…Paediatricians urge change
Nigerian children in 32 states, including the capital Abuja, live at risk of early death, their dreams snuffed out prematurely in a nightmare of short-lived futures.
This national tragedy has become a rallying cry for health advocacy groups across the country, most recently the Paediatric Association of Nigeria (PAN).
32 states or 88 percent of Nigeria are holding back on the progress on under-five survival, according to the 2021 Multiple Indicator Cluster Survey (MICS).
These are states where the risks of dying between birth and the fifth birthday are higher than the global target of 25 per 1,000 live births.
The average under-five mortality rate in those states is 96 per 1,000 live births, implying that a child’s risk of dying is 3.8 times higher than in the safest states.
Kashim Shettima, Nigeria’s vice president hails from one of those states: Borno, where the under-five mortality rate (140) is 3.6 times higher than the global average of 38 per 1,000 live births.
Similarly, Muhammad Ali Pate, Nigeria’s coordinating minister of Health and Social Welfare hails from Bauchi, a state that records 153 deaths out of every 1,000 children below age five, according to MICS data.
Only five states: Ekiti (14), Lagos (15), Anambra (22), Ebonyi (24), and Osun (24) have got it right with their approach and are considered the safest for a child’s survival in Nigeria.
This leaves the majority of the country underperforming in a dire struggle with health systems that are undeveloped to deliver optimised care to every Nigerian child.
Nigeria’s under-five mortality rate paints a grim picture: 111 children per 1,000 live births don’t make it to their fifth birthday.
This staggering statistic, placing Nigeria far behind its GDP peers like Ghana and Kenya, underscores the urgency of Dr. Olufemi Mobolaji-Lawal’s message at the 55th Annual General Meeting and Scientific Conference of PAN in Lagos.
As past president of the association and a member of the Royal College of Physicians UK, he warns that without immediate action at the local level in 32 key states, progress in reducing child mortality will remain painfully slow.
These states hold the key to unlocking brighter futures for countless Nigerian children, and their responsibility is clear: prioritise child health and implement effective interventions to break the cycle of preventable deaths.
“Nigeria failed to make the millennium target because most of the states did not make it. Now we have another target of SDG and if we continue at this rate, Nigeria is unlikely to make it unless we pay special attention to those states that are struggling,” Mobolaji-Lawal said.
Lagging Health Factors
Examining health factors that are necessary to foster a child’s health, he highlighted seven indicators including socioeconomic policies; access to immunisation; basic education; child protection; water sanitation and hygiene; neonatal and mother health; and child living as crucial.
However, many Nigerian states fare poorly when pitted against these indices.
On the socioeconomic level, for instance, poverty occasioned by economic hardships is a major obstacle to the well-being of many children in poor households.
A 2022 study of Multidimensional Child Poverty in Nigeria by UNICEF shows that 53.9 percent of children are multidimensionally poor, a form of deprivation that covers at least three dimensions of poverty concurrently.
Just about seven percent of children are not deprived in any dimension while 60 percent of children below age five are considered poor.
But how are they profiled? One of the markers is that their nutrition is deficient. They are neither exclusively breastfed, nor meet the recommended meal frequency and diversity standards.
“Any policy that results in mass poverty is not kind to the health of a child,” Mobolaji-Lawal stressed.
In terms of access to quality healthcare, some children are not vaccinated and they lack assistance from a skilled birth attendant at birth.
For example, only 32.5 percent of Nigerian children are fully vaccinated by age two, MICS data shows.
UNICEF data also indicates a proportion of 76.4 percent of children between 0 and 23 months are not fully vaccinated.
Also, Mobolaji-Lawal, citing United Nations statistics stated that the percentage of Nigerian children who are zero dose under-five children is about 50 percent and this could vary from 50 percent in the poorest household and less than 10 percent in the wealthiest household.
The paediatrician noted that comparatively worldwide, just one in five children are zero dose or unvaccinated.
“This statistic is very worrying considering that we know there is proven efficacy of vaccines in the prevention of diseases and death in children,” he stated.
In the area of basic education, the level is suboptimal with the out-of-school rate for primary school children at 25.6 percent.
It is higher at the secondary level and in some states, as high as 50 percent of children who ought to be in school are not.
The mother’s education level also affects the child’s chances of survival, he said. UNICEF data, for instance, reveals that a larger proportion of children with illiterate mothers are multidimensionally poor in comparison to children with literate mothers.
“These factors influence child development and survival and they are cross-cutting. The summary is that we are underperforming in factors affecting child development and protection,” Mobolaji-Lawal, also the founder of Emel Hospitals Limited explained.
According to him, Nigeria has developed different strategies and policies as legal tools to push child welfare.
Some of them include the National Health Policy (2016); the National Child Health Policy (Revised 2022); and the National Strategic Health Development Plan (NSHDPI)(2018-2022).
Others include the Integrated Reproductive Maternal Newborn Child Adolescent Health and Nutrition-IRMNCAH+N (2018-2022) and the Integrated Management of Childhood Illnesses (IMCI).
Last December, President Bola Tinubu unveiled Nigeria’s Health Sector Renewal Investment Initiative, which targets a holistic revamp of physical infrastructure, equipment, and re-training of frontline health workers starting in 2024.
The president also committed to addressing the high cost of healthcare by restructuring the Basic Health Care Provision Fund (BHCPF) to improve access to essential healthcare services.
The BHCPF, comprising at least one percent of the Consolidated Revenue Fund, is expected to receive about $2.5 billion in pooled and unpooled financing from 2024 to 2026 to improve the primary health system nationwide, according to the president.
Pate also outlined plans to double the number of fully functional Primary Healthcare Centres (PHCs) from 8,809 to 17,618 by 2027 across all 36 states and the Federal Capital Territory (FCT), adding that these PHCs will be linked to a comprehensive emergency care system.
According to Mobolaji-Lawal, there are shortcomings or pitfalls in policies and strategies that challenge effective implementation.
He stated that the Federal Ministry of Health has developed over 50 policies and strategies, more than half of which address the health of women and children.
“The policies could be better streamlined and funding arrangements for defined goals could be clearer and more realistic and national targets tend to mask major differences between states,” he said.
“A goal has a better chance of success if it is smart. It is important that when you are setting these you should take into consideration states that are struggling and tailor them to suit their needs so that they will be encouraged. We need to focus more on the state and local governments. Let us have more of LG’s participation.”
Efforts in Vaccines
Muyi Aina, executive director, the National Primary Health Care Development Agency (NPHCDA) told BusinessDay that the government is working to expand the portfolio of vaccines within the resources that are available.
He said there are about 2.3 million zero-dose children in Nigeria which the government has begun to target with immunisation schemes and other health benefits.
He also highlighted the introduction of the human papillomavirus (HPV) vaccine last October as one of the strategies being used to protect female children against future risk of cervical cancer.
About 16 states and the FCT have been mapped out in the first phase of distribution which began in 2023, while the rest of the states are expected to be reached by May 2024.
“If a child has never received any vaccine, there are chances that the child has not received any other health benefit that should be received from the system. Those children are a marker of broader deprivation,” Aina said, speaking on the sideline of the conference.
“It is important for us to identify where they are and who they are. We have prioritised 100 local government areas which cover just only half of these populations with routine immunisation, and investigations.”
Ifedayo Adetifa, director-general, Nigeria Centre for Disease Control (NCDC), speaking during an exclusive chat with BusinessDay at the conference said disease outbreaks and emergencies also disproportionately affect children.
He explained that this occurs even though a lot of the outbreaks facing Nigeria, especially diphtheria and measles are vaccine-preventable.
In preparation for outbreaks, he said efforts are being made to mitigate the impact of outbreaks on the populations affected, especially children.
The government is expanding its early warning system capabilities as well as the deployment of its surveillance platform, Adetifa told BusinessDay.
“We are strengthening our laboratories and expanding the networks. We are working to consolidate the labs into a network and have different pre-specified standard menu tests at every level of healthcare,” Adetifa said.
“This is so that we know what test primary healthcare can carry out, and what secondary and referral labs can do. Part of the reason why we are seeing more outbreaks is that we have increased capabilities to detect them.”
He also noted that the NCDC is working to expand genomic surveillance capacity, with the renovation of its reference laboratory campus in Lagos near completion.
The centre has started wastewater environmental surveillance, which hitherto was focused on polio, he said, adding that it is building on it to expand the capacity to identify priority pathogens that emerge as a public health challenge.