Unveiling Northern Communities With Zero Maternal/Infant Mortality
By
By
Damilola Oyedele
28 Sep 2013
With just about two per cent of global population, Nigeria contributes 10 per cent of the world’s maternal and infant mortality. The North has the highest rate with Katsina State having one of the highest due to its top ranking in the area of teenage pregnancies. But there are communities in the state that are now marking two years of zero maternal and infant mortality. Damilola Oyedele recently toured several remote villages in Katsina where DFID/Norway Government intervention is making a huge difference in the lives of mothers, especially teenage mothers.
Angwar Agage is about two hours drive from Katsina’s capital city into its hinterland. Without electricity or even the most basic form of sophistication, it is home to about 6000 people with over 3000 families. Ikilima Abubakar delivered her fourth child 12 days ago at a health facility in the next village Tandama, which is less than a kilometre away. Unlike her previous three pregnancies, the 20 year old mother attended Ante Natal Classes (ANC).
“This delivery was different from my previous ones where I delivered the children at home. At the facility, the matron assisted me, encouraged me and gave me and my baby treatments. I had benefitted from the PRRINN safe pregnancy plan discussions so I quickly recognised the labour signs and walked to the facility immediately I started feeling the pains,” she told this reporter in Hausa language.
Partnership for Reviving Routine Immunisation in Northern Nigeria, Maternal, Newborn and Child Health Initiative (PRRINN-MNCH) started as PRINN in 2007 in Jigawa, Katsina, Yobe and Zamfara States solely funded by the Department for International Development (DFID) of the United Kingdom to boost routine immunisation of children in the states. Due to the successes recorded, the Norwegian government came on board and added the maternal health component.
Ikilima’s friend and age mate, Jamila Bala, is a mother of six children, who under the tutelage of PRRINN – MNCH has learnt how to take better care of her children and household. She told THISDAY that her children now hardly fall ill as she feeds them with the proper nutrition and takes them for routine immunisation.
Angwar Agage recently celebrated two years without a single maternal or infant death.
These women, who can be classified as teenage mothers have benefitted from the intervention of the PRRINN project. The project works to educate young women especially teenage mothers to recognise signs of danger in pregnancy to avoid complications during and after childbirth. This, it achieves by setting up a Young Women Support Group (YWSG) where under the guidance of a Local Engagement Consultant (LEC), the members hold weekly meetings to discuss their pregnancies, motherhood, nutrition, hygiene and issues that affect them in their communities. Mentors are also selected from among the young women.
Zainab Kabir, 26, while attending one of these meetings in Tandama had realised that the ailment she was secretly battling with were actually the signs of a Sexually Transmitted Infection (STI). She had foul discharges from her private part which continued for a long time as the local herbs she was self medicating with did not seem to work. She had no idea what the ailment was and she resigned herself to fate especially after her husband from her eight year old marriage decided he would marry another wife.
After the meeting, she quietly beckoned to the LEC and explained the symptoms she was experiencing. The LEC and the mentor from the group arranged for her to be taken to a health facility where she received treatment. Her husband, Kabir was also invited and he also underwent the course of treatment. Kabir cancelled the impending marriage to a new wife after he saw his wife was cured. Zainab credits the project with saving her marriage; she is now a mentor in one of the four YWSG in her community.
The successes of the YWSG can actually be attributed to the collaboration of the men in these conservative communities where the permission of the husband is sought even before a woman can be taken to a health facility.
The men are trained by PRINN-MNCH on how to recognise signs of anaemia in their pregnant wives. Working with the lead Community Volunteers in their communities, they are taught how to carry pregnant women in times of emergency to a health facility. In the communities where there is easier access to tricycles, they are taught how to transport pregnant women. The men in these community are also blood donors and after a random sampling, THISDAY confirmed that almost every man in these communities knew what his blood group is; they are always ready to donate blood when there tis need for it.
THISDAY gathered that when a pregnant woman is being taken to a health facility, between four to six men follow her, and proudly present themselves as her blood donors. Working with cultural and religious leaders due to the sensibilities of the people, PRINN-MNCH has worked to erase suspicions associated with donating blood.
Gizawa Community, under Dutsanma Local Government is also about to roll out the drums to mark two years without a single maternal or infant death. A lead community volunteer, Mallam Ibrahim Nuhu told THISDAY that there has rarely been the need to donate blood to any woman in recent times because the signs of anaemia are recognizable to the men and the women.
“We know that we should take a pregnant woman to the hospital immediately we see signs of anaemia. We know what foods to encourage her to eat to increase her blood ahead of delivery. So, even though we all know our blood group and are present at the hospital when our women are giving birth, we have not had the need to donate blood in a long time”, he said.
In the community, THISDAY encountered Sahura, 15, and her husband Abubakar Kala, 25, who both used to work as labourers. Married for three years with two children, the couple said Sahura’s participation in the YWSG, where the members also contribute money to help one another, has changed their lives.
She was given a loan of N2000 by the group and bought a local noodles making machine. She generated N4500 from the business, repaid her loan and after a while gave her husband N2000 to hawk cheap jewellery from a portable show glass. She later sold the noodles machine and bought a second hand sewing machine.
“Sahura now patches clothes for people; she would soon go and learn how to sew from the scratch. I no longer have to work as a labourer. Her participation in PRRINN has changed us; she takes better care of the children and the house now. After seeing what she benefitted, I joined the community volunteers group of the men where we are blood donors and participate in emergency transport of pregnant women in the community. PRRINN has brought us closer and we have peace in my family,” Abubakar proudly told THISDAY.
Most children in the community are participating in both Islamic and Western education, THISDAY gathered.
The project also works with the National Union of Road Transport Workers (NURTW) to provide Emergency Transport Services (ETS) for the pregnant women in labour. The Secretary General of the union in Funtua Bus Park, Mallam Masaudu Naira told THISDAY that the bus drivers when called upon by any community to render this special service only charge for the cost of petrol without intent for profit. Masaudu is also a facilitator for the ETS training.
PRRINN MNCH does not pay any stipends or incentives to their volunteers in the community. The project got the people involved through education, enlightenment and advocacy using the traditional and religious leaders in the communities. The Community Health Extension Workers (CHEW) who preside over the young women’s groups are junior level health workers and they are paid by the local governments. The Lower Level Facilitators (LLF), who are educated have their salaries paid by PRRINN. They reside in the communities or very close to the communities to allow easy access by the teenage mothers. They can also treat minor ailments, cuts, colds, check foetus positions in pregnancy, and refer to health facilities. They also follow up to ensure that the mothers comply with treatment procedures and medication dosages.
In Ruwan Godiya community, PRINN MNCH hcommunity has complemented the efforts of the community who strove to develop their local health care system. The community built a facility and bought an ambulance for transportation of their sick to more equipped facilities in Funtua.
The Chairman of the Facility Health Committee, Alhaji Lawal Garba, disclosed that the staff members in the facility were trained by PRRINN MNCH who also provided the solar panels to power the facility, solar freezers for storage of immunisation drugs, and equipment in the maternity ward and labour room.
The community, like the others, is set to mark two years without a single maternal or infant health related death. It has a population of about 12000 people.
The lab attendant, although he could barely speak English, proudly showed this reporter his equipment used to ascertain blood groups, and screen for HIV and hepatitis before clearing donated blood for transfusion.
The District Head of Maska, Alhaji Abdullahi Magaji Maska, in an interview said many groups have brought interventions to the community, the impact of PRRINN MNCH has however been felt the most.
He disclosed that he, with other traditional rulers, has been actively involved in sensitizing the people on the need for routine immunisation and ensuring that the women deliver in health facilities and not at home as used to be the practice.
“People used to complain that there were no drugs at the old facilities. But now things are different; we let them know that PRINN facilities are different because since they provide drugs at subsidized rates, they are not looking to make profit. The records of all patients are available at the facilities and you can verify that we have reduced maternal and infant death drastically,” he said.
“Of course, some people are stubborn and I have to threaten them before they allow their wives go for treatment,” he admitted.
When asked whether he receives any form of incentive from PRRINN for being a part of the project, he responded “What more incentive do I need other than our people not dying in childbirth like we used to experience?”
The State Team Manager of PRRINN MCNH, Katsina, Dr. Usman Musa Matazu, said it was easy to replicate the PRRINN model in all communities in Nigeria and drastically reduce the rate of infant and maternal mortality in the country.
He described as a ‘major feat’ for any community in sub-Saharan Africa to be able to celebrate two years without a single maternal and infant mortality with just the most basic facilities.
“We do not give money to anyone, because if we adopt that method, the people would stop doing whatever they were instructed to do once the money stops. Once the people are convinced and adequately sensitized, they are able to take care of themselves; some people in these communities used to think a pregnant woman having swollen legs is a good sign,” he said.
Matazu added that simple interventions are more successful than hyped programmes where the beneficiaries are directly involved in the processes.
Nigeria, at just two per cent of the world’s almost seven billion people, contributes 10 per cent of the world’s maternal and infant mortality rates; Nigeria’s Adolescent Birth Rate Stands at 121 per 1000 live births. Katsina state has one of the highest rates of maternal and infant deaths due to its top ranking in the rate of teenage pregnancies. According to the 2008 Nigeria Demographic and Health Survey (NDHS), the state has the highest rate of teenage pregnancies with 65 per cent.
While the governments at all levels continue to work to reduce the rate of maternal and infant mortality, simple models used by PRRINN through adequate community engagement would assist in taking the country off the high point of the global mortality index.
http://www.thisdaylive.com/
With just about two per cent of global population, Nigeria contributes 10 per cent of the world’s maternal and infant mortality. The North has the highest rate with Katsina State having one of the highest due to its top ranking in the area of teenage pregnancies. But there are communities in the state that are now marking two years of zero maternal and infant mortality. Damilola Oyedele recently toured several remote villages in Katsina where DFID/Norway Government intervention is making a huge difference in the lives of mothers, especially teenage mothers.
Angwar Agage is about two hours drive from Katsina’s capital city into its hinterland. Without electricity or even the most basic form of sophistication, it is home to about 6000 people with over 3000 families. Ikilima Abubakar delivered her fourth child 12 days ago at a health facility in the next village Tandama, which is less than a kilometre away. Unlike her previous three pregnancies, the 20 year old mother attended Ante Natal Classes (ANC).
“This delivery was different from my previous ones where I delivered the children at home. At the facility, the matron assisted me, encouraged me and gave me and my baby treatments. I had benefitted from the PRRINN safe pregnancy plan discussions so I quickly recognised the labour signs and walked to the facility immediately I started feeling the pains,” she told this reporter in Hausa language.
Partnership for Reviving Routine Immunisation in Northern Nigeria, Maternal, Newborn and Child Health Initiative (PRRINN-MNCH) started as PRINN in 2007 in Jigawa, Katsina, Yobe and Zamfara States solely funded by the Department for International Development (DFID) of the United Kingdom to boost routine immunisation of children in the states. Due to the successes recorded, the Norwegian government came on board and added the maternal health component.
Ikilima’s friend and age mate, Jamila Bala, is a mother of six children, who under the tutelage of PRRINN – MNCH has learnt how to take better care of her children and household. She told THISDAY that her children now hardly fall ill as she feeds them with the proper nutrition and takes them for routine immunisation.
Angwar Agage recently celebrated two years without a single maternal or infant death.
These women, who can be classified as teenage mothers have benefitted from the intervention of the PRRINN project. The project works to educate young women especially teenage mothers to recognise signs of danger in pregnancy to avoid complications during and after childbirth. This, it achieves by setting up a Young Women Support Group (YWSG) where under the guidance of a Local Engagement Consultant (LEC), the members hold weekly meetings to discuss their pregnancies, motherhood, nutrition, hygiene and issues that affect them in their communities. Mentors are also selected from among the young women.
Zainab Kabir, 26, while attending one of these meetings in Tandama had realised that the ailment she was secretly battling with were actually the signs of a Sexually Transmitted Infection (STI). She had foul discharges from her private part which continued for a long time as the local herbs she was self medicating with did not seem to work. She had no idea what the ailment was and she resigned herself to fate especially after her husband from her eight year old marriage decided he would marry another wife.
After the meeting, she quietly beckoned to the LEC and explained the symptoms she was experiencing. The LEC and the mentor from the group arranged for her to be taken to a health facility where she received treatment. Her husband, Kabir was also invited and he also underwent the course of treatment. Kabir cancelled the impending marriage to a new wife after he saw his wife was cured. Zainab credits the project with saving her marriage; she is now a mentor in one of the four YWSG in her community.
The successes of the YWSG can actually be attributed to the collaboration of the men in these conservative communities where the permission of the husband is sought even before a woman can be taken to a health facility.
The men are trained by PRINN-MNCH on how to recognise signs of anaemia in their pregnant wives. Working with the lead Community Volunteers in their communities, they are taught how to carry pregnant women in times of emergency to a health facility. In the communities where there is easier access to tricycles, they are taught how to transport pregnant women. The men in these community are also blood donors and after a random sampling, THISDAY confirmed that almost every man in these communities knew what his blood group is; they are always ready to donate blood when there tis need for it.
THISDAY gathered that when a pregnant woman is being taken to a health facility, between four to six men follow her, and proudly present themselves as her blood donors. Working with cultural and religious leaders due to the sensibilities of the people, PRINN-MNCH has worked to erase suspicions associated with donating blood.
Gizawa Community, under Dutsanma Local Government is also about to roll out the drums to mark two years without a single maternal or infant death. A lead community volunteer, Mallam Ibrahim Nuhu told THISDAY that there has rarely been the need to donate blood to any woman in recent times because the signs of anaemia are recognizable to the men and the women.
“We know that we should take a pregnant woman to the hospital immediately we see signs of anaemia. We know what foods to encourage her to eat to increase her blood ahead of delivery. So, even though we all know our blood group and are present at the hospital when our women are giving birth, we have not had the need to donate blood in a long time”, he said.
In the community, THISDAY encountered Sahura, 15, and her husband Abubakar Kala, 25, who both used to work as labourers. Married for three years with two children, the couple said Sahura’s participation in the YWSG, where the members also contribute money to help one another, has changed their lives.
She was given a loan of N2000 by the group and bought a local noodles making machine. She generated N4500 from the business, repaid her loan and after a while gave her husband N2000 to hawk cheap jewellery from a portable show glass. She later sold the noodles machine and bought a second hand sewing machine.
“Sahura now patches clothes for people; she would soon go and learn how to sew from the scratch. I no longer have to work as a labourer. Her participation in PRRINN has changed us; she takes better care of the children and the house now. After seeing what she benefitted, I joined the community volunteers group of the men where we are blood donors and participate in emergency transport of pregnant women in the community. PRRINN has brought us closer and we have peace in my family,” Abubakar proudly told THISDAY.
Most children in the community are participating in both Islamic and Western education, THISDAY gathered.
The project also works with the National Union of Road Transport Workers (NURTW) to provide Emergency Transport Services (ETS) for the pregnant women in labour. The Secretary General of the union in Funtua Bus Park, Mallam Masaudu Naira told THISDAY that the bus drivers when called upon by any community to render this special service only charge for the cost of petrol without intent for profit. Masaudu is also a facilitator for the ETS training.
PRRINN MNCH does not pay any stipends or incentives to their volunteers in the community. The project got the people involved through education, enlightenment and advocacy using the traditional and religious leaders in the communities. The Community Health Extension Workers (CHEW) who preside over the young women’s groups are junior level health workers and they are paid by the local governments. The Lower Level Facilitators (LLF), who are educated have their salaries paid by PRRINN. They reside in the communities or very close to the communities to allow easy access by the teenage mothers. They can also treat minor ailments, cuts, colds, check foetus positions in pregnancy, and refer to health facilities. They also follow up to ensure that the mothers comply with treatment procedures and medication dosages.
In Ruwan Godiya community, PRINN MNCH hcommunity has complemented the efforts of the community who strove to develop their local health care system. The community built a facility and bought an ambulance for transportation of their sick to more equipped facilities in Funtua.
The Chairman of the Facility Health Committee, Alhaji Lawal Garba, disclosed that the staff members in the facility were trained by PRRINN MNCH who also provided the solar panels to power the facility, solar freezers for storage of immunisation drugs, and equipment in the maternity ward and labour room.
The community, like the others, is set to mark two years without a single maternal or infant health related death. It has a population of about 12000 people.
The lab attendant, although he could barely speak English, proudly showed this reporter his equipment used to ascertain blood groups, and screen for HIV and hepatitis before clearing donated blood for transfusion.
The District Head of Maska, Alhaji Abdullahi Magaji Maska, in an interview said many groups have brought interventions to the community, the impact of PRRINN MNCH has however been felt the most.
He disclosed that he, with other traditional rulers, has been actively involved in sensitizing the people on the need for routine immunisation and ensuring that the women deliver in health facilities and not at home as used to be the practice.
“People used to complain that there were no drugs at the old facilities. But now things are different; we let them know that PRINN facilities are different because since they provide drugs at subsidized rates, they are not looking to make profit. The records of all patients are available at the facilities and you can verify that we have reduced maternal and infant death drastically,” he said.
“Of course, some people are stubborn and I have to threaten them before they allow their wives go for treatment,” he admitted.
When asked whether he receives any form of incentive from PRRINN for being a part of the project, he responded “What more incentive do I need other than our people not dying in childbirth like we used to experience?”
The State Team Manager of PRRINN MCNH, Katsina, Dr. Usman Musa Matazu, said it was easy to replicate the PRRINN model in all communities in Nigeria and drastically reduce the rate of infant and maternal mortality in the country.
He described as a ‘major feat’ for any community in sub-Saharan Africa to be able to celebrate two years without a single maternal and infant mortality with just the most basic facilities.
“We do not give money to anyone, because if we adopt that method, the people would stop doing whatever they were instructed to do once the money stops. Once the people are convinced and adequately sensitized, they are able to take care of themselves; some people in these communities used to think a pregnant woman having swollen legs is a good sign,” he said.
Matazu added that simple interventions are more successful than hyped programmes where the beneficiaries are directly involved in the processes.
Nigeria, at just two per cent of the world’s almost seven billion people, contributes 10 per cent of the world’s maternal and infant mortality rates; Nigeria’s Adolescent Birth Rate Stands at 121 per 1000 live births. Katsina state has one of the highest rates of maternal and infant deaths due to its top ranking in the rate of teenage pregnancies. According to the 2008 Nigeria Demographic and Health Survey (NDHS), the state has the highest rate of teenage pregnancies with 65 per cent.
While the governments at all levels continue to work to reduce the rate of maternal and infant mortality, simple models used by PRRINN through adequate community engagement would assist in taking the country off the high point of the global mortality index.
http://www.thisdaylive.com/
