**Reducing Early Neonatal Mortality in Nigeria—The Solution Solution**

**Reducing Early Neonatal Mortality in Nigeria—The** 

DOI: 10.5772/intechopen.69221

Hippolite O. Amadi and Mohammed B. Kawuwa

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

Hippolite O. Amadi and Mohammed B.

http://dx.doi.org/10.5772/intechopen.69221

#### **Abstract**

Kawuwa

The West African nation of Nigeria seems to have run out of ideas on how their neonatal mortality rate may be lowered. This situation has become dare as the country could not make any significant progress even with the great supports of the last 10 years of Millennium Development Goal. Presently, one in every two deceased child under 5 years of age in Nigeria is a neonate. Literature reveals that most of these deceased neonates are classified preterm or low birthweight, of which nearly four in five must die within first 7 days. This clearly identified the categories and stages of highest mortality; however, it is disappointing that the authorities of the Nigerian health care system have for too long been unable to devise a solution for the neonates. Probably, inadequacy of climatic and cultural compatibilities might partly be responsible for the failure of their current conventional ideas and technologies—these being predominantly imported. Yet, there seems to be lack of interest in some home-grown unconventional ideas that have achieved the needed reduction at few centers. In this chapter, we present the unconventional approaches and encourage across-the-nation translation of the applications to achieve accelerated end to this situation.

**Keywords:** neonate, Nigeria, neonatal mortality, innovative technique, thermal distress

#### **1. Introduction**

Neonatology in the West African sub region, especially in Nigeria, will remain in a state of "scientific comma" until a decisive solution is found to reverse her high neonatal mortality that has continued to be the highest in the world. The solutions required might not necessarily be conventional, as practiced in developed countries of the world, since such imported

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scientific methods and systems have failed to completely eliminate or drastically reduce the mortality rates. These certified foreign solutions have been probably rendered ineffective within the Nigerian practice due to complications of poor infrastructure, climate, and above all poor work ethics and cultural inadequacies. The effective solution might not necessarily be the "state-of-the-art" procedures that are applied in the United States of America, United Kingdom, and Europe as Nigerian practitioners continue their endless importation of all kinds of relevant and irrelevant ideas but without the necessary infrastructural base to effectively operate these. This country requires a new breed of scientists and neonatologists that can believe in themselves, look inwards, and apply research methods to develop culturally compatible neonatal solutions using easy-to-acquire and locally available materials.

**2. Many are dying**

dle-belt [3]

In 2016, an estimated average of 248 neonates out of 1000 presenting at special care baby units (SCBUs) in Nigeria died. Most of these babies reportedly died of various causes during their first 1 week of life. These data were extracted from a collection of independent outcome publications during the 47th national conference of Paediatrics Association of Nigeria (PANCONF) in January 2016. It is a common practice in Nigeria that SCBUs try to use this annual conference to showcase their discoveries, best practices, and outcomes. Therefore, data that were presented could be taken to be what they considered the most impressive or the best of what the centers were prepared to let others know about. The beauty of the content of the proceeding of the PANCONF 2016 on this subject was that the seven coincidental reports came from

Reducing Early Neonatal Mortality in Nigeria—The Solution

http://dx.doi.org/10.5772/intechopen.69221

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(2) University of Abuja Teaching Hospital (UATH) Gwagwalada in the North-central/mid-

It is worthy of note that six of these independent outcomes came from data sets that were generated based on the conventional techniques of newborn care in Nigeria. This resulted in a national mortality average of 248/1000 [2–6, 8]. However, two of these independent centers presented outcome data that had been influenced by their adoption and practice of the various unconventional methods that were developed through the collaborative research of Neonatal Concerns for Africa [9]. In-between these two institutions, the average neonatal mortality crashed below 34/1000 [3, 7]. This translates to a national average reduction of

Previous publications on conventional practices within the last 10 years have reported facility-based averages such as 254/1000 and 250/1000 [9, 10]. These figures are quite similar to the present 248/1000; hence, this raises the question of why the custodians of neonatal health in Nigeria have been unable to articulate decisive solutions for such a national emergency situation. The scientists seem far too busy with other things than to own the blame, put on their thinking caps, and synthesize an affordable and sustainable home-grown solution to save their neonates. Instead, the over-dependence on unsustainable importation of foreign technologies and ideas have left the Nigerian health care professionals so scientifically lazy that the neonates are still far away from their hope for survival. It was expected that the high publicity and available funds during the last 10 years of the millennium development goals

(3) Lagos State University Teaching Hospital (LASUTH) Ikeja in the South-west [4]

(5) University of Port Harcourt Teaching Hospital (UPTH) in the South-south [6]

(4) Stella Obasanjo Specialist Hospital (SOSH) Benin-city in the Mid-west [5]

centers spread equally across the entire country. This includes:

(6) Federal Medical Centre (FMC) Owerri in the South-east [7] (7) Federal Medical Centre (FMC) Asaba in the South-south [8]

facility-based mortality by a whopping 86%.

(1) Yariman Bakura Specialist Hospital (YBSH) Gusau in the North-west [2]

The Nigeria neonatal record is among the worst in the world. There is no evidence to suggest that more neonates are surviving in Nigeria today as compared to 10 years ago, even with the very celebrated millennium development goal (MDG) campaign. Presently, neonatal contribution to mortality rate below 5 years of age in Nigeria has risen in the last 10 years from 40 to nearly 50% despite the huge expenditure of MDG in Nigeria on importation of ideas and systems [1]. The big questions before anyone who might attempt to solve the high neonatal mortality in Nigeria are:


In this chapter, our research group of a team of young Nigerian neonatologists and technologists will discuss our vast experiences and progressive syntheses of ingenious local-content ideas that have drastically reduced the neonatal mortality rate at pockets of neonatal centers across Nigeria; thus, achieving an average facility-based mortality rate of 33/1000 presenting neonates as compared to the national average of 248/1000. We shall discuss the various applications that have restored hope to neonates within our practice—including the handyapproach and initial-setpoint-algorithm (ISA) techniques—and how all the applications have contributed to achieve nearly 100% facility-based survival of premature and low birthweight neonates (including 600-g birthweight) within their first 7 days of life.
