The Dangerous World of the Little People of Nigeria
By Femi Olugbile
In November every year, one day is set aside to commemorate World Prematurity Day.
On this day, in Lagos, the Abiye Maternal and Child Health International (AMCH), a foundation dedicated to ensuring the health and welfare of mothers and children in Nigeria, is holding its annual celebration, in collaboration with Lagos State University Teaching Hospital, Ikeja.
The theme of the worldwide celebration for 2024 is ‘Over 13 million children born too soon every year. Access to quality care everywhere.’ It is a stirring call for help, a primal scream that all is not well with the little people of the world, but that the situation is especially dire in some red spots, like Nigeria.
The keynote speaker at the event is Dr Efunbo Dosekun, one of the most renowned voices for Paediatrics and Neonatology in Nigeria, an inveterate medical entrepreneur, proprietor of Outreach Children’s Hospitals in FESTAC Town and Ojota, as well as Chairman of BABIES MATTER, a facility located in Lekki. BABIES MATTER is a unique concept in Healthcare in Nigeria, a reference hospital dedicated exclusively to the care of at-risk premature babies.
The lives of children – the little people – in the Nigerian environment, are extremely precarious. 107 children out of every 1,000 live births die before reaching the age of 5 years.
That does not even begin to tell the full story of the little people.
‘Infant’ is a term used to describe a baby from the point of birth till it is about one year old. Although there have been measurable improvements in services and survival in the past few years, the Infant Mortality Rate across the nation is still 55.17 deaths for every 1000 live-births.
It would seem obvious, from the figures, that being born as a Nigerian is a reality fraught with great danger for a little person. The one who survives to be five years old is already a battle-hardened veteran.
It gets worse.
The most precarious period of life for little people is their first month of life. If their first year of life may be described as their ‘annus horribilis’, their first month of life may be labelled as their true battlefront experience.
The first four weeks of life is the ‘neonatal’ period. Across the world, 2.3 million children die annually during this period, the equivalent of 17 deaths out of every 1000 live births. Sub-Saharan Africa, including Nigeria, has the highest neonatal mortality world-wide, with 27 deaths out of every 1000 live births. Their commonest killers are premature birth, birth complications – especially asphyxia and trauma, neonatal infections and congenital abnormalities.
The focus of the World Prematurity Day gathering organised by AMCH and its collaborators in LASUTH on this occasion is on building bridges over the exceptionally difficult hurdles that stand in the way of the healthy survival of little people in Lagos, and Nigeria, so that they may go on to lead normal lives as useful citizens.
A ‘normal’ pregnancy lasts for an average of 40 weeks. Any child born from a pregnancy that is less than 37 weeks is described as ‘premature’. Within this group, those who are born after less than 28 weeks pregnancy are ‘extremely pre-term’, and at high risk of death or severe disability.
As Dr Dosekun proceeds with her lecture, there is pin-drop silence in the auditorium. Like her friend Professor Elizabeth Disu, the host and moving force of AMCH, Dr Dosekun has dedicated a sterling career to improving survival and general lives of the little people of Nigeria, and to teaching skills and spreading awareness of their dire situation.
Even Lagos State, the El Dorado of Nigerian Healthcare, presents no cause for cheer. A population of twenty-four million people make, by some estimates, 600,000 babies a year. One out of every 10 of those babies are ‘small’, or ‘sick‘. One out of every 28 die. 85% of those deaths are preventable.
There are 138 acute care neonatal beds in public hospitals. There are some in the private sector, but these are generally too expensive for the masses to access in the current situation. The numbers of ‘level 3’ neonatal intensive care beds in public and private facilities are miniscule, and the cost of running each of them is astronomical. Collaboration and communication between the public and private experts is virtually non-existent at a service level, leading to ‘no bed’ situations on one side, while beds may lie unoccupied on the other side. Referral is often delayed, leading to longer hospitalisation and poorer outcomes.
The advent of many centres offering Invitro Fertilisation (IVF) for couples with fertility problems has compounded the situation, with the production of a rash of multiple births, sometimes with very pre-term babies. Some die, and some survive with disabilities.
In her view, apart from a need for government to massively scale up resources and services for the care of little people, specialised services between public and private sector hospitals need to be coordinated seamlessly, with removal of the access barrier of cost through some creative financial arrangement. Every effort should be made to reduce prematurity to the barest minimum through better ante-natal care and early referral of at-risk pregnancies. Prematurity risks should be delivered in places with neonatal intensive care facilities to look after such babies. Transportation of small, sick babies is itself a specialised activity requiring special equipment and vehicles, and not private cars or public transport. Medical staff must be taught recognition and management skills. Neonatal specialists need to be present at the delivery of ‘small’ and ‘sick’ babies.
It is going to be a tough journey building structures and competencies for the little people of Nigeria to have the same chances of a good, healthy life as their counterparts in better-serviced areas of the world.
But it is a journey that, for Dosekun, as for her friend Disu, is really a Hobson’s choice. The little people – the future of Nigeria, must survive, and thrive.
