The Nigerian health authorities have announced an outbreak of diptheria in the capital, Abuja, after the death of a four-year-old child.

The highly contagious infection can cause breathing difficulties and heart problems that can be fatal, particularly in children.

The Nigeria Centre for Disease Control and Prevention (NCDC) said there had been multiple outbreaks across the country since late last year, with almost 800 confirmed cases and at least 80 deaths.

It said the vast majority of cases were among people who had not been vaccinated – despite diptheria being covered by the country’s routine childhood immunisation programme.

The NCDC has urged the public to remain vigilant and ensure that people with symptoms to report early to health facilities for prompt diagnosis and treatment.

The recruitment of nurses by high-income countries from poorer nations is “out of control”, according to the head of one of the world’s biggest nursing groups.

The comments come as the BBC finds evidence of how Ghana’s health system is struggling due to the “brain-drain”.

Many specialist nurses have left the West African country for better paid jobs overseas.

In 2022 more than 1,200 Ghanaian nurses joined the UK’s nursing register.

This comes as the National Health Service (NHS) increasingly relies on staff from non-EU countries to fill vacancies.

Although the UK says active recruitment in Ghana is not allowed, social media means nurses can easily see the vacancies available in NHS trusts. They can then apply for those jobs directly. Ghana’s dire economic situation acts as a big push factor.

Howard Catton from the International Council of Nurses (ICN) is concerned about the scale of the numbers leaving countries like Ghana.

“My sense is that the situation currently is out of control,” he told the BBC.

“We have intense recruitment taking place mainly driven by six or seven high-income countries but with recruitment from countries which are some of the weakest and most vulnerable which can ill-afford to lose their nurses.”

The head of nursing at Greater Accra Regional Hospital, Gifty Aryee, told the BBC her Intensive Care Unit alone had lost 20 nurses to the UK and US in the last six months – with grave implications.

“Care is affected as we are not able to take any more patients. There are delays and it costs more in mortality – patients die,” she said.

She added that seriously ill patients often had to be held for longer in the emergency department due to the nursing shortages.

One nurse in the hospital estimated that half of those she had graduated with had left the country – and she wanted to join them.

‘All our experienced nurses gone’

The BBC found a similar situation at Cape Coast Municipal Hospital.

The hospital’s deputy head of nursing services, Caroline Agbodza, said she had seen 22 nurses leave for the UK in the last year.

“All our critical care nurses, our experienced nurses, have gone. So we end up having nothing – no experienced staff to work with. Even if the government recruits, we have to go through the pain of training nurses again.”

Smaller clinics are also affected by staff migration because even one nurse leaving a small health centre can have a large knock-on effect.

At Ewim Health Clinic in Cape Coast, one nurse has left their small emergency department and another has left the outpatients unit. Both nurses were experienced and had found jobs in the UK.

The chief doctor there, Dr Justice Arthur, said the effects were enormous.

“Let’s take services like immunisation of children. If we lose public health nurses, then the babies that have to be immunised will not get their immunisation and we are going to have babies die,” he told the BBC.

He said adult patients would also die if there were not enough nurses to look after them after surgery.

Most of the nurses that the BBC team spoke to wanted to leave Ghana due to the fact they could earn more elsewhere.

At Kwaso healthcare centre near the city of Kumasi, Mercy Asare Afriyie explained that she was hoping to find a job in the UK soon.

“The exodus of nurses is not going to stop because of our poor conditions of service. Our salary is nothing to write home about and in two weeks you spend it. It’s from hand to mouth.”

Ghanaian nurses told the BBC that in the UK they could more than seven times what they are receiving in Ghana.

Perpetual Ofori-Ampofo from Ghana’s Nurses and Midwives Association said her country’s healthcare system needed more help.

“If you look at the numbers, then it is not ethical for the UK to recruit from Ghana because the numbers of professional nurses compared to trainee or auxiliary nurses is a problem for us,” she said.

But she added that it was not possible to stop nurses from leaving as migration was a right and that the Ghanaian government needed to do more to persuade them to stay. The health ministry in the capital, Accra, declined to comment.

Ghana is on the World Health Organization’s list of 55 vulnerable countries, which have low numbers of nurses per head of population. The list – dubbed by some as the “red list” – is designed to discourage systematic recruitment in these countries.

The UK government recently gave £15m ($18.6m) to Ghana, Nigeria and Kenya to help boost their healthcare workforces.

But the country is known to be looking at brokering a formal deal with Ghana whereby it might be able to recruit more proactively in return for giving the government there a sum of money per nurse.

It already has a similar agreement with Nepal.

But the ICN’s Mr Catton questioned whether it was enough.

He told the BBC that he believed such deals were “trying to create a veneer of ethical respectability rather than a proper reflection of the true costs to the countries which are losing their nurses”.

The WHO’s Director of Health Workforce, Jim Campbell, explained to the BBC that Brexit had been a factor in the UK turning to African countries for nurses to fill NHS vacancies.

“The labour market is extremely competitive around the world and, having closed off the potential labour market from European freedom of movement, what we’re seeing is the consequences of that in terms of attracting people from the Commonwealth and other jurisdictions.”

Physician Specialist at International Maritime Hospital (IMaH) at Tema, Dr. Zuleila Fuseini, has stated that there are about 2.4 million Ghanaians, constituting 8.3 percent of the total population, living with diabetes. 

“This means that when you take every hundred people, there is a chance of getting eight of them to be diabetic, which is quite a bad thing to say,” she stated.  

She quoted the World Health Organization (WHO) statistics on diabetes, which indicate that about 422 million people worldwide have the disease, with the majority living in low- and middle-income countries, and that 1.5 million deaths are directly attributed to diabetes each year. 

“Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades,” she stated. 

Dr. Fuseini said this at the weekly “Your Health! Our Collective Responsibility! A Ghana News Agency Tema Regional Office initiative aimed at promoting health-related communication and providing a platform for health information dissemination to influence personal health choices through improved health literacy 

The Ghana News Agency’s Tema Regional Office developed the public health advocacy platform “Your Health! Our Collective Responsibility” to investigate the components of four health communication approaches: informing, instructing, convincing, and promoting. 

Speaking on “Diabetes Melilitus,” Dr. Fuseini expressed concern that the disease was becoming common in the country, mainly due to the sedentary lifestyle of Ghanaians. 

Dr. Fuseini stressed that diabetes was a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. 

She said the most common was type two diabetes, usually in adults, which occurred when the body becomes resistant to insulin or doesn’t make enough insulin.  

“In the past three decades, the prevalence of type two diabetes has risen dramatically in countries of all income levels. 

She said type one diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. 

“For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025,” she said. 

She mentioned that preventive modalities included balanced diets, regular exercise, cutting down on alcohol intake, cessation of smoking, and keeping weight, saying the ideal Body Max Index (BMI) should be between 18 and 25, among others. 

Dr. Fuseini also expressed worry that although type one was common among children and type two was prevalent among adults currently, type two was now being highly recorded among children. 

Mr. Francis Ameyibor, Regional Manager of Ghana News Agency in Tema, warned against the rise of sedentary lifestyles and inactivity, which are associated with our current way of life: modes of transportation, working in a seated position, and other new ways of doing things imply that we are less active. 

He emphasised the importance of combating sedentary lifestyles, which have become a public health crisis.