ihebuzor: addressing newborn mortality in nigeria
TRANSCRIPT
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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
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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
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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
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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
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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
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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
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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
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SBA
13
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PoorFinancialAccess
toHealth
S
ervices
14
Source
:Soyiboetal2009
14
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WhydoN
igeriannew
bornsdie?
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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
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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(