What would you do if you discovered that by skipping your child’s immunisation and routine antenatal checkups, 200,000 stillbirths are expected to occur in 117 low-income countries, including Nigeria, in a single year? How would you feel to learn that your failure to good nutrition within 1000 days of life for a child contributed to the 2.4 million newborns death worldwide? CHIOMA UMEHA attempts to provide answers to questions
According to health experts, exclusive breastfeeding, good nutrition for both mothers and children, and compliance with routine antenatal and immunisation is the pathway to promote child health and survival. According to them, it is a critical move towards accelerating efforts to improve maternal and newborn survival and prevent stillbirths ahead of the 2030 Sustainable Development Goals (SDGs) deadline, which is seven years from now.
The World Health Organisation (WHO) recommends exclusive breastfeeding for six months and adequate complementary feeding within the first 1000 days of an infant to prevent stunting, malnutrition, its associated problems, and child mortality. According to the world body, this is the cheapest and simplest way forward to prevent severe acute malnutrition and its consequences among Nigerian Children and curb infant deaths.
Good nutrition within 1000 days of life is part of the recommendations of the United Nations (UN) SDGs which are targeted to end hunger by 2030. The SDGs also require every country to ensure that all people have access, particularly, the poor and people in vulnerable situations including infants, to safe, nutritious, and sufficient food all year round.
The first 1,000 days of a child’s life present a special window of opportunity to adopt maternal and newborn child (MNCH) survival strategies to prevent stunting, malnutrition, and lower infant mortality, experts have reiterated time and time again. Yet, attainment of good nutrition within the first 1,000 days of a child’s life and SDGs number two is still a far cry as Nigeria has one of worst child nutrition indicators worldwide.
Joy Bisi, a 40-year-old teacher told Saturday INDEPENDENT that, “One hour after giving birth to my second baby, Sibi, I started breastfeeding. I’ll finish the six-month breastfeeding exercise with him, who is now five months and two weeks old. I had no need to visit the hospital on a regular basis other than to present my baby for immunisation. My second baby hardly falls sick.
“The experience is different for Tosin, my first child. She was always ill, because, I was unable to practice exclusive breastfeeding for Tosin. I also counsel other women to choose exclusive breastfeeding,” the Lagos-based mother of three added. Joy is lucky to have learnt by experience, there are hundreds of Nigerian mothers whose babies have missed good nutrition within the first 1,000 days.
The United Nations Children Fund (UNICEF) reports that every day, some 6,500 world babies die in the first month of life. In 2020, an estimated 2.4 million newborns died worldwide.
If current trends continue, 48 million children under the age of five are projected to die between 2020 and 2030, half of them newborns. Sadly, too, almost two million babies are stillborn every year – or one every 16 seconds – according to a recently released report by four United Nations (UN) agencies. The four world bodies are UNICEF, WHO, World Bank Group, and Population Division of the United Nations Department of Economic and Social Affairs report bemoaned the trend.
The Burden of Stillbirths
Entitled, “A Neglected Tragedy: The Global Burden of Stillbirths,” the report noted that the vast majority of stillbirths, 84 percent, occur in low- and lower-middle-income countries. In 2019, three in four stillbirths occurred in sub-Saharan Africa or Southern Asia.
Nigeria accounts for one of the highest stillbirth rates in the African continent. It is one of six countries that bear the burden of half of all stillbirths globally, together with India, Pakistan, the Democratic Republic of the Congo, China, and Ethiopia.
Between 2000-2019 Nigeria reported a 15 percent increase in the number of stillbirths. It is estimated that the total number of stillbirths in Nigeria in 2019 was 171,428. A stillbirth is defined in the report as a baby born with no signs of life at 28 weeks of pregnancy or more.
At a global conference in October last year, on “Ending preventable stillbirths: A renewed call to action”, Dr. Osagie Ehanire, Nigeria’s Minister of Health, said, “The need for awareness of stillbirths in Nigeria cannot be over-emphasised. Stillbirths have been overlooked as a global public health challenge, despite the fact that useful preventive measures could easily augment maternal and newborn health interventions to limit their occurrence. Nigeria, unhappily, has the second highest rate of stillbirths in the world with 42.9 per 1,000 births. The government has set a target of reducing it to 27 per 1000 live births by 2030.”
Ehanire said that this would require a multipronged approach and multi-sectoral collaboration – including with the education sector, whose role relates to the health-seeking behaviour of women and adolescents.
Infant Mortality At Birth Or During Pregnancy
“Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Henrietta Fore, UNICEF Executive Director. “Every 16 seconds, a mother somewhere will suffer the unspeakable tragedy of stillbirth.
“Beyond the loss of life, the psychological and financial costs for women, families, and societies are severe and long-lasting. For many of these mothers, it simply didn’t have to be this way. A majority of stillbirths could have been prevented with high-quality monitoring, proper antenatal care, and a skilled birth attendant.”
The global stillbirth report warns that the COVID-19 pandemic could worsen the global number of stillbirths. A 50 percent reduction in health services due to the pandemic could cause nearly 200,000 additional stillbirths over a 12-month period in 117 low- and middle-income countries, including Nigeria.
This corresponds to an increase in the number of stillbirths by 11.1 percent. According to modeling done for the report by researchers from the Johns Hopkins Bloomberg School of Public Health, 13 countries could see a 20 percent increase or more in the number of stillbirths over a 12-month period.
Most stillbirths are due to poor quality of care during pregnancy and birth. Lack of investments in antenatal and intra-partum services and in strengthening the nursing and midwifery workforce are key challenges, the report says. Similarly, the report added that more than 50 percent of stillbirths occur during the intra-partum and delivery period in Nigeria.
“While the high number of stillbirths in Nigeria is a huge loss, we must remember that every single one is an individual tragedy, and one that reaches far beyond the loss of life for the family concerned,” said Peter Hawkins, UNICEF Representative in Nigeria.
“Each stillbirth has a traumatic and long-lasting impact on women and their families, who often endure profound psychological suffering and often a stigma in their communities. Perhaps even more tragically, the majority of these deaths could have been avoided with high-quality care before and during birth. More than 40 percent of all stillbirths occurred during labour – a loss that could be prevented with improved monitoring and access to emergency obstetric care when needed,” said Peter Hawkins.
Experts are therefore calling for accelerating efforts to improve maternal and newborn survival and prevent stillbirths to meet the 2030 Sustainable Development Goals (SDGs). The issue was a major focus at the ‘Media Advocacy on COVAX and RI uptake in Lagos state,’ weekend organised by National Orientation Agency in collaboration with UNICEF where the experts stressed the role of antenatal care, family planning, and immunisation in promoting maternal and newborn child health (MNCH).
Mrs. Modupe Clara Owojuyigbe, Director, Health and Education Promotion Services and State Health Educator, Lagos State Primary Health Care Board recommended routine antenatal care, family planning, and immunisation as the way forward to MNCH.
Owojuyigbe urged mothers to ensure registration for antenatal as soon as pregnancy is confirmed and attend all appointments, which is eight visits during pregnancy would help to monitor the progress of the foetus and the mother’s health. According to the State Health Educator, ensuring delivery in a health centre, comprehensive health centre or hospital by skilled birth attendants (Midwife or doctor) would be a crucial step in MNCH interventions. Also, she stated that eating a diet rich in all food groups before, during, and even after childbirth is an essential integral component of MNCH strategies.
According to UNICEF, breastfeeding has an important role in the prevention of different forms of childhood malnutrition, including wasting, stunting, over- and underweight, and micronutrient deficiencies.
Commenting, Ada Ezeogu, UNICEF Nutrition Specialist, said, poor nutrition contributes largely to the high rate of child mortality. “When an expectant mother does not feed well, it affects the unborn baby. So, poor nutrition in 1,000 days from the conception of a child to two years of age results in permanent damages.”
Ezeogu while highlighting poverty as the major factor causing malnutrition and affecting the well-being of a child, she regretted that Nigeria remains off track to achieving the SDGs target to ensure adequate nutrition for children and women.
The UNICEF Nutrition Specialist said 45 percent of child deaths are a result of poor nutrition, stressing the need for good nutrition for the survival of a child. She told Saturday INDEPENDENT that children under the age of two are most vulnerable to all forms of malnutrition – stunting, wasting (low weight for height), micronutrient deficiencies, overweight, and obesity.” This is as a result of poor diets, due to their greater need for essential nutrients per kilogram of body weight than at any other time in life.”
Ezeogu explained that childhood stunting which is under-nutrition (a child too short for his or her age) affected children may have a long-term effect on physical development, cognitive development, educational performance, and economic productivity in adulthood. It can also affect women’s ability to give birth to normal-weight children.
- Saturday INDEPENDENT