ihebuzor: addressing newborn mortality in nigeria

7/28/2019 Ihebuzor: Addressing Newborn Mortality in Nigeria

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Addre

ssingnewbornmortalityin

Nig

eria

DrN

nennaIhebuzor

Dire

ctorCommunityHe

althServices

NationalPrimaryHealthCareDevelopmentAgency

Abu

ja,

Nigeria

Team

Nigeria@

Glob

alNewbornHealth

Conference

Joha

nnesburg,SouthAfrica

April16th2013

1


2/37

Contextandobjec

tivesoftodaysdiscussion

W

omenandchildrenin

Nigeria

co

ntinuetolosetheirlivesinlarge

numbers

AlthoughNigeriahasm

adesome

stridesinAlthoughNige

riahas

m

adesomestridesinimproving

womenandchildrenshealth,

progresshasnotbeenfastenough

an

dNigerialagsbehind

other

co

untriesindramaticallyshifting

outcomes,especiallyfo

rnewborns

Th

ecurrentshiftinNig

erias

re

sponseaspirestodeliver

significant,visible,and

immediate

re

sultsinthelivesofNigerias

newborns,womenand

children

Co

ntextualisetheproblem,major

an

dunderlyingcausesofnewborn

mortalityinnNigeriaan

ddiscuss

whytheGovernmentc

ando

be

ttertoimprovethelivesof

Nigeriannewbornsand

women

De

monstratesomeoftheresults

an

dprogressinnewbornhealth

De

scribeNigeriaseffortsto

de

liversignificant,visib

le,

and

im

mediateimpactand

bendthe

cu

rvefornewbornsurv

ivalby

scalingupaccesstoess

ential

ne

wborncare

Context

1 2 3Objectives

2


3/37

Nigerias

Demographics

Federationo

f36States

Population:

167million+

Largeunder

fivepopulation

andhighbirthcohort

Fivemainlanguagegroups,

250+regional

languages/d

ialects

Infrastructureandlogistics

challenges:roads,unstable

power,dens

eandrural

populations,poorsanitation

WestAfricastransportand

migrationhubborderingfou

r

countries

Rivers

Ekiti

Osun

Lagos

Ogun

Oyo

D

elta

B

ayelsa

Ondo

Edo

Kogi

Sokoto N

iger

Kwara

Kebbi

Kaduna

Zamfara

A

damawa

Abia

Imo

Anambra

Enugu

CrossRiver

AkwaIbom

EbonyiB

enue

Taraba

Jigawa

FCT,Abuja N

assarawa

Katsina

Kano

Gombe

Plateau

Bauchi

Yobe

Borno

Zone

Southsouth

Southeast

Northcentral

Southwest

Northeast

Northwest

MapofNigeriaShowingtheSix(6)Geo-Politic

alZones

Chad

Niger

Camer

oun

AtlanticOcean

Benin

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Onenation:167Million+

People

,25

0

languages,manycu

ltures

4


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Rank

ingfornumbersof

n

eonataldeaths

Rankingfornumbersof

mater

naldeaths

India

1

1

NIGER

IA

2

2

Pakistan

3

8

China

4

13

DRCongo

5

3

Ethiopia

6

5

Banglad

esh

7

6

Indones

ia

8

7

Afghanistan

9

4

Tanzania

10

9

2.4

million

neonatal

deaths

Approx

67%

ofglobal

total

270,0

00

maternal

death

s

Appro

x

65%

ofglobal

total

Ref:LawnJEetalBJOGsept2009.

Datasources:Estimatesofmaternal(2005)andneonatal(2008)deathsfromWHO.U

pdatedJune2010

Nigeriahasthehighestn

umberofnewborndeathsin

Africa

andranks

17thintermso

frates

254,0

00dea

thsin2010(N

MRof40)

Countriesw

iththehighestnumbersofnewborndeathsare

sim

ilartothosewithhighmaternaldeaths

5


6/37

Mo

remothersa

ndbabiesdie

inNigeriape

ryear

thanin

comparable

countries

6

SOURCE:Na

tionalDemographicHealthSurvey,W

orldHealthOrganization,InstituteofHealthMetricsandEvaluation

1MMRData2008NDHS,

NMRData2008ND

HS

2MMRData2008IHME,

NMRData2005WH

O

Maternal

mortality

Deathsper

100,000live

births

N

igeria1

5

45

Sudan2

306

Ghana2

409

Ugand

a2

352

Neo-natal

mortality

Deathsper

1,000live

births

4

0

36

31

29


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VariationinM

MRacrossg

eopoliticalzo

nes

Very

highMMR

HighMMR

Mo

derateMMR

7


8/37

Ata

leoftwor

egions:

N

orthandS

outh

Sele

ctedsocio-demographicstatistics

Northern

States

Southern

States

M

aternalMortalityR

atios(deathsper

100,000livebirths)

1025-1549

165-286

TotalFertilityRate(children/woman)

5.7-7.0

4.1-4.6

AtleastoneAN

Cattendance(%)

41-75

83-99

DeliverywithSkilledBirthAttendant(%)

12-49

56-88

Neo

natalmortality(deathsper1000live

births)

40-5

3

36-5

08


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N

eonatalmortality:th

erichalso

cry

9


10/37

ThepoorestNigerianwomenhave

significantlylessaccess

toMNCHservicesthanr

icherwomen

SOU

RCE:WorldBank:Socio-economicDifferencesinHealth,Nutrition,andPopulationwithinDevelopingCountries

91%

+196%

31%

Multiple

antenatalcare

(ANC)visits

%ofpregnant

women

Skilledattendant

atbirth

%oflivebirths

+555%

13%

85%

Contraceptive

prevalence

%ofwomenof

reproductiveage

21%

+4

69%

Richest

20%

Poorest

20%

4%

MCHserviceacce

ssbythepoorestand

richestwomenin

Nigeria,2003

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Nigeria

:Health

System

De

concentrationSM

oH,SACA,SASCP

De

legationNAFDAC

,NPHCDA,NASCP

De

volutionLGAsforPHC

He

althisontheconcurrentlist

SomeStatesandLG

Assimplydonotprio

ritizehealthand/ormake

adequatebudgetaryallocationsresultingininconsistenthealthservices

acrossstatesandlo

calgovernmentareas

Ge

nerally,healthserv

ices,uptakeandin

dicatorsinsouther

nStates

be

tterthaninnorthernStates

Gov

ernmentTier

Responsibility

Federal

Nationalpolicy;Monitoring;Tertiary

hospitals

Stat

e

Populationhealth

inState;ReferralState

hospitals

LocalGovernment

PrimaryHealthCareFacilities

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HealthWorke

rPopulation

RatiosinNige

ria

CadreofHealth

CareWorkers

Workforceper10,000

p

opulation

2005

2006

20

07

Ph

ysicians

3.0

3.54

3.7

0

Nurses

10.0

8.95

9.1

0

Midwives

6.8

6.36

6.3

9

Source:Hea

lthWorkforceProfile,N

igeria,2

008

Tra

nslatesto20physicians,nursesandm

idwivesper10,00

0

population

Mu

chhigherthanfor

manySSAcountrie

s

Clo

sertoWHObenchmarkof25/10,0

00

populationrequiredto

pro

videminimumMN

CHservices.

Butmainconstraintis

maldistribution

12


13/37

SBA

13


14/37

PoorFinancialAccess

toHealth

S

ervices

14

Source

:Soyiboetal2009

14


15/37

WhydoN

igeriannew

bornsdie?

15


16/37

20

2.3

3

0.4

0.17

0510

15

20

25

30

35

Earlyneonatal

(Day0-6

)

Late

Neonatal

(D

ay7-2

8)

Post-neonatal

(1

-11

mo

nths)

Age12-5

9

mon

ths

Weeklyriskofdeathper1000live

births(globalaverage)JELawnbasedonglobalENMR,NMRestimatesbyWHO,andIMRandU5MbyUNchildmortalitygrouparoundtheyear2008

Th

eriskiest

w

eekoflife

Birthandfirstweekisk

ey:

yetcoverage

ofcareislow

for

mothersandbabies

When?T

hefirstweekistherisk

iestweeko

flife

Mo

rtalityriskbyw

eekoflifeforth

efirst5years:

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Source:SavingNewbornLivesinNigeria,2011.DatafromDH

S2008

Wh

y?Coverag

ealongthe

continuum

ofcare

Notoneke

ypackagef

orMNCHabove60%co

verage

17


18/37

Source:SavingNewbornLives

inNigeria,2

ndedition,2011Pro

gresstoM

DG4

157

1

38

160

40

050

100

150

200

250

1990

1995

20

00

2005

2010

2015

Mortalityper1000livebirths

Year

NDHSU5MR

UNU5MR

IHMEU5MR

NDHSNMR

UNNMR

IHMENMR

M

DG4target

(71)

Childdeaths(

ihebuzor: addressing newborn mortality in nigeria

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