For the benefit of the uninitiated, a preemie is a term used to refer to an infant born before term. That is, babies born alive before the completion of 37 weeks of pregnancy. There are sub-categories of preterm birth, based on gestational age: extremely preterm (less than 28 weeks); very preterm (28 to 32 weeks); and moderate to late preterm (32 to 37 weeks).
Last November 17, Nigeria joined the rest of the world to celebrate the annual World Prematurity Day, which, according to NIDCAP Federation International, “acknowledges the journeys of preterm infants and their families as well as raises awareness of the challenges faced by children born preterm and their families.” This effort has become imperative given the claim by the World Health Organisation that an estimated 15 million infants are born preterm in the world every year with the complications of preterm birth accounting for the leading cause of death of children under five.
Incidentally, figures obtained from the WHO indicated that Nigeria is placed third among the 10 countries with the highest number of preterm births with 773,600. Top on the list is India with 3,519,100; and China 1,172,300. Pakistan is fourth with 748,100; followed by Indonesia 675 700; United States of America 517,400; Bangladesh 424,100; Philippines 348,900; Democratic Republic of the Congo 341,400; and Brazil 279,300.
As if that is not scary enough, UNICEF in a report released earlier in 2018 entitled, “Newborn Mortality”, ranked Nigeria in the 11th position on newborn deaths globally. According to the report, “eight of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions.” It noted further that “with the newborn mortality rate of 29 deaths per 1,000 births, the global estimates rank Nigeria as the 11th highest on newborn deaths.”
Earlier, the Mamaye 2016 Factsheet on Nigeria Preterm Babies had claimed that “About 87,600 premature children in Nigeria may have died from complications mainly due to lack of incubators and other specialised devices to care for them in the health facilities.” A Professor of Paediatrics at the Lagos University Teaching Hospital and president of Nigeria Society of Neonatal Medicine, Prof. Chinyere Ezeaka, in an interview with a national newspaper, observed that “premature birth complication is the direct cause of 31 per cent of newborn deaths in Nigeria and 80 per cent indirect cause.”
I did not have much knowledge of the burden confronting preemies in the country until recently when I had an encounter with a family battling to save their preterm in the Oshodi area of Lagos. On this Saturday evening, my family had gone to visit a church member who was on her way to attend to a distress call by another member, a young lady, who was said to have been delivered of a premature infant. Like most of the health facilities in Lagos, the clinic where the young mother was delivered of her baby did not have any incubator for the survival of the preemie. On getting there, we began an uncertain long search for a medical facility to keep the infant in order to ensure its survival and so as not to add to the depressing statistic mentioned above.
The nearest “big medical facility” around that we were referred to was the Isolo General Hospital, and off we drove off furiously in a struggle to save life. The preemie was wrapped in a clean woolen shawl and carried by his father at the back of the car. Getting to Isolo from Oshodi was one hell of a journey even though it should be a stress-free short one: the craters on the road causing some nervy traffic snarl in the process made sure a journey of about 20 minutes took the whole of over two hours.
On getting to the hospital, tired and scared about the fate of the infant, we were told there was no incubator available. Only one functional incubator, we were told, served the hospital. The others had packed up, all entreaties to government to fix them or replace had been caught up in the web of bureaucratic bottleneck or government indifference. “There is nothing we can do here for the child, it is unfortunate that is the situation we found ourselves here. We have sent several letters to the Lagos State Ministry of Health all to no avail”, a compassionate healthcare provider volunteered. As a way out, the young woman suggested we took the baby to the Mother and Child Hospital in FESTAC at the Amuwo Odofin area of Lagos. But this was after the woman stabilized the infant with some medication. She was distressed that was all she could do, and we appreciated her assistance and concern and off again we moved. By this time, it was past 5.30pm. For a child born before noon, it was one desperate struggle for survival.
If the traffic from Oshodi to Isolo was a burden, that on the road to FESTAC Town at that time of the evening was a nightmare. It was a bedlam, at most. Reckless and feckless drivers and road users struggling for right of way on a stretch of road whose surface had been eaten up by gullies. By the time we got to the hospital eventually, it was past 9pm. The deplorable road from the damaged bridge by FESTAC Hotel to the hospital was one huge pain in the neck. We were muttering prayers in our hearts so the baby would not die before we got to the place, as we drove along.
On getting there finally, we were told the same tale of unavailability of incubators. Only four, out of eight, we were informed, were functioning. And they were all in use.
For me, the child had endured long enough and there was no guarantee he could survive another uncertain search for a facility with incubators across the state. After a few calls here and there, one of the medical doctors on duty offered to assist. This she did by conferring with a colleague who agreed that one of the infants in one of the functioning incubators in the facility could be removed, having spent some time so that the one we brought could take its place. That way, they would be alternating the use of the incubator. And this is in a state where its monthly Internally Generated Revenue of averaged N34bn while the N302bn it raked in in 2017, according to the financial intelligence magazine, Economic Confidential, was higher than those of 30 states put together!
Not every preterm could be as fortunate as the one mentioned here. This makes it something the Lagos State Government should look into. No preterm should be made to die needlessly on account of non-availability of incubators. Judicious use of the resources of the state in the equipping of health facilities could go a long in saving the lives of preemies.
Sadly, this is the same story across the state. Almost all the health centres in Lagos lack functional incubators. And for a state with an estimated population of 20 million residents, this calls for concern from the relevant authorities. If it is that bad in Lagos, one only imagines what the situation could be like in other less fortunate states of the federation.
jnwokeoma@punchng.com. 07085183894
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