Maternal and Child Health in Nigeria

1
Maternal and Child Health in Nigeria

• Professor Friday Okonofua
• Provost, College of Medical Sciences, University
  of Benin,
  
• Executive Director,
• International Federation of Obstetricians and
  Gynecologists (FIGO), and
  
• Hon Adviser to the President on Health

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Background

• The 1991 national census reported life expectancy
  of 52.6 years for males, and 53.8 years for
  females
  
• However, the crude birth declined from 27 to 14
  per 1000 in 1991
  
• Despite this, the WHO ranked Nigeria low (163rd
  out of 191 countries) in terms of Disability
  Adjusted Life Expectancy (DALE) with a value of
  only 38.3 years

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Disability Adjusted Life Expectancy (DALE)

• DALE adjusts life expectancy for disability, and
  is a more robust measure of survival
  
• In DALE estimation, Nigeria ranked higher than
  countries like Sierra Leone and Liberia, but was
  behind countries like Ghana and South Africa
  
• Further analysis showed that the low DALE ranking
  of Nigeria was due to the high maternal,
  neonatal, infant and under-five mortality in
  Nigeria

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Global Comparison of Score and Ranking of
Disability adjusted life Expectancy

• Country DALE (years) DALE ranking
• (out of 191 countries)
• Sierra Leone 25.9 191
• Liberia 34.0 181
• Nigeria 38.3 163
• South Africa 39.8 160
• Ghana 45.5 149
• USA 70.0 24
• UK 71.7 14
• Sweden 73.0 4

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Objectives of this Presentation

• Present current statistics relating to maternal
  and child mortality in Nigeria
  
• Identify some of the most important determinants
  of maternal and child mortality in Nigeria
  
• Review the development of the enabling frameworks
  for the delivery of MCH services in Nigeria, and
  
• Make substantive recommendations on ways to
  improve maternal and child health in Nigeria

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Maternal Deaths in Nigeria

• An estimated 500,000 women die each year
  throughout the world from complications of
  pregnancy and childbirth
  
• 55,000 of these deaths occur in Nigeria
• Nigeria is only two percent of the worlds
  population but accounts for over 10 of the
  worlds maternal deaths in childbirth
  
• Ranks second globally (to India) in number of
  maternal deaths

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Maternal Mortality Ratios in Nigeria
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Maternal Mortality Ratios in some States (SOGON,
2005)
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Other indicators of Maternal Morbidity and
Mortality

• Risk of a woman dying from child birth is 1 in 18
  in Nigeria, compared to 1 in 61 for all
  developing countries, and 1 in 29, 800 for
  Sweden
• For every woman who dies from childbirth in
  Nigeria, another 30 women suffer long term
  chronic ill-health
  
• The UNFPA estimates that 2 million women suffer
  vesico-vaginal fistula globally, 40 of these
  (800,000 women) are in Nigeria
  

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Medical Causes of Maternal Mortality in Nigeria
Hemorrhage - 23 Infection - 17 Malaria -
11 Anaemia - 11 Abortion - 11 Eclampsia
- 11
Narrow Pelvis - 11 Others - 11
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Unsafe Abortion in Nigeria

• An estimated 610, 000 women undergo clandestine
  abortion annually in Nigeria
  
• The FMOH (1991) estimates that 20,000 Nigerian
  women die from abortion complications each year
  
• Abortion complications also predispose women to
  infertility and ectopic pregnancy

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Child Mortality Statistics in Nigeria

• Infant mortality rate
• 71 per 1000 live births
• Under -5 mortality rate
• 140 per 1000 live births
• Perinatal mortality rate
• 51 per 1000 live births
• 103 per 1000 live births

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Comparative Performance in Reducing U5MR
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Indicator of Equality of Child Survival (ECS), WHO

• Equality of child survival (ECS) measures the
  extent to which underfive mortality reflects
  pure chance of death (equal to all children)
  rather than variations in underlying factors
• A value of 1 represents complete equality of
  child survival, unaffected by underlying factors
  
• The more the value lies below one, the greater
  the degree of inequality in child survival, due
  to these underlying factors

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Performance of Nigeria in ECS Ranking

• Nigeria scored 0.336 in the ECS ranking meaning
  a high probability of child mortality from
  underlying factors
  
• Nigeria ranked 4th lowest out of 191 ranked
  countries
  
• Nigeria was only ahead of Central African
  Republic, Mozambique and Liberia
  
• Nigeria ranked worse than war-torn Sierra Leone
  and Angola
  

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Factors contributing to Maternal Mortality in
Nigeria

• Lack of antenatal care
• Low proportion of women attended to by skilled
  birth attendants
  
• Delays in the treatment of complications of
  pregnancy
  
• Poverty
• Harmful traditional practices
• Low status of women

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Utilisation of MCH Services in Nigeria

• Contraceptive prevalence rate 8
• Unwanted pregnancy rate
• among adolescents 60
• Use of antenatal care by a
• trained provider 64
• Proportion of pregnant women
• delivered by a trained provider 37
• Proportion of pregnant women
• who deliver at home 57

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Delays in Treatment of Pregnancy Complications
Type I Delay - when a woman with a
pregnancy complication fails to get to a
hospital in time Type II Delay - when the d
elay is due to difficulty with
transportation Type III Delay - when the
re is delay in treatment after the patient
has reached the hospital
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Contribution of Delays to Maternal Mortality
in Nigeria

• No delay 10
• Type I Delay 30
• Type II Delay 20
• Type III Delay 40

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Causes of Type III Delay

• Non-affordability of antenatal costs, delivery
  costs and post-natal costs
  
• Delays in seeing staff in health facilities
• Incessant strikes and lockouts
• Delays due to poor supplies and consumables
• Delay in referral of patients
• Basic essential obstetrics care not available in
  most facilities
  
• Systemic problems doctors and midwives refusing
  rural postings
  
• External brain drain

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Characteristics of Nigerias Health System

• Weak and inefficient
• Under-capitalized
• Poor motivated health units
• Costly
• inaccessible

22
Comparative Performance of Nigerias Health
System, out of 191 Countries
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MCH service delivery in Nigeria Historical
milestones

• 1980s - Emphasis on family planning/MCH
  services
  
• 1989 - International Safe Motherhood
  Conference in Nairobi, Kenya
  
• 1990 - National Safe Motherhood conference,
  Abuja
  
• 1994 - International Conference on
  Population and Development (ICPD),
  Cairo, Egypt
  
• 1995 - Fourth World Conference on Women
• Beijing, China
• 1995 2005 - ICPD 5, Beijing 5, ICPD 10,
  Beijing 10
  
• 2000 - UN Millennium Development Goals

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Millennium Development Goals, UN (2000) how far?

• Goal 4 Reduced child mortality - To reduce
  mortality rate among children under 5 by two
  thirds by the year 2015
  
• Goal 5 Improved maternal health - To reduce by
  75, the maternal mortality rate by the year
  2015
  
• Six years into the 15 years deadline for
  achieving these goals, there is no clear evidence
  that Nigeria has yet achieved any remarkable
  achievements.

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Recommendations

• Political leadership is needed.
• The Presidency should personally speak to the
  problem of the high rate of maternal and infant
  mortality in Nigeria, just like he has done for
  HIV/AIDS
• Executive Governors and Local Government Council
  chairmen should do the same in their States and
  LGAs
  
• A multi-sectorial approach should be adopted
  whereby all sectors (Legislative Assemblies,
  Information, Education, Women Affairs etc) should
  include MCH programming in their portfolios
• 3. Costs alleviation for women seeking antenatal
  care and delivery services. Such a policy has
  been successful in reducing maternal mortality in
  Kano State
• 4. The creation of a National Institute for
  maternal and child health
  

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National Institute of Maternal and Child Health

• Will provide an avenue through which government
  will providing funding for MCH
  
• Will reduce donor dependency on MCH programming
• Will provide an avenue for research and data
  collation on matters related to MCH
  
• Will develop guidelines, policies and strategies
  for reducing maternal and child mortality in
  Nigeria
  
• Will provide a forum for capacity building and
  resource mobilisation for MCH

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Programs to reduce Maternal and Perinatal
Mortality in Nigeria

• Provision of information and services about
  family planning and contraception
  
• Programs to encourage all pregnant women to
  receive antenatal care and to be delivered by
  skill birth attendant
  
• Improvement of antenatal and delivery services in
  hospitals, especially emergency obstetrics care
  
• Government should address the problem of women
  dying from poorly performed abortions
  

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Recommendation Contd.

• The government should make compulsory the
  registration of all maternal deaths in the
  country, as recently legislated in Edo State
  
• Disease specific preventive measures for child
  mortality
  
• Promotion and scaling up of childhood immunization

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Conclusions

• There can be no doubt that maternal and child
  morbidity contribute significantly to the low
  life expectancy in Nigeria
  
• The disease conditions that lead to maternal and
  child mortality in Nigeria are the same as in
  most parts of the developing world
  
• However, it is the adverse socio-economic and
  cultural circumstances under which these diseases
  occur that increase the risks of these deaths in
  Nigeria

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Conclusions

• 4. A case is being made for a purposeful,
  multi-disciplinary and multi-sectorial approach
  for addressing the problem
  
• 5. An increased prioritization of the problem and
  impetus from the Presidency, the State Governors
  and Local Government Councils will greatly
  accelerate the pace of attainment of the MCH
  aspects of the MDGs in Nigeria
• 6. Indeed, addressing the high rate of maternal
  and child mortality will be a visible
  contribution to socio-economic development and
  transformation, and a major legacy of this
  administration

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• THANK YOU