Ahead of the forthcoming 55th annual conference of the Paediatric Association of Nigeria (PAN), CHRIS ESEZOBOR, a professor of paediatrics and paediatric nephrology at the College of Medicine at the University of Lagos and chair of the Scientific Committee for the conference, tells TEMITAYO AYETOTO-OLADEHINDE that the medical community and the society at large must champion child health initiatives and advocate for increased resources including paediatric workforce in the country
As a pediatrician working in Lagos, how have government policies on child health impacted your daily practice and the immediate concerns you face for your patients compared to two decades ago?
The same things killing our children 20 years ago are the same things killing our children now. Number one is that the majority of our children that die, die in the first month of life. We call these deaths neonatal deaths. Almost 30 to 40 percent of under-fives die in the first month of life. Of those people who die in the first month of life, the vast majority die in the first week of life. Of those people who die in the first week of life, the vast majority of them will die within the first two or three days of life. What that immediately tells us is that it is tied to pregnancy. The newborn’s health is also closely tied to the mother’s health. And it’s a big problem in Nigeria. Why are our newborns dying? They are dying because at birth they don’t cry. They die because they are born too early. They die because they develop jaundice, which is the yellowness of the eyes, which also affects the brain. They are dying because they develop infections. Virtually all of these deaths are preventable or could be mitigated. However, they can only be mitigated if the pregnant woman is recognised to be at risk and gets the necessary intervention. At delivery, she can only get the necessary intervention if she delivers in a health facility. A big chunk of our pregnant mothers in Nigeria do not deliver in healthcare facilities. They deliver in places where they are not attended to by skilled manpower to help the child.
Malaria is also a leading cause of death. Pneumonia is also killing our children. Diarrhea is still a big cause of death. However, we’ve made much more progress with diarrhea compared to some of the other illnesses. A great number of our children do not get vaccines. We still have regions in this country where we have 10 to 15 percent of one-year-olds who have not received one dose of any vaccine.
Despite consistent advocacy from your association, PAN, Nigeria’s child healthcare budget remains below the recommended 15 percent. Given the severe impact this has on rural communities and preventative care, what specific initiatives is your association pursuing to push for a budget increase in these critical areas?
So that’s the beauty of a moving picture. If we sit back today and take a snapshot of Nigeria’s healthcare funding, we will conclude that it is below par.
There is no reason why we should be in the league of some nations that I have mentioned when we are sometimes above these people in terms of GDP per capita.
Government works slowly and so while it appears that nothing much has been done, things are being done from dispensation to dispensation. We have been making progress but not as fast as we would like to.
Concerning financing, the main theme of 2024 Paediatric Association of Nigeria Annual Conference (PANConf) is reaching every child with optimal care, and we are saying it’s beyond strategies and goals we have been setting such as the SDGs; we align with them but beyond these targets, how do we make sure that the average Nigerian child gets what qualifies as optimal care? On the issue of funding, we cannot shy away from it, so one or two symposia during PANConf 2024 are specifically targeted at the issue of finance. How do we make it sustainable?
How much do we need to spend to ensure they get optimal care? Does the government rate health as key to economic productivity?
The truth about it is that no nation economically can be greater than the health of its people.
With just 2,000 paediatricians available to 100 million Nigerian children, what specific challenges does this pose to achieving optimal care for every child?
Most pediatricians are in urban settings. Almost 50 percent of Nigerians live in rural areas, so even this number that we have is not enough and is concentrated not only in the southern part of Nigeria and in the major cities. It’s not peculiar to the pediatric workforce but that is a very important point. Our main theme is reaching every child with optimal care. Just the way that finance is important, we also realise that manpower is crucial. If you are going to ensure that every Nigerian child gets the optimal care he deserves, then you need a critical number of manpower.
The health minister has proposed increasing medical school admissions to combat brain drain. Do you think expanding access is the right solution, or are there alternative strategies?
So, I won’t sit here and say there is one solution to all this. However, even now, fewer young people are interested in reading medicine. If you limit yourself to even children of doctors, the percentage is even far lower. The point I’m making is that children will be attracted to what society places a premium on. We need to rejig our value system. We need to say this is important and put our mouth where our money is.
We need to sit at the table, with all the stakeholders and ask ourselves, how do we attract the best? How do we retain them? Now we are not even attracting, let alone retaining.
This year’s conference theme is ‘Reaching Every Child with Optimal Care’. Can you elaborate on how the conference programme reflects these goals?
The PANConf is a scientific conference that will be held in January here in Lagos, marking the 55th annual conference. It’s the flagship annual scientific gathering of experts in pediatrics. The Paediatric Association of Nigeria was founded in 1969. Very early people, including Professor Ransome, and Dr. Bolaji Ajenifuja, who passed away just recently at the age of 93.
The main goal is to promote the health of children in Nigeria. And how do we achieve that? We achieve that by advocating for them. So that’s one thing we’ll be heavily doing during the PANConf. We want to examine current policies. We want to examine current programmes that affect children. And we want to see how we can influence them.
The other role we do as an association is to conduct research. We must understand why, for instance, children in Nigeria are twice as likely to die before their 5th birthday compared to children in Afghanistan. So a child born in Afghanistan today has a better chance of getting to his 5th birthday than a child born in Nigeria. Same for a child born in Yemen. Even in Niger and Cameroon, children born there have better chances of reaching their 5th birthday, of living longer than the average Nigerian child.
Why is reaching their 5th birthday better than the average Nigerian child? That’s one task for the pediatricians, to understand the underpinnings. It doesn’t all have to do with health. It may be with how we live. It may be with our nutrition. It may be with how we accept life-saving interventions like vaccines. How exclusively breastfed are our children? Because all these things have long-life implications. How many children does the average woman in Nigeria have? How much is the government spending on health care per child or individual per year? And even if money is budgeted, are they eventually released?
And if they are released, how many are devoted to what they were budgeted for?
What are the key segments or activities planned for the conference, and how will they unfold?
At PANConf 2024, we are expecting about 1,000 participants. It’s going to span five days. The first two days will be devoted to the sub-specialties. We have people that specialise in children with sickle cell and other blood disorders, people with brain issues, children having epilepsy, and children that have diabetes or thyroid issues. So the first two days of the conference, we’re leaving it for all these sub-specialists to meet amongst themselves, discuss their topics of interest, and have their mini-conference.
However, in that same two days, the association is also trying to train caregivers in Lagos in how they resuscitate newborns. When children are born, a small percentage of them may not cry at birth. And the first few minutes of life are critical. What you do during that period will determine whether the child will survive. Within the first one, two, three, four, or five minutes that they do not cry at birth, the brain is deprived of oxygen. But the interventions we need to make that baby cry at birth to take that first breath are very simple.
So PAN will give a community service, and engage with the managers of the state’s health manpower to send doctors, nurses, and midwives for training.
The main conference will hold from the 17th to the 19th of January.
