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Safe Motherhood: Any Hope For Nigeria?

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Cross section of nursing mothers at a safe motherhood programme in Port Harcourt.

Cross section of nursing mothers at a safe motherhood programme in Port Harcourt.

Amina Daerego is a typical
normal girl in one of the riverine areas of the Niger Delta in Nigeria. She was forced into early marriage against her wish at 14 for the singular reason that her parents needed someone to relieve them of the burden of catering for her.
Three times shortly after the marriage, she ran home, only for her parents to bring her back on each occasion with apologies to her husband, seeking his understanding of her feeling homesick.
Her husband, fondly called “Big Bros” by the locals, is a 58 year old male chauvinist who has 13 children with five women through concubinage, and eight grandchildren, six of whom are senior to Amina. He has never been officially married.
Four months into the marriage, Amina got pregnant and became even more embittered about her situation. Her husband, who claims to have all the experiences of child bearing, did not want to hear anything about ante-natal, but believed in traditional medicine. Meanwhile, he is known to have been nonchalant in catering for all the women he had children with, both during and after childbirth.
On several occasions, Amina attempted aborting the pregnancy through the use of various concoctions and cassava stems with advice from peers and friends. After several attempts without success, she gave up and decided to have the baby.
Being innocent and obedient, Amina faithfully patronised Traditional Birth Attendants (TBAs) for ante-natal services until she delivered, only to find that her baby boy was deformed. His right leg was far shorter than the left, and his left ear was sealed.
In another scenario, Tochukwu Ihaenacho, a 28 year old house wife in Nsukka, Enugu State, accessed neither ante-natal nor TBA services all through her pregnancy. When she was due, she and her husband went to a quack nurse who placed her on herbal concoctions preparatory to her delivery.
After some days, she started stooling and vomiting. The quack nurse explained to the husband that these were signs of labour, not knowing that his wife was gradually dying. When it became very obvious and getting out of hand, the woman referred them to a hospital.  Tochukwu and her baby died on the way to the hospital.
These scenarios are very common in Nigeria, especially in the hard-to-reach areas, popularly called rural areas. The circumstance surrounding the health of the girl/woman before, during and after delivery is what has come to be referred to as Safe Motherhood in modern day.
Safe motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth. This, in practice, means addressing all the factors that make pregnancy unsafe.
Ordinarily, having a baby is a natural process: after a full-term pregnancy, which usually lasts for nine months, a woman goes into labour on or near her due date, also known as Expected Date of Delivery (EDD), and gives birth to a healthy baby. A day or two later she leaves the hospital to begin day-to-day life with her growing family. But not all pregnancies go smoothly. Some women experience what doctors refer to as high-risk pregnancy.
A pregnancy is considered high-risk when there are potential complications that could affect the mother, the baby, or both. High-risk pregnancies require management by a specialist to help ensure the best outcome for both the mother and baby.
Factors that constitute high-risk and hence makes pregnancy unsafe can be categorised into Maternal Age, Medical conditions that exist before pregnancy, and Medical conditions that occur during pregnancy.
Naturally, women who will be under age 17 or over age 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s. The risk of miscarriage and genetic defects further increases after age 40.
In the same way, conditions such as high blood pressure; breathing, kidney, or heart problems; diabetes; autoimmune disease; sexually transmitted diseases (STDs); or chronic infections such as HIV can present risks for not only the mother, but also her unborn baby.
For medical conditions that occur during pregnancy, even if the woman was healthy, when she becomes pregnant, it is possible for her to develop or be diagnosed with problems during pregnancy that can affect her and her baby.
Nigeria, regarded as the most populous African country, is said to have the highest maternal mortality ratio in the world. According to the newly revised estimates of the World Health Organisation (WHO), there are 576 maternal deaths in every 100,000 live births in the country, and a woman’s life time chance of dying during pregnancy, child birth or the postpartum period is 1 in 18.
WHO also estimates that annually, 59,000 Nigerian women die in childbirth, which is the second highest in the world, after India. Many factors have contributed to the above scenario. They include: severe bleeding (haemorrhage), which accounts for 25% of deaths; infection (15%); unsafe abortions (13%); enclampsia (12%); and obstructed labour and other direct diseases (16%).
Maternal deaths from direct causes accounts for the remaining 20% of deaths. These deaths, according to WHO, results from diseases (usually present before or during pregnancy) such as malaria, anaemia, hepatitis, heart disease and HIV/AIDS that are not complications of pregnancy, but complicate pregnancy, or are aggregated by it.
In a recent presentation on safe motherhood, titled “Women’s Sexual and Reproductive Health and Rights”, organised by Ipas, Nigeria, in Port Harcourt, Mrs. Mikiai Amachree, Desk Officer, Safe Motherhood in the Rivers State Ministry of Health, said only 10% of women deliver in government-owned health care facilities in the State.
According to her, “statistics show that out of 237,114, which is 80% of our target pregnant women, estimated to register for antenatal services, in 2011, only 120,990, which is 62.8%, came for antenatal care services.
The Tide’s investigation revealed that out of this number only 11,878, which is 10% of them, delivered in the health care facilities. This reveals gross under-utilisation of the services. Such records cannot be easily ascertained in the secondary, tertiary and private health facilities as well as Traditional Birth Attendants (TBAs).
One way to check the trend of poor record keeping as it concerns the secondary, tertiary, private and TBAs, according to Mrs. Amachree, is to make the Ministry of Health a record bank of all deliveries in Rivers State.
Impliedly, where to begin to keep records would be ensuring that all health facilities involved in deliveries in the country are made to submit their records bi-annually to the State Ministry of Health.
“The implication of this is that the State Government need to make it mandatory, including enacting a law to that effect, for such health facilities to submit their records of deliveries and deaths to their various state ministries of health”
Also, a study of deliveries that occurred in Kano State, Northern Nigeria, for instance, revealed a very high maternal mortality ratio of 2,420 deaths per 100,000 live births. The Tide gathered that about half of these deaths were caused by enclampsia, rupture of the uterus, and anaemia.
A research carried out by Shiffman J. and Okonofua F. identified  key challenges faced by safe motherhood practices in most parts of developing countries, where it is more common, to include institutionalising political priority for safe motherhood in Nigeria.
A critical look at these challenges, however, reduces them to three key areas: bringing about coalescence of the existing network of champions, developing strategies to increase federal budgetary resources, and promoting attention for the cause at state and local government levels.
How to transform the existing network of champions into a potent political force is the ûrst challenge. There are numerous networks working on safe motherhood that have many capable individual members but still not as functional as they should be, and have no overarching strategy and do not act in unison.
Members have numerous responsibilities within their own organisations, and these organisations themselves have multiple mandates, making it difûcult to bring about this coalescence.
Developing a unified common political strategy for safe motherhood promotion in Nigeria is possible, but would not only require a lot of resources and time, but also a leader or set of leaders at various levels of governance to appear, backed by a supportive organisational structure.
The second challenge is to generate significant federal budgetary resources for the cause. The relatively minimal amount the Federal Government has devoted to the cause, compared to those of donor agencies and the like raises questions about the meaningfulness of its commitment.
For instance, the 2014 Nigerian budget for health was N262 billion (about1.7 billion USD). The bulk of this amount was used in such areas as HIV/AIDS, immunization, capacity building programmes, etc. Safe motherhood was not given the attention it required, in spite of the high rate of maternal and infant mortality in the country.
Since HIV/AIDS has begun to attract signiûcant federal resources, it is not impossible for other health challenges, including maternal mortality reduction, to be adequately funded.
The implication is that the budgetary circumstances for safe motherhood should improve as the Federal Government, in response to national legislative and international pressure to achieve the maternal mortality reduction aims of the MDGs, may augment funding for the cause.
A major key towards the actualisation of this possibility is for safe motherhood advocates to pressurise the Federal Government, which also needs to view such pressure as nothing more than it truly is.
The third challenge is to generate meaningful political priority in state and local governments. This challenge has several components: the first is to generate reliable information on the scope of the problem so that ofûcials come to understand and appreciate it as a problem.
Secondly, there is the pressing need to re-orientate the political priorities of these officials, recognising that they operate as much from political self-interest as from a desire to promote social welfare.
This is mostly because many see little political value in making safe motherhood a policy priority. They, therefore, prefer to devote resources to other causes that they understand to be more visible and hence to be capable of generating greater political capital for themselves.
The challenge for safe motherhood advocates is, therefore, to frame the issue in such a way that it would convince governors and other elected officials that they can gain political support by acting on the problem and that they will lose political support by ignoring it.
Third is encouraging the diffusion of policy attention among state-level officials themselves. It is only through these means that the hope of the Nigerian mother can have meaning in terms of Safe Motherhood.

 

Sogbeba Dokubo

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‘How Micro RNA Research Won Nobel Prize’

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Two United States scientists who unraveled the human micro RNA have won the Nobel Prize in Physiology or Medicine 2024.
Victor Ambros and Gary Ruvkun won the coveted  prize for their work on microRNA as their discoveries help explain how complex life emerged on earth and how the human body is made up of a wide variety of different tissues.
MicroRNAs influence how genes – the instructions for life – are controlled inside organisms, including humans.
Every cell in the human body contains the same raw genetic information, locked in our DNA.
However, despite starting with the identical genetic information, the cells of the human body are wildly different in form and function.
The electrical impulses of nerve cells are distinct from the rhythmic beating of heart cells. The metabolic powerhouse that is a liver cell is distinct to a kidney cell, which filters urea out of the blood.
The light-sensing abilities of cells in the retina are different in skillset to white blood cells that produce antibodies to fight infection.
So much variety can arise from the same starting material because of gene expression.
The US scientists were the first to discover microRNAs and how they exerted control on how genes are expressed differently in different tissues.
The medicine and physiology prize winners are selected by the Nobel Assembly of Sweden’s Karolinska Institute.
They said: “Their groundbreaking discovery revealed a completely new principle of gene regulation that turned out to be essential for multicellular organisms, including humans.
“It is now known that the human genome codes for over 1,000 microRNAs.”

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WHO Begins Regulation On Antibiotic Waste

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The World Health Organisation (WHO) has begun acting to curb effects of antibiotic pollution.
The new guidance on wastewater and solid waste management for antibiotic manufacturing sheds light on this important but neglected challenge ahead of the United Nations General Assembly (UNGA) High-Level Meeting on antimicrobial resistance (AMR) taking place on 26 September 2024.
The emergence and spread of AMR caused by antibiotic pollution could undermine the effectiveness of antibiotics globally, including the medicines produced at the manufacturing sites responsible for the pollution.
Despite high antibiotic pollution levels being widely documented, the issue is largely unregulated and quality assurance criteria typically do not address environmental emissions. In addition, once distributed, there is a lack of information provided to consumers on how to dispose of antibiotics when they are not used, for example, when they expire or when a course is finished but there is still antibiotic left over.
“Pharmaceutical waste from antibiotic manufacturing can facilitate the emergence of new drug-resistant bacteria, which can spread globally and threaten our health. Controlling pollution from antibiotic production contributes to keeping these life-saving medicines effective for everyone,” said Dr Yukiko Nakatani, WHO Assistant Director-General for AMR ad interim.
Globally, there is a lack of accessible information on the environmental damage caused by manufacturing of medicines.

 

“The guidance provides an independent and impartial scientific basis for regulators, procurers, inspectors, and industry themselves to include robust antibiotic pollution control in their standards,” said Dr Maria Neira, Director, Department of Environment, Climate Change and Health, WHO. “Critically, the strong focus on transparency will equip buyers, investors and the general public to make decisions that account for manufacturers’ efforts to control antibiotic pollution.”

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Kebbi Harmonises Doctors’ Salaries To Curb Brain Drain

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In a concerted effort to curb brain drain, the Kebbi State Government has harmonised medical doctors’ salaries to be at par with their colleagues in the federal government’s tertiary health facilities.
Kebbi State Commissioner for Health, Musa Inusa-Isma’il, disclosed this at the handing over of ambulances to the state-owned health facilities at the Ministry of Health in Birnin Kebbi yesterday.
Inusa Isma’il, according to a statement by Ahmed Idris, the Chief Press Secretary to the governor, said the essence of the harmonisation was to retain the existing medical doctors and attract more to the services of the state.
According to him, the doctors across the state had already started enjoying the new salaries from August 2024.
He said the release of the vehicles was in fulfilment of Governor Nasir Idris’ promise to uplift health care services in the state.
“His Excellency said I should inform you, the beneficiaries of this gesture, that the vehicle should be strictly used for the intended purpose. It should not be used for anything else.
“If there is no referral case, each of the vehicles must be parked at the hospital by 6 pm. The governor said you should warn your drivers against reckless driving as well as violating the instructions.
“We should also do everything possible to reciprocate the gesture by working according to the terms and conditions attached,” he advised.
The benefiting health facilities included Sir Yahaya Memorial Hospital, Birnin Kebbi; State Teaching Hospital, Kalgo; General Hospital, Argungu; General Hospital, Yauri; General Hospital, Zuru; and General Hospital, Bunza.

 

 

In his speech, the permanent secretary of the ministry, Dr Shehu Koko, recalled that the ambulances were handed over to the ministry last Friday by the governor for the onward handover to the benefiting hospitals.
He observed that the ambulances would go a long way in improving the referral system in the state, adding that delays in reaching the secondary and tertiary facilities would be eliminated.
The permanent secretary attributed the high rate of maternal mortality in the country to delays in getting to the health facilities for proper medical care.
“We believe with the provision of these ambulances, part of the gaps we have in our referral system will be addressed, whereby patients who require secondary healthcare could be easily transported to secondary and tertiary health centres, where they can get such help,” he said.
In a goodwill message, Commissioner for Information and Culture Alhaji Yakubu Ahmed expressed gratitude to the governor for the support he has given to the ministry to excel.
While advising the beneficiaries to use the vehicles judiciously, the commissioner advised that services and maintenance of the vehicles must be prompt to derive the maximum benefits from the vehicles.
The commissioner also highlighted some achievements recorded by the government in the last year, including beautification of the state capital, completion of a multimillion-naira ultramodern state secretariat, road construction, construction and renovation of classrooms and upgrading of some health facilities, among others.

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