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Maternal and Child Health in Nigeria. Professor Friday Okonofua Provost, College of Medical Sciences, University of Benin, Executive Director, International Federation of Obstetricians and Gynecologists (FIGO), and Hon Adviser to the President on Health. Background.

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Maternal and child health in nigeria l.jpg

Maternal and Child Health in Nigeria

Professor Friday Okonofua

Provost, College of Medical Sciences, University of Benin,

Executive Director,

International Federation of Obstetricians and Gynecologists (FIGO), and

Hon Adviser to the President on Health


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Background

  • The 1991 national census reported life expectancy of 52.6 years for males, and 53.8 years for females

  • However, the crude birth declined from 27 to 14 per 1000 in 1991

  • Despite this, the WHO ranked Nigeria low (163rd out of 191 countries) in terms of Disability Adjusted Life Expectancy (DALE) with a value of only 38.3 years


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Disability Adjusted Life Expectancy (DALE)

  • DALE adjusts life expectancy for disability, and is a more robust measure of survival

  • In DALE estimation, Nigeria ranked higher than countries like Sierra Leone and Liberia, but was behind countries like Ghana and South Africa

  • Further analysis showed that the low DALE ranking of Nigeria was due to the high maternal, neonatal, infant and under-five mortality in Nigeria


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Global Comparison of Score and Ranking of Disability adjusted life Expectancy

Country DALE (years) DALE ranking

(out of 191 countries)

Sierra Leone 25.9 191

Liberia 34.0 181

Nigeria 38.3 163

South Africa 39.8 160

Ghana 45.5 149

USA 70.0 24

UK 71.7 14

Sweden 73.0 4


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Objectives of this Presentation adjusted life Expectancy

  • Present current statistics relating to maternal and child mortality in Nigeria

  • Identify some of the most important determinants of maternal and child mortality in Nigeria

  • Review the development of the enabling frameworks for the delivery of MCH services in Nigeria, and

  • Make substantive recommendations on ways to improve maternal and child health in Nigeria


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Maternal Deaths in Nigeria adjusted life Expectancy

  • An estimated 500,000 women die each year throughout the world from complications of pregnancy and childbirth

  • 55,000 of these deaths occur in Nigeria

  • Nigeria is only two percent of the world’s population but accounts for over 10% of the world’s maternal deaths in childbirth

  • Ranks second globally (to India) in number of maternal deaths


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Maternal Mortality Ratios in Nigeria adjusted life Expectancy



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Other indicators of Maternal Morbidity and Mortality adjusted life Expectancy

  • Risk of a woman dying from child birth is 1 in 18 in Nigeria, compared to 1 in 61 for all developing countries, and 1 in 29, 800 for Sweden

  • For every woman who dies from childbirth in Nigeria, another 30 women suffer long term chronic ill-health

  • The UNFPA estimates that 2 million women suffer vesico-vaginal fistula globally, 40% of these (800,000 women) are in Nigeria


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Medical Causes of Maternal Mortality in Nigeria adjusted life Expectancy

Hemorrhage - 23%

Infection - 17%

Malaria - 11%

Anaemia - 11%

Abortion - 11%

Eclampsia - 11%

Narrow Pelvis - 11%

Others - 11%


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Unsafe Abortion in Nigeria adjusted life Expectancy

  • An estimated 610, 000 women undergo clandestine abortion annually in Nigeria

  • The FMOH (1991) estimates that 20,000 Nigerian women die from abortion complications each year

  • Abortion complications also predispose women to infertility and ectopic pregnancy


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Child Mortality Statistics in Nigeria adjusted life Expectancy

  • Infant mortality rate

    71 per 1000 live births

  • Under -5 mortality rate

    140 per 1000 live births

  • Perinatal mortality rate

    51 per 1000 live births

    103 per 1000 live births



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Indicator of Equality of Child Survival (ECS), WHO adjusted life Expectancy

  • Equality of child survival (ECS) measures the extent to which under–five mortality reflects pure chance of death (equal to all children) rather than variations in underlying factors

  • A value of 1 represents complete equality of child survival, unaffected by underlying factors

  • The more the value lies below one, the greater the degree of inequality in child survival, due to these underlying factors


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Performance of Nigeria in ECS Ranking adjusted life Expectancy

  • Nigeria scored 0.336 in the ECS ranking meaning a high probability of child mortality from underlying factors

  • Nigeria ranked 4th lowest out of 191 ranked countries

  • Nigeria was only ahead of Central African Republic, Mozambique and Liberia

  • Nigeria ranked worse than war-torn Sierra Leone and Angola


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Factors contributing to Maternal Mortality in Nigeria adjusted life Expectancy

  • Lack of antenatal care

  • Low proportion of women attended to by skilled birth attendants

  • Delays in the treatment of complications of pregnancy

  • Poverty

  • Harmful traditional practices

  • Low status of women


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Utilisation of MCH Services in Nigeria adjusted life Expectancy

  • Contraceptive prevalence rate 8%

  • Unwanted pregnancy rate

    among adolescents 60%

  • Use of antenatal care by a

    trained provider 64%

  • Proportion of pregnant women

    delivered by a trained provider 37%

  • Proportion of pregnant women

    who deliver at home 57%


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Delays in Treatment of Pregnancy Complications adjusted life Expectancy

Type I Delay - when a woman with a pregnancy complication fails to get to a hospital in time

Type II Delay - when the delay is due to difficulty with transportation

Type III Delay - when there is delay in treatment after the patient has reached the hospital


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Contribution of “Delays” to Maternal Mortality in Nigeria

  • No delay 10%

  • Type I Delay 30%

  • Type II Delay 20%

  • Type III Delay 40%


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Causes of Type III Delay Nigeria

  • Non-affordability of antenatal costs, delivery costs and post-natal costs

  • Delays in seeing staff in health facilities

  • Incessant strikes and lockouts

  • Delays due to poor supplies and consumables

  • Delay in referral of patients

  • Basic essential obstetrics care not available in most facilities

  • Systemic problems – doctors and midwives refusing rural postings

  • External brain drain


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Characteristics of Nigeria’s Health System Nigeria

  • Weak and inefficient

  • Under-capitalized

  • Poor motivated health units

  • Costly

  • inaccessible



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MCH service delivery in Nigeria: Historical milestones 191 Countries

  • 1980s - Emphasis on family planning/MCH services

  • 1989 - International Safe Motherhood Conference in Nairobi, Kenya

  • 1990 - National Safe Motherhood conference, Abuja

  • 1994 - International Conference on Population and Development (ICPD), Cairo, Egypt

  • 1995 - Fourth World Conference on Women

    Beijing, China

  • 1995 – 2005 - ICPD + 5, Beijing + 5, ICPD + 10, Beijing +10

  • 2000 - UN Millennium Development Goals


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Millennium Development Goals, UN (2000) – how far? 191 Countries

  • Goal 4: Reduced child mortality - To reduce mortality rate among children under 5 by two thirds by the year 2015

  • Goal 5: Improved maternal health - To reduce by 75%, the maternal mortality rate by the year 2015

  • Six years into the 15 years deadline for achieving these goals, there is no clear evidence that Nigeria has yet achieved any remarkable achievements.


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Recommendations 191 Countries

  • Political leadership is needed.

    The Presidency should personally speak to the problem of the high rate of maternal and infant mortality in Nigeria, just like he has done for HIV/AIDS

    Executive Governors and Local Government Council chairmen should do the same in their States and LGAs

  • A multi-sectorial approach should be adopted whereby all sectors (Legislative Assemblies, Information, Education, Women Affairs etc) should include MCH programming in their portfolios

    3. Costs alleviation for women seeking antenatal care and delivery services. Such a policy has been successful in reducing maternal mortality in Kano State

    4. The creation of a National Institute for maternal and child health


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National Institute of Maternal and Child Health 191 Countries

  • Will provide an avenue through which government will providing funding for MCH

  • Will reduce donor dependency on MCH programming

  • Will provide an avenue for research and data collation on matters related to MCH

  • Will develop guidelines, policies and strategies for reducing maternal and child mortality in Nigeria

  • Will provide a forum for capacity building and resource mobilisation for MCH


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Programs to reduce Maternal and Perinatal Mortality in Nigeria

  • Provision of information and services about family planning and contraception

  • Programs to encourage all pregnant women to receive antenatal care and to be delivered by skill birth attendant

  • Improvement of antenatal and delivery services in hospitals, especially emergency obstetrics care

  • Government should address the problem of women dying from poorly performed abortions


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Recommendation Contd Nigeria.

  • The government should make compulsory the registration of all maternal deaths in the country, as recently legislated in Edo State

  • Disease – specific preventive measures for child mortality

  • Promotion and scaling up of childhood immunization


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Conclusions Nigeria

  • There can be no doubt that maternal and child morbidity contribute significantly to the low life expectancy in Nigeria

  • The disease conditions that lead to maternal and child mortality in Nigeria are the same as in most parts of the developing world

  • However, it is the adverse socio-economic and cultural circumstances under which these diseases occur that increase the risks of these deaths in Nigeria


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Conclusions Nigeria

4. A case is being made for a purposeful, multi-disciplinary and multi-sectorial approach for addressing the problem

5. An increased prioritization of the problem and impetus from the Presidency, the State Governors and Local Government Councils will greatly accelerate the pace of attainment of the MCH aspects of the MDGs in Nigeria

6. Indeed, addressing the high rate of maternal and child mortality will be a visible contribution to socio-economic development and transformation, and a major legacy of this administration


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THANK YOU Nigeria


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