Worried about the incessant deaths of children in Nigeria from preventable causes such as pneumonia, malaria, diarrhea, measles etc aside ignorance and lack of information about the chances of survival of a child from birth, the National Orientation Agency in conjunction with United Nations Children’s Fund recently organised 2-day Media advocacy meeting to increase uptake of COVAX in Lagos State.
Unknown to many, the gap between pregnancy and a child’s second birthday is the most critical time for positive impact on a child’s cognitive and physical development.
This all important issue was exhaustively dealt with as experts and specialists in different areas like unicef nutritionist specialist, Ada Ezeogu; Owojuyigbe Clara Modupe; Dr. Olubunmi Akinlade; SBC Specialist, Aderonke Akinola –Akinwole among others took turns to educate the media on the importance of this subject matter and related topics.
Areas of focus as were discussed included antenatal care; delivery by skilled birth attendant; essential new born care and routine immunization.
Under nutrition, maternal nutrition; early initiation and exclusive breastfeeding; infant and young child feeding and growth monitoring had close attention. Then, Wash and Child protection were part of areas of concentration.
The gathering were informed that every child stands the chance to survive and develop into an healthy and productive adult if given a great start in life and that the great start for a child begins from the day the child is conceived in the womb, delivered and cared for in a clean and protected manner.
The first 1000 days is a passport to a healthy and brighter future for every child if promoted behaviors are strictly and intentionally adhered to and it is a unique period of opportunity when the foundations for optimum health and development across the lifespan are established.
The health and well-being of a pregnant and lactating woman is directly connected to the growth and health of her infant.
Preventable causes of deaths of children are influenced by poor health seeking behaviour, health care, infectious diseases, nutrition and hygiene of the pregnant mother and child during the first 1000 days.
Neonatal deaths account for nearly 40 per cent of overall deaths of children under the age of 5. While access to prevention
of mother to child transmission of HIV (PMTCT) services is nearly universal, retention in care, poor infant feeding practices,
as well as challenges with immunization coverage continue to jeopardize the health and development of babies and young
children.
Promoted behaviours in the first 1000 days during pregnancy are as follows:
.Maternal nutrition pre and upon conception that promotes healthy foetus development
▪ Regular Antenatal visits to a health facility
▪ Alertness on dangers signs during pregnancy
▪ Sleeping under mosquito nets to prevent malaria
▪ Delivery by a skilled birth attendant
After delivery, the following should be observed:
▪ Early Initiation and Exclusive Breastfeeding
▪ Routine Immunization
▪ Complimentary feeding after six months – Infant and Young child feeding
▪ Regular hand washing with soap and water
▪ improved hygiene practices
▪ Regular growth monitoring
▪ Birth Registration.
Based on available data on delivery in a health facility, Lagos state has the highest coverage in the South west region for institutional deliveries. Institutional delivery is lowest in Ondo and Ogun states. Over 21% of children are born outside the health facilities in south west.
Skilled birth attendant are highest in Lagos and lowest in Ondo state, higher than Southwest and National average.
On Neonatal mortality, Lagos Osun and Ondo states have the lowest neonatal mortality in the southwest.
Oyo, Ekiti and Ogun have a neonatal mortality greater than the national average.
56% of children have the probability of dying within the first month of birth in Ogun state, the highest in southwest.
Infant mortality is lowest in Lagos and Osun states.
Ogun, Ekiti and Oyo are higher than the southwest average. Ogun has the lowest infant survival rate at 32%.
Infant mortality per 1000 live births
The probability of a child dying between his first and fifth birthday is highest in Ondo with 35% (higher by 12% than the SW average) and lowest in Lagos.
Under five (5) mortality is lowest in Lagos state and highest in Ogun state. Oyo, Ondo, Ekiti, Ogun under five mortality is higher than the southwest.
On Immunization Coverage of Penta 1 and Penta 3, Lagos state had the second highest Penta 3 immunization coverage in the South west region. However, it accounts for the highest number of unimmunized children by population in the region at 116,103.
The two antigens are administered as birth doses, however the coverage for HepB was 2.2% lower than the coverage for BCG. This can be attributed to poor awareness among caregivers.
Coverage of Antigens given at Birth in Lagos
Lagos had the lowest dropout rate from Penta1 – Penta3 in the South west region. However 9% of those immunized did not return for the Penta final dose thus jeopardizing vaccination coverage.
Lagos had the highest coverage of children fully immunized at 1 year of age and higher than the southwest average. However, only 66% of children were fully immunized.
Immunization
Defined is a way of protecting children from vaccine preventable diseases as soon as a baby is delivered through the administration of vaccines orally or by injection.
-TB, Measles, meningitis, diphtheria, tetanus, whooping cough, diarrhoea & poliomyelitis etc.
-Children who are immunised are protected against these dangerous diseases which can lead to illness, disability and/or death.
– All children male/female have the right to this protection and should be fully immunized.
Immunization should not be delayed, it should commence immediately a baby is born.
A child who missed immunization at birth should start immediately.
Every child is expected to have completed immunization before the age of one.
Immunization is not harmful to the child, it is safe to vaccinate a child that is malnourished, has a disability or sick.
Children may have fever or pain at the site of injection after taking the vaccines, this is normal. If fever persist, report to the nearest health facility.
Every child should be taken for immunization 6 times during the first year as stated in the immunization schedule.
Parent or care givers should take the child health card along to the health facility to record the immunisation the child is given and the date for the next immunization.
Key health practises
Evidence demonstrates that it is far more effective to support brain development in the first place through prevention and adoption of key healthy practices than to depend on replacement therapy once a deficit has occurred. This requires:
-Improved nutrition for adolescent girls and young women before, during and after pregnancy; early booking and attendance of antenatal care; timely uptake of PMTCT services by HIV positive pregnant women and their babies; delivery carried out by skilled birth attendants; exclusive breastfeeding during the first six months of the infant’s life; complete routine immunization; provision of nutritious, safe and appropriate food to complement breastmilk as the baby grows; availability of safe water; improved hygiene and sanitation practices; and regular monitoring to track growth and development.
These are high impact public health interventions that are well known to optimize child survival, and must be supported by regular growth monitoring, complete immunizations and adequate complementary feeding. Preventing diarrhoeal and respiratory illnesses through handwashing with soap, and ensuring mental stimulation through play and affection are also fundamental for optimal child development up to age 2 and beyond.
Essential Newborn Care
Essential newborn care refers to key routine practices in the care of the newborn, at the time of birth and over the first hours
of life.
Steps in essential newborn care
• Warmth and appropriate hygiene in handling newborns,
• early and exclusive breastfeeding,
• umbilical cord care, eye care,
• vitamin K administration, and
• immunization are all key components of essential newborn care (ENC).
Cord care:
-Proper care of the cord may prevent infection. Keep the cord exposed and dry.
– DO NOT apply anything to the cord, including herbs, animal dung or other substances.
– Do not bandage or cover the cord. If soiled, wash the cord with clean water.
– If there is blood coming from the cord, place a
new tie tightly around the cord.
The following practices have been shown to improve results along the first 1000 days:
• Strengthening health systems by identifying bottlenecks, prioritizing actions and building capacities at primary care and community levels – has shown dramatic reductions in under-five child deaths and improvements in coverage and access to care.
• Improving linkages with early childhood development centres in communities with primary care clinics – including building capacities of these practitioners for growth monitoring, improved hygiene practices, early identification of problems in children and referrals to care.
• Building capacities of front line community health workers to support mothers and families for exclusive breastfeeding, improved hygiene practices, early stimulation and completing immunizations.
• Improving knowledge and demand for services through community structures, health education and social mobilization activities, that provides tailored information to the mother/caregiver on all aspects of child health and development.
All Pregnant Women Should Do The Following:
– Register for antenatal as soon as pregnancy is confirmed.
– Attend all appointments (8 visits) during pregnancy
– Ensure delivery in a health centre, comprehensive health centre or hospital by skilled birth attendants (Midwife or doctor)
– Eat nutritionally adequate diet comprising of all classes of food.
– Eat seasonal fruits and drink copious fluids especially water
– Be acquainted with early initiation of breastfeeding within the first hour of life of the baby, exclusive breastfeeding and adequate complementary feeding.
– Be actively involved in your own care and that of your baby.
– Communicate freely with your health care team and feel free to ask questions and raise concerns if any, about yourself or your baby.
Take TD in pregnancy and complete the immunization schedule as recommended even after delivery (A total of 5 doses for WCBA)
Prompt reporting of danger signs in pregnancy such as:
– Bleeding or spotting water from the vagina
– Extreme swelling of the feet
– Convulsion
– Pain in the stomach or chest
– Painful urination or blood-stained urine
– Fever chills
– Exceptional fatigue
– Dizziness, frequent vomiting
It is instructive to note that the coronavirus scourge is still very much around. The general public is encouraged to take the coronavirus vaccines as many are still dying on account of not taking the vaccines. Those who have not yet gotten vaccinated are said to be at greater risk than those who have been vaccinated as they are already protected.
Those who are yet to take the full dose are advised to do so to balance their chances of survival should another breakout occur.
