Transcript REDUCING MATERNAL AND NEWBORN DEATHS

REDUCING MATERNAL AND
NEWBORN DEATHS
in
Nigeria
United Nations Human
Development Index
Socio-Economic Indicators

per capita income
 access to health facilities
 access to potable water
 school attendance
N35,340
(US$310)
63.5%
54.1%
55.1%
Characteristics of the Population
 Total Population
120 Million
 Women of Reproductive Age 27 Million
 Married by Age 34
95%
 Median Age at 1st Marriage
18 Years
 Adult Female Literacy Rate
41%
 Contraceptive Prevalence Rate 8.9%
 Total Fertility Rate
5.1
Total Fertility Rate by Zone
8
7
6.5
6.8
6
5
4.5
4.5
4.6
4
3
2
1
0
Central
Southwest Southeast Northwest Northeast
High Risk Fertility Behaviour
Birth Order 4+
Birth Interval < 24
months
Mother's Age > 34
years
Mother's Age <18
years
0
5
10
15
20
Percent of all births
25
30
Place of Delivery
 Health
Facility:
37%
 Home:
58%
Zonal Disparities: Health Facility Delivery
70
60
50
40
percent
30
20
10
0
Southwest Southeast
Central
Northeast Northwest
Maternal Deaths / 100 000 Live Births
Selected Maternal Mortality
Ratios in Africa
1200
980
800
800
610
400
480
340
0
South Africa
Botswana
Zimbabwe
Nigeria
Mozambique
Maternal Mortality Ratio by Zone
per 100,000 live births
2000
1549
1500
1025
1000
500
286
165
0
Southwest
Southeast
Northwest
Northeast
Death in the First 5 Years of Life
Deaths per 1000 live births
200
180
160
140
120
100
80
60
40
20
0
Northeast
Northwest
Southeast
Newborn (<1 month)
Southwest
1-11 months
Central
Nigeria
12-59 months
Causes of Maternal Death
Anemia
11%
Other
5%
Haemorrhage
23%
Malaria
11%
Infection
17%
Obstructed
labour
11%
Unsafe
Abortion
11%
Toxemia/
Eclampsia
11%
Women’s Low Status
•Lack of access to
and control of
resources
•Limited access to
education
•Lack of decisionmaking power
The First Delay
 Lack of information
and inadequate
knowledge about
signs of
complications of
pregnancy and
danger signals
during labour
 Cultural practices
that restrict women
from seeking health
care
The Second Delay
Inability to access health
facilities
 Poor siting of health
facilities
 Poor roads and
communication network
 Poor community support
The Third Delay
Delay between arriving and
receiving care at the health
facility
 inadequate skilled attendants
 inadequate equipment and
supplies
Health Facilities with Midwives
At Least One
Midwife
46%
No Midwives
54%
Other Factors Contributing to
Maternal Mortality
Adolescent pregnancy- 16% of total births
 Unsafe abortions- 610,000 per year
 High prevalence of malaria
 High rate of malnutrition – 16%
 HIV/AIDS pandemic 5.4%
Estimating the Consequences of
Poor Maternal and Newborn Health
Data on Maternal Health
REDUCE MODEL
Impact on survival and productivity (2001 - 2010)
Data Sources
 Nigeria Demographic and Health Survey,1999
 Nigeria Common Country Assessment, 2001
 HIV/Syphilis Sentinel Sero-Prevalence Survey in
Nigeria, 1999
 Multiple Indicator Cluster Survey, 2000
 The Global Burden of Disease, 1996, 1998
 The Human Development Report, 2001
Maternal Mortality
2001-2010
No interventions
437, 000 maternal deaths
Effects of Mothers’ Death
The death of a
woman and mother
is a tragic loss to the
family, community
and nation as a
whole.
Child Mortality
2001-2010
No interventions
1,500,000 children
will die
Disability Consequences
2001-2010
 Chronic anemia
 Stress incontinence
 Fistulae (VVF,RVF)
 Chronic pelvic pain
 Emotional depression
 Maternal exhaustion
Economic Losses
2001-2010
The loss of productivity due to maternal deaths
will be $341,000,000
or about 39 billion Naira
Economic Gains
2001-2010
Interventions
$536 million or 61
billion naira gained
Commitment to Reducing
Maternal and New Born Deaths
Goal:
50 % by 2010
(Vision 2010)
Reduction in Maternal Deaths
2001-2010
Maternal deaths / 100 000 live
births
1000
750
500
250
0
2001
2002
2003
2004
2005
2006
2007
2008
Year
No change in maternal care
Improved maternal care
2009
2010
Interventions
Implementation of existing policies,
guidelines and programmes related to
maternal health issues should be faithfully
implemented immediately and nationwide.
Allocate and release at least 15% of total annual
budget for health and at least 10% of that budget
for reproductive health services.
Ensure partnerships: private sector, civil
society, religious and other community-based
organizations.
Interventions 2
All health facilities must have regular supply of water
and electricity;
All facilities that offer maternity services must
implement the Baby Friendly Initiative (BFI) which
includes breastfeeding within 30 minutes of delivery,
warmth, and general cleanliness ;
In each health district, equip one facility to provide
basic obstetric care (Cost 3 million Naira), which
offers:
•intravenous sedatives
•antibiotics
•oxytocic drugs
•manual removal of the placenta and retained
Interventions 3
In each LGA equip one facility to provide
comprehensive essential obstetric care (Cost 7
million Naira) which includes basic obstetric care
as well as surgical procedures including
ceasarian section under anesthesia and safe
blood transfusions;
Keep facilities open for 24 hours;
In each LGA equip one secondary health facility
to provide comprehensive essential obstetric
care;
Maintain two way referral system;
All obstetric emergencies must be treated free for
the first 24 hours.
Interventions 4
Capacity building and improvement of skills:
Train more midwives and obstetricians
Train CHEWs to offer basic obstetric care
Incentives for these cadres to attract and
retain them
Community involvement and improvement of
the social and infra-structural amenities in the
rural areas
If we act now…
108,000 women’s lives saved
2,000,000 disabilities averted
340,000 children’s lives saved
$ 536 million (N61billion) in
productivity gains
Conditions Needed
 strong commitment to maternal and newborn
survival and health by political leaders and
decision makers at national and local levels
 realistic and appropriate investment in women’s
education, health and economic empowerment
 implementation framework with clearly defined
supervision, monitoring and evaluation
mechanisms.
The Way Forward
 lead the fight against maternal and newborn
death and disability
 enable women to fully enjoy their rights
 fully contribute to the social, economic and
political development of Nigeria
Conclusion
To guarantee the right of Nigerian women to
health and life, they must have access to quality
reproductive health services, including skilled
attendance at childbirth.
THANK YOU
FOR JOINING THE
REDUCE TEAM