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Health

Meningitis: Lagos Govt. introduces Men-A vaccine into routine immunisation

Risk factors for meningitis

Meningitis
by Vivian Ihechu
Lagos, Aug. 16, 2019 (NAN) The National Primary Health Care Development Agency, the Lagos State Ministry of Health and the Lagos State Primary Health Care Board in conjunction with Partners on Monday announced the introduction of Meningitis vaccine (Men-A vaccine) into Routine Immunisation schedule in Lagos State.

Mrs Modupe Owojuyigbe, Director, Health Education, Lagos State Primary Healthcare Board, told the News Agency of Nigeria (NAN) in Lagos on Friday, that the meningitis vaccination would start from Aug. 19.

According to her, Meningitis vaccine (Men-A vaccine) is safe, free and effective.

Owojuyigbe, who is the Social Mobilisation and Demand Creation Director for Lagos state, told NAN that other states are also introducing the Men-A vaccine into the routine immunisation schedule at the same time.

“Meningitis vaccine was not part of our routine immunisation but now we have introduced it. It is going to be part of the immunisation.

“It is going to be given at age nine months to 15 months; children also take yellow fever at nine months; so now, they will also be taking meningitis vaccine.’’

She said the introduction of men-A vaccine into the routine immunisation is necessary because Nigeria is within the belt of meningitis disease, whereby meningitis is common.

On the causes and possible ways to prevent meningitis, she said: “Meningitis is caused by viruses, bacteria and fungi.

“The incidence is most common during the dry season, especially with the dust of the dry season and the cold night.

“It is not only children that can be affected with meningitis, it can affect any age group.

“But it is most common in and affects children of one year to seven years more than adults and this is the age that we can prevent now.

“Vaccinating children with meningitis vaccine and maintaining hygiene in the environment by avoiding overcrowding helps prevent the disease,” she told NAN.

She advised that places with poor ventilation be also avoided.

Owojuyigbe emphasised that the meningitis vaccine would be given alongside with Measles and Yellow fever vaccine.

According to her, it is very safe to take the three vaccines together the same day.

She urged parents and wards to take their nine to 15 months old child/children to the nearest Primary Health Care Centres for Meningitis vaccination (Men-A vaccine) from Aug. 19.

Owojuyigbe explained that meningitis involves the inflammation of the meninges and it is a devastating disease that causes serious global public health concern.

“The membranes that line the skull and the vertebrae as well as enclose the brain are called the meninges and the function of the meninges is to protect the nervous system.

“The bacterial meningitis is caused by Neisseria meningitides of group A and it is the cause of 90 per cent of meningitis outbreak in the African Meningitis belt.”

On the possible signs and symptoms, she said they include fever, sudden onset of severe headache, and feeling of vomiting, child highly irritable, neck stiffness, convulsion and loss of consciousness.

“The meningitis bacteria are transmitted from person to person through respiratory droplets, throat secretions or direct contact with infected people.

“Meningitis can be prevented by vaccination with meningococal vaccine; other methods of prevention include good personal hygiene, avoiding overcrowding, and exclusive breast feeding to build a child’s immunity,” she said. (NAN)
VIV/IS
======
edited by Ismail Abdulaziz

Health

Bauchi records 4 cases of meningitis

Bauchi records 4 cases of meningitis
By Mohammed Kaigama Ahmed
CSM
Bauchi, April 11, 2019 (NAN) The Bauchi State Government has confirmed recording four suspected cases of Cerebro‎-Spinal Meningitis (CSM) in the state.
Mr Adamu Gamawa, the Executive Chairman, Bauchi State Primary Health Care Development Agency (BSPHCDA), confirmed the outbreak to newsmen in Bauchi on Thursday.
Gamawa said one of the suspected cases was confirmed to be a Streptococcus Pneumonia, a strain which does not cause an epidemic.
He added that one other case was under investigation as samples had been taken for analysis to confirm whether it ‎is meningitis or another disease.
Gamawa however advised residents to avoid sleeping in crowded and unventilated rooms to avoid contracting the disease.
He urged the people to quickly report any noticed case of abnormality in their body to the nearest health facility. (NAN)
MAK/KOO/MST
Edited by Kevin Okunzuwa/Muhammad Suleiman Tola

Health

Meningitis kills 14 in Jigawa – Commissioner

Meningitis kills 14 in Jigawa – Commissioner
NAN-H-8
Meningitis
By Muhammad Nasir Bashir
Dutse, March 7, 2018 (NAN) The Jigawa Government says meningitis has killed 14 persons as 51 suspected cases were recorded in 10 local government areas of the state.
Dr Abba Zakari, the state Commissioner for Health, confirmed this to newsmen in Dutse on Wednesday.
Zakari said that 51 suspected cases of Cerebro Spinal Meningitis (CSM) had so far reported to the ministry since November 2017.
He said: “For instance, in Birninkudu we had two cases with one death; in Gagarawa one case but no death; in Jahun seven cases but no death;
“Malam Madori 10 cases with four deaths, in Ringim one case but no death; in Miga one case but no death; in Babura 11 cases but no death; in Dutse one case but no death;
“Maigatari recorded three cases but no death, and in Taura we had 10 cases and five deaths.
“And out of the 51 suspected cases, 10 were confirmed as meningitis, about 44 were not meningitis as it was only 10 that were confirmed meningitis.
“But out of 51, we lost around 14 of them, not nine as reported by some of the media.
“So, it is 51 suspected cases, 10 confirmed and 15 mortalities, and it cut across several local government areas of the state.’’
The commissioner pointed out that the state was within the meningitis belt of the African region, where meningitis epidemic is being recorded between every five and 10 years.
“You know Jigawa state falls within what is called meningitis belt of the African region and then from time to time you have the epidemic of meningitis.
“And incidentally it happens in a circle almost like every five to 10 years you have one or two epidemics.
“Now in Jigawa state, since November 2017, we have about 51 suspected cases of meningitis, and what we mean by suspected cases of meningitis is that people are showing some signs and symptoms that look like meningitis.
“But you cannot really say they have meningitis until you take what is called cerebrum spinal fluid and look at it under the microscope, if you can see the bacteria there then you can say that this is meningitis,’’ the commissioner explained.
According to him, the ministry had contacted the Federal Government for drugs.
“The major challenge has always remained the non-availability of the drugs/vaccines.
“Fortunately, this morning as I spoke with National Primary Healthcare Develop Agency (NPHCDA), they confirmed to me that federal government has already donated drugs for us to fight the menace.
“We’ve increased the level creating awareness across the state so that people will be able to prevent themselves from getting infected and also quickly bring to hospital anyone that has the symptoms.
“We also use jingles on radio stations in the state so as to reach to the populace.
“We are therefore, advising residents to take precautions against the disease and make sure that they do not sleep in un-ventilated and overcrowded rooms,’’ Zakari said.
The commissioner added that the ministry would soon conduct state wide campaign against the disease, targeting children between two and 15 years. (NAN)
MNB/FF/MST
Edited by Fela Fashoro/Muhammad Suleiman Tola

Health

Meningitis kills 3 in Yobe – Commissioner

Meningitis kills 3 in Yobe – Commissioner
NAN-H-30
Meningitis
Damaturu, Feb. 7, 2018 (NAN) The Yobe Commissioner for Health, Dr Bello Kawuwa, said the state has recorded 10 new cases of Cebro Spinal Meningitis with three deaths this year,
He disclosed this on Wednesday at the flag off of measles vaccination campaign in Damaturu.
Kawuwa said the state government in collaboration with National Primary Healthcare Development Agency and development partners have commenced early campaign and vaccination of children from one to six years old.
“The immunisation which targets 771,778 children will be conducted at health centres and designated fixed posts.
“The exercise is staggered in two phases; the first comprising eight local government areas from Feb. 7 to 11, while the second phase commences on Feb. 14 through 18,’’ he said.
The commissioner urged parents and caregivers to immunise their children.
“It is our obligation as parents to routinely immunise our children against all vaccine preventable diseases; routine immunisation is given at health facilities by qualified healthcare givers,” he said.
Dr Hauwa Goni, the Executive Secretary, Yobe Primary Healthcare Management Board, also urged parents to cooperate with health and medical personnel to ensure the success of the exercise.
She expressed confidence in traditional authorities mobilising their subjects to participate in the vaccination. (NAN)
MM/KOLE/MST
Edited by Remi Koleosho/Muhammad Suleiman Tola

General news

North East states battle meningitis – NAN Survey

North East states battle meningitis – NAN Survey

NAN-H-3

Meningitis

Abuja, May 21, 2017 (NAN) States in North East Nigeria have adopted proactive measures against the outbreak and control of Cerebro Spinal Meningitis (CSM).

A survey conducted by the News Agency of Nigeria (NAN) in the region indicated that the states have made adequate logistic arrangements and set up rapid response teams to combat the disease.

The report also said that while some states have acquired the CSM vaccines, others made contingency arrangements with the Federal Government to fight the scourge.

In Bauchi, the Executive Chairman of the state Primary Health Care Development Agency (PHCDA), Malam Adamu Gamawa, told NAN that unused vaccines procured in 2016 were mopped up by the federal government and allocated to states most severely affected by the disease.

Gamawa said the remaining few doses left were used in vaccinating people considered to be at high risk of contracting the disease.

He refuted reports that the vaccines were being sold by operators of private health facilities in the state.

“We normally allocate these vaccines to private operators for easy access by the people and they account for them.

“Since we do not have single dose at our disposal now, there is no way they could have acquired the vaccines and sold to people.

“We have not received any complaint from the public that the vaccines were being sold to them,” he said.

However, the chairman said that efforts were being made by the agency to procure the vaccine.

He called on the people to report suspected cases of CSM to the nearest health facilities for prompt action.

From Adamawa, the State Government has confirmed receiving enough CSM vaccine from the federal government through the support of the World Health Organisation.

Dr Bapetel Pariya, Director Public Health, State Ministry of Health, who disclosed this to NAN in Yola, said that the vaccines were provided last month when the state recorded an outbreak of CSM.

“We received enough vaccines from the federal government, with the collaboration of the World Health Organisation and UNICEF,” Pariya said.

According to him, government has provided enough doses of CSM type `C’ to all the 21 health facilities in the state.

“So far, we have not received any complaint about non-availability of the vaccines and we are ready to deal with any case of sabotage,” he assured.

On its part, the Gombe State Government said it had concluded arrangements to procure the vaccine.

Dr Kennedy Ishaya, the state Commissioner for Health, told NAN that pending the procurement of the vaccines, government had already purchased drugs worth N4 million and distributed to government and private hospitals across the state.

He said that so far, there were no reported cases of meningitis in state.

In Borno, health workers in the state commended the State Government for providing enough vaccines in public hospitals towards preventing an outbreak of the disease.

A cross section of the workers told NAN in Maiduguri that the present administration took proactive steps to avert an epidemic in the state.

Mrs Zara Balami, a Nursing Superintendent at the Maryam Abacha Children Hospital in Ruwan Zafi, said that the provision of adequate vaccines by the government had helped curtailed the outbreak of the disease.

“Some years back, we used to record large number of cases of meningitis in this hospital, but I am happy to say that we have not recorded any case yet.

“In spite of this we have a stockpile of vaccines in the hospital in case of emergencies,” Balami said.

Mrs Mary Misheliza, a health worker at the Specialist Hospital Maiduguri, also confirmed that the state has a stockpile of vaccines.

“I think government has done so well in the area of preventing meningitis outbreak this year.

“Most importantly the idea of massive vaccination has actually helped in preventing an outbreak of the disease,” Mishelia said.

The state Commissioner for Health, Dr Haruna Mshelia, said that government had set aside 200,000 doses of vaccine for meningitis as a proactive measure against any outbreak.

Mshelia said that the state had earlier carried out a vaccination capable of protecting the vaccinated for a decade.

“Between 2012 and 2014 the whole state was covered with a special type of meningitis vaccine that lasts for 10 years.

“However, we have over 200,000 doses in our stores for outbreak response, should there be any case,” he said. (NAN)

Reporters/ASH/MST

Edited by Abdullahi Salihu/Muhammad Suleiman Tola

Health

Meningitis: WHO deploys 190 Polio personnel to Sokoto State

NAN-HG-82
Deployment
By Yashim Katurak
Abuja, May 4, 2017 (NAN) The World Health Organisation (WHO), says it has deployed 190 Polio Eradication Initiative (PEI) officers to Sokoto State to support the fight against Cerebro Spinal Meningitis (CSM) by the state government.

WHO Country Representative to Nigeria Dr Wondimagegnehu Alemu said this in a statement in Abuja on Thursday.

Alemu said PEI officers, drawn from the Nigeria country office and field offices, would be working with the Sokoto team at the Polio Emergency Operating Centre (EOC) to plan for the response to the outbreak.

He said in the last two months, Nigeria had been experiencing widespread epidemic of meningitis, mainly caused by Neisseria meningitidis type C serotypes.

According to Alemu, states mostly affected by the epidemic are; Zamfara, Sokoto, Kastina, Kebbi, Yobe and Niger.

He said with the formidable workforce of the organisation, it had facilitated the immediate creation of an Incident Management System at the EOC.

“Several planning meetings, chaired by the Sokoto EOC Polio incident Manager with Commissioner for Health in attendance, culminated in the development of a micro plan that targeted 770,000 susceptible young persons aged 1 to 21.

“The target population informed the request and release of 820,000 doses of vaccines for reactive vaccination in the state by the International Coordinating Group (ICG) on Vaccine Provision through WHO.
“With the support of WHO, the state conducted detailed outbreak investigations in the most affected local governments of Gudu, Dange Shuni, Sokoto South, Sokoto North, Rabah and Tureta.
“Over 3,687 of suspected meningitis were reported in all the 23 local government areas of Sokoto State as at May 1, 2017 with more than 80 per cent of the cases in the 1 to 20 years cohort,’’ he said.
Alemu further said more than 200 deaths had so far been recorded from 10 local government areas of the state.
He said one of the cardinal strategies employed by the organisation to rapidly curtail the outbreak of the disease was the involvement of different cadres of WHO polio personnel.
“These include cluster consultants, Local Government Areas facilitators and Field Volunteers.
According to Alemu, other strategies include planning and coordination of training, vaccine management and supervision of meningitis C pre-implementations activities with the state team and other partners.
He said with four days into the reactive vaccination, 560,000 of the targeted 740,000 had been vaccinated, representing 76 per cent coverage.
Alemu said the vaccination would be extended by two days of mopping in wards where the personnel had not achieved 90 per cent coverage.

He said the support to the Federal Government in the eradication of polio was made possible with funding from the Bill & Melinda Gates Foundation, European Union and the Government of Germany through KfW.
Others he said, were; Global Affairs Canada, USAID, Community Chest Korea through the Korea Foundation for International Healthcare (KOFIH)), DFID (UK), Rotary International and the World Bank. (NAN)
KRY/JPE/DUA

Edited by Joseph Edeh/Dada Ahmed

Health

Meningitis: Expert wants FG introduce vaccine into routine immunisation

 

NAN-HG-7
Meningitis
By Raji Rasak
Lagos, April 21, 2017 (NAN) Dr Folake  Olayinka, an Immunisation Team Leader, Maternal and Child Survival Programme,  on Friday  urged the Federal Government  to introduce meningitis vaccine into the routine immunisation programme.

Olayinka, a USAID awardee, said in Lagos that the inclusion would be a proactive and preventive measure against strains of meningitis.

The medical expert spoke with the News Agency of Nigeria (NAN).

She added that there was the need for further studies to determine the appropriate meningitis vaccine to be introduced in Nigeria.

She spoke against the backdrop of meningitis outbreak in some parts of Nigeria and the forthcoming 2017 World Immunisation Week.

The weeks comes up from April 24 to April 30.

According to Olayinka, preparing against  outbreaks begins long before the first case is recorded.

She said that the  preparation must entail strong routine immunisation system that would provide vaccination to target groups.

“In a meeting of experts in October 2015 at the World Health Organisation (WHO), concerns over Meningitis C were raised.

“The preventive measures that needed to be put in place were discussed, such as enhanced surveillance, prepositioning for rapid laboratory diagnosis, lumbar puncture kits and antibiotics.

“Vaccination was also discussed.

“However,  given the shortage of the vaccines for the  Meningitis C strain, it was suggested that rather than the  ideal preventive campaign with a polyvalent vaccine, a reactive  campaign should be conducted at the onset of an outbreak.’’

She told NAN that the recent outbreak of Meningitis C in 19 states of Nigeria had resulted in more than 400 deaths.

“The worst meningitis outbreak in Nigeria and neighbouring countries occurred in 1996 and 1997 with over 25,000 deaths, mostly from the Meningitis A strain.

“The major strain seen in Nigeria in the past had been the Meningitis A strain.

“However, it is gradually reducing as a result of massive preventive campaigns in the Africa Meningitis Belt with the  MenAfriVac, a vaccine targeting the Meningitis A strain.

“Nigeria is due to introduce MenAfricVac vaccine into the immunisation system in 2017. However, what happens next time a different strain emerges, a strain such as this Meningitis C?

“So, we need further studies and research,’’ she said.

Olayinka, a Public Health Specialist with JSI, Arlington,Virginia, U.S.,  noted that cases of Meningitis C were reported in Nigeria in 2013, 2014 and 2015.

“This should have been an early warning for Nigeria.

“The pathway to preventing similar emergencies should also include a prepared health workforce, surveillance, lab testing and diagnosis, prompt identification, treatment and vaccination.

“It must also include engaging with communities and providing items with the right information about prevention and treatment.

“There is also an urgent need for Nigeria to come up with resources needed to ensure that the total amount of vaccines required are purchased, and that they arrive in time and distributed to where they are needed most.’’

According to her, regular education of the public,  regular  upskilling of health workers, strong surveillance, prepositioning and stockpiling of vaccines and appropriate medicines are also required.

NAN reports that since the beginning of this year, the country has reported about 4,637 suspected cases and 489 deaths from meningitis C.

The affected states include Zamfara, Katsina, Kebbi, Sokoto and Niger. (NAN)

ROR/VIV/IGO
============
(Edited by Vivian Ihechu/Ijeoma Popoola)
 

General news

Nigeria needs 2m vaccine doses to fight meningitis – Expert

Nigeria needs 2m vaccine doses to fight meningitis – Expert

NAN-HG-5

Meningitis

By Desmond Ejibas

Port Harcourt, April 19, 2017 (NAN) Dr Fred Weli, a family health expert in Port Harcourt, says Nigeria will need about 2 million doses of vaccine to fight current meningitis epidemic.

Weli told the News Agency of Nigeria (NAN) in Port Harcourt on Wednesday that current 500,000 doses available in the country were grossly inadequate to fight the epidemic.

NAN recalls that the country recently received 500,000 doses of meningitis C vaccine from the World Health Organisation (WHO) to combat the epidemic that has caused the death of 489 deaths across four states.

Weli expressed optimism that the 2 million vaccines would checkmate the epidemic in the worst hit states of Katsina, Sokoto and Zamfara, and halt its spread to other states.

According to him, 336 new cases have been recorded in 16 states and 19 local government areas which are quite worrisome.

“The country currently has about 500,000 doses of vaccines which is a far cry to the about 2 million needed to fight the scourge in some parts of the country.

“So far, procurement of the vaccine has not been fast enough and the fact remains that the vaccines are needed quickly as possible for the disease to be contained,” he said.

Weli said that meningitis could be transmitted and spread from individual to another through throat secretion, sneezing, coughing and contact with infected materials.

He said that meningitis which was similar to Ebola could be avoided through good personal hygiene like washing and sanitising one’s hand after using the toilet, among others.

“We can also checkmate the spread of meningitis by coughing and sneezing into our elbows or tissue papers rather than into someone else’s face or handkerchief.

“We need the right education, sensitisation and awareness to checkmate the disease, and as such, everyone must get involved,” he said.

Weli said that there was no case of the disease in Rivers, but that it was not enough for residents to relax “especially as the disease had been reported in Lagos and Cross River states”.

The healthcare worker urged residents to report cases of high fever, headache, stiff neck, memory loss, convulsion and loss of appetite to nearest health facility for proper diagnosis of the patient. (NAN)

DES/JIE/MST

Edited by Julius Enehikhuere/Muhammad Suleiman Tola

Health

Nigeria receives 500,000 doses of Meningitis C vaccine- WHO

NAN-HG-1

Meningitis

By Yashim Katurak

Abuja, April 14, 2017 (NAN) Nigeria has received 500,000 doses of meningitis C containing vaccine to combat the epidemic in the country, the WHO has said.

The doses were sent by the International Coordinating Group (ICG) on Vaccine Provision, an organisation that coordinates the provision of vaccine during outbreak emergencies.

Dr Wondimagegnehu Alemu, the WHO Country Representative to Nigeria, said this in a statement in Abuja on Friday.

He said the vaccines, funded by Gavi, the Vaccine Alliance, have been administered in Zamfara and Katsina States where the disease was most endemic.

Alemu said an additional 820,000 doses of the meningitis C conjugate vaccine donated by the UK government to WHO was currently being sent to Nigeria.

He said in the last week, the ICG also sent 341,000 doses of the meningitis C-containing vaccine to Niger Republic.

He said this was because over 1,300 suspected cases of the disease had been found in the region particularly in districts that border with Nigeria and in the Niamey region of the country.

“A vaccination campaign is underway in Nigeria to contain an outbreak of meningitis C, a strain of meningitis which first emerged in the country in 2013.

“In 2013, the outbreak was initially limited to a few areas in Kebbi and Sokoto States. However, in 2015, more than 2,500 cases of the disease have been reported across 3 states in the country.

“Since the beginning of this year, the country has reported 4,637 suspected cases and 489 deaths across five states.

“WHO’s Country Office in Nigeria, including a number of field offices, have been supporting the government since the meningitis outbreak began.

“In addition to improving the care of the sick, we are focusing on ensuring accurate information about the spread of the outbreak is available as quickly as possible to help us make the most effective use of vaccines,” Alemu said.

He said that the Nigeria Centre for Disease Control (NCDC) with support from WHO, the US Centre for Disease Control (CDC), UNICEF and other partners were leading the response to the on-going outbreak.

He said these organisations were also carrying out intensified surveillance, capacity building for case management and risk communication.

Alemu said in addition to the use of vaccinations to prevent the transmission of meningitis, 20,000 vials of antibiotics have been sent by the ICG to treat people who had the disease in Nigeria.

He said most vaccines currently being used for meningitis C outbreaks in Africa were polysaccharide vaccines, adding that they were in short supply as they were being phased out in other parts of the world.

“The more effective and long-lasting conjugate vaccines, however, are not readily accessible for outbreak response in the region. The ICG global emergency stockpile currently has approximately 1.2 million doses of meningitis C-containing vaccines left.

“The very limited supply of vaccines to control outbreaks of meningitis C can affect our ability to control these epidemics.

“In the long term, the accelerated development of affordable and effective conjugate vaccines to cover all epidemic types of meningitis is a high priority for WHO and partners,” Alemu said.

He noted that in the past, Nigeria had suffered large-scale outbreaks of meningitis A stating that in 2009, such an outbreak in the country caused over 55, 000 cases with close to 2,500 deaths.

He, however, said that preventive mass vaccination campaigns supported by Gavi and partners have provided high and long-term protection against the bacteria. (NAN)

KRY/IS

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Edited by Ismail Abdulaziz

Health

FCTA records 2 new cases of meningitis

FCTA records 2 new cases of meningitis

NAN-HG-2 Meningitis

By Mustapha Sumaila

Abuja, April 13, 2017 (NAN) The Federal Capital Territory (FCT) Primary Health Care Development Board on Thursday said it had recorded two fresh cases of Cerebro Spinal Meningitis (CSM) in Abuja.

The Executive Secretary of the board, Dr Rilwanu Mohammed, told the News Agency of Nigeria (NAN) in Abuja that the two confirmed cases were in Abuja Municipal and Abaji Area Councils.

Mohammed said that result from the laboratory test between Tuesday and Wednesday had shown that the two victims were infected with type C of CSM.

He explained that one of the victims in Nuku village of Abaji area council came from Sokoto State where it was allegedly that one person had died of meningitis.

He added that another six-year-old child in Garki Area 8, Abuja, was also confirmed at the Jabi Federal Medical Centre, Abuja.

According to him, these were the only confirmed cases FCT had recorded so far since the outbreak, adding that there are 10 suspected cases in the past where six persons died.

The scribe said that his agency had cordoned off the area where the two victims reside to immunise and sensitise residents against the disease.

Mohammed therefore advised FCT residents to desist from self-medication and report to hospital when they notice any sign of CSM, which include fever and stiff neck or neck pain.

He also enjoined residents to avoid crowded places especially this Easter season where people were travelling to villages for the celebration.

He added that people must ensure ventilation in their homes and cultivate the habit of hand washing as well as covering of mouth while coughing or sneezing to avoid the spread of the disease.

Mohammed said that immunisation against CSM would continue as soon as the agency receives additional vaccines from the Federal Government. (NAN) MS/HS/MST

Edited by Halima Sheji/Muhammad Suleiman Tola