•Experts give tips on reducing maternal, child mortality rate
Generally, pregnancy and childbirth come with some measure of risks. For some women, however, especially in certain parts of the world, the risks are much higher. In fact, for such women, going through the pregnancy and child birth experience is like a mine-field filled process that can unfortunately result in death from pregnancy and delivery-related complications.
Indeed, figures from the United Nations Children’s Educational Fund (UNICEF) on Nigeria indicate that over a hundred women and children die on a daily basis from pregnancy-related complications, malnutrition and other reasons. This makes the country the second largest contributor to the under–five and maternal mortality rate in the world with India taking the first position. To corroborate this are World Bank figures for Nigeria which place the maternal mortality rate (MMR) at 630 deaths per 100,000 live births and the infant mortality rate (IMR) at 74.09 deaths per 1000 live births (2014).
To medical experts, the sad thing about this unacceptably high maternal and child mortality rate is that it is preventable. “Basically, most of these deaths can be prevented with proper medical care and other essential interventions that can reach women and babies on time,” stated Dr Max Ogwah, an obstetrician in Lagos.
He blamed the high MMR on various factors such as lack of proper prenatal medical care, inadequate health facilities, properly trained health care personnel among others. “For instance, very few health facilities in the country have emergency obstetrics care facilities in case of difficult deliveries. Besides, very few deliveries in our health centres are attended by trained personnel like midwives. This is worse in many rural areas where deliveries are done usually at home by ill- trained local birth attendants using unsterilised equipment and tools in unhygienic environments. All these add to the MMR and IMR death burden,” he noted.
Corroborating this, Dr. Ngozi Nnadozie-Kalu, a medical practitioner noted: “About 69 percent of women still give birth in a traditional setting especially at home. Only 30 percent of people in the rural areas have access to health care within four km distance. The same issue is applicable to people in the urban setting where attendants of these births out of hospital settings are unskilled or ill-trained.”
Malnutrition caused by poverty contributes as well to the problem, said Dr Dan Gadzama of the Primary Health Care Development Board, Federal Capital Territory, Abuja. “Lack of money may not allow pregnant women access food or drugs,” he said.
Adding to these factors are others including socioeconomic, weak health care system and inadequate infrastructure. Recently, at the inaugural meeting of the technical committee on Maternal, Newborn and Child Health held in Bauchi, Dr Halima Abdu, the representative of UNICEF in Bauchi attributed pregnancy related deaths to delay in going to health centres, lack of good roads and transportation and inadequate number of health centres. She added that child deaths are caused by under nutrition, malaria, neonatal care, measles among others, stating that Nigeria contributes ten percent of global maternal, newborn and child deaths. Painting a grim picture of the situation, she stated: “Each hour in Nigeria, a plane load of pregnant women, newborn and children die.”
Mena Okoro, a clearing agent’s wife is among this grim harvest of death. His wife of seven years, Clara, 34, died a few days to Christmas last year while in labour. Worse, the baby died in the womb during the prolonged labour. Today, Mena is still in mourning for the lose of not just his wife but baby girl. He believes incompetence on the part of the hospital personnel caused his wife’s death. “My wife was in labour for over 20 hours. At a point, she grew very weak and could not push anymore. They should have done a CS (ceasarean section) but the doctor insisted she could deliver normally. They tried forcing the baby out; what kind of medical doctor does that? My wife lost so much blood!” he lamented. Left with two young children aged five and two, a worried Mena wonders what the future holds for his young family with no mother to provide the maternal care and love they need.
‘Babies’ having babies
One major contributor to the maternal death burden in the country, according to medical experts is the issue of ‘child brides’ or early marriages particularly in the Northern part of Nigeria. In such scenarios, young girls ranging in age from 8 to early teens are given out in marriage to much older men some as old as their fathers or even grandfathers. “In many countries, especially where child marriage is prevalent, the lack of primary education and lack of access to healthcare as well as physiological factors contribute significantly to child and maternal mortality statistics,” said Nnadozie-Kalu. She added that early marriages account for about 23% of maternal mortality due to severe hemorrhage resulting from obstructed and prolonged labor. “The narrow pelvis of these young girls, which are not fully developed at their ages, may also result to fistula and often time still births,” she pointed out.
Indeed, a research paper by a group of university dons namely Olujimi Olusegun, Rosemary Thomas and Ikorok Michael and published in the International Journal of Nursing and Midwifery (2012) identified factors such as severe maternal bleeding, infections, unsafe abortions, hypertensive disorders of pregnancy especially eclampsia as major contributors to MMR.
The paper titled ‘Curbing maternal and child mortality: the Nigerian experience’ noted that hemorrhage, sepsis, toxemia and complications from abortion account for 62 percent of maternal deaths in Nigeria. It also states that, in Nigeria the North West part of the country has the highest maternal mortality rate followed by the North-East. ‘Post partum hemorrhage (PPH) ranges between 23 and 44 percent of total maternal deaths especially in the Northern States. The ratio of women dying from PPH is 1 in 6 in the North East and North West as against 1 in 18 between South West and South East geopolitical zones. Unsafe abortions account for at least 13% of all maternal deaths. If people are not aware of good contraceptive methods, there will be a lot of unwanted pregnancies among the young age group. These most often resort to unsafe abortions with its resultant infections, hemorrhage and injuries to the cervix and uterus,” the paper noted.
Motherhood without tears
Considering the pivotal role women play in the lives and wellbeing of their families, keeping them alive and well is of crucial importance, health experts point out. They note that deaths of infants and children under five are closely linked to maternal health since babies who have lost their mothers have lower chances of survival. It is with that in mind that medical experts and other stakeholders advise major interventionist programmes to drastically reduce the maternal and child death burden.
As Ogwah posited: “These rates are too high and unacceptable. We cannot afford to continue losing our women and babies to deaths that are preventable. Our women cannot be dying while giving birth to newborns. With this high rate, Nigeria is lagging behind the rest of the world in maternal and child health intervention and will not likely meet the target of the Millenium Development Goals (MDGs) four and five. There’s an urgent need therefore to put the right measures in place to reduce the rate.”
Such measures, health experts believe should include free medical treatment for pregnant women and children under the age of five, care during pregnancy, birth and post partum supports, proper nutrition during and post pregnancy and family planning to cut down on family size and proper spacing which gives enough time for the mother to fully recover and the young baby to grow and become strong before another pregnancy. Others are community participation in integrated health care services to ensure holistic primary health care, a comprehensive health insurance scheme to cover a large proportion of the populace, prevention of mother to child transmission (PMCT) of HIV and management of childhood illnesses and the use of misoprostol, a proven uterotonic, in the control of post partum hemorrhage (PPH) which accounts for an estimated 25 percent of maternal mortality and is a major cause of post partum disability in sub-Sahara Africa.
To Gadzama, government should play a major role in reducing the high rate of maternal mortality rate in the country. “It is actually their primary responsibility. The government is supposed to provide for its citizenry by ensuring good policies that will empower women and the provision of affordable health facilities for maternity hospitals and other health care centres,” he said.
Experts advise a wholistic approach to curbing infant and child mortality. “Survival intervention for children should begin from conception, that is from the womb,” said Dr Ogwah, adding: “Pregnant women should be encouraged to eat nutritious food that contain the essential nutrients that the growing baby and the mother need. They should eat plenty of proteins like beans, meat, eggs and poultry. Also plenty of fruits and vegetables. After delivery, care is equally important for the health of the mother and baby. This should be provided by a competent healthcare provider with the necessary equipment, drugs and other essential supplies.”
Other intervention strategies include breast feeding, immunization (immunising children against vaccines-preventable diseases before the first year of life is life saving), vaccination against tetanus, polio and other life threatening diseases, improvement in public health services (which are essential including safe water and better sanitation that can reduce childhood infections and diarrhea), mosquito prevention and treatment through the use of insecticide treated nets (ITNs) and anti-malarial drugs among others.
