Despite having only two percent of the world’s population, Nigeria ranks second highest in the world in maternal mortality, which translates to a disturbing 13 percent of the global burden.

 

Research records show that across the world, nearly three million newborns die each year. Again, Nigeria, with a population of about 160 million records the continent’s highest number of newborn deaths as more than 250,000 babies die in their first month of life each year, accounting for more than a third of all under-five deaths.

 

Though there has been minimal improvement in the county’s infant and maternal mortality rate in the last four years, evidence reveals that one in five women, equivalent to over one million births in Nigeria are completely alone and unassisted when they deliver their babies.

 

The World Health Organisation (WHO) reports indicate that postpartum hemorrhage (PPH), which means excessive bleeding after delivery is responsible for nearly one quarter of deaths recorded among pregnant women worldwide. Data from the last three Nigeria Demographic and Health Surveys (NDHS 2003, 2008 and 2013), indicate that the negative trend can be attributed to human resource shortages, skill gaps among health workers, inadequate policy backing and the non-availability of life-saving newborn health commodities.

 

The good news however is that government especially at the federal and state levels along with development partners aren’t relenting in the fight to save the lives of mothers and children. This was discovered by participants at a recent media roundtable organised by USAID’s, Targeted States High Impact Projects (TSHIP). At the dialogue held in Abuja last month, Nosakhare Orobatan, Chief of Party, USAID’s TSHIP stated that to reverse this negative trend, Nigeria supported by donors such as USAID through its flagship programme, TSHIP is working to increase the use of high-impact integrated maternal, newborn and child health and family planning/reproductive health interventions.

 

TSHIP is implemented by John Snow Research & Training Institute, Inc. (JSI) and other partners.

 

Orobatan pointed out that one of TSHIP’s most promising interventions involve pioneering a two-medicine initiative that uses culturally-appropriate, low-tech and high-impact methods to protect both mother and newborn during and after birth. “The first medicine, misoprostol, is for the mother to take immediately after delivery. Just three orally ingested pills prevent PPH. The high death rate among newborns is partially the result of harmful traditional practices in umbilical cord care.

 

He said: “For generations, hot compress, charcoal, cow dung and other droppings have been applied on newborns’ umbilical cord stumps after birth, causing rather than preventing infections.”

 

A second drug, chlorhexidine (CHX), is an easy-to-use antiseptic to replace traditional umbilical cord care.

“Originally produced for infant use in Nepal, the gel is applied on the newborn’s cord stump within an hour after birth, sealing the wound, preventing bacteria from latching on the cord, and allowing it to heal. When used together, misoprostol and CHX offer critical protection to both mother and child in the delicate hours of childbirth; what is commonly referred to as the ‘golden hour’,“ Orobatan said.

 

“In line with numerous indigenous and international researches, keeping the newborn’s umbilical cord clean with CHX can reduce the risk of infection and death by up to half. Nigeria, adopted the use of CHX for newborn cord care at the 56th National Council on Health meeting in 2013.

 

“TSHIP is a multi-year project aimed at strengthening healthcare delivery in the northern Nigerian states of Bauchi and Sokoto. The project is working to establish strong and durable bonds between community institutions and the health care delivery system to improve household health practices and increase people’s use of health services”, he further said.

 

With the support of USAID through TSHIP, Sokoto State government launched its procurement of these two lifesaving drugs since March 2013. It is the first government in Africa to launch the use of CHX. Later in the year, Bauchi State emulated this action also with TSHIP’s assistance. State by state, Nigeria is procuring and distributing the drug pair – misoprostol and CHX – to help save the lives of mothers and their newborns. The lessons learned in Bauchi and Sokoto, where health indices are amongst Nigeria’s least favorable, are already informing programmes and policy at the national level.

 

For the major players in the USAID TSHIP, the success recorded in Bauchi and Sokoto point to the need to promote partnerships, engender inclusion, leverage on existing platforms (e.g. faith-based groups and community-based distribution systems), engage the policy process, ensure funding commitments, plan for integration and leverage resources from other programs.

 

Sokoto’s initial order of misoprostol and CHX alone meant that up to 2,250 newborn deaths due to cord infection and up to 1,000 maternal deaths due to postpartum hemorrhage were averted.

 

Again, Orobatan reiterated that as with many communities in Nigeria, 95 percent of all births in Sokoto take place outside clinics; therefore,  the ability to deliver such lifesaving, low-cost drugs to women in their homes is important.

 

According to him so far, delegations from 31 of 36 Nigerian states and the Federal Capital Territory, Abuja, who represent 123 million Nigerians; have undertaken study tours of Sokoto’s programme.

 

Nigeria gave approval to a local company who began manufacturing CHX in March 2014. In February 2015, a second firm received approval to start producing CHX. Between these two firms, Nigeria’s production capacity of CHX has gone from none in January 2014 to one with an annual production capacity of 60 million tubes as of January 2015.

Bauchi, Sokoto and six other states have since launched their own programmes.

 

Other states have included CHX procurement in their drugs for free health services while some have created budget lines in their 2015 budget. A major national programme procured 290,000 tubes of CHX and the United States government made a generous donation of 200,000 tubes to ensure that there are no supply shortfalls as Nigeria regularises its production and distribution systems for CHX.

 

The other medicine in the drug pair – Misoprostol – has been readily available locally in Nigeria. Working through a Public-Private and People Partnership (PPPP) Model, TSHIP is setting the stage for sustainable local production by shaping the local market under applicable drug laws.

 

Sun