NONYE SOLUDO MATERNAL, PERINATAL AND CHILD MORTALITY REDUCTION STRATEGIES.

Nigeria is one of the 193 countries United Nations Members that agreed on these 17 Sustainable Development Goals to end poverty, ensure prosperity, and protect the planet by 2030.With the deadline for the attainment of the Sustainable Development Goals rapidly approaching, many countries are developing strategies aimed at fast-tracking efforts being made towards the attainment of the SDGs.

Nigeria still has one of the highest maternal mortality rates in the world. Each year in Nigeria, over seven million babies are born, 240,000 of these babies die in their first month of life with 94,000 dying on the day of birth, in addition, there are nearly 314,000 still births. In 2018, the figure for Anambra State, although slightly worse than the national average at 512/100,000 live births (NDHS 2018), was unacceptably high.

In addition, an estimated 250,000 newborns die annually in Nigeria and the Neonatal Mortality Rate is 48 per 1000 live births. Although Nigeria is on track for some of its targets, it is showing slow progress especially with the health-related ones.

Nigeria being a major contributor to the global burden of maternal   deaths, requires intensified efforts to rapidly reduce the high mortality indices. Nigeria only represents 2% of the world population, yet currently accounts for about 10% of the world’s maternal and under-5 deaths. These deaths are as a result of declining quality of health care services rendered to communities [traditional birth attendants] especially hard to reach communities, where they are already disadvantaged with respect to current economic hardship in the country.

According to our statistics [DHIS 2022] Anambra state maternal mortality ratio is 255.1 per 100,000, this means that the state is major contributor to the National maternal mortality ratio. Sixty percent [60%] of maternal death in Anambra is as a result of post-partum hemorrhage, and so any novel strategies should involve post-partum haemorrhage interventions.

Two decades of various Safe Motherhood initiatives since the Launch in Nairobi 1987 has failed to make any remarkable impact on the maternal health indices in Nigeria.

The main causes of maternal mortality identified in Nigeria are:

1. Hemorrhage (23%)
2. Infection (17%).
3. Unsafe abortion (11%)
4. Obstructed labour (11%)
5. Eclampsia (11%)
6. Malaria (11%)
7. Anaemia (11%)
8. And others including HIV/AIDs (5%).

Surprisingly majority of the conditions could be prevented, and thus minimizing the impact to such an extent that they do not cause maternal death. 75 percent of neonatal deaths occur within the first week of life, therefore linking the survival of the newborn to the quality of maternal care.

ANAMBRA STATE

In 2018, the State Government inaugurated a sterling committee to offer technical guidance on the various measures needed for the reduction of the maternal mortality using the National guidelines and for the on Maternal and Perinatal Death Surveillance and Response (MPDSR) and the SOGON National Partnership plan for sustainable Reduction in maternal and Newborn Death in Nigeria as templates.

Commissioner for Health- Chairman

Commissioner Economic Planning – Co chairman

Commissioner Women Affairs and Poverty Alleviation

Permanent Secretary Ministry of Health

Permanent Secretary Economic Planning

Executive Secretary ASPHCDA

Hospital Administrator, Hospital Management Board

Director Public Health Director/Disease Control

Reproductive Health Coordinator-secretary

Ministry of Finance/Budget

Representative of SOGON

Representative of PAN

Chairman NMA

Chairman Anambra  Sector AGPMPN

National Population Commission

Chairman State Blood Transfusion association.

HOD, Dept of O&G NAUTH

HOD Dept of O&G COOUTH

Director Nursing and Midwifery

State HMIS

Coordinator Anambra State indigenous Traditional Medicine

Perm Sec Ministry of Women Affairs and Poverty Alleviation

Special Adviser to Governor on Health

Ministry of Local Government & Chieftaincy Affairs

At the inaugural meeting, major challenges identified were:

1. Inadequate manpower especially doctors and midwives at the primary, secondary and tertiary level of care.
2. Prevalence of traditional birth attendants at the community level and the refusal of their body to follow laid down rules.
3. Inadequate blood transfusion services at the secondary and tertiary centres.
4. Poor two-way referral system.
5. Lack of community-based insurance scheme.

Situation analysis showed the following:

PHCs.

A total of 617 PHCs were distributed across the Local Government Areas in the State. 329 were admitted into Basic Health Care Provision Fund, however majority were poor staffed and unable to deliver basic emergency obstetric care. [EMOC]

General Hospitals:

Most of the general hospitals had complement of doctors, nurses and midwives, but were unable to provide comprehensive emergency obstetric care due to inadequate staffing, unavailability of necessary equipment and infrastructure and lack of blood banking facilities.

Suggestions/Recommendations from the inaugural meeting:

1. Sustained advocacy to Government for improved budgetary allocation and social mobilization to communities.
2. Increased community and public awareness on issues concerning maternal and child health care to address type 1 delay through the development, printing and dissemination of information, education and communication (IEC) materials.
3. Capacity building of health workers on the various maternal and child health interventions.
4. Integrated services for maternal, newborn and child health (IMNCH)
5. Strengthening of Primary Health Care and effective referral systems.
6. Training and retraining of birth attendants: (Faith based, Community and Traditional).
7. Effective supervision of Community and Faith Based Organizations.
8. Linking of community-based ambulances with the State Ministry of Health.