Ebola hero, Adadevoh alongside 18 others recognised by MDCAN

The Medical and Dental Consultants Association of Nigeria (MDCAN) has given Dr. Amayo Stella Adadevoh a post-humous Star award for her selfless and heroic service to the country.

The Minister of Health, Prof. Isaa Adewole, was also honoured for his efforts towards revitalisation of the dilapidated primary health care facilities across the country. The minister had targeted to upgrade 10,000 primary health care centres.

Late Dr. Amayo Stella Adadevoh

It was at the MDCAN 2018 Public Lecture and Award, with the theme “Politics and Health: Implications of Nexus To The Nigerian Citizen,” in Abuja

Adadevoh was the lead clinician treating Sawyer in the First Consultant Hospital, Lagos, when he was presented to that hospital.

She, in defending the country, refused all entreaties to allow Mr. Sawyer, the Ebola patient leave the hospital to attend the Calabar conference.

The grand-daughter of late Nigerian foremost politician, Herbert Marculay, was eventually diagnosed of the killer virus and died in the process.

The MDCAN star award, which is the highest in the award category, was therefore in recognition of her strength of character and singular ultimate sacrifice to prevent the spread of Ebola virus in Nigeria in 2014.

In his welcome remark, Prof. Ngim Ngim, MDCAN President, said the honour to Adadevoh was deliberate as she was yet to get the recognition that she deserved.

He said, “The honour on late Stella was a deliberate decision as we believe that not enough have been done to appreciate her sacrifice and to immortalised her.”

Ngim also called on the government to do the needful by giving the late Adadevoh the recognition she so much deserve for her heroic act.

He stressed that for her patriotic act, the country would have been in a serious problem at that time; adding that a lot of people would have died in the process as it would have been very difficult to contain the spread of Ebola if she had not played her part very well.

She paid the supreme price with her life to prevent the country from being plunged into serious calamity.

Ngim who also spoke on the theme of the public lecture, urged medical practitioners to play active role in the politics. Stressing that there is no way the practice will address the health challenges without playing politics.

The immediate past Minister of Health, Prof. Onyebuchi Chukwu, on his part blamed some politicians for preventing the past government from honoring the late Adadevoh.

The former minister who was the Chairman of the occasion revealed that the former President Goodluck Jonathan had concluded arrangement to name her along some other Nigerians as national heroes in recognition of their efforts in containing the outbreak of Ebola virus in country when he was advised against the move.

He said: “At a time, I know how many hours I spent on the phone and laptop some time in 2014 with Dr. Rueben Abatan, who you know was the Chief Spokesperson of Mr. President Jonathan,” he said.

He added, “There are people who told Mr. President that this woman cannot be a national hero. Yes but sometimes people just write. Let me tell you it is part of what the guest speaker is going to tell us today on how health mixes with politics.”

So when someone becomes Mr. President, pity him because he does not take all the decisions but receives blames for what he did not say.”

He, however, assured that he will expose those who went against announcing Adadevoh as a national hero in his book.

Speaking on politics and health, he said even at the World Health Organisation politics goes on.

Let me just say that health will always be part of politics and politics part of health. Ministers’ are politicians,” he added.

In his lecture, Prof. Akin Osibogun, who was the Guest Speaker, was of the opinion that the contribution of MDCAN may yet set the tone for the expected national debates ahead of the 2019 general elections.

Former Chief Medical Director, Lagos University Teaching Hospital (LUTH) and public health expert, also revealed that about 70 million Nigerians live below poverty line.

The poor are more likely to be sick and when sick, least likely to access health services promptly. The cost of illness is not just the cost of treatment, but includes the cost of treatment-seeking activities such as transportation to the hospital.

Poverty remains a most important determinant of ill-health as it contributes significantly to increased exposure to disease-causing agents and also prevents access to health care services once disease has occurred,” he said.

Other awardees are: Prof. Mohammed Borodo, Emeritus Prof. Umaru Shehu, a royal father, Prof. Itam Hogan Itam, and Prof. Mustapha Abudu Danesi.

MDCAN also recognised it past leaders among who are Prof. Florencio Ike Iweze, Prof. Akitpye Olusegun Coker, Prof. Adenike Grange, Prof. Philip Abiodun, Prof. Edward Ejiro Emuveyan, Prof. Augustine Orhue, Prof. Geoffrey Onyemelukwe, Prof. Stanley Anyanwu, Dr. Wadzani Gashau, Prof. Suleiman Giwa, Dr. Lamidi Isah Audu, Prof. Owoidoho Udofia, Prof. Gadzama and Prof. Balarabe Sani Garko.

Psychiatrist reveals why women need to have more SEX regularly

Aside from the fun and momentary enjoyment regular sexual intercourse have other immense gains it has been revealed.

A psychiatrist, Dr Maymunah Kadiri, on Saturday, advised married women to have regular sex in order to prevent depression.

Kadiri, the Medical Director of Pinnacle Medical Services gave the advice in an interview with the News Agency of Nigeria in Lagos.

According to her, sex is not just to nourish a woman’s body, it is also beneficial for her mental health.

“As women, there is need for us to make our spouses our best friends if we want to be mentally healthy.

“Studies have shown that women who have more active sex and are in long-term relationships are less likely to be depressed than women who go without sex.

“So, more sex is important and essential. It is a remedy for a persistent headache in women.

“Low sexual drive, which leads to depression, should be looked into. A woman can be depressed when her sexual drive drops.

“Frequent sex can play a role in women’s sense of well being and quality of life,’’ Kadiri said.

She explained that sex was not just for procreation, adding that it could create bonding, good companionship and sound sleep.

Kadiri, popularly called ‘celebrity shrink’, urged women dealing with depression to frequently indulge in sex, as it boosts their self-esteem.

She also advised women who are over-weight to consider having an active sexual life, as it boosts their endorphins levels. Endorphins are happy hormones.

“The happy hormones will make them lose some calories as well as sleep better.

”Orgasms trigger the release of endorphins which are happy hormones secreted by the brain that act as effective painkillers,’’ she said.

SAD! After five years of chemotherapy and biopsies, Man discovers he does not have cancer

A Colorado man says he was on chemotherapy and painkillers for five years to treat a rare cancer – only to learn he never had the disease at all.

James Salaz, of Montrose, went to Montrose Memorial Hospital in 2012, where doctors performed numerous tests before they found two ‘abnormalities’ in his left lung.

After performing an open lung biopsy, Salaz was told he had a rare form of cancer in which an excess of white blood cells caused tumors to form throughout the body.

Despite immediately undergoing treatment, the abnormalities weren’t going anyway – that is until he visited another doctor who told him he didn’t have cancer, but rather a condition that causes inflamed blood vessels.

‘I just started getting a pain under my armpit way deep, so I went to the hospital and they did some tests and then the doctor told me that they found two abnormalities inside my left lung,’ Salaz told KKCO in an exclusive interview.

He was diagnosed in 2012 with Langerhans Cell Histiocytosis (LCH), a rare cancer that begins in LCH cells, white blood cells that help fight infection.

The immature white blood cells multiply, which cause tumors called granulomas to form and can lead to organ damage.  Although LCH is most often diagnosed in childhood, between ages two and three, it can appear at any age.

According to the Histiocytosis Association, it is estimated to occur in one-to-two adults per million. Salaz also visited doctors in Delta, Denver, Grand Junction and Montrose whom all confirmed his initial diagnosis. ‘They said that I was the only one in Colorado that had it,’ Salaz told KKCO.

Montrose, where Salaz lives, is in the southwestern part of the state located near the Rio Grande National Forest.

For years, he was on chemotherapy, pain medication and had a few open lung biopsies, but the abnormalities in his lung remained.

When he went to visit his primary doctor, Dr Choon-Kee Lee at the San Juan Cancer Center, operated by Montrose Hospital, in 2017, the doctor was no longer practicing there.

‘So Dr Lee got dismissed…and they didn’t even tell anybody that he got dismissed. I was waiting in the waiting room for an appointment,’ Salaz said.

Health Tips: What Normally Cause Coma-Like Deep Sleep

Some people sleep so deeply that they are quite difficult to awaken and appear to be in a coma-like sleep. This can present problems in people who need to wake up to get to school or work at a specific time yet persistently sleep through alarms.
The Deepest Sleepers

Coma-like sleep is characterized by a deep sleep devoid of movement. Sleeping so deeply it appears coma-like is only an issue if it affects your daily functioning. For example, if you consistently sleep through alarms or can’t wake up to care for young children, this merits a visit to a doctor for a referral to a sleep specialist for further evaluation. This may involve a physical examination and a sleep study to rule out any medical cause.

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Medication

Medication can have a huge impact on how a person sleeps; some medications make people sleep much more deeply. Harvard Health warns that some antihistamines (those with diphenhydramine) and motion sickness medication can make users sleep more deeply than usual, as can some anti-depressants or anti-anxiety medications.

People react differently to medications, however, so a medication that lulls one person into a deep, coma-like sleep may have no impact on another user’s sleep. Additional medications that can make people sleep more deeply than usual include:

  • Blood pressure medications
  • Some cancer medications
  • Muscle relaxants
  • Pain medications
  • Seizure medication
  • Recreational drugs and alcohol

Medical Conditions

The American Sleep Association classifies recurring coma-like sleep as Long Sleeping Disorder, characterized by individuals needing 10 to 12 hours of sleep nightly in order to function. People with this sleep disorder are usually difficult to awaken and should strive to get the sleep their body needs. Otherwise, they may find it difficult to function during the day.

Patients recovering from surgery or major medical events may sleep more deeply than usual as their body or brain works to repair damage. Heart disease and thyroid disorders can cause increased and deeper sleep too.

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Depression and Deep Sleep

While some people with depression experience sleep disturbances to where they can’t have a restful night’s sleep, others experience deeper sleep while depressed. Depression – regardless of its effect on sleep – should be evaluated and treated.

Hypersomnia and Narcolepsy

These two sleep disorders aren’t typically associated with deep nighttime sleep, but instead can be the cause of deep, coma-like sleep during the day. Hypersomnia causes an irresistible urge to sleep during the day and extended sleeping at night, while narcolepsy is characterized by sudden sleep accompanied with paralysis any time of day. Neither condition is considered curable, but is instead helped with maximized nighttime sleep and, in some cases, medication.

Teenagers and Deep Sleep

Teenagers experience a shift in their circadian rhythm that can prompt incredibly deep sleep, making it difficult to wake them up. This can frustrate or alarm parents.

As their brains work to rapidly develop and their bodies work to produce growth hormone, sleep becomes even more vital to a teenager’s health and well-being. The deep, coma-like sleep that teenagers often experience is simply their brains and bodies working hard to transition from adolescence into adulthood.

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Gender Differences

Women tend to have more lifetime events with the potential to affect their sleep, including menstruation, menopause, and pregnancy. Women also tend to spend more time during sleeping hours in deep sleep than men do, researchers report, and they are more likely to experience sleep disorders.

A Deeper Sleeper

Sleeping so deeply to where it appears to be coma-like is not generally classified alone as a sleeping disorder and isn’t necessarily a concern unless it causes problems. It’s important to understand that this is simply how some people sleep and is not a sign of laziness. If deep sleep is causing issues, visit a medical professional to ensure an underlying medical condition isn’t causing the issues with sleep.

Most Women in Africa use covert methods for family planning

Women in Ethiopia, Nigeria and Uganda are often pressured by family and through societal expectations to have more children, but commonly resort to covert or indirect means of contraception to maintain some reproductive autonomy. This is a central finding from a cross-country study led by researchers at the Johns Hopkins Bloomberg School of Public Health, United States (U.S.).

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The findings were presented Wednesday at the 5th International Conference on Family Planning (ICFP) taking place November 12 to 15, 2018 in Kigali, Rwanda. The investigations by researchers were part of a larger project known collectively as the Women’s and Girls’ Sexual and Reproductive Empowerment (WGE-SRH) study. In one analysis of the WGE-SRH being presented at the conference, the researchers found that women’s motivations to become pregnant were not only based on their own values, but also shaped by external pressures from husbands, families and communities.

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“In northern Nigeria, motivations to bear more children were particularly prevalent in polygamous families, where wives secured their influence and children’s inheritance through childbearing,” one of the researchers said. A second WGE-SRH analysis found that both male and female interview respondents tended to consider sex principally a marital obligation and a means of procreation. Sexual pleasure was often an afterthought, and sex outside of marriage was seen as wasteful—except in Uganda, where married men frequently pursued extramarital partners and even married women could do so without sanction if their husbands failed to support them financially.

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However, even men and women reporting multiple partners considered faithful monogamous relationships the ideal. Similarly, in a third analysis, the WGE-SRH team found evidence of widespread covert use of contraception in all three countries, including long-acting injectable contraceptive methods, among women who felt that they could not voice their reproductive choices directly. For some women, covert use of contraception resulted from disagreements with their husbands over having more children. For others, it was a strategy to delay commitment to a new partner or distance themselves from a failing relationship. The WGE-SRH study was designed to explore the motivations and constraints women experience and the choices they make concerning sex, contraception and pregnancy. Ultimately, the researchers have used their findings to construct a cross-cultural index to measure women’s sexual and reproductive empowerment.

Health: Check Out How To Treat Childhood Anxiety Disorder

When it comes to childhood anxiety disorder, treatment depends on the specific type of disorder, the results of a professional assessment, and the individual circumstances of the child affected with the disorder.

Childhood Anxiety Disorders

According to the Anxiety Disorders Association of America, one in every eight children are affected by one or more types a childhood anxiety disorders. These disorders include:

1. Generalized anxiety disorder (GAD)
2. Obsessive-compulsive disorder (OCD)
3. Panic disorder
4. Posttraumatic stress disorder (PTSD)
5. Separation anxiety disorder
6. Social anxiety disorder
7. Selective mutism
8. Specific phobias

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Childhood Anxiety Disorder Treatment

The treatments for childhood anxiety disorders fall into three main classifications:

  • Psychological Treatments
  • Psychopharmacological Treatments
  • Environmental Treatments

Depending on the specific case, more than one type of treatment is often used at the same time.

Psychological Treatments

Many different psychological treatments are used effectively for children suffering with anxiety disorders.

Cognitive-Behavioral Therapy

One of the most popular treatments is cognitive-behavioral therapy, which is also known as CBT. Cognitive-behavioral therapy is a talk therapy with sessions that typically last for approximately twelve weeks. This type of therapy teaches children the techniques and skills they need to learn to reduce their feelings of anxiety. The basis of cognitive-behavioral therapy is to teach a child how to identify their patterns of negative behavior and thinking and replace them with ones that are positive. Children are also taught how to tell the difference between thoughts that are unrealistic and those that are realistic.

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Dialectical Behavioral Therapy

Dialectical behavioral therapy, also known as DBT, teaches children how to cope with the strong negative and emotional feelings they experience, as we as the feelings of conflict within themselves by showing them how to take responsibility for their own problems.

Acceptance and Commitment Therapy

Acceptance and commitment therapy, also known as ACT, teaches children various strategies of acceptance based on the mindfulness. The concept of mindfulness focuses on living in the moment and is taught as a way to cope with feelings, thoughts and sensations that are unwanted. Mindfulness also teaches children how to experience the things that come into their life without judgment.

Additional Forms of Psychological Treatments

Other forms of psychological treatments that are sometimes used for childhood anxiety disorders include:

  • Psychotherapy
  • Behavioral therapies such as relaxation training, guided imagery and progressive desensitization
  • Flooding

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Prescription Medications

Prescription medications, also known as psychopharmacological treatments, are often used in combination with cognitive-behavioral therapy or other forms of psychological treatments. Depending on the severity of the symptoms of the child, the medications are prescribed on either a long-term or short-term basis.

The most popular type of prescription medications for children suffering with anxiety disorders is antidepressants which are selective serotonin reuptake inhibitors, or SSRIs. Examples of SSRIs include:

  • Prozac
  • Celexa
  • Lexapro
  • Sarafem
  • Paxil
  • Pexeva
  • Zoloft
  • Symbyax

Although there are many other types of medications used to treat anxiety disorders, they are not generally used in the treatment of children.

Lifestyle Changes

Environmental treatments for childhood anxiety disorders include overall good habits such as getting enough sleep and eating a healthy well balanced diet. In addition, children with anxiety disorders should also:

  • Avoid stimulants as much as possible including foods or drinks that contain caffeine
  • Avoid nasal decongestants, diet pills and certain cough medicines
  • Remove stressful tasks or reduce them as much as possible
  • Remove stressful situations or reduce them as much as possible

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Child Anxiety Disorder Resources

The following websites provide further information on child anxiety disorders and their treatments:

  • The Anxiety Disorders Association of America
  • The Child Anxiety Network
  • The Saint Louis Behavioral Medicine Institute

Children Are Different

It is important to remember that children are different. Even if two children suffer from the same childhood anxiety disorder, treatment for each child may not be the same. There is no single child anxiety disorder method of treatment that works best for every child. It is very common for one child to have a better or faster response to a specific method of treatment than another child with a diagnosis that is exactly the same.

What Adoption will do to Vulnerable children in Nigeria

The Heritage Adoption Support and Advocacy Group has said that adoption can reduce the population of orphaned and vulnerable children in Nigeria, as well as the number of married couples without children. The Project Coordinator of the Group, Mrs Eme Akenzua, in a statement made available to our correspondent, said that adoption was still viewed with a negative mindset in Nigeria and women struggling from infertility were stigmatised and abused by the people due to ignorance.

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Akenzua stressed that the vision of the organisation was to change the negative perception towards adoption in the society and render support to prospective adopters, adoptive parents, and adoptees. She also described the issue of infertility in the country as a serious issue affecting 25 per cent of married couples in Nigeria are affected. “Although male infertility has been found to be the cause of failure to conceive in about 50 per cent of the cases, the social burden falls on the women who suffer discrimination, stigma, and ostracism according to a WHO report on sub-Saharan Africa.

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“While some infertile couples will respond to different types of fertility treatments, some sadly will not, this is usually a very difficult position for them to accept. Fortunately, though, for such couples, adoption offers the opportunity to have children,” the statement read. Akenzua, in the statement, also said that the second annual adoption conference would hold on Thursday, November 15 at the Federal Palace Hotel to mark the World Adoption Day.

Percentage of people living with Diabetes in Ondo state revealed

The Ondo State Commissioner for Health, Dr. Wahab Adegbenro, on Wednesday expressed concern over the rising number of people living with diabetes in the state. Speaking during an event held in Akure, the state capital, to mark the World Diabetes Day, Adegbenro disclosed that one out of 20 residents was living with the deadly disease. The commissioner also said the state government had taken the necessary steps to check the disease.

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Part of the government’s efforts to curtail diabetes, he noted, was the creation of an awareness programme to enable the people detect it early enough and seek medical assistance. Adegbenro said, “Diabetes and hypertension are major diseases troubling the whole world. Incidentally, both of them can torment a patient at the same time. The state government is doing its best to nip them in the bud.

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“We have a lot of specialists and facilities that can handle diabetes. People should visit these facilities. They should stop eating junk food and indulging in self-medication. “The media should also help to create more awareness so that people can be educated on the inherent dangers of being a diabetic.” In her remarks, a Consultant Endocrinologist at the University of Medical Sciences Teaching Hospital, Ondo, Dr Adenike Enikuomehin decried the increasing number of people living with diabetes in the state, saying that out of 8,500 patients admitted to the teaching hospital between January and November, 2018, about 3,500 were diagnosed with diabetes.

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Noting that no fewer than 700 people out of 1,500 patients admitted to the hospital in recent time were diabetic, Enikuomehin also disclosed that every six seconds, one person must die of diabetes around the world. She said, “When you admit 40 patients in our hospital, almost 30 of them are living with diabetes. That is more than two-thirds of admitted patients. This is worrisome. It calls for the attention and support of all and sundry.

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“The family also has a major role to play in this aspect to give all necessary support to people living with diabetes.” Enikuomehin said that a healthy lifestyle and regular physical exercise were the best antidotes for diabetes. She also urged school authorities to create platforms where the young generation can engage in physical exercise.

Health Tips: Check Out Symptoms Of Anxiety Attack

If you have ever felt a sense of being helpless or in danger, while your heart is pounding wildly or you are having feelings of lightheadedness and shortness of breath, you may be experiencing the symptoms of a mild anxiety attack.

What is an Anxiety Attack?

An anxiety attack, also called a panic attack, often occurs suddenly and without warning. Sometimes you may know the cause, or trigger, such as thinking about an upcoming presentation or driving through a tunnel. At other times there seems to be no apparent reason for the sudden onset of the anxiety attack.

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The symptoms that you feel during an anxiety attack can occur even if you are not in the situation that is the cause of your anxiety. For example, if you work in a job that is stressful you may experience symptoms of anxiety when you are not at work. You might have trouble sleeping at night, notice that your hands are trembling while you are watching television or experience blurry vision on your day off.

Feelings of anxiety are the body’s normal reaction to stress. The feelings are the body’s way of helping to cope with a stressful situation or event. However, when the feelings of anxiety become irrational or excessive the result is often an anxiety attack.

Symptoms of a Mild Anxiety Attack

When you experience an anxiety attack, the feelings of anxiousness and panic affect you both mentally and physically. Generally, the symptoms experienced during a mild anxiety attack are the same as those experienced during a more severe anxiety attack, only to a lesser degree.

The symptoms of a mild anxiety or panic attack may begin to subside in ten minutes or less. If the anxiety attack is caused by thoughts you are having of something bad, or something you perceive as bad, the anxiety attack generally lasts slightly longer but should subside in ten to twenty minutes.

Not everyone experiences the same symptoms, or group of symptoms, when an anxiety attack occurs. During an anxiety attack some people may only experience one or two symptoms, while others experience a greater number.

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Physical Symptoms

One of the first signs of an anxiety attack people generally feel is a quickening of their heartbeat.

Additional symptoms of an anxiety attack might include:

  • Slight chest pain
  • Tightness in the chest
  • Heart palpitations
  • A pounding sensation in your ears as the blood flows faster through your body
  • An increase in blood pressure
  • A choking sensation
  • Lightheadedness
  • Dizziness
  • Unsteadiness
  • Nausea
  • Rapid breathing
  • Shortness of breath
  • Excessive sweating
  • Clammy palms
  • Trembling hands
  • Dry mouth
  • Headache
  • Tingling
  • Diarrhea
  • Shakes
  • An upset or nervous stomach
  • Indigestion
  • Pale skin

Emotional and Mental Symptoms

One of the most common feelings associated with an anxiety attack is an overall sense of fear, terror or impending doom that occurs for no apparent reason.Other emotional and mental symptoms of an anxiety attack might include:

  • Feelings of suffocation and not being able to breathe
  • Feeling as if you may lose your grip on reality
  • A sense of dread
  • Apprehension
  • Losing sense of reality
  • Dreamy
  • Losing sense of self
  • Lack of uncertainty
  • Tension
  • Difficulty focusing or concentrating on things
  • Jumpy
  • Expecting the worst to happen
  • Restlessness
  • Irritability

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What to Do During a Mild Anxiety Attack

There are things that you can do while you are experiencing a mild attack of anxiety to help yourself get through it.

  • Remind yourself that it will only last about ten minutes and it will be over soon.
  • Consciously breath in a steady slow pattern.
  • Distract yourself by singing, listening to music or watching television.
  • If you can, go to a place that you find comfortable and happy.
  • Tell yourself reassuring things.
  • If you are with a trusted person let him or her know what is happening and let the person give you words of reassurance that everything is going to be fine.

When you are aware of the symptoms of a mild anxiety attack, you know what to expect if you, or someone with you, experiences one.

Shocker! Nigeria is the third highest country with Pre-Mature babies

A report released by A Non-Governmental Organisation called  Blue Baby Support Initiative, to mark World Prematurity Day, described Nigeria as a country with the third highest number of premature births in the world. The organisation put the number of premature births in Nigeria at 773,600, while China and India had 1, 172, 300 and 3,519,100 premature births, respectively.

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Warning that premature babies might experience long-term health problems, which could affect their brain, lungs, hearing, and vision, the Founder of the initiative, Dania Ogieriakhi, in a meeting with journalists, described premature birth as a leading cause of death among children under the age of five    globally. She said, “The World Prematurity Day is to raise awareness of this serious health crisis. According to the World Health Organisation, an estimated 15 million babies are born every year before the 37 weeks of gestation and this number is rising. Premature birth complications are the leading cause of death among children under five years of age.

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“Three-quarters of these deaths could be prevented with current, cost-effective interventions. More than 60 per cent of preterm births occur in Africa and South-Asia. In the low-income countries, 12 per cent of babies are born too early. “The top 10 countries with the greatest number of premature births are India, China, Nigeria, Pakistan, Indonesia, United States of America, Bangladesh, Philippines, the Democratic Republic of the Congo and Brazil.”

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Ogieriakhi called on stakeholders to devote more energy and resources towards children’s social welfare, including health care and quality education. “We believe that material, maternal, infant mortality and unnecessary preventable deaths can be reduced to the barest minimum through collaborative efforts between government at all levels and the people,” she added.