Experts tie reduced under-five mortality to low-cost interventions

Nigeria is a signatory to several pledges made in international conferences to solve the problem of hunger, malnutrition, and child survival across the globe. Notable among those commitments are the 1989 Convention on the Rights of the Child. As the most ratified human rights treaty in history, the convention called for recognition of the child’s right to the “highest attainable standard of health.”

In its wake, the World Declaration and Plan of Action on the Survival, Protection & Development of Children given at the 1990 World Summit for Children, remains by far the most celebrated instrument in history for ensuring child survival. In the Declaration, Nigeria, along with other world leaders, committed to “giving high priority to the child”.

This document was one of the most convincing proofs that the cause of the child is at the top of the world’s agenda. It symbolized the drive to save millions of young lives from premature and preventable death and reflected hopes for a reduced childhood mortality, increased immunization coverage, better development, protection and overall survival. Sadly, though, many years after this historic movement began, several millions of children have been left behind. Amongst the unfortunate group of children so terribly let down is the Nigerian child.

While child mortality rates in sub-Saharan Africa seem to have generally decreased since 1990, Nigeria remains one of the countries on the African continent with the highest child mortality rates. In view of this background, medical experts in the country have called for a holistic intervention plan to effectively address infant mortality which is still ravaging many Nigerian families if the country is to meet the United Nations 

 Millennium Development Goal 4 (MDG) target of reducing infant mortality by 2015.

Speaking at the 6^th Olikoye Ransome-Kuti Memorial Lecture and Scientific Dialogue which held recently at the Lagos University Teaching Hospital (LUTH) Idi-Araba, Lagos, Jackson Omene, professor of Child Health, University of Benin (UNIBEN) disclosed that India and Nigeria alone would prevent nearly 20 per cent of global child mortality if both countries could marshal political courage to commit national resources to strengthen the health care system.

According to him, there is consensus that only very minimal progress has been made in Nigeria regarding newborn and child mortality and one of the reasons for the high level of child deaths in Nigeria is inadequate postnatal care provided to newborn infants.

Omene stressed the need for provision of effective antenatal care to pregnant women; addressing poor maternal health and under-nutrition; prompt maternal treatment of maternal infections and immunisation against tetanus. He however emphasised that the provision of essential obstetric care of high risk pregnant women is paramount if neonatal deaths are to be reduced.

According to the medical expert “it is disturbing to know that despite several millions of naira spent over the years, Nigerian children under the age of 5 die annually from preventable childhood illnesses. With less than four years away from the MDG target, Nigeria still has unacceptably poor health indices in infant mortality rate, Under 5 mortality rate, and maternal mortality rate many countries are and this is a course of concern.

Lending her view, Adenike Grange, former minister of Health, stated that although the annual number of deaths among children under age five is on the decline, the country is yet to record a stable or improved rate of child mortality over the last decade.

Grange, a renowned consultant paediatrician, stated that the solution to this problem lying in those piloting the nation’s health sector working together as a team and identifying those areas that are actually causing the majority of child mortality.

“As you know most of the children, about 23 to 25 per cent die in the neonatal period. Malaria in the country accounts for a fifth of the deaths of children; that is about 20 percent. We also have diseases such as diarrhoea and pneumonia; these two diseases account for about 35 per cent of under-five deaths in the country.

“Now what do we really have on ground? What we have on ground is that we know that immunisation as it is in this country at this moment is working for the diseases that we are using it for. But the children are not been taken to the hospitals routinely to go and get their vaccines. Routine immunisation needs to be revived. The second thing that needs to be done is that we need to expand number of vaccines in immunisation schedule of the country,” Grange concluded.

For a nation that keyed into the global campaign of MDGs most of which are predicated on healthcare - primary healthcare system, the evident shortcomings betray how distant the nation is from global benchmarks which is less than four years away.

No doubt, the Ministry of Health and other relevant health agencies should brace up with the challenge of reviving the comatose Primary health care institution so that it could provide quality healthcare to infants at the grassroots.

For Omene,“With inadequate infrastructure, lack of basic amenities like electricity, water and sanitation, poor outreach management strategies, it is obvious the authorities in charge have to be in tune with the goal health revolution of promoting health of the child at the community level.  At the various levels of government, a framework of activities should be developed with the cooperation and support of key leaders to reduce mortality associated with Child Birth. We need to strengthen the health care capacity through staff development, and develop surveillance of key birth outcomes to establish a sound data base for identifying the priority problems to be addressed.

It will be recalled that at a major UN development summit in New York last September, participants adopted the Global Strategy for Women and Children’s Health, committing $40 billion in resources to a global effort to save the lives of 16 million women and children by 2015.

The strategy, which identified the finance and policy changes needed, along with vital interventions, is expected to prevent - between 2011 and 2015 - the deaths of over 15 million children under five. That is besides stopping as many as 33 million unwanted pregnancies and the deaths of 740,000 women from complications relating to pregnancy and childbirth.