40% of our babies not born in hospitals – Dr Okolo
Dr Angela Okolo,
What is the essence of your 7th scientific meeting?
We have been bothered that so many newborns die in Nigeria. In fact, Nigeria is ranked second in the number of newborn babies [dying] next to India and Pakistan. We looked at why these babies are dying and what can we do? We have contributed a lot to the number of children aged less than one year who are dying globally. Nigeria has an extremely high burden of deaths of such categories of infants. We have had our child survival strategies going on for many years, and that has reduced drastically the number of children older than one year who are dying. Up to the extent of 30 to 40% of our infant mortality comes from the deaths of babies less than one month. If we have to achieve MDG4, we must do something to prevent the deaths of babies less than one month.
As an expert in neonatal medicine, what’s causing babies’ deaths?
The commonest cause of the deaths of our babies is birth asphyxia—failure of our newborns to start breathing as soon as they are born. This is understandably so, because as many as 40% of our babies are not born in the health system where they can get help: they are born at home and in the communities. Infections constitute a major cause of death and prematurity. In premature babies, you have commonly asphyxia and infections. The meeting is to cover these areas.
There are simple things we can do. Today we are talking about infections, even starting from the skin. We are looking at what populations apply to baby skin: are they useful, can they help? If they can, as the studies go on, we can find out? If they cannot help, we will find ways of transmitting that information to them that we should do better.
One priority area is the way forward to save lives. What strategies are you considering?
We are looking at supporting the respiration of babies, because they are dying, particularly the premature babies. We are looking at how to help babies who fail to breathe when they are born. We have had pre-conference workshops that showed methods of assisting their respiration—ventilating babies mechanically, using simple devices. Even continuous airway pressure, when applied, can be useful. We have looked at solutions that we can recommend to government at all levels on how to help our babies better.
What are those recommendations you can give to government?
Starting from respiratory support, we intend to recommend that we should encourage access to health care facilities for mothers and their babies. When we talk access, it is not just transportation. We need to support them to transport. Because some of these things we have been examining need a lot of finances. And when we are talking finances, it is both to the health system and individual families. Up till now, health insurance has not spread appropriately, so families still pay out of their pockets. In our experience, a lot of families will prefer to do it their own way, because they would say, ‘this small baby just coming to life is going to [sic] suffer us, we have other things to do’, so they will opt for not caring for the baby. It is not because they are wicked to the baby, but because they have not got the means.
That’s number one recommendation. Improve
The
The commonest cause of death among babies born in Nigeria is birth asphyxia, says President of the Nigerian Society for Neonatal Medicine, and professor of paediatrics and child health at University of Benin Teaching Hospital. “This is understandably so, because as many as 40% of our babies are not born in the health system where they can get help: they are born at home and in the communities.” The seventh scientific meeting of Nigerian Society for Neonatal Medicine concluded that neonatal medicine faces an uphill battle to stop infant deaths, but requires will and zeal.
access, means of community reaching the facility to support
their needs.
With the level of poverty in Nigeria, how do you think child survival can be ensured, especially in
rural areas?
health insurance scheme is very good and very important. We have to encourage our communities to get into a community health insurance scheme, because not everybody falls ill at the same time. It is just like having your car insured. It is not all of us who have accidents, but the insurance brokers make their profit, because most of us don’t have accidents, but the ones that have accidents will have benefits from their insurers. Same thing: not all of us have ailments at the same time. Whatever our needs are, I believe that health insurance, when practised appropriately, even when applied to the community, will be an equitable way of looking at how to help our rural communities.
What about human resource?
We have scarcity. Right now the membership of our association is open to specialists in neonatal medicine or paediatricians who, even though they are in general practice, at least spend 60% of their time in caring for newborn babies. It is amazing to note that in all the geopolitical zones, we have members. If we want to spread any information or support new government policies, we have the membership to support that.
Still on the scarcity of human resources, how can that be helped?
We do train locally, support supervision of health workers, but the bottom line is that a sick newborn must get specialized help. However, we work with communities to train the community health extension worker on health promotional issues to encourage mothers in their homes to use their health facilities. They would rather do the things they want to do in their own way, and that leads us into dangerous situations.