Monitoring health misinformation in Nigeria: Africa Check
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Monitoring health misinformation in Nigeria: A collection of potentially harmful claims from May to July 2020 J January This study was conducted by a group of researchers from the Department of Mass Communication at the University of Lagos as part of a health misinformation fact-checking project in Nigeria. It contains a J collection of potentially false and harmful health claims that circulated in the public domain during the May to July 2020 period. It is the third in a series of quarterly reports that will be shared with the network of journalists, fact-checkers, health experts and policymakers to increase the uptake of evidence-based health information in Nigeria. The project is funded by the Bill & Melinda Gates Foundation. Published under the Creative Commons Attribution-ShareAlike 4.0 International License August 2020
INTRODUCTION Misinformation can be described as information that is false, but which the disseminator believes to be factual (Amobi, Obia, Udodi, & Akinuliola, 2019). This includes false claims surrounding health issues, shared ignorantly by people who believe them to be true and without the intention to harm the consumer. Even though the intent of the creator or purveyor of the misinformation might not be to cause outright harm, health misinformation has potentially damaging implications for the health of the population. Kim (2019) argues that widespread health misinformation is a cause for alarm, as it has the possibility to create public health crises. In agreement, Zielinski (2020) notes that in Nigeria, it is undermining medical advice, proffering fake cures, and inciting panic. A prime example from Nigeria is contained in a video which although has been taken down by Facebook, Twitter and YouTube, is still circulating on WhatsApp. This video contains the unsubstantiated claim by Dr. Stella Immanuel, a Nigerian trained General Practitioner in the U.S. that she has treated over 350 patients of COVID-19 with a combination of Hydroxychloroquine, Zinc and Zithromax (Moshood, 2020). Although, the Nigerian Guild of Medical Directors and Clinical Pharmacists Association of Nigeria have challenged her claim as lacking in scientific evidence (Folorunsho-Francis, 2020), the video continues to be shared among several groups on the WhatsApp platform. Health misinformation in Nigeria ranges from rumours, such as claims that bathing with salt water will cure Ebola, to ethnically based beliefs and superstitions, such as the claim among the Igbos of Southeast Nigeria that palm oil poured on a red-hot knife can disinfect and cure a cut or nail puncture on the feet, to misperceptions about causes of diseases and illnesses, their modes of transmission and treatment, and the herbal concoctions which can treat them. Social media gives people without medical backgrounds and self-proclaimed “herbal” doctors the ability to disseminate health misinformation to a wide range of people, and exacerbates the risks posed by it. The biggest challenge is that misinformation drowns official public health advice, making it difficult for the voices of healthcare professionals to be heard. The fallout can be dangerous, and can range from a patient suffering unnecessarily and protractedly from a treatable condition, to outbreaks of an entirely preventable disease (Kaltwasser, 2019). There is a dire need for rapid verifications of claims and awareness among consumers about the nature and dangerous implications of health misinformation. This research sought to identify the prevalent examples of health misinformation in Nigeria, what motivated their creation and the potential harm to the consumers of such messages. It covers the circulation of false health claims for the period May to July 2020 and was guided by the following research questions: 1. What are the prevalent examples of health misinformation in Nigeria? 2. What are the sources and channels of dissemination of health misinformation in Nigeria? 3. What are the motives behind the formulation and spread of health misinformation in Nigeria? 4. What are the potential harms of health misinformation in Nigeria? 2
COMMUNITY BELIEFS Brief description of claim Origin/Platform circulated on Motivation for Potential harm dissemination It is claimed that Neem leaves This belief is increasingly becoming The uncertainty, Reliance on this (Dogonyaro), Guava leaves, Pawpaw popular among some Nigerians. It is fear and remedy may result leaves, Lemongrass, Mango leaves and largely circulated via interpersonal desperation in people not Lime leaves, can be used to prevent and networks and private social media resulting from seeking prompt cure COVID-19. To process: Put leaves in platforms, such as WhatsApp. the medical help when water and bring to boil for about 30 unavailability of they are infected minutes. Remove from heat, cover a preventive with the yourself with a blanket while leaning vaccine or Coronavirus, thus towards the pot to inhale the steam from highly effective placing their lives at the liquid. Do this for about 15 minutes. therapeutics for risk. COVID-19, may be driving the claim. Neem leaves Guava leaves Pawpaw leaves Lemongrass Mango leaves Lime leaves 3
It is claimed that Okra (Abelmoschus This belief is common among the To perhaps This claim could esculentus) popularly known as Ila Yoruba community in Southwest provide a misinform pregnant amongst the Yorubas, helps force out Nigeria. It is circulated by traditional traditional women as the claim babies during childbirth. health practitioners and other method for has not been interpersonal networks, such as hastening the scientifically family and friends. It is believed by labor and proven. the Yorubas to be an effective delivery assistance for easy child birth process. amongst pregnant women. Okra It is claimed that Ragleaf or Okinawa This belief is common among the To provide Belief in this claim Spinach, also Gynura crepidioides (Efo Yoruba community in Southwest traditional may negatively Ebolo in Yoruba) helps in the treatment Nigeria. It is circulated by traditional medicine for drive health seeking of heart diseases. To process: the health practitioners and other treating heart behaviors, as vegetable is soaked in water to extract interpersonal networks, such as diseases, and individuals the juice, which is then taken for two family and friends. promote local confronted with weeks. alternative heart diseases may herbal be tempted to remedies. adopt this herbal remedy, as opposed to seeking treatment from medical experts. Ragleaf It is claimed that adding lime juice to a This is a common belief among the To provide Since this claim is hot drink called Schnapps is an effective Yoruba community in Southwest traditional not subjected to remedy against dizziness. Nigeria. It is circulated by traditional medicine for any scientific health practitioners and other treating laboratory testing, interpersonal networks, such as dizziness. its potential risks family and friends. and side effects for the consumer are unknown. It may also prevent people from seeking Lime Juice medical treatment for dizziness from experts, thus placing their lives at risk. 4
A series of claims were made about These claims are held as cultural These claims are Although there are Yoruba community beliefs. Some of them community beliefs amongst the all related to no serious harms include the claims that when a pregnant Yorubas. They were culled from an cultural beliefs associated with woman walks under the sun, she will give article about Yoruba beliefs which that have some of the claims, birth to a disfigured child; that beating a was published on NG Pulse formed over they could lead to male child with a broom will render him many not seeking proper impotent, and that drinking of coconut generations. medical care, or water will make a person ‘dull’. The motivation cultivate false for the media beliefs that prevent platform to optimal health. For publish it, was example, the most likely to disfigured child inform or claim could prevent provide women from interesting getting some of the reading about benefits from the Coconut Water traditional sun, like vitamin D; health beliefs the potency claim and practices could mislead men among the into attributing Yorubas. their impotency to having been beaten with a broom in the past and prevent them from seeking medical help; while the coconut water claim could wrongly attribute and prevent people from seeking appropriate care for children with developmental problems. 5
SOCIAL MEDIA HEALTH MISINFORMATION CLAIMS FACEBOOK Brief description of claim Source/Platform Motivation for Potential Harm circulated on dissemination It is claimed that Wormwood or Artemisia These claims were posted Possibly to promote Believing the claim might Absinthium, (called Ewe Egbin in Yoruba), on Facebook. Nigerian plants and lead people to ignore the Guava leaf (Psidium guajava), Paw-paw remedies, and provide safety measures leaves with Ginger, Turmeric and Garlic, They also circulated on ‘natural’ preventive prescribed by the Nigeria Coconut oil, all available in Nigeria, can WhatsApp. measures against Centre for Disease be taken to cure COVID-19. COVID-19. Control (NCDC) and medical experts. Wormwood Guava plant Ginger Pawpaw Turmeric (ata Ile pupa in Yoruba) 6
It is also claimed that three leaves of Eucalyptus (Eucalyptus globulus Labillardiere) boiled for two minutes, aids in the cleaning of the lungs. Similarly, inhaling a pinch of Aboniki balm added to a cup of boiled water clears the lungs, thus preventing COVID-19. Eucalyptus leaves Aboniki balm It is claimed that tea made from Guava This claim was posted on To perhaps inform the This might drive people to leaves helps hair growth, cures Facebook public on the health depend solely on guava stomachache, coughs and bronchitis, and benefits of guava leaf leaf tea to treat aids with weight loss through suppressing tea. stomachache, coughs and appetite. bronchitis, instead of seeking prompt medical care. Guava leaves 7
WHATSAPP Brief description of claim Source/Platform Motivation for Potential Harm circulated on dissemination It is claimed that Scent leaf or Ocimum This claim was Possibly to provide Scholars and fact-checkers gratissimum (Efinrin in Yoruba, Nchanwu circulated on organic remedies for advise that information in Igbo, and Daidoya in Hausa) has the WhatsApp. the listed sicknesses. from social media groups following health benefits: should be viewed with • Cures coughs scepticism and should be • Solves indigestion verified as they often lack scientific evidence. It may • Prevents heart disease therefore be dangerous to • Lowers sugar levels accept such health • Relieves pains, fever and respiratory information as this may issues lead to consumers’ sole • Repels mosquitoes dependence on the plant, and refusal to seek help from medical experts when necessary. This could lead to health complications. Scent Leaves It is claimed that the juice from boiled This claim was widely The lack of a tested This claim is not evidence Neem leaves or Azadirachta Indica circulated on vaccine or orthodox based and may mislead (popularly known as Dongoyaro in many WhatsApp. drugs presenting a readers into adopting the parts of Nigeria), Pawpaw leaves, Lime, definitive cure, remedy without seeking Orange, Garlic, Ginger, Guava Leaves, especially for proper medical attention, Mango leaves, lemongrass or vulnerable COVID-19 which could lead to serious Cymbopogan, (Kooko Oba in Yoruba), patients, such as the health complications. taken three times per day is elderly, those with Madagascar’s solution to COVID-19. underlying conditions, Image below: or patients with severe symptoms, appears to be driving the rapid development and spread of herbal remedies, as well as speculations and conspiracies. 8
It is claimed that COVID-19 is not a virus, This was a claim in Researchers do not Consumers of the message but a bacterium and it is amplified with video format that have enough evidence may be tempted to try out 5G electromagnetic radiations that also circulated on on the motivations antibiotics, anti- produces inflammation and hypoxia, and WhatsApp. behind conspiracy inflammatories, as well as can therefore be cured with antibiotics, theories during the the indicated drugs instead anti-inflammatories and anticoagulants. COVID-19 pandemic, of seeking medical Furthermore, it is claimed that Italy used but the uncertain attention if infected by 100mg Aspirin, and Apronax to combat context is driving COVID-19. COVID-19 and it proved effective. many conspirac It is claimed that sleeping in the dark This claim was The intention behind People who prefer sleeping enables the body to produce a hormone circulated on the WhatsApp is with the lights on for called Melatonin which fights diseases. WhatsApp. possibly harmless, and psychological reasons, may See image below: seems to promote change the habit, and this better sleep hygiene. may affect them negatively. It is claimed that a group of Japanese This claim circulated on This claim may have Although water in itself is doctors have confirmed that warm WhatsApp. been driven by the not harmful to the body, water is 100% effective in resolving: high desire to encourage claiming that water is blood pressure, migraines, low blood It was also published on the regular intake of effective in resolving the pressure, joint pains, sudden increase Bgnyan, an online water, and may not listed diseases is misleading and decrease of heartbeat, epilepsy, website. have a direct intent to and may prevent people high cholesterol levels, coughs, bodily cause harm. from seeking necessary pains, and asthma, amongst others. medical attention. 9
It is claimed that experts have warned This claim was To sensitize the public, This claim may cause fear that eating late at night puts people at circulated on perhaps genuinely, on of eating late at night in the danger of heart attacks and strokes. WhatsApp. the dangers of eating people’s minds and may See image below: late at night, or there lead them to abstain from This claim was also could be commercial food, even when ecessary. posted on Facebook. gains. In general, it also feeds a culture where old wives tales are presented as fact. It is claimed in a video that Ginger offers This claim was made in The widespread belief It might encourage people innumerate health benefits because it a video which circulated in the efficacy of not to seek prompt medical contains over 115 highly beneficial on WhatsApp, and went ginger may have attention where and when chemical ingredients, including: viral on YouTube. motivated the claim. necessary, and instead • Improves heart health focus on ginger for the • Powerful anti-inflammatory agent listed ailments. • Prevents heart diseases INSTAGRAM Brief description of claim Source/Platform Motivation for Potential Harm circulated on dissemination It is claimed that African Walnut or This claim was posted To perhaps provide It might lead people to rely Tetracarpidium conophorum (Okhue in by an Instagram user the health benefits of solely on walnuts to cure the Edo, Asala in Yoruba, Ukpa in Igbo, and with the handle African Walnut and listed ailments rather than Kaso in Cameroon) prevents cancer, @askdamz available at also gain more seeking appropriate and helps weight loss and cleanses the this link. followers on prompt medical care. digestive system. Instagram. African Walnut 10
It is claimed that Lime and Chia Water is This claim was posted To provide a natural No scientific evidence was great for a gentle daily detox that helps on the Instagram page remedies for daily provided to back up the shed weight, improves skin, and has @_beautyremedies at detoxing and to claim. The authenticity is abundance of vitamins and minerals. this link. perhaps gain more therefore questionable. See image below: followers on Instagram. It is claimed that a certain capsule This claim was posted To popularise, The claim appears not to be known as Maca pills can be used for on the Instagram page: promote and boost evidence based and it is booty and boobs enlargement. @sexualden here. sales of a quack unclear how safe the See image below: product and attract capsules are when more followers. consumed. This is more so when it has not been approved by the National Agency for Food and Drug Administration and Control (NAFDAC), the appropriate drug control agency in Nigeria. It is claimed that the remedy called This claim was posted To promote and boost The claim is not backed up by Fertileboost below is used in treating on the Instagram page sales of the herbs. any scientific research or unexplained infertility in women. @fertileboost at this evidence, and the safety of link. this remedy is unclear. It may put the lives of users at risk. 11
It is claimed that the remedy shown This claim was posted To promote and boost The claim is not backed up by below can be used to flush and unblock on the Instagram page sales of the herbs. any scientific research or the tubes in females. See image below: @fertileboost – evidence. Women may rely see this link. on the drug, when they have for more serious symptoms that require science-based medical treatment. It is claimed that the herbal concoction This claim was posted To promote and boost It is unclear if the product called Fertileboost can be used for all on the Instagram page sales of the herbal has been endorsed by menstrual issues, as well as early @fertileboost – see this concoction. NAFDAC. Also, individuals menopause. See image below: link. suffering from serious menstrual issues may depend solely on the herbal remedy, when they could have a life-threatening underlying medical condition. It is claimed that a cup of warm water This claim was posted To provide a natural Such information may lead and fresh grape juice taken on an empty on the Instagram page remedy for infertility to consumers’ dependence stomach from cycle day 1 to cycle day 10 @fertilecorner_hq at and perhaps increase on the remedy for curing helps in producing cervical mucus, and this link. the page’s follower infertility, and may deter this helps lubricate the floor of the base, which has them from seeking orthodox womb for the sperm cells to easily swim commercial value. medical attention, when to and fertilise the egg. needed. 12
It is claimed that one leaf of Cyelon This claim was posted To provide a natural Such information may lead Cinnamon or Cinnamomum verum on the Instagram page remedy to boost to consumers’ dependence (Oloorun in Yoruba), five bay leaves or @fertilecorner_hq at fertility and increase on the remedy for curing Bay Bunkum (Laurus nobilis), five Guava this link. the page’s follower infertility, and may deter leaves or Psidium guajava, boiled in base, which has them from seeking orthodox three cups of water for five to ten commercial value. medical attention, when minutes acts as daily fertility boosters. necessary. WEBSITES Brief description of claim Source/Platform Motivation for Potential Harm circulated on dissemination It is claimed that the following leaves can The claim was written To provide traditional It might encourage people cure diabetes: by Fadaka Louis and alternatives for the to ignore more appropriate • Bitter Leaf (Vernonia amyygdalina published on Gbetu TV treatment of diabetics medical attention and focus known as Ewuro in Yoruba) at this link. and to promote the instead on the plant-based • Scent Leaf or Ocimum gratissimum Nigerian traditional remedy. (Efirin in Yoruba, Nchanwu in Igbo) health sector, as well as • Mango Leaf drive traffic to the • Aak Plant or Calotropis gigantean) website. It is claimed that Cove leaf assists in the This claim was posted To drive traffic to the This claim might drive fight against diabetes, lowers high blood on Opera news at this blog and perhaps people to depend solely on pressure, aids weight loss. link. provide readers with the local remedy to treat 13
See image below: the traditional health the ailments listed instead benefits of cove leaf. of seeking prompt medical attention when necessary. This might lead to health complications. It is claimed that avocado pear prevents This claim was To perhaps sensitize Individuals with any of the and combats cancer, aids great vision, published on Pulse.ng. the public on the health listed ailments may depend prevents osteoporosis and other chronic benefits of avocado solely on the traditional diseases, and helps to reduce bad breath. pear and to drive traffic remedy instead of seeking to the website. medical attention. This may lead to serious health complications. It is claimed that Pawpaw seeds aid This claim was posted To possibly drive traffic This claim might drive treatment of cancer, ulcers, infections, on to the website and people to depend solely on etc. It is also claimed that scented oil the website called perhaps educate the pawpaw seeds as extract, rich in amino acids from pawpaw Opera News App. readers on the health treatment for the ailments seeds is potent in the treatment of sickle benefits of pawpaw listed instead of seeking cell disease and related disorders. seeds. prompt medical attention when necessary. This might lead to health complications. Pawpaw Seeds 14
It is claimed that Aloe vera, Honey, Garlic, This claim was To possibly drive traffic This claim might drive Flavonoids and Bananas, can be used as published on Pulse.ng. to the website and people to depend solely on remedies for stress and Ulcers. provide natural the remedy to treat the remedies for treating ailments listed instead of stress and ulcers. seeking prompt medical attention which might lead to health complications. It is claimed that Okra or Abelmoschus This claim was To provide traditional This claim may mislead esculentus (Ila in Yoruba, Okwulu in Igbo) published on Opera alternatives for the people into having can treat Asthma, Diabetes and Kidney news’s website. treatment of the listed misguided trust in Okra and diseases. diseases and to lead to them to refuse promote traffic to the seeking the attention of site. medical experts for serious conditions such as diabetes or kidney diseases. It is claimed that the following benefits This claim was To drive traffic to the This claim may mislead can be derived from taking a blend of published on Opera blog, and provide people into having Soursop (Annona muricata a specie of News’s website organic remedies for misguided trust in the fruits the genus Annona of the custard apple the listed illnesses. and prevent them from tree family) and Guava (Psidium guajava) seeking proper medical • Prevents kidney problems attention. • Cures insomnia • Cures catarrh and coughs • Aids digestion • Prevents diabetes 15
It is claimed that the following is a This claim circulated on To promote the Believing the claim might COVID-19 medical kit required at home: WhatsApp. services of the Tata lead people to ignore the health site, using preventive measures COVID-19 as the pull. prescribed by medical experts and the Nigeria Centre for Disease Control (NCDC). Some of the medications in the “kit” may be harmful when taken in excess. For example, a paracetamol overdose could lead to liver failure, thus, without any dosage directions, this could be the It also claims that COVID-19 occurs in case. three stages: Infected persons may also resort to home care instead of expert medical care. Furthermore, the link at the end of the claim, takes the reader to the TATA home page and not the article referred to in the claim. Consumers may rely solely on the WhatsApp version and may not be tech savvy enough to click and verify the claim on the TATA website. It is reported that Rev. Fr. Raymond This claim was To possibly promote a It may lead individuals to Arazu claimed that the Anambra published on this “local” cure for COVID- trust the supposed remedy Traditional Medical Board has developed website. It also 19, especially as there and ignore NCDC’s is still no vaccine or recommended safety 16
a cure for the Covid-19 virus using circulated on highly efficacious measures. This might place indigenous ingredients. WhatsApp. therapeutic drug or as their lives in grave danger. clickbait driving traffic to the site. It is claimed that Okra or Abelmoschus This claim was The belief that Okra is It might encourage people esculentus (Okwulu in Igbo, Ila in Yoruba) published on The medicinal might have not to seek prompt medical stabilizes blood sugar and prevents and Montserrat Reporter’s motivated this claim, as attention and instead focus improves constipation amongst others. website. It also well as the desire to on Okra as a treatment for See image below: circulated on increase traffic to the the listed ailments. WhatsApp. website. It is claimed that the oil from mint leaves This claim was To perhaps sensitize It might lead people to rely (Mentha a genus of plants in the family published on the readers about the solely on Mint leaf rather of Lamiaceae (Ewe Minti in Yoruba) Nigerian Finder website. health benefits of Mint than getting appropriate contains antioxidant and anti- leaf, and drive traffic to medical care when inflammatory components which can the website. necessary. help in relieving seasonal allergies. It is claimed that unripe pawpaw soaked This claim was The motivation might This claim does not include in water for four days can be used to published on a be traffic to the chat any medical evidence and cure ulcers and haemorrhoids. Nairaland chat forum. forum, or it’s simply an lacks scientific merit. Hence, ill-informed remedy it is capable of misleading that some people do and placing users as risk by believe in. preventing them from seeking actual treatment for haemorrhoids. The further 17
discussions on the forum highlights more unscientific examples of how pawpaw cures serious conditions. It is claimed that the mixture of banana, This claim was This may have been This is not evidence based raw honey and tomatoes increases published on the motivated by the desire and therefore cannot be sexual well-being and moisturizes the Nairaland forum. to promote natural authenticated. skin, among others. fruits and extracts, as well as drive traffic to the website. An excerpt from the claim reads: “We have Raw Original Honey straight from the Bee farm”. This suggests that the claim is also motivated by the desire to create awareness and promote the sale of their honey. It is claimed that cloves or Syzygium This claim was To inform readers on Although the writer aromaticum, (Kanafuru in Yoruba, published on Punch the health benefits of supported some of the Osasagbogbo in Igbo, Kanumfari in Online. cloves and perhaps claims with some studies, Hausa) strengthens the immune system, increase traffic on the s/he failed to provide the reduces inflammation, aids digestion, website. sources. Thus, the boosts testosterone levels, has anti-viral, authenticity of the claim is anti-microbial, and antibacterial unclear. The claim may drive properties amongst other health individuals to depend solely benefits. on cloves instead of seeking medical attention and this might put their health at risk. 18
REFERENCES Amobi, T., Obia, V., Udodi, L. & Akinuliola, O. (2019) Media and the Menace of Information: Disorder in Nigeria’s Public Sphere. (In Press) Centre for Democracy and Development (2020). Health misinformation: False stories from Ebola to Coronavirus. Retrieved from https://www.thecable.ng/health-misinformation-false-stories-from-ebola-to-coronavirus Kaltwassar, J. (2019) Health threat without easy cures. Retrieved from https://www.contagionlive.com/news /misinformation-is-a-public-health-threat-without-easy-cures Kim, S. (2019) Health misinformation on social media. Retrieved from https://www.asc.upenn .edu/news-events/news/kim-studies-health-misinformation-social-media Moshood, Y. (2020) Physicians say Dr Stella Emmanuel’s claim about hydroxychloroquine unproven. Retrieved from https://healthwise.punchng.com/physicians-say-dr-stella-emmanuels-claim-about- hydroxychloroquine-unproven/ Wardle, C. & Derakhshan, H. (2017) Information disorder: Toward an interdisciplinary framework for research and policy making. Council of Europe Report. Retrieved from https://www.theewc.org/content/download/ 2105/18430/file/INFORMATION%20DISORDER.pdf World Health Organization (2014) WHO declares end of Ebola outbreak in Nigeria. Retrieved from https://www.who.int/mediacentre/news/statements/2014/nigeria-ends-ebola/en/ Zielinski, C. (2020) Coronavirus (247) Fake news in Nigeria Retrieved from http://www.hifa.org/dgroups- rss/coronavirus-247-fake-news-nigeria 19
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