Child’s healthcare counselling for nursing mothers key to checking under-5 mortality — Ojikutu

Professor Abdur Rasheed Kola Ojikutu has said that many children in Nigeria, especially those under-5 lost the battle for life in the hands of unwholesome cultural practices that are inimical to survival, maintaining that every parent who delivers at the hospital should be taken through counselling on childcare and child health before discharge from wards.

Ojikutu, who stated this while delivering his inaugural lecture titled, Under-Five Children In Nigeria: Expensively Acquired, Cheaply Discarded, at the University of Lagos last Wednesday, added that those who deliver at home should be exposed to the same process through the local government and community development areas.

Providing some data around child mortality, Ojikutu said that of the deaths of children under the age of 5 years, 90 per cent occur in 42 countries including Nigeria, noting that 42 per cent of all child deaths in the world occur in sub-Saharan Africa. He added that in 2019, an estimated 5.2 million children under 5 years died mostly from preventable and treatable causes.

“Children aged 1 to 11 months accounted for 1.5 million of these deaths while children aged 1 to 4 years accounted for 1.3 million deaths. Newborns (under 28 days) accounted for the remaining 2.4 million deaths. An additional 500,000 older children (5 to 9 years) died in 2019.

“Leading causes of death in children under 5 years are preterm birth complications, birth asphyxia/trauma, pneumonia, congenital anomalies, diarrhoea and malaria, all of which can be prevented or treated with access to simple, affordable interventions including immunization, adequate nutrition, safe water and food and quality care by a trained health provider when needed.

“Older children (5-9 years) had one of the largest declines in mortality since 1990 (61%), due to a decline in infectious diseases. Injuries (including road traffic injuries and drowning) are the leading causes of death among older children.”

The professor of statistics stated that the total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to 5.2 million in 2019.

“While it is not the objective of this lecture to go into the causes of the unabaiting high maternal mortality in Nigeria, it suffices to say that most of the deaths are avoidable and are due more to attitude and behaviour. It is the same tendency that affects the overall existence of the children born by those who eventually survive the fatality of childbirth.”

Going personal on his experience with child mortality, he said that his mother during her lifetime would repeatedly remind her children that she visited the midwife’s emergency ward eleven times in her life but had the grace to have only five children.

“My mother’s experience with child mortality is not unique as many women in Nigeria in particular and Africa in general have lived through the harrowing experiences of losing children in their infancy. Unfortunately, the tradition of Africa is sometimes double-faced in the sense that it offers sympathy to the woman for losing her child on the one hand, and accuses her of witchcraft on the other hand, particularly if there is reoccurrence of such an event. The key role of today’s inaugural lecture is to take a statistical look at the trend and prevalence of the Under-Five mortality in Nigeria and attempt to revisit the answer to the questions: “ Why is Nigeria one of the most notorious losers of children in the world?”, “Why is it that child mortality in Nigeria has failed to decrease drastically, sixty-three years after independence?”.

“Anyone who is above 65 years old in this gathering, must be one of the remaining surviving three percent of the cohort that shared a date of birth with him because there is very high probability that 97 per cent of those born at the same time with each of us in this hall today, will not live to celebrate the 66th birthday as most of them would have died before reaching age 65 years. This is the reality of our time in Nigeria. The question is ´Why must it be so easy to cheaply dispense with life in an environment where high premium is placed on childbearing?”

In a subtitle, Mothers acquire children at great cost in Nigeria, Ojikutu quoted Dyer who observed that while in the Western world, children are desired for happiness and personal well-being, the reason for parenthood in Africa and the negative consequences of childlessness reflect the value of children to parents and the community.

“Parenthood therefore appears to have more and, arguably, deeper roots in African communities when compared to industrialized countries. It is this attitude of the society that leads women to want to acquire children at all cost. This includes ‘hidden adoption’ whereby a woman makes special illegal arrangements such as kidnapping, outright stealing of babies in maternity wards and other unacceptable means, some women pretend to be pregnant, only to surface with a baby after nine months of pseudo gestation.

“Research in Africa has neglected focus on the contributions of men to childlessness couples due to the erroneous belief that the woman is to be held solely responsible for childlessness. This may be because the woman is the container that transports the baby into the world while men are seen as having only the responsibility of fertilizing the eggs. While women are being hounded and traumatized as a result of childlessness, their spouses seem to enjoy unhindered and unfettered immunity as though they are not contributors to childlessness.

“Though, not held accountable by the society, men are a key contributor to childlessness in every part of the world. Recent research is beginning to focus the lens on the contribution of men to couples infertility.

“The prevalence rate of male factor infertility in the United Kingdom and the United States of America is estimated to be 6 per cent and 10 per cent respectively compare to Nigeria and some parts of sub-Saharan Africa which far exceeds 30 per cent, (Abarikwu, 2013), yet Africa is one region of the world where women are solely blamed for infertility and childlessness.”

Ojikutu further observed that humanity can hardly complete the story of the experiences of women of the world in their quest to have children without a mention of the supreme price some of them have to pay during pregnancy and childbirth.

“It is most unfortunate that the child, when sick, cannot choose his own treatment intervention method. Therefore, his life and well-being are placed in the hands of the parents, particularly, the mother whose decision or indecision can result in positive or adverse fatal consequences for the child’s life.

“The child is the beneficiary of the action of the parents particularly the mother, who most of the time engages in health risk behaviour that might have a negative impact on the health of the hapless child. In one word, the “saviour” may unintentionally most of the time, become the “killer”.

“Most of these deaths are unnecessary and avoidable as they would have been substantially reduced through lifestyle modification by parents, particularly mothers and the community that enforces life-threatening traditions on health care of the children.”

Ojikutu was optimistic that with a bit more of carefulness and positive discretion of parenthood, the Nigerian child would have surmounted the challenges of mortality and morbidity.

He noted that even where medical and health infrastructures are within reach, the disposition of the mothers to these opportunities is most times nothing to write home about.

“The worst of it all is the unwillingness to explore the available orthodox health facilities at the earliest opportunity. This is compounded by the refusal of parents to accept that most of these health challenges are physiological rather than theological.

“To compound the problem, the maternal mortality situation is equally worse. Unfortunately, a large chunk of these deaths is a consequence of our attitude and dogmatic disposition towards improvement and unwillingness to adopt timely and effective available intervention.

“Life is sacred, therefore, all hands must be on deck to ensure that the abysmal statistics of maternal and under-five deaths is reduced to the barest minimum. In this regard, the policy makers and policy executioners wherever they are and at all levels must take the bull by the horn as we cannot continue ‘to stand and stare ‘ while the citizenry are killed by ignorance and gullibility.

“There is no doubt that Nigerian mothers, like each of their counterparts in other countries of the world, are the epicentre of love, compassion, and sympathy for their children. Mothers are instinctively created with a solid bond to their children’s well-being and survival, and they would naturally sacrifice their lives to keep their children alive.

“The concern here is that the Under-Five who is the subject of this lecture and one that is at the receiving end of the choice of treatment intervention is vulnerable because whatever choice is made could go a long way in determining his survival or extinction at the end of the day since he is not in a position to make the choice. Therefore, his life is solely in the hands of the parents, particularly, the mother. Granted that the mother’s love for the child is almost instinctive. However, sometimes, this love is taken to the extreme to the point where children are harmed in the process.”

The professor of statistics said that Nigeria was recently branded the poverty capital of the world. “Many poor people are unable to pay for treatment in hospitals and that is one reason most of them will result to cheaper but less efficacious means in their quest to get treatment for their children.

In some states like Lagos, treatment is cost free for children. The Federal Government of Nigeria should increase access to basic lifesaving intervention through universal health coverage to enable children have unhindered access to health services without the impediment of financial hardship.

“Every parent who delivers at the hospital should be taken through counselling on childcare and child health before discharge from wards. Those who deliver at home should be exposed to the same process through the local government and community development areas. Mother education is essential if child survival and well-being must be improved in Nigeria and if the sustainable development Goals.3.2.1 must be attained.”