Imam Imam
4 November 2008
opinion
The problem of maternal mortality has, over the years, been a source of serious concern to health practitioners in sub-Saharan Africa. The problem reached a gargantuan proportion in the last four to five years, with number of women dying at child birth quadrupling from figures available 10 years ago.
Nigeria happens to be second only to India in the worst rating provided by the World Health Organisation and other development partners, and realising the precarious situation pregnant women are in the country, the Federal Government aligned with the Millennium Development Goals 4 and 5, which set a target of reducing the number of deaths occurring at birth to about 100 deaths per 100,000 live births.
In an effort to realise the target, the Society for Family Health (SFH), a leading non-governmental organisation, which specialises in health related matters, recently launched what it termed as the 'most ambitious' nationwide child spacing and prevention of excessive bleeding that occurs after birth, otherwise known as Post Partum Haemorrhage (PPH). The project is implemented by the SFH and its partner, Population Services International (PSI), in conjunction with Federal Ministry of Health.
The project's aim, according to Dr. Hajo Sani, SFH's general manager, corporate communications and marketing, is to expand access, availability and safer child spacing practices with special emphasis on the use of longer term methods as well as the prevention and management of excessive bleeding after child birth. She said Nigeria is one of the 14 countries selected world wide, with the remaining 13 countries spread across Asia, Latin America and Africa.
She said they are particularly concerned about maternal mortality because recent evidence has confirmed that lack of child spacing practices and incidences of PPH are jointly responsible for about half of all maternal deaths in most developing countries. "The sad thing is that PPH is not a disease, but a condition which is preventable and can be managed with adequate training of both medical and paramedical personnel, and providing access to information and drugs."
Mr. Chris Enenche, deputy general manager, family planning at SFH, said the project will integrate and leverage on the resources and interventions of already existing SFH projects. He said in the first six months, the project will start with some focal states selected based on the situation analysis (SA) findings and un-met needs for child spacing.
It will later scale-up to the remaining states in the country including FCT. It will also target both rural and urban populations, while public, private and faith based health facilities will be involved in the project. According to him, by the end of the project, about 265,000 units of Intra Uterine Contraceptive Devices will be inserted to vulnerable women, while at the same time, 70,000 implants would also be inserted. In the same vein, about two million Misoprostol tablets are expected to provided, which will in turn improve the Health Seeking Behaviour of Women.
While delivering a paper on the situation analysis on the project compiled by four others, Dr. Clara Ejembi of Department of Community Health at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria said the issue of maternal mortality has become a burden which Nigeria must address. She said the country contributes 10 per cent to the global burden of maternal mortality and has the second highest number of maternal deaths globally. She argued that birth spacing saves lives and research has shown that healthy timing and spacing of pregnancy has positive effects on maternal health and newborn outcomes. It has also proven that women who have their babies at 27 to 32 month intervals are more likely to avoid anaemia, more likely to avoid third trimester bleeding and more likely to survive childbirth. She however argued that unfortunately, use of Family Planning is very low in Nigeria.
She said she and her colleagues undertook the research on maternal mortality in order to assess the perceived burden of PPH as seen in health facilities, to determine the places of delivery of women, to determine how PPH is managed, to determine the knowledge and use of Misoprostol in the management of PPH, to determine the availability and cost of Misoprostol, to determine the level of coverage of IUD, and implants in the country, to appraise health workers knowledge of IUD and implants and finally to assess the availability, use and cost of IUD/ implants in the country.
Clara said their findings have shown that there are limited availability, access and quality of services at mostly primary health care centres in areas surveyed in the six geo-political zones of the country. The findings show that less than half of PHC facilities in Nigeria provide delivery services, while less than a fifth of health facilities provide EOC-4.2 per cent of public health facilities-and only 3.9 per cent provide EOC, it also showed that basic equipment are lacking, there are dearth of skilled attendants while drug stocks are out of norm.
In terms of where women give birth in Nigeria, the findings show that only 37 per cent of women use health facilities to give birth, while 58 per cent of Nigerian women give birth at home. It also issued an alarming and increasing use of churches and prayer houses in the South-South and the South-East as places where women deliver babies. This, according to Dr. Clara, affects access to uterotonics. And in terms of prevention and management of PPH, it was discovered that there are dearth of skilled attendants for provision of RH, while only 6.1 per cent of PHCs have at least four midwives for 24-hour delivery service provision. Similarly, 56% of PHCs have no midwives and a further 17 per cent have no CHO/CHEWs. Only 27.3 per cent of health workers interviewed had some form of training for the management of PPH, while only doctors, nurses, midwives were trained to deliver babies safely. In reality however, traditional birth delivery are widely used, to the detriment of the health of the mother and the child.
In Dr. Clara's estimates, the ability to tame the high number of mortality rate in the country is available, considering the fact that there are the environment supports the present strategy especially since there is national commitment towards attainment of MDG goal five. Also, there is commitment to increasing access to maternal health through free provision of drugs and delivery services as well as existence of large number of heath facilities and workers in Nigeria. There is also wide network of private sector distribution outlets, while a variety of drugs already registered and on the essential drug list for the treatment of PPH.
Already, Misoprostol has already been registered for the treatment of PPH in the country, while guidelines for use of the drug have already been developed. In the same vein, the drug is being manufactured locally, and is available in pharmacies and other sale outlets all over the country.
However, to achieve rapid success for the project, Dr. Clara calls for serious advocacy in all the nooks and crannies of the country, improve capacity building for health service providers, expand categories of providers of service, development of sustainable commodity supply system, evolve affordable strategies so as to expand access, demand creation from communities most in need and the strengthening of the health Management Information Systems (MIS).
Giving an insight into the efforts made by the Zamfara State Government to tackle the problem, Alhaji Ibrahim Abu Maru, the Director of Nursing Services at the state Ministry of Health said considering the fact that many rural dwellers fear the need to spend huge resources in taking care of pregnant women, the state government, last year introduced a free medical care for women and children in all its hospitals.
He said additional health care centres are being provided in all parts of the state, while a comprehensive health policy has been introduced with a view to making the state's policy a model in the country. He however appealed to the Nursing and Midwifery Council of Nigeria to remove the cap placed on the in-take of students allowed into schools of nursing and midwifery in the country from the present 50. He said by so doing, the various schools will be able to admit more students and in turn increase the number of professionals in the field.
Be the first to Write a Comment!
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
