Infant and Maternal Mortality in Nigeria

Recently, I ended up in a popular spot in Lagos state where a group of people crowded around a sidewalk, all beaming with joy and chattering away at the wonder they crowded around; a pregnant woman who had just been delivered of a healthy baby boy by a passer-by obstetrician in an emergency labour by that side of the road. The new mother was said to have been on her way to a traditional herb maker when she went into early labour before the doctor, who was on his way to his clinic, came to the woman’s aid in an event that wowed an impressed crowd.

About 37% of Nigerian women go to churches, local midwives and all sorts of professionally unqualified personnel for delivery of their babies. This is a disturbing phenomenon as this set of expecting mothers are exposed to higher risks of loss of their baby’s, as well as their own lives arising from complications that might unexpectedly become a problem before, during and after labour, as this may have fatal complications if not appropriately dealt with.

According to the United Nations Children’s Fund (UNICEF) record, “every single day, Nigeria loses about 2,300 babies under five years old and 145 women of child-bearing age”. This makes the country one of the largest contributors to the infant and maternal mortality rate of the world. Infant and maternal mortality is the death of a child or mother caused by diseases and other conditions related to pregnancy, labour, childbirth, etc. In Nigeria, 1 in 13 of pregnant women runs the risk of dying from pregnancy and child birth, with a significant portion of these deaths preventable. Traditionally, the most common causes of maternal mortality worldwide are, labour complications, diarrhea, pneumonia, hypertension, dehydration; while infants may die due to malnutrition, malaria, congenital malformation, infection and SIDS (Sudden Infant Death Syndrome).

Nigeria and many other third world countries have been touted as not so good places to give birth, or, in fact, raise a child, essentially because of the harsh economic predicaments and the abysmally low standard of hygienic practices. Experts at World Development Indicators (WDI) have asserted that both issues are a threat to fundamental human rights. Analysis of recent years proves that even though Nigeria has been cutting down the trend of infant and maternal mortality rates, it is still not close to the United Nation’s Millennium Development Goals (MDGs) of reducing the horrible plight by a third by the end of 2015. Underneath all these assertions and statistics lies the psychological trauma of thousands of families who have lost children, wives and mothers to this preventable scourge.

So why is the ratio of maternal and infant mortality still relatively high in Nigeria? The overarching problem has to be the stagnant healthcare system in the country that has been beclouded by inadequate equipment and facilities. Chief Nursing Officer in Ilasa Public Health Centre (PHC) had this to say “(members of) staff contribute money from their own pockets to pay PHCN officials whenever they come around for disconnection (of power supply); we still use lanterns and torch lights in the labour rooms”. In 2013, only 30 Public Health Centers (PHC) were assessable in Lagos; while out of the 30 PHCs, almost all were unable to handle post-partum-hemorrhage which is one of the leading causes of maternal mortality (ThisDay, April 2014).

Another cause of this pitiful plight can be traced to the incessant strikes of the Nigerian Medical Association (NMA) and the absence of palliative care in emergency situations, but this can also be traced back to the government’s commitment to an adequate healthcare system. Other equally dangerous causes may include sociocultural factors majorly illiteracy and poverty which have contributed to continued harmful traditional practices.

Experts have attributed the level of a country’s development to its maternal and infant mortality rate (Articles Ng, 2013). Thus, the lower the rate it happens, the higher the perceived growth of the country. Hence, this objective - to lower the mortality rate - is a national priority. Children and mothers are dying because those who are meant to prevent it are not acting or committed enough to cause massive improvement; the government and health professionals are not encouraging pregnant women to attend ante-natal clinics early enough especially rural dwellers. Rural areas should be a particular area of interest as they are areas that need a lot of orientation on harmful traditional health practices. Midwives should also get consistently updated education on safe delivery.

The complete disregard and sad disrespect of human lives should no longer be tolerated; a woman has no right to die while giving life and an infant should not be deprived of life due to our lackluster attitude to their welfare. We have to back our commitment to reducing this awful plight faced by mothers and infants with necessary actions.

                                                                         Copyright © 2015 Wemy Industries.

The Vesico Vaginal Fistula (VVF) Plague In Nigeria.

United States Agency for International Development (USAID) in partnership with Federal Ministry of Health and Ministry of Women Affairs has estimated that about 160,000 to 200,000 women develop Vesicovaginal Fistula (VVF) every year. Vesicovaginal Fistula and Recto vaginal Fistula (RVF) are holes resulting from the breakdown in the tissue between the vaginal wall and the bladder or rectum caused by unrelieved obstruction during labour causing continuous involuntary discharge of urine (urinary incontinence). The consequences related to these conditions may also include dermatitis, erosion of the skin and other tissues in the vulva and vagina with constant leaking of urine and faeces. Also, in extreme cases, nerves at the lower limbs can be damaged which may lead to loss of coordination. 

Historically, cases of VVF date back to the earliest existence of humans. It was an especially rampant problem between the 17^th and 19^th centuries in much of what is now the developed world. In fact, in 1855, the world’s first VVF specialist hospital was established in New York, United States of America. Everywhere in the world, VVF is seen as a social and economic scourge, as many women with the condition are regarded as social outcasts, deprived of their fundamental rights and privileges as they are left on the streets, or in deserted places far away from family and associates.

In most cases of VVF, there is a lethal obstruction during child delivery that causes prolonged childbirth as the unborn child is pressed tightly against the pelvis, cutting off blood flow to the vesicovaginal wall, which kills the tissue and makes a hole. According to experts, 90% of VVF is caused by unattended labor, and is especially common in women delivering for the first time.

VVF is responsible for over 55%-60% of divorce cases in Nigeria alone, as the VVF patient is enveloped by offensive odours resulting from the smelly nature of the condition. Teenagers are highly susceptible to VVF due to their small pelvic sizes. This is why it is unsurprising that it is very common in the northern parts of the country where early marriage is a norm which naturally results in early conception by the young bride. A VVF expert in the region has investigated how so many young girls lose their lives during childbirth, and how the ones that survive the ordeal are left almost incapable of conceiving ever again. Nigeria has been said to account for 40% of VVF cases in the world. This makes it a very big health concern for the country.

Experts have argued that the major cause of VVF is illiteracy as it is prominent in rural areas filled with uneducated women who have little or no access to information and adequate health care services. Recent research has established that most women prefer to give birth in traditional maternity centers than in proper health institutions. This is one of the biggest reasons for the high rate of VVF in Nigeria as ill-equipped and unskilled medical personnel are more likely to tear through their wombs, press hard on their abdomens and make so many other unhealthy choices. National Demographic Health Survey in 2012 estimated that every year in Nigeria, 12,000 more women will develop vesicovaginal fistula and only 5,000 will seek medical intervention and probably undergo surgery. Experts believe that by year 2015, these figures will double to at least 2 cases of VVF per 1000 pregnancies. 

Despite the fact that VVF is most prominent in childbearing, it has also been discovered to result from cases of violent rape and female genital mutilation. Conscious efforts have been made by the government and non-governmental organizations to combat this scourge with quite a number of VVF centers established in the northern parts of the country where it is most prevalent. However, it is still worth mentioning that these efforts have to be stepped up as these centers still remain underfunded. To improve maternal health, awareness should be created as to the importance of antenatal care for pregnant women to easily detect early cases of VVF when it can be easily cured; a service they won’t get from traditional maternity centers. Educational materials should be produced to create this awareness and primary health networks provided to the rural areas where poor uneducated women can easily have access to. VVF treatment is achieved by surgery and rehabilitation. This intervention package should also focus on repairing the mental, social and economical damage women suffer from VVF. These will be very vital to reducing the rate at which Nigerian women continue to suffer from a scourge that can be controlled and easily prevented.

                                                                                    Copyright © 2014 Wemy Industries.