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."