By Bashir Hassan Abubakar
It is no longer news that infant and child mortality rates are much higher in the North Eastern part of Nigeria than any other region. All validated statistics from the National Demographic Health Survey (NDHS 2018) and the the current Multiple Indicator Cluster Survey (MICS 2021) indicated that the Region contributes to high burden of infant and child mortality in Nigeria.
These mortality rates in infants and children in North East Region are mostly associated with certain basic health care needs that is lacking in the first 1000 days of a child’s life.
The first 1,000 days refers to a child’s life from the moment they are conceived until they reach 24 months.
A baby’s experiences in their first 1,000 days of life can have a lifelong effect on their health and wellbeing. It is an important foundational period which shapes their development and wellbeing.
As captured in the Multiple Indicator Cluster Survey (MICS) 2021, under-five mortality per 1000 live birth in the North East is 114, which is above the National average of 102.
Also the MICS 2021 has it that child mortality rates per 1000 live births in the North East Region is 49 as against 42 of the National average. With regards to infant mortality rate, the region goes hand in hand along with the National average of 63 deaths per 1000 births.
While the national average on post-neonatal mortality rate per 1000 live birth is 28 as the National average the North East is having 34. Both the National and North East are having the the same number of 34 Neonatal mortality per 1000 live births (MICS 2021).
Early childhood development is another indicator that leaves much to be desired in the North East region, teetering at only 12 percent as against the National average of 38 percent.
What is more worrisome for stakeholders is that, even amongst the North Eastern States, Bauchi State has the highest burden of such deaths, superseding both the Regional and National Averages.
All the indices highlighted above posed a huge threat to first 1000 days of a child life in the North East Region. The State Governments of Adamawa, Bauchi, Borno, Gombe, Taraba, Yobe and other non state actors should be worried about these threats facing it’s future human capital resources .
Recently, United Nations Children Fund (UNICEF) Bauchi Field office organized a media dialogue with select group of Journalists drawn from the States of Adamawa, Bauchi, Gombe, Taraba and the FCT to acquaint them on what the 1000 days of a child’s life entails.
The objective of the dialogue was to get the buy-in of the media practitioners in calling the attention of various State Governments to take action in reversing trend and give children the space to thrive and grow up to their full potentials, with all the opportunities to excel in their lifetime.
At the commencement of the dialogue held in Gombe, UNICEF’s Chief of Field office Bauchi ,Dr. Tushar Rane said that the first 1,000 days of a child is crucial for physical development and brain growth and that a woman’s nutrition during pregnancy, breastfeeding as well as baby’s nurturing care in the first two years is extremely important for a healthy future of any child.
He said maternal and child nutrition and health can determine the child’s ability to grow, stressing that poor nutrition in the first 1,000 days cause irreversible damage to a child’s growing brain and body.
“The period of rapid brain growth and maturation is 80 percent by two years and failure of growth during this period is associated with long term consequences which includes schooling, productivity and income”, said Dr. Rane.
So, from the foregoing it is clearly established that nutrition of the mother is as important as the that of the child in the first 1000 days of the child’s life.
It is important to note that aside taking a newborn, infant or child to access immunization, (which has a very low coverage in the Region as seen in NICS 2021), or other health care services at the health facility, the major care and attention that newborn, infant and a child needs to survive that critical 1000 days of life is basically to be provided at the household level.
One of these key level of care at the household is placing that newborn on exclusive breastfeeding for the first six months of its life.
This submission was also corroborated by Dr. Rane when he posit that, high impact intervention from 0-5 months of a child’s life include exclusive breast feeding, immunization, infection prevention and treatment and nurturing care.
Experts in child healthcare have, at several fora have stressed that Exclusive Breastfeeding (EBF) has the potential to save more children’s lives than any other preventive intervention.
Also studies have shown that breastfed children have at least six times greater chance of survival in the early months than non-breastfed children.
Again it is at the household level that nursing mothers are expected to take healthy diets that would translate to what the infant will take through breast milk. So, healthy and nutritional food for the mother is another key factor in ensuring 1000 days child survival and growth to healthy life.
Also, malnutrition in children resulting from lack of intake of nutritional food often times degenerate into acute or extreme malnutrition that leads to death of children before attaining 1000 days of their lives.
According to UNICEF Chief of Bauchi Field office, who is also a medical doctor, “if a child is not properly breast-fed or given the proper nutrition early, a case of stunting sets in which have potential consequences, pointing out that nurturing care in early life is very important”.
Though health facilities have their roles in enhancing the 1000 days of child’s life as stated above, the major intervention has to come from the household level of care for both mother and child.
Two major challenges that is militating against this level of care that readily comes to mind is poverty and ignorance.
As pointed out in the disturbing health indices of the North East Region, the poverty index too is as worrisome. Greater part of the Region’s population, especially those in the rural communities are living far below the poverty level. This is also compounded by the glaring ignorance of basic healthcare practices pervading these communities and the insurgency challenge within the North East.
The Role of the Media
At the commencement of the recent media dialogue that attracted journalists from UNICEF Bauchi Field Office (BFO) focus States, the Communication Officer of the BFO Opeyemi Olagunju informed the Journalists that the objective of the media dialogue was to educate them on the peculiar threats to a healthy first 1,000 days and the extent of implications with a view to galvanize North East State Governments, key stakeholders and other non state actors into taking action aimed at addressing the threats.
At the Day 1 media dialogue meeting, participants were presented with validated data on the current maternal, Newborn and Child (MNC) health status of the BFO focused States, with emphasis on newborn, infant and child mortality rates.
On what was expected of the Journalists, health specialist of UNICEF BFO Dr. Emmanuel Emedo said that the idea of engaging the media on the ‘First 1,000 days of a child’s life’ is to enlighten the public on the need to reduce infant deaths by adhering to guidelines that help children achieve better health and developmental outcomes.
According to Dr. Emedo, “The whole idea is to enlighten the press on the challenges we are having in this zone (Bauchi, Gombe, Taraba and Adamawa States). These state are chosen because of the high burden of infant deaths across the states. As we move towards the SDG goal of less than 12 deaths per 1,000 life births and less than 25 death of under 5 children per 1000 life births, we try to look at where we are. Although some progress have been made, there is still more work to be done.”
“The challenges are broad, but poverty is a major factor because there are people who are living in multidimensional poverty. There are still many households to be reached and we still don’t have adequate coverage across our facilities. So to leave no child behind, we will need media and every stakeholder on board to achieve it”, said Dr. Emedo.
It goes without saying that,one of the major role Journalists could play is trigger behavior change through an innovative and evidence based advocacy reports that would make an impression in the minds of targeted audience to demand for healthcare services. For instance, a sustained media advocacy campaign on the importance of exclusive breastfeeding, uptake of local nutritional diets, improved immunization coverage, ANC, Postnatal care, uptake of family planning services etc, using evidence, could convince caregivers and mothers to imbibe the practices. Also, using same method, the media could target State Governments through their reports and spur them to take proactive measures that may lead to better health outcomes in the North East Region.
The above submission was supported by a renowned academic and Vice Chancellor of the Federal University of Kashere (FUK), Gombe State, Professor Umaru Pate during his presentation at the media dialogue when he called on Journalists to devote more time and resources on reportage of development issues, advising Journalists to always present media contents that would promote behavioural change and national development.
He explained that behavioural change was about altering habits and behaviour for long-term benefits, saying, “The media is a veritable tool for facilitating behavioural change using factual information and accurate data”
According to Pate, “Practitioners must be conversant with the Child Rights Act to project issues around behavioural change towards children for the well-being of future generations.”
He further stated that, “evidence based Journalism must take centre stage in order to change the attitude of people especially those resistant to healthy change.
Professor Pate then called on journalists to take the interest of children into consideration and minimize harm and danger to them as top priority by carefully thinking about the result of their actions, pointed out that, “if children are deprived of their chidhood socially, economically, physically and mentally, the nation will be deprived of the potential human resources for social progress, economic empowerment, peace and social stability as well as good citizenry”.
As part of the media dialogue meeting, participants were divided into groups that visited some healthcare facilities for a first hand information on how the facilities were providing services that are targeted at newborn, infant and child care .
During a field visit to the Gombe Specialist hospital, where UNICEF has intervened to reduce child mortality, the Medical Director, Dr. Muazu Ishaq noted that there has been significant changes in enrollment of women for antenatal and postnatal services in the facility.
He said that the hospital has been educating and helping to modify health-seeking behaviour of mothers and caregivers to seek proper healthcare for their children instead of local vendors.
According to him, “We have people that have been trained to provide training for mothers. We showed them how important it is to pursue exclusive breastfeeding for the children. We also collaborate with development partners to provide support for caregivers and evaluate their activities from time to time to see whether they are complying with what they have learnt.”
He added that, “To be honest, we have seen changes that have encouraged us to do more,” the hospital chief noted. Recently, we started by educating women to change their health-seeking behaviour because we discovered that mostly they did everything at home with the help of local vendors. So we told them of the implications and encouraged them to seek proper healthcare for their children, not only when the situation is out of hand, but to ensure that they regularly visit the hospital for proper treatment of their children to ensure a healthy future for them, and honestly, the response has been massive.”
It is important also to note that in-laws and extended family members play significant role in altering mode of providing newborn healthcare. One thing that comes to mind to buttress this observation is testimonies of nursing mothers where they confirmed that their in-laws don’t allow them to practice exclusive breastfeeding even if they want to.
It is estimated by UNICEF that 13 percent of child deaths could be averted if 90 percent of mothers exclusively breastfed their infants for the first six months of its life.
Against the background of the importance of exclusive breastfeeding, routine immunization and nutrition as the first line of defense against child killer diseases, the need for stakeholders to champion the uptake of these services in communities cannot be over emphasized. This is because, the above mentioned healthcare behavior, when fully imbibed, serves as preventive measures. When you prevent occurrence of ailment, you won’t have to worry about the cost of cure that is much more higher than the preventive measure. Most of these preventive measures , like exclusive breastfeeding and children routine immunization, comes free of charge.
Experts further revealed that delaying breastfeeding by 2- 23 hours after birth increases the risk of a baby dying in the first 28 days of a baby’s life by 40 percent.
But as attractive, and cheap as these healthcare practices are, quite a number of caregivers, nursing mothers, in-laws and other extended family members still shares negative perceptions and myths regarding such live saving practices.
Hassana Usman, a 34 years mother of four of Bulkachuwa community in Katagum Local Government Area of Bauchi State said, “my mother in-law made sure that my babies must be given water along side breast milk. I am very much aware of the importance and benefits of exclusive breastfeeding and how it adds value to healthy growth of a child, but what do i do if my mother in-law practically gives water to my newborn. Even my husband don’t have control over that”, lamented Hassana Usman.
Another respondent from Bama LGA of Borno State, North Eastern Nigeria, Mrs. Mamaji Goni Abba (32 year old mother of four) who spoke with our correspondent via telephone conversation said that, though she heard about about the benefits of exclusive breastfeeding, she had not practiced EBF before weaning her children. According to her, she did not see it being practiced in her family even before she got married.
“How can i not give my child water along side breast milk especially looking at the weather conditions of our environment that is characterised by excessive heat? Our situation is even compounded by the insurgency that kept us all apprehensive. We were not in the right frame of mind to even consider the six months EBF even if we wanted to and this is not limited to my household alone.
EBF, as the first line of immunity for newborn and infants that is supposed to be administered at the household level is having a huge challenge due largely, to ignorance, myths, cultural perception and extended family pressures especially among the low level family cycles. One would have thought that these challenges only manifest in such family settings alone , but even the elites are not immuned against such challenges.
Mrs. Fa’i Mohammed , a 27 year old mother of one from Yola, Adamawa State, is a university graduate, who expressed her views regarding EBF practice.
“I am very much aware of the health benefits of EBF. Apart from health talk from health care service providers regarding EBF during my antenatal/postnatal care days, I have also read extensively on the benefits of EBF. But to be honest, I did not practiced it wholly during my lactating days. I combined EBF with giving my child Zamzam ( a special water that is gotten from a natural source in Macca, Saudi Arabia, and imported into countries across the World). I really can’t stand imagining my child feeling thirsty and me not giving him water”.
“Though, I am aware that breast milk contains water, somehow for some inexplicable reasons, i gave my child Zamzam water, though my child did not missed any of his immunization dates. I will really like to practice EBF when i have more children in future and may Allah give me the strength to do that”, said Mrs. Mohammed.
It is note worthy to mention the efforts of world bodies like UNICEF, WHO and other international development organizations like USAID, BMGF, Aliko Dangote Foundation Commonwealth office (UK) etc, in propergating health seeking behavior through their various interventions in Nigeria and the North East in particular.
For instance, UNICEF Bauchi field office in collaboration with It’s focused State Governments, local CSOs and other key non state actors like religious and community leaders, have been on the vanguard in carrying out activities and programs aimed at improving health outcomes of mothers and children, not only in Bauchi State, but the entire BFO focused States.
Way Forward
Although Communities should be seen to demonstrate the zeal and passion to imbibe health seeking behavior, Government especially at the States and LGs levels should create the enabling environment for citizens to access effective, efficient and quality health care services in their immediate environments. This, the various levels can do through adequate budget provisions and timely releases for improved immunization coverage and financing for prevention and treatment of malnutrition.
There is also need for North East Region to enhance collaboration with private sector, NGOs/CSOs and professional bodies like the media in order to sustain the campaign for health seeking behavior change at different levels of the communities.
The North East should also consider institutionalizing the concept of Maternal, Perinatal and Child Deaths Surveillance Response (MPCDSR) that is being championed by WHO, with a view to auditing deaths of mothers, newborns, infants and under children at both the healthcare facilities and communities. This audits enables the service providers and other key stakeholders to establish the cause of such deaths and to make adequate arrangements to forestall future occurrence. It is heart warming to note that the strengthening and institutionalization of MPCDSR in Bauchi State is being supported by a USAID funded Integrated Health Program (USAID-IHP).
The Region can further strengthen it’s healthcare system through integration of nutrition services during routine immunization campaigns or any outbreak responses. This integrated services will have the duel purpose of serving as both preventive and treatment measures to children and mothers.
It may also not be out of place for the Region, during it’s quarterly review meeting of the North East Governors Forum to have either UNICEF or WHO make an evidence presentation on the Region’s status on maternal, newborn, infant and child mortality. This may trigger policy shift towards better health outcomes in the Region.
This piece will not be complete without wrapping it up with the clarion call in the style of the motto by UNICEF that says, “Prevention First and Where Prevention Fails, Treatment”.
Featured and some insert pictures used for illustrative purposes only