In Nigeria, a woman’s chance of dying from pregnancy and childbirth is 1 in 13, compared to 1 in 5,000 in developed countries. Although many of these deaths are preventable, the coverage and quality of healthcare services remain a major concern with about 40 percent of deliveries attended to by skilled birth attendants.
The deaths of new-born babies in the country represent a quarter of the total number of deaths of children under-five, according to United Nations Education Fund (UNICEF). Sadly, majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery reflecting the intimate link between new-born survival and the quality of maternal care.
A SURE-P MCH 2013 document shows that only 23 percent of children aged 12-23 months received all recommended vaccination in the country. While vaccination coverage varies widely by residence and zones, 40 percent of children in urban areas are fully vaccinated compared to only 16 percent in rural areas and about 29 percent of children estimated not to have received any vaccination against childhood killer diseases such as measles, tetanus, whooping cough, polio, hepatitis B, pneumonia, etc.
While the main causes of neonatal deaths include birth asphyxia, severe infection like tetanus and premature birth, on the other hand, malnutrition remains an underlying cause of morbidity and mortality of a large proportion of children under-five in Nigeria. It accounts for more than 50 percent of deaths of children in this age bracket.
Underneath the statistics lies the pain of human tragedy, for thousands of families who have lost their children. Although analyses of recent trends show that the country is making progress in cutting down infant and under-five mortality rates, experts believe that the pace to achieve the Millennium Development Goals (MDG) 4 and 5 targets of reducing under-five and maternal mortality rate by two-thirds and three-quarters respectively by 2015 is still slow as the date approaches.
Onyebuchi Chukwu, minister of health, said while Nigeria has developed a well articulated strategic plan for achievement of its health targets including MDGs 4 & 5, it is bedevilled with low coverage of high impact interventions such as exclusive breastfeeding, problem accessing healthcare, poor functioning health system with weak referral linkages especially for obstetrics and neonatal emergencies and inadequate financial support.
While noting that the country adopted and implemented the Integrated Maternal, Newborn and Child Health Strategy (IMNCH), Chukwu maintained that it decided to strengthen institutional capacity and infrastructure in a bid to meet MDG target for Nigeria.
According to Chukwu “Current strides to meet the MDG target include improving human resources at PHC level through the Midwives Service Scheme and capacity building of midwives in Life Saving Skills (LSS) and Integrated Management of Childhood Illness (IMCI) to enhance their performance in providing quality care, establishment of vesico-vaginal Fistula centres and the upgrade of Ebonyi VVF centre to a national one, management of childhood Illness, implementation research projects on Prevention of Mother-to-Child Transmission of HIV (PMTCT), Maternal, Newborn and Child Health (MNCH), etc.
Osahon Enabulele, vice president, Commonwealth Medical Association, noted that there is need for urgent resuscitation and strengthening of primary healthcare and referral system with an adequate mix of health manpower to improve health outcomes in the country.
A peep into health indices in Nigeria show that in 2011, 6.9 million children under the age of five reportedly died, which is a drop from 7.6 million in 2010, 8.1 million in 2009 and 12.4 million in 1990. Child mortality is more prevalent in sub-Saharan Africa with about half of child deaths recorded as Nigeria and Democratic Republic of Congo accounting for 20 percent of global deaths.
In a bid to improve the situation analysis in Nigeria as revealed by the preceding account of the existing health indicators, as well as in her commitment to achieving the MDGs 4 and 5, Nigeria has put in place some programmes such as; National Health Insurance Scheme(NHIS); Health Sector Reforms (HSR); introduction of Midwifery Service Scheme (MSS).
As Nigeria marches towards 2015, experts believe that government must take the issue of maternal and child mortality seriously by matching words with actions for it to achieve the set target.
There is also the need to allocate 15 percent of government annual budget to health in order to meet the Abuja commitment of 2001 by heads of governments in Africa, review implementation of the National Health Insurance Scheme to identify gaps and to scale-up services to offer community-level insurance, continue roll-out of IMNCH strategy in all states, including support for supervision, logistics and data tracking.
Besides this, there is need to develop a national KMC guideline to address service standards, admission and discharge criteria, and best practices that can be adapted for all levels of healthcare, enable communication and information sharing between national, state, LGA, facility and community levels as well as keep lower- and mid-level health facilities up to date on new and revised national policies and link national strategic planning and action in LGAs.
Alexander Chiejina
