The Problem of Memory Loss in Nigeria: The Burden and Way Forward
8 January 2021
Professor Isyaku Umar Yarube
Are you becoming more forgetful? When you are above 45 years old and you often fail to remember if you locked the front door; or often forget where you kept your keys and find them later; or miss your scheduled appointments; you know that your time has come, and you’re entitled to it. But when you pay a visit to your 65-year-old favourite aunt, whom you last saw a year ago, and she recognises you but fails to recall your name; who was elated but could barely find the right words to tell you how happy she was to see you; and who has lost track of the time of the year; you know it’s a different ball game all together, she is not entitled to it. In both situations, something is wrong, but to a different extent – memory loss.
What is memory loss?
A number of related terms are being used in this regard. Memory loss refers to a condition when our ability to recall what we already know is impaired. Amnesia, as it is called, is a partial or total loss of memory. Cognitive impairment connotes deterioration of memory alongside other brain functions such as language, perception, thought and others (collectively called cognition), but the sufferer is able to carry out the normal activities of daily living. In dementia, the severity of cognitive impairment is to the extent that the sufferer is unable to carry out normal activities of daily living; and thus has become dependent on care givers for most of their needs.
What causes memory loss?
A host of different conditions can lead to memory loss. One of them is the so called age-related memory loss, a condition associated with mild deterioration of cognition seen in many individuals due to aging. Others are Alzheimer’s disease, and other diseases or injury that affects the brain, including stroke, diabetes, head injury, alcohol abuse, certain medications (sedatives), emotional shock or trauma such as the one seen in victims of violent crimes.
Risk factors for memory loss include age (above 65 years), lack of regular exercise, smoking, excess body weight, unhealthy diet, high blood pressure, excess cholesterol and blood sugar levels, depression, low educational attainment and social isolation.
The burden of memory loss in Nigeria
According to the World Health Organisation (WHO) (2019), around 50 million people have dementia worldwide, with nearly 60% living in low- and middle-income countries. About 5-8% of the general population aged 60 and over is living with dementia. Every year, there are nearly 10 million new cases. Much of this increase is attributable to the rising numbers of people with dementia living in low- and middle-income countries. With Nigeria’s current population of 206,139,589, and forecast population of 401,315,000 by 2050, the population of people with dementia is expected to rise from the current estimate of 14 million to over 28 million.
Dementia has significant social and economic implications in terms of direct medical and social care costs, the costs of informal care, as well as economic losses. In 2015, the total global societal cost of dementia was estimated to be 818 billion USD, or about 311 trillion Naira. This cost ranges between 0.2% - 1.4% of GDP, varying among low- and middle-, to high-income countries. For Nigeria, with GDP of 494.6 billion USD (2015), this cost translates to about 1 billion USD, or 375 billion naira. This is a huge burden representing about 0.03% of annual national budget, which is more than three times the capital allocation to agricultural sector.
Apart from these figures emanating from global estimates on dementia, there are no accurate statistics on the real socio-economic cost of memory loss in Nigeria. This is due to lack of comprehensive nationwide research on the problem. Indeed, the burden of memory loss will sum up from not only dementia, but also the multitude of diseases and conditions that present as or with memory loss; and the statistics on many of these contributing diseases and their economic impact are not available.
A few local studies provide some insight into the problem of memory loss. Mavrodaris (2013), Adeloye (2019), Yusuf (2011), and their co-workers in their studies mainly localized to one part of the country reported prevalence rates of dementia from as low as 0-2.79% to as high as 4.9-10.1%.
There are hospital-based studies conducted in Kano by Yarube and co-workersin 2018 and 2019 that examined the prevalence of cognitive impairment in different conditions. These studies reported that majority of the diabetics had impaired cognitive function. Similarly, cognitive impairment was observed in 79% of stroke survivors, 86.7% of hypertensive patients and 88.3% of first-time-pregnant women. This high local burden of memory loss and dementia is a source for concern and a call for a search for a remedy that may be locally available.
It is obvious that there is the need for a standardized, large-sample, multi-centred, country-wide study in order to generate good estimates of the burden of memory loss in Nigeria; and this is a challenge. These figures are necessary for policy making and healthcare delivery planning regarding cognitive impairment and dementia in Nigeria.
Way forward on memory loss in Nigeria
A multi-prong approach is required to tackle the challenge posed by the apparently huge burden of memory loss in Nigeria. First, the WHO recommendations regarding dementia are crucial and should be implemented. WHO recognizes dementia as a public health priority and has come out with a comprehensive plan of action. Nigeria needs to key into these plans as much as possible. The Global action plan on the public health response to dementia 2017-2025 provides a comprehensive blueprint for action – for policy-makers, international, regional and national partners, and WHO.
The Global Dementia Observatory, has been established for policy-makers and researchers to facilitate monitoring and sharing of information on dementia policies, service delivery, epidemiology and research.
WHO has developed a number of documents and guidelines in order to harmonize and facilitate actions across nations. Some of these documents include: Towards a dementia plan: a WHO guide, Guidelines on risk reduction of cognitive decline and dementia, Mental Health Gap Action Programme (mhGAP) and iSupport, available both as an online version and as a hard copy manual.
Equally important is improving access to care by the affected persons, especially the patients and their caregivers. This can be achieved by training and retraining of personnel to handle patients with memory loss. In this regard, there is need to establish memory clinics, specialised centres that cater for people with memory-related problems, in all tertiary hospitals across the nation, which is hardly the practice now anywhere in the country.
Adequate funds should be made available for research and innovation in the area of memory loss. It is vital to start by conducting a nationwide, multi-centred studies in order to identify more accurate statistics on memory loss in Nigeria. Search for remedies from local herbs to alleviate memory loss should be enhanced. Government needs to provide adequate funding and enabling environment for this, through its various institutions such as the National Research Fund/TETFund, research institutions and universities. Healthcare and pharmaceutical companies, financial institutions and other non-governmental organizations (NGOs) should play a crucial role in this endeavour.
Journalists and public educators have a big role to play towards addressing the burden by creating awareness about memory loss and dementia, their preventive measures and where to access care and support. They can as well help to draw the attention of government and spur it to action on the problem.
The general public can make a difference by changing their behavior to avoid risk factors for memory loss and dementia highlighted above. The public can also serve by creating NGOs for support. A few already exist, such as the Dementia Care International, Nigeria–Dementia Friendly Communities and Dementia Care Society of Nigeria; but more needs to be done.
With concerted efforts, members of our society with forgetfulness will not be forgotten.