In August 1987, the federal government launched its Primary Health Care plan (PHC), which President Ibrahim Babangida announced as the cornerstone of health policy. Intended to affect the entire national population, its main stated objectives included accelerated health care personnel developmeÍÍÍÍnt improved collection and monitoring of health data ensured availability of essential drugs in all areas of the country implementation of an Expanded Programme on Immunization (EPI) improved nutrition throughout the country promotion of health awareness development of a national family health program and widespread promotion of oral rehydration therapy for treatment of diarrheal disease in infants and children. Implementation of these programs was intended to take place mainly through collaboration between the Ministry of Health and participating local government councils, which received direct grants from the federal government.

Of these objectives, the EPI was the most concrete and probably made the greatest progress initially. The immunization program focused on four major childhood diseases: pertussis, diphtheria, measles, and polio, and tetanus and tuberculosis. Its aim was to increase dramatically the proportion of immunized children younger than two from about 20 percent to 50 percent initially, and to 90 percent by the end of 1990. Launched in March 1988, the program by August 1989 was said to have been established in more than 300 of 449 LGAs. Although the program was said to have made much progress, its goal of 90 percent coverage was probably excessively ambitious, especially in view of the economic strains of structural adjustment that permeated the Nigerian economy throughout the late 1980s.

The government's population control program also came partially under the PHC. By the late 1980s, the official policy was strongly to encourage women to have no more than four children, which would represent a substantial reduction from the estimated fertility rate of almost seven children per woman in 1987. No official sanctions were attached to the government's population policy, but birth control information and contraceptive supplies were available in many health facilities.

The federal government also sought to improve the availability of pharmaceutical drugs. Foreign exchange had to be released for essential drug imports, so the government attempted to encourage local drug manufacture because raw materials for local drug manufacture had to be imported, however, costs were reduced only partially. For Nigeria both to limit its foreign exchange expenditures and simultaneously to implement massive expansion in primary health care, foreign assistance would probably be needed. Despite advances against many infectious diseases, Nigeria's population continued through the 1980s to be subject to several major diseases, some of which occurred in acute outbreaks causing hundreds or thousands of deaths, while others recurred chronically, causing large-scale infection and debilitation. Among the former were cerebrospinal meningitis, yellow fever, Lassa fever and, most recen 172tly, AI AIDS the latter included malaria, guinea worm, ÍÍÍÍschistosomiasis (bilharzia), and onchocerciasis (river blindness). Malnutrition and its attendant diseases also continued to be a refractory problem among infants and children in many areas, despite the nation's economic and agricultural advances.

Among the worst of the acute diseases was cerebrospinal meningitis, a potentially fatal inflammation of the membranes of the brain and spinal cord, which can recur in periodic epidemic outbreaks. Northern Nigeria is one of the most heavily populated regions in what is considered the meningitis belt of Africa, stretching from Senegal to Sudan and all areas having a long dry season and low humidity between December and April. The disease plagued the northern and middle belt areas in 1986 and 1989, generally appearing during the cool, dry harmattan season when people spend more time indoors, promoting contagious spread. Paralysis, and often death, can occur within forty-eight hours of the first symptoms.

In response to the outbreaks, the federal and state governments in 1989 attempted mass immunization in the affected regions. Authorities pointed, however, to the difficulty of storing vaccines in the harsh conditions of northern areas, many of which also had poor roads and inadequate medical facilities.

Beginning in November 1986 and for several months thereafter, a large outbreak of yellow fever occurred in scattered areas. The most heavily affected were the states of Oyo, Imo, Anambra, and Cross River in the south, Benue and Niger in the middle belt, and Kaduna and Sokoto in the north. There were at least several hundred deaths. Fourteen million doses of vaccine were distributed with international assistance, and the outbreak was brought under control.

Lassa fever, a highly contagious and virulent viral disease, appeared periodically in the 1980s in various areas. The disease was first identified in 1969 in the northeast Nigerian town of Lassa. It is believed that rats and other rodents are reservoirs of the virus, and that transmission to humans can occur through droppings or food contamination in and around homes. Mortality rates can be high, and there is no known treatment.

The presence of AIDS in Nigeria was officially confirmed in 1987, considerably later than its appearance and wide dispersion in much of East and Central Africa. In March 1987, the minister of health announced that tests of a pool of blood samples collected from high risk groups had turned up two confirmed cases of AIDS, both HIV Type-1 strains. Subsequently, HIV-2, a somewhat less virulent strain found mainly in West Africa, was also confirmed. In 1990 the infection rate for either virus in Nigeria was thought to be below 1 percent of the population.

Less dramatic than the acute infectious diseases but often equally destructive were a host of chronic diseases that were serious and widespread but only occasionally resulted in death. Of these the most common was malaria, including cerebral malaria, which can be fatal. The guinea worm parasite, which is spread through ingestion of contaminated water, is endemic in many rural areas, causing recurring illness and occasionally permanently crippling its victims. The World Health Organization (WHO) in 1987 estimated that there were 3 million cases of guinea worm in Nigeria--about 2 percent of the world total of 140 million cases- -making Nigeria the nation with the highest number of guinea worm cases. In affected areas, guinea worm and related complications were estimated to be the major cause of work and school absenteeism.

Virtually all affected states had campaigns under way to eradicate the disease through education and provision of pure drinking water supplies to rural villages. The government has set an ambitious target of full eradication by 1995, with extensive assistance from the Japanese government, Global 2000, and numerous other international donors.

The parasitic diseases onchocerciasis and schistosomiasis, both associated with bodies of water, were found in parts of Nigeria. Onchocerciasis is caused by filarial worms transmitted by small black flies that typically live and breed near rapidly flowing water. The worms can damage the eyes and optic nerve and can cause blindness by young adulthood or later. In some villages near the Volta River tributaries where the disease is endemic, up to 20 percent of adults older than thirty are blind because of the disease. Most control efforts have focused on a dual strategy of treating the sufferers and trying to eliminate the flies, usually with insecticide sprays. The flies and the disease are most common in the lowland savanna areas of the middle belt.

Schistosomiasis is caused by blood flukes, which use freshwater snails as an intermediate host and invade humans when the larvae penetrate the skin of people entering a pond, lake, or stream in which the snails live. Most often, schistosomiasis results in chronic debilitation rather than acute illness.

Data as of June 1991