Poor maternal, newborn and child health care remains a significant challenge in low and middle income countries (LMICs). The death-risk vulnerability of a child is highest during the first 28 days of life when about 3.5 percent of under-five deaths take place, translating into 2.85 million deaths. Up to one half of all newborn deaths occur within the first 24 hours of life and 75 percent occur in the first week.
Children in LMICs are nearly 56 times more likely to die before the age of five than children in high-income countries (HICs). Assessing the global statistics, one will learn that, despite significant successes among the 75 so-called countdown countries that have 98 percent of all maternal deaths and deaths among children younger than 5 years of age, only 17 are on track to reach goal 4 of Millennium Development Goals (MDGs) target for child mortality and only 9 are on track to reach the goal 5 of the MDGs target for maternal mortality. In other words, although substantial progress has been made towards achieving the goals 4 and 5 of the MDGs, the rates of decline in maternal, newborn and under-five mortality remain insufficient to achieve these goals by 2015. The inability of Nigeria to maximally achieve an increased rate in MNCH before the expiration of MDGs rubbishes the scheme. The right to health remains an integral and inextricable part of the right to life, for without good health, the right to life may be as extinct as the dinosaurs.
In spite of this crucial necessity, it is recorded that, worldwide, 250,000-280,000 women die during pregnancy and childbirth every year and an estimated 6.55 million children die under the age of five. The majority of maternal deaths occur during or immediately after childbirth, while 43 percent of child death occurs during the first 28 days of life.
The major causes of maternal, newborn, and child death have increased in parallel with improved global statistics on mortality burden and trends and improved methods for allocating cause of death, although methods and estimates vary considerably. The Child Health Epidemiology Reference Group estimated that out of 40.3 percent of 7.6 million deaths among children younger than 5 years of age in 2010, 3.1 million deaths occurred in neonates. Major causes of death in newborns included complications of premature birth; 14.1 percent of deaths among children younger than 5 years of age, 1.1 million deaths; uncertainty range, 0.9 to 1.3 million; intrapartum-related complications, previously labelled as birth asphyxia; 9.4 percent, 0.7 million deaths; uncertainty range, 0.6 to 0.9 million; and sepsis or meningitis; 5.2 percent, 0.4 million deaths; uncertainty range, 0.3 to 0.6 million. Other leading causes of death among children younger than 5 years of age included pneumonia; 18.4 percent of deaths,1.4 million deaths; uncertainty range, 1.2 to 1.6 million, diarrhoea; 10.4 percent 0.8 million deaths; uncertainty range, 0.6 to 1.2 million, and malaria; 7.4 percent, 0.6 million deaths; uncertainty range, 0.4 to 0.8 million.
Maternal infections and other poor conditions often contribute to indices of neonatal morbidity and mortality (including stillbirths, neonatal deaths and other adverse clinical outcomes). Considering the fact that most maternal and child deaths are preventable using current knowledge, the burden of mortality and morbidities is unacceptably high. The majority of maternal deaths occur during labour, delivery, and the immediate postpartum period, with obstetric haemorrhage being the main medical cause of death. Hypertensive diseases, infections, obstructed labour and abortion-related complications are the other causes of maternal mortality. The maternal mortality ratio is approximately 500 per 100,000 live births in sub-Saharan Africa including Nigeria, compared to around 150 per 100,000 live births in South Asia and 16 per 100,000 live births in high income countries (HICs). Furthermore, the main direct causes of neonatal mortality and morbidity are infections, complications arising from preterm birth, and intrapartum-related neonatal deaths, which account for nearly 80 percent of all neonatal deaths globally. Almost (99 percent) all maternal, newborn, and child deaths occurs in low and middle income countries.
Nigeria is one of these LMICs. Regrettably, unquestionably, appropriate interventions along with appropriate health resources which have the potential to significantly reduce the burden of maternal and child mortalities remains in huge deficit.
While considering that good maternal health care and nutrition are important contributors to child survival, it is expected of Nigeria to utilize the available resources to ensure the realization of the right to health including her commitments to effective maternal, new born and child health (MNCH) in the country. Nigeria cannot be in denial of huge resources made available towards proffering lasting solutions to MNCH including foreign aids and annual budgetary allocations.
Evidences have shown that MNCH is a component that Nigeria has not maximally and effectively achieved for several years in spite of fiscal allocations in annual budget resulting in high rates of neonates of all levels.
The 2014 World Health Statistics has shown that our immunisation coverage is poor, depleting the enhancement, development and sustainability of the sector. As at 2012, immunisation coverage for one-year-olds is 42 percent for measles, 41 percent for each of DTP3 and HepB3, and 10 percent for Hib3. While many factors contribute to maternal and neonatal deaths, one of the effective means of reducing this burden is provision of effective preventive measures or early treatment provided to women and newborns, often at their home or in primary health care settings. Nigeria is not precluded from countries in the world where over 50 million births take place at home or quack maternity homes operated by what is popularly called “Nurse Eliza” without a skilled birth attendant (SBA). The rates of no access to skilled birth care and emergency obstetric care are also high in Nigeria where majority of deaths and morbidity related to complications of childbirth take place. Therefore, effective interventions and enhanced coverage in low-resource settings have great potential to avert maternal and neonatal deaths. Similarly, access to antenatal health visits and medicines can prevent death from hypertensive disorders, while death due to sepsis can be averted by screening for prenatal maternal infection and sexually transmitted infections (STIs) during antenatal visits and with hygienic infection control measures during birth provided by SBA.
Nigeria has committed herself to the course of Millennium Development Goals 4 and 5 to reduce child mortality reduce by two-thirds, between 1990 and 2015. This is 2015 the year set out for the expiration of MDG scheme. It is imperative that these commitments still be pursued, met and sustained by making it a top most priority towards advancement of human development from the cradle.
Smart C. Amaefula
