situation action plan - nigeria.pdf - Healthy Newborn Network

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Chapter 1: Current State of Nigeria’s NewbornsNigeria is the most populous country in Africa withapproximately 140 million people, and the tenth largest countryin the world. 1 Nigeria’s health status indicators are worse thanmost low and medium-income countries. Nigeria ranks 155 thout of 177 countries in terms of health status according tothe United Nations Development Programme (UNDP) 2 and in2000, the World Health Organization ranked the performance ofNigeria’s healthcare system 187 th among 191 countries. 3 Whilewe have made some progress toward reducing child mortality,the country is still off track for Millennium Development Goal(MDG) 4 for child survival and 5 for maternal health.Liz Gilbert/David and Lucile Packard Foundation, courtesy of PhotoshareEach year in Nigeria almost 1.2 million children die before theirfifth birthday, but until recently it has not been noted that one quarter of these – 284,000 – die in the first monthof life as neonatal deaths. Reducing these deaths is a crucial step to advancing Nigeria’s progress towards MDG4. In addition, many of the solutions fornewborn deaths link closely to reducingthe estimated 47,000 maternal deaths inNigeria each year. (Table 1.1)To address this urgent issue, the FederalMinistry of Health (FMOH) and partners, inalliance with the Global Health Partnershipfor Maternal Newborn and Child Healthhave developed the Integrated Maternal,Newborn and Child Health (IMNCH)strategy. The strategy urges states toaccelerate actions that will ensure universalcoverage of MNCH interventions. TheIMNCH strategy moves away from thecurrent, fragmented implementationstructure for maternal and child healthTable 1.1: Numbers of deaths of Nigerianmothers, babies and childrenPopulation 144,720,000Annual births 5,909,000Neonatal Mortality Rate (2003) 48Annual number of neonatal deaths 284,000Under-5 Mortality Rate (2003) 201Annual number of under-5 deaths 1,188,000Percent of under-five deaths that are neonatal 24%Maternal Mortality Ratio (1999) 800Annual number of maternal deaths 47,000Source: 1,4-6services. Instead, it focuses on integrated services that can accelerate coverage of effective MNCH interventions.The strategy aims to pull together an evidence-based maternal, newborn and child health framework in a practicalcontinuum in order to achieve MDGs 4 and 5. 7Historically, maternal and child health packages in Nigeria addressed the mother and the child separately and didnot address the special need for newborn care. In the absence of a comprehensive analysis on newborn healthissues, the challenges facing newborns and possible opportunities to save newborn lives now may be missed. Thissituation analysis aims to provide a more comprehensive understanding of the state of newborn health in Nigeria.It provides a foundation for the systematic development and implementation of evidence-based interventions toimprove newborn health in the overall context of the IMNCH strategy.16SAVING NEWBORN LIVES IN NIGERIA
CHAPTER 1: CURRENT STATE OF NIGERIA’S NEWBORNSNigeria’s Commitment to Millennium DevelopmentGoals 4 and 5The international community, including Nigeria, endorsed the eight MDGs in 2000. The goals present an historiccommitment to eradicate extreme poverty and improve the health of the world’s poorest people by 2015.Nigeria’s failure to make progress towards meeting the MDGs contributed to the 2007 United Nations mid-termprogress report to conclude that “the [MDGs] are very unlikely to be achieved in Sub-Saharan Africa.” 8Meeting MDG 5 for maternal survivalrequires a 75 percent reduction inmaternal mortality from an estimated1,000 maternal deaths per 100,000live births at baseline in 1990 to 250per 100,000 live births by 2015. 7 ForNigeria to meet MDG 4, the countrymust attain a two-thirds reduction inthe under-five mortality rate (U5MR)from 230 deaths per 1,000 live birthsin 1990 to 76 by 2015. Nigeria has onlyreduced under-five mortality by anaverage of 1.2 percent per year since1990 yet needs to achieve an annualreduction rate of 10 percent from nowuntil 2015 to meet MDG 4. 9 There hasbeen no measureable progress madetowards reducing neonatal mortality inthe past decade. (Figure 1.1)Figure 1.1: Rate of progress towardsMDG 4 in NigeriaMortality per 1,000 live births400300200100Mortality per 1,000 live birthsNeonatal mortality rateUnder 5 mortality trendMDG 4 TargetUnder 5 mortality rate (MICS 2007)Under 5 mortality rate (NDHS 2003)4801960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015YearSource: 4, 54820113876The 2003 Nigeria Demographic and Health Survey (NDHS) reported an U5MR of 201 deaths per 1,000 livebirths and the recent 2007 Multiple Indicator Cluster Survey (MICS) estimates U5MR at 138 deaths per 1,000live births, suggesting a considerable decline. 4, 5 Wide geographic variation was seen with U5MR ranging from 106per 1,000 in the South West zone to 166 per 1,000 in the North West zone. 5 Neonatal causes of death accountfor an estimated 24 percent of the estimated 1.2 million children who die annually in Nigeria under the age of five.Malaria (24 percent), pneumonia (20 percent), diarrhoeal diseases (16 percent) and measles (6 percent) are otherdirect contributors to the death of children under five. 7While a neonatal mortality rate (NMR) estimate for 2007 is unavailable, experts assume that it has not declinedas much as the U5MR. This is because an increase in preventive programmes for child health, such as the NationalProgramme on Immunisation and previous Integrated Management of Childhood Illness (IMCI) protocols, whichreduce post-neonatal deaths but do not target deaths in the first four weeks of life.Health and Survival of Nigeria’s NewbornsGlobally each year 130 million babies are born, yet nearly four million die within the first four weeks of life. Anadditional 3.2 million are stillborn. 10 Only one percent of these deaths occur in high-income countries where theaverage NMR is between 2 to 4 deaths per 1,000 live births. Ninety-nine percent of neonatal deaths take place indeveloping countries. 1In Nigeria, vital registration of births is generally low. MICS 2007 reports birth registration of 23 percent nationally. 5Even fewer deaths are registered, especially neonatal deaths which mainly occur at home. The majority of Nigeria’snewborns who die do so without any record, often totally uncounted. There are few estimates of neonatalmortality at a national level and all are dependent on retrospective household surveys such as the NDHS. The17SAVING NEWBORN LIVES IN NIGERIA
Page 1 and 2: FEDERAL REPUBLICOF NIGERIAMINISTRY
Page 3 and 4: Table of ContentsAcronyms 4Foreword
Page 5 and 6: ForewordThe first 28 days of life,
Page 7 and 8: Saving Newborn Lives in NigeriaSITU
Page 9 and 10: Status of newborn care in NigeriaEX
Page 11 and 12: Newborn health policies and program
Page 13 and 14: EXECUTIVE SUMMARYPriority opportuni
Page 15: Track progress and use the data to
Page 20 and 21: CHAPTER 1: CURRENT STATE OF NIGERIA
Page 26 and 27: CHAPTER 2: STATUS OF NEWBORN CARE I
Page 42 and 43: Chapter 3: Newborn Health Policies
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REFERENCES30. Safe Motherhood in Ni
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FEDERAL REPUBLICOF NIGERIAMINISTRY
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