IN a bid to reduce the high Maternal Mortality ration, MMR, in Lagos, the State State Government commissioned a research which showed unacceptably high maternal mortality ratio of 555 per 100,000 live births higher than the national average put at 545 per 100,000 live births.
The research showed that Alimosho Local Government Area, LGA, has the highest Maternal Mortality Ratio with 826 per 100,000 live births while Lagos Island LGA has the lowest ratio of 310 per 100,000 live births. Following this, there have been worries in various quarters about the challenge of improving or redesigning another strategy towards reducing MMR to the barest minimum.
In this interview with Chioma Obinna, Lagos State Commissioner for Health, Dr. Jide Idris, explains how the State intends to achieve a 30 percent reduction in the MMR by 2015. Excerpts:.
MATERNAL Mortality Ratio in Lagos State: We commissioned a research to give us a baseline figure on what our maternal mortality is. The figure it gave us was 555 per 100,000 which is high and that is why we said it is unacceptable to us. And that is what brought about the launch of the maternal and child mortality programme in the state.
Now, we have baseline figure and we have set up strategies and we are implementing programmes after a couple of years we will do re-assessment and see how far we are going. But you cannot reduce maternal mortality 100 per cent.
It is not possible, even in the best of countries they cannot do that. You cannot educate all the people in one day. By 2015, we expect the MMR to have been reduced by 30 percent and if by 2015 we do another assessment we hope it would have gone beyond that. If not, we will amend our strategies and review why we are not achieving that and do what is right.
Efforts to check the high MMR: We have invested in infrastructural development of Primary Health Centers, building of Maternal and Child Care facilities, MCCs, training and re-training of health care providers, procurement of basic obstetrics drugs and consumables, and the production of behavioural change communication materials.
Governor Babatunde Fashola launched Maternal and Child Mortality reduction programme in the state, precisely on October 18th, 2012 and that was supposed to be the first in the series of our implementation of the strategies.
Health education for mothers
It has been shown that health education can reduce maternal mortality rate by 50 percent. This is why health education is our major stride. We have developed jingles in English and Yoruba language as part of services to go down to the grassroots. The maternal hand booklet and child booklet was launched by the Governor, these books were developed specifically to contain information that mothers and children should know and they are supposed to be provided free.
These booklets contain history of each pregnancy up to four pregnancies. Right from the time the woman gets pregnant throughout the delivery and that is why it also ensures that the mother tries as much as possible to go for antenatal care. It serves first, as a documentation of the progress of pregnancy. It is also a way to capture some of these women to bring them within the healthcare net.
So it also serves as a record that the mother can keep. The same information here will be kept in the facility where they are. So even if the mother does not go to the same facility ‘A’ and she goes to another facility, with this booklet the doctor or health worker there will have a history of the pregnancy.
For the child: Each child under five years of age should have the booklet because it also contains a lot of information on the child when the child was born, what immunisation regime the child has been introduced from birth. What kind of food and growth monitoring which is very essential.
As the child visits the facility they check the height, the weight, the growth all these things they chart. And these give an idea of whether the child is growing properly or not. As they chart, there is a graph that is being done. And there is what we call a standard graph of what is expected of a child.
Proper care and examinations
Once you plot, if what you are plotting for that child falls below that standard it means there is something wrong with that child and that is why we need to refer that child for proper care and examination to nip the problem in the bud. It also contains the type of food you must give the child, personal hygiene. It is both educative and records. We have English and Yoruba.
Strategies: In the last couple of years in the context of this programme to reduce maternal and child mortality a number of strategies have been established by the ministry and those strategies cover the issues of infrastructure, health work force, advocacy and public sensitisation aimed at changing people behaviour and educate the people, issue of monitoring activities as we go a long and how to ensure sustainability.
We are equipping and restructuring some of these facilities. We have trained staff on the use of some of the equipment and drugs and the training is a continuous thing and that training covers both staff at the primary, secondary and tertiary levels.
We have developed information education materials in terms of pamphlets, leaflets, postal and even jingles addressing specific topics that are relevant to this programme such as dangers signs of pregnancy, things people should check when they are pregnant, the need for ante natal care, the need for family planning, the need to immunise our children under five years of age, what nutrition and what kind of foods our pregnant women should eat and the kind of food for children.
We have contacted some of the artists to develop drama presentations. A lot of things have been put in place. But that is the supply side but what we are addressing now is the demand side, which prompted the issue of Town Hall meetings. The essence is to let people in the community know that all these things are available. We are get ting feed back from the dialogue so that we can amend as we go along.
Helplines: We have also created some help lines. They are 08074574109, 08074574108, 08074574110. Anybody can call these lines 24 hours of the day if there are problems or requirement of information concerning pregnancy or children .
Family planning services : If people adopt family planning practices, it is a very efficient way of reducing maternal mortality. Pregnancy is a natural and physiological process. When a woman gets pregnant, there is a modification of the physiology of that woman.
So when you are pregnant, something unusual is happening and the body happens to react abnormally and that will be on for about nine months. After nine months, that body of the womb and every other thing requires a period of time to get back to normal.
If you can space your family properly it allows the body to adjust properly before you put on the burden on the body again. Unfortunately, in this country from researches and statistics, the uptake of family planning commodities is very low. One of the major reasons is cultural practices.
We have embarked on sensitisation, enlightening the people and putting up facilities very close to the grassroots. People must know the essence of family planning and the different methods available. It is a major component part of this programme.
Child spacing, when is the right time?
Throughout the period of nine months, pregnancy affects the brain, there is something we call post partum depression. It is common in some women. After delivery, they will become depressed some people sometimes mistake it for madness but it is not.
Sometimes people get pregnant even after delivery and the hypertension may remain. When people are pregnant the muscles in the uterus have stretched for not les than nine months. Some of these muscles may snap, some may get rigid because of this.
That is why it is necessary to give the body time for at least two years before the next pregnancy. This is because the two years will give you time to look after the baby, you have to breast feed the child and be responsible for the immunisation amongst other pressures on the body.
Challenges of unsafe abortion: It has been found to be a major cause of high maternal mortality and this is common amongst the younger youth even mothers. Post abortion care is another major component of this programme. If you look at these vacuum extractions as part of the instrument we are providing them and we are training staff on how to use some of these equipment. Abortion can cause bleeding or perforation of the uterus and you must have facilities to be able to carter for these complications and this is why MCCs are there.
Drugs to reduce maternal mortality: One of the major reasons why women die is as a result of bleeding during pregnancy or during delivery. Another reason is eclampsia. A pregnant women may develop high blood pressure and when the urine is checked, it may contain protein.
When protein is above a particular level there is a problem. If care is not taken, the woman may start to convulse. Two drugs people that can reduce these problems are magnesium sulphate and oxytocin.
Magnesium sulphate is used for people with eclampsia. It reduces blood pressure etc. If it is time for a baby to be delivered it could be through Caesarean Section if the woman cannot deliver normally. Oxytocin is used to reduce bleeding so that the person can be taken to the hospital where the problemcan be adequately dealth with.