that people usually consume. Among these are medicines such as Ampiclox, Flagyl, Tetracycline and Septrin, to mention a few.In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. In the end, these trace antibiotics in water resulting from manufacturing or urine will be unable to kill bacteria. Instead, they just select for the survivors, making resistance the new normal. By so doing, the surviving bacteria learn how to escape from the deleterious effects of the antibiotics sent after them.One real-world example of this is a situation in whichEscherichia coli (E. coli)from poultry farms contaminates irrigation water, which in turn infects lettuce that is consumed in soup and thereafter causes gastroenteritis in a patient who eventually fails ciprofloxacin treatment.The second scenario is created by mutation among these bacteria and the information sharing that occurs among them. In these contaminated environments, bacteria are constantly exposed to low doses of antibiotics. This stress triggers mutations and what is described as horizontal gene transfer among themselves, which sees such bacteria sharing resistance DNA basically like people trading cards.By engaging among each other in this way, they learn the tricks of surviving such antibiotics even when they are now unleashed upon them at much higher doses. This is the greatest disservice done to ordinary Nigerians when medications that bear substantially less chemotherapeutic value than what they are touted to contain are made available for use through the basic channels of trade with profit-making as the ultimate aim.The damage does not end there, because when you eat produce rinsed with tainted water, or you consume undercooked meat or fish or even these vegetables such as lettuce, you ingest these resistant organisms. Therein lies the real danger in consuming such contaminated food. Once these bacteria get into your gut, they can cause infections that do not respond to first-line drugs, which are the simple antibiotics that people usually consume. Among these are medicines such as Ampiclox, Flagyl, Tetracycline and Septrin, to mention a few.In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. One real-world example of this is a situation in whichEscherichia coli (E. coli)from poultry farms contaminates irrigation water, which in turn infects lettuce that is consumed in soup and thereafter causes gastroenteritis in a patient who eventually fails ciprofloxacin treatment.The second scenario is created by mutation among these bacteria and the information sharing that occurs among them. In these contaminated environments, bacteria are constantly exposed to low doses of antibiotics. This stress triggers mutations and what is described as horizontal gene transfer among themselves, which sees such bacteria sharing resistance DNA basically like people trading cards.By engaging among each other in this way, they learn the tricks of surviving such antibiotics even when they are now unleashed upon them at much higher doses. This is the greatest disservice done to ordinary Nigerians when medications that bear substantially less chemotherapeutic value than what they are touted to contain are made available for use through the basic channels of trade with profit-making as the ultimate aim.The damage does not end there, because when you eat produce rinsed with tainted water, or you consume undercooked meat or fish or even these vegetables such as lettuce, you ingest these resistant organisms. Therein lies the real danger in consuming such contaminated food. Once these bacteria get into your gut, they can cause infections that do not respond to first-line drugs, which are the simple antibiotics that people usually consume. Among these are medicines such as Ampiclox, Flagyl, Tetracycline and Septrin, to mention a few.In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. The second scenario is created by mutation among these bacteria and the information sharing that occurs among them. In these contaminated environments, bacteria are constantly exposed to low doses of antibiotics. This stress triggers mutations and what is described as horizontal gene transfer among themselves, which sees such bacteria sharing resistance DNA basically like people trading cards.By engaging among each other in this way, they learn the tricks of surviving such antibiotics even when they are now unleashed upon them at much higher doses. This is the greatest disservice done to ordinary Nigerians when medications that bear substantially less chemotherapeutic value than what they are touted to contain are made available for use through the basic channels of trade with profit-making as the ultimate aim.The damage does not end there, because when you eat produce rinsed with tainted water, or you consume undercooked meat or fish or even these vegetables such as lettuce, you ingest these resistant organisms. Therein lies the real danger in consuming such contaminated food. Once these bacteria get into your gut, they can cause infections that do not respond to first-line drugs, which are the simple antibiotics that people usually consume. Among these are medicines such as Ampiclox, Flagyl, Tetracycline and Septrin, to mention a few.In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. By engaging among each other in this way, they learn the tricks of surviving such antibiotics even when they are now unleashed upon them at much higher doses. This is the greatest disservice done to ordinary Nigerians when medications that bear substantially less chemotherapeutic value than what they are touted to contain are made available for use through the basic channels of trade with profit-making as the ultimate aim.The damage does not end there, because when you eat produce rinsed with tainted water, or you consume undercooked meat or fish or even these vegetables such as lettuce, you ingest these resistant organisms. Therein lies the real danger in consuming such contaminated food. Once these bacteria get into your gut, they can cause infections that do not respond to first-line drugs, which are the simple antibiotics that people usually consume. Among these are medicines such as Ampiclox, Flagyl, Tetracycline and Septrin, to mention a few.In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. The damage does not end there, because when you eat produce rinsed with tainted water, or you consume undercooked meat or fish or even these vegetables such as lettuce, you ingest these resistant organisms. Therein lies the real danger in consuming such contaminated food. Once these bacteria get into your gut, they can cause infections that do not respond to first-line drugs, which are the simple antibiotics that people usually consume. Among these are medicines such as Ampiclox, Flagyl, Tetracycline and Septrin, to mention a few.In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. In addition, these bacteria transfer those resistance genes to your own healthy intestinal bacteria, with which you have been at peace, thereby turning them into hidden “reservoirs” that can later cause untreatable infections by acquiring the ability to produce more resistant strains of the bacteria.In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. In addition to these, there are many organisms which have become prime drivers of community-acquired infections. Ordinarily, many such infections should be easily treatable without any lasting, deleterious effects, but the preponderance of fake antibiotics, insincerely prepared medications and the recycling of expired samples continues to change the nature of these bacteria in fundamental ways that eventually make them harmful.People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. People are familiar withStaphylococcus aureus,Escherichia coli and Salmonella,but these are increasingly difficult to treat. Not to mention those very dangerous bacteria whose names are almost unpronounceable, such as Alkalegenes faecalis and Enterococcus gallinarum. With these organisms, the speed of progression from the first symptoms of sepsis to death can be just a matter of days.Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Other terrible bacteria that even doctors fear include Klebsiella and Clostridia; these remain challenging to treat and are a constant threat to the successful outcome of many surgical procedures within hospital wards. In an environment like that, even minor wounds can kill if they get infected.These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. These organisms increase the problems associated with the high burden of infectious diseases seen in Nigeria. Within hospitals and in private homes, the combination of this combustible mix often leads to more infections and less easily treatable diseases, thus making the deployment of more antibiotics a necessity, which in turn leads, with the passage of time, to more resistance.In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. In all public hospitals, overcrowding is the single most depressing feature. There are simply too many patients and too few staff attending to them. Patient backlog is the result. Many hospitals lack proper infection control, sterilisation equipment and isolation wards.This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. This creates perfect conditions for resistant infections. It is not surprising that the most dangerous AMR‑related threats right now are drug‑resistant tuberculosis (DR‑TB) and bacterial infections leading to sepsis. First, MDR‑TB treatment takes 18–24 months. Cure rates in countries such as ours are often below 50 per cent. Costs can be 100 times higher than normal TB treatment.Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Now, Carbapenem‑resistant bacteria (“superbugs”) represent the second major threat. These bacteria resist even last‑line antibiotics. Direct patient harm is the result of such a scenario. Resistant infections cause over 1 million direct deaths and contribute to nearly 5 million globally each year. Patients with resistant infections face nearly double the risk of death compared to those with non-resistant ones.Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Then the financial costs are punishing, leading to significantly more expensive treatment. A resistant infection can add $4,000–$9,000 (US) to a patient’s hospital stay, with intensive care increasing by nearly 40 per cent.In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. In Europe alone, AMR costs an estimated €11.7 billion annually. AMR threatens the safety of routine surgeries, cancer therapy, and organ transplants, which rely on effective antibiotics to prevent infections. A simple urinary tract infection can now require five days of intravenous antibiotics in a hospital.Related NewsMedical students now plan japa before graduation — NMAOver 65,000 suspected cholera cases recorded in 35 states – NCDCResident doctors raise the alarm over manpower shortage at LAUTECH hospitalResistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Resistance is escalating quickly and represents a direct threat to every patient. 1 in 6 common infections are now drug-resistant. The problem is acute for E. coli and K. pneumoniae, where over 40 per cent and 55 per cent of cases, respectively, are resistant to standard treatments. The burden falls heaviest on poorer nations.In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. In parts of Nigeria, resistance rates to some antibiotics exceed 70 per cent, forcing the use of toxic, expensive “last-resort” drugs which are often unavailable, and may have to be ordered specifically for specific clients, with the result that such expenditure could wipe out family incomes. If AMR continues unchecked, Caesarean sections will become dangerous. Chemotherapy could become impossible and organ transplantation, challenging enough for Nigeria, will become high‑risk.So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. So, what developing countries, Nigeria inclusive, need urgently are strong antibiotic regulation, better sanitation services and clean water. Surveillance systems to detect resistant strains must now be institutionalised while investment in new antibiotics must be done in partnership with the wealthy nations. Public education on antibiotic misuse must be persistent and unequivocal, while the strengthening of primary healthcare is a task that must be pursued vigorously.Questions and answersSundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. SundayDoctor, many thanks for the good work you’re doing through Sunday Punch. Your write-up on Nigeria’s most urgent health issues is very concerning. I hope relevant authorities will act accordingly. However, I believe that our waste management systems need to be adequately addressed too. It breeds mosquitoes in numbers. Lagos and many other states are merely paying lip service to the issue of waste management.+23481*******Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Thank you so much for your contribution and comments. That is why some of these lessons are discussed on this page, because health issues and matters of disease prevention ought to belong to every citizen. Such contributions undoubtedly assist the government to focus more sharply on the location and enormity of some of the problems citizens face.Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Sunday Doctor, I have a serious dental issue. I reside at Onicha Ugbo in Delta State, very close to Asaba. Please can you recommend a good dentist? Thanks.081*******Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Since you live near Asaba, your best bet is to go to the Federal Medical Centre there and seek treatment. That way, you won’t be seeing one good dentist, but several good ones.Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Sunday Doctor, please, I am a 49-year-old woman who has not been menstruating regularly for the past eight- nine months. My doctor has assured me before that I have entered menopause, but I have noticed over the past three weeks that my breasts are growing again and are heavy like those of a woman who is breastfeeding. Is this not a problem?0802*******It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. It is not a problem if both breasts are involved with such growth. If it is one-sided growth, you must see a doctor. However, if both breasts are growing like this, it is possible, and it is also reversible, most likely when you menstruate again, even if that happens just once in 3 or 4 months.Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Sunday Doctor, I am a 30-year-old businesswoman, still single. I have been treated with Ulsakit by my doctor for a peptic ulcer, which was found to be caused by severe gastritis when I did endoscopy nearly two years ago. Do I need to repeat the endoscopy?0802******If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. If all you had was severe gastritis, and no ulcer was found or atrophic gastritis, or any active bleeding, there is no need to do a repeat endoscopy. A urease breath test or stool antigen test would be sufficient to confirm cure.Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Sunday Doctor, Mectizan or Ivermectin is often recommended for patients with filariasis. However, it is not for pregnant or breastfeeding women, or children under 5 years of age. Is there an alternative drug for these people? How do we rid our environment of the disease’s vectors? Thanks. 0705******Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Although Mectizan has no strict alternatives, Diethylcarbamazine citrate should be used instead. In places that do not have river blindness, DEC can be used in combination with Albendazole. As for vector control, since this disease is also transmitted by mosquitoes and blackflies, such control is the same as in that of malaria parasites, and that includes the usage of insecticide-treated mosquito nets.Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Sunday Doctor, my daughter is just over a year old. She just started to refuse to take the normal foods she used to like, and she is losing weight. She just refuses any food at all, including milk. What should we do?0806******Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Well, if there is no fever, cough or any signs of abdominal discomfort, there may be nothing serious. It may just be a whim that growing children have many. However, you must take her to see a paediatrician for a proper examination. In the end, a multivitamin supplement may be needed.Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. Sunday Doctor, my son is 11 months old. There is a fleshy thing holding the upper lip to the upper teeth, which he just grew. It doesn’t look right to me. I have shown it to two different doctors and a nurse, all of whom said that it is nothing, but as a parent, I am not reassured. Please, what should we do? I will send you the picture on WhatsApp. Thank you.0803******This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip. This is called a lip tie. It is holding that upper lip down. You will need to take your son to see a paediatric surgeon, who will divide that fleshy growth and free the lip.