By: CHIOMA UMEHA
The maternal and child mortality situation in the country has
continued to worsen with Nigeria still retaining the second highest
global burden of maternal deaths in the world next to India. Dr.
Oluwarotimi Ireti Akinola, Chairman, Society of Gynaecology and
Obstetrics in Nigeria (SOGON), Lagos Sector–in an interview with CHIOMA
UMEHA (HEALTH EDITOR) gives an overview of maternal and child mortality
reduction programme in the country. Excerpts:
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| Oluwarotimi Ireti Akinola |
Why are pregnancy-related health complications and deaths on the increase?
Pregnancy is not a disease but privileged function entrusted to
women. However it has become such a great battle that many have lost
their lives in the struggle. Following the rise on the incidence of
pregnancy-related health complications and deaths, Prof Mahmoud Fathalla
commended the English term used to describe what women do to give birth
to a child as ‘labour.’ Unfortunately this is ‘labour that has never
been unionized’ and has therefore suffered neglect.
Many still remember with sadness the plane crash of last year, in
which more than 130 people died. If any country has a plane crash which
kills 145 passengers daily, which is an equivalent of the estimated
daily maternal deaths in Nigeria, there would be serious crisis. It is
safe to assume that about 17,400 Nigerian women have died due to
pregnancy- related issues this year, from January to April. This is
because 145 women die daily due to pregnancy-related reasons in the
country. In addition, for every woman who dies, approximately 20 more
experience infection, injuries or disability.
Define maternal death?
Maternal death is the death of a woman during pregnancy or within 42
days of termination of pregnancy, due to reasons related to pregnancy or
its management. This is irrespective of the duration of the pregnancy.
Late maternal death is the death of a woman due to direct or indirect
obstetric causes, more than 42 days, but less than one year after
termination of pregnancy. Despite being caused by pregnancy-related
events, these deaths do not count as maternal deaths in routine civil
registration systems.
Assess maternal death situation in the country?
Nigeria is home to one out of five
Africans, with its population of
over 160 million that is estimated to be one per cent of the global
population. The country however, accounts for a disproportionate 10 per
cent of global maternal deaths. Nigeria presently has one of the highest
maternal mortality rates in the developing world – accounting for the
second highest global burden of maternal deaths in the world next to
India. The last National Demographic and Health Survey in 2008 placed
the national Maternal mortality Rate at 545 per 100,000 live births
,this is unacceptably high when compared to 350/100,000 and 400/100,000
in Ghana and Benin Republic respectively over the same period of time.
This is even as the February 2009 UNICEF report, showed that the
figures were under-estimated. The report stirred the hornet’s nest when
it updated its earlier estimation of the incidence of maternal mortality
in Nigeria from 800 per 100, 000 to 1,100 per 100,000 live births, an
indication that the strategies to address the situation were not
yielding anticipated results. This created uproar in government circles
that warranted the then minister of information and communication
issuing a political statement to refute the information.
What is the prenatal mortality situation in the country?
Prenatal mortality tends to follow the same geographical pattern as
maternal mortality. 3.3 million still-births occur yearly, while over
four million newborns die during the first 28 days of life, even as
three million dies during the first seven days. In developing countries,
about one third of these deaths are related to prenatal complications
responsible for birth asphyxia.
Assess efforts to address maternal and infant mortality problems in the country?
Many acronyms representing programmes have been designed to address
maternal and infant mortality issues since the past 20 years in the
country. These include: SMI (Safe Motherhood Initiative), MPS (Making
Pregnancy Safer), LSS (Life Saving Skills), IMNCH (Integrated Maternal,
Newborn and Child health) and MSS (Midwife Service Scheme). Others are:
EOC (Essential Obstetric Care), EMOC (Emergency Obstetric Care), IMCI
(Integrated Management of Childhood Illness) and MDGs (Millennium
Development goals). Huge funds have been directed to execute these
programmes which are so many that even those who coined them can be
forgiven if they forget their meanings.
Give the data of maternal and infant mortality rates in the country?
Published maternal mortality rates in the country have been
particularly diverse and sometimes contradictory depending on their
sources. For instance, it was 800/100, 00 based on the Federal Ministry
of Health (FMOH) 2000 survey; the figure was high as 3,000/100,000
according to Society of Gynaecologists and Obstetricians of Nigeria
(SOGON) 2004, while the National Demographics Health Survey (NDHS) 2008
gave the figure as 545/100,000. The Lagos State Survey 2010 showed
555/100,000 at the state level; in Alimosho LGA- 826/100,000 and Ibeju-
Lekki LGA- 758/100,000. The Lagos State Survey 2010 further showed the following figures:
Ikorodu – 754/100,000; Ikeja -354/100,000; Surulere- 332/100,000;
Lagos Island- 310/100,000 and Lagos Island- 310/100,000. According to
another statistics: “Woman’s chance of dying from pregnancy and
childbirth in Nigeria is one in 13 compared to one in 1750 (developed
countries), one in 870 (East Asia), one in 90 (Latin America), one in 24
(Africa).” There is also a wide disparity in the burden of maternal
death across the country: for instance, the north-eastern zone of the
country having almost ten times the number of deaths that occur in the
south-western zone.
How can the problem of maternal and infant mortality be addressed?
The second out of Prof M. Fathalla’s 10 propositions for safe
motherhood for all women is recommendable in addressing the issue. It
stated that “maternity is special and society has an obligation to make
it safe. It further said; “pregnancy is not a disease. It is the means
for the survival of our species. All women have a basic human right to
be cared for and protected when they undertake the risky journey of
pregnancy and childbirth, and society has an obligation to fulfil this.
Safe motherhood is a human rights issue for which countries should be
held accountable.”
Identify major causes of maternal mortality in the country?
The major causes are haemorrhage, infection, hypertensive disorders
of pregnancy, obstructed labour and anaemia. It is important to state
that utilising available know how as at today will render most of the
deaths preventable. Maternal death is however is a consequence of three
levels of delay , including: Delay in seeking health care, delay in
accessing health care and delay in receiving help at the health
centre. Any effort to drastically reduce maternal mortality rates must
address the root causes of these delays.
Discuss infant mortality?
The World Health Organisation (WHO) published 10 facts on child
health which include; “A child’s risk of dying is highest in the first
month of life. Three million children die every year within a month of
their birth Pneumonia is the largest single cause of death in children
under five years of age. The WHO report further stated; “diarrhoeal
diseases are a leading cause of sickness and death among children in
developing countries Every 45 seconds a child dies from malaria in
Africa. “Over 90 per cent of children with HIV are infected through
mother-to-child transmission. About 20 million children worldwide suffer
from severe acute malnutrition. Three-quarters of child deaths occur in
Africa and South-East Asia, the report said. Two-thirds of child deaths
can be prevented through increased investment, according to WHO. In
this regard, the Lagos State Government established the maternal and
child mortality reduction programme, to address the situation.
Assess maternal and child mortality reduction programme in Lagos state?
The Lagos State Maternal and Child Mortality Reduction Programme
Advisory Committee was established by the Ministry of Health in year
2008 to map out strategies and activities for the reduction of the
unacceptably high maternal and child mortality rate in the state. It is
made up of relevant stakeholders drawn from Society of Gynaecologists
and Obstetricians of Nigeria (SOGON), Paediatrics Association of
Nigeria, Lagos State University Teaching Hospital (LASUTH), Association
of Private Medical Practitioners of Nigeria (AGPMPN), Lagos State Board
of Traditional Medicine Board (LSTMB), Lagos State Primary Health Care
Board (co-opted after board inauguration in February 2009), Local
Government Service Commission, Ministry of Local Government and
Chieftaincy Affairs, Ministry of Women Affairs and Poverty Alleviation
and officials in the Ministry of Health. The committee developed a five
year work-plan for the implementation of activities aimed at
accelerating attainment of the Millennium Development Goals 4 and 5. The
work-plan was designed to improve the health seeking behaviour of women
and children and also improve the quality of health services rendered.
The work-plan was marked with the launch of the maternal and child
mortality reduction programme, by Governor Babatunde Raji Fashola on
Thursday October 18, 2012. This date was named the Maternal and Child
Mortality Reduction Programme Day by the Governor, during which the
state and respective LGAs/LCDAs gives report of all programmes aimed at
improving the health of mothers, pregnant women and children. The
District Town Hall meetings are designed to ensure that key messages get
to the grass roots where the maternal and child health interventions
are needed most. A major focus is public enlightenment/sensitization and
community mobilization. In this regard, series of town hall meetings
are being planned on a Senatorial District basis. The first town hall
meeting took place in Lagos west 1 Senatorial District on March 21, 2013
at Oshodi-Isolo LGA. LGAs/LCDA within the District include Mushin,
Alimosho, Ifako-Ijaiye, Ikeja and Oshodi-Isolo) and the corresponding
LCDAs.
This story was published in Daily Newswatch on May 23, 2013.
