Beyond the tragic health hazards and human consequences of the COVID-19 pandemic, the economic uncertainties, and disruptions that have resulted come at a big cost to the worldwide economy, Nigeria not being excluded. The tumultuous events that COVID-19 had spread across the world cut across every facet of human existence and therefore the consequences may linger beyond the last half of 2020.

The slowdown within the global economy and lockdown in some countries, like Italy, Spain and most Eurozone economies and beyond, as a result, COVID-19 has also taken its toll on the worldwide demand for oil. The decline in oil demand is estimated to surpass the loss of nearly 1 million barrels per day during the 2007-08 recession. this is often also coming at a time when two key players within the global refining industry – Russia and therefore the OPEC cartel – are hostile on the choice to cut output. The unequivocal oil price competition started between these two global oil market giants has more dire consequences on the oil price that has began to dive. Currently in Nigeria, the price of oil per litre goes for ₦125 as oppose the ₦145, previous price.

Sector-specific implications and impacts could vary. For instance , the impacts on the Nigerian aviation and tourism sectors are a results of the implications of the pandemic on global and interstate travel as travel cancellations continue. As discretionary spending by consumers continues to reduce, cruise companies, hotels, and hospitality face declining demand and patronage. The virus is additionally taking its toll on health facilities and infrastructures across the world. Most hospitals and health facilities that would not handle the hazards are resulting to operating below their capacity by taking a couple of regular health-related cases or shutting down. What might be more devastating is that the incontrovertible fact that the economic pains that accompanied the virus won't get away soon as envisaged.

There are limitations to the successes which will be recorded when demand shocks are combined with supply shocks. it's already apparent from the emergence of the present crisis that there are implications on the economy from both the demand and provide sides. a number of the demand factors include social distancing with consumers staying reception , limitations in spending and declining consumptions. On the availability side, factories are shutting down or lowering production and output, while in other instances, staff work from home to limit physical contact.
Given the dimensions and scope of the economic impact of the pandemic, there's the necessity to implement other recovery strategies to stimulate demand. Thus, we recommend the subsequent fiscal and monetary policy measures:

Although there's a cash transfer program in situ , the federal should improve efforts towards enhancing the efficiency and effectiveness of the distributive mechanisms to succeed in households that are worst-hit by the pandemic.
Federal Inland Revenue Service (FIRS) also as State Inland Revenue Services (SIRS) should waive payments on personal and company tax for the second quarter of 2020, considering that the shock has affected the income and profits of households and businesses.
The CBN’s decision to extend the cash reserve ratio (CRR) from 22.5 percent to 27.5 percent in January 2020 should be revisited to supply liquidity for banks in order that banks can, in turn, create credit to the private sector.
FIRS and SIRS should delay collection for the worse-hit sectors including tourism, the airline industry, and hoteliers so as to enable them get over the steep decline in demand.

To provide additional liquidity within the forex market, the CBN should establish a swap facility with the U.S. Federal Reserve System and/or the People’s Bank of China, as was wiped out 2018, to supply dollar and yen liquidity to financial institutions, investors, and exporters. This move would ease up forex shortage within the financial market and economy.
While the naira has been adjusted as a results of the forex shortage, it's important that the CBN maintains rate of exchange stability by deploying external reserves so as to avoid investors selling off naira-denominated assets.

The COVID-19 pandemic may be a warning call to policymakers because the unusual and unprecedented nature of the crisis has made it impossible for citizens to believe foreign health care services and harder to solicit for international support given the competing demand for medical supplies and equipment.

A more integrated response spanning several sectors—including the health, finance, and trade sectors—is required to deal with structural issues that make the country less resilient to shocks and limit its range of policy responses. within the future , tougher decisions got to be made, including but not limited to diversifying the country’s revenue base faraway from oil exports and improving investments within the health care sector in ensuring that the economy is in a position to recover quickly from difficult conditions within the future.

© Oladele Damilola.

CLIMATERIC IN WOMEN: CONCEPT, MISCONCEPTIONS AND CARE
Although climacteric and menopause are terms that are used synonymously, they mean very different situations. Menopause is nothing quite a one-time event within the woman's life, the cessation of menstruation, while the climacteric represents an extended period which will span 25-30 years between the reproductive stage and adulthood.

For many years climacteric has been considered, from a social perspective, as a "disgrace" for ladies , and sometimes this perception has been fueled by some health professionals who have come to think about it almost a disease, cataloging it as a "Endocrinopathy", supported the very fact that hypostronism was the merchandise of an ovarian "failure", without taking under consideration that this supposed failure is genetically determined and depends on the follicular endowment established during intrauterine life.

Banishing any connotation of disease or pathology linked to the physiological event of climacteric and menopause is, possibly, one among the foremost important aspects to be developed from any field of health which can most contribute to de-dramatizing this stage for several women. This aspect, clearly linked to health education, intrinsically could solve many of the issues related to climacteric, also as "liberate" many other women from a number of the good myths and taboos that contribute to keeping them, even today, subjugated under the load of a sexist and discriminatory history.

To finally eliminate any trace of doubt that the climacteric is nothing quite an absolutely physiological transition period, during which only a couple of adaptive changes happen to a replacement biological situation, as a consequence of the top of reproductive capacity which it's related to a hormonal change, as estradiol production is linked to the existence of ovarian follicles. It's often forgotten that ladies , a few years before, had already skilled an identical situation, adolescence, also a period of adaptive transition between childhood and maturity, necessary to accumulate full reproductive capacity and with the entry into the endocrinological game of various and, if possible, far more complex hormonal changes than those which occur during climacteric.
Going by this, the question arises: Why do those that defend that climacteric is an endocrinopathy, with a transparent connotation of disease, don't do an equivalent with adolescence? Although we don't know the solution , perhaps it might be because, for those that think that way, women, from the onset of menopause, would have less "social value" as they were not a "reproductive", while the adolescent increased its value , being a "young breeder". All this invites a deep reflection and shows again how science, society, economy and politics go hand in hand in many aspects that has got to be modified. from the onset of menopause, she would have less "social value" as she was not a "reproducer", while the adolescent increased her value, being a "young reproducer".
Another important debate that has occurred in recent years has been where to locate, within the structures of public health, assistance to climacteric women. With this, it's necessary to differentiate between the healthy climacteric woman, with a selected problem derived from that period of physiological transition, and therefore the climacteric woman with associated pathology who should receive an equivalent diagnostic and therapeutic approach as any diseased person , whatever their age, sex, and hormonal status.

To resolve this question, all you've got to try to do is use sense and leave aside any corporatist position. Following this work scheme, the primary thing would be to define what are the requirements and / or problems that healthy climacteric women may present, which on the opposite hand represents the overwhelming majority of women , who in the society are at this stage. We could distinguish three sorts of needs:
1 . SOCIAL NEED : Fundamentally the necessity to de-dramatize the climacteric, since this conception only gives rise to misunderstanding, anxiety, loss of self-esteem and globally prevents, in many cases, the event of a normalized social and professional activity and on equal terms as men of an equivalent age.



2 . PERSONAL NEED:It varies in each woman and depends on the existence, or not, of symptoms derived from hypostronism, the sort of symptoms (neurovegetative, psychological, genitourinary, sexual, etc.), their intensity and therefore the own perception that every woman has of the planet. In short, it'll depend upon the degree of degradation of their own quality of life.



3 . PREVENTION NEEDS:This aspect can't be generalized either, since although there's a better prevalence of some diseases associated with hypoestronism, like osteoporosis, this is often not the sole factor that influences and it's necessary to independently evaluate the danger of every woman. Other diseases are mainly cardiovascular and cancer. As for the previous , there are more important risk factors than hypostronism itself, of much greater epidemiological weight (tobacco, overweight, HT, diabetes ...) whose prevention programs are already well differentiated and structured in medical care . As for cancers, thanks to their frequency, it's desirable to hold out prevention programs within the climacteric population, especially in cases of genital and carcinoma.

If we take under consideration the above, the requirements that are posed to healthy climacteric women are often summed up in information, quality of life and prevention , three natural aspects that constitute, in itself, the rationale for the existence of medical care , which in our opinion leaves out of dialogue the situation of this sort of assistance.

The next question to answer is the way to approach the care of climacteric women from the primary level of health. the solution is straightforward to offer , but more complex to hold out. Simple because from medical care there's nothing quite to assume the requirements of the climacteric woman. However, so as to hold them out, it might be necessary to involve the health authorities with a greater allocation of resources, perform institutional campaigns and support the centers for comprehensive look after women, where the climacteric was one among the precise aspects of approach. In any case, and following the requirements scheme outlined above, the approach should be as follows:
INFORMATION AND TRAINING: It should be done at three levels:

1. TO ALL OR ANY SOCIETY: Through an institutional campaign that de-dramatizes this era and contributes to eliminating social misunderstanding.

2. INTEGRATE TRAINING IN SCHOOLS WITHIN HEALTH EDUCATION: This is able to contribute to a far better acceptance, as another stage within the lifetime of women, and would serve to get positive habits for the first prevention of osteoporosis.

3. INFORMATION TO THE LADIES DIRECTLY AFFECTED: The personalized explanation of the biological events and therefore the derived symptoms facilitate the answer of the many of the concomitant problems, especially those of the psychological and sexual sphere.
IMPROVED QUALITY OF LIFE
The standard of life tends to deteriorate in climacteric women thanks to the presence of subjective and objective symptoms derived from hypostronism and, in many cases, thanks to the fear generated by ignorance of the origin of the changes that occur and of the symptoms themselves. It's important to detect what proportion of the deterioration in quality of life corresponds to the purely biological aspects and what's secondary to insecurity and fear, since the treatment is different. The tools that ought to be available are:

1. Personalized information to every woman about her symptoms and changes: explaining that their cause may be a physiological process and not a disease, with which the disappearance of fear of the unknown and insecurity are often achieved, which in many occasions could also be enough to enhance quality of life.

2. Generation of positive habits: it's necessary to spotlight the necessity for an accurate diet, especially with reference to a calcium intake of 1,000 mg in premenopausal women and 1,500 mg / day in postmenopausal women, a crucial aspect that contributes to the prevention of osteoporosis; the practice of programmed workout that, additionally to helping to regulate weight, facilitates joint mobility and also contributes to the prevention of osteoporosis; finally, the elimination of harmful habits and therefore the correction of any imbalance in vital sign , weight, cholesterol and blood sugar are important elements for cardiovascular prevention.

3. Establishment and subsequent control of a hormone replacement therapy (HRT): in those symptomatic women, whose quality of life is impaired by the presence of symptoms and in those at high risk of osteoporosis or osteoporotic without antiresorptive treatment, there would be a sign for the establishment of THS, no matter the time of the climacteric during which they're . For the establishment of THS, the direct participation of girls within the sort of preparation, the route of administration and balanced information on risk-benefit is vital , since, during this way, it'll be possible to get adequate compliance with THS.



Prevention. This section has in common with the previous ones the knowledge , which is that the key element of any prevention program. the most pathologies that, thanks to increasing their prevalence within the climacteric, require special attention are:

1. OSTEOPOROSIS: Additionally, to informative work, scales are often used from the first care to detect and quantify risk factors, which, although they are doing not allow us to directly know the state of bone mass, are often very useful for detecting the high-risk population and choose it to be studied with more sophisticated and expensive techniques.

2. CARDIOVASCULAR DISEASES: The foremost important element for prevention is that the detection of risk factors and their correction, eliminating harmful habits and treating those concomitant processes.

3. CANCER: The foremost frequent neoplasms in climacteric women are carcinoma , endometrial carcinoma , ovarian cancer and, less frequently, cervix cancer. Taking under consideration its frequency and, in many cases, its poor prognosis, it's desirable to determine and incorporate climacteric women into programs for the prevention of genital and carcinoma .

Finally, not only should assistance to climacteric women be administered from the first level of health care, but also any plan to provide general attention to all or any these women, from the three perspectives analyzed, will never be possible without the involvement of its professionals and without its infrastructure.

© Oladele Damilola

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