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Maternal deaths: Reversing a prediction

…World Bank report jolts Nigerians as mothers relieve pains …Medical doctors, other stakeholders chart way forward “There were no signs that the morning of May 31, 2018 would be different until I started feeling the pangs, requiring medical assistance,” said Naomi Muyadeen. “Initially, I dreaded going to the government facility but stepping into the health facility, I immediately noticed the change.” A resident of Kuchingoro, a satellite town in the Federal Capital Territory, Mrs. Muyadeen is a 23-year-old mother of one and nine months pregnant. She has had previous antenatal visits to the Primary Healthcare Centre (PHC) in Kuchingoro. Mrs. Muyadeen’s initial fear was informed by the demise of her elder sister while giving birth in a similar setting. According to her, members of her family were shocked as they held the widespread belief that one cannot die while giving birth in a hospital. “My sister was consistent with her antenatal sessions and did everything a pregnant woman should do, yet she bled to death,” Mrs. Muyiwadeen lamented. The head of nursing unit at Kuchigoro PHC, Mrs. Esther Adepoju stated there are several causes of maternal mortality. “A woman can die while giving birth due to poor hygiene on the woman’s part, negligence by nurses and doctors, lack of consistency in attending antenatal sessions, and even fear can cause death during childbirth”, she said. A joint report (Trends in Maternal Mortality: 1990 to 2015 by WHO, UNICEF, World Bank and United Nations Population Fund) had estimated that Nigeria has approximately 58,000 maternal deaths, accounting for 19% globally. Put differently, at least 800 women die in every 100,000 live births. Northeast has the highest maternal mortality rate, compared to other regions, with 1,549 deaths per 100,000 live births. To address the high maternal mortality rates, Minister of Health, Professor Isaac Adewole, in July 2017 inaugurated a 34-member Task Force to accelerate reduction of maternal mortality in Nigeria. “Maternal mortality remains unacceptably high in Nigeria, ranking among the highest in the world and the rate of reducing these deaths has been slow as many of the contributory factors remain unaddressed. The Federal Ministry of Health is committed to bringing it to an end,” Professor Adewole said while inaugurating the Task Force. The World Bank of 29, November 2018 had revealed that Nigeria will take overtake India as the world capital for deaths of children under the age of five by 2021. The bank’s report was based on the fact that India, with a population of 1.3 billion recorded 989,000 under-five deaths in 2017, while Nigeria, with 196 million citizens, recorded 714,000 deaths in the same year. In its bi-annual economic update on Nigeria, the World Bank said Nigeria records the highest number of child malaria deaths anywhere in the world, adding that Nigeria had the highest number of out-of-school children anywhere in the world, and that 90 percent of these children are from northern Nigeria. According to the Bank, “Nigeria’s weak revenue mobilisation has major implications for its growth and development including improving its dire social service delivery outcomes. “Poverty remains high in Nigeria and access to basic social services is not universal. In 2016, the World Bank estimated poverty at 38.8 percent of the population using the national poverty line. “By international poverty line of PPP-corrected $1.90 per capita per day, an estimated 49.2 percent of the population lived below poverty in 2017. “With nine million children out of school, Nigeria has the highest number of out-of-school children of primary school age in the world: North takes over 90 percent of this figure.” Meanwhile, some health experts have blamed the development to decay infrastructural facilities in the country. According to them, until government at all levels give more priority to the health system, it will be difficult to stem the tide. Speaking with The Daily Times, an Abuja based Paediatric Surgeon, Dr. Ike Nwachukwu, said: ‘’Nigerian health system as a whole has been plagued by problems of service quality, including unfriendly staff attitudes to patients, inadequate skills, decaying infrastructures, chronic shortages of essential drugs and the well-known “out-of-stock: syndrome. ‘’Tracking changes in maternal mortality in developing countries such as Nigeria can be difficult, because the data are unreliable. Vital registration systems in rural areas of most developing countries are deficient and surveys produce estimates with wide margins of uncertainty. ‘’Nevertheless, strategies need to be more appropriately focused. This will enable pregnant women in whom complications develop have access to the medical interventions of emergency obstetrical care’’, he added. Also, Dr. Iyabo Dapo of Maitama General Hospital, Abuja said that functioning health-care system, interventions at the community level, such as the use of misoprostol to strengthen contractions will help expel the placenta and control bleeding before transfer to a health care facility could contribute to significant reduction in maternal mortality. ‘’Programmes that are likely to make such care more widely available involve upgrading rural health centres and referral hospitals and stocking them with the necessary drug supplies and equipment, such as magnesium sulphate for eclampsia, antibiotics for infection and basic surgical equipment for cesarean sections. ‘’Coupled with this is the need to train cadres of health workers and develop strong referral systems between communities and health care facilities, since delays in care can be life threatening. A referral system includes means of communication and transport as well as mechanisms for ensuring that referral facilities are able to provide services at all hours. ‘’The effective functioning of any facility will depend on whether pregnant women have skilled attendants at delivery–an accredited health care professional (e.g. a doctor, midwife or nurse) who can conduct normal deliveries, identify and manage complications, and refer women to the next level of care, ‘’ he added. In Nigeria, World Health Organization (WHO) and other partners are supporting government to develop and adapt various guidelines and policies on reproductive, maternal, new-born and child health. Records indicate that between 2000 and 2015, the maternal mortality rate in Nigeria reduced from 1,170 deaths to 814 deaths per 100,000 live births (30.4% decreases). Additionally, WHO with support from Bill & Melinda Gates Foundation is providing technical support for implementation of the initiative in Federal Capital Territory, Sokoto and Kebbi states as well as supporting the Federal Government through the Quality, Equity and Dignity (QED) network for coordination and monitoring implementation in Nigeria. There is also in the pipeline, a maternal and newborn Quality of Care (QOC) initiative to be supported by partners (led by WHO & UNICEF) which will focus on instituting quality improvement in selected health facilities towards ensuring positive pregnancy and birth experience for women. According to Dr. Wondimagegnehu Alemu, WHO Country Representative to Nigeria, QOC interventions will improve the capacity of health workers to provide efficient, evidence-based interventions to pregnant women. “In order to effectively reduce maternal mortality rates in Nigeria, it is imperative that government, working with other stakeholders, including community and traditional leaders at all levels; ensure provision of affordable quality maternal and new born services to the people wherever they live at a cost that will not impoverish them while accessing the services,” Dr. Alemu noted. Doosuur Iwambe, Abuja

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