Where Nige­ria’s women die the most

Weekly Trust - - Front Page - Judd-Leonard Okafor

Ato­tal 971 women died from preg­nan­cyre­lated causes in hospi­tals be­tween July and Sep­tem­ber this year, ac­cord­ing to rou­tine data on the na­tional health man­age­ment in­for­ma­tion sys­tem.

The data also shows a to­tal 8,085 chil­dren died within the same three-month pe­riod.

The women died in 35 states com­bined, in a to­tal 320 health fa­cil­i­ties across 228 lo­cal gov­ern­ment ar­eas.

The data is col­lected rou­tinely by lo­cal gov­ern­ment health of­fi­cers and up­loaded to a na­tional data­base man­aged by the fed­eral health min­istry.

The child deaths were re­ported from 37 states, span­ning 483 lo­cal gov­ern­ment ar­eas and 1,311 health fa­cil­i­ties.

The Na­tional Health Act calls for a health man­age­ment in­for­ma­tion sys­tem. It calls for lo­cal health of­fi­cers to rou­tinely sub­mit data to the data­base from across fa­cil­i­ties.

Nige­ria uses a plat­form called DHIS2, con­sid­ered the world’s largest. A to­tal 67 low and mid­dlein­come use the plat­form to track health in­dices cov­er­ing close to 2.3 bil­lion peo­ple.

Dig­ging into DHIS2

It was de­ployed to help the health sec­tor man­age and an­a­lyse data on cus­tom dash­boards to mon­i­tor and eval­u­ate health pro­grammes. It dou­ble as a reg­istry of fa­cil­i­ties and maps where ser­vices are avail­able, ac­cord­ing to its mak­ers.

It also helps man­age lo­gis­tics and mo­bile track­ing of preg­nant moth­ers in ru­ral com­mu­ni­ties.

Nige­ria’s DHIS2 plat­form holds nearly 300 data sets, to be an­a­lysed for any­thing from malaria test­ing to HIV coun­selling. The na­ture of the DHIS2 al­lows an­a­lysts to drill through na­tional data and fil­ter down to in­di­vid­ual state, lo­cal gov­ern­ment area and right down to sin­gle fa­cil­i­ties.

Be­tween July and Sep­tem­ber, it shows 971 women and 8,085 chil­dren died. The deaths are only those re­ported by health fa­cil­i­ties.

The in­fer­ence is that many more deaths go un­re­ported; not talked about due to be­liefs or just un­doc­u­mented.

States where women are dy­ing most

Nearly 74% of all 971 deaths among women in the pe­riod was in only 10 states.

Katsina is first among states with the high­est deaths re­ported. A to­tal 191 women died from preg­nancy-re­lated causes in Katsina.

Ji­gawa is next, with 113 women dead in the pe­riod. Kebbi, Kano, Bauchi and Adamawa up to Gombe and Zam­fara ac­count for the most deaths of woman. The group of states also cu­ri­ously in­cludes La­gos, high­est among south­ern states, with 41 women dead within the pe­riod.

Seven con­di­tions were re­spon­si­ble for the deaths. A to­tal 529 women died from pre-eclamp­sia, a preg­nancy com­pli­ca­tion that comes with high blood pres­sure and causes dam­age most of­ten the liver and kid­neys. The next cause of death recorded for 437 women was malaria. In­fec­tion ac­counted for 101 deaths in preg­nant women, far more than 65 deaths linked to ob­structed labour.

See the chil­dren dy­ing

And 8,085 chil­dren aged un­der five also died in the pe­riod-64 in ev­ery 100 of the deaths were in 10 states.

A to­tal 1.018 of the chil­dren were in Katsina. La­gos had the fourth high­est num­ber, with 519 chil­dren dy­ing in La­gos. More chil­dren died in La­gos in three months than in Yobe or Adamawa, parts of which face in­sur­gen­cyre­lated prob­lems.

A to­tal 5,712 of the chil­dren died from malaria, top among four ma­jor con­di­tions re­spon­si­ble for child deaths within the pe­riod. It sur­passed the to­tal num­ber of chil­dren who died from di­ar­rhoea, mal­nu­tri­tion and pneu­mo­nia com­bined.

Level of death, pri­mary sec­ondary ter­tiary

An­a­lysts at the Ini­tia­tive for Health Ac­count­abil­ity and Trans­parency got in­ter­ested in the DHIS2 data and be­gan drilling deeper to find out the fa­cil­i­ties where women and chil­dren died the most.

Nearly 56% of all the deaths were in 40 health fa­cil­i­ties: 15% of them were pri­mary health cen­tres, 55% of them sec­ondary health cen­tres. Three out of ev­ery 100 deaths were in ter­tiary health cen­tres.

Dr Mo­hammed Ab­dul­lahi, pub­lic health ex­pert at IHAT, says the find­ing was “dis­turb­ing” and sig­nals a weak­ness in hos­pi­tal re­fer­rals.

“We have a three tier sys­tem­pri­mary, sec­ondary and ter­tiaryand they are sup­posed to be ef­fec­tively linked. Un­for­tu­nately you see a lot of deaths at pri­mary care level, es­pe­cially of women and chil­dren. You don’t ex­pect that, be­cause the ex­pec­ta­tion is that se­ri­ous cases are sup­posed to be re­ferred to the next level.

“That is not hap­pen­ing. The pri­mary health cen­tres are be­com­ing spe­cial­ist cen­tres to han­dle very so­phis­ti­cated cases.”

IHAT has started a pe­ri­odic news­let­ter that mines data from the DHIS2 and com­piles vi­su­al­iza­tions to con­nect the pub­lic to health sit­u­a­tion based on rou­tine data.

The wide use of the data com­ing out of DHIS2 is lim­ited by how dili­gently health of­fi­cials feed their data into the data­base, a pub­lic health ex­pert in Zam­fara told Daily Trust.

De­spite the lim­i­ta­tion, what is re­ported is sig­nif­i­cant, an­a­lysts say.

But the dash­board shows a re­al­ity that is com­ing close to what sur­veys sug­gest.

“Sur­veys are based on sam­ple pop­u­la­tion, and they make in­fer­ence to what hap­pens in larger pop­u­la­tions,” says Ab­dul­lahi.

“What we have is not a sur­vey. It is what is ac­tu­ally hap­pen­ing in the pop­u­la­tion.

“When they tell you close to 1,000 women have died in a quar­ter, and you and I know there may have been un­der­re­port­ing, then there is need for us to look at these num­bers.”

PHC in Ruwan Gizo, Zam­fara un­der­goes re­pairs

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