Eleven per cent of the children that die in the world yearly are from Nigeria. Bukola Adebayo writes on the issue involved

Tunminu had been feeling feverish for the past two days, and her mother, Shade Akintayo, had been giving her some anti-malaria drugs for treatment.

Akintayo, a nursery school teacher, who is used to managing sick children in her school, thought her three-year-old daughter’s condition was really nothing to fret about.

However, three days after the fever started, Tumininu’s case grew worse, as she developed diarrhoea and was also vomiting blood in the night.

The agitated single mother called on her neighbours, who assisted her to take the ailing child to a private hospital in Surulere where they lived.

The nurse on duty told Akintayo that there was no doctor around,adding that it would take some time before the physician would come to attend to the child.

The doctor showed up two hours later and, after examining Tumininu, he advised them to rush her to the general hospital.

She said, “After waiting for two hours for the doctor, she started convulsing but the nurse reassured us that we would take care of her, all for him to tell us to take her to the Lagos University Teaching Hospital in Idi-Araba or the general hospital in our area. They did not have the facilities or the specialist to diagnose what was wrong with her. He also refused to give us a referral letter.”

Akintayo, who narrated her story to our correspondent in LUTH, on Thursday, said they opted for the general hospital that was closer to their area.

She said on getting to the hospital around 5am, there were other women with their sick children waiting to see doctors.

A nurse advised them to take her to LUTH if they wanted quick intervention because there were 15 children on emergency.

Akintayo rushed her sick daughter to LUTH.

“She was already gasping by the time we were leaving the general hospital.There was no ambulance. Tumininu had begun gasping for breath before we got to the hospital. But as we were taking her into the emergency unit in there, she died,” she says.

So, Tumininu’s was taken to the mortuary.

The overwhelmed doctors said the child died of acute diarrhoea.

Yet, about 13 children under the age of five-like Tumininu- die every minute in Nigeria due to lack of immediate care and basic medical interventions.

According to the World Health Organisation, 6.9 million children under five years of age died in 2011 globally.

It also estimated that 19, 000 children die each day and; almost 800 every hour.

What is troubling about these statistics is that though other countries have made remarkable progress in reducing the number of children dying in their countries, Nigeria still records an unbelievably high death rate of children under the age of five.

For example, after India, Nigeria is second on the list of countries with the highest infant deaths in the world.

Why are these children dying? Doctors and caregivers, who spoke with our correspondent at three-day training for doctors in Nigeria by the Imperial College Faculty, London, said dearth of trained health personnel at all the primary health care centres, poor child care workforce and lack of emergency paediatric response facilities in our hospitals were reasons for high infant mortality rate in the country.

For instance, a consultant paediatrician, Dr. Dayo Ajayi-Obe, said Nigeria, with a population of 70million children under the age of 18 ,has only 600 trained consultant paediatricians. Out of this 70 million children, over 40 million are under the age of five.

“The United Kingdom has 3,084 trained consultant paediatricians and 1,184 associate paediatric specialists for its 20 million children and it does not include the 3,174 paediatricians in training. That is how much importance that is placed on children. We have just 600 paediatricians to 70 million children and most of them are in Lagos and Abuja. Some states do not even have a single paediatrician!,” she adds.

Ajayi-Obe notes that Nigeria has yet to make any significant progress in reducing infant deaths because its health system is still redundant.

She states that infectious diseases and respiratory ailment such as diarrhoea, pneumonia and measles, malnutrition and ill-prepared responses to emergencies in children contributed to about 90 per cent of child deaths in the country.

She adds, “Child care is inadequate in Nigeria and there are gaps. It reflects in our health indices of 145 per 1,000 births. I found out that the vacuum I left in the system 30 years ago still exists, it is the same diseases, and infections that are still killing people now.”

Other experts argue that all the three tiers of government in the country should invest more in the implementation of health policies that could reverse the trend, otherwise more Nigerian children would be lost.

They express fears that the situation pose a major challenge to the possible achievement of the Millennium Development Goals 1,2,4,5 ,which aim at significantly reducing hunger(malnutrition), infant and maternal deaths by 2015.

Ajayi-Obe, therefore, calls for a review of the referral system such that health workers could quickly refer babies who would need specialist care to the secondary health facilities where they have more experts in emergency cases.

She says, “ A situation whereby you are taking a child from one hospital to another in an emergency would not help us at all. Our referral system is faulty; we must be able to quickly assess a baby at the primary health care to know where she can get help immediately. The hospital they are going should also be prepared to take the baby. We have to be ready for emergencies,especially for children all the time.”

Also, a specialist in paediatric medicine with the Imperial College Faculty, Dr. Gareth Tudor- Williams, adds that transmission of the HIV/AIDS, hepatitis B and C virus from mothers to their children is also responsible for the high infant mortality rate.

“HIV in children is not under control in Nigeria, especially its transmission from mothers to their children. The country has a long way to go and they need help. Also, the rate of infections of Hepatitis B and C is high in children;they get this through their mothers. That is why you see young people developing liver failure because they contacted hepatitis B, a vaccine preventable disease at a young age.

“Government, doctors and caregivers must recognise that we protect children against these diseases by vaccination, early diagnosis and provision of drugs. A child that is not vaccinated is open to all diseases. Our experts should be able to, in a matter of seconds, diagnose a sick child. There are diseases that mimic fever and measles in children which, if not properly diagnosed or treated, kill a child in an hour,” Tudor-Williams adds.

Also, Ajayi- Obe argues that adoption of self-medication approach by parents and delay in seeking proper medical care for sick children are counter-productive.

“A baby is having fever for the past two days, you keep giving him analgesic and when the child is about giving up, you rush him to the clinic.Lets not forget that doctors are not magicians. The baby may need to go to the intensive care unit, which many cannot afford. Parents must never wait till the health of their children get out of hand before they come to the hospital,” she advises.

Ajayi- Obe calls for more training on new practices in child medicine for doctors, nurse and caregivers to ensure that they have the skills to quickly detect and treat children, especially those under the ages of five.

She notes, “It is time for government and our caregivers to know that medicine grows every day. We must improve the quality of training available to our young doctors and keep training experts, specialist and nurses. The quality of training available to our health workers must improve.”

http://www.punchng.com/health/help-nigeria-has-600-paediatricians-for-40million-children/

Here in ilorin, we have only about 13 consultants for over how many children in kwara state....

Some parents even bring their children from neighbouring states like niger, ondo, etc...

Nigeria i hail thee!!!!!

Shocking to say the least. So many med students graduate every year, what exactly do they specialise in? I still don't believe the stats that a child dies every minute tho.

dominique: Shocking to say the least. So many med students graduate every year, what exactly do they specialise in? I still don't believe the stats that a child dies every minute tho.

everybody wants to be a surgeon, because of the money, money mentality!!!!!

Lagusta:

everybody wants to be a surgeon, because of the money, money mentality!!!!!

I figured as much.

Wow shocking reality. It bugs M̶̲̅ε̲̣ everytime I take my kid to the clinic and I specifically ask for a paediatrician only to be told they have none and I should manage whichever doctor available. My hospital has just one consulting paed that comes once a week . Why are our med students avoiding that field? Isn't it also lucrative?

HIV in children is not under control in
Nigeria, especially its transmission from
mothers to their children. The country has
a long way to go and they need help.

Now the above statement is not being fair to healthcare practitioners in Nigeria. A lot is being done to prevent mother to child transmission. Most LGs have health centres that enlightens HIV+ mothers to be about prevention of MTC transmission. Of course more can be done, but at the moment its above average.

^^^^^^ i refer to your first post...

You see, an MBBS graduate must know some basic stuff about common illnesses and how to manage them...

If a doctor cannot treat malaria, acute diarrhea, typhoid, etc in children, that doctor is a dangerous doctor

if a doctor cannot perform some simple surgeries like appendectomy, herniorraphy and if possible a laparotomy, then he is a useless doctor...

In fact, if an ordinary doctor cant perform a caesearean section, he is doomed!!!

All these do not need specialists, its only in severe cases like cancers, "hole in the heart", and other congenital anomalies do we need the skilled hands of a specialist...

It is not about performing surgeries or treating common illnesses, it is about logistics and facilities. Doctors can not work alone without nothing. Some hospitals do not have theatre and few hospitals do not have theatre nurse, anaesthetist. What about functioning laboratories and imaging centres for postoperative monitoring. It is not good to be heroic in medicine, follow procedures to avoid iatrogenic deaths. Most medical graduates are afraid of litigation and more careful. Regarding common illnesses e.g diarhoea. Diarhoea is not simple as u think. Management of acute severe diagrhoea may include respiratory support, intensive care and monitoring by intensive care or paediatric nurse. Most private though have doctors attending to patients but how many doctors who admit critically ill child for auxilliary nurse to monitor. Cases severe malaria e.g cerebral malaria cannot be managed in centres without paediatric support.

Lagusta: ^^^^^^ i refer to your first post...

You see, an MBBS graduate must know some basic stuff about common illnesses and how to manage them...

If a doctor cannot treat malaria, acute diarrhea, typhoid, etc in children, that doctor is a dangerous doctor

if a doctor cannot perform some simple surgeries like appendectomy, herniorraphy and if possible a laparotomy, then he is a useless doctor...

In fact, if an ordinary doctor cant perform a caesearean section, he is doomed!!!

All these do not need specialists, its only in severe cases like cancers, "hole in the heart", and other congenital anomalies do we need the skilled hands of a specialist...

Laalamed: It is not about performing surgeries or treating common illnesses, it is about logistics and facilities. Doctors can not work alone without nothing. Some hospitals do not have theatre and few hospitals do not have theatre nurse, anaesthetist. What about functioning laboratories and imaging centres for postoperative monitoring. It is not good to be heroic in medicine, follow procedures to avoid iatrogenic deaths. Most medical graduates are afraid of litigation and more careful. Regarding common illnesses e.g diarhoea. Diarhoea is not simple as u think. Management of acute severe diagrhoea may include respiratory support, intensive care and monitoring by intensive care or paediatric nurse. Most private though have doctors attending to patients but how many doctors who admit critically ill child for auxilliary nurse to monitor. Cases severe malaria e.g cerebral malaria cannot be managed in centres without paediatric support.

boss, we are driving the same point...

Nigerian hospitals are not well equipped with basic facilities, doctors are not well trained, and the nigerian government is not helping matters....

I have once worked in a hospital where there is no laboratory, no oxygen cylinder and just a make-shift theatre where the doc there performs brutal operations, some without the guide of an anaesthetist....

Well, where i schooled i.e unilorin college of health sciences, we were trained to manage common illnesses holistically, with little or no resources and in the end, achieve bright results....

Concerning acute diarrhea, yes there may be need for respiratory support, etc, these are still basic, a doctor MUST know how to manage all-through, we are just lazy in this country wallahi

cerebral malaria has once been managed wholly by a house-officer, without the supervision of a registrar in UITH, well, maybe its the way we are trained here shaa

Lagusta:

boss, we are driving the same point...

Nigerian hospitals are not well equipped with basic facilities, doctors are not well trained, and the nigerian government is not helping matters....

I have once worked in a hospital where there is no laboratory, no oxygen cylinder and just a make-shift theatre where the doc there performs brutal operations, some without the guide of an anaesthetist....

Well, where i schooled i.e unilorin college of health sciences, we were trained to manage common illnesses holistically, with little or no resources and in the end, achieve bright results....

Concerning acute diarrhea, yes there may be need for respiratory support, etc, these are still basic, a doctor MUST know how to manage all-through, we are just lazy in this country wallahi

cerebral malaria has once been managed wholly by a house-officer, without the supervision of a registrar in UITH, well, maybe its the way we are trained here shaa

it is not about training. it is about facilities. do u know number of dangerous treatments quacks are performing. most mismanaged cases are refered to teaching hospital when it is too late. most of the referals are from quacks not doctors. check who guidelines on management of severe diarrhoe in rural setting u would realise most health workers just want to be heroic to the detriment of patient.a doctor has something to loose for not following procedures while quack doctors have nothing to loose expect being jail. my friend pls anything u do follow instructions. even chew or cho has guidelines to follow . nurses and clinical pharmacists have limitation of what they can do. i am waiting for time when litigation would become new order in nigeria medical practice.

you mention typhoid like that. what about typhoid perforation or typhoid septicaemaia with shock. such case need very good facilities and extra hands. what about renal failure due to malaria. malaria is broader than what u think. just be careful.

Boss you seriously dont understand what i am saying.....

Well, all good shaa

But let me just reply some comments you made;

quacks are not doctors, so they are ruled out....

Yes, we all have limitations, but we are all trained with the basic knowledge of managing common illnesses at primary level, all other advanced cases will be referred to the secondary and tertiary level where necessary.... For example, the typhoid and malaria you mentioned, would a sound doctor allow thhat typhoid to perforate or lead to endotoxic shock Wont the doctor give the appropriate dosage of the appropriate drugs... Same goes for malaria, how would i, as a doctor, manage a case of malaria and allow it to progress into quantal malarial nephropathy or cerebral malaria?

Yes, nigerian hospitals are not well equipped, but we are progressing!!! UITH is now well equipped with state of the art equipment that can manage critical cases, and i am sure of other teaching hospitals...

A PHC must have at least an oxygen concentrator, a nebulizer, an AMBU bag, and an MPPM, with all the other drugs, beds, etc... I have worked inabout three hospitals here in kwara state with even more equipment and facilities than these

and yes, i follow instructions, cos if i didnt, i wont be where i am now!!!

@Laalamed, a auack imo is one that didn't get any training for the profession he's posing as. I don't think its fair calling Nigerian doctors quacks for not having the proper facilities to manage complex cases. Sadly most of ours doctors depend on their guts and hunches when making diagnosis and prescriptions. Not that they don't know what's to be done, but they know a good number of the people can't afford most of these tests as well as extensive medical care. To be honest, a lot of our doctors are trying considering the resources at their disposal. If only our government can subsidise healthcare.

Ok we don hear

Ok

dominique: @Laalamed, a auack imo is one that didn't get any training for the profession he's posing as. I don't think its fair calling Nigerian doctors quacks for not having the proper facilities to manage complex cases. Sadly most of ours doctors depend on their guts and hunches when making diagnosis and prescriptions. Not that they don't know what's to be done, but they know a good number of the people can't afford most of these tests as well as extensive medical care. To be honest, a lot of our doctors are trying considering the resources at their disposal. If only our government can subsidise healthcare.

exactly on point my sister!!!

We are under equipped, we all agree, but do we now fold our arms and watch like sitting ducks

Thats why we usually preach preventive medicine; use long-lasting insecticide treated nets, wash hands, sanitation.... Then come to hospital early before things get out of hand....

Diarrhea becomes worse if instead of rehydrating, the mum gave the child herbal concoctions to make it worse...

Malaria becomes worse if we still give chloroquine instead of ACTs

the list is endless!!!!

Another lie by the imperialists designed to rubbish Nigeria's image.

In my village alone there are 60 Pediatricians, so what the hell are they talking about. huh

Wow dis is serious oo it needs intervention of d government,college of medicines and medical doctors to curb dis but i think d figure is being exaggerated but dat does not rule d fact dat our health care facilities sucks though d doctors are really trying their best.

ballabriggs: Another lie by the imperialists designed to rubbish Nigeria's image.

In my village alone there are 60 Pediatricians, so what the hell are they talking about. huh

excuse me!!!

Did you say 60 pediatricians in your village, as in 60 consultant fellows of either the west african or nigerian colleges of pediatrics??

Age old truth!!!! Prevention is better than cure!!!!
Even though we lack the qualified manpower to provide the needed medical services, we do not need anybody to tell us that we need to adhere to prevention as much a possible and stop the blame game!!!

you then ask what exactly is the vision of the so called minister health sector

obi123: they are all abroad

Is there anything wrong with that?

While it is true paediatrics is singled out here, it should be stated clearly that the number of qualified doctors to patients is even more alarming. When you visit a typical government owned general hospital you will understand, not even talking about a teaching hospital.
Back to the issue of few paediatricians, many doctors detest paediatrics because of their experience during med skool or house job. Even the few residents are frustrated by the so called examiners @ the colleges be it national or west africa.
So you can deduce why they are few.
#my1cent

How can you have pediatricians when they have all gone for project fame and Nigerian Idols. The rest are wih their laptops talking to magas.

The whole value system is wrong. It is not just about government. Government is not going to force people to read medicine and become pediatricians. One of the biggest lies being spread in Nigeria is that government is responsible for everything and that government is aso rock. So no one takes responsibility anymore. People talk about lack of facilities but have anyone ever realised that a lack of something is also equal to an opportunity for someone to make good business. If these private hospitals are equiped, won't they be patronised and won't they make money? At least, that is the case for schools in Lagos where the poor state of public schools have led to a boom in private schools.

There is a fundamental mindset we have as Nigerians that is wrong. Most people who made some of the greatest impact in history, did so as private citizens, not government officials. That is not to excuse governmentt but we must not forget that when we say government, someone typing on this thread right now could become an LGA chairman or a governor tomorrow.

Freiburger:
Is there anythinG wrong with that?

of course not , cant blame anyone for leaving Nigeria

[s]

thelastPope: How can you have pediatricians when they have all gone for project fame and Nigerian Idols. The rest are wih their laptops talking to magas.

The whole value system is wrong. It is not just about government. Government is not going to force people to read medicine and become pediatricians. One of the biggest lies being spread in Nigeria is that government is responsible for everything and that government is aso rock. So no one takes responsibility anymore. People talk about lack of facilities but have anyone ever realised that a lack of something is also equal to an opportunity for someone to make good business. If these private hospitals are equiped, won't they be patronised and won't they make money? At least, that is the case for schools in Lagos where the poor state of public schools have led to a boom in private schools.

There is a fundamental mindset we have as Nigerians that is wrong. Most people who made some of the greatest impact in history, did so as private citizens, not government officials. That is not to excuse governmentt but we must not forget that when we say government, someone typing on this thread right now could become an LGA chairman or a governor tomorrow.

[/s]


Nonsense and trash. Do you know how much resources the British government commits to the NHS? In terms of training Doctors and medical workers? That is a leadership that values the health of the nation. Government will not force but government will take it as a responsibility and design policies to get more and more people into the field given the high mortality rate.

Health should be a public good, it should be prioritised in development most especially in a country with a very high mortality rate, it is the responsibility of leaders to direct the nation to good health.

ballabriggs: [s][/s]


Nonsense and trash. Do you know how much resources the British government commits to the NHS? In terms of training Doctors and medical workers? That is a leadership that values the health of the nation.

Health is a public good, most especially in a country with a very high mortality rate, it is the responsibility of leaders to direct the nation to good health.

So why not talk to them at Alausa to sit up then since you are there with them. In Nigeria, primary health care is the preserve of states and LGA. So tell them to step up and perform since you think you know what is right.

Lagusta:

excuse me!!!

Did you say 60 pediatricians in your village, as in 60 consultant fellows of either the west african or nigerian colleges of pediatrics??

The joke is on you.

This is alarming