Tuesday, 18 December 2007

Attacking malaria…tackling the common enemy

With malaria being responsible for up to 63% of attendance at health facilities, 30 percent and 25 percent of child and infant mortalities in Nigeria respectively and 11 percent of maternal mortality in Nigeria, the federal ministry of health is pulling all stops at ensuring that the different interventions under the country’s roll-back malaria initiative are properly implemented for maximum impact.

Recognising Malaria as a common enemy to humanity, especially to pregnant women and children, Dr Yemi Sofola, the Coordinator of the Nigeria Malaria Control Programme has called on all tiers of government, countries, partners and stakeholders to take affirmative action to address in a broad based manner the issue of malaria and to collectively make all efforts to eliminate malaria.

While speaking at the national review meeting for malaria programme managers at the picturesque Gateway Hotel in Ijebu-ode Nigeria recently, Sofola stated that the devastating effect of malaria has not only laid a heavy burden on the gaunt health system in Nigeria but has also diverted funding priorities creating huge gaps in our national development.

The Nigerian national malaria control programme is employing a workable and evidence-based framework for the elimination of malaria and this includes; improving prompt and appropriate management of malaria cases; promotion of multiple preventive measures such as the use of Insecticide Treated Nets; promotion of the use of Intermittent Preventive Treatment for pregnant women; development of workable partnership for Health System Development; improvement of monitoring and evaluation including tracking of project implementation and commodities and operational research to increase the evidence base for policy.

As she urged greater commitment of the programme personnel, Sofola commended the programme partners ‘who have stuck with us through thick and thin. We believe that our concerted efforts will definitely yield the successes we have been expecting since the Roll Back Malaria initiative.’

She shared with participants that the meeting was also to enable the programme to commence the process for the development of a new Business that would enable the programme to mobilize the required resources form within and outside Nigeria in order to massively scale up service delivery to have the desired impact.

Sofola opined that with the rising profile of malaria, the current bottlenecks being experienced at the state and local government levels will soon be overcome and the expected output and outcomes of interventions met to halve the burden of malaria by 2010 and a malaria-free Nigeria by 2015.

By Nnenna Ike

Goge Africa’s charity event raises awareness for orphans and children with special needs

While most fingers point at the Nigerian government and the health institutions they fund as being the culprits when it comes to the appalling number of women and children who die needless deaths in Nigeria, corporate organisations are pitching in to highlight the need to have better health policies that would ensure that children are born healthy because of the quality of care their mothers had access to during pregnancy and childbirth.

Improving MNCH takes more than government policies and roundtable discussions among policy makers. Though the different tiers of government have an obligation to ensuring the health of its residents, there is an immediate need for effective involvement of organizations at the community levels as a stepping stone for making a difference in the society.

To this end, the Lagos-based organization Goge Africa took the opportunity of the festive season to host a charity event for orphans and children with special needs. Knowing that many children in Lagos do not have the privilege of visiting parks or cultural shows because of their physical challenges, congenital disabilities, and lack of opportunities arising from coming from broken homes, the management of Goge Africa decided to invite them to enjoy a day of dancing and music.

Isaac Moses, the co-director of Goge Africa, while speaking with the Devcoms team stated that this year’s event was part of Goge’s ongoing community support projects meant to bring publicity to MNCH issues such as child development and maternal health.

His words, ’The government should continue to educate women on the need to access antenatal care in clinics so as to prevent child disabilities in the future, they should also endeavour to provide these clinics with the skilled medical staff and equipment.”

According to Moses, “They [the government] are most visible, so I usually mention them first. But organizations have their own responsibilities, too. I find if people aren’t asked to give, they won’t give. So it’s up to organizations like ours to push multinationals to give funds to children.”

The daylong charity event, held at Apapa Amusement Park in Lagos, drew a crowd of children, families, media, non-profit organizations, and government sectors, including the Federal Ministry of Health and UNICEF, who led a health and nutrition workshop for the children. Dance competitions, gift-giving, and cultural performances were among the festivities throughout the event, as well as a visit from the popular musicians the Mamuzee Twins.

By Amanda Hale

Tuesday, 11 December 2007

Empowering Youths to Drive Nations Forward

The growing need for youth involvement in development issues was at the forefront of Nigeria’s agenda last week as Action Health Incorporated (AHI) Nigeria, alongside an array of non-governmental organisations in Lagos met with Donald Floyd, President and CEO of the National 4-H Council, a U.S.-based non-profit organization, in Lagos to discuss partnerships for innovative youth development projects in Nigeria.

The National 4-H Council is the partner of 4-H, one of the United States’ largest youth development programs, which works with the mission to advance youth development movement; building a world in which youth and adults learn, grow, and work together as catalysts for positive change. According to Floyd, youth empowerment can only take place when adults step up and give young people the skills and opportunities to grow personally and professionally.

Youth involvement in decision-making is an important fuel to the social and economic strength of every nation, and should thus be encouraged in every developmental organization. “We need to give young people governance positions,” said Floyd. “Youths should have the power to sit on the board of directors or to make funding decisions within their organization, and also to make important decisions about the development of their communities and country.”

Floyd described his own experience working with four young people on the board of directors for the National 4-H Council. “It was an often painful experience,” he said with a laugh, “but the best strategy was for youths and adults to learn to mentor each other-- sometimes young people knew things we didn’t, and sometimes we knew things that they didn’t.

“It’s all about mutual learning to work together as catalysts for change.”

The meeting took place at a brunch reception hosted by AHI and drew a variety of non-profit organizations from Lagos to discuss the importance of youth empowerment in Nigeria, and how creative partnerships between local, national and international organizations can boost the level of youth projects and youth involvement in Nigeria’s future.

*By Amanda Hale

Thursday, 6 December 2007

Creative social marketing can stem unintended pregnancies in Africa

In Nigeria, the rise of unintended pregnancies and sexually transmitted diseases demands a revolutionary approach to social marketing in order to promote positive behaviour among youth. The following story of successful youth social marketing programs in Cameroon, Rwanda, and Madagascar could be applied to Nigeria’s social framework as well. With such a wide range of print, radio, and broadcast journalists pulling together to highlight sensitive and controversial issues regarding reproductive health and safe sex—such as cross-generational sex (sex between older men and younger women)—Nigeria could see a substantial reduction in harmful sexual and reproductive practices.

The social learning theory, which categorizes human behaviour in terms of the dynamic interaction between personal factors (knowledge, expectations, and attitudes), behavioural factors (skills and self-efficacy), and environmental factors (social norms, access to information, products and services, and ability to influence others), has been identified as capable of shaping young people’s perception of safe sexual behaviour.

This is based on a study by Population Services International (PSI), which was conducted across Cameroon, Madagascar, and Rwanda. PSI’s theory is based on the belief that individuals learn not only through their own experiences, but also by observing the actions of others and the consequences of those actions. The program concluded that after two years of media interaction with youth on reproductive issues in Cameroon, Rwanda, and Madagascar, that repeated exposure to multiple communication channels is necessary to change youth’s sexual behaviour.

Population Services International (PSI), a US-based non-profit group, implemented youth-oriented programs to prevent unplanned pregnancies and STDs, including HIV/AIDS, among youth between the ages of 15-24 years.

Past social marketing programs in Africa endeavoured to stem the tide of unintended pregnancies and STDs by using donated products such as condoms, and then selling them—attractively advertised under a brand name—in small shops and outlets to low-income shoppers. This encouraged people with low incomes, particularly youth, to buy condoms without fear of social backlash from shopkeepers or friends.

PSI workers took this conventional approach, but added a new twist—based on PSI’s behaviour change framework, which incorporates elements of the most commonly used behaviour change theories, such as the social learning theory, the health belief model, and the theory of reasoned action, PSI used the media to communicate intensively with youth and encourage them to use condoms or abstain from sex. In Cameroon, PSI launched a multi-media program with peer educators, journalists, comic strip artists, radio personalities, and scriptwriters to develop messages in the media, which highlighted experiences of youth who challenged social norms to protect their health. Television and radio advertisements aired repeatedly for four to six weeks and encouraged positive sexual behaviours, such as young women buying condoms to protect themselves from pregnancies and STDs. Additionally the program employed street vendors to sell monthly youth newspapers, called 100 % Jeune Le Journal, to youth around Cameroon. The newsletter included articles about reproductive health, letters from readers and responses from peer educators, sports, music, comic strips, and tear-out colour posters.

By Amanda Hale

Monday, 3 December 2007

Immunization of children: the greatest achievement of all…

Immunization: gifting disease immunity to children of all social status


Experts have reiterated the fact that up to 3 million deaths are prevented yearly and 750, 000 children saved from disability if vaccination services are improved and maintained. The immunization of all children remains one of the greatest achievements of all humanitarian goals.

This assertion was made at the high level 1-day Conference session titled ‘immunization in Nigeria during the just concluded 34th edition of the international Medical Exhibition and Conference held at the Ocean View Hotel, Victoria Island Lagos.

Prof Chris Obionu of the college of medicine, University of Nigeria, Enugu Campus Nigeria, gave the presentation for the day titled the ‘Value of vaccine’. According to him, vaccine-preventable diseases/ infections constitute a major cause of morbidity and mortality worldwide, especially in developing countries like Nigeria. These diseases include: measles, yellow fever, smallpox, poliomyelitis, neonatal tetanus, tuberculosis, hepatitis B, and cerebrospinal meningitis. According to him, with future vaccine development, the number of preventable diseases will increase with future.

Though eradication of these diseases is possible through vaccination, there are concerns that vaccine coverage is falling. While a surprisingly large number of people are reluctant to accept vaccinations even when they are given free of charge, some governments view vaccines as a capital intensive venture instead of an investment and thus are reluctant to allocate funds to vaccination programmes. Thus there is no sustainable financial backing for the different vaccination programmes. He also lamented the ignorance of the value of vaccines which leads to squandering of immunization resources.

Outlining the values of vaccine for the individual, Prof Obionu said ‘Three million deaths are prevented yearly and 750,000 children are saved from disabilities. For the community, next to clean drinking water, vaccines are the most effective intervention in reducing and preventing the incidence of infectious diseases. While for the economy of the nation, its benefits are a decrease in: hospitalization, loss of productivity, and need for expensive treatment, permanent disabilities and disease outbreak.’

Prof Obionu maintained that government and individuals need to recognize the value of vaccines and disease prevention. The Government should recognize that a healthy population attracts investments and increase in productivity. He stressed that adequate investment in resources (human, material and financial resources) is needed for effective immunization. Applying the lessons learned from smallpox eradication in the use of other vaccines to fight diseases will enhance the value of vaccination.

He stressed that vaccines must be made available to all people no matter where they are in the world. Vaccines should be as highly valued as pure drinking water. With a motto such as “No vaccination, no achievement of the health-related MDGs”, the government will work harder towards achieving these goals. ‘Living in a world free of polio, and maybe measles, is not a dream. It can actually be realized’, he concluded.

By Adanma Ike.

Friday, 30 November 2007

Fight Against HIV/AIDS Carried To Imams

Fight Against HIV/AIDS Carried To Imams

In the continuous and combined efforts at ensuring better public health in Nigeria, the ongoing workshop organized by the Muslims Against Aids (MAIDS) in conjunction with the Public Affairs Section of the United States Consulate General is a major landmark in the fight against HIV/AIDS pandemic in the Nigeria.

‘Protecting the Ummah: Role of the Imam’ is the theme of the 3-day HIV/AIDS workshop.

Speaking at the opening, Ms Mary Lou Johnson Pizarro, Public Diplomacy Officer at the US Consulate reiterated the important role of religious leaders in the effort to reduce HIV infection and the resultant effects of the social stigma. According to her, since HIV/AIDS does not discriminate against everyone based on their race, colour, ethnic tribe or religion, there is a need to ensure that the efforts at its reduction to come from various sectors of the society. She stressed that the Imams will serve as a catalyst for change because of their influential positions in their various communities.

Pizarro said, the US Government will continue to support the fight against the spread of HIV/AIDS in Nigeria and also expect that the workshop will serve as an eye-opener for the participants who have ample opportunities of relating and practicing the things they would learn in the course of the workshop.

Capt. M.B. Ahmad, one of the workshop participants said that the role of religious leaders in the fight against HIV/AIDS cannot be over emphasized because of the influence they have over their followers. He lamented the fact that there has always being workshops on HIV/AIDS organized for various groups of people but there has not being any for religious leaders especially the Imams. While lauding the organizers of the workshop, he was optimistic that programme will serve its objectives and expectation and urged for a more regular workshops.

The training for the Imams, which will be the first of its kind in Lagos, Nigeria, has participants from the various local government areas of Lagos. The workshop which is part of activities to mark the 2007 World AIDS Day is expected to end on the 29th of November 2007.

By Akinpelumi Akinlolu

Monday, 19 November 2007

Training of non-obstetrician healthcare workers can stem haemorrhage

Dr. Sadauki and Prof. Otolorin during a session at the SOGON conference.

FRIDAY Nov 16, 2007

BENIN NIGERIA ----- The Effective competency-based training of non-obstetrician healthcare workers can lead to the successful management and prevention of Post partum haemorrhage (PPH) which has been acknowledged to be the leading cause of death among women globally and particularly in Nigeria. In the same vein, the use of anatomic models has been found to be invaluable for clinical skills development in the absence of PPH client load.

This result of the study conducted by Access to Clinical and Community Maternal, neonatal and Women’s Health Services (ACCESS, Nigeria) with the support of USAID was disseminated at the ongoing 41st scientific conference and AGM of the Society of Obstetrics and Gynaecology of Nigeria (SOGON) by Professor Emmanuel Dipo Otolorin, Chief of Party of ACCESS, Nigeria in a presentation titled ‘Competency Based Training for the Prevention and Management of Postpartum Haemorrhage’.

According to Professor Otolorin, since PPH can be drastically reduced with the Active Management of the Third Stage of Labour (AMTSL) and other medical skills, there is a critical need to ensure that birth attendants develop skills for managing this stage and other skills such as Manual removal of placenta; Repair of episiotomy and vaginal/perineal lacerations; Repair of cervical lacerations; Compression of abdominal aorta and the Bimanual compression of uterus.

The study which showed that there was marked improvement in the competence levels of the study participants was conducted in Zamfara and Kano States in Northern Nigeria. The maternal mortality rate in northern Nigeria is estimated at 1000 per 100, 000 live births and this can be attributed to the fact that many deliveries are done with no skilled attendant present and where they are present, may lack the skills required to manage the haemorrhage. The simulated scenarios which required different cadre of health personnel such as the laboratory scientist, anesthesian, working together brought to fore the need to develop and encourage the effective collaboration/team spirit among different medical personnel.

In the study, both skilled and semi-skilled health workers were trained using Anatomic models which included childbirth simulator, Fetal model, Placenta model with velcro attachment to abdominal wall, Cloth placenta with membranes and Foam blocks. While equipment such as Delivery kit, Episiotomy repair kit and print teaching materials were used and the study participants made to use Personal protective equipment, Decontamination equipment and Sharps disposal boxes.

However, the study showed that there was a need to step down the language of the training package for Community Health Extension Workers (CHEWs) besides training more midwives and CHEWs who are closest to these women in the community. Otolorin pointed that other skills that needs to be included in the curriculum include Suturing and knot tying (simple, vertical and longitudinal mattress stitches), conducting bedside clotting test, Use of hydrostatic balloon, and the use of antishock garment.

Otolorin concluded that competence-trainings should be a regular feature in Nigerian health facilities and for personnel in different fields relevant to maternal and neonatal health. This will ensure the properly management of emergency pregnancy complications but attention should be paid to the training of the community extension workers who are the people closest to the women in resource poor settings.

*Reported by Nnenna Ike

Haemorrhage-stopping device unveiled at SOGON conference

FRIDAY November 16, 2007 BENIN, NIGERIA ----- A novel method of treating haemorrhagic shock in women during or after childbirth has been unveiled and is being advocated for use by obstetricians and gynaecologists of Nigeria. The revelation of the Non-Pneumatic Anti Shock Garment (NASG) was made at the ongoing 41st Scientific Conference of the Society of Obstetrics and Gynaecology of Nigeria (SPGON) taking place in Benin Nigeria.

Professor Oladosu A. Ojengbede, Director Centre for Population & Reproductive Health, College of Medicine, University of Ibadan Oyo State Nigeria made this known in his presentation titled ‘Management of haemorrhagic shock’.

According to Ojengbede, obstetric haemorrhage is blood loss or bleeding during pregnancy; labour and within 42 days of termination of pregnancy. When there is excessive blood loss, women go into a state of shock which is progressively more dangerous if actions are taken on time to revive the patient. The major method of managing haemorrhagic shock’ is through resuscitation, which involves oxygenation, restoration of circulation, drug therapy, further evaluation and remedy of the basic problem that led to the shock.

The NASG is constructed like a pair of open-seamed trousers with one half made of velcro material so that it can be worn by women of varying sizes. It is worn from the abdomen to the legs and works by applying external counter pressure to the lower body, such that the blood is forced back towards the head and chest when the women is in a prone position. This way, the NASG can be used for Postpartum hemorrhage, Post cesarean hemorrhage, Ectopic Pregnancy, Trauma with injury/hemorrhage below the diaphragm while stabilizing the woman for further evaluation, transporting or preparing for definitive surgical treatment.

The NASG can be applied by anybody –doctors, nurses, CHEW, health attendants, ambulance drivers etc - who has been trained and with proper monitoring for adverse effects, can be safely and comfortably used for 24 - 48 hours. The NASG is so effective, it may arrest bleeding and avoid surgical intervention and even decrease the need for blood transfusions.

Prof Ojengbede however warned that the use of anti shock garment does not avert the necessity for evaluation to identify cause of shock, management of fluid and blood replacement, and appropriate therapy.

Prof. Ojengbede and colleague testing NASG at SOGON conference.

*Reported by Nnenna Ike

Friday, 16 November 2007

Govt makes pronouncement on post-partum haemorrhage drug

FRIDAY Nov 16, 2007

BENIN NIGERIA ------As Post-Partum Haemorrhage (PPH) continues to be the leading cause of maternal deaths in Nigeria accounting for 25% of maternal mortality, the search for a drug that can be administered to women especially in rural and resource poor setting got a boost with the federal ministry of health making a pronouncement on the drug Misoprostol. This is because the burden of maternal mortality rests on the grass root population and since this drug requires little/no expertise; its use should be promoted in order to reduce PPH which hitherto is the commonest cause of maternal mortality.

Dr Moji Odeku Director at the Reproductive Health Unit of the Ministry of Health made this pronouncement on behalf of the government at the 41st Conference of the Of Gynaecology and Obstetrics Of Nigeria (SOGON) taking place in the ancient city of Benin, Nigeria from the 14th to 17th November 2007.

She told participants that the present maternal mortality situation were basically due to the three delays namely: seeking care; accessing care and reaching healthcare. This was besides the fact that most pregnant women are anaemic and thus cannot tolerate blood loss, the lack of blood bank in most health facilities, and the socio-cultural and religious bias against blood transfusion. These trends according to her led to the study on the dug ‘Misoprostol’, a 3rd line uterotonic which is stable at room temperature, has a long shelf life and can be used at primary level were 70% of Nigerians dwell.

Dr Odeku said that the federal Ministry has since reviewed the clinical guideline and is recommending that ‘Misoprostol’ be introduced at health facility levels where it ca be administered by skilled birth attendants including doctors, nurses and midwives, and can also be administered by trained health care providers who are MLSS trained Community Health Extension Workers (CHEWS). She stressed that every effort would be made to ensure that the drug is readily available in the country and at generic dosages at affordable prices.

However, her presentation maintained that though ‘Misoprostol’ should be used for the prevention of PPH, uterotonics should be used in the following order Oxytocin, Erometrin and Misoprostol. She concluded that the information memo will be presented at the National Council on Health later in the year while a National dissemination meeting by the Minister of health would convene in December 2007. Thereafter, the ministry would commence a State training and sensitisation on the use of ‘Misoprostol’ in the 36 state of Nigeria including the FCT. This would be to enlighten the personnel who might be administering ‘Misoprostol’ in future against mis-use.
Dr Odeku urged medical personnel to embark on data gathering as an form of operation research to assess side effects, compare the cadre of the drug administrators and other relevant information as this would him in the formulation of the right policy on the drug use in Nigeria.

*Reported by Nnenna Ike

For more updates please join 1. http://groups.yahoo.com/group/SciPHJournalismForum/ and 2. http://health.groups.yahoo.com/group/ReproductiveHealthforum/


IMNCH endorsed by Nigerian Obstetricians and Gynaecologists

Chief (Dr.) Abiola-Oshodi, 1st Vice President with Dr. (Sir) JOhn Okaro, President, SOGON.

FRIDAY November 16, 2007 BENIN, NIGERIA ----- Nigerian Obstetricians and Gynaecologists have formally thrown their weight behind the Federal government’s new initiative to effectively ameliorate the dismal state of the maternal and child care delivery in Nigeria. The initiate known as the Integrated Maternal, Newborn and Child Health (IMNCH) Strategies is being spearheaded by the federal ministry of health involves the reorganization and reorientation of the health system to ensure the delivery of a set of essential interventions which will provide a continuum of care for women, neonates and children. The IMNCH strategy is a holistic approach; it replaces the competing calls for mother or child.

Dr (Sir) John Okaro, President of the Society of Obstetrics and Gynaecology of Nigeria (SOGON) made this assertion, Thursday at the opening of the 41st Scientific Conference and AGM of the Society in Benin Nigeria. Dr Okaro was reacting to a speech made by Dr Moji Odeku, Director, Reproductive Health Unit at the Federal Ministry of Health Abuja.

In her speech, Dr Odeku said, the IMNCH represents the articulation of bold and new thinking on how to fast-track comprehensive action to turn around maternal and child health in the country. It pulls together in a practical continuum, an evidence-based maternal, newborn and child health framework for achieving Millennium Development Goals. Since maternal and neonatal mortality are often the result of a badly managed pregnancy and home delivery without a skilled birth attendant, the thousands of needless deaths would be prevented by implementing the integrated maternal, newborn and child health interventions.

She maintained that the new initiative would only be effective when bodies of medical professionals such as SOGON buy in into it and thus reduce the numerous parallel-running programmes on maternal and child healthcare. According to Odeku, IMNCH is a multisectoral approach which can only work when the different sectors acknowledge their roles and start implementing the responsibilities accruing to the roles.

She maintained that a sustained investment and a systematic phased gradation of essential IMNCH interventions, integrated in a continuum of care is required — when these interventions are in place the lives of many more mothers, infants and children will be saved. While commending the Edo State government for the new directive of tree treatment for pregnant women and children under five years, Odeku urged every state government to make adequate investment plans for the human resource and health facility in the areas under their jurisdiction so that the roll-out of IMNCH would yield lasting impact.

Responding, Dr. Okaro, asserted that maternal death, stillbirths and newborn deaths are strongly linked to deliveries which take place outside of health facilities, without properly trained birth attendants in attendance, or in health centres which are not equipped or staffed to handle emergency obstetric or neonate crises. He hoped that with the roll-out and implementation of the IMNCH strategy, the problems of not having skilled attendants, health centres without necessary facilities to deal with obstetric emergency and all the other problems that the members of the Society face in the discharge of their duties.

It is hoped that integrating maternal, newborn and child healthcare services will provide an opportunity for the health sector to eliminate unhelpful dichotomies (i.e. mother vs child, short term vs long term, skilled care vs community approaches, and intrapartum vs continuum of care) that stifle funding and lead to confusion and ultimately cost lives.

The SOGON Conference is a 4-day event with the main theme being Intersectorial collaboration for improving maternal and Neo-natal Health, while the Subthemes are Prevention of Cervical Cancer, Post-partum Haemorrhage.

*Reported by Nnenna Ike

For more updates please join 1. http://groups.yahoo.com/group/SciPHJournalismForum/ and 2. http://health.groups.yahoo.com/group/ReproductiveHealthforum/

Thursday, 15 November 2007

SOGON conference begins: Experts call for adherence to WHO recommendations

Prof. Emmanuel Dipo Otolorin, Chief of Party, ACCESS Nigeria

THURSDAY Nov 15, 2007

BENIN NIGERIA------Prof. Otolorin, Chief of Party, ACCESS Program Nigeria has made a call to Nigerian medical professionals in the field of Obstetrics and Gynaecology to update themselves with current recommendations for the prevention of Post-partum Haemorrhage. Since PPH is the leading cause of maternal mortality globally and especially in Nigeria.

He made this call while presenting his paper titled Prevention of Post-Partum Haemorrhage the role of Uterotonics at the pre-conference workshop preceding the opening of the 41st Conference of the Society Of Gynaecology and Obstetrics Of Nigeria (SOGON) taking place in the ancient city of Benin from the 14th to 17th November 2007.

According to him, the various uterotonic agents used to prevent PPH include Oxytocin, Ergometrine and Prostaglandin analogues. However there is evidence to show the choice of Oxytocin as the first line of drug for the prevention of PPH over other uterotonics. He maintained that the large number of death experienced by Nigerian women would be reduced if proper attention is paid by medical personnel to the services rendered during a last stage of delivery. This, he said is known as Active management of third stage of labour (AMTSL)

Prof. Otolorin added the advantages of Oxytocin as being effective within 2 to 3 minutes after administration, minimal side effects, can be used on all women and that it is inexpensive. He cited its disadvantage as requiring cold chain handling and storage to maintain its potency. This he said can be remedied with the provision of solar cooling facility.

According to him, with Nigeria being in the tropics, we should be able to utilise the abundant sunlight we have with cost effective innovations. He recommended that Nigerian States should use the UNICEF prototype of solar coolant for vaccines for the storage of Oxytocin. He explained that one solar cooling facility can be procured and maintained by a number of health facilities in a State, such that there is always an availability of Oxytocin in health centres for use by women during delivery.

To ensure that the AMTSL is enhanced such that women do not die of PPH in Nigeria, there is need for an intersectoral approach to the services offered at that period. There should be an efficient collaboration among the different medical personnel, from the midwives, the laboratory scientist, doctors and even the people outside of the health facility. The government’s role would be in the provision of utilities such as electricity, water, and drugs supply at all times to health facilities.

Benin cultural troop at the opening ceremony of the SOGUN Conference.

*Reported by Nnenna Ike

Failure of CEDAW, NIRH bills passage retrogressive

Dr. (Sir) John Okaro, President, Society of Gynaecology and Obstetrics of Nigeria (SOGON)

Failure Of CEDAW, National Institute of Reproductive Health Bills Malicious And Retrogressive---SOGON

THURSDAY November 15, 2007 BENIN, NIGERIA ----The failure of the National Institute of Reproductive Health (NIRH) and the CEDAW Bills at the Nigerian legislative houses has been described as malicious and retrogressive in view of the fact that these bills would have started a marked reduction in the number of women who die in Nigeria due to pregnancy-related complications and their natural roles as women. Though Nigeria contributes only 2% of the world population, she contributes up to 10%of the deaths of women who die from pregnancy with an estimated 53,000 dying every year!

Prof (Sir) John Okaro, President of the Society of Obstetrics and Gynaecology of Nigeria (SOGON) made this assertion, Wednesday at the Pre-Conference Press briefing of the 41st Scientific conference and AGM of the Society. According to him, the failure of passage of the National Institute of Reproductive Health (NIRH) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), both women-friendly Bills would make the Nigerian statistics on maternal and neonatal deaths remain unacceptably high because of the misconception that the bills will promote abortion.

The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) is the only human rights treaty which affirms the reproductive rights of women and targets culture and tradition as influential forces shaping gender roles and family relations, while the National Institute of Reproductive Health (NIRH) sought to promote the reproductive health of the vulnerable –all women. The Convention provides the basis for realizing equality between women and men through ensuring women's equal access to, and equal opportunities in, political and public life -- including the right to vote and to stand for election -- as well as education, health and employment. State parties agree to take appropriate measures against all forms of traffic in women and exploitation of women.

The 41st SOGON scientific conference kicked off yesterday Wednesday 14, 2007 in the ancient city of Benin in Nigeria, with the body calling on the media to wake up to its responsibility of educating the Nigerian masses with the view of reducing the three delays that lead to maternal mortality in Nigeria. His words, ‘the press is the bulwark of the future of the Nigerian women, and thus the future of Nigeria. Only the effective partnering of the Press with the medical professional associations would bring about the needed change amongst the populace and even among policy makers.’

Prof. Ladipo, Executive Director AFRH Ibadan, Oyo State, Nigeria

Professor Ladipo, Executive Director of Association for Reproductive and Family Health Ibadan, reiterated that only the proper understanding of the three delays by all would lead to a reduction in the deaths of Nigerian women during pregnancy. The Press should educate Nigerians about the delays at home, delay in getting to a health facility and the delay in accessing medical care at the facility. According to him, ‘Addressing these delays require that we provide appropriate education to our people, and we raise their level of confidence in the health system, then at the same time, make provision for community midwives who will reside at the communities to be available and skilled. A lot more still needs to be done from the point of view of improving the man power, improving the commodity supply, ensuring that electricity is regular, ensuring that water supply is regularly available, and ensuring that the morale of the health workers themselves is improved.’

Professor Emmanuel Dipo Otolorin, Country Director of ACCESS Nigeria called for more political commitment towards issues that concern women and children from the Nigerian polity. He called on the political leaders to take necessary steps that would ensure that posterity remembers them for good, by making statements and taking the actions to implement them. According to him, ‘Leadership should not be about oneself and the gains for one’s family, it should be about what I helped other people to achieve, what legacies I was able to put in place that would make people to remember me for good.’

The fact that about 53,000 women die annually in Nigeria is a grim realty that Nigeria policy makers have not firmly grasped in the past. These women die mainly from complications during pregnancy and delivery which include excessive bleeding after delivery, sepsis, pregnancy associated high blood pressure, anaemia, malaria and unsafe abortion. Most of these deaths are preventable if the society is better enlightened, social amenities in place and the health system given a boost of motivated personnel, drug supply and the right equipment to handle emergency obstetric complications.

The SOGON Conference is a 4-day event with the main theme being Intersectorial collaboration for improving maternal and Neo-natal Health, while the Subthemes are Prevention of Cervical Cancer, Post-partum Haemorhage.

*Reported by Nnenna Ike

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Friday, 9 November 2007

MacArthur Foundation pledges to lower maternal mortality in Nigeria

During last month’s Women Deliver conference in London, the president of the John D. and Catherine T. MacArthur Foundation, a private US based grant- making organization, announced that the Foundation will invest $11 million to reduce maternal deaths due to post partum hemorrhage in Nigeria and India.

This substantial investment includes the distribution of anti shock garments, a low cost neoprene suit that helps to stabilise women who are bleeding after child birth, as well as the uterus-contracting drug misoprostol to prevent bleeding, a calibrated blood collection drape to diagnose bleeding, and transportation to get patients to a health facility for assessment and treatment as appropriate. This promises to be very useful as 23 percent of Nigeria’s maternal deaths are due to hemorrhage, particularly in rural areas where transportation to health facilities is often delayed due to poor roads and poor communication.

The anti shock garments are made of lightweight neoprene and resemble the bottom part of a wetsuit. Originally it was developed for use on the battlefield. One of its benefits in a resource-poor environment is that it can be manufactured inexpensively and is reusable up to 100 times. When the suit’s five Velcro closures are tightened around the patient’s body, the compression stops blood from flowing to the lower extremities and forces it back to the hearths, lungs, and brain to counteract the shock. The results are immediate, buying time to transport the woman to a health facility where she can receive care. The woman can even remain in the garment for two to three days, if necessary.

According to a release by Pathfinder International, an organization that provides women, men, and adolescents with access to quality family planning and reproductive information, the introduction of the intervention package will happen in three waves. Pathfinder International and its partners will conduct outreach at the national and local levels to educate policymakers and local leaders about its benefits. Then they will provide training to over 900 health care personnel working in 500 sites and 500 traditional birth attendants working in communities. This training will enable health workers to implement the life-saving interventions and to ensure that women who are referred from the community will receive appropriate care once they reach the hospital. Finally, Pathfinder International will raise awareness among community members about complications that can be remedied with the help of the anti-shock garment.

The grant money allocated by MacArthur Foundation will not only go towards the anti shock garments and health packages for women, but also to addressing other indirect causes of maternal mortality include poverty, income inequities, underdevelopment, gender disparities, poor education, conflicts, food insecurity, and other social determinants of health.

Women Deliver was the biggest conference on women’s health in the last 20 years. Over 1,500 politicians including Ministers from Africa and Asia, human rights activists, NGOs, faith based organisations, health professionals and economists met at London's Excel Conference and Exhibition Centre to assess progress made in preventing maternal deaths and promoting child survival since the 1987 Safe Motherhood conference in Nairobi, Kenya.

*Reported by Amanda Hale

Thursday, 8 November 2007

Malnutrition is a leading cause in child deaths

A recent release from Population Reference Bureau in Washington D.C. showed that malnutrition plays a prominent role in the deaths of about 16, 000 young children every day, and virtually all of them in the developing world. This a yearly toll of almost six million children lost to malnutrition. According to the report, nearly 50 per cent of all young children in the developing world do not receive enough iron in their diets, endangering their mental and physical development.

"Malnutrition is the underlying cause of millions of deaths, but lacks public recognition because it does not kill young children directly, as does pneumonia or diarrhea," said Bill Butz, PRB's president. "Many of these deaths could be averted through nutrition measures that are known to be effective, often at low cost."

In Nigeria, where fertility rates continue to rise, women give birth to an average of six children during their lifetime. With so many children born annually, the population has skyrocketed. This means that many children are left without the proper nutrition or vitamins needed to fully develop their bodies into adulthood. According to Doctors Without Borders emergency coordinator Ton Koene, malnutrition in Nigeria is a growing and dangerous problem. Koene worked in southern Borno state in Northern Nigeria during a measles epidemic in 2005, and saw first-hand the effects that malnutrition had on the young population. Out of the 2,500 children screened in southern Borno state, between one to two per cent suffered from severe acute malnutrition (SAM).

"This is quite alarming and particularly unacceptable in conflict-free Borno state," said Koene.

Such a high rate of malnutrition is caused by a number of factors. For one, a large number of young mothers stop breastfeeding too early and are unable to give their babies a healthy, varied diet. Chronic food insecurity is another factor. According to Koene, severe droughts throughout the northern region of Nigeria upset the food supplies of families living there.

To respond, Doctors Without Borders set up several therapeutic feeding centers in Borno state to give malnourished children up to eight meals of special high-protein milk around the clock until they gained enough weight to be released. When little ones were too weak to swallow, they were fed through a tube to their stomach or put on a drip. This process lasted up to six weeks.

Koene suggests that in order to prevent the issue of malnutrition in Nigeria, the government has to deal with deeply rooted social and cultural aspects and to get involved into development issues such as agricultural schemes and long-term education.

"The sad part is that so many child deaths can be prevented through micronutrient supplies or a more effective agricultural system," said Koene. "The government just need to implement these things to see a difference."

*Reported by Amanda Hale

Tuesday, 30 October 2007

The Right to Life and Survival in Nigeria

The right to life is the most obvious right that could be applied to protect a woman at risk of dying in childbirth due to lack of obstetric care. Given the magnitude of an estimated 1,400 maternal deaths worldwide each day, it is remarkable that so few legal proceedings have made their way into Nigeria's national courts to require that the government take all appropriate measures to identify the causes of maternal mortality. This is due in part to families and communities in which women have died of pregnancy-related causes not understanding how governmental neglect of the conditions in which women bear pregnancies and give birth violates their right to life.

Effective protection of the right to life requires that positive measures be taken to ensure access to appropriate health-care services, enabling women to go safely through pregnancy and childbirth and providing couples with the best chance of having a healthy infant. Positive measures might include progressive steps taken to ensure an increasing rate of births are assisted by skilled attendants.

The right to liberty and security of the person is one of the strongest defenses of the right of women to free choice of maternity. If governments and agencies which administer health services fail to provide conditions necessary for safe motherhood, they are accountable for violations of women’s right to liberty and security of the person, and must take all appropriate steps to prevent and remedy the situation.

The right to liberty and security of the person can be applied to require that positive measures be taken to ensure respect in the delivery of reproductive health services to women who are at particular risk. Sometimes adolescents hesitate to seek reproductive health services because they fear that their confidentiality might be breached. They fear, perhaps incorrectly, that information about their sexual behaviour, which they have to make for appropriate health care, will be disclosed to their parents, parents of their partners, teachers and others.

As a result, special care and attention needs to be given to informing adolescents in the community through positive assurances that confidentiality will be protected, and to training health personnel appropriately.

*Reported by Adanma Ike

Domestic violence spurs maternal and child deaths

While the level of violence against Nigerian women in the home remains poorly mapped, pilot studies conclude it is "shockingly high".

According to the Amnesty International 2005 Report on Violence Against Women in Nigeria, one-third of women in the country are believed to have experienced sexual, psychological and physical violence in the family. The report states that 50 per cent of men and women justified the beating of women. The study also showed that 64.5 per cent of women and 61.3 per cent of men said that a husband has the right in hitting or beating the wife for some reasons including lateness in cooking food.

Closer to home in Lagos state, up to two-thirds of women in certain communities are believed to have experienced physical, sexual or psychological violence in the family, and in other areas, around 50 percent of women say they are victims to domestic violence. In a recent small-scale study of gender inequality in Lagos and Oyo states, 40 percent of the women interviewed said they had been victims of violence in the family, in some cases for several years. The study concluded that such violence was not documented in Nigeria because of widespread tolerance of violence against women.

“Once a woman is married, she is expected to endure whatever she meets in her matrimonial home," according to information released by Amnesty International.

Though a bill on violence against women (prevention, protection and prohibition) is pending in Nigeria, many women are still denied a fair trial in cases relating to domestic violence. Many courts see domestic violence as a personal affair within the family, and leave the issue to husbands and male family members to judge.

But the consequence of hushing domestic violence is enormous. Researchers have found that abused women tend not to use family planning services, even if readily available, for fear of reprisals from husbands. Women in Nigeria and Kenya, for instance, often hide their contraceptive pills because they are terrified of the consequences should their husbands discover that they no longer control their wives' fertility. Similarly, abused women who participated in focus group discussions in Peru and Mexico said they did not discuss contraceptive use with their husbands out of fear that the men would turn violent. As a result many abused women have unwanted pregnancies resulting in unsafe abortions.

Domestic violence can cause sexually transmitted diseases, including HIV/AIDS, persistent gynecological problems, and psychological problems, including fear of sex and loss of pleasure. As such, domestic violence must be addressed as one of the crucial barriers to maternal, newborn and child health. Politicians, health workers, educators, and the media cannot hope to eradicate maternal and child deaths if such violence against women in Nigeria continues.

*Reported by Amanda Hale

Thursday, 25 October 2007

Advancing Safe Motherhood through Human Rights

Do laws and policies facilitate or inhibit women’s access to reproductive health care and obstetric care? Most systems have core principles of medical law that protect the right to informed and free decision-making by patients, their privacy and confidentiality, the competent delivery of services, and the safety and efficacy of products.

Laws that obstruct women’s access to information and care can function as direct causes of maternal mortality. Preventing access to services are laws that criminalize medical procedures that only women request, and that may be indicated to save their lives and health, such as those that govern contraception and abortion. While often tied to social or religious concerns, these criminal laws put women at risk when they prohibit treatment necessary to save the lives of pregnant women.

Systems of health law and policies that restrict women’s reproductive choices are usually based on historical connections between sexuality and morality. Many restrictive policies reflect the idea that women’s sexuality and access to birth control endanger morality and family security.

Laws that entrench women’s inferior status to men and interfere with women’s access to health services seriously jeopardize efforts to reduce maternal mortality. These laws take a variety of forms, such as those that obstruct economic independence by impairing women’s inheritance, employment or acquisition of commercial loans or credit. Account should be taken of criminal laws that condone or neglect violence against women, and, for instance, of inequitable family, education and employment laws that deny adult women alternatives in life to marriage, or that condition women’s self-realization on marriage and motherhood.

The cumulative impact of such laws is often that daughters are seen to burden their families, that their deaths in infancy are inconsequential, and that they will remain in the home to serve other family members until marriage. On marriage, they will obey their husband’s families by rendering services and bearing sons. Accordingly, daughters will be given in marriage to men they do not choose, have no independent status or means while unmarried, conceive early and often in marriage, obediently protect family, social and cultural values before and in child rearing, and be vulnerable to violence and death if perceived to endanger family honour.

A necessary first step towards applying human rights to advance safe motherhood is an assessment of the scope and causes of unsafe motherhood in a particular community, based on available data sources, or on the collection of relevant new data. Where possible, maternal death should be investigated. A maternal death investigation should establish both medical and non-medical causes of death, and whether the death occurs in a hospital or at home. Several factors may influence the success of a maternal death investigation. It must be made clear that the purpose of the investigation is to find ways to reduce maternal mortality – not to find blame.

Account should be taken of criminal laws that condone or neglect violence against women, and, for instance, of inequitable family, education and employment laws that deny adult women alternatives in life to marriage, or that condition women’s self-realization on marriage and motherhood.

Laws and policies that obstruct free choice of maternity, and the availability of and access to services, should also be identified, along with laws that facilitate women’s empowerment and laws that obstruct women's empowerment.

*Reported by Adanma Ike

Wednesday, 24 October 2007

Confronting the Issue of Unsafe Abortion

London, Oct. 22, 2007 (NAN): Every year, unsafe abortion kills more than 66,000 women worldwide and maims millions more, the latest statistics show that figure has remained virtually unchanged over the last decade.

The medical journal The Lancet which called it one of the most neglected public health issues of our time, also said that in Africa the statistics have even increased.

What actions can those in power take to stop these deaths? This will form part of the talks at the Global Confrence on Safe Abortion holding in London from Tuesday.

The News Agency of Nigeria (NAN) correspondent who is covering the conference interviewed some participants.

Mrs Maria Meva, a female activist and member of `Catholics Advocate for Choice' from Mexico who spoke with NAN said that those in power should look beyond religious and cultural sentiments and look at the maternal mortality rate in their countries.

She said: ``Mexico just de-criminalised abortion after several years of struggle and between April and now, maternal mortality has dropped trmendously in the city, where it is allowed.''

She said also the U.S restrictions have created a climate in which health care providers in developing countries cannot provide safe abortion care without jeopardising their US funding.

The Ipas co-ordinator of the Advocacy meeeting which took place in London today, Charlotte Horde told NAN that the few countries where the abortion laws had changed, maternal deaths had dropped significantly.

``Conversely, the new blanket abortion ban in Nicaragua pushed through by conservative church leaders has led to increased maternal death,'' said Christine

Gunzalose, a medical doctor and the Nicaraguan representative at the adocacy meeting.

``These deaths are an outrage and completely preventable,'' she added.

The conference which starts tomorrow is expected to have speakers Like Moji Makanjuola of Nigeria Television Authority presenting a paper on Media partnership and other speakers from various countries including Kenya. (NAN)

Melodrama as pro-life activists beseech conf. venue

London, Oct. 23, 2007 (NAN): A melodrama ensured today outside the Queen Elizabeth 11 Conference Hall, London as `Pro-life' activists beseeched hall chanting pro life slogans and giving out flyers.

Queen Elizabeth 11 Conference Hall is the venue of the Global Conference on Safe Abortion holding in London, the conference started today, few days after the Safe Motherhood Conference in the same city.

`Pro-Life' activists are those who do not believe in the reformation of abortion laws, they believe that any conception is Life and should not be terminated under any guise.

The News Agency of Nigeria NAN) reports that by eight in the morning, the activists were outside the hall holing placards bearing pro-life messages and distributing flyers with the same messages.

There was quite a number of security personnel clad in yellow reflective coats and helmets, holding batons and making sure the activists do not cross the line, and do not enter the hall.

Karen Fish, a pro-life activist, who gave the NAN correspondent a pro-life flyer said that the leaflet was meant for intelligent open minded people, discussing issues of justice and human rights around abortion.

`` So killing someone is now a human right ? who protects the rights of the unborn child ?'' she asked.

In Karen's hand was a banner bearing, ``Women's needs are more than Abortion''.

Other male and female activists had banners bearing different messages like ``Women do not need Abortion'', ``To legalise abortion is to bring guilt of innocent blood upon the whole nation'' and ``Abortion is a sin against another human being and God''.

The activists were still seen outside the hall when the opening ceremony started at noon.

A black woman, who says she is just Ngwemu told NAN that, the donor bodies who want to help Africa could do other things for them other than abortion.

``Our women do not need abortion, they need empowerment, if they have things to do they will not get pregnant, nor seek abortion.

``These funds should be channelled towards skills acquisition and capacity building as well as loans for small scale enterprise for them to have economic power. (NAN)

Nigerian Women urged to stand-up for their rights

London, Oct. 23, 2007 (NAN): As the Global Safe Abortion Conference begins today in London, Nigeria women have been asked to stand-up for their rights.

Prof. Fred Sai, A former Senior Population Advisor to the World Bank on Population, and Adviser to the Ghanian President told the News Agency of Nigeria that for Abortion laws to be reformed, Nigerian women had to be stand up to say they want the reforms.

Sai, who said he knew when the late Prof. Olikoye Ransome Kuti was trying to get the laws reformed in 1994, that some women groups opposed it and up to last year women were still opposing the reforms of the abortion laws in Nigeria.

``There are many powerful women in Nigeria, when they stand up to say they want the laws reformed
they will get it reformed.

``Nigeria needs an internal revolution, the women should see the lives lost or maimed by the restrictive laws and speak out to keep women alive.

``Abortion happens whether legal or illegal, by making it legal, women would access it when they need in health facilities that are registered and with experts, Sai said.

The population expert told NAN that sometimes he wishes some African countries did not get their independence before 1967, because then they would have inherited the reformed abortion laws not the old one which was inherited.

He said : ``We inherited the abortion laws, fourty years after the colonial master reformed their laws, we are yet to change ours in most African countries.''

In a philosophical manner, he said we in Africa were like a choir and we take songs from the western world, change them into our local language and they become ours, that is what we have done with abortion laws, we have made it ours.

He said that before colonialism, there had been issues of unwanted pregnancies in Africa, in cases of rape or incest or pregnancy out of wedlock.

He said in such cases infacticides were committed. ``Any child who would bring dis-honour or stigma to
the family was killed at birth, why are we now behaving as if unwanted pregnancies was new to Africa.?''

He said that the number of valuable lives lost in Africa through unsafe abortions and unwanted pregnancies cannot be quantified economically.

He said some people commit suicide when they have unwanted pregnancies, some visit quacks and loose their lives or become eternally infertile.

``When will we begin to value these lives and allow the woman make her own choice,'' Sai questioned.

Expand access to safe abortion

London, Oct. 23, 2007 (NAN): Expanding access to safe abortion around the world formed the agenda for the opening ceremony of the Global Abortion Conference today in London.

The News Agency of Nigeria (NAN) reports that not less than 800 delegates, made of public health experts, government representatives and women's health advocates from 60 countries around the world are at the global meeting.

Mr Dana Hovig, Chief Executive of Marie Stopes International (MSI) who opened the conference said that the purpose of the global meeting was to build a momentum around the appalling toll on women's health and lives caused by unsafe abortion.

The organisers of the Conference, MSI, Ipas and Abortion Rights, all NGos working to promote women's reproductive health and rights, called for increased access to safe abortion services, recognised women's
right to self-determination in exercising their reproductive choices, and encouraged efforts to secure legal reform.

Christine McCafferty, a member of the British Parliament, chair of the All Party Group on Population, Development and Reproductive Health, who chaired the opening ceremony, said that the unsafe abortion.
was a tragedy.

``The tragedy of unsafe abortion is still greater given that we have the technology to prevent almost all of the these deaths resulting from unsafe abortion. we cannot sweep it under the carpet.''

Hovig told NAN that attention to the need for governments and donors to significantly increase their investment in making comprehensive sex education, contraception and safe abortion more widely accessible.

``All around the world especially in the poorest countries, unsafe abortion kills women and girls solely because they lack access to safe abortion care, of all the causes of maternal mortality, unsafe abortion is the easiest to prevent.

``It is time for governments and donors to step up and make resources available,'' the MSI Chief Executive said.

Ipas President, Elizabeth Maguire, told NAN that the continuing death toll and injury from unsafe abortion
was a moral outrage and a gross violation of women's basic human rights.

``How many more poor women and girls must suffer or die before we start taking action?'' she asked.


Friday, 19 October 2007

Child Brides: Stolen Lives

Bilikisu doesn't want to marry. She is adamant about this. But in her village nobody heeds the opinions of headstrong little girls. She is desperate to turn herself into an adult. Then maybe, just maybe, her family would respect her wishes not to wed. She could rebuff the strange man her papa has chosen to be her husband. And she wouldn't have to bear his babies.

Bilikisu's short legs can't carry her away fast enough from the death of her childhood. Her wedding is five days away. And she is seven years old.

Child Brides: Stolen Lives is the title of one of the many documentaries showcased at this year's Women Deliver Global Conference, a conference aimed to reduce maternal and child mortality. The conference, held on October 18-20 in London, brings together medical practitioners, health workers, government bodies, teachers, and advocates to pressure governments into integrating maternal, newborn and child health into their budgets and health plans.

Bilikisu's story is one of many. Coerced by family and culture into lives of servility and isolation, scarred by the trauma of too-early pregnancy, child brides represent a vast, lost generation of children. According to child-rights activists, an estimated 50 million Bilikisus are scattered across the world--young teen or preteen girls whose innocense is sacrificed to arranged marriages, often to older men.

The most far-reaching injustice of child marriage by far is probably its most subtle: it pries millions of young girls out of school. Confined to their husbands' homes, cheated of the benefits of education, these legions of demoralized children are condemned to lives of ignorance and dire poverty from which they rarely escape, and which they endure with numbed desperation.

All the misery and pain occur in silence. They are just children. They don't speak out. They are never heard from.

Problems attributed to child marriage include health and education issues such as poor health, early death and lack of educational opportunities. Education is the most important key to helping end the practice of forced child marriages. Many believe that education may prove to be more successful in preventing child marriages than simply banning child marriages. It is important to provide education to children and parents that will broaden their horizons and convince parents that educating their children is beneficial to their future.

Apart from reading, math, and writing, young girls should learn life skills (including reproduction and contraception information), as well as how to have fun and how to play in sports--all of this is proving to be a positive way to change the lives and futures of adolescent girls.

In India, child marriages have reduced by up to two-thirds due to more educational opportunities for young girls. Girls who are able to complete primary school tend to marry later and have fewer children, thus lowering the rate of maternal and child mortality.

*Reported by Adanma Ike

Thursday, 18 October 2007

Investing in Women Is Smart Economics, Women Deliver Conference Shows

A Family Care International Press Release

LONDON – Skyrocketing health care costs and slow economic growth in developing countries could be combated by government investments in family planning, antenatal care for mothers-to-be and skiled care at delivery, according to reports prepared for an upcoming conference here.

Financial experts and leading economists are among more than 1,500 world leaders taking part in Women Deliver, a landmark gathering 18-20 October at the ExCel Conference Centre on reducing pregnancy-related deaths and disabilities worldwide. The theme of the conference is "Invest in Women: It Pays!"

One study estimates that the global economic impact of maternal and newborn deaths at US$15 billion per year in lost potential production, half associated with women and half with newborns. At the moment, one woman dies every minute from complications of pregnancy and delivery--some ten million per generation--and four million newborns die every year.

The World Bank says much of the illness and death that strikes down women and their children each year could be avoided if they had access to stronger helath systems capable of providing core programs of maternal and child health, nutrition, and family planning. Stronger systems could help developing countries to improve the health and well-being of millions of the world's poorest people, boost economic growth, and reduce poverty caused by catastrophic illness.

"Investing in better health for owmen and their children is just smart economics," said Joy Phumaphi, the World Bank's Vice President for Human Development, a former WHO Assistant Director General for Family and Community Health; and Health Minister in Botswana, 1999-2003. "Good health is often thought to be an outcome of economic growth, but increasingly, good health and sound health systems policy have also been recognized as major drivers of economic growth. Educating girls, equal economic opportunities for women, and fewer households living below the poverty line are also vital parts of a strategy to achieve lasting good health for mothers and their children."

At the moment, women's work in housholds, farms, and care-giving equals about a third of the world's gross national product, according to repeated studies--and that is just unpaid work. In addition, women are the sole income earners for up to a third of all households. A mother's disability or death not only raises death and illness rates for her children and destroys families; it also lowers overall community productivity.

Documents prepared for the gathering argue that spending on women's needs creates a "virtuous circle" that raises productivity and lowers overall health care spending. Investing in family planning, for example, lowers the rate of unintended pregnancies, which reduces unsafe abortions, which reduces health care costs. In some countries, up to half of all hospital spending on obstetrics and gynecology goes for treating complications of unsafe abortions.

"Investing in saving women's lives is an incredibly cost-effective thing to do," said Jill Sheffield, president of Family Care International, organizing partner for the conference. The package of services needed to make significant improvements in maternal health would cost less than US$1.50 per person in the 75 countries where 95 per cent of maternal deaths occur, she said.

"This amount is well within reach of donor countries and governments," Sheffield said. "Ministers of health, finance, development and economy are going to hear this message loud and clear at Women Deliver."

Contact: Philip Hay at phay@worldbank.org.

UK Pledges 100 million Euro to UNFPA to make childbirth safer and promote reproductive health

UNFPA and DFID Joint Press Release

18 October 2007

LONDON, -- Maternal deaths and unwanted pregnancies can be cut dramatically in countries around the globe after hte British government today pledged 100 million Euro to UNFPA, the United Nations Population Fund, to achieve universal access for reproductive health.

"Maternal health can be improved through strengthened political commitment and the dedication of increased resources. Life or death is a political decision," said Thoraya Ahmed Obaid, UNFPA Executive Director. "The United Kingdom's generous investment in women will enable UNFPA to provide urgent, coordinated and sustained action to save mother's lives. There can be no safe future without safe motherhood--no women should die giving life."

The 100 million Euro over five years was announced today by Douglas Alexander, the UK's Secretary of State for International Development, who called on leaders of the world's poorest countries, especially in Africa, to make women's health a priority on the opening day of Women Deliver, a three-day global conference aimed to reduce maternal mortality.

"The death of a mother deprives a child, a family, a community and ultimately a couny of one of its most valuable sources of health, happiness and prosperty," said Alexander, addressing delegates on the opening day of Women Deliver, a global conference aimed at reducing maternal mortality. "Every minute a woman dies from complications during pregnancy or childbirth. More than 10 million women have died in the last 20 years. This is a tragedy but so is the fact these deaths could have been prevented."

To address this challenge, the UN General Assembly endorsed earlier this month a new target to acheive universal access to reproductive health as part of the Millennium Development Goal 5, which calls for hte reduction of maternal mortality by three quarters by 2015.

Although progress has been made in such countries as Egypt, Honduras, Sri Lanka and Thailand, maternal deaths remain high, particularly in sub-Saharan Africa and South Asia. A woman in Africa faces a 1 in 26 lifetime risk of maternal death compared to 1 in 8,200 in the United Kingdom.

An estimated 720,000 unwanted pregnancies could be averted, 300,000 abortions could be prevented and the lives of 1,600 mothers and 22,000 infants could be saved for every 1 million Euro invested in family planning, Alexander said.

Capps to Lead Bipartisan Women’s Caucus Congressional Delegation to Represent United States at Women Deliver Conference in London


Press Release from U.S. House of Representatives

Contact: Emily Kryder
October 16, 2007 202-226-7747 office
202-225-6513 cell

WASHINGTON, DC – Congresswoman Lois Capps, Co-Chair of the Congressional Caucus for Women's Issues, will lead a bipartisan Congressional delegation in representing the United States at the Women Deliver Global Conference on Maternal Mortality. The delegation members, Congresswoman Hilda L. Solis, Congresswoman Gwen Moore, Congresswoman Donna Christensen,Congresswoman Louise Slaughter, and Congresswoman Candice Miller will join more than 1500 world leaders--including cabinet ministers, heads of United Nations and other multilateral agencies, senior government officials, health professionals, researchers, economists, and reproductive health advocates- in a historic conference in London from October 18-20. Conference participants are meeting in an effort to reduce the 500,000 deaths that occur annually due to pregnancy and childbirth.

Despite advances in medical care and technology around the world, motherhood remains a risky endeavour that results in millions of tragic deaths annually. These fatalities are a major factor in persistent global poverty, yet many of these needless deaths could be prevented with effective, low-cost investments in preventive health care and education. The Women Deliver Conference participants will examine strategies to improve how health information and care are funded and provided as well as address other important issues for women including poverty reduction, women's human rights, and economic development.

Nigeria’s Minister of Health presents Maternal, Newborn and Child Health Strategy benefits at Women Deliver Conference in London

Nigeria’s Honourable Minister of Health travels to London this week to present at the 2007 Women Deliver Global Conference on how a national maternal, newborn, and child health strategy can promote a continuum of care and reach out to mothers and newborns everywhere.

The Women Deliver conference, from October 18th to 20th, marks the twentieth anniversary of the world's first-ever Safe Motherhood conference in 1987 in Nairobi, Kenya, where delegates gathered to protest the near-silent tragedy of mothers dying from childbirth, and issued an international call to action to cut maternal mortality in half by the year 2000.

Now, twenty years later, mothers and children are still dying from avoidable deaths. In Nigeria alone, six women die every hour from birth-related causes that could be prevented from simple medical interventions such as cesarean sections or malaria vaccinations. Funding for state and local hospitals, while increasing, is still only about 20 per cent of the overall government health funds in Nigeria, which is not enough to provide adequate staff, equipment, or medical training.

It is conditions like these in Nigeria and around the world that prompts the Women Deliver conference to revisit the 1987 goal of reducing maternal mortality and cast an urgent cry to governments and agencies to invest in women, mothers, and children. The conference, themed, "Invest in women--it pays" focuses on improving women's and newborn health, advancing human rights, expanding financial resources, building political will, and promoting women in the world.

Women are central to every society, and investing in women's health will not only save lives but strengthen the economic, social, and political health of every nation. Following this theme, the conference includes personal testimonials from women and children illustrating how small investments helped them to become agents of change in their communities. As well, representatives of World Health Organization (WHO), International HIV and AIDS Alliance, United Nations Population Fund and more will present studies on how improvements in the lives of women and girls translate into improvements in their health, in the health of their children, reductions in fertility, and high returns to overall economic progress. Delegates will be given the opportunity to then devise innovative strategies and partnerships for increasing investment in women’s health.

By encouraging governments to integrate women’s health and rights into national plans and strategies, the health policymakers, medical professionals, and public-health experts at the conference can fulfil the promise made in Nairobi, Kenya, and deliver for today’s women, mothers, and children in Nigeria and around the world.

*Reported by Amanda Hale

Tuesday, 16 October 2007

It’s a Boy!...but she died

Somewhere in rural Nigeria...Zeinab had been pregnant six times within eight years, and had given birth to six girls. Though they had decided not to have another child, they felt they could not afford to see a family planning method just yet. During the time her husband was putting aside money so she could go and obtain a contraceptive method, she became pregnant for the seventh time.

The pregnancy proceeded normally, but when she went for her first and only visit to the village health post, the local nurse’s aide told her she was anemic and recommended that she take iron supplements.

Late one night, Zeinab began to feel abdominal pains and thought it was time to give birth, though the pain seemed different.

By dawn, eight hours later, the baby was still not coming out and she started to bleed. A local birth attendant was summoned who administered some herbal medications for the bleeding and attempted to manually manipulate the baby.

By then Zeinab’s husband was terrified, and gathered his savings to get a vehicle to take her to a health centre. Finally, at 1:00 in the afternoon, Zeinab’s husband managed to hail a truck to transport his wife. They arrived at the health centre, but had to wait for a doctor to eventually deliver her of a baby boy. However, the arrival of the baby boy rather than kickstart a phase of joy for the family, began what seemed an endless moment of grief. Zeinab began to hemorrhage shortly after child birth. There was no blood available for a transfusion, and Zeinab died.

This scenario depicts the social and health situations that give rise to the high maternal mortality rate in Nigeria. Lack of decision-making power and insufficient access to resources prevent women from making the strategic decision to seek medical help at the point where it can determine if she or her baby dies or lives. Often male members of the family, who largely control the resources, make these decisions. This underscores the importance of male involvement to ensure that resources are available to women in need. Effective male involvement will ensure that childbearing is made safer for mother and child.

Lack of resources is another reason why women fail to use available health facilities. 67 % of Nigeria’s population lives below poverty line, and bills for hospital treatment do not rank high for families, especially where traditional birth attendants are available. Low use of contraceptive contributes to high fertility rates thus increasing the risk for mother and child. Though family planning awareness is increasing, contraceptive use is still low. Place of delivery and the quality of maternal health care have a significant impact on maternal mortality. At present only 37 per cent of births take plaace in a health facility though the figure varies slightly in different regions of the country. Malaria is known to predispose women to anemia, low birthrate babies, spontaneous abortions and premature deliveries while HIV/AIDS make them vulnerable to opportunistic infections besides passing the virus to their babies during pregnancy, delivery and/or through breast feeding.

The goal of the Reproductive Health (RH) Policy is to create an environment for appropriate action and provide the necessary impetus and guidance to national and local incentives in all areas of RH. In this regard, greater attention shall be paid to reducing high maternal mortality through effective antenatal, prenatal, and neonatal care, delivery, post-natal and breast feeding programs. The overall goal of the Reproductive Health Policy are laudable but the issue at stake is how effective have the policy strategies to achieving this goal been?

*Reported by Nnenna Ike

Married at Seven: Stories from Child Brides in Nigeria

“I was married at the age of seven. My husband was much older than me. He waited until I was nine years old to have intercourse. It was very difficult. He passed away when I was 12 years old. I was pregnant at the time, but lost the baby after a difficult labor, which went on for days. I do not want to re-marry. I do not want any man to come near me.”
-Amina, a child bride

Amina is one in thousands that has such a story. Around 15 million young women between the ages of 15 and 19 give birth annually, accounting for more than 10 per cent of the babies born worldwide. Because adolescent females are not yet fully developed emotionally and physically, pregnancy and childbirth are often life threatening and the outcomes for their newborns are much worse than for older women.

The impact of early marriage is tremendous on women and their families worldwide. Besides the number of health issues associated to early marriage such as fistula or maternal death, child bridges are typically deprived of an education, and thus condemned to a lifetime of dependence on her husband and his family. More than one third (35 per cent) of Nigerian women experience their first pregnancy by the age of 19 or below (10 per cent have their first pregnancy by age 16).

The early age of marriage, especially in certain parts of Nigeria, puts these girls at great risk. The earlier a girl is married, the earlier she starts having children. The earlier she starts getting pregnant without a fully developed body and reproductive system, the higher her risk of dying with the pregnancy or from birth complications. Many of these young mothers, due to natural ignorance, cannot decipher and alert
others of the signs and symptoms of pregnancy malfunctioning and/or labour complications. These often lead to help getting to them when its too late.

Many of these women die in the prime period of their lives; the last glimpse of life being that of pain and great distress: from hemorrhage, convulsions, obstructed labour, or severe infection after delivery or unsafe abortion.

Research findings indicate that younger adolescents have a higher risk of delivering babies with low birth weight and delivering prematurely than older adolescents and persons who are 20 to 34. One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviours such as touch, smiling, and verbal communication.

*Reported by Adanma Ike

Practices in the Dark: Unsafe Abortion in Nigeria

Imagine you're travelling down a dark alley in Lagos. The road is uneven; potholes and open gutters seem to cover every step as you walk home. Grilled suya and plantain drifts into the air from cluttered street stands, and high life music mixes with hip-hop in the city's medley of car horns. The only light to guide you comes from amber flames lit in tin trashcans, and you stretch your arms out in front of you with each step, feeling for anything you may not see in the dark.

Now imagine that a young girl is crouched behind a cement wall, not five feet away from you. You don't see her, but she's there. In her hands are a small hanger and a pair of knitting needles. She's about to perform surgery. Armed with nothing but a pair of sharp objects and a bucket of water, she stabs her uterus and cervix until she nearly faints, unsure of whether she'll live or die. Today is her fifteenth birthday.

This is Nigeria's reality. Every day young girls and women perform unsafe abortions on themselves to terminate unwanted pregnancies, and no one notices. Moral and cultural beliefs prevent open dialogue about abortion, and laws prohibiting the procedure unless in order to save a woman's life make it very difficult for women to seek help when faced with an unwanted or accidental pregnancy. Because of this women must turn to private or unlicensed clinics, traditional healers, or themselves to terminate their pregnancy, which often ends with serious medical complications.

According to the World Health Organization, an unsafe abortion is “a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both.” Untrained medical practitioners, incorrect equipment, and unsanitary conditions in developing areas combined with certain laws that restrict abortion as a legal practice can lead to unsafe abortions for such women, resulting in deaths or serious infections that lead to infertility.

About 20 million, or approximately half, of the induced abortions each year are estimated to be unsafe. Out of these 20 million, ninety-five percent occur in developing countries like Nigeria.

But most deaths and complications from unsafe abortions are preventable. Abortions performed by trained health care providers with proper equipment, correct technique and sanitary standards are relatively simple and safe. According to the Alan Guttmacher Institute in the United States, the likelihood of women dying as a result of abortion performed with modern methods is no more than one per 100,000 procedures. In developing countries, this figure is several hundred times higher. This is due to factors like discrimination against abortion patients, inaccessible services in rural areas, poor medical equipment, and lack of attention to patients' medical, social, and cultural circumstances.

There is hope, however, for Nigerian women who face the uncertainty of an unwanted pregnancy. Many organizations and advocacy groups, such as Centre for Reproductive Rights and World Health Organization, have advocated that abortion procedures be made legal in non-emergency situations, to avoid women visiting non-licensed medical practitioners and putting themselves at risk of illness or death. These organizations demand that abortion delivery be improved around the world, and recommend the use of manual vacuum aspirations (MVA) for treatment of complications, that health care providers should be trained in the use of MVA, and that post abortion care services should be established throughout to offer contraceptive counseling and services to women who've had an abortion.

With these organizations lobbying for safe abortion practices, and with the rise of women undergoing painful procedures to terminate unwanted pregnancies, the Nigerian government will have to re-examine its abortion policies and determine whether the lives of thousands of women are worth throwing into the dark.

*Reported by Amanda Hale

To learn more about safe abortion advocacy, please visit the World Health Organization website at www.who.int.

Thursday, 4 October 2007

Nigeria hosts Global Mission for Maternal, Newborn and Child Health

Abuja, Nigeria— Efforts to reduce maternal mortality and improve child health in Nigeria are on the front burner as Nigeria joins the Partnership for Maternal, Newborn and Child Health. The Mission met with top government functionaries including Nigeria’s Honorable Minister of Health in Abuja.

Apart from government officials, the Global Partnership met with UNAIDS, the World Bank, the Society of Obstetricians and Gynaecologists of Nigeria, the Nigerian Medical Association, the Governor of Niger State, and the Honourable Speaker of the House of Representatives, among other professional health bodies. The purpose of the Partnership’s visit was to advocate a national strategy to eliminate maternal, newborn and child health across Nigeria, and to create a strong alliance among government agencies, NGOs, professional bodies, and media organizations to support the strategy.

The Partnership for Maternal, Newborn and Child Health is a new global health partnership launched in September 2005 to accelerate action towards achieving Millennium Development Goals (MDGs) 4 and 5. The Partnership joins the maternal, newborn and child health (MNCH) communities into an alliance of currently more than 125 members representing governments, donors, United Nation agencies, non-governmental organizations, private institutions, and academic and research institutions—all committed to ensuring that women, infants and children not only remain healthy, but thrive.

Since the Maternal, Newborn and Child Health National Conference held in March 2007, Nigeria has undertaken a number of steps towards rolling out the Integrated Maternal, Newborn and Child Health (IMNCH) Strategy. These include stepping up advocacy for strong and wide support; re-organizing the country’ Ministry to meet the challenges of roll-out; finalising the IMNCH Strategic document for printing and dissemination; mobilising resources for kick starting roll-out, and other support.

But much more needs to be done. Nigeria still suffers from one of the worst maternal mortality rates in the world; in fact, six women die every hour in Nigeria from birth-related complications. This is why members of the Global Partnership for Maternal, Newborn and Child Health met with Nigeria’s top government figureheads, including the Honorable Minister of Health and the Governor of Niger state, to discuss the growing need for a more effective implementation of a national maternal and child health care policy in Nigeria.

Following the Partnership’s advocacy tour, the Nigerian Federal Ministry of Health held a week-long orientation and planning workshop for selected stakeholders and partners on their roles in rolling out the IMNCH strategy. Development Communications Network will coordinate the media efforts behind Nigeria’s initial implementation of the Maternal, Newborn and Child Health strategy.

*Reported by Amanda Hale

Harvard-PEPFAR Tri-Country Conference concludes in Abuja

Abuja, Nigeria—The Harvard-PEPFAR Tri-Country conference wrapped up on September 15 in Abuja, after an intense round of forums, debates, and interactive sessions sharing the challenges and successes of Harvard-PEPFAR’s HIV/AIDS prevention projects in Nigeria, Tanzania, and Botswana.

Patient adherence, hospital and lab infrastructures, and challenges of administering antiretroviral treatment in resource-poor countries were among the top topics discussed at the conference this year. Harvard-PEPFAR directors also elaborated on the need to build partnerships with local and international NGOs and health institutes over the next ten years, so as to transition to sustainable and completely African-governed programs by the year 2017.

The conference, themed “Building Sustainable Partnerships in HIV/AIDS Programming” took place at the Abuja Sheraton and Towers from September 11 to 15, 2007 and featured delegates and partners from Botswana, Nigeria, Tanzania and the Harvard University teams based in Boston and Chicago, United States. The two previous conferences were held in Botswana and Tanzania respectively and allowed in-depth review and visits to PEPFAR supported sites in the host country.
“We want to show the world that African institutions can responsibly manage these large programs,” said Dr. Joe. Makhema of Botswana’s Harvard-PEPFAR program.

The PEPFAR ten year plan also calls for treating more than 2.5 million people and preventing more than 12 million new infections in Africa. To aid this ambitious vision, President George Bush of the United States announced a five-year, $30 billion proposal in addition to the United States’ initial $15 billion commitment made in 2003.

The keynote address of the conference was presented by Dr. Phylis Kanki, Principal Investigator of the Harvard-PEPFAR program, and focused on overlapping uses of antiretroviral drugs for HIV/AIDS prevention and therapy. Kanki’s presentation showcased the dilemma of researchers who struggle to create effective drug therapy in the face of high mutation rates and multiple AIDS subtypes that resist patients’ immune systems. The solution so far has been to overlap uses of antiretroviral drugs to target different subtypes, but according to Kanki this always runs the risk of generating drug resistance in patients.

There are no easy answers to the challenges facing researchers and medical staff in Harvard-PEPFAR’s programs, but as Dr. Joe Makhema stated at the end of the conference, “We need to carry these challenges on our shoulders and move forward.”

With plans for sustained HIV/AIDS prevention and treatment over the next decade, Harvard-PEPFAR will continue to be a leader in working with African institutions, international organizations and other partners to put accessibility, quality and sustainability at the center of all HIV/AIDS work. Next year’s Tri-Country conference will be held in Botswana, and will once again share the latest best practices and lessons learned from Harvard-PEPFAR’s treatment programs across the continent.

*Reported by Amanda Hale

Saturday, 15 September 2007

Challenges of antiretroviral treatment in resource-poor settings

In a 2001 U.S. Congress Hearing, Chief U.S. Aid A. Natsios publicly stated that if Africa was given antiretroviral treatment (ART) for its HIV/AIDS epidemic, its citizens wouldn’t know how to take the pills on time because they measured the hour by the sun.

“Africans do not know what watches and clocks are,” said Natsios. “They do not use western means for telling time. They use the sun. These drugs have to be administered during a certain time during the day and when you say 10:00, people will say ‘what do you mean by 10:00?’”

But contrary to Natsios’ statement, the complication of administering ART in Africa has nothing to do with the sun. Antiretroviral treatment has a possibility of serious side effects and it requires a high level of adherence on a daily basis. The drugs have been labeled as “unforgiving” in many medical studies if they are not used properly, and resistance may develop in patients that could compromise the entire treatment. For medical clinics, the cost of ART together with the cost of monitoring patients taking these drugs poses a major financial challenge to public health programs, particularly in developing countries where a lack of medical infrastructure and human resources could limit the access to professional and safe ART.

The overall goal of antiretroviral treatment is to better the life of people living with HIV/AIDS, as there is no known cure or vaccination for the virus. But scientists and medical practitioners have debated for years on the best time to start treatment to prevent immunologic damage and adverse side effects from drug toxicity. Cost of treatment, too, must be factored into the argument, as some resource-limited countries must give priority treatment to patients with obvious immunologic damage before moving on to the less urgent cases.

Dr. John A. Idoko, Department of Medicine at the University of Jos, spoke about the benefits of early antiretroviral treatment in Nigeria this week at the annual Harvard-PEPFAR conference on HIV/AIDS prevention. According to Idoko, a delay in initiating ART increases the risk of toxicities—such as skin rashes and bloated stomachs—in a majority of patients. Thus he proposes that medical staff initiate ART when patients have a CD4 level of +350 mm3.

“Firstly, there’s an issue of toxicity. Toxicity is the number one reason that patients stop adhering to their drugs—and the lower the CD4 count when given medication, the higher the toxicity rate,” said Idoko. “Secondly, those who die from HIV/AIDS usually start their medication at lower CD4 counts. Thirdly, the medication given for higher CD4 counts is stronger, less toxic, and more convenient.

“So with all these factors, why not start medication later?”

Nigerian government health guidelines state that patients must have a CD4 count of below 350 and show symptoms of HIV/AIDS before they can receive antiretroviral treatment. But many patients with a CD4 count of between 200 and 350 don’t show symptoms, said Idoko, and cannot receive their needed treatment because of these guidelines.

In the United States, the government changed their health guidelines in less than one year to reflect recent studies and to state that medical facilities can treat patients with 350 CD4 count and monitor patients at lower levels. Dr. Idoko advocates that the Nigerian government follow in the U.S.’s footsteps and make earlier ART part of national health policies and guidelines.

“We want to be suppressing the virus as much as possible,” said Dr. Idoko.

Apart from finding the perfect time to administer ART, enforcing patients’ adherence to ART is always another challenge in resource-poor settings. If a bus driver cannot afford to miss work, he will find it extremely difficult to trek to the clinic each month and wait several hours to pick up his medication. Or, if a mother has to choose between feeding her six children and buying antiretroviral treatment for herself, she will likely pick her family over her own health.

This financial reality stirs up big problems for patient adherence, but many clinics and hospitals in Nigeria are working their way around it. The Jos University Teaching Hospital provides inpatients with transportation to and from the hospital to lower their financial burden. The hospital also encourages local governments to support their HIV-positive staff with transportation to the hospital, and encourages their HIV/AIDS support groups to approach the government for grant money. According to Idoko, “the government does help with funding when it can, but overall it’s not doing enough.”

In addition, the Jos University Teaching Hospital assigns treatment partners to each patient to not only provide financial support, but also emotional, psychological, and physical support. And though the challenge of providing ART to patients in Nigeria and other resource-poor settings continues, scientists, researchers, and doctors have shown that the solutions lie in adherence, access, and support, and not in clocks or the sun.

*Reported by Amanda Hale