Bleeding disorders remain a huge challenge to maternal, newborn and child health (MNCH) worldwide, with the burden higher in low-resource countries like Nigeria. These disorders result from the inability of the body to stop bleeding and, if undiagnosed and untreated, may result in life-threatening complications during childbirth and early childhood. This issue calls for medical attention to address it and ensure that such care is accessible, especially for families who can't afford it.
Bleeding disorders are mainly inherited and include disorders such as haemophilia, von Willebrand disease, and platelet function disorders that affect the clotting process, leading to excessive bleeding. This burden of bleeding disorders in Nigeria is increased by a lack of awareness, limited availability of diagnostics, and shortage of adequate treatment products, with significant, far-reaching implications for the health and financial stability of families.
Maternal mortality remains a serious global problem, with postpartum haemorrhage (PPH) accounting for 27.1% of deaths. Undiagnosed bleeding disorders in women may result in complications such as heavy menstrual bleeding, complications during pregnancy, and PPH during or after childbirth. It is therefore a public health concern.
For instance, women who are haemophilia 'carriers' may remain asymptomatic but go through excessive bleeding at delivery. In many health settings in Nigeria, obstetricians and midwives may not often consider bleeding disorders as the cause of PPH, resulting in delayed or inappropriate interventions. Stigma remains another reason many women go through symptoms in silence, dismissing them as normal or fearing societal judgment.
Impact of bleeding disorders on child health
Life-threatening conditions in newborns, such as intracranial haemorrhage, prolonged bleeding from circumcision, or delayed healing of the umbilical cord stump, could be the first manifestations of a bleeding disorder. In 2022, sub-Saharan Africa accounted for 57 per cent of bleeding disorders with Nigeria reportedly having 34.3 % in the same year, putting it amongst the highest globally. The absence of routine screening for bleeding disorders leaves many cases undiagnosed, with many families remaining unaware of the condition until a major bleeding episode occurs that may lead to disability or death.
For children who have bleeding disorders and remain undiagnosed, the dangers extend beyond infancy into life. Minor injuries can mean long-term bleeding or joint damage because of recurring internal bleeding. These challenges greatly affect the quality of the child's life, limiting his or her ability to engage in normal activities like school. If not managed properly, families can often experience repeated visits to the hospital, loss of income, and social isolation. In most instances, parents use traditional remedies or do not seek care at all, putting the child's health in further jeopardy.
Over the past five years, the Haemophilia Foundation of Nigeria (HFN) has been a beacon of hope for families affected by bleeding disorders. Their work spans awareness, advocacy, diagnosis, and access to treatment. Recognising the special challenge that bleeding disorders pose to MNCH, HFN has prioritised efforts to address this gap using various strategies.
HFN, with partners like the World Federation of Hemophilia (WFH) and Novo Nordisk Haemophilia Foundation (NNHF), provides training for healthcare practitioners on managing bleeding disorders during pregnancy, childbirth, and early childhood. They also conduct awareness programs and support laboratories with training and diagnostic tools. Through the WFH Humanitarian Aid Programme, HFN has improved access to anti-haemophilia factor concentrates and other treatment products. HFN collaborated with healthcare providers, stakeholders, and policymakers to advocate for the inclusion of bleeding disorders in the National NCD policy in August 2024. The organisation organises activities like the annual Camp Bravehearts for children and youths supported by Save One Life Inc and the Red Heart workshops for women and girls with bleeding disorders supported by NNHF.
Collaboration by all relevant stakeholders will help strengthen MNCH outcomes in Nigeria by ensuring undiagnosed bleeding disorders are identified early before they result in life-threatening complications.
Expanding diagnostic reach through mobile units ensures early diagnosis of bleeding disorders, reducing complications during childbirth and neonatal care. Joint training workshops for health workers in rural and urban areas can help integrate bleeding disorders into routine maternal and child health care.
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Collaborative policy advocacy and engagements can help increase funding, treatment subsidies, and inclusion of bleeding disorders in MNCH programs and health insurance. Joint community education will help amplify messages, address stigma, and empower families to seek care and adhere to treatment.
Addressing bleeding disorders in maternal, neonatal, and child health is a lifeline that can be given to Nigerian families. Awareness, access to diagnosis and treatment, and integration of bleeding disorder care into maternal, neonatal and child health programmes can reduce mortality and ensure a better quality of life for thousands of families.
The journey ahead requires multisectoral collaboration. The rewards are healthier mothers, thriving children, and resilient families.
No family in Nigeria, a country of such diversity and great resources, need to suffer the tragedy of the prevented death of a loved one from an undiagnosed or untreated bleeding disorder. It is now time to act.
