Don makes case for genotype screening of newborns, free antenatal care
With one out of four Nigerians born with sickle cell traits, Professor of Obstetrics and Gynaecology, Abosede B. Afolabi, has charged government to initiate a policy that would have newborns screened to enable everyone know his or her genotype within a few weeks of birth.Screening for genotype of newborn babies is usually not available at hospitals until age one or thereabouts. This development, the don said may deny the child the proper care needed for survival at the early stage.
Highlighting this during the 4th Inaugural Lecture of the Department of Obstetrics and Gynaecology of the University of Lagos, Afolabi said: “One out of four Nigerians has the sickle cell traits and this makes it very important to get screened as early as possible for people to know and prepare their minds on how to further prevent the situation from escalating.
“Many people are not even aware of their status. If they are aware and decide to carry on a relationship with another person with the sickle cell trait, then at least they would do so with the knowledge of the consequences and can plan for such. The government also needs to commit more resources to the care of people with this disorder by contributing to research, counselling and subsidising their healthcare expenses. This will drastically reduce the rate of maternal mortality in our country,” she said during the lecture titled, “Maternal Medicine; Journeys of Women in Pregnancy, Delivery and Sickle Cell Disease.”
At the event, which was the school’s 341st inaugural lecture, she also dwelt on other factors affecting the issue of maternal mortality, why it has been on the increase, especially in case of people with sickle cell disorder. Afolabi equally discussed factors such as diabetes in pregnancy, hypertension and preeclampsia, poor nutrition during pregnancy, bacterial vaginosis, and the painful consequences of women that have gone through the circumcision.
On the need to drastically subsidise or even make free, ante-natal and delivery healthcare to all in a bid to eradicate maternal mortality, the 49-year-old don explained: “It is important to ensure skilled healthcare in pregnancy and delivery for all women by removing the barrier of cost and allowing free ante-natal and delivery care for all women, either by taxing specific consumer items, or by developing a mobile phone subscription-based community health insurance. It is to make maternal healthcare free and this has been attempted and shown to work in Ondo State, where they met the Millennium Development Goal (MDG) for the reduction of maternal mortality.”She also emphasised the need for more hands to be on deck in order to address the issue of female genital mutilation/cutting, which is still prevalent in the country.
According to her, Osun State has the highest prevalence of female circumcision in the country, and Yoruba women generally are reported to have the highest prevalence of female circumcision, followed by Igbo women. Insisting that the reasons for the practice of female genital mutilation Afolabi were abhorrent, she said, “unlike the male circumcision, it has no medical benefit whatsoever, but instead, it leads to a high incidence of complications, ranging from life threatening bleedings, severe infections in the immediate period, to infertility, obstructed labour, and maternal mortality in the long term. The reduction, or lack of sexual pleasure that the women are also predisposed to depending on the type of circumcision, is often ignored since we like to pretend that this aspect of life is unimportant, especially for women. On the contrary, it is very important as the derivation of sexual satisfaction denies women of their right to sexual health and psychophysical wellbeing, a fundamental part of sexual and reproductive health rights. So this is a clarion call to all to help stop this abhorring act and if you know anyone still in the practice, you should help stop it.”
The university teacher equally advocated the need for proper nutrition during pregnancy saying this could affect both the mother and the child. According to her despite the fact that this is a sunny environment, which is a great source of Vitamin D, there is no assurance of getting enough of this vitamin that is needed for proper growth of the body, adding that due to skin colour, which is dark, the increased melanin prevents exposure to the ultraviolet B rays of the sun required for the production of Vitamin D.
Added to this, she said, most pregnant women also hide away from the sun and are either inside one form of transportation or the other en route to their protected destination. Findings reveal that the rate of insufficiency of this vitamin in both the mother and child, despite the climate is alarmingly low.
“Even in some mothers with some level of the vitamins, there was a challenge in transferring the Vitamin D to the foetus, thereby creating even more deficiency of the vitamin for the unborn child, which is why some children are born with rickets and asthma.” She said. She recommended that pregnant women, especially those with restricted lifestyle to be supplemented with Vitamin D during pregnancy to support fetal growth and decrease infantile rickets and asthma in their babies.
Afolabi, who also touched on the use of anaesthesia during caesarean sections, revealed that general anaesthesia is more in use than the regional/spinal anaesthesia in the country.
According to her, “the difference between the general anaesthesia and the regional/spinal one is that in the general anaesthesia, the patient is put to sleep and rendered immobile while in the regional/spinal anaesthesia, an injection is given to numb the particular area of the body and in the case of the pregnant woman it is put in the woman’s back to numb her from the waist down so she doesn’t feel any pain during the surgery.”
“The research I did using both types of anaesthesia revealed that the babies of those delivered using the general anaesthesia needed assistance with breathing and their Apgar score, (a score that gives an idea of babies wellbeing in the first few minutes of birth) were lower and the need for transfusing the mothers was more when the general anaesthesia was used compared to the use of the regional/spinal anaesthesia. And since then, most of our Caesarean sections have been done using the spinal anaesthesia.”
She enjoined all male and female of reproductive age, but who are not ready for childbirth to embrace the family planning saying, “all women and men of reproductive age should avail themselves of contraception and reduce maternal deaths. Limiting pregnancy also reduces deaths from pregnancy generally as maternal death can only occur if a woman gets pregnant.”