By Cosmas Omegoh
Ask those older women in the villages. Some of them gave birth to 12 children. One reason they kept having children was because they were unsure of what the future held and how many of those children would survive. For some of them only few of the children survived, to attain adulthood.
Now, when you see adults who are crippled, or limping on one leg with the aid of a long, sturdy stick, perhaps they survived polio. Some of their mates never made it beyond infancy. They were either killed by measles, diphtheria or some other childhood diseases.
But today, improvements in medicine and technology have changed the narrative. Now, a retired University College Hospital (UCH) Ibadan, and ex-Lagos State Ministry of Health senior consultant pediatrician Dr Omotunde Ogunlaja, wants improved child healthcare to be taken more seriously by both parents and the government. Drawing from his wealth of experience, he dropped quality nuggets he believes will effectively reduce child mortality in the country to the barest minimum.
What needs to be done to improve child health?
The most important tool here is health education. That is part of primary health. Through education, parents need to be aware of the need to have only the number of children they can take care of. A man who is jobless and cannot even sustain himself shouldn’t attempt marrying two wives.
Unfortunately, one cannot control human beings. You can only change them by education on the benefits of family planning programmes that are available. There are many taboos and much cultural resistance to some of these things, so we just need to continue educating people and making facilities available to help them.
In the 1940s and 1950s when we were growing up, childhood mortality was very high. And people used to talk about ogbanje and abiku. But if one has the right number of children that are well nourished, they will overcome all that. Nutrition is very important. If a child has good nutrition, that child can resist many diseases. Immunisation is important. It can prevent many deadly diseases. Child spacing is equally very important. All these have to come together in a good balance. That is why they say prevention is better than cure. All of these are encompassed in primary healthcare.
For the government, rather than spending lots of money on tertiary centres, if we can improve the coverage of primary healthcare, we will be able to prevent many diseases. By doing so, the number of people going to hospitals because of various illnesses will be reduced to a manageable level. So, it is all about primary healthcare and taking care of our environment, in terms of providing portable water, and adequate toilet facilities. If we don’t take care of these things, they will lead to illnesses. In fact, we can significantly reduce illnesses by taking preventive measures.
Ordinarily, local governments should take care of primary healthcare, but the question is: do we have local governments? If we can have an effective local government system, it will take care of these things.
The Expanded Programme on Immunisation was laid aside. What is the right thing to do?
That is definitely not okay. That why it is said that prevention is better than cure. Looking back, late Prof Olikoye Ransome-Kuti’s Expanded Programme on Immunisation (EPI) changed a lot of things especially for paediatrics. When I started my training in paediatrics in UCH in 1977, in an average ward with 20 beds, we always had five children on admission with paralysis from polio. Then EPI started coming gradually. But about the time I finished my postgraduate training, you could go into the whole of the Department of Paediatrics comprising three big wards and for a whole year you would see about one or two cases of polio, whereas before then, we were seeing about five on a monthly basis. So that changed a lot of things.
Then, measles was very common. But when EPI came, even younger doctors until lately were finding it difficult to make a proper diagnosis of measles because it virtually disappeared. They would see a child who had fever during the warm season and ordinary heat rash, and conclude it was measles.
But sadly with time, and the way we do things in Nigerian, we started having regression. Coverage of such programme was no longer as impactful it used to be. There was a time, polio completely disappeared from Nigeria. But I understand that new cases are now coming up, though not very common.
So, we plead with the government to intensify efforts at ensuring that all programmes on immunisation aimed at reducing deadly childhood disease should come back.
I can also give an example. I saw one or two cases of diphtheria in the late 1970s. With Diphtheria Pertussis Tetanus (DPT) vaccine being given, I have never seen a case of diphtheria in the last 40 years whereas it is a very deadly disease. The ‘D’ in it is the diphtheria. It attacks the throat, infects and corrodes it; usually the child will die. But with the vaccine, it has virtually disappeared.
That is why we are pleading with the government to intensify the normal preventive measures we have so that we can save our children from preventable diseases.
Is the current immunisation scheme, National Programme on Immunisation, NPI, in anyway different from Olikoye’s EPI?
There is scarcely no difference. Immunisation is still being given adequately at many centres especially here in the South. But new vaccines are being added from time to time to what Olikoye had then. For instance, we now have a combination of Measles, Mumps, and Rubella (MMR) and others.
Generally all of the vaccines are very expensive. And may be because of the cost, the government is not adequately providing them.
But before, a lot of the vaccines we were giving to infants and children were manufactured locally. Now, we are buying many of them, and they are very expensive. May be that is why. But that is better. So, all we are saying is that the government should intensify efforts at ensuring that all these programmes are sustained.
All the same, what we have now is an improvement on what Olikoye had, but the coverage is not as adequate as it used to be, may be because everything in Nigeria as we know keeps regressing. Or may be sometimes the vaccines are not available or may be sometimes people do not avail themselves of such programme. We all know that the population is expanding, and development is not keeping pace with it, because there are a lot of people in some rural areas who don’t even have primary healthcare centres where they can take the vaccines.
But we have seen that nurses are sent to schools and worship centres to vaccinate the children. These are some of the things that can improve coverage. If the people are not doing as much as they are supposed to be doing, maybe they should be sensitised to do so.
But on the whole, Nigerian children are better immunised now than in pre-Olikoye days. So it is just a question of making sure that we don’t relax in implementing the programme under primary healthcare.
How does extended immunisation help?
Immunisation in Olikoye’s time, I remember, it used to end between nine and 18 months. But in these modern times, the programme is extended five to 15 years. Some of the vaccines are repeated. Booster doses are even given. That sometimes may not be present in government hospitals, but some private hospitals try to keep abreast with what happens abroad.
In Olikoye’s time, a child always had single dose of measles vaccine. Now, we give MMR once. It took sometime before the government hospitals could embrace this; but many of them now have done so..
In the US, immunisation is never ended. It keeps extending maybe to 18 months.
But some private settings here try to keep abreast with what happens abroad; at 18 months, a child gets MMR booster and at five years, he gets the same MMR booster.
Apart from that, in Olikoye’s time, meningitis vaccine was not available, but now it is available. However, the only challenge we have now is coverage. This may be inadequate because of population explosion. Of course, in the northern part of the country, in areas where you have Boko Haram menace and banditry, coverage is being affected.
What is your assessment of wellness of the average Nigerian child?
Generally and globally things have improved, but they can be better. Because of preventive measures, childhood diseases, especially those covered by immunisation, have reduced. So, children survive more now. In spite of all the inadequacies, things are on a general trend of improvement. Of course, there are many more hospitals now and many more specialists to look after the children when they are ill. But of course, we just need to be careful so that we don’t have regression. So, we need to continue maintaining and improving on coverage mainly. The knowledge is there. But sadly, the vaccines may not be available for economic reason or some other reasons because some of these vaccines have to be kept in cold chains. They require electricity; they require mobile refrigerators, and all that. Sometimes for logistic reasons these things are not as adequate as they should be. But we need to keep doing our best.