World of Genomics: Nigeria

Original article written by Poppy-Jayne Morgan, June 2022. Updated by Gemma Davies, September 2023.

One of the most populated countries in the world, Nigeria is a multi-lingual, multi-ethnic nation in West Africa. One of Nigeria’s largest and most successful industries is its movie sector, with Nollywood producing 200 films every week. In comparison, its genomics sector is in its early days, as it seeks to reduce neonatal disorders, commit to universal health coverage and utilise international partnerships. In our latest World of Genomics piece, we travel to Nigeria to see how it is contributing to placing African scientists at the forefront of discovery in the genomics space.

The population of Nigeria

Nigeria is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east and Niger in the north. Nigeria is the most populus country in Africa, with an annual population growth rate of 3.5%. Due to the high fertility rate, over half the population is under 30 years of age.

Archaeological research indicates that the geographical area that is currently Nigeria was inhabited as early as 11,000 BC. The earliest known example of a fossil human skeleton found anywhere in West Africa was found at Iwo-Eleru in Isarun, western Nigeria. Later, the Nok culture thrived from approximately 1,500 BC to about 200 AD.

Arab traders arrived in Northern Nigeria by the 9th century AD, while the first Europeans were Portuguese explorers who arrived in southern Nigeria in the 1470s. Nigeria was a British colony from the early 1900s until gaining independence in 1960, although it remains part of the British Commonwealth.

The climate varies, ranging from equatorial in the south to tropical in the centre and arid in the north. Nigeria has the largest economy in Africa, with its source of foreign exchange and government earnings coming largely from the oil sector.

Nigeria is one of the most densely populated countries in Africa. Approximately 50% of Nigerians are urban dwellers. While English is the official language, over 500 indigenous languages are spoken.

**Figure 1 |** Map of Nigeria (Source: Encyclopaedia Britannica)

Geographic and demographic information

Summary statistics

Land area: 923,768 km²
Gross domestic product (GDP):
- Total: $477.3 billion (2022 estimate).
- Per capita: $2184.4 (2022 estimate).

Population statistics

Population size: 218.5 million (2022 estimate).
Birth rate: 37.1 live births per 1,000 people (2021).
Death rate: 13.1 per 1,000 people (2021).
Infant mortality rate: 56.7 deaths per 1,000 live births (2021).
Average life expectancy: 61.3 years (2022).
- Male: 59.5 years (2022).
- Female: 63.3 years (2022).
Ethnicity: Nigeria is home to over 250 ethnic groups. In 2018, the distribution was Hausa (30%), Yoruba (15.5%), Igbo (15.2%), Fulani (6%), with the remaining 32.6% come from other African groups. Over 1 million people living in Nigeria are from a continent other than Africa (0.5%).

Healthcare system

The World Health Organisation (WHO) ranks Nigeria’s healthcare system at 163 out of 191 countries. A significant disparity in health status exists across States and geopolitical zones, as well as across rural/urban divides, education and social status.

Healthcare is provided by public and private sectors. Primary, secondary and tertiary levels of care are the responsibility of the local government area, state government and federal government respectively. Nigeria’s National Health Insurance Scheme (NHIS) was introduced in 1999, aiming to provide high quality healthcare at an affordable cost through various prepayment systems. However, as enrolment is not mandatory, less than 5% of Nigerians are thought be registered, leaving the majority of the country without health insurance coverage. The private sector therefore provides close to 60% of health service delivery.

The use of traditional, complementary and alternative medicines has increased significantly over the past few years.

Key challenges faced in Nigeria’s healthcare system include a shortage of doctors (only 3.8 doctors per 10,000 people), underfunding, and poor data collection and record keeping. Many Nigerians pay out of pocket for healthcare, lacking health insurance or access entirely.

Nigeria has committed itself to delivering universal health coverage by 2030, to ensure that all people in Nigeria have access to essential health services without enduring financial hardship. Initiatives to establish new teaching hospitals are key to improving the numbers of healthcare professionals, however a lack of funding and resources is slowing progress.

Health priorities

In 2019, the main causes of death in Nigeria were neonatal disorders (12.25% of all deaths). Malaria accounted for 12%, diarrheal diseases 11.4%, lower respiratory infections 10.9% and HIV/AIDS 5.2%.

One in eight Nigerians suffers from mental illnesses, although this is an under-researched area and is viewed as a neglected issue in public health.

Non-communicable diseases (NCDs) are on the rise, including hypertension, diabetes and neurological disorders. The Centres for Disease Control and Prevention (CDC) established an office in Nigeria in 2001. The CDC works with the Federal Ministry of Health (FMOH) and state ministries of health to fight HIV, tuberculosis, malaria and vaccine-preventable diseases. The CDC also supports laboratory, surveillance and workforce capacity in response to disease outbreaks.

Most national health policies in Nigeria do not directly focus on genetic services or genomic medicine, with the exception of sickle cell disease. Nigeria has the highest birth prevalence of sickle cell disease in the world. In 2021, the Sickle Cell Prevention, Control and Management Bill was passed, establishing the legal framework for managing the spread of the disease. Part of the bill makes pre-marital blood tests compulsory to deter sickle cell carriers from marrying. However, this policy has been criticised as weak and ineffective by WHO and the Sickle Cell Disease Foundation. Pilot tests for new-born screenings are being trialled.

Some successes include the use of TB BASICS, a successful infection control program preventing healthcare-associated TB infection and other airborne infections. From 2015-2019, Nigeria saw a 20% increase in routine immunisation coverage. In 2021, Nigeria launched the Global Fund 2021-2023 Malaria grant supporting malaria elimination and building resilient, sustainable systems for health across the country.

In May 2022, Nigeria had 256,227 confirmed COVID-19 cases and 3,143 confirmed COVID-19 deaths.

Genomic medicine capabilities

The first medical genetics service in Nigeria was established in the early 1970s in Ibadan, with a unit providing clinical genetics services and conducting seminal research on the autosomal trisomy, skeletal dysplasia and other dysmorphic disorders.

Currently, there are few medical geneticists and genetic counsellors in Nigeria. Facilities for molecular diagnosis (including prenatal diagnosis) also remain less than optimal and are not widely accessible. Opportunities for training in medical genetics are not available within the country and prospective trainees are required to travel outside Nigeria. Few laboratories are able to do routine genotyping or sequencing for patients on‐site and most molecular diagnosis is still carried out internationally.

Neonatal screening is not integrated into Nigeria’s current healthcare system. However, initiatives are being piloted to ensure that low-resource options could be made feasible. Sickle cell disease and congenital hypothyroidism are Nigeria’s neonatal screening priorities. Medium-to large health facilities often have dedicated sickle-cell anaemia clinics and several hospitals can conduct sickle cell screening.

Less than 3% of genomic data represented in research is from African ancestry populations, despite Africa containing much more genetic diversity than any other continent. Genome‐wide linkage studies conducted on or including Nigerian populations have been largely facilitated by investigator‐driven studies and international collaborations, such as the International HapMap Project and the 1000 Genomes Project Consortium.

Notable projects

The Nigerian Bioinformatics and Genomics Network (NBGN): A not-for-profit, apolitical, national initiative to facilitate collaborative activities amongst Nigerian bioinformatics and genomics investigators.
Centre for Human Virology and Genomics (CHVG): A WHO designated national laboratory for HIV drug resistance testing in 2021. The CHVG contains three research groups: viral surveillance, population genomics and cancer, and blood genomics and transfusion.
The African Centre for Translational Genomics (ACTG): A not-for-profit initiative led by 54gene promoting genomics research and development in Africa to enhance precision medicine therapy.
The Non-Communicable Diseases Genetic Heritage Study (NCD-GHS): A consortium established to produce a comprehensive catalogue of human genetic variation in Nigeria and assess the burden and etiological characteristics of non-communicable diseases in 100,000 adults in Nigeria.

Notable organisations and companies

Nigerian Academy of Science (NAS): The foremost independent scientific body in Nigeria, dedicated to the development and advancement of science, technology and innovation in the country.
Nigerian Institute of Medical Research (NIMR): A medical research institute established by the Federal Government of Nigeria in 1977 to promote national health developments.
National Biotechnology Development Agency (NBDA): Established in 2001, the NBDA implements policies aimed at promoting, coordinating and setting research and development priorities in biotechnology for Nigeria.
Africa Centres for Disease Control and Prevention (Africa CDC). The West African Regional Collaborating Centre is Nigerian-based. Priority disease and public health issues in the region include Ebola, Lassa fever, yellow fever, diabetes and cancer.
54gene: A Nigerian-based genomics company that aims to sequence the genomes of 100,000 Nigerians by the end of 2022. The 54gene Biobank consists of highly curated clinical, phenotypic and genetic data, for use by academic and development research.

Notable individuals

Olumbe Bassir (1919-2001): Bassir founded the Biochemistry and Microbiology departments at the University of Ibadan and laid the foundations for what became the first medical school in West Africa.
Adeynika Gladys Falusi: Falusi is co-founder of the Sickle Cell Association of Nigeria and former Director of the Institute for Advanced Medical Research and Training. She specialises in human genetics, bioethics and molecular genetics related to hereditary diseases.
Segun Fatumo: Fatumo is a computational geneticist, founder of the NBGN and former vice-president of the African Society for Bioinformatics and Computational Biology. His expertise includes Genome-wide Association Studies (GWAS), Polygenic Risk Score(PRS) and Drug Targets Discovery.
Christian Happi: Happi is a molecular biologist at Redeemer’s University in Ede, running the African Centre of Excellence for Genomics of Infectious Diseases. His team quickly sequenced Nigeria’s first Ebola case and sequenced the first coronavirus genome from an African.
Iruka Okeke: Okere is a microbiologist who studies pathogen genomes and researches ways to improve microbiology laboratory practices in Africa.
Olufunmilayo Olopade (1957-): Olopade is a haematology oncologist who conducted ground-breaking work on the BRAC1 and BRAC2 genes in women of African descent. In 1987 she identified a gene that helps supress tumour growth.
Charles Rotmi (1957-): Romti is a geneticist who founded the African Society of Human Genetics and was instrumental in the launch of H3Africa. He is Director of the Trans-National Institutes of Health Centre for research in genomics and global health.
Grace Oladunni Taylor (1937-): Taylor is a biochemist specialising in the analysis of lipids and metabolisms in cardiovascular disease.

The future genomics landscape

The Human Heredity and Health in Africa (H3Africa) Project invests in improving infrastructure and capacity building for genome research in Africa. Nigerian sites are participating in several of these projects, including studies of stroke, chronic kidney disease, febrile illness, cervical cancer and glaucoma. Several H3Africa bioinformatics nodes are in Nigeria. These databases will illuminate studies of human variation worldwide, in part because the great genomic diversity in Africans can uncover links to medical conditions.

The Non-Communicable Diseases Genetic Heritage Study (NCD-GHS) aims to produce a comprehensive catalogue of Nigeran genetic variation to assess the burden and etiological characteristics of non-communicable diseases in 100,000 Nigerian adults from 300 ethnic groups. This project, running from 2020-2025 aims to create a scientific community to empower African genomic scientists to use large-scale genomic data to benefit this underrepresented area.

Another H3Africa project with Nigerian contribution is the Collaborative African Genomics Network (CAfGEN). This project aims to develop a blood test for HIV-positive new-borns to show how quickly their infection could progress to AIDS.

The BioGenome Project (NBGN) aims to sequence all known species indigenous to the Nigerian state. The aim is to provide open-access shared platforms for Nigerian bioinformatics researchers and form a Nigerian National Bioinformatics Institute.

The status of medical genetics and genomic medicine in Nigeria is still far from meeting the needs of the population. However, the situation is rapidly changing due to recent funding opportunities for new research projects and infrastructural development, creating a foundation for the development of medical genetics and genomic medicine.

References

Adeyemo et al. “Medical genetics and genomic medicine in Nigeria.” Molecular Genetics and Genomic Medicine. 2018.
Buckholtz. “New Nigerian biobank advances Africa’s genomic revolution”. IFC, World Bank Group. 2020.
Fatumo et al. “The Nigerian Bioinformatics and Genomics Network (NBGN): A collaborative platform to advance bioinformatics and genomics in Nigeria.” Global Health, Epidemiology and Genomics. 2020.
Fatumo et al. “Promoting the genomic revolution in African through the Nigerian 100K genome project.” Nature Genetics. 2022.
Iroro et al. “New-born screening in Nigeria: will incorporating congenital hypothyroidism with sickle cell disease improve neonatal screening programme?” Acta bio-medica. 2019.
Nigeria – Country Commercial Guide. 2023. Available at: https://www.trade.gov/country-commercial-guides/nigeria-healthcareLetsebe. “Nigerian 100K genome project on track to completion”. Research Professional News. 2022.
Nnodu et al. “Implementing new-born screening for sickle-cell disease as part of immunisation programmes in Nigeria: a feasibility study.” The Lancet Haematology. 2020.
The Nigerian Academy of Science “Understanding the context of health coverage in Nigeria and progress towards universal health coverage.” The Academy of Medical Sciences. 2020.
Pennisi. “Genomes arising: Africans have begun to study their continent’s rich human diversity, but what comes after current grants end?” Science. 2021.
Wada et al. “Mental health in Nigeria: A neglected issue in public health.” Public Health in Practice. 2021.
World Health Organisation. “Country cooperation strategy at a glance: Nigeria”. WHO. 2018.

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