Child mortality: Rage of a silent emergency

from Vanguard

Written by Sola Ogundipe

Nigeria is signatory to several commitments devised in international conferences to solve the problems of poverty, hunger, malnutrition and child survival in the world. Notable among these commitments were those made at the 1989 Conven tion on the Rights of the Child. As the most ratified human rights treaty in history, the Convention calls for recognition of the child’s right to the “highest attainable standard of health.”

In its wake, the World Declaration and Plan of Action on the Survival, Protection & Development of Children given at the 1990 World Summit for Children, remains by far the most celebrated instrument in history for ensuring child survival. In the Declaration, Nigeria, along with other world leaders, committed to “giving high priority to the child”.

This document remains one of the most convincing evidences that the cause of the child is at the top of the world’s agenda. It symbolises the drive to save millions of young lives from premature and preventable death and reflects hopes for a reduced childhood mortality, increased immunization coverage, better development, protection and overall survival.

But it is a sad commentary to note that 18 years after this historic movement began, several millions of children have been left behind. Amongst the unfortunate group of children so terribly let down by their country’s leaders inability to live up to their vows of the 1990 Declaration is the Nigerian child.

Over the years, progress towards ensuring survival of the Nigerian child has been a patchy mixture of conspicuous achievement and dispiriting failure. Saturday Vanguard’s health team of Sola Ogundipe and Chioma Obinna take a look at the fortunes of the Nigerian child in the face of the overwhelming odds. Their findings are not pretty.

They note that while child mortality could be reduced through “simple, reliable and affordable interventions” that are “readily available” and have the “potential to save about two-thirds of the children currently at risk, obstacles in the form of disease-specific approaches to health care, low profile of maternal and child health, inadequate financing and a lack of political, are the mainstay of the Nigerian response. Simply out, the verdict is that much is still to be desired in the drive towards the much-belabored maxim of uniting to save the Nigerian child.

SURVIVAL is the most fundamental law of nature. Indeed where issues of life are concerned, only the fittest can survive. But as a country currently ranked sixth in the world for child mortality, Nigeria has nothing to cheer by way of child survival. Nigerians know all too well that hunger and poverty are birds of the same feather.

They know that hunger and poverty flock together. But Nigerians are confused about which comes first. They wonder if they have to be alive in order to survive, or whether they must survive in order to be alive. Even the children have been compelled to ask what their lot is.

“Are we surviving to live of or are we living to survive?” A group of youngsters once threw this poser during a public debate. The answer they got is blowing in the wind. In their limited wisdom, children have learned to appreciate the role of poverty in matters concerning survival. They know that poverty is one of the greatest stumbling blocks that often militate against survival. They have learned to accept that though survival is their right, it is not always guaranteed.

But even the level of poverty in the country today does not justify the grim picture of the health status of the Nigerian child. Of the estimated 9.7 million children worldwide under age five dying annually from preventable and treatable causes, including HIV/AIDS, malaria, diahorrhea and major vaccine preventable disorders, a significant proportion are Nigerians.

According to the State of the World’s Children 2008, although the annual number of deaths among children under age five is on the decline, Nigeria is yet to record a stable or improved rate of child mortality over the last decade – meaning the country is not on track to meet the Millennium Development Goals 5 target for child survival, which calls for reducing by two-thirds the 1990 child mortality rate by 2015.

While child mortality rates in sub-Saharan Africa have generally decreased by 14 per cent since 1990, Nigeria remains one of the countries in the continent with the highest child mortality rates. Currently, Nigeria actually has one of the highest rates of child mortality in the world. Indeed while child mortality has improved in recent times in neighbouring West African countries such as Republic of Benin and Ghana, little by way of improvement has been observed here in Nigeria.

Estimates from UNICEF indicate that the country’s infant and under-five mortality rates remain no better than 110 and 183 per 1,000 live births respectively. Death from preventive childhood diseases is still commonplace. Every year, an estimated 900,000 Nigerian children aged five and below die of causes ranging from malnutrition, measles, pneumonia, malaria, acute respiratory infections, polio, diarrhoea and vaccine preventable diseases amongst others.

There is still little or no access to good health facilities, safe drinking water or sanitation facilities.
With deteriorating or non - existent facilities, collapsing or collapsed infrastructure, depleted personnel, non - availability of drugs, lack of basic amenities like electricity, water and sanitation, poor outreach management strategies, it is obvious the authorities in charge are yet to be in tune with the goal health revolution of promoting health of the child at the community level.

Looking at the issue retrospectively, it would be recalled that in 2000, top government officials from the country joined other world leaders under the auspices of the United Nations to offer commitment towards ensuring survival of the world’s children. A goal was set to reduce by two-thirds the number of children who die before reaching age 5. This target was one of eight Millennium Development Goals (MDGs) designed to tackle hunger, poverty and disease.
While many countries are successfully meeting or about to meet this important “child survival” goal, many countries, including Nigeria remain as far from this goal as they were eight years ago. There are millions of Nigerian mothers and fathers who know it as a fact that their country is yet to make appreciable in-roads towards save the lives of their children. Particularly affected are newborns in their first four weeks of life. They account for 40 per cent of deaths among children under age 5.

However, in recognition of the enormous problems faced by Nigerian women and children, the current Minister of Health, Prof. Adenike Grange on resumption, without mincing words, declared that issues concerning women and children would be the ministry’s priorities during her tenure.

Grange also promised to look into immunization services and expand and strengthen the Inter- agency Coordinating Committee (ICC) for it to accommodate other health interventions programme aimed at improving the health of children.

Other measures, she proffered was to revitalize the Primary Health Care (PHC) Centres and do a re-orientation of staff in the tertiary health institutions as well as ensuring that Local Government Areas (LGAs) and the civil society would be made to work more closely with the Federal Ministry of Health in the delivery of health services at their various levels.