situation action plan - nigeria.pdf - Healthy Newborn Network

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CHAPTER 1: CURRENT STATE OF NIGERIA’S NEWBORNSEducation for girls and womenA woman’s education is one of the mostimportant determinants of neonatalmortality; mortality levels decline asthe mother’s education increases. TheNDHS 2003 showed almost a two-folddifference in neonatal mortality betweenwomen with no education (NMR of 60)and women with secondary educationand above (NMR of 37). 4 (Figure 1.9) Thehigher a woman’s level of education, themore likely it is that she will marry later,use contraception, utilise health services,recognise danger signs in the newborn andplay a greater role in reproductive healthdecision-making.Figure 1.9: Neonatal mortality rateby mother’s level of educationNeonatal mortality per1.000 live birthsSource: 47060504030201060Neonatal 0 mortality per 1,000 live birthsNo education Primary Secondary53Level of mother's education37The National Bureau ofStatistics reported anadult female literacy of 57percent, compared to 75percent among males. 31However, these rates varywidely: there are lowerliteracy rates in the ruralareas and in the northernpart of the country.Recent MICS data reflecta national literacy rate of56 percent among femaleyouth between 15 and 24years of age. Of these, only21 percent are literate inthe North West and 39percent are literate in theNorth East. These dataare compared to higherliteracy rates in the SouthEast (88 percent) andSouth West (85 percent). 5(Figure 1.10)Figure 1.10: Female literacy among 15-24 year olds,by zoneFemale youth literacy (%)100%75%50%0%56%Female 25% youth literacy (%)Source: 4NorthCentral39%NorthEast21%NorthWest88%SouthEastZone81%SouthSouth85%SouthWest56%NationalaverageGender issuesIntertwined with low levels of education, the process of household decision-making in regard to healthpresents another underlying factor that contributes to neonatal mortality. Control of finances and thedecision-making authority often lies with the husband or other male relatives. Studies have shownthat “many women have lost their lives and that of their babies in pregnancy-related conditions, whileawaiting a decision to be taken by such gatekeepers.” 7Constraints placed on women’s movement outside the home sometimes limit their access to healthfacilities. This contributes to low levels of antenatal attendance, low rates of birth in health facilities, lowattendance of postnatal services, poor newborn immunisation, inadequate child care practices and poorhealthcare-seeking behaviour. This is especially true in the northern parts of the country.24SAVING NEWBORN LIVES IN NIGERIA
Chapter 2: Status of Newborn Care in NigeriaAn effective continuum of care connects essential maternal,newborn and child health packages through the pre-pregnancy,pregnancy, childbirth and postnatal periods into childhoodand adolescence. This builds upon natural linkages of care formother and baby throughout the life cycle and by integratingservice delivery from the home with the first level facility andwith the hospital. 32Recognising the importance of this continuum of care, theFMOH built upon this framework in the IMNCH strategy. 7(Figure 2.1) There are a number of evidence-based interventionsto reduce newborn death and disability that can be integratedwithin health packages already present within the Nigerianhealth system. More newborn lives can be saved in a costeffectivemanner by increasing the coverage of these existingpackages and at the same time adding key high impact interventions to save newborn lives.Jonathan Hubschman/Save the ChildrenFigure 2.1: Interventions to reduce newborn deaths within thecontinuum of careOutreach/outpatient ClinicalFirst referral ReferralREPRODUCTIVEHEALTH:•Family planning•Prevention &management ofSTI & HIV•Folic acidANTENATAL CARE:–Focused 4-visit ANC,including:•hypertension/preeclampsiamanagement•tetanus immunisation•syphilis/STI management•IPTp and ITN for malaria•PMTCT for HIV/AIDS•Detection/ treatment ofbacteriuriaCHILDBIRTH CARE:•Emergency obstetric careto manage complications•Skilled obstetric care atbirth and immediatenewborn care (hygiene,warmth, breastfeeding) andresuscitation•PMTCT of HIVNEWBORN AND CHILD CARE:–Emergency newborn care for illness, especially sepsis–Management and care of low birth weight babies, includingKangaroo Mother Care–Case management of pneumonia, malaria and diarrhoeaPOSTNATAL CARE:–Support healthy practices–Early detection and referral ofcomplications–Extra care of low birth weight babies–PMTCT for HIV including support forappropriate feedingPREVENTIVECHILD CARE–Vaccinations–Malaria ITN–Nutrition–Care of childrenwith HIV, includingcotrimoxazoleFamily/community–Adolescent andpre-pregnancynutrition–-Education–Prevention ofHIV and STIs–Knowledge ofpregnancycomplications andemergencypreparedness,counselling for newborncare and breastfeeding–Where skilled care is notavailable, clean deliveryand simple early newborncare including warmth andearly initiation ofbreastfeeding–Healthy home care including:promotion of exclusive breastfeeding,hygienic cord/skin care, keeping thebaby warm, promoting demand forquality skilled care–Case management for pneumoniaand neonatal sepsis, and care of LBWbabies where referral is not available–Water, sanitation,hygiene–Demand for careand linkages tofacility carePre-pregnancy Pregnancy BirthNewborn/postnatalChildhoodSource: 11However, several challenges threaten the success of a seamless continuum for maternal, newborn and child health.These may include apparent competition between advocates for mother or for child; the difficulties of effectivelylinking homes (where most births still occur in Nigeria) with effective and timely care especially at birth and in the25SAVING 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 and 16: Track progress and use the data to
Page 17 and 18: 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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CHAPTER 5: STATE NEWBORN HEALTH DAT
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REFERENCES30. Safe Motherhood in Ni
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FEDERAL REPUBLICOF NIGERIAMINISTRY
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