Prof. Akin Bamigboye is a specialist Gynaecologist and Obstetrician. He is the Dean, Faculty of Clinical Sciences at the University of Medical Sciences, Laje, Ondo State. In this interview with Gabriel Ifinnwa, he expressed dissatisfaction with the worrisome high maternal and infant mortality rate in the country, and what can be done to halt the trend.
What exactly does Maternal Mortality Ratio mean?
Maternal Mortality Ratio is a figure which depicts the health status of a community or a nation. It has a direct correlation with the health status of a nation and it is defined as the number of women who die from pregnancy-related conditions during pregnancy or within 42 days of ending a pregnancy. It includes incidental causes. The rate in Nigeria in 2015, according to WHO statistics, stands at about 814 per 100,000 pregnancies.
What is your assessment of the maternal mortality rate in the Nigeria?
The maternal mortality rate in Nigeria is not encouraging at all. The world average is about 800 per 100,000 live births. Even though, there are some areas in the country where the maternal mortality rate seems to be diminishing, but in general the situation raises serious concerns. The mortality rate of about 814 per 100,000 child births is definitely worrisome. In some Scandinavian countries like Norway the rate is about less than 10 per 100,000. So the trend in Nigeria is alarming.
What are the major causes of maternal mortality in Nigeria?
We have issues of haemorrhage, sepsis and infection like HIV and AIDS. Of course, there are other common problems such as cases of high blood pressure during pregnancy and incidental causes such as road traffic accidents. Other factors that are related include poverty, unorthodox beliefs and cultural practices including religion, ignorance, inappropriate nutrition and accessibility to good facility including good road or waterways transportation during emergencies.
What are the implications for the country?
Maternal mortality rate is an indicator of the health care delivery system of a country. The countries that have high income levels, the maternal mortality is enviably low. However, in Nigeria, MMR is extremely high for a country with diverse human and natural resources as ours. However, there are factors responsible for this. In the last 5 years, efforts have been made to reduce this, but the impact of the insurgency in the north-east is an issue. Also, the economic downturn in the country has impacted on this as well. But, of course, there are some states in Nigeria that have done well. For instance, Ondo State is arguably one of the states that have done well in reducing the maternal mortality rate to about 70 which is quite impressive. The impact on the country cannot be over-emphasised. When the women are not very well looked after, there is going to be a vicious cycle that can have a huge problem in the society.
How can women prevent hypertension in pregnancy?
Hypertension in pregnancy is a phenomenon that occurs when there is raised blood pressure above a particular figure and it is persistent. The cause is unknown hence there is no serious preventive intervention. The women are usually puffy and may have headache and blurred vision. It becomes important to have a pre-pregnancy counselling session with your doctor. Then they need to ensure that their weight is not excessive, in another words, you need to watch their weight. Pregnant women should strive to have a weight of about 58kg or a weight not above 85kg. Then another thing is the choice of foods. You need to keep away from foods that are salty or with excessive spices. They should stick to the normal diet that is recommended by WHO. These are foods containing adequate protein, fats and carbohydrates. The regions of the world when there is a higher dietary intake of calcium seem to have less incidence of preeclampsia. Many other supplements containing Zink, Magnesium among others have been tried but no real evidence to back it up
Is it true that the increasing number of caesarean sections in the country contribute to maternal death?
That is not true. It depends on the parts of the world where caesarean section are been done. I know that in Nigeria, efforts are being taken to improve how caesarean section is done, especially on how to prevent infections (use of antibiotics) which is becoming more rampant. Also, doctors are now very well trained in performing this surgery among many other things. Whereas, if you are carrying out a caesarean section in an extremely poor area or environment, where there is no anaesthetic, consultants or doctors trained, of course women will die. In those, areas, it is advisable not to go for caesarean section but rather normal delivery. In South-Africa, where I worked in the urban areas, there is no difference between a normal birth and a caesarean section, so it depends on the region.
How can Nigeria improve on her health care facilities?
The government of some of the states have improved on the availability of skilled birth attendants. The case of Ondo state is an example where the traditional and unskilled birth attendants were gathered and offered free training in any area of their choice as incentive to give up the trade. They have a health policy called “Tracking”, which they use to monitor pregnant women in the state by provision of mobile communication to all pregnant women. They monitor the woman during pregnancy and after child delivery. The pregnant women in the state are also provided with mobile phones to track them. And in case of an emergency, the health care services can get to them on time. There is also free medical care given to the women during pregnancy and after child delivery. This has really helped to reduce the maternal mortality in the state. So, I think that this model in Ondo State can be adopted across the Nigeria. There is need for Government and other stakeholders to make health facilities like ICU readily available to reduce the death of women from eclampsia, haemorrhage, sepsis. The government must be committed to ensure a health delivery of good quality. They must commit the recommended budgetary allocation of at least 15% to health backed with a strong political will. Early marriage should be discouraged in its entirety as it has been shown to significantly contribute to improving MMR. When these areas are addressed in Nigeria and indeed in the whole of developing world, MMR will start to improve.
What is your advice to women, especially pregnant women?
It is important for pregnant women to take ante-natal care very seriously. Pregnant women should ensure that they follow instructions given to them by the health care practitioners. They should ensure that they go for regular blood tests. A HIV test should be done to ensure they do not transfer that to their child. Also, pregnant women should endeavour to visit the nearest health care facilities. Finally, the midwives must learn how to refer their patients early, especially when there is a condition that they cannot manage or handle. This will help to prevent death of both the pregnant mother and child.