Infant mortality is still a threat in most states across the country even though some state governments have woken up to challenge the scourge as ELEOJO IDACHABA reports.
The majority of Nigerian children are at risk of dying a few months after birth, according to reports. The number of the lucky ones that survive to formative years is rather less compared to the number of fatalities especially in many states in the North. This is due to many reasons, according to UNICEF and other stakeholders.
Frightening statistics
According to Human Resources for Health, a health awareness publication, about 99% of newborns and child deaths occur within developing countries. Nigeria which is the most populous country within sub-Saharan Africa similarly has a very high and poor newborn/child mortality rate.
“Nigeria has a mortality rate (MMR) of 576 deaths per 100,000 live births and estimates indicate that infant mortality is largely responsible for about a third of all infants.
“The situation is much worse within the northern parts of the country where the pandemic is estimated to be over 1,000 deaths per 100, 000 live births. In other indices, Nigeria’s infant mortality and under-five mortality rates are estimated at 69 deaths per 1,000 live births and 128 deaths per 1, 000 live births, respectively. “Newborn and child health indices in Nigeria are typically worse within rural areas. For example, rural communities in Nigeria account for high newborn mortality rates in the country. Thus, there is a need for innovative models of service delivery, possibly with greater community engagement,” the report indicated.
The report stated further that the introduction and strengthening of community midwifery practice within the Nigerian primary health care would serve as a clear policy option.
“The potential of community midwifery to increase the availability of skilled care during pregnancy, at birth and within postpartum periods in the health systems of developing countries has not been fully explored.”
On its part, UNICEF in 2019 released a document that showed that malnutrition was the direct or underlying cause for 45 per cent of all deaths of under-five children in the world, especially in Nigeria.
The studies put Nigeria’s prevalence rate of stunted growth at 32 per cent of children under the age of five. The report further showed that two million Nigerian children suffer from severe acute malnutrition (SAM), while two out of every 10 malnourished children receive treatment. This, according to the report, accounts for the rate of infant mortality in the country.
Writing on Reducing Early Neonatal Mortality in Nigeria: A solution, health researchers, Amadi and Kawuwa, respectively, said the Nigeria neonatal record is among the worst in the world. According to the duo, “There is no evidence to suggest that more neonates are surviving in Nigeria today as compared to 10 years ago, even with the very celebrated millennium development goal (MDGs) campaign. Presently, neonatal contribution to mortality rate below five years of age in Nigeria has risen in the last 10 years from 40 to nearly 50 per cent despite the huge expenditure of MDGs in Nigeria on importation of ideas and systems. The big questions before anyone who might attempt to solve the high neonatal mortality in Nigeria are numerous considering the huge Investment in that regard.”
They noted that in 2016, an estimated average of 248 neonates out of 1,000 presenting at special care baby units (SCBUs) in Nigeria died of various causes during their first one week of life on earth.
Also, Charles Okwuwa and Simeon Adejo, two community health experts, on their part, noted that globally, infant mortality has not decreased since 2015. Making reference to a World Health Organisation (WHO) publication in 2016, developing countries continue to face challenges in meeting their health needs and in achieving the Millennium Development Goals.
“Infant mortality has become more prevalent due to lack of access to health care before, during and after delivery. This contributes to high infant mortality rates both in developing and under-developed countries. Every day, Nigeria loses about 2,300 under-five year olds and 145 women of child-bearing age due to childbirth, making the country the second largest contributor to under-five and maternal mortality rate in the world. Many lives can be saved if global inequalities are reduced.
“Today, 89,700, day-old babies die in Nigeria yearly. Nigeria has the 12th highest rate of first day deaths in the world, making it one of the riskiest places to be born. Nigeria is one of the 10 countries with highest infant mortality rates in Africa and ranked 152nd out of 176 countries and among the 10 worst countries to be a pregnant woman or a child, according to Save the Children International in 2016.”
It noted further that, “Infant mortality rate symbolises a measure of a country’s health policy, systems and practices, an aspect of its national development. It is often associated with socio-economic factors of unemployment, poverty, income disparity, among others, in a polity.
“Infant and maternal challenges should be contextualized in overall national development policies and practices. High rates of infant and maternal mortality express low social integration of children and women. It symbolises low female gender participation and inclusion in socio-economic processes. Nigerian women generally lack the power to determine child spacing, access and choice of modern healthcare, among others. This is a denial of women human rights, and remotely, children’s survival rights and a backward step towards high birth and death rates.”
The Jigawa initiative
The Jigawa state Food and Nutrition Policy document indicated that the stunting prevalence among children under-five in age is 63.4 per cent, the highest in the whole country and by extension in the entire North-west zone. The reports indicated further that the state moved higher from 63.4 per cent to 68 per cent in child mortality brought about by malnutrition. Because of this, many children in the state are said to be suffering from stunted growth and underweight, a development that has placed many of them below their peers in other states.
“These frightening indices showed the steady increase from 53.4% in 2008 to 63.4 per cent in 2015 which is an over- increase of 10 per cent.”
Moves to check the trend
It is for this reason that concerted efforts are being made towards addressing the situation in many parts of Nigeria. For instance, some public hospitals in Kwara state, according to reports, have devised a means to help in the fight against high incidences of malnutrition and mortality of infants. The Civil Service Hospital located in Ilorin is one of the hospitals that adopted food demonstrations for nursing mothers in order to check cases of malnourished children and death.
Mrs. Margret Olayinka who heads a section that spearheads the food demonstration activities for nursing mothers said the programme was introduced following the discovery of cases of malnourished children among infants who came for immunisation.
She said, “There is something we call growth monitoring that we carry out for a child from birth until he or she is fully immunised to avoid premature death. From growth monitoring like checking weight and arm circumference, we discovered children that are underweight for their age.
“When we interviewed their mothers, especially children of six months and above on what they feed their children with, some would say breast milk, while others could not give satisfactory answers. From this, we decided to introduce what we called fortified pap to them. Fortified pap is a semi-solid food they can give to the children once they reach the age of six months in order to guide against malnutrition.”
Olayinka also said the effort had been very fruitful as no case of malnourished child was reported since the introduction of the demonstration.
“This is because what we taught them to be doing amounted to a balanced diet. All the nutrients that a child needs are found in the foods we asked them to prepare.
Speaking in the same vein, Mrs. Chinwe Ezeife, a nutrition specialist at the Kaduna Field Office of UNICEF, commended the health workers for their commitment in the fight against malnutrition.
“I am happy that they are integrating nutrition services as part of their routine. The food demonstration services would give practical skills to pregnant and nursing women on how to prepare complementary foods which they have to introduce to children of six months and above in order to avoid stunted growth and fatalities.
“The counselling on maternal nutrition would build their skills and enhance their capabilities for optimal infants and young child feeding practices,” she said.
She said policy makers must know that nutrition is not just a health intervention, but a human capital development that requires attention.
In Jigawa, for instance, a non-governmental organisation, Action Against Hunger (ACF), a United Kingdom-funded programme, has made everything possible to control the menace of malnutrition among children of under five years in the state.
The three focal local government areas of Buji, Gagarawa and Guri earlier taken as pilots to test the programme were successful and made meaningful outcomes.
To this end, the programme manager of ACF, Stella Esedunme, said the reason responsible for stunting children in the state is due to poor feeding practices, food quality and poor hygiene which is being addressed through a concerted effort of all stakeholders.
In Gombe state, Governor Inuwa Yahaya, who was recently named Nutrition Champion for the Nigerian Child by the International Society of Media in Public Health (ISMPH), gave the assurance that his administration would spare no effort at ensuring that children in the state do not suffer the needless health challenges associated with malnutrition.
The governor added that having gone into partnership with the United Nations International Children’s Emergency Fund (UNICEF) for the provision of the Ready-to-Use Therapeutic Food (RUTF), his administration would continue to ensure the timely payment of counterpart funding.
The governor who recently unveiled 30, 000 cartons of complementary feeding that was locally produced by the government for management of malnourished children said his desire and passion to see children grow to their full potentials predated his administration.
He said, “We have a lot of food products that we produce locally, but somehow somewhere, the state failed to utilise them properly for the benefit of the children; so when I became the governor, I realised that we are still so backward on the issue and I took it upon myself to relate with development partners and agencies to achieve the objective of giving proper nutrition and healthcare services to our children and others.”
As it is, in the opinion of Amadi and Kawuwa, Nigerian scientists seem far too busy with other things than to accept the blame.
“They should put on their thinking caps and synthesise an affordable and sustainable home-grown solution to save their neonates. The over-dependence on unsustainable importation of foreign technologies and ideas have left the Nigerian health care professionals so scientifically lazy that neonates are still far away from their hope for survival. It was expected that the high publicity and available funds during the last 10 years of the millennium development goals (MDG) would have empowered a great success.
“Since this was an unfortunate failure for the neonatal sector at the national level, Nigeria can restore hopes by a humble study of what constitutes the pockets of successes recorded by some few centres that adopted unconventional techniques.”
