High Infant Mortality Rate in Sierra Leone, SSA (140 per 1,000 deaths)

Sierra Leone, a much smaller country in SSA, has implemented an actionable solution to combat its high maternal and infant deaths. Is this a pilot project, is it sustainable and, was needs assessment done properly?  There are pitfalls in the programme, as they are currently experiencing, nevertheless hurray to the president and healthcare workers for putting some thing in place after much debate and strike.
www.bbc.co.uk/worldservice/africa/2010/10/101008_sierraleonehealthcare.shtml  This program came about due to the efforts of the Global Village; as in (a) Robert Zoellick, Director of the World Bank, (b) Mr. Gordon Brown of U.K who said "the World must be 'ashamed into stopping child deaths", "a few pence is the price of life or death for millions" he added, (c) Austria, Netherlands, Norway, United Kingdom (Douglas Alexander- International Development Secretary) and (d) Centre for Progressive Health Financing.
http://news.bbc.co.uk/2/hi/africa/8645968.stm
http://news.bbc.co.uk/2/hi/uk_news/politics/8271882.stm  "This won't happen overnight but we hope in the years ahead we will see a shift in approach that will revolutionise health services in the world poorest countries.  Poor health and poverty go hand-in-hand and so we must first improve people's health if we are to improve their lives" said Secretary Douglas Alexander.

Staying focused on High Infant Mortality Rate in Nigeria, SSA

I got a call recently, and the person said, "you know you can start a blog called venting :-)". I wouldn't bore you with the recent of the conversation, suffice to say my take away lesson from the conversation, was I seem to be deviating from my aim of this blog,  to (a) highlight the High Infant Mortality Rate in SAA (Nigeria) and (b) hope and pray the numbers would be reversed. But praying wouldn't do it,  and hoping is a positive sign, hence there needs to be actionable solutions to the problem.  Furthermore. I remember my uncle saying "stay away from politics, stay focused to the cause", wise words from a man of wisdom, I wonder if I have stayed true to his comment.  Nor does my brother's comment help when he said, "folks who blog think people really need to hear what they have to say because, I think it is ridiculous, people who post crap on face book are stupid... abusing the internet with no training".  Apart from enjoying the art of reading, especially a piece of good writing, I felt compelled to comment on the downtrodden nature of the U.S. economy (as a public consumer of news), since being from California I am deeply affected by it or know lots of people being equally affected by it.  As I previously mentioned I did not know what blogging entails however, I know it is fluid in nature, and so would 1.

Falash Mura aliyah

Hurray to Prime Minister Benjamin Netanyah to allow approximately 8,000 Ethiopian Jews to call Israel home in the next three years.  www.bbc.co.uk/news/world-middle-east-11753909 "These are the seeds of Israel- men, women and children that currently find themselves in the worst living condition,"  'Israel had a moral duty to resolve the complex humanitarian crisis,' said Netanyah.   Would this aliyah complete the immigration of the entire Falash Mura community in Ethiopia as Silvan Shalom (2007) suggested? Ethiopians would tell you "No".  I wonder the rate of infant mortality at these camps- is it high, medium or low in the past twenty years?  Nevertheless, aliyah gesture from Prime Minister Netanyah is a wonderful one.  Hence, to end the persistent hunger of infants and their families homelessness in these camps.

America's Economic Robustness and High Infant Mortality Rate in SSA

What has America's economic-financial strength got to do with my cause celebre? Everything! When I call upon the Global Village in a public-private partnership to help reverse a tide, the U.S. is in the fore front of that call. When I think of which country that donates more than others to causes within its boundaries? The U.S. comes to mind.  When I think of who gives a bit more than most to causes outside its borders? The U.S. is the answer.  When I think of which country among the G20 that believes in philanthropy the most? The U.S.  And when I think of which country has the most concentrated wealth?  The U.S. www.forbes.com/2009/03/11/worlds-richest-people-billionaires-2009-billionaires_land.html   So, U.S. retaining its preeminence, being fiscally robust, with a viable economy benefits my cause, and countless others globally. When people are comfortable and happy in their zone thus, they are able and or willing to assist the less fortunate. Hence, the adage- I have to feed my stomach first, before worrying about the hungry man next door.

Charlie Rose and Realism

My aunty always says "America is a very organized society." Last night I caught Charlie Rose on my local PBS channel KCET, and there were his guests David Walker (Peterson Foundation) and Mr. Friedstein (sp) or Frieden (Harvard) talking about fiscal responsibility and tough choices that needs to be made.  According to Mr. Walker, "the president has to lead", regardless of whether or not the bipartisan panel reaches the 14 out of 18 votes needed for agreement. The country is waiting for the president to lead, continued Mr. Walker.  But one would not have known that from the midterm election, I might add.  On the other hand may be Mr. Walker knows something I do not know, since I am neither an economist nor a politician. After all he is of the Peterson Foundation. So, I give him the benefit of the doubt, and believe that the country is waiting for President Obama to lead. The New York Times echoed a similar theme this morning "Waiting for the President" www.nytimes.com/opinion  to lead.  I read Paul Krugman's "The Hijacked Commission", I am still LOL, and next to it was David Brooks "preserving American pre-eminence" beautiful piece of writing, especially his last sentence.  Let me say, I appreciate Mr. D. Brooks style of writing, shall we say his prose and command of the language.

Guitar Hero on Veterans Day

Shall we salute all veterans, today being veterans day. There were many stories about veterans today.  The guitar hero story by Brian Williams of NBC Nightly News in his "Making A Difference" segment (I think that has become a signature piece of his), showed effectiveness of a simplified strategy to a complex problem.  http://www.msnbc.msn.com/id/3032619/ns/nightly_news/  In short it is a story about a PTSD Vietnam veteran who started a program of helping injured veterans by giving them guitars and teaching them how to play the instrument (using Kaizen approach).  And this is my point, using collective effort in helping others, as Brian would say to make a difference in others lives.  To date the program has given out 800 guitars. Thus, the process of learning to play the guitar  in addition to the music helps the veterans in healing. As a daughter of a major in the army (civil war) who lost her father from the ills of the war, lost a young uncle (father's only brother) at the war front, lost an aunt at a market when a bomb exploded and other relatives from effects of war, I simply understand the anguish of war ramifications. Kudos to those who sacrifice their lives in the war front. That is the utmost sacrifice, and they are the true heros of today.

Prayer Line response to IF

I m still LOL. Obviously you read every line with a fine tooth comb. That is the down side of blogging. As my friend said you have to always check for accuracy ie in spelling. You caught the tight-tithes sentence. Thanks for the correction.  From what I understand the pastor is too busy saving souls and doing deliverance prayer that he would not be interested in my cause. Thanks for the suggestion. I may pick up the courage and present the idea to him. Stay tuned.

Kaizen approach in solving high infant mortality rate in Nigeria, SSA

Thanks April for noticing and mentioning Kaizen philosophy.  Because when I call upon the global village  to take note of infants dying needless deaths in SSA especially Nigeria, and help reverse the dying numbers, I am not singing a new mantra song.  Kaizen is all about collective culture, values, vision, approach of working together to solve problems with innovative ideas,  room to fail, no fear, no perfection but room for refinement and improvement. Thus my vision of evoking the "Global Village". Japan has been very successful in manufacturing with this philosophy.  Furthermore for all the so called third world or developing countries who have achieved some semblance of modernity be it Brazil, Indonesia, Singapore or Malaysia, the West have heavily invested in those countries to assist them in feeding their citizens and solving their problems.  So why not invest in SSA countries? As president Obama said in Indonesia earlier this week, the United States believes in Human Progress, I couldn't agree with him more, I believe more in Human Progress to the point of helping to stop infants from dying needlessly, since they are our future.

A Dose of Reality- Response to april

[Thanks for reading the article- posting. I was not quite done, in terms of putting the proper link, and I appreciate the question].

The question is a good one, to answer you one look no further than the ladies of "The View" to get a glimpse of how some people are responding to the issue of U.S. fiscal insolvency.  This morning Joy said, in paraphrasing her- they have not finished building a bridge or have not found money for the bridge and they are talking about saving money for social security forty years from now (missing the point).   Sherri added that savings of four decades from now would affect today's toddlers,  one of them being her son, Jeffrey.  Meanwhile, Ms Barbara Walters was congratulating the bipartisan commission, while trying to evoke the seriousness of the issue, which they never got to discussing.
On another show, one of the commission members (Ken Conrad) said social security is insolvable, that is "broke", we are looking at $400 trillion debt, (400 percent of the GDP?) and we must solve this problem now, not two years from now.  Would Americans buckle down to sacrifice something or would they keep on voting from their heart, you asked me? I think the premise to solving a problem, is first to accept that one has a problem. As the saying goes an alcoholic never admits he has a problem till he is is the gutter. So to systematically think about this, the citizens needs to be educated about the seriousness of the problem. They must be told the factual truth. Not biting around the bush.  [To the best of my knowledge that has not been. So far, the media seems to gloss over the issue, that is why I cited Mr. Herbert's article in the New York Times. California voted their way due to the realness of their fiscal problem that has affected every facet of the state].  Second, illustrate (as in CA) the effects of the fiscal problem and the consequences, then have a panel to propose solutions and put this out to the public.  In terms of politicians the dictionary defines a politician as one who is involved in the business-art of governing, and another definition is one interested in the political office for selfish or short run interests. I think the public would be served well by the first definition rather than the second.

A Dose of Reality

Blogging is no joke if one aspires to do it well. That is to say, I did not know what I got myself into when I started this blog. So, here I am, and we would see how it goes. Some say you need to blog daily, others say it does not matter.  What ever the case may be, I blog daily for those who care, I just happen to blog in my head twice a day, yes in my head. Because (a) I have a life, (b) it is just a bit much for me in terms of of the going-on in my life to do this, that is blog 2x/day, 7 days/week. Although I seem to be consumed with this process of blogging (it may not show), trying to figure out what I am doing, as an outlet I read the paper, ie The New York Times.  Since President Obama is in India this week I read The Times to keep up with his visit. And Amidst all the news, was an article by Arundhati Ray "Kashmir's fruit's of Discord", and below it was a dose of reality article,"The Impossible Dream" by Bob Herbert. - http://  www.nytimes.com/2010/11/09/opinion/09herbert.html  This is an example of why I read the times. It tells it like it is. It puts things in prospective. Only the Times would print such a raw, honest, realistic, factual imperative regarding the state of current affairs (economy) in the U.S. today.  Kudos. It is also a reminder to check my daily reality regarding my ambition of trying to bring about some semblance of change via the global village, regarding high infant mortality rate in SSA.

A Prayer Line for Reversing High Infant Mortality Rate in Nigeria-SSA

Yes, a prayer line for my cause celebre.  Prayer line is big these days among christians (Born Again).  It is not good enough to have a few people praying on the line, now it has to be thousands of people, yes as in the letter "T" praying on the telephone.  So, I woke up this morning thinking about securing a pastor who would believe in my cause not "his", not his ego, not his big house, not his GQ dressing, but a believe in the cause of mitigating a severe problem of infant deaths. Imagine that!, where by six thousand core individuals would pray twice a day, with the pastor leading the prayer.  At the end of each session, the pastor would remind the virtual congregation to pay their tithes, support the ministry-which is the cause, and donate any offering they wish.  According to the pastor we need to build a sacred place for children as in children's hospital, followed with women's hospital, then recruiting of personnel, less I forget, build roads to access these institutions, fund transportation for the villagers to get to these institutions or better yet, bring the institutions to them.  Oh! what an enterprise. The only thing stopping this idealist ambition of mine is a willing pastor. I have yet to find one.  Stay tuned.

While women suffer, who cares for their infants-children.

I blog about infant mortality rate. And I think about it a lot.  In reality, infant mortality rate is a scientific word. The fact is that babies die. Babies die due to various causes.  They die in their mothers stomach.  They die immediately after birth. They die a few months after birth or a few years after birth.  And the mothers who gave birth to these babies suffer the most. They suffer from guilt, sense of self and subjugation.  This suffering of women came to mind after I read "For Afghan Wives, a Desperate, Fiery Way Out"  http://www.nytimes.com/2010/11/08/world/asia/08burn.html.  I thought of SSA, where some women suffer from subjugation, or loss of their infants and where maternal deaths is high.  The Afghan women in the article also suffer from subjugation, and some women set themselves on fire to die and stop the suffering?  What a horrific, painful process.  Why so much suffering? Then I realized women have been suffering for ages, and there seems to be no end in site.  Enki came to mind.  Time period 3rd millennium BCE and 2500 BCE.  Enki- a god in Sumerian mythology,  the gods banished Enlil from Dilmun ('home of the gods') for raping Ninlili.  That was then, and today the raping and suffering of women continues.

Africa Rules the 41st New York City Marathon

Despite all that ails the continent of Africa (war, disease, famine, ethnic strife, corruption, poor governance, low life expectancy and high infant mortality rate), it was pleasing to see runners from the eastern part of the continent sweep the New York City Marathon.  Gebre Gebremariam (Ethiopia) first in 2:08:14, Emmanuel Mutai (Kenya) second in 2:09:14,  Moses Kigen Kipkosgei (Kenya) third in 2:10:39,  Abderrahim Goumri (Morocco-north africa) fourth in 2:10:51, James Kwamabi (Kenya) fifth in 2:11:31, and Abel Kirui (Kenya) finished ninth in 2:13:01.  For the women Edna Kiplagat (Kenya) first in 2:28:20, Mary Keitany (Kenya) third in 2:29:01, Caroline Rotich (Kenya) eighth in 2:29:46, and Buzunesh Deba (Ethiopia) finished tenth in 2:29:55.  However, my main man of the event is none other than Mr. Chile himself; Edison Pena, who finished in 5:40:51.  What a remarkable human being.  What a determined individual, not to speak of his perseverance. He was the highlight of the race for me.   My take-away listen is to de determined and persevere and believe that in not so distance future high infant mortality deaths in Nigeria- SSA would be reversed. I do not mean to persevere in a believing system without action, but in my determination in call to action.

Tears-Crying and Advocating a Cause

I turned on my television on thursday-11/4/10, and there was Ashton Kutcher crying-tearing up while advocating for Human Trafficking. "I care" he said and he wants others to care as well, (or does anyone care...., I think he said).  I pondered, why tear up?  Will one's cause be advanced by tearing up?  Thus, I thought....if only I could get a hollywood power couple and engage them in my cause (High Infant Mortality Rate in Nigeria, SSA), and have them cry while talking about it, would the strategy be very effective?  My first thought went to that beautiful couple; Will Smith and Jada Pinkett Smith.  How about them? I asked myself.  A pause, I doubt very much if  Mr. Will smith would cry nor tear up, and neither would Jada. Besides, those two already brought us "FELA" the musical via Broadway and now the show is being staged in London. In other words they have done something positive for SSA. Further more Will has engaged himself enormously in various causes.  If crying would assist in bringing to bare the issue I am advocating I need to start shedding tears each time I talk about it, maybe the global village would pay attention and help immediately.

"Global Strategy for reversal" of high infant mortality rate in Nigeria-SSA

"The world needs to rise....The world needs to say enough is enough... we cannot do it alone...We must come together".   We need "Good Governance"..."Global Community"...."Global Strategy" for reversal of...." environmental disaster, "ecological war" brought upon by Shell oil-gas production and pollution at the Niger-Delta region of Nigeria.  These words were uttered by Oronto Douglas (Environmental and Human Rights Lawyer, Advisor to the Nigerian President) to Harry Kreisler during an interview at  the Institute of International Studies, UC Berkeley. (http/global trotter.Berkely.edu- UC TV).  Mr. Douglas was responding to his visit to the gulf of Mexico before the oil disaster and how the area compares to the gulf of Guinea.  It was of interest to note that Mr. Douglas was advocating for global response regarding on going issues at the gulf of guinea.  Suffice to say that I am not the only one calling upon the global village to be responsive to human issues in Nigeria, Sub-Saharan Africa.

BEING AN ADVOCATE

I read New York Times almost everyday, and in any given week there are articles that comes close and personal as in my world view.  Take for example the article written in The New York Times Magazine, titled "Why Women's Rights Are the Cause of Our Time"  by Nicholas D. Kristof and Sheryl WuDunn in http://www.nytimes.com/2009/08/23/magazine/23Women-t.html? about how "liberation could help solve many of the world's problems, from poverty to child mortality..."  Albeit a lengthy article, and excellent piece of writing.  They concluded by urging the readers to engage in "Do-It-Yourself Foreign AID", such as "BECOME AN ADVOCATE".  After reading the article the first impulse was to write them, of course I never did. Nevertheless, the article left an impression on me.  Suffice to say I am responding to their call to become an advocate.  I am now my own do-it-yourself foreign aid (LOL), advocating for infant mortality rate in Nigeria, Sub-Saharan Africa.  I thank Nicholas and Sheryl for having a picture of a real African woman on the cover of the magazine and for urging us to do something as opposed to complaining and blaming others for our social ills.

World Health Organization article on Nigeria's high infant mortality rate

What ails the world is plentiful.  Be it hunger, famine, HIV/AIDS, war, cholera outbreak in Haiti, or my cause celebre- infant mortality rate in Nigeria.  When I originally did my research in 2007 it was difficult to find rich data on the topic. Today I am delighted to find plenty of figures. Thanks to UN and its collaborators. As I said previously, the high infant mortality rate in Nigeria is not new, See article below.  http://www.who.int/pmnch/activities/countries/nigeria/en/index1.html  It is pleasing to read general consensus on the issue, then "what to do about it"? Is my question.  It is important for me to stay on the message, hence I would not take issue with low reported numbers such as under 100 deaths per 1000. I refuse to be political about what is ailing my father's land.  Regardless of the reported numbers,  the deaths are "unacceptably" high, said WHO.  My concern is that the global village collectively do not care enough about these infants death in Nigeria, SSA to assist in reversing the numbers.  Why do I say this? Because  I believe the global village have the voice-money-power to do anything it sets its eyes upon.

My original research on infant mortality rate in 2007

Introduction

 In the 21^st century more than 10 million children under 5 years old die each year.  Most of these deaths are from preventable and treatable conditions, and almost all deaths are in poor countries.  Of these 10 million deaths, eight million are infants, half of who are newborns in their first month of life.  A high proportion (40%) of deaths in children under 5 years occur in the first month of life, and 30% during their first week ¹.  Infant and child mortality rates vary among world regions, and these differences are large and increasing.  In 1990, in Sub-Saharan Africa (SSA) there were 180 deaths per 1000 live births, and only 9 deaths per 1000 live births in industrialized countries, that is a 20-fold difference.  In 2000, SSA had a mortality rate of 175 deaths per 1000 children and 6 deaths per 1000 children in industrialized countries, an increase to 29-fold diffrence.²

For the past three decades, significant progress has been made towards the reduction of infant mortality rates in third world countries.  As a result between 1960 and 1993 in the Arab states infant mortality rates declined from 167 to 66 per 1000 live births, in South East Asia from 146 to 42 per 1000 live births, in Latin America from 107 to 45 per 1000 live births, and in SSA from 167 to 97 per 1000 live births.  Although SSA experienced a decline it still retains more than five times the rate for East Asia (excluding China; UNDP, 1996).  Also, in most developing countries mortality rate among children under the age of five years decreased from 243 to less than 100 and once more, SSA lags behind with a rate of 174 per 1000 live births when compared with the Arab States (73 per 1000). ³ At present the high infant mortality rate in SSA are attracting international, national and individual researchers seeking effective and definitive health programs or methodology to implement sustainable measures or solutions towards reduction of infant mortality rates⁴.

Objective

This paper will focus on a SSA country-Nigeria, where there is an urgent need of intervention for reduction of infant mortality rate.  The main objective being two fold: (i) to lay out some determinants of high infant mortality rate in Nigeria within a historical context and (ii) suggest some strategic interventions towards reduction of high infant mortality rate using “theories on change in communities and communal action for change.”⁵

Nigeria and Numbers

Nigeria is the most populous country in the African continent.  It has a population of 140 million people and per capita GDP: $840 (ELCA.org, 2006).   Nigeria is said to be a major contributor to infant mortality rate globally, and also a major contributor to the estimated stillbirths of 32.2 per 1000 deliveries in SSA, which is the highest globally.⁶   In contrast, stillbirth rate in developing countries is 25.5 per 1000 deliveries, and 5.3 per 1000 deliveries for developed countries.  Thus, estimated global total stillbirths is said to be 3.2 million (uncertainty range 2.5-4.1 million), a conservative data.¹ 

In Nigeria the stillbirths for the period in 2005, translates to a crude rate of 158.6 per 1000 deliveries.  This figure is perhaps not unusual for Nigeria, being the fourth largest contributor to global neonatal deaths, at a rate of 247 per 1000 births ⁷.  In 1993 the perinatal mortality rate among teenage mothers in northern Nigeria (Sokoto), was 375 deaths per 1000 live births, making age specific difference in mortality statistically significant in this study⁸.

In 2005 Nigeria infant mortality rate was 98.8 deaths per 1000 live births (CIA Word Factbook).  In “goggle” it is 72.5 deaths per 1000 live births (www.nigeria.com).  And in the country itself in December 2006, News Papers put the figure between 200-300 per 1000 live births.  In spite of the inconsistency in reporting accurate infant mortality rate, it is widely accepted and acknowledged that Nigeria has a high unacceptable infant mortality rate and some scientists even argue that above figures are still underestimated.⁶

There are various epidemiological, programmatic, and cultural reasons for the void in vital statistics in infant mortality rate in Nigeria.  First, counting all births-dead or alive increases the probability of correctly recording all the important outcomes, including livebirths, stillbirths, and early neonatal deaths.  Second, babies who die very soon are less likely to be registered than are older babies who die.  Third, live-born babies who die early might be misclassified for several reasons: lack of information, lack of knowledge, avoidance of extra work, or blame, or audit, ill assessment for signs of life, and cultural reasons of perceived gain or loss for the family¹.

Because of the substantial variations in reporting mortality data, a global initiative is imperative in establishing a definitive measuring tool.  In view of this difficulty and scarcity of timely and accurate vital registration data especially in SSA with high mortality rates, world health organization (WHO) and Global Statistical groups are working on establishing a systematic, transparent, peer-reviewed accessible databases procedure for vital statistics¹.  Nigeria needs such a measure because census, population and statistical data have always been fraught with angst since the country’s inception coupled with its ill-funded health system.

Health care

 Health-care services in Nigeria are inadequate and unevenly distributed.  Obtaining health-care commodities are problematic.  A quarter of the people have no access to a pharmacy.  “Some-

times services have expired products or have run out altogether, probably 90% of reproductive health commodities are imported, supply and distribution is very challenging”, said Dr Arbayeru of  Federal Ministry of Health (FMoH) to Lancet in 2003.  Fewer than half of primary health facilities offer antenatal care, delivery, and postnatal services.  36% of births have no antenatal care and more than half of childbirth are not supervised by skilled attendants. Nigeria has one of the lowest levels of modern family planning use in the world, with contraceptive prevalence rate of less than 10 %.   After many years of mismanagement and military rule, 66% of the population live below the poverty level on less than US $1 a day, only 40% of households have access to portable water, and corruption is endemic⁹.

Nigeria

In 1990 the World Summit for Children pledged each nation to reduce child mortality to below 70 deaths per 1000 livebirths.  As part of the pledge Nigeria FMoH set reproductive health targets for 2006 to reduce infant mortality rate; neonatal morbidity by 30%, maternal mortality and morbidity by 50%, unwanted pregnancies by 50% and sexually transmitted infections by 50%.  Due to inadequate investments in the health system and lack of interventions, regrettably the above reductions were not met.  Funding for such projects has been vulnerable, especially with the US administration’s constant promotion of abstinence-based family planning and IMF insistence on third world countries cut social services in order to repay dept of 40 years in the past.  Increasing levels of foreign debt are associated with substantial excess mortality burden, and, without addressing high levels of foreign debt it may be difficult to improve child mortality across SSA (Mogford L).

In 2002 as part of the UN millennium development goals (MDGs-4), nations pledged a two-thirds reduction in child mortality by 2015, so in December 2006, the Federal Education Commission (FEC) of Nigeria approved 60 billion niara (approximately $60 million) to reduce infant and mother mortality rates in the country by two-thirds by 2015.  The money has not yet been utilized due to disagreements among states (ethnic groups) on plan of action.   Such is Nigeria’s dilemma, for equitable division of resources and power, due to the fact that population, census and data collection has been complicated and contentious in the country.   As is widely accepted population size and composition is an important asset as resource for development, and has far reaching implications for change and progress, thus a prime beneficiary for quality of life in any society.¹⁰

Historical trends

To understand the lack of accurate vital data for statistical usage in Nigeria is to understand that Nigeria distrusts itself due to its composition and formation.  The map of Nigeria is a product of the continent (Africa) redrawing during the precolonial period (Berlin Conference, 1847).  This brought about different tribes with different identities and cultures being grouped together.  So in light of the country’s 250 ethnic groups (4 dominant and politically influential ones; Hausa and Fulani 29%, Yoruba 21%, Igbo (Ibo) 18%)¹⁰ with their own languages and cultures, population has been a rather sensitive issue because of its implications for shaping regional, state and tribal relations and balance of power.

This has been responsible for the chequered history and census controversies the country has been associated with previously (PAN, 1990; Ottong JG, 1983).  “It is however salutary to note that the phenomenon now appears to be a thing of the past, especially with the successful conduct of the 1991 census”.   However, population growth, balance of power and distribution of resources between state and ethnic groups is influenced by the interplay of three main demographic processes of fertility, mortality (infant and maternal) and migration that inevitably affects vital statistics.¹⁰

Determinants of Infant Morality rate

Infant mortality rate is an accepted global indicator of the health and socioeconomic status of a given population (WHO; 1981, 1990).  Neonatal health is said to be dependent on healthcare services, and postneonatal health is dependent on environmental factors.  Hence, a high infant mortality rate is an indicator of unmet health care needs and unfavorable environmental factors.¹¹ Even though there is a dearth of information regarding direct causes of neonatal deaths in SSA, it is estimated that 29% are caused by birth asphyxia, 24% by severe infections, 24% by complications of prematurity, and 7% by tetanus.²    

A five-year retrospective study of childhood mortality (n = 12,522) at the University College Hospital, Ibadan found that neonatal deaths accounted for 50.8% of the total number of deaths and were preventable.  The leading causes of death were neonatal tetanus, prematurity/low birth weight, neonatal septicaemia, severe birth asphyxia, meningitis, severe malaria, pneumonia, severe malnutrition and measles.¹²  

Another 4-year study of pediatric deaths in the University of Calabar Teaching Hospital observed that newborns accounted for 47% of the deaths. Major causes of death were: tetanus, low birthweight and birth asphyxia in the newborn; malnutrition, pneumonia and measles in the pre-school age children.  Neonatal tetanus and malnutrition were leading causes in the overall mortality rate.¹³

In a prospective study in a rural community in southwestern Nigeria, population 3,308, infant mortality rate resulted in neonatal death rate accounting for 55.1% of all infant deaths, while postneonatal deaths accounted for 44.9% of the deaths.  44.4% of all neonatal deaths occurred within 24 hours of delivery while 74.1% of all neonatal deaths occurred in the first week of life and were perinatal deaths.  In the study significantly more deaths occurred during the rainy season than in the dry season, suggesting environmental factors play a role in neonatal deaths.  The commonest cause of death in the neonatal period was due to complications of low birth weight, while in the postnatal period it was due to infection.¹¹

Hence, the high infant morality rate in Nigeria is systemic and endemic stemming from exposure of certain environmental risk factors in contextual sites (household and community levels) in which mothers are forced to give birth and raise their children².  From the literature review infections (environmental factors), low birthweight-prematurity, birth asphyxia, tetanus and malnutrition were leading factors of infant mortality rate, indicating an urgent need for efficient prenatal care and public health services in the country.  

The root causes of persistent high infant mortality rate in developing countries have been explored.  Caldwell (1979) described a model, “the classical determinant” of childhood mortality.  He suggested that maternal education is the most significant determinant in child survival rates.  In other words there is a direct relationship between child survival and mothers’ education.  “The pathways by which maternal education enhances child survival are interwoven with decisions and actions mothers take in health situations as their educational qualifications improve” (Caldwell & Caldwell, 1988).   Consequently, the relationship between maternal education and child survival was advocated as a strategy and a measure to reduce infant morbidity and mortality rate. 

The problem with the above findings is that, in SSA it failed to materialize.  There was no observed strong correlation between maternal education and child survival in SSA.  At best the relationship was weak.  An increasing number of surveys began to reveal inconsistencies in the relationship between mothers’ education and childhood mortality rates  (Stewart & Sommerfelt, 1991), indicating that mother’s educational status yields no advantage in reducing infant mortality rate.  In addition, studies by UN and the World Bank stated that “the role of maternal education in child survival is least striking in SSA.   The impact of mother’s education has not been found to be statistically significant for infant mortality in some of the research projects conducted in SSA in the 1980s and 1990s.  Some scholars found contradictory relationships between child survival and mother’s education (Federal Office of Statistics (FOS), Nigeria, 1990; Sandifford et al., 1997; UNICEF, 1994).  

The irony out of the above contradictory findings between mothers’ education and child mortality were evidence of environmental conditions; lack of clean water, lack of portable water, poor hygiene and health care services and possession index under which children are reared (Cleland & van Ginneken, 1988; Defo, 1996).  In areas where living conditions are lowest, infant mortality rate were found to “peak” (Millard, Ferguson & Khalia, 1990).  Environmental or behavioral risk factors such as poor sanitation, insufficient waste disposal; poor domestic and human waste disposal, streams polluted with human wastes, an open toilet system, bushes littered with domestic wastes, no water drainage system (breeding grounds for mosquitoes), overcrowding in homes,  poor basic health facilities or no breastfeeding in infancy leads to increased exposure to infections. Such synergisms are leading risk factors of high infant mortality rate.

 Current theoretical perspectives suggest embracing an ecological perspective in other to understand the complexities behind child survival.^2,3   Researchers are stressing the impact of environment on child survival which has uped the ante in the face of the on-going economic crises in many African countries whereby cities, towns and villages are not able to maintain basic social amenities such as safe water supply and sanitation for the increasing population.  As the government acknowledged, “Nigeria would have to double its entire infrastructure for food production, health services, education, water supply, housing, energy, and services just to maintain today’s low standard of living.”

Intervention strategy

Mosley and Chen (1984) identified determinants that directly increase the risks of infant mortality and morbidity to include maternal factors, environmental conditions and nutrient deficiency.  These factors are physical and socio-cultural.  They are also associated with the community, regional ecology and household environmental characteristics.  If the ecological hypothesis³ of infant mortality rate in SSA is the exposure of infants to certain environmental risk factors and susceptibility to infectious diseases in households and surrounding communities in which mothers are forced to bring their babies into this world, then it is incumbent on the nation as a whole to significantly improve the said environment towards reduction of infant mortality rate. 

Nigeria needs thorough epidemiological information to plan and implement public health interventions.  The importance of public health interventions in improving infant survival has been confirmed with studies in developing countries (Muhuri PK).  There are multiple ways for Nigeria to improve infant survival.  A reduction in the aforementioned environmental risk factors will surely reduce babies dying from infections. Improving household sanitation and personal hygiene will improve infant survival.  Provision of public toilets, safe water, primary health care centers and health education will add to the improvement of health status in the country. 

The health policy should include increase coverage with appropriate services for prenatal care, increase number of midwives and obstetric staff to include traditional birthing attendants, repeated in-service training of existing staff in maternity and prenatal issues and problems, strengthening community services, culture-specific educational approaches using existing value system, educational campaigns to discourage harmful practices and behavior and incorporate native customs into government programs.  Post trained midwives in villages to attend to home deliveries, detect and manage infant and mother complications at onset and accompany patients requiring referral for higher-level of care to hospitals.  Immunization of children and their mothers in addition to nutrition and breastfeeding education will reduce neonatal risk factors that lead to death.  Interventions must be done through a participatory community organization and community building based strategy.

 Proposed Intervention: a three-year plan in 3 strategic phases [a pyramid format]

Phase 1:  Health Education Fair in a sample town- Nnewi in Eastern region of Nigeria

The town met all inclusion criteria. Fair conducted in churches, town halls, market places and hosted by individuals with big homes-compounds. 

8 by 11 flyer will include: babies pictures, [in native languages]

Traditional practices of reproductive health; breastfeeding picture, spacing children every 2 to 3 years, mother visiting midwife-doctor in a hospital for care.

Basic hygiene; drink clean water, wash hands, bed with mosquito nets, no littering of domestic waste, do not use open toilet.

Prenatal care: signs of pregnancy or stomach discomfort go to the doctor-Midwife.  pregnant woman eating fruits/vegetables-good nutrition.  Immunization education.

Fair to be done once a month for a12 month period.

Phase 2:  Training medical staff  -to begin 6 months after phase I began.

                Train doctors-midwives-traditional birthing attendants in prenatal care and hygiene.

                 Repeat training every 3 months. Evaluate training with a mock pregnancy event.

Train community- by holding training sessions in churches, town halls, and individual            compounds. Community training includes basic hygiene and clean environment.

                 Training to last for a 12-month period

    

 Phase 3:  Policy Formation – to begin 12 months after phase 1

Management team (physicians, public health officials, policy makers, scholars) from        state level to supervise, monitor and evaluate by collecting data.

Government to build-rebuild infrastructure; better sanitation system, sewage system, institute waste management, furnish hospitals and pharmacies with tools to function.

NGO and private grantors and donors represented.

Program to be evaluated every year and fine tuned seeking the ultimate goal of reduction in infant morality rate, thus may be implemented nation wide. 

Conclusion

 It is of interest to note that in the 21^st century, we are able to transport man to the moon and stay for days, we are able to do stem cell research for diseases, and we are able to sequence the human genome, yet we seem incapable of counting infant mortality rate in developing countries. “The health status of populations in developing countries will never be understood until the void in vital statistics is addressed”.   Some suggest that better counting of infant mortality rate and improved cause of death rate are means to advocate and prioritise policy action.   Infant survival should be a major policy goal for Nigeria, because of the multiple short-term and long-term effects on human and economic development for the progress of a society.   A global initiative is imperative in the wider context of the required progress towards relevant Millennium Development Goals (MDGs) for SSA by 2015.

REFERENCE:

1. Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K. Stillbirth rates: delivering estimates in 190 countries. Lancet 2006; 367:1487-94.

2. Black RE, Morris SS, Bryce J, Where and why are 10 million children dying every year? Lancet. 2003; 361: 2226- 2234.

3. Folasade IB. Environmental factors, situation of women and child mortality in southwestern Nigeria. Social Science & Medicine 51 (2000) 1473-1489 [Dept of Pan African Studies, University of Louisville, Louisville, KY 40292, USA].

4. Bulletin World Health Organization v.81 n.3 Genebra 2003.  WHO 2006 Neonatal and Perinatal Mortality Country, Regional and Global Estimates. Adebayo SB & Fahrmeir L. Analyzing child mortality in Nigeria with geoadditive discrete-time survival models. Statistics in Medicine 2005; 24:709-728. Black RE, Morris SS, Bryce J, Where and why are 10 million children dying every year? Lancet 2003; 361:2226-2234.

5. Nutbeam D & Harris E. Theory in a Nutshell, Apractical guide to health promotion theories. 2^nd Edition, The McGraw-Hill Australia Pty Ltd. 2004.

6.  Bolajoko O Olusannya, Olumuyiwa A Solanke, Angela A Okolo. Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria (BOO); Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London WC1N 1EH, UK (BOO); Lagos Island Maternity Hospital, Lagos, Nigeria (OAS); and Department of Pediatrics and Community Child Health, University of Benin Teaching Hospital, Benin City, Nigeria (AAO).

7. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365: 891-900.

8. Akpala CO. Perinatal mortality in northern Nigeria rural community. Journal of Royal Society for the Promotion of Health. 1993; 113(3): 124-7.

9. Roberts H. Reproductive health struggles in Nigeria. Lancet 2003; 361 p. 1966.

10. http://www.nigeria-planet.com/population-of-nigeria.html

11. Lawoyin TO, Risk factors for infant mortality in a rural community in Nigeria. The Journal of The Royal Society for the Promotion of Health. 2001; 121(2): 114-118.

12. Ayoola OO et al, A five-year review of childhood mortality at the University College Hospital, Ibadan, Nigeria. West Africa Journal of Med. 2005; 24(2): 175-9.

13. Asindi AA, Ibia EO, Udo JJ. Mortality pattern among Nigerian children in the 1980s. Journal of Tropical Medical hygiene. 1991; 94(3): 152-5.

14. Save the Children. http://www.savethechildren.org/mothers/newborn  (accessed 3/14/07

15. ECLA.org; Evangelical Lutheran Church in America, 2007 (www.ecla.org )

16. Pradip K. Muhuri. Health Programs, Maternal Education and Differential Child Mortality in Matlab, Bangladesh. Population and Development Review, vol. 21, 1995.

17. Mogford, L. Structural determinants of child mortality in sub-Saharan Africa: A cross-national study of economic and social influences from 1970 to 1997. Social Biology.  2004; 51(3-4): 94-120.

                                                University of California Los Angeles

                                  SCHOOL OF PUBLIC HEALTH-MPH           

                                           COMMUNITY HEALTH SCIENCES 100

                                      Winter Quarter 2007- Dr. Bonnie Taub

            Infant Mortality Rate in Nigeria

“Is the life of a child worth less to those with political

 power than the life of a child in a high-income country?”

   Final project

          By

                                Mukosolu N.C. Onwughalu- March 16, 2007

U.N. Millennium Development Goals appear out of reach in Africa - latimes.com

U.N. Millennium Development Goals appear out of reach in Africa - latimes.com

SSA and UNMDG (United Nation Millennium Development Goals) 2015

Friends would read my blog then call to ask why blog about such a serious topic?  Blogging is a conversation with the world (said my sister).  Furthermore, the issue I am blogging about is neither new nor novel.  One needs to read Robyn Dixon's article in Los Angles Times (http://www.latimes.com/health/la-fg-africa-millennium-goals-20100920,0,393254.story), "Africa lags in development goals" to grasp the gist of why I blog.  Robyn's article is a good one, albeit brief, broad, and rife with complexity of the continent.  She did mention child mortality. The piece is about Africa, specifically SSA and UNMDGs.  The article presented some variables and barriers endemic and emblematic to SSA, thus positioning the region not to reach UNMDGs by 2015.  Even Nigeria has acknowledged it would not achieve MDGs.  In 12/8/06 the Nigerian Federal Commission (FEC) approved N60 billion for the MDGs health scheme, designed to reduce infant and mother mortality rates by two-thirds by 2015. By 2007 the money has not yet been distributed due to ethnic and or tribe infighting.  I think it is a foregone conclusion that the MDGs would not be met.  So I would continue to blog because I  I care, because I have a vision, because I believe that one day the global village with its man power and resources would wake up and begin the reversal of infant deaths in SSA just as the AIDS/HIV numbers in the U.S. have been thumbed down.  I blog because I want to bring attention to the high rate of infant mortality death in SSA, and for the global village to acknowledge the facts, to find it unacceptable and act upon the facts.

My Best "AIDS Walk Los Angeles" so far-October 17th 2010

Sub Title: What is Wrong with Nigeria and What is Beautiful about Nigeria.

My cause is high infant mortality rate. However I support other causes as well, one being AIDS Walk Los Angeles. I used to raise money for them, but it has been difficult lately.  This year a team-fraternity invited me to join them on the walk. The team leader instructed me to arrive at the AIDS Walk by 7:30 a.m. which I did.  At 8:00 a.m. the group stand was empty. At 8:30 a.m. I telephoned the group leader only to learn they were on La Cienega Blvd. navigating traffic, "please hold our table for us... hold our table for us please..." he pleaded.  At 8:45 a.m. I called again, "calm down calm down calm down we are coming we would soon be there..." he said.  At 9:00 a.m. AIDS Walk festivities were over, warm up began, and the early walkers took off (this is when I normally start my walk).  Meanwhile the only thing my daughter cared about was being on the play ground ("the park" she calls it), and not being there elicited crying. So I ran between the playground and the group stand, as I watched group after group, gather, chat, eat breakfast and disperse.  At 9:20 a.m. I contemplated walking by myself.  At 9:28 a.m. the "boys" arrived with few female spouses. They were gracious and thankful I showed up on time. They took ubiquitous pictures. And the leader left to turn in the raised funds. Thus, I used this time to ask how come their late arrival? The answers varied.  Some said they were on a caravan.  Some said "you come at 7:00 a.m. and you have to wait".  "I am a Nigerian, I am always late... " and I would be late, said a family man I met at a child's birthday party the  previous night.  The leader returned with gifts from AIDS Walk in proportion to the amount raised and we took off for the 10k.

I could not believe my eyes and ears. I was transformed. My feelings went from disappointment and anger, to joy, happiness and euphoria.  From the time we started the walk till we completed the walk, this group of Nigerian fraternity men played traditional music using traditional instruments such as drums, shells, and a sing along. It was unbelievable. The participation was very lively. The group attracted attention due to the native music and dance. Journalists and ordinary folks took pictures. What a beautiful experience.  It was a joyous occasion. An ordinary 10k walk was transformed into an extraordinary 10k festival. Most importantly, my daughter slept most of the time due to the music.  She did not to leave her stroller and walk part of the kilometer which she did at one year old and two years old.  For that I was very grateful.  I even partook on playing an instrument. That was generous of a team full of men.  It was exciting.  At the end of the walk, the team did not receive certificates because AIDS Walk ran out. An unintended consequences of lateness. That was new to me. I never knew they ran out of certificates because I normally finish early. We culminated the walk at a restaurant for lunch.  So, I experienced an old comment "Nigerians are one of the happiest people" on earth. I also experienced what is wrong with Nigeria.  Nigerians are perpetually late to events, seem not to give a damn, then justify it, and be gracious about it at the same time. However, when engaged in that event they give it their best. And by the end of the day, the event comes out beautiful, colorful and gracious.  I suggest that if the country and her people would stop being late to events they might achieve a lot more like China, India, Indonesia and Malaysia. And might possess the wherewithal to reverse high infant mortality rate in their country.

Melinda Gates highlights Intervention on BBC World News

I turned my television on sunday morning (17th October 2010), and there was Melinda Gates talking about their foundation and the vision of the foundation; which is to give away about "90 percent" of their wealth in their lifetime. How impressive.  She talked about basic interventions in making a difference such as mosquito nets in preventing malaria.  I wish I would have been able to ask Mrs M. Gates how come she is not directing her money to the ills of infant-maternal health in Nigeria as she is in India, given their investment in Nigeria energy industry and its ramifications among the population.

Using Capitalism to make a Difference

Mr. Khosla, the poor is not looking for "enough money to be given away in the world to make the poor well off" http://www.nytimes.com/2010/10/06/business/global/06khosla.html?   Mr. Khosla prefers to invest in companies that focus on the poor (India, Africa ) by providing services like health, energy and education.  All Mr. Khosla needs to do is venture out of his Menlo Park office to Sub-Saharan Africa, for example, Nnewi (South East Nigeria), and see poor entrepreneurs- shop keepers (auto parts), mechanics, farmers and tailors all trying to be like Ramila Chawda of Ujjiva, Bangalore in an effort to school their children, feed them and pay for basic health care.  As Mrs. Melinda Gates has her money (where her mouth is) in India trying to eradicate polio and assist women and children in health care, Mr. Khosla needs to bring his money to a Small corner of the African continent where he would find many companies that "fit his model of profitable poverty alleviation" to help solve social problems for the sake of public good, I suggest.

60 Minutes interview with Melinda Gates (Foundation)

I was glad to hear Melinda Gates mention "Women and Children" as the 3rd prong issue in their foundation, during last sunday's 60 minutes interview.  That was not originally the case in 2006. I remember discussing their foundation in my Public Health graduate class. And my group asked me to research the foundation as a source to fund our project. Well we did not qualify based on the projects they were funding then. I have a dream to one day realize my goal of reversing the trend of high infant mortality rate in an African country. I predict  that this couple are poised to receive the noble peace price in my generation.  Melinda Gates is putting her money where her mouth is, so to say.  I watched with delight as she talked about this issue holding an Indian child. I urge her to bring her money to Africa where the need is urgent and desperate. As Hilary Clinton said "it takes a village". Thank you Melinda Gates.