Hussein (not real name) was born preterm at 27 weeks, weighing about half a kilogram (0.5kg). Hussein's mother did not get to see her son until 12 hours after his birth, and when she did, he was covered in tubes, fighting for his life in a neonatal intensive care unit (NICU) with the help of an incubator and ventilator to support his fragile lungs. Hussein, spent a few more weeks in the neonatal unit and slowly gained weight and he was able to breathe independently. Hussein has just celebrated his first birthday.
This was not the case for Tola, who lost her premature baby in a small village in Nigeria. Tola's baby was not as fortunate and did not have access to neonatal care with the incubators and ventilators, as well as the trained neonatal health care professionals who were able to provide the specialised care for such fragile patients.
Each year in Nigeria over seven million babies are born; 240,000 of these babies die in their first month of life with 94,000 dying on the day of birth. In addition, there are nearly 314,000 stillbirths, Nigeria should not be witnessing such daunting statistics. The world has witnessed remarkable improvements in maternal and child survival since 1990. Although Nigeria has developed the Nigeria Every Newborn Action Plan to end preventable newborn deaths, not enough progress has been made in reducing neonatal mortality rate.
Major causes of neonatal deaths in Nigeria
Experts passionate about achieving optimal quality of care for newborn health in Nigeria gathered in Birnin Kebbi, Kebbi State between the 25th -29th June 2018 for the 11th Annual General Meeting & Scientific Conference of the Nigerian Society of Neonatal Medicine (NISONM) , with the theme "Achieving Optimal Quality of Care For Newborn Health In Nigeria: The Current State". The week began with pre-conference workshops which included the training of Community Health Extension Workers (CHEWs) and nurses on different aspects of newborn care including neonatal ventilation. During the conference, Her Excellency, Dr. Zainab Bagudu, wife of the Governor of Kebbi State and Chief Host explained that infections including sepsis, pneumonia, and tetanus, are among the major causes of neonatal deaths in Nigeria. "The reason why our premature babies are so susceptible to death is because they are knocked down by infectious diseases," she said.
Most of these neonatal deaths could be averted through simple preventive measures, such as improving hygiene and ensuring that proper care is available to the premature babies. Unfortunately, Nigeria currently has no cadre of healthcare workers specifically trained and certified for Infection Prevention and Control (IPC). Other causes of neonatal deaths in Nigeria include prematurity and complications during birth. Preterm birth complications are the leading cause of death for children under 5, causing an estimated 1 million deaths in 2015 globally.
How can Nigeria catch up with the rest of the world?
As the rest of the world works towards achieving the Sustainable Development Goals (SDGs), it has become increasingly clear that Nigeria must accelerate efforts to improve outcomes for its newborn babies. We must strengthen all healthcare facilities in Nigeria to provide quality care for newborn babies. According to the World Health Organization (WHO), primary health care (PHC) can meet 80-90% of an individual's health needs over the course of their life. It is therefore important that all primary health centres in Nigeria have the capacity to provide every mother and baby with the necessary drugs and equipment needed for a healthy start in life. All PHCs should have functional newborn baby care/resuscitation corners in delivery rooms. Prof. Chinyere Ezeaka, President of NISONM said at the conference, "There is a need for every PHC in Nigeria to have a 'bag and mask' to give air to newborns, shaking them is not the way to go".
In addition, equitable distribution of skilled health workers including midwives and nurses should be prioritised. Dr. Bose Adeniran, Head of Child Health at the Ministry of Health, however, discussed the steps that the government is taking towards filling the human resource gap. "We developed a National Task Shifting and Task Sharing Policy to increase the functions of midwives and CHEWs at the health facilities and community levels, including the provision of essential care for newborns," she said.
Giving birth should be a thing of joy and Nigerian mothers should not be left out of this experience. We cannot afford to be left behind. We cannot fail our newborns. We must ensure a Nigeria with the preventable deaths of newborns and stillbirths, where babies survive, thrive, and reach their full potential.
"The first quarter of an hour after birth is the most dangerous period of life; its mortality is as great as that of any subsequent month," Dr. Kalu Ogbureke, Consultant and Paediatric in Neonatal Medicine, said.
We in Nigeria should do all that is possible to make that first hour after birth, and in fact the first 1000 days, safer for all newborns across the country.