Experts worry over maternal, child mortality rate in Nigeria
By Job Osazuwa
EVERY day across Nigeria, cries of agony reverberate from the homes of bereaved families.
Most times you hear of mothers succumbing to death, either before of after childbirth, or the baby dying even before discovering what the world is all about. It is a sad tale that is increasingly spreading in the land, even as no solution seems to appear in sight.
Alhaja Kudirat (not real name), who lived in the Command area of Agbado Oke Odo Local Council Development Area, Lagos State, had a daughter five years ago. After more than four years’ delay, she took in early last year and her joy as well as that of her husband, who works in Rivers State, was full.
Like every expectant mother, Kudirat began to shop for her unborn baby as her due date drew nearer. But on that fateful Tuesday night in November 2016, the unimaginable happened.
Daily Sun reliably gathered that in the dead of the night, the pregnant woman, who lived with only her little daughter, began to bleed. She managed to put a telephone call across to her husband in Port Harcourt to inform him of the development.
The reporter was told that, without delay, her husband communicated with his wife’s landlord. The landlord, in company with his own wife, laboured to get a vehicle to take the woman to the hospital. But all efforts failed, even as she continued bleeding seriously.
About two hours later, a private hospital in the area brought an ambulance to convey her to the facility. But by the time she was wheeled to the theatre, it was too late. The woman and her unborn baby died even before the doctors could start the surgery.
With Nigeria losing an estimated 2,300 children under the age of five and 145 women of child bearing age every single day, and accounting for the second largest number of maternal and child deaths in the world, stakeholders are calling on government at all levels to scale up health care delivery in order to curtail the frightening trend.
The maternal mortality rate is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). It includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.
According to the Nigerian maternal mortality chart, 815 deaths out of 100,000 live births were recorded in 2016, which many experts have interpreted as a national shame. This is against eight to 100,000 live births in developed countries.
Different health indicators show that a woman dies every 90 seconds from complications related to childbirth. It is pathetic to note, as it was revealed, that more than 90 per cent of the deaths are preventable. A woman in sub-Saharan Africa has a one-in-16 chance of dying in pregnancy or childbirth, compared to one in 4,000 cases in developed countries.
Beneath the statistics, which was provided by the United Nations Children’s Emergency Fund (UNICEF), revealing the alarming death rate, lies the indescribable pain for families who have lost their loved ones. Even more devastating is the fact that, according to different researches, necessary interventions reaching women and babies on time would have averted most of the deaths.
Unfortunately, the death of a woman during pregnancy and labour remains one of the most overwhelming misfortunes that have endured throughout Nigeria’s healthcare sector in the last few decades. The misfortune comes with a huge burden of grief and disappointment. Unarguably, the hazard of maternal and infant deaths has continued to violently damage numerous households, leaving footprints of irreparable loss.
It might not be an exaggeration to state that the birth process is perhaps one of the most dreaded and dangerous journeys that most women pass through in this part of the world. This is especially troubling as statistics show that the extent of loss of lives across low and middle-income countries occasioned by the issue is increasing on a daily basis.
According to a 2016 report from the World Health Organisation (WHO), approximately 900 women die from preventable causes related to pregnancy and childbirth every day and more than half of all maternal deaths across the globe occur in Africa, with Nigeria having the highest figure.
Maternal mortality remains a major problem in many parts of Nigeria. Health monitors have posited that understanding the causes of maternal mortality is crucial in confronting the challenge of unyielding high rates.
In 2000, member countries of the United Nations, Nigeria inclusive, agreed on eight Millennium Development Goals (MDGs) to improve the health and socio-economic wellbeing of the people in their countries in the 21st century. MDG 5 clearly stated the need to improve maternal health, setting a target of reducing maternal mortality by three-fourth by 2015. Unfortunately, two years after the target of all the MDGs, MDG 5 has made the least progress in Nigeria.
No wonder a representative of the United Nations Population Fund (UNFPA), Ms Rati Ndhlovu, once likened the deaths experienced daily from pregnancy-related complications to a Boeing 747 plane crash occurring every day, adding that because the women were poor and disadvantaged, their deaths were often ignored.
“Yet, these numbers of deaths don’t just happen once in a while like plane crashes. They happen every blessed day, which ordinarily should make the country scale up interventions to achieving the targets of reducing maternal and child mortality rates,” she explained.
Although the huge burden of deaths among Nigerian women is caused by lack of access to proper healthcare or ignorance among most Nigerian families due to religious or cultural beliefs, experts still believe, if the country’s primary healthcare system were made more robust, effective and functional through increased health financing, maternal mortality would decline drastically in the country.
Government, especially at the federal level, had at some point increased efforts to combat the menace of child mortality. But experts argue that even though a considerable amount of effort has been expended by successive administrations in a bid to save the country from the atrocious killer, progress has not been sufficient enough to meet the UN’s resolution.
The need for a robust partnership with private medical practitioners targeted at a creating unhindered access to affordable healthcare facilities and services, particularly for the safety of pregnant women and their children, has been projected by many, but it is often ignored by policymakers.
A general practitioner in Lagos, Dr. Jefferson B. Olufemi, told Daily Sun that it was sad that Nigeria and many other African countries were still battling to overcome infant and maternal health challenges. He lamented that the number of paediatricians and gynaecologists in Nigeria was far below what was needed to cater for the growing population.
Olufemi called for the government to sensitise every Nigerian woman of reproductive age and even younger in every part of Nigeria on the importance of antenatal services.
Said he: “Above all, the onus lies on the government to provide a conducive environment with up-to-date facilities that would make health care delivery seamless for health workers. Nigerian doctors are doing exploits all over the world because of the facilities provided over there.
“One of the greatest barriers that the sector has faced in the last three decades is the brain drain syndrome. I can authoritatively tell you that more than 50 per cent of Nigerian-trained doctors are practising abroad. Nigerian budget on health care is too low, and the sector is underfunded. There are government hospitals you will go to in Nigeria and you won’t be attended to by a doctor for two or three hours. Some complications can kill a patient within 15 minutes.”
He said northern Nigeria had remained the most dangerous place in Nigeria and, perhaps, the world to be an expectant mother, stressing that enlightened women who have had pre-natal care have a better chance of delivering their babies safely.
According to him, malnutrition, hypertension in pregnancy (eclampsia), human immunodeficiency virus/acquired immunodeficiency syndrome, infections and malaria were the common causes of maternal death in the six weeks following the end of pregnancy/childbirth.
Olufemi submitted that over half of the maternal deaths occurred during labour and the postpartum period. He canvassed community education on the importance of having skilled attendants during childbirth at all times. He also advised health care providers to make referrals as soon as possible to avoid endangering the lives of the baby and mother.
“Emergency obstetric care should be made available, accessible and affordable at health facilities throughout the country, and efforts must be made to prevent unwanted pregnancies and unsafe abortions by increasing contraceptive use. The malaria control efforts should be intensified,” the expert said.
Other interactive factors contributing to maternal mortality that Olufemi listed are behaviour of families and communities, social status, education, income, and availability of health services. He added that non-health sector activities, such as education, lack of potable water and poor sanitation, poor road network and communication, and internal security such as Boko Haram activities, also influence outcomes on maternal and child health.