**2. Many are dying**

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.

mortality in Nigeria are:

222 Selected Topics in Neonatal Care

survival in Nigeria?

could this one factor be?

ing equally?

country?

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

**1.** What is *really* the primary factor(s) behind the failure to achieve improved overall neonatal

**2.** Up to 18 morbidity factors contribute to neonatal deaths in Nigeria but are these contribut-

**3.** Is it needful to save time and resources from some factors and dedicate these to synthesize absolute solutions just for one factor or few that could bring about huge impact, and what

**4.** Are there any cluster point(s) of highest mortality that might require in-depth investiga-

**5.** How may any locally grown "appropriate technological" solution be integrated into Nigeria's health care system; how may this be applicable both at the tertiary and primary health care levels and be made available to the hardest-to-reach neonates across the hinterlands of the

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

tion within the spectrum of neonatal life-span of 28 days from birth?

neonates (including 600-g birthweight) within their first 7 days of life.

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 centers spread equally across the entire country. This includes:


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 facility-based mortality by a whopping 86%.

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 (MDG) would have empowered a great success. Since this was an unfortunate failure for the neonatal sector at the national level, Nigeria could restore hopes by a humble study of what constituted the pockets of successes recorded by some few centers that adopted unconventional techniques.

This showed that most deceased neonates died before their 7th postnatal day, beyond which most surviving neonates would successfully go home alive. We hypothesize that after the first quarter of neonatal life, i.e., 7 of 28 days, most Nigerian neonates are strong enough to contribute their minimal quotas in resisting and fighting their various debilitating morbidities, howbeit, within a conducive and stable physiological state. The first few days after birth are their greatest period of need for external life support systems and procedures. Inadequate support and procedures during this period would normally be associated with such high rate of death as reported in Nigeria. The most vulnerable of the neonates is the premature ones who may necessarily require knowledgeable support for survival. Nigerian authors have shown that mortality for very preterm and extremely low birthweight neonates at some hospital centers can be quite high, even as high as 933/1000 [17–20]. It is our opinion that the current Nigerian conventional facility-based practices during early neonatal life is inadequate or fundamentally faulty. Our resonating questions remain: Has Nigeria got any other ideas for preventing such high rate of early neonatal deaths that has not yet been tried since the last 10 years as these are urgently needed? Is it time for the FMoH and the establishments to come out openly to accept the failure? Is it time to have compassion on the neonates and search for other sustainable, and perhaps, unconventional methods as have been demonstrated in few

Reducing Early Neonatal Mortality in Nigeria—The Solution

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

225

It is always attractive to import latest technologies for application in Nigeria. However, poor infrastructural development makes such applications unsustainable. Modern medical equipment is quite expensive and unaffordable to many medical institutions that must look after the neonates. However, the procurement of these systems is not necessarily the main problem. Sadly, the age long pattern at these mostly government-owned referral centers is such that after many years of impoverished neonatal outcomes and political harassments, the government manages to provide appropriate funds to purchase only few of the required equipment. However, no sooner this is done, the center goes back into comatose due to inability to maintain the systems. The efficiency of a system or procedure can often depend on factors relating to infrastructural base, climate, peoples' culture, work attitude, manpower, maintenance supply chain, etc. It is essential that these factors are carefully considered, or else a wholesale adoption of a foreign idea may not yield same result as expected. Nigeria's 100% reliance on importation of needed technologies and ideas are unsustainable due to these fac-

tors. The best options forward are either adaptation or synthesis of own solutions.

Most of Nigeria's neonatal systems, techniques, and procedures are imported from the United Kingdom, Europe, or America where these are well-proven to be very effective, reliable, and sustainable. Unfortunately, similar outcomes would depend on the abilities of the importing

pockets of Nigerian centers? The time cannot be any sooner than now.

**4. Wholesale importation is unsustainable**

**5. Adaption requires scientific thinking**
