Currently, Nigeria ranks third in global preterm births with 774,100 preterm births annually and a high perinatal mortality rate.
Shakira Abubakar, a resident of Ogijo, a boundary community between Lagos and Ogun states, received the news of her pregnancy with joy, but that joy was nearly threatened when she entered labour prematurely, giving birth to her son at 27 weeks gestation.
"I was at the salon plaiting my hair during a visit to my mother at Yaba when I experienced a sharp pain in my stomach.
"From there, I was rushed to the hospital, where I was examined and told it was a contraction. I was shocked, scared and burst into tears, but my mother kept encouraging and praying for me.
"I gave birth to a baby boy weighing 1.2 grams. We were referred from the private hospital to Lagos University Teaching Hospital (LUTH) because the baby was premature and developed jaundice among other complications.
"The birth of a child is supposed to bring joy to the family, but in my case, the birth of my child has brought me pain and sorrow because we find it difficult to meet the expenses to keep him alive," Shakira said.
Ms Abubakar's baby is among the 13.4 million babies who are born too soon globally every year, with sub-Saharan Africa bearing a disproportionate, uneven, high burden of these births.
The journey of many mothers with a preterm baby, especially those who have their babies admitted to the neonatal intensive care unit (NICU) is harrowing due to uncertainties in survival, challenges accessing care, psychological distress and high economic burden on the family.
Premature infants may require months of round-the-clock care in a highly regulated NICU with specially trained staff during this vulnerable time.
Data from the World Health Organisation (WHO), further showed that about 1.1 million deaths occurred among these preterm neonates, mostly from a lack of equity in healthcare resources to provide the needed interventions.
Moreover, the health agency emphasised that complications relating to prematurity are now the leading cause of child death in low-income countries and settings.
Preterm birth is defined as any live birth that occurs before 37 weeks of pregnancy, the gestational age when key vital organs, including the brain, lungs, and circulatory system, have developed to maturity.
Currently, Nigeria ranks third in global preterm births with 774,100 preterm births annually and a high perinatal mortality rate.
Natasha Williams, a Nigerian-American who delivered a triplet preterm baby at a high-brow private hospital in Lagos, said the chances of survival of preterm babies depend largely on where they were born.
Narrating her experience, Mrs Williams said she suffered disappointment from several failed In vitro fertilisation (IVF) procedures before conceiving her triplets.
Unfortunately, she said one of her triplets died from infection days after birth, "leaving an ache in her heart." She called for concerted efforts to ensure quality care for all babies born early or small.
"Imagine, spending over N15 million on medical bills six years ago in one of Nigeria's leading private hospitals, yet one of my babies died.
"I was traumatised and determined to see my daughters live against all odds. I left the country a few months after our discharge from hospital, moved back to the U.S., and my kids are thriving," she said.
Sarah Ango, secretary of the Nigerian Society of Neonatal Medicine (NISONM), said every baby deserved the best chance at life. She emphasised collaborative efforts to improve care and support for babies born prematurely.
Ms Ango noted that preterm infants face significant challenges, making it imperative to have timely and equitable access to quality care. She said this is crucial to significantly improve their survival chances and long-term well-being.
"The mortality rate in preterm babies is higher than other babies. For parents to go through these harrowing experiences and still not go home with their babies is heartbreaking," Ms Ango said.
She said NISONM worked with stakeholders to educate healthcare professionals, provide essential medical equipment, and advocate for policies that prioritise maternal and newborn health.
Chinyere Ezeaka, a professor of Paediatrics, argued that the quality of care preterm babies access in Nigeria is subject to their parents' economic condition.
Ms Ezeaka, head of the Neonatology-Perinatology Unit at the Lagos University Teaching Hospital (LUTH), added that "there are expected expenditures that many new mothers prepare for, but it is hard to envisage cost for a preterm baby who has unique needs."
The professor emphasised that the cost of medical care for preterm babies was enormous and had gone beyond the reach of many Nigerian mothers and their babies.
She lamented that the situation had worsened to the point that more parents now abandon their preterm babies at the hospital.
"Many families are overwhelmed by the cost of medicare because access to quality care is integral to keeping these babies alive.
"That's why we neonates advocates in Nigeria are asking, what quality of care can these babies have when they have to pay for everything?
"The situation is getting worse as we see more parents abandoning their preterm babies of 28 weeks, 30 weeks with us at the hospital.
"In most of these situations, we have to call social welfare officers, or look for philanthropists, and sometimes we doctors contribute money among ourselves to buy antibiotics for these abandoned babies.
"Recently, a mother with a 30-week preterm baby presented at the hospital with her family. We requested a Biliirum test to know if the baby has jaundice; the test is about N1,000 to N1,500, but the mother said she doesn't have the money.
"How can these children get quality care in these situations?
"Whereas, in high-income countries, the medical expenses of these babies are borne by health insurance from birth," she said.
Ms Ezeaka, a former president of the Nigerian Society of Neonatal Medicine (NISONM), noted that medical cost and hospitalisation length for preterm largely depend on gestational age at birth and their comorbidities, stressing that care is individualised.
According to her, many preterm babies require access to medicine and equipment that gives support for respiratory, hydration, nutrition, drug delivery, warmth and jaundice management during their treatment.
"Surfactant is a substance that can help preterm babies with respiratory distress syndrome (RDS) by reducing surface tension in their lungs and preventing air sacs from collapsing.
"Surfactants work with the CPAP machine to ensure the lungs don't collapse. Babies in the US and UK get surfactants free through health insurance.
"If a parent is to buy surfactant here, it costs about N135,000 per vial, and the baby needs lots of these.
"One vial of antibiotics is N30,000, and a baby may need three a day.
"So, in a week, a baby has taken over N500,000, depending on location. In a private facility, it may be over N2 million, that's a lot.
"This shows that right from the delivery room, a preterm baby is already disadvantaged," she said.
To improve the survival of these neonates, Ms Ezeaka appealed to the government to provide robust health insurance coverage targeted at preterm babies to reduce the financial burden on parents, citing Malawi's strides in using health insurance to improve its maternal and neonatal indices.
Ms Ezeaka stated that WHO guidelines required 80 per cent of health facilities rendering childbirth services to have CPAP machines, noting that less than 10 per cent of health facilities have the machine.
"While more women now deliver their babies in health facilities, many of these hospitals lack the life-saving technologies, equipment, and trained staff that are necessary to manage preterm babies and newborns in distress," she said.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
She disclosed that NEST360, an initiative which she oversees in Nigeria, would continue to work with the government to bridge care gaps and champion efforts to improve coverage and quality care for newborns in Nigeria and Africa.
Ms Ezeaka emphasised the promotion of cost-effective interventions to save newborns, which include kangaroo mother care (an immediate skin-to-skin contact used for neonatal care that serves as an effective alternative to an incubator, especially in resource-limited settings) and early initiation of breastfeeding.
The positive and protective effects of the interventions include regulation of cardiac and respiratory rates, prevention of sepsis (severe infection), regulating temperature and reduced hospital readmission.
She emphasised the need for the government to invest in low-cost, minimum-package equipment such as bilirubinometers, neonatal suction machines, radiant warmers, phototherapy machines, pulse oximeters, continuous positive airway pressure (CPAP) machines and oxygen concentrators, in strategic health facilities across the country.
Neonatal experts also advocated strengthening antenatal care, training and re-training of healthcare providers, particularly at the primary and secondary care levels, on early identification of high-risk pregnancies to facilitate early referral for adequate care.
The experts recommended the establishment of support groups in hospitals and communities to assist mothers of preterm babies cope with the emotional and psychological challenges they may face.
They maintained that the Nigerian government must prioritise improving safe and effective care of preterm babies if it intends to attain fulfilment of its commitment to Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages.
