Wednesday, 18 November 2009

As Stubborn VVF Scourge Stays with Us...

It is estimated that about 800, 000 women are caught in the web of
Vesico-Vaginal Fistula (VVF) in Nigeria. The figure is reflective of the dismal
health indices of the country as experts lament that the weak healthcare
delivery system has combined with the moribund cultural practice of betrothal to
decapitate the womenfolk. Of the sundry health challenges the nation is facing,
investigations show that VVF is a scourge Nigeria can do without. GODWIN HARUNA

They look pale and sickly as a result of weeks of hospitalization. The first is
25 year-old woman, Mrs. Hauwa Umar, who was cornered at the Vesico-Vagina
Fistula (VVF) centre in Zaria, Kaduna State. Hauwa got married after her primary
school education. Married for about a decade now, she has been hospitalized at
the centre for more than a month, but her VVF condition started years ago.
She told THISDAY in an interview that she has never given birth in a hospital
but had visited it sometimes for antenatal care. In her words: "Three years ago
when I was in labour, the child refused to come out. We tried everything, but my
situation was getting worse and so I was brought to a hospital in Kaduna where I
gave birth later to a child that died immediately. Later, I started noticing
urine coming out from my body, which I couldn't stop. After so many different
kinds of traditional treatments without success, I was told about the center in
Zaria and I was brought here."
She said she didn't want to come initially because was scared of the fees but
somebody who had come to the hospital, who told her it was free, encouraged her.
Hauwa was lucky in her own case because she did not suffer rejection, as her
husband has been standing by her in her worst moments. Several other women
suffering the condition are not as lucky as family and friends have abandoned
THISDAY also spoke to 26 year-old Monica Garba at the Zaria centre. Married for
11 years with two children, Monica had spent about three weeks at the centre.
She said she went to a hospital when she had a difficult labour and after
delivery, she was diagnosed with VVF. She too, has the support of the husband,
who was present at the hospital, but declined interview.
Experts say there are two types of obstetric fistula, which are Vesico-Vaginal
Fistula (VVF) and Recto-Vaginal Fistula (RVF). They say VVF occurs when blood
supply to the tissues of the vagina and the bladder are restricted during
prolonged obstructed labour leading to the death of the tissues between these
organs forming holes through which urine can pass uncontrollably while
Recto-Vaginal Fistula (RVF) occurs in a similar way to VVF when the holes form
between the tissues of the vagina and the rectum and leads to uncontrollable
leakage of faeces.
Several women, who are not up to childbearing age, but forced into marriage and
others who could not access hospital care on time are tied down with this
condition in Nigeria. Dr. Clara Ladi Ojembe, a consultant community physician
with the Department of Community Medicine, Ahmadu Bello University (ABU) Zaria,
and the Secretary of the National Foundation of VVF, said Nigeria has the
highest number of VVF in the world. Ojembe said it is estimated that there are
about 800,000 cases of VVF in Nigeria out of a global estimate of 2 million.
"It is a major maternal issue. The bottom line is that anywhere a woman is
allowed to labour for days at home without seeking medical attention; she may
come down with VVF. We know the health situation in Nigeria, so anywhere you
look for VVF in Nigeria, you will find it. But unfortunately, the northern part
of Nigeria has the highest burden, and I think available data tends to suggest
that; as many as between 60 – 70 of the total VVF in Nigeria is found in the
core northern part of Nigeria.
We have done some work and we have found out that the incident of VVF is about 1
per 1000 deliveries and that compares with the same study that was done by Dr.
Kees in Katsina. He covers Katsina, Sokoto and many of the northern centers of
VVF. The same study also found the rate to be 2 per 1000 deliveries. So for
every 2 out of a 1000 deliveries a woman has VVF, according to his study in
Katsina and ours," Ojembe told THISDAY in an interview.
Dr. Ado Zakari Mohammed, former Chief Medical Director of the hospital and
currently the officer-in-charge of VVF surgery at the Gambo Sawaba General
Hospital, Zaria said VVF has been a major maternal problem in the north. "You
know it is part of the morbidity that women experience in the process of birth,
so in every woman that die about 10 others have complications in the process of
birth. One of the complications is the VVF, so as much as we have high number of
women dying in Nigeria, we will continue to have a high number of women with
VVF," Mohammed said.
He said there are five major centers in the northern part of the country where
those with the condition are looked after. These include Katsina as the
headquarters, Kano, Zaria, Sokoto and Kebbi. He said the activities of the
National VVF Project are in these five centers in the north under a Dutch
surgeon known as Dr Kees, who is the head of the whole project. He added that
Krees trained all of them in these centers.
Ojembe sees VVF as more of a social problem than medical. She says even though
they look at it as a medical condition, the major determinants are social, and
also, people that have VVF are the ones that have been able to escape maternal
death. "They had the problem but luckily they did not end up dead but ended up
with VVF. If you look at the statistics of maternal mortality in Nigeria, the
rate in the north-west is 6 times the rate of the south-west, the rate in the
north-east is 9 times higher the rate of south-west. So when you look at it,
what is the problem? Why should we have higher rates in the north than in the
south? Then you need to look at what the causes of maternal mortality are
because they are the same.
"You have the immediate ones that you know cause it, but beyond that, are lot of
factors that include the environment, social condition and the state of
development of a country's health care system. And one of the determinants of
VVF is the reproductive behavior of women, and one of the reproductive behaviors
is early onset of child bearing. Once you marry early and you start bearing
children early, it is like the case of a baby getting married and attempting to
give birth to another baby.
The pelvis is not sufficiently mature and so if the pelvis is small, when you
want to give birth, the head of the baby cannot pass through the birth canal.
The head of the baby gets stuck in the birth canal and if the thing remains here
for a long time it just crushes the tissue around. The bladder is in front, the
rectum where the faeces come out at the back, nerves at the sides, and if the
head gets impacted for a long time, it just cut off the blood supply and the
tissues die, so a woman will now end up with a hole connecting her bladder or
urethra to her vagina or connecting her rectum to her vagina or destroying her
nerves. So if the thing continues and you are not able to get the woman to a
hospital on time so that they can carry out an operation to remove the baby,
then the tissues will just die because the blood supply has been cut off, and so
obstruction can happen. But if the woman is taken to a hospital on time,
something could be done. So if you are too young and your pelvis is not
sufficiently big enough and you want to give birth, then you have a very high
chance of getting VVF than somebody that is mature," the consultant physician
She said early marriage was a problem in the north. According to her about 80
per cent of girls in the north begin to give birth before they are 18 years old;
adding: "Around Zaria where I work, the medium age of marriage is 13 – 14 years
and it has remained like that for more than 20 years that I have been living in
this area because I keep doing surveys with medical students. When you marry at
13 you are still a child who has gone to start servicing a man and having
children. So early marriage is a major problem which is one of the reproductive
behaviors of women."
Ojembe said the other cause of VVF has to do with health services-related
factors. She said if there are healthcare services that are fully equipped with
qualified health personnel and women attend anti-natal care and there is a
problem with birth, it could be adequately handled and the women can even go for
cesarean operation. "Even if you don't go, but you are able to be quickly rushed
to the hospital in good time, an operation can be done on you and the baby
quickly removed. But where are the hospitals in the north? They are nowhere.
You have all sorts of health clinics and all sorts of nonsense called health
facilities. You don't have the doctors, theatres or anything and you may have to
ride on an animal to get to the road before you can get a bus, and then get to
the hospital. When you get to the hospital, you are told to go and bring money.
The man has to go and sell his animal before coming back with the money. By that
time the woman would have died, if she doesn't die she will get VVF. So these
are issues relating to availability and qualities of services of obstetrics
services to deal with complications," she added.
She also located another cause in the fact that most of the deliveries are done
at home adding that 9 out of 10 are at home and it is often late before they
recognize that there is a problem. She said they must have tried Koranic
reciting, herbal treatment, which include salt cut by a local barber, before
finally deciding to come to the hospital. She stressed that the delay at home is
due to ignorance and traditional practices that are inimical to health. The high
rate of poverty, which is higher in the north is a major barrier to getting
quality health care; adding: "How many people in rural Nigeria can afford
N40,000 – N50,000 to pay for caesarian section, because that is the only way
they can bring out the child, except if the baby is dead then you crush the head
and pull it out. Poverty is a major limitation."
She stated that the issues of infrastructure, which are in deplorable condition
in a country with a huge population, also contribute to the problem. She said
attempts to make maternal health free via legislative framework have remained a
mirage as many state governments are paying lip service to the issue.
"Marginalization in decision making is also an issue. The status of women is bad
in the north. Much of them lack education, they are secluded and can't even go
out. Most don't even know what is going on in the outside world. They can't go
to the hospital without the express permission of their husbands. They can't
take decision as even when they have complications during pregnancy, they have
to wait for their husbands to come and give them direction about going to the
hospital and if he had traveled, then the woman may be sitting in front of the
hospital and die waiting for her husband to tell her what to do. Lack of
autonomy in decision making even about their health, limitation of movement,
lack of knowledge about any other happening outside their homes and all sorts of
problems which include lack of education, economic dependence on their husbands
for everything are all vices that are worst in the north, and consequently, you
tend to find out that maternal mortality and cases of VVF are much worse in the
northern part of the country," Ojembe stated.
However, Mr. Iyeme Efem, Project Manager, USAID ACQUIRE-Fistula Care Project
(Engender Health), Abuja, said the Problem of Fistula (VVF/RVF) is generalized
around the country. He noted that it is more prevalent in states where the
health indices are much poorer, adding that the failure of the health system is
reflected by the existence and indeed increase in fistula cases. He said in the
north, the condition is much more prevalent in all the geo-political zones.
"We do not have clear statistics of those with the condition. However, there is
the general belief that there are between 800,000 and 1,000,000 women with the
condition currently in Nigeria. Globally, there are 2,000,000 women with the
condition. Hopefully, with the recent DHS conducted, we are hoping that we will
have data of the prevalence rate in Nigeria," Efem said.
He said cultural practices are generally implicated as contributors to women
developing this condition. He added that female genital cutting is one of them
as it damages the environment and either makes women susceptible during
childbirth or even during the cutting itself. "Also, the practice of early
marriage which does not allow the girl child to develop fully thus creating the
opportunity for obstructed labour is another. Prevention of the discussions on
family planning which does not allow the women to obtain services that will
prolong the period before pregnancy thereby allowing their bodies heal well is
also a major culprit. Practice of insisting that women should have their first
baby at home as a sign of strength is also very bad. Refusal to have Caesarian
Section done on women because it shows sign of weakness is also another factor.
All these, including the delay in making a decision to take the woman to
hospital, delay in finding vehicle to move the pregnant woman to a suitable
facility and delay in finding a trained health care provider to take immediate
action are major culprits in the cause of obstetric fistula," Efem added.
The situation at the Kwalli VVF hostel, Kano where the people with the condition
are kept, is deplorable. When THISDAY visited the hostel recently, the place is
in dire need of government attention because of the unhygienic condition of the
hostel. The patients, numbering over 200, are living under terrible condition,
because of the inability of the government to provide basic facilities.
THISDAY observed that patients at the Kwalli VVF hostel are crying out, saying
enough medical and rehabilitative attention are not being given to them even as
the state government disclosed that it would build N1billion VVF centre in the
Mr. Suleiman Ilyasu, husband of a VVF patient, Mallama Zulaihatu Suleiman, said
if government would honour its pledge and commit such a huge amount of money on
VVF, the sufferings of the patients would reduce. According to him, "my wife
spent six years receiving the treatment after she became the victim of VVF. It
took a lot of resources from me to ensure that the surgery is done for her. She
is now normal as if nothing happened to her, but the bad condition of the Kwalli
hostel is terrible."
However, medical experts in the state observe that keeping control of VVF goes
beyond the confines of the hospital. Experts spoken to in Kano think government
should adopt a robust enlightenment campaign about the side effects of early
marriage and also, empower women so as to douse the effects of excruciating
poverty in the rural areas.
Kano State Commissioner for Health, Mallama Aishatu Isyaku Kiru, said as part of
government's effort to control VVF, it provides rehabilitation centres where the
patients are kept for three months before their discharge. She added that
government also schedules the patients' spouses and gives them seminars on
reproductive health-related issues.
18 year-old Mallama Aminatu Abdussalami Kunya, a VVF patient, told THISDAY that
she encountered the condition after she became pregnant at the age of 16.
Aminatu said her husband divorced her when he saw her in that condition and
lamented that her parents are taking care of her, adding that her former husband
is nowhere to be found.
She also lamented that, even her relatives also ran away from her when the
problems manifested, but managed to say with some cheer: "As you can see now,
my condition has improved and I am expecting to be discharged anytime from now.
I have recovered from the successful surgical treatment, many thanks to the
state government because the government is providing three square meals for us."
Dr. Amiru Imam, a consultant surgeon with Kano State Ministry of Health, said
many issues compound the case of VVF. He said apart from low literacy, poverty
and poor access to medication, the dearth of medical personnel in the state is
detrimental to maternal health as it relates to VVF. Dr Imam, who performs
surgery on VVF patients said prolonged and obstructed labour is the major cause
of the ailment. Other complications associated with this obstetric fistula, he
said, are psychological and neurological conditions where the women come up
limping, adding that notwithstanding all the joint efforts, the incidence are on
the increase. Imam noted that, at least, 15 new cases are operated upon every
week and the number is still increasing. According to him, "One should question
why things are not moving. Why are we still stagnant?"
Ojembe said although VVF cases are on the increase, but the area of success is
that in the past, when a woman has VVF, she is treated like an outcaste in the
society, nobody wants to stay close to her because she is smelling and passing
out urine. "Sometimes they have both VVF and RFV. Then, the chances of treatment
were slim. Even the Dutch surgeon that is in charge of the VVF programme only
developed interest in it. He was not a gynecologist but a different surgeon,
but seeing the cases of VVF occurring in Katsina, he decided to take an interest
in it, and so he started operating on it, and later developed the skill with
which he presently operates on the women. Fortunately for Nigeria, because of
the fact that the doctor is ready to pass his skills to any doctor in Nigeria
that wants to operate on the women, he started training us. We now have a lot
of indigenous doctors that can operate VVF successfully. At least we have about
300 doctors now and all were trained by Dr. Kees," she said.
Mohammed expressed the optimism that their work is attracting help from outside
government. He said Rotary International came into it by assisting them just
like Family Care (a Japanese NGO) that has started rehabilitating the patients
after their operations. "They are the ones that bought the sewing and knitting
machines that are given to the women after their training. They also give the
soft loan of N20,000 to the women to start something which is to be repaid in
two years. They are also the ones that employ the teacher that teaches the women
adult literacy. Family Care is also the ones that built the new wards we now
have, which includes the kitchen, store, toilets and the training center,"
Mohammed said further.
On his part, Efem said: "From ACQUIRE Fistula Care Project, we work to prevent
occurrence through community education and family planning, repairs of those
that have occurred through support to the fistula centers like provision of
operating tables, theatre consumables, training of more surgeons and nurses,
refurbishing of the facilities; rehabilitating those that have been repaired and
reintegrating them into their communities of families."


The writer is a grantee under 2009 Investigative Report for Maternal, Newborn and Child Health in Nigeria, moderated by Development Communications Network under the Ford Foundation supported projects in Nigeria.

Nutrition may hold key to saving the lives of mothers and children in Nigeria

Lagos, 30 October, 2009 -- Food insecurity and lack of access to basic health services are the major factors causing high level of malnutrition in Nigeria especially among women and children who are the most vulnerable. This was the submission of experts to the issues and nutritional challenges facing maternal, newborn and child health in Nigeria at a one day workshop organized by Alltech Nutrients Limited, World Initiative for Soy in Human Health (WISHH), United States for Agriculture and National Institute for Food Science and Technology to proffer solution to the state of nutrition in the communities of Nigeria.

The stakeholders at the event, at Protea Hotel Ikeja, Lagos, include nutritionists, bakers, media and various organisations who together examined the possibility of soy in reducing the 60% child mortality due to malnourishment and achieving the millennium development goals. Soybean and soy products contains adequate nutrients such as protein-energy, fats, vitamins and other micro-nutrients that can combat the high cases of ill-growth indicated in stunting (height for weight); wasting (weight for height) or under-weight (age for weight) constrasts.

Among the several issues raised include the availability of soybean in Nigerian markets; how to inculcate the benefits of soy into the frequently taken Nigerian meals such as loaves of bread and the various nutritional combination soy can be made available in local meals. Professor Isaac Akinyele, Head of Department - Human Nutrition University of Ibadan who served as the chairman of the workshop stated that “once a young girl is stunted at age 3, she can never give birth to a normal child, which makes this issue an inter-generational issue, a silent emergency”. In the same vein, president of the Nigerian Institute of Food Science and Technology (NIFST), Professor Isaac Adebayo Adeyemi said “there is a need to incorporate alternative strategies different from conventional methods to address malnutrition. Soyabeans, as we all know, are grown in many parts of the world and are a primary source of vegetable oil and protein for use in food”. He also shed lights on the pending bill that will enable Nigerian Council of Food Science and Technology to, among others, protect and uphold professional standards and competence in the practice of food science and technology to sustain the dignity accorded to the profession worldwide.”

Dr. Akinloye Afolabi, Country Coordinator Infant and Young Child Nutrition Project, from the University of Agriculture, Abeokuta affirmed that resources must be available to effectively reduce malnutrition through innovative approaches to resource mobilization from all sectors and levels including --- government, community, development partners,private sector and civil societies, He reiterated that ownership the programme should be encouraged through community participation, efficient communication and information system as well as entrenching a sustainability plan from the onset.

He advocated for an efficient coordination mechanism encompassing the institutionalization of a national coordinating mechanism, inter agency coordination and collaboration and effective partnership building



Femi Amele

Friday, 30 October 2009

PRESS RELEASE: Nutrition may hold key to saving the lives of mothers and children in Nigeria


Nutrition may hold key to saving the lives of mothers and children in Nigeria

Lagos, 30 October, 2009 -- Food insecurity and lack of access to basic health services are the major factors causing high level of malnutrition in Nigeria especially among women and children who are the most vulnerable. This was the submission of experts to the issues and nutritional challenges facing maternal, newborn and child health in Nigeria at a one day workshop organized by Alltech Nutrients Limited, World Initiative for Soy in Human Health (WISHH), United States for Agriculture and National Institute for Food Science and Technology to proffer solution to the state of nutrition in the communities of Nigeria.

The stakeholders at the event, at Protea Hotel Ikeja, Lagos, include nutritionists, bakers, media and various organisations who together examined the possibility of soy in reducing the 60% child mortality due to malnourishment and achieving the millennium development goals. Soybean and soy products contains adequate nutrients such as protein-energy, fats, vitamins and other micro-nutrients that can combat the high cases of ill-growth indicated in stunting (height for weight); wasting (weight for height) or under-weight (age for weight) constrasts.

Among the several issues raised include the availability of soybean in Nigerian markets; how to inculcate the benefits of soy into the frequently taken Nigerian meals such as loaves of bread and the various nutritional combination soy can be made available in local meals. Professor Isaac Akinyele, Head of Department - Human Nutrition University of Ibadan who served as the chairman of the workshop stated that “once a young girl is stunted at age 3, she can never give birth to a normal child, which makes this issue an inter-generational issue, a silent emergency”. In the same vein, president of the Nigerian Institute of Food Science and Technology (NIFST), Professor Isaac Adebayo Adeyemi said “there is a need to incorporate alternative strategies different from conventional methods to address malnutrition. Soyabeans, as we all know, are grown in many parts of the world and are a primary source of vegetable oil and protein for use in food”. He also shed lights on the pending bill that will enable Nigerian Council of Food Science and Technology to, among others, protect and uphold professional standards and competence in the practice of food science and technology to sustain the dignity accorded to the profession worldwide.”

Dr. Akinloye Afolabi, Country Coordinator Infant and Young Child Nutrition Project, from the University of Agriculture, Abeokuta affirmed that resources must be available to effectively reduce malnutrition through innovative approaches to resource mobilization from all sectors and levels including --- government, community, development partners,private sector and civil societies, He reiterated that ownership the programme should be encouraged through community participation, efficient communication and information system as well as entrenching a sustainability plan from the onset.

He advocated for an efficient coordination mechanism encompassing the institutionalization of a national coordinating mechanism, inter agency coordination and collaboration and effective partnership building



Femi Amele

Friday, 9 October 2009



Journalists receive grants to investigate needless deaths of women, newborn and children in Nigeria

Lagos-09 October, 2009 -- Grants have been awarded to five Nigerian journalists to explore issues surrounding the needless deaths of women and children in Nigeria. Winners of the 2009 grant for “Investigative Report on Maternal, Newborn and Child Health” announced today in Lagos would investigate circumstances surrounding the death of about 145 women everyday, due to complications of pregnancy and child birth, as well as the over 1.0 million under five who die in Nigeria annually.

Among several entries that cut across both print and electronic mediums, the five recipients were awarded the investigative grants based on their outstanding entries and relevance to addressing the challenges of women and children under the MDGs 1, 4, 5 and 7, Development Communications Network, organizers of the grant stated. An award, open to all other work by journalists in Nigeria, for best stories on maternal, newborn and child health issues would be given by the Well Being Foundation (WBF), at an International Forum on Child Rights coming up in November 2009 in Ilorin, Kwara State.

Founder of WBF and wife of the Executive governor of Kwara State, Mrs Toyin Saraki explains that journalists are important in the dissemination of empirical and factual information that could lead to improvement of the health of women and children in Nigeria. “Journalists need to be encouraged in this bid,” she asserted.

With institutional support and commitment from their media organizations each of the five (5) recipients are to investigate unique story angles as follows:
• Abiose Adelaja of Next Newspapers -- {To explore the state of Primary Health Centres in rural areas and their role in maternal and child health care};
• Godwin Haruna of Thisday Newpaper {Vesico Virgina Fistula as a key contributor to infirmities in maternal health};
• Ibrahim Apekhade Yusuf of The Nation {Would explore communities examining how poverty remains a metaphor of existences with linkages to maternal and child health};
• Iliya Kure of Federal Radio Corporation of Nigeria, Kaduna {Would evaluate the effectiveness of the Free Maternal and child health care services being offered in Kaduna and a number of other Northern states}; and
• Vivienne Irikefe of Silverbird Television {Would explore the problem of malaria as an environmental issue and linkages to maternal, newborn & child healthcare issues in Sagbokoji and Bishop Kodji island two riverside communities across the seas in Lagos}.

The clarity of their entry, depth in discussing the issue at hand and ability to point vividly to the problem to be addressed through their intended story ideas have made it possible for them to meet with the high and in-depth criteria of the panel. More so, the innovation in the news angle of their story idea made them stand out.

Sola Ogundipe, Health Editor at the Vanguard, one of the judges, commented on the entries describing the recipients as having “an impressive understanding of the issues. It is clear they know what to do and how to go about it.” Lekan Otufodunrin, Sunday Editor of The Nation Newspapers commended the effort describing the story ideas as “well articulated.” Sele Eradiri from the Nigeria Television Authority (NTA) hope the grant would further raise editorial analysis on issues concerning women and children.

The investigative report grant is a N75, 000 cash prize that will aid each journalist to investigate their story without constraint in carrying out the necessary field investigation. The grant was awarded on Friday, 9th October, 2009, at Development Communications (Devcoms) Network, Lagos, by 11:00am.

The grant is part of commitment to reducing the high rate of women and child death, and is supported by the Ford Foundation project on “Strengthening mass media advocacy on improved national response to the poor maternal health situation in Nigeria.” Everyday Nigeria loses about 145 women due to complications of pregnancy and child birth while over 1.0 million children would die before their fifth birthday annually in the country.

Devcoms received the ONE Africa Award 2008 based on this innovative work with journalists that has created national awareness and a gradual response to the needless deaths of women and children in the country.

Thursday, 3 September 2009


“ male leadership
involvement is required in
family planning
urgently. ”
- Rev. Elijah Olu Fatile
Regional Director (South West)
Planned Parenthood Federation of Nigeria (PPFN)

“ ...high maternal mortality rate is
still prevalent because of some
social and cultural factors such
as illiteracy, low status of women,
poverty, religion, taboos, harmful
traditional practices..

Dr.Kofoworola Odeyemi
Public Health Physician &
Campaign Against Unwanted Pregnancy (CAUP)

Media Forum on The role of family planning in reducing maternal and infant mortality

Femi Adeolu Amele

Friday, 14 August 2009


Dear All,

We are pleased to inform you that the ‘Call for application on Investigative Journalism Stories on Maternal, Newborn and Child Health (MNCH) in Nigeria’ has been extended. DEVCOMS is aware of the challenges you may have faced in the bid of completing and filling the application form, it was due to some technical hitches.

To this end the competition has been extended to the 21st of August, 2009. For further details on how to complete the form, please log on to

Note that you will have to register as a new user on the said page to access the application form.

For enquiries please call 07029232133, 07029104821


Wednesday, 5 August 2009


Development Communications Network (DEVCOMS), winner of ONE Africa Award 2008, is pleased to invite APPLICATIONS from all eligible professional journalists in Nigeria, ON INVESTIGATIVE IDEAS in the area of Maternal, Newborn and Child Healthcare (MNCH). The grant is supported under the Ford Foundation funded project on "Strengthening mass media advocacy on improved national response to the poor maternal health situation in Nigeria." The grant will be followed by awards, in collaboration with the Well Being Foundation, to the best reports.

Maternal, Newborn and Child Health (MNCH) is a key issue that all health stakeholders, public and governments need to be sensitized on, most especially as it concerns saving the lives of women and children in Nigeria. Hence creating awareness about the high level of maternal, newborn and infant deaths paramount to measuring the success achieved so far in reaching the MDGs 4 and 5.

This call is to bring to fore the challenges inherent in programming and implementation of projects aimed at addressing the needless deaths of Nigerian women and children. Journlists are expected to document their ideas in form of issue oriented stories in prints, electronic, news agency or online format in a manner that enable the society to monitor and evaluate measurable progress made so far in MDGs 4 & 5 in Nigeria. The stories should also educate and advocate how to harness the strategies adopted in addressing maternal, nwborn and child health for more efficient results from local communities up to state and national platform.

Applicants are to develop at least 2 story ideas that would feature an accurate documentation in any of the following video, audio, online or print (including news agency) format.

- Compelling feature story on MNCH linked to developmental issue(s)

- Governmental Policy on ‘Women and Children’ and its implementation at local communities and all levels of governance

- Human angle story ideas that bring to fore key challenges of women and children in accessing healthcare in Nigeria.

Grants for approved story idea is worth (N75, 000) which is strictly for field/investigative feature length reporting on MDGs 4 and 5 and related issues concerning women and children.

All winning entries are automatically nominated to compete for an award ceremony for ‘Best Story/Report on maternal, newborn and child health, 2009.

Opening date: 31st July, 2009 08.00 GMT (9am local time, Nigeria)
Closing date: 14th August, 2009 15.00 GMT (4pm local time, Nigeria)
Selected stories must be aired or published on or before September 4th 2009



Tuesday, 4 August 2009

Debilitating effects of HIV/AIDS on Nigerian Women and Children

Debilitating effects of HIV/AIDS on Nigerian Women and Children

HIV/AIDS has emerged as one of the greatest pandemic which hunts everyone, not sparing the weakest of all, women and children. At present, the most recent HIV sero-prevalance survey shows that women aged 15 – 49 years, constitute 56 percent of the 4.74 million infected, (Adekeye, 2005) with quite a number who have given birth to babies that have become infected also. Others who had the virus after birth have had to battle with the challenge alone, due to the devastating effect it has on them. Women are more prone to contracting HIV because of certain factors. One important factor is biological, which explains the physiological characteristics of women, the general vulnerability of women partly accounts for a wide range of female reproductive health problems, and variation in socio-economic and political status by gender. These have emerged as some of the factors responsible for increasing the spread of HIV infection among Nigerian women.

Children, on the other hand, can also be infected by HIV/AIDS. They are particularly affected if one or both parents are infected and the effect of HIV/AIDS is greatly felt by those orphaned by AIDS, because they have to face life’s challenges without their parents. Apart from grief, depression, dependency on others and denial of basic necessities, children orphaned by AIDS are often stigmatized and discriminated due to fear surrounding AIDS by people around them. Many of these orphans are therefore forced into exploitative situations such as prostitution, robbery and other evil acts which could get them infected as well, and even land them in jail or expose them to risks that may cut short their lives. The HIV/AIDS endemic toll on the number of school age children is very alarming, because the scourge decreases the rate of growth of the school age population.

Also HIV positive women have reduced fertility and mother-to-child transmission of the virus, which means increase in child mortality rate. HIV-Positive women have significantly more negative pregnancy outcomes, such as spontaneous abortions and still-births, than uninfected women. This is likely to further decrease the number of children 0-5 years of age in the households (Chomba and Piot, 1994). Women who are infected with the virus, are also regarded as child bearers, child rearers and care givers, they bear the brunt of the impact of HIV/AIDS, as they are responsible for their sick children or spouse. They are also saddled with the responsibility of caring for orphaned and vulnerable children. This is often a difficult role and task for women to perform.
Further more, the effect of HIV/AIDS on children relates to the projected increase in AIDS orphan hood and school dropouts. These may contribute to increased child labour, as children enter the work force at even younger age in search of financial support (Lisk, 2002).
In order to control HIV/AIDS and its effects on women and children, women’s vulnerability should be checked by passing and enforcing laws against gender discrimination, empowering women economically, improving access of girls to education and provision of basic necessities for the orphans.

Ikeoluwa AWE

The Battle lines of Malaria

The Battle lines of Malaria

Malaria is a prominent disease which has continued its plight across the regions of the world. With a significant effect on countries across Africa, its landmark features has resulted in death of mothers, children, families, communities and cultures. Available records show that at least 50 per cent of the population of Nigeria suffers from at least one episode of malaria each year and malaria accounts for over 45 per cent of all out-patient visits. The disease accounts for 25 per cent of infant mortality and 30 per cent of childhood mortality in Nigeria. World Health Organisation (WHO, estimates 300-500 million cases of malaria, with over one million deaths each year. The battle lines to fight malaria through prevention, eradication and treatment continues to be a top priority assignment for Nigerians and advocate groups within various communities.

Malaria develops in the human body through a cycle of transmission which is assisted by bites from a female anopheles mosquito, the carrier of malaria parasite. The female anopheles mosquito is constantly looking for a blood meal to feed on to sustain itself through its breeding period. In a large population society like Nigeria, there is a strong possibility that the female anopheles mosquito will find the perfect blood meal in humans. When a female anopheles mosquito takes it routine bites in human’s everyday, it injects saliva mixed with an anticoagulant, if the mosquito is infected with plasmodium, that is the asexual cells of malaria parasites it also infects the host. The newly transmitted cells of malaria parasite continues to evolve and increase in number throughout the human body. These parasitic cells are born with an innate nature to swim through the human bloodstreams; they live comfortable within every organic corner they find in the human body. Their active movement continues to create a sense of chill, increase in body temperature, headaches, muscle aches, tiredness, nausea and vomiting, diarrhoea, anaemia, and jaundice (yellow colouring of the skin and eyes). Convulsions, coma, severe anaemia and kidney failure can also occur. Most people begin feeling sick within10 days to 4 weeks after being infected. At this stage, the malaria parasitic cells, are in a state referred to as gametocytes, which comprises of male gametocytes and female gametocytes. Their growth and multiplication takes place inside red blood cells. As the malaria parasite continues to multiply and have an increased activity in the human body, the human host continues to grow weak and develop a low resistance to fight against this invasion hence needs to seek medical care.

In its mischievous attempt to continue its existence, malaria parasitic cells wait for the next flight… that is wait for the next mosquito bite and mix carefully with the mosquito saliva and passes on the gametocytes. The male and female gametocytes recombine in the intestinal walls of the mosquito forming another ready made parasite waiting for the next mosquito bite on another human host.

In Nigeria, malaria is not a backdoor disease but has taking the leading role in creating 11% of the cause of maternal death, rapid death of under five children, absenteeism from work and multiple health complications. Its problematic features make its budget siphoning to every stakeholder of the health sector. At the moment, Africa is largest territory region affected by activities of malaria trend with a share hold of 90% across the world. Leading research in medical science as found ways to prevent, treat and eradicate malaria across various zones in Nigeria. Organisation such as National Malaria Control Programme continues to foster measures to combat malaria and closely flanged the eloquent communication to the people by Development Communications Network to create public awareness of the high stake the disease has in the society.

Although common prevention measures exist (including use of medicine (prophylaxis), insecticides (coils and sprays), ordinary mosquito nets, insecticide-treated nets (ITNs) and widow and door nets) malaria accounts for millions of needless deaths in Nigerian children, pregnant women and elderly people every year due to lack of knowledge of prevention, symptoms and proper treatment.

Malaria parasites continues to draw attention by evolving in its resistance to drug treatment which is now the leading cause for more research on its treatment and eradication. Strategic impartation of ways to prevent malaria continues to serve as the key to rescue the society from mortality pending the implementation of health policy for women, children, mothers, family and the community. Malaria continues to take high spot in the news across from rescue stories; to prevention and mass loss of people infected with malaria.

Malaria can be cured completely if only treated well, but many Nigerians rely on herbal drugs, traditional healers or just do without any medication at all. Information gaps need to be bridged and all Nigerians must be well informed about malaria and its implications to curb its prevalence and above all its shockingly high mortality rate.

Femi Adeolu Amele

Tuesday, 21 July 2009

Journalists commit to saving women and children’s lives

Press Release:

Journalists commit to saving women and children’s lives

Lagos, Nigeria: Nigerian journalists have decried the needless deaths of Nigerian women and children in the course of child birth and debilitating child health services in the country. At the conclusion of a two day capacity building on ‘policy analysis for budget tracking of MDGs 4 & 5’, the senior editors and correspondents from 20 media organizations called on government to ensure that the health of mothers and children are made a priority in the implementation of health programs in the country.

The training, organized by Development Communications (DEVCOMS) Network, winner ONE Africa Award, 2008 under the aegis of the Lagos State chapter of the Nigerian Union of Journalist (NUJ), is DEVCOMS initiative in fulfilling the Ford Foundation supported project on “Strengthening mass media advocacy on improved national responses to the poor maternal health situation in Nigeria.

Akin Jimoh, Program Director of DEVCOMS Network, says it became necessary to organise the training for journalists since they are the ones who are the voice of the people, and at present the only hope of the common man. He asserts; “lots of funds are allocated every year by governments at all levels in Nigeria for health related issues, but much of the impacts are hardly seen nor felt”. Jimoh enunciates that the high rate of maternal, newborn and child mortality in Nigeria, could be reduced appreciably to a reasonable ebb if funds allotted for Primary Health Centres, drugs and other health challenges are judiciously used for the purpose for which they were released. This also echoes the aim of the ONE Award 2008, which Devcoms is the flagbearer in Africa.

NUJ Chairman Lagos State Chapter, Wahab Oba descries the training as a “wonderful opportunity that equips journalists to appraise budget from formulation to monitoring its implementation as well as evaluating the performance of government’s yearly budget. With the skills acquired we will now be able to monitor the growth and development in the country in achieving the MDGs and other key areas.”

In the same vein a facilitator at the training Emeka Nsofor, of Human Supports Services said that government world-over are being held accountable for the way they appropriate the people’s funds in their custody. Nsofor said it is high time the media in Nigeria, set the agenda of holding governments at all levels accountable for the funds/revenue they generate.

Also buttressing his views on the necessity of budget tracking, Kayode Iyalla one of the speakers during the training notes that since budget statements are fiscal policies, it is pertinent journalists know why policies fail in Nigeria. He stressed that policies ought to be deliberate plans of action, selected to achieve definite needs and goals. But “the reason why many policies do not succeed in the country is because they are not formulated as a result of the needs of the people,” he says.

Many of the journalists at the training said the programme was really an eye opener. Adekunle Yusuf, Senior Writer at Tell Magazine says “this training is highly beneficial and would aid in giving depth to whatever story we do concerning development issues in our work.” The participants pledged ensuring to give the news behind the figures, rather than just statistics which do not give the audience the true picture of governments spending as may have been proposed. The media professionals in attendance who represented all spheres of the media in Nigeria came up with ‘A call to action’ which was duly signed by all of them.

The media training on policy analysis and budget tracking of MDGs 4 & 5 organised by DEVCOMS network is the second in a series. The first was held for 22 journalists in May, 2009 at Ijebu-Ode, Ogun State.

DEVCOMS network, is a pace setter in media development especially capacity building in public health and science journalism in Nigeria.

Friday, 10 July 2009

Groups seek imminent solutions to maternal mortality in Nigeria

The high rate of maternal mortality encountered in Nigeria has caused a great concern to the Government, Non Governmental Organizations (NGOs) that focus on reproductive health issues, as well as to donors both at National and International levels. With barely six years to the stipulated targets of MDGs 4 & 5 which is year 2015, Nigeria is still not listed amongst the ten countries seen to have made rapid progress to meet the target.
At present Nigeria ranks one of the thirteen countries in the world with the highest MMR (Maternal Mortality Ratio).

  • However, intensive interventions are being put in place by both Government and Non Governmental bodies to see how to curb this alarming menace of maternal mortalities recorded in Nigeria. Also, strategic steps are taken to ensure that the country is given a new face in the global rating, as concerns MMR.

    One of such interventions was a programme held in Abuja mid June, 2009 tagged “Nigerian NGOs workshop: Towards a consolidated role as Maternal, Newborn and Child Health advocates”. The programme which was put together by ACCESS (Access to Clinical and Community maternal, neonatal and women’s health services) and JHPIEGO (John Hopkins Program for International Education in Gynaecology and Obstetrics) in partnership with the Nigerian Government was aimed at bringing members of Non Governmental Organisation in line with (Maternal, Newborn and Child Health) MNCH strategy from the six geo-political zones in Nigeria to brainstorm on best strategies to addressing maternal mortality issues.

    As the target of reducing the MMR by three-quarter in 2015, as stipulated by MDG 5 draws nearer, many people have begun to express doubts, as to how feasible this goal could be achieved. However for this target to be met, some health professionals and active NGO players in the area of reproductive health said that one key area that needs to be improved on, is primary health services at all levels. They are of the opinion that once there are adequate and well equipped primary health centres across the country, maternal and child health issues will be a work over.

    Other participants at the program said that bulk passing amongst the three tiers of government needed to be addressed also, especially as it relates to funding. Also that health policies and implementation at all levels needed to be harmonized.

    An official from one of the federal parastatals said that, “since NGOs play an important role in awareness raising and advocacy, their roles at the state and local governments cannot be over emphasised.”

    In suggesting ways of curbing maternal and child mortality scourge in Nigeria, representatives of NGOs from the six geo-political zones were of the view that, primary health care centres needed to act as the coordinating point for implementation of (Integrated Maternal, Newborn and Child Health) IMNCH strategy. They canvassed to be part of the multi-sectoral platform for the planning, implementation, as well as at the monitoring and evaluation. They also solicited for improved funding at all levels for IMNCH.

    The consensus at the two day workshop was that there is need for the federal government to scale up its activities at the states and local Government area. Being that NGOs have better ability to reach the grassroots effectively, there is need for the government to work closely with them.

    In line with this, wife of Kwara State Governor, Mrs. Oluwatoyin Saraki who also participated at the workshop encouraged Non Governmental Organisation at the state level to work closely with wives of state Governors in the states they represent. She said that in Kwara state, government has taken the bull by the horn, to confront the menace out rightly. Some of the strategies she mentioned are:

  • Kwara State Official Wives Association, (KWASOWA) Safe Motherhood. (A vehicle with which she has made commendable progress in promoting Maternal and Child Survival in the state.)

  • Kwara Safe Motherhood-Be a Mother Programme.

  • Alaafia Kwara (The Kwara Wellbeing Trust) A sister organization with the mother foundation. (A pet project of the first Lady of Kwara State, an Independent Organisation

  • Alaafia Kwara Twins and Multiple Births Assistance Project: (Grants from this project are given to indigent mothers who have had multiple births. This financial and social support is also available for children under 5 years who lost their mothers at childbirth. The fund ensures that a sustainable structured plan is put in place to ensure that their immediate needs are met and are privy to a continuum of healthcare, in addition to educational opportunities.)

    It could therefore be said that if the states and local governments could put in place comprehensive and functional health structures at all levels, then Nigeria will be seen to be making progress. Thus bulk passing amongst the tiers of government will be a thing of the past, as there will be apt cooperation from members of the community, since fighting this scourge needs all hands to be on deck.

    According to the First lady of Kwara State, “it takes passion and commitment to fight this menace.” She said sacrifice is pertinent in dealing with the prevailing set back. One of her sacrificial effort she said is using her up-keep allowance to save the life of mothers and children in the Kwara state.

    Indeed the Federal government’s current strategies on Maternal Newborn and Child Health needed to be replicated at the state and local government levels, where these mortalities are highest. Every state government should embrace the health insurance scheme and put up viable primary health structures.

    In the words of the Mrs Oluwatoyin Saraki, “there is need for Nigeria to have a home grown donor agency where funds are made available devoid of International agencies all the time.”

- Ijeoma IHEME

Wednesday, 3 June 2009

Malaria in Pregnancy- The silent threat for mothers and unborns

A bite from a mosquito is usually not considered a big deal. It itches for a short time and if you do not scratch it you will forget about it in a few minutes. But this little sting can threaten the life of every pregnant woman and the unborn child, if that particular mosquito passes on the malaria parasite. Malaria is the leading indirect cause of maternal mortality, accounting for 11% of deaths during pregnancy or delivery, what comes down to 5830 Nigerian women annually. Further more, it accounts for one quarter of all deaths in under five children in Nigeria.
Malaria is caused by the Plasmodium parasite which is carried by the female Anopheles mosquito. Mosquitoes come out at night in search of a bloodmeal. If a mosquito now bites a person who has malaria parasites in his or her blood the mosquito becomes the transmitter of the disease: The next time it bites another person and inject Plasmodium parasites in the person's blood which will cause malaria. This cycle repeats itself endlessly, resulting in about 300 million of malaria infections each year globally, with 90% of occurring in Africa. It is estimated that a person dies of malaria every ten seconds, most at risk are pregnant women and children under five. WHO estimates malaria sickens about 247 million people and kills nearly 1 million every year. Malaria disproportionately affects the poor, with 58% of malaria deaths occurring in the poorest 20% of the world’s population – a higher percentage than for any other disease of major public health importance.

Taking into consideration that about 7.5 million pregnancies occur every year in Nigeria, the magnitude of the malaria problem reveals itself: Malaria is more frequent and serious during pregnancy, causing anaemia (low blood) a main cause of maternal mortality and morbidity. During an epidemic of malaria, pregnant women are up to three times more likely to develop serious malaria as other adults. Severe malaria is classified by all the signs of uncomplicated malaria (which are fever, shivering, headaches, muscle/joint pains, nausea, mild anaemia and bitter taste in the mouth) plus one ore more of the following danger signs: Dizziness, difficult breathing, feeling drowsy, confusion, coma, severe dehydration, and severe anaemia. At the occurrence of any of this danger signs the woman must be referred to the hospital immediately to avoid complications and death. Complicated malaria requires specialized management at the health facilities, whereas uncomplicated malaria can be easily treated at home if recognized early. It is, however, essential to finish the course of treatment to ensure its efficiency. Unfortunately, malaria in pregnancy not only endangers the mothers. It can also have severe effects on the growth and development of the unborn child. The parasites hide in the placenta where they interfere with the transfer of oxygen and nutrients to the baby. This increases the risk of a spontaneous abortion, stillbirth, pre-term birth, and low weight babies- the single greatest risk factor for newborn death within the first month of life. Malaria accounts for about 5-14% of low birth weight prevalence.

The health consequences of malaria and HIV co-infection are not yet fully understood, but studies show serious implications for pregnant women and their unborn babies. Co-infected pregnant women are at very high risk of anaemia, and their children will havelow birth weights and are more likely to die in infancy. Recent research revealed that levels of HIV in the blood almost doubled when pregnant women with HIV got malaria. Those with impaired immune systems due to HIV/AIDS may also experience more malaria treatment failure. But malaria not only causes huge numbers of preventable deaths, its effects are also influencing communities to a large extent. Malaria results in frequent school absenteeism, missed work and lower productivity, and spending of large sums on medication and treatment. The presence of malaria has also been shown to have a negative impact on macroeconomic growth, inhibiting long-term growth and development to a degree that was previously unimagined. A comparative study of countries with and without malaria suggest that the presence of a high malaria burden results in a 1.3% lowering of the annual growth of the Gross Domestic Product per capita.

Malaria influences socioeconomic decisions, such as the siting of industrial projects, and it impacts negatively on the ability to attract capital developments and skilled labour. The presence of malaria is also an obstacle to the development of tourism in many regions.
The good news is: Malaria is easily preventable, and if detected early is also curable without much effort. The old practice of malaria chemoprophylaxis in pregnancy prescribed a 4 tablets dose of chloroquine at the first antenatal care visit, followed by a weekly dose of pyrimethamine during pregnancy up to six weeks postpartum. This practice, despite its effectiveness, created various problems: Many women are allergic against chloroquine and experienced itching pains, the frequent, regular intake is not guaranteed and sometimes impossible because of the financial burden, and health care providers tend to be uninformed about the correct dosages. As a result, FMOH and malaria Action Coalition implemented a new policy for malaria in pregnancy. One of its key pillars is focused antenatal care, including health education on malaria aiming at malaria prevention. Pregnant women are advised to always sleep under insecticide treaed bed nets (ITNs).

The benefits of ITNs are clear: They repel and kill mosquitoes, prevent physical contact with mosquitoes and additionally kill and repel other insects as lice, bedbugs, and cockroaches. The cost factor must also be considered: ITNs are far cheaper than treatment of acute malaria and they furthermore reduce the number of sick children and adults, ensuring productivity. ITNs can be purchased at pharmacies, in markets, in public and private health facilities or they are distributed by community health workers or NGOs working in the area of disease prevention. If they are used correctly and persistently and are re-treated every six months, ITN have been shown to avert around 50% of malaria cases.

Other areas of focus of the new policy on malaria in pregnancy are early detection & prompt appropriate case management of symptomatic women and intermittent preventive treatment (IPT). IPT replaces the old practice of malaria chemoprophylaxis and is based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria. WHO recommends that every pregnant woman should receive two doses of IPT and attend at least 4 antenatal care visits. Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP). Overall coverage of IPT to every pregnant woman is targeted, but special target groups are women in their first or second pregnancies, HIV positive women, adolescent women (aged 10-19), and women with sickle cell disease, as they are more prone to high risk pregnancies.
IPT is best given when the foetal growth velocity is at its highest, in order to reduce placental parasitaemia and resultant foetal growth retardation. That means practically that the first dose should be given from week 16 of pregnancy on, and the second dose should follow with at least 4 weeks space in between up to week 36. But however, if any signs of malaria occur in the woman she still needs to seek medical care.

Without a doubt, these interventions on community level can only succeed if government and other stakeholders completely commit themselves towards the fight against malaria. The key message of the importance of preventing malaria in pregnant women by sleeping under ITNs and taking IPT medication must be passed on to every Nigerian citizen, using both English and the local dialects. The media must be engaged fully in the coverage of malaria issues and educate their audiences on prevention and treatment of the disease. The federal ministry of health need to ensure supply with adequate and sufficient drugs to every health facility and accelerate coverage of free or highly subsidized ITNs and otehr materials for pregnant women and children. All efforts aiming at prevention must be complemented by effective case management of malaria illness for all women of reproductive age, emphasizing screening and prompt treatment for anaemia.

If only detected early enough malaria can be cured, its effects on the unborn child can be prevented and maternal and newborn mortality can be effectively curbed. Antenatal care and treatment can save the lives of thousands of Nigerian mothers and children, so make sure every pregnant woman takes that opportunity!
---Sofia Krauss

Now published on

Wednesday, 29 April 2009

Economic Meltdown and Maternal Mortality

Today the entire world seems to be thrown into a state of panic over the present global economic meltdown. All countries of the world are talking about it and strategising on how to get out of the worst in no time. However, one begins to wonder why this is getting this much attention . The answer may not be far fetched. Aside from every other guesses, one salient fact why we have such a rapid and “sincere” response to address the issue of global economic meltdown is because it affects men directly.

The above assertion is based on the fact that despite the alarming rate at which women die while trying to give life (that is during pregnancy, childbirth or 42 days after pregnancy), governments of the world still remain silent on the issue. Even when something seems to be done, it ends up being a policy without a political will. Today, it is estimated that 6.8 million pregnancies occur each year in Nigeria with about 63% ending in planned birth, 10% in mistimed or unwanted births, 16% in miscarriage and 11% in induced abortion amounting to 760,000 induced abortions occurring in Nigeria annually. While considering these facts on the one hand, on the other hand it is equally pertinent to avert our mind to the fact that 1/3 (one in three) of maternal deaths is caused by abortion and 25% (that is, 1 out 4 women in this category) die from abortion complications every year (Facts deduced from “Unsafe Abortion: The silent Killer” by The Campaign Against Unwanted Pregnancy).

Furthermore, the world Health Organisation (WHO) puts maternal mortality ratio at 1,100 to 100,000 life births while the Federal Ministry of Health puts it at 800 to 100,000 life births. However, some practitioners still posit that both figures are under estimated. Beyond the figures, the issue remains that women are dying in the process of giving life. Unfortunately, Nigeria, being the giant of Africa, remains a giant heavily hit by death which could have been avoided as she finds herself in a situation where in every one hour 6 women are lost to complications arising from pregnancy.

Despite the above facts, Nigeria is still deeply rooted in the “denial culture”. While induced abortion continues to cause maternal death still we deny its existence. Maternal mortality is also on the increase, because getting contraception is difficult, the primary health care system is weak and there is little or no sincerity in government policies at addressing this issue.
Maternal mortality, most likely, would have been long dealt with by a radical approach if men also directly experienced it (possibly in form of paternal mortality). Concrete results would have been achieved if men also experienced pregnancy and complications arising.. There would have been progressive laws and adequate funds for tackling this silent killer. However, this first proposition is impossible at least given the human biological nature.

Thus, it is pertinent to look at practical ways of reducing maternal mortality. Firstly, there must be conscious effort of all and sundry geared at improving upon family planning services and increasing the knowledge base of women on the proper use of contraceptives including emergency contraceptives pills. Secondly, poverty and illiteracy level of women must be looked into. Sexuality (Family Life) education should be incorporated into secondary school curriculum. Thirdly, abortion care services should be made safer and the laws reformed. Also, the media should make positive effort at disseminating clear message on the need to prevent unwanted pregnancy and unsafe abortion. More importantly, men should be educated about their sexual and reproductive health responsibility to their wives, partners, and daughters and so on. Lastly, a situation where a girl who gets pregnant is sent out of school and never readmitted to school while the boy who had impregnated her remains in school is not proper. The girl should be given an opportunity to return to school after child birth.

The above not withstanding, women, aside from children, are the worse affected by the economic meltdown. Given the situation where a lot of women live below poverty level (that is, less than $1 a day) and now compounded by the present global economic meltdown, the purchasing power of women even to assess contraceptive is further inhibited. Therefore there is need to look at making contraceptive not just available to women but also available to women free of charge. It is worthy to note also that the proper use of contraception by women would also help the country in its population control with a rather bad growth rate of 2.8%.
Saving the lives of our women is our responsibility as a nation. Save the life of a woman, save the nation from going into extinction some day.

*Lucky Kawe

Tuesday, 28 April 2009

Hazards of Teenage Pregnancy

It is no longer a diplomatic statement that young people in the last decade, especially within the age group of 10-18 years, are living beyond the yard sticks of adventures compared to the youths of the 60s'. A blend of unpredictable, news breaking activities and issues of topmost concern has risen in the last few years. One of the most striking facts is the rising number of teenage pregnancy. Teenage pregnancy is a result of sexual intercourse between young girls and boys who are in their growing years, exploring the changes happening in their bodies by having unsafe sex with each other. Health organizations across the world are still in the frontlines of reducing maternal deaths due to complications and diseases, with an ever rising more to do with the increasing number of teenage pregnancy.

Bearing a child while still a child themselves, these young mothers are prone to birth injuries and maternal death. It also affects their emotional well being: Teenage mothers are 3 times more likely to suffer from post-natal depression and experience poor mental health for up to 3 years after the birth. Children born to teenage mothers have 60% higher rates of infant mortality and are at increased risk of low birth-weight which impacts on the child's long-term health. Further more, they are at increased risk to be brought up in poverty.

“These adolescent actions have matured consequence”, states Chineye Nwokolo (18 years), a member of Youth Rescue Club, a teenage advocacy group based at Association for Family and Reproductive Health (ARFH) Ibadan. Chineye narrated about the terrain of her adolescence, compared to the experience with a pregnant girlfriend of hers:“About three years ago, I lost a friend to the plight of teenage pregnancy. She dropped out from being my classmate in school and could hardly be regarded to enjoy any teenage experience, like I did. Her name is also Chineye. I saw my friend draw back from what could have been a future for her into the waters of idleness, pain, outright isolation and oblivion. Against my convictions, Chineye's family believed she had brought home a gift into the family. Her mother was a sales woman in the market and her dad just lost his job; tentatively speaking they are a well-to-do family. Chineye had four sisters, for their middle age mother who was closing in to the end of child bearing years this was an opportunity to have a son through her daughter. Her parents did not really care who was responsible but looked forward to the joy of having a male child in the family at all cost, which makes me wonder if she was not pushed out by her parents in the first place to get pregnant! With her parents support, my friend exploited the opportunity to be pampered in her new state. She gave birth and soon enough was back in the crooks and corners were she got pregnant in the first place; I tried reaching out to her to understand the social setback it has cost her but she excusably pointed out to other girls around us who were also getting pregnant. Pregnancy was now a fashionable trend in our community, and week in and out somebody was naming a child, become victim of maternal death, or was commercially parading their pregnancy status. Chineye's child, the adorable little girl, died 4 weeks after delivery. Apparently the family had stopped celebrating the newborn girl with respect to having expected a boy. Little attention was being paid to her medically. She was gone within a short while of her arrival.I can't put a value on the opportunity she missed out in her academics, social growth and uniqueness. My strong convictions are that Chineye represents thousands and thousands of children who are living under the hazard of teenage pregnancy due to the low level of orientation about teenage pregnancy; indiscipline by the parents and moral guidance on understanding the teenage adventures.”

Evidence from areas with the largest reductions has identified a range of factors that need to be in place to successfully reduce teenage pregnancy rates. These factors include a well-publicised contraceptive and sexual health advice service which is centred on young people. The service needs to have a strong remit to undertake health promotion work, as well as delivering reactive services. It is key to prioritize sexual and reproductive health education at schools, supported from the local authority to develop comprehensive programmes of sex and relationships education (SRE) in all schools. A strong focus on targeted interventions with young people at greatest risk of teenage pregnancy, in particular with looked-after children must be put in place to effectively curb teenage pregnancies and its many undesirable effects.

-Femi Adeolu Amele

Friday, 17 April 2009

Which way to 2015, Nigeria?

Creating a supportive environment for maternal and newborn health

Despite the relatively short time left until 2015, Nigeria still lags behind in reaching her Millennium Development Goals. The gap becomes most obvious in the area of maternal, newborn and child health, encapsulated in the MDGs 4 & 5. Nigeria is the world's second largest contributor to maternal mortality, accounting for 10% of all global maternal deaths. This sad second-highest ranking is also found in under- five mortality rates, resulting in the death of one out of every five Nigerian children before their fifth birthday (191 out of every 1000 children). This number is shockingly high, especially compared to the target of 77 out of 1000 which is to be achieved in only six years time. If we look at maternal morbidity the condition seems similarly grim: MDG 5 aims at curbing maternal mortality from presently 1000 per 100.000 life births, signifying mothers dying in the course of pregnancy, delivery or immediately after childbirth, to 250 out of 100.000, a reduction of about three quarters. The key question remains: Can these goals ever be met?

The most reasonable response is: Yes, they can. But there are many steps to be taken to effectively curb maternal and infant deaths in Nigeria. A supportive environment for maternal, newborn and child health must be created through various approaches, programs, community interventions and involvement of all stakeholders, most importantly the Nigerian society. Education for women and girls is essential, as women are the center of all interventions in maternal and child health issues. Research has shown that education until at least secondary level lowers maternal and child mortality drastically. On the one hand, these women are less likely to marry early which delays their first pregnancy and lowers their exposure to maternity risks. Complications from pregnancy and childbirth are an important cause of mortality for girls aged 15-19 worldwide, accounting for 70.000 deaths annually.

If the first pregnancy can be delayed till at least 20 years of age maternal mortality risks are curbed drastically and the babies of women over 20 are most likely to be healthier. These women are far more likely to immunize their children and provide adequate nutrition and disease prevention, resulting in reduced infant deaths. Furthermore, women's education sustains economic growth, thereby automatically creating a better health system. Children of underage mothers often suffer from low birth-weight, malnutrition, and late physical and cognitive development. To create a supportive environment for mothers and children, women must be more involved in decision making processes, both at household level (studies have shown that when women are able to participate in key decisions in the household, they are more likely to ensure that their children are well nourished and seek appropriate medical care for themselves and their children) and within the communities. Community initiatives are highly effective in improving the health of mothers and children as they can challenge attitudes and practices that entrench gender discrimination. Women can share work and pool resources, for example in contributing money to pay transport to the hospital in case of an emergency.
Regular visits and basic health education through community health workers is a key pillar of necessary interventions. The health workers advocate for key household practices such as sleeping under insecticide treated bed nets to prevent mosquito bites and malaria, exclusive breastfeeding, and hand-washing with soap or ash. All these interventions have been proved highly effective in ensuring the health of children and mothers and prevent the most common causes of child death. And they are practically for free.

These initiatives aiming at women empowerment need to be backed up by community support, above all by from ment. Present attitudes of gender discrimination need to be addressed and challenged. This calls for the help and commitment of religious & community leaders towards improving the situation for women in Nigeria. Harmful traditional practices such as child marriage and female genital mutilation (FGM) need to be abolished completely. Another field of action is the prevalence of physical violence against women, which causes many health problems for women and their born or unborn babies. Legislation against woman-battering must be implemented and effectively enforced throughout the country.
Without a doubt, the government also has to play its role and deliver the adequate services at critical points. This includes investment in infrastructure to ensure the access to safe water, good nutrition, adequate sanitation and hygiene facilities, as well as disease prevention and treatment for every Nigerian citizen. Facilities must have sufficient medicines, supplies, equipment and trained personnel. Every pregnant woman must be granted the access to quality antenatal care, skilled assistance at delivery and clean delivery facilities to prevent severe infections. In case of an emergency, EOC (Emergency Obstetric Care) should be available at every secondary and tertiary health facility to save the life of mothers and newborns alike.

After giving birth post-natal care and neonatal care should be easily available at every health facility. Antenatal and postnatal care also serve as a means of educating the mother on best practices with her newborn, stress the importance of exclusive breastfeeding and promote hygienic child care. In order to put all this initiatives in place it is essential to expand the Maternal, Newborn and Child health workforce and establish solid financing mechanisms. Government must be prepared and willing to allocate more resources to MNCH- because it is the nation as a whole who will finally profit from living mothers and healthy babies.

--Sofia Krauss

A critical view of malaria homecare and the new global malaria drug subsidy

Treating African children at home for malaria doesn't help in cities because most fevers aren't actually caused by malaria, said a new study published online in the medical journal Lancet. Experts monitored more than 400 children aged between 1 and 6 in Kampala, Uganda, from 2005-2007. Malaria drugs were distributed to households where parents had been told by researchers to automatically treat their children if they became feverish. Roughly half the children were treated at home while the other half were taken to health clinics within a day of developing a fever. The study found that children at home got twice as many medicines as those taken to clinics, but didn't do any better.

Home-based management of fever aims to improve the chances that a child with malaria will be promptly and appropriately treated. In high-prevalence settings, treatment with antimalarial drugs is likely to be appropriate, since the cause is more likely to be malaria than not. However, in settings with lower transmission rates, there is a risk that children with non-malarial fever will be treated as having malaria and the true underlying cause (such as pneumonia) will not be addressed.Some doctors said the study showed a worrying tendency to treat fevers before they were diagnosed as malaria: "If you just go on fever, you're over-treating so many children and you could miss other diseases by using malaria drugs," said Dr. Tido von-Schoen Angerer of Doctors Without Borders. Malaria medicines don't work on fevers caused by other diseases, and children can die if they are not properly treated.

Previous studies have found home treatment works in rural areas. But malaria is also a problem in cities, and will have to be tackled differently there than in the countryside. Across Africa, the World Health Organization puts the figure of children promptly treated with effective medication at only 3 percent. The United Nations and partners lately announced a $200 million strategy called the Affordable Medicines Facility for Malaria to make drugs cheaper in 11 African countries. The Affordable Medicines Facility for Malaria (AMFm) will massively subsidise the price of artemisinin-based combination therapies (ACTs), the most effective malaria treatments that exist today. The scheme seeks to reduce the price of ACTs sufficiently to drive older, ineffective treatments that are still being purchased because they are considerably cheaper, out of the market. Von-Schoen Angerer and others worry the tendency to over-treat malaria, as provn by the Lancet study, will be worsened by the strategy. They fear it will flood the market with drugs that promote resistance.

The initiative, led by WHO and the Global Fund to fight AIDS, tuberculosis and malaria, will subsidize the price of artemesinin combination therapies, the most effective malaria treatments. But the U.N. has not insisted the drugs be combined in a single pill, which would curb the resistance risk. Artemesinin combination therapies are also sold as several pills. Some cause side effects like nausea, and patients commonly throw those pills out, encouraging resistance. "The risk of resistance is very scary," von-Schoen Angerer said. "We don't have a back-up medicine at this stage." Richard Tren, director of the nonprofit Africa Fighting Malaria, called the U.N. initiative "an untested experiment," and warned the strategy could backfire. "We need policies based on evidence," he said. "And the evidence this could work is pretty shaky."

Thursday, 26 March 2009

The Role of Education in addressing maternal health and the newborn child

At a critical time, when one could describe the status of educational impartation to be tangling across progress and recession, stakeholders in the education sector, media and advocate of national hope converged at Development Communications Network to discuss the way forward. Facilitators for the media forum were Mrs. Abolaji Osime, State team leader of Education Sector Support Program in Nigeria (ESSPIN), supported by Mrs. Taiye Alagbe, Communication & Knowledge Management Officer of ESSPIN.

Abolaji Osime briefed the media group on the core values which ESSPIN represents and on how the organization has been in the fore front of supporting the Federal and State Governments in Nigeria to make sustainable improvements in basic education services. “With a strong program output, ESSPIN has ventured into strengthening the governance framework of the Federal Government to enable basic education reform, strengthening State-level governance and management of basic education reform, improve the learning environment for children and promote demand for better education services” stated Mrs. Osime.

The state team leader also pointed out the pivot relationship between education and health: “Investments by Government in nutrition, health and education have a long term impact on economic growth and social development. Education improves hygienic practices. The use of health practices such as family planning allows the individual to make better choices impacting on productivity, which in turn has a significant impact on economic growth, poverty eradication, child survival and improved maternal health.”

She stressed that health & education were extremely important, as they are subject of 5 out of 8 Millennium Development Goals. Healthy populations are a major engine of economic growth. But Nigeria continues to strive to meet up with its goals for 2015, which are (MDGs related to health & education):
Achieve universal primary education
According to FME, only about 50% of children under the age of 15 are in school in Nigeria. There are major disparities between the North and south, rural/urban areas and across genders

Promote gender equality and empower women
Percentage female enrolment is about 45%

Reduce child mortality
Nigeria is ranked 14th in the world in under-fives deaths. 1million children under age 5 die each year (close to 200 out of every 1000 children in national average). The major causes of infant mortality are acute respiratory infections, malaria, diarrhoea and HIV/AIDS. Underlying these deaths are levels of education, poverty, ignorance, socio-cultural and religious issues. If we proceed at this level, it will take us 70 years to achieve the MDGs.

Improve maternal health
Nigeria accounts for 10% of maternal deaths worldwide; although the country only accounts for 20% of the worlds population

Combat HIV/AIDS, malaria and other diseases
Due to its prevalence, malaria has had an impact on productivity and is a major cause of infant mortality. Studies show that between 1 and 5% of Nigeria’s GDP is lost to malaria

It was pointed out that there is a need to anchor our values in the health and education system around core features such as motivation to learn, active community participation, value of academic achievement, ability to proceed to further learning, social and civic skills, economic well-being and healthier students.

WHO defines Health as a State of complete physical, mental and social well being and not merely the absence of disease or infirmity. Good health not only promotes human development, it enhances work skills and promotes economic growth via increased productivity.
Early marriage is a huge contributor to maternal morbidity and mortality. Bearing a child while still an adolescent herself, these teenage girls are twice as vulnerable to complications during pregnancy, birth injuries, and maternal mortality than mothers above the age of 20.
National Demographic Health Survey (NDHS) 2003 shows that women who attended at least 7 years of school are far less likely to marry before the age of 20 ( 25,5%) compared to those who attended less than 7 years of schooling (83,5%). Female education must therefore be given priority in effectively curbing maternal mortality, as women with a higher educational level are also more aware of risk signs during pregnancy and after delivery, are more likely to seek medical care, and use modern methods of contraception more often. Furthermore, female education is closely linked to child survival : An educated woman is 50% more likely to have her children immunized and deaths of children under five years of mothers who have spent at least seven years in primary education is reduced drastically. (NDHS,2003)

Friday, 6 February 2009

6th of February: International day of zero tolerance for Female Genital Mutilation (FGM)

"All over my thighs were marks from the ropes, dotted with patches from the lice wounds. Now I was to look after myself, to ensure that everything remained intact until the day I married."
—From "The Cut," Maryam Sheikh Abdi's autobiographical poem

Female Genital Mutilation/Cutting, the act of cutting, removal, and sometimes sewing up of external female genitalia for cultural or other nontherapeutic reasons still poses a huge threat to the health and life of millions of women: An estimated 100 million to 140 million girls and women worldwide have undergone female genital mutilation/cutting (FGM/C) and more than 3 million girls are at risk for cutting each year on the African continent alone.
This harmful tradition continues to take place today in Nigeria, irrespective of religion or culture, for reasons that include: Beliefs about health and hygiene, custom and tradition, religious demand, aesthetic reasons, protection of virginity, increasing sexual pleasure for the husband, enhancing fertility and increasing matrimonial opportunities.
According to the latest DHS findings (2003) 85% of girls who have undergone FGM were circumcised between the ages of one and four.
A highly respected woman in the community, such as birth attendants, barbers and medical health workers, performs the ritual. It causes physical and psychological damages to the victims and its effects are both immediate and life-long. The physical effects are as follows: Uncontrolled bleeding, severe pain, urine retention, genital ulcerations, scar formation, VVF/RVF, shock, increased risk of HIV/AIDS infection, and even death.
Some long-term complications, such as infection, have been known to cause infertility and obstructed labour.

The psychological effects are seen in anxiety, depression, frigidity and elimination of sexual pleasure. (Nigeria Progress Report on FGM for WHA 2008)

FGM is a fundamental violation of women’s and girl’s rights. It violates the right to health and to physical integrity, to be protected from harmful traditional practices, to be free from injury and abuse.
Furthermore, girls usually undergo the practice without their informed consent, depriving them of the opportunity to make independent decisions about their body.

Ten states in Nigeria have passed legislation outlawing FGM and zonal training workshops for ex-circumsisors on alternative employment have been conducted, but as a result of inadequate funding, resistance to change as FGM is deeply rooted in culture and erroneously in religion, the so-called “medicalisation” of the FGM practice ( involvement of modern health practitioners in the performance preventing the development of effective and long-term solution for the abandonment of FGM ), and lack of legislation against FGM at the national level there is still an estimated 19 % prevalence of affected women aged 15-49 throughout the country.