An additional 950 Nigerian children could die every day from preventable causes over the next six months as the COVID-19 pandemic disrupts routine services and threatens to weaken the health system, the United Nations Children’s Fund (UNICEF), has said. Globally, 6,000 additional children under five could die every day.
UNICEF warned that these disruptions could result in potentially devastating increases in maternal and child deaths:
“The analysis offers three scenarios of the potential impact of COVID-19 in 118 low- and middle-income countries, including Nigeria. In the worst-case scenario, the estimate is that an additional nearly 173,000 under-five deaths could occur in just six months, due to reductions in routine health service coverage levels, including routine vaccinations – and an increase in child wasting.
“In Nigeria, these potential child deaths would be in addition to the 475,200 children who already die before their fifth birthday every six months threatening to reverse a decade of progress in ending preventable under-five child mortality in Nigeria. About 6,800 more Nigerian maternal deaths could also occur in just six months.”
“Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades,” said UNICEF Executive Director, Henrietta Fore. “We must not let mothers and children become collateral damage in the fight against the virus.”
UNICEF Nigeria’s Country Representative, Peter Hawkins, said: “We have made steady progress in reducing preventable child and maternal deaths in Nigeria over the last 20 years and it would be devastating if that progress is lost or reversed devastating for Nigerian families, communities and for the country as a whole.
“The under-five mortality rate has declined gradually over the last two decades in Nigeria from 213 deaths per thousand in 1990 to 120. This is likely due to improved access and coverage of key lifesaving interventions at primary health care and community levels and improved immunization rates.
“But in countries with still overall weak health systems, like Nigeria, COVID-19 is causing disruptions in medical supply chains and straining financial and human resources. Visits to health care centres are declining due to lockdowns, curfews and transport disruptions, and as communities remain fearful of infection.”
The 10 countries that could potentially have the largest number of additional child deaths are: Bangladesh, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Uganda and United Republic of Tanzania.
“The 10 countries that are most likely to witness the highest excess child mortality rates under the worst-case scenario are: Djibouti, Eswatini, Lesotho, Liberia, Mali, Malawi, Nigeria, Pakistan, Sierra Leone and Somalia.
“The estimates in this new study show that if, for whatever reason, routine health care is disrupted, the increase in child and maternal deaths will be devastating.
“Registration at the appropriate time is essential with a good facility. Following instructions, visit your hospital as at when due and when necessary. When it’s labour time, get to the facility on time.
“It is not usually about the money all the time, most emergencies one is meeting for the first time are being attended to. But our people would prefer to wait until things get out of hand, at times they are being presented to the hospital half dead.”
Rise in maternal and child mortality rate
Recently, the Federal Government expressed concerns over the rise in maternal and child mortality due to disruption in essential services caused by the COVID-19 pandemic.
A family health physician and Medical Director, God’s Goal Hospital, Lagos, Dr Gabriel Omonaiye, told Daily Sun: “It is important to understand that maternal mortality is the number of pregnant women per thousands that die due to pregnancy and delivery complications. While infant mortality is number of children that die from birth to one-year.
“Before COVID-19, there has always been rise in maternal and child mortality in the country. Nigeria ranks as one of the highest in maternal and child mortality rate, we should have this at the back of our mind.
“There are many factors responsible to the rise. One of the factors, however, is that pregnant women are not doing antenatal as it should be done. Some register and never come back for antenatal, while some with the intent of just registering their name and then go elsewhere to deliver, that is to traditional birth attendants or home delivery and only come to the hospital when things get out of hand.
“Others factors are complications such as; eclampsia, haemorrhage, bleeding during pregnancy, antepartum, intrapartum and postpartum haemorrhages.
“Most doctors, do not have much in terms of number of delivery as compared to what traditional birth attendants or auxiliary nurses who run antenatal care at home have. They have more patients than well-established hospitals with doctors. Some of these pregnant women only remember to go the hospital when they have problem.
“A case scenario is a patient who has a case of previous Caesarean section at a general hospital. The woman happens to be a sicklier; she got pregnant again and was breeched.
“At the general hospital where she registered, of course, there is going to be an elective tear. Instead, she went somewhere where they were trying to manoeuvre by turning the baby from breeched to cephalic (head down), which they succeeded and eventually she put to bed.
“But this singular action ruptured her uterus causing her to have internal bleeding and very little bleeding outside. By the time they brought her to the hospital, she was in shock and was referred to a general hospital, unfortunately, she died on the way.
“It is important, however, to stem the tide of women dying during pregnancy and delivery. Pregnant women need to carry out proper antenatal from the word go for a better outcome.
“If a patient is registered with a hospital, especially private hospital and to some extent, government facilities and it gets to the time of delivery, except it is very glaring that the individual is a case of COVID-19, because, this is your patient, the doctor of course would be affected. Notwithstanding, there is moral and medical obligation as well as contractual agreement.
“On the part of the patient, maybe for reasons the attention has been shifted to COVID-19. If a patient is going to a private or general hospital and in a bad shape that is eclampsia or bleeding, this means complication has set in. The risk of affecting health workers and the fear association with it is also there.
“But, if things were done properly, for example; registration and continuous follow up until time of delivery, it is most likely the patient would not be rejected when due for delivery.
“When you probe carefully, most patients turned down by some facilities during this period are likely due to emergency cases. And in most cases, these patients wait until the odd hours or when things get out of hand after severally trying to ameliorate the condition until the last minutes when it is glaring that something bad is about to happen, then they start going from one facility to another.
“Also, because a lot of attention has been shifted to COVID-19, most hospitals would think twice before accepting to treat patients. Because, most of these patients are also coming with one infection of the other like, sepsis, or running temperature, which is also bad case on its own, as a private practitioner, if you accept these patients, anywhere in the world, the chances of survival is a bit obscure.
“One is not sure of what the outcome would be as you do not want to have a fatality on your hand. By this time, the doctor would want to do a referral to maybe a general hospital, of which they too are also overworked with their own patients.”
Omonaiye noted that before the advent of COVID-19, these factors were there: “But when we learn to do things properly and at the right time, some of these issues would be averted. Let me also add here that some of pregnant women do not take antenatal seriously.
“There is also the economic factor, which contributes to infant mortality. For example, if their parents are not well to do, most times they present the child’s case very late to the hospital.
“Cost is one of the impacts of COVID-19 on health services. Prices of most of the consumables used in hospitals have skyrocketed. For example, the infrared thermometer, sold for N5000 was sold for N75,000 between March and April. And of course, other medical equipment and personal protective equipment (PPE) such as hand gloves and hand sanitisers.
Impact of COVID-19 on health care
“Cost has also inflated health care delivery. Because the cost is on the high side, you find out that it has become out of rich for some patients. And again, some patients are afraid of coming to the hospital with the notion that the virus is already at the hospital waiting to pounce on them once they get there.
“On health workers, the fear of asymptomatic or pre symptomatic carriers, they tend to be a bit scared. Also, some patients with symptoms similar to that of other problems like; pneumonia, fever, catarrh, cough, which are also symptoms of COVID-19, to be sure and going by Nigeria Centre for Disease Control protocol, you will have to call the helpline or refer them to the appropriate centres for test.
“Even when you want to admit a patient who is negative, because you want to limit the exposure of COVID-19 in the health facility as well as reduce the likelihood of them being infected, you prefer they be outpatients.
“Those whom ordinarily you have to run test or examine or take down their medical history, but to reduce exposure in both the health workers and patients, some prefer online services via; telephone, Skype, zoom etc. By this process, the quality may be watered down.”