Reducing high mortality in Bauchi State via Hard To Reach programme

Factual Pursuit of Truth for Progress
By Huseyn Mbar, News Agency of Nigeria (NAN)
Iya Abdullahi,35, mother of eight, of Jabbal Settlement in Bindir Ward of Katagum Local Government Area of Bauchi State was desirous to have more children.
The desire to have more children was to enable her benefit maximally from the Islamic inheritance tradition that provides that larger share should be given to the woman with the highest number of children.
This is even more compelling if the woman has more male children.
Iya could not realise her dream of getting the ninth child, as she died after prolonged labour. Before she died, she delivered, but the baby also died because of poor medical care.
The nearest health facility to the settlement is the Azare Federal Medical Centre, about 10kilometres away.
The story of people like Iya is common in the settlement, an area available statistics showed that over 1.5 per cent of pregnant women die from pregnancy-related complications.
World Health Organisation(WHO), data showed that the maternal mortality rate in Bauchi State is far above the national average of 800 per 100,000 births.
It showed that the figure almost tripled the 300 deaths per 100,000 births in the entire South-West states.
For under five, WHO’s figure was not cheering, as it put mortality rate at 596 per 100,000 births.
This “clearly indicates that the state parades one of the highest maternal mortality rates in the world.’’
However, the European Union and UNICEF are intervening to redress the trend through the Hard To Reach (HTR) Project.
The EU/UNICEF Team Leader in charge of HTR in Katagum Local Government Area, Mrs Adebisi Ibinola, said that the maternal mortality rate in the state called for concern.
Of the 63 per cent of women who received antenatal care from health professionals in the state, she said, only about 17 per cent had their babies with help from trained professionals.
Ibinola, who is also a retired nurse and midwife, believed that the high teenage pregnancy and unsafe abortions compounded the ugly trend.
She also blamed the state’s high maternal mortality rate on the low socio-economic status of women.
This, she argued, had denied women access to modern reproductive health services due to the high cost of health services.
Another reason, she said was distance to health facilities, “bad roads and poor attitude of health providers to pregnant women are also contributing factors,” Ibinola said.
Other factors, she said, included socio-cultural barriers that prohibit women from accessing reproductive health information and services. The tradition that a woman must first seek permission from her husband before leaving home for the hospital was also identified as a problem.
Ibinola said that even under emergency situations, a woman must not leave home for the hospital without the permission of her spouse.
Hajiya Amina Abdu, Team Leader of HTR in Misau Local Government Area, corroborated what Ibinola said.
She also attributed the negative trend to the activities of untrained birth attendants.
Abdu cited other factors to include harmful traditional practices, poverty, ignorance and malnutrition among women of reproductive age.
According to her, some women die due to excessive bleeding caused by pregnancy-related complications. She said that the dearth of qualified reproductive health experts and the absence of modern health facilities were part of the problem.
UNICEF-Nigeria, got 54million Euros funding from the European Union in 2017, to support the implementation of health care services in three Northern states.
The project is titled: “Strengthening Primary Health Care and Community Resilience for Improved Maternal, New-born, Child Health and Nutrition (MNCHN).”
The goal according to the Communication Officer of UNICEF, Bauchi Field Office, Sam Kaalu, is to significantly contribute to the reduction of maternal, new-born and child mortality and morbidity in the state.
He said that this would help achieve the objectives of Sustainable Development Goals (SDG) of improving the nutrition and health status of women and children, through sustainable primary health care delivery system and improved community resilience.
According to Kaalu, several interventions are being carried out to meet the objectives, with many achievements recorded.
He listed the achievements as: supply of equipment to 323 main Primary Health Care Centres (PHCCs), training of health workers, Prevention of Mother-to-Child Transmission (PMTCT), Integrated Management of Common Childhood illnesses (IMCI), Integrated PHC services, Health Management Information Systems.
Also achieved were: Free commodities supplied to the main PHCs to ensure free treatment for all under 5-year-old children; free ante-natal care (ANC), hospital deliveries and post-natal care (PNC), including screening of every pregnant woman for HIV; provision of antiretroviral drugs to prevent mother-to-child transmission.
The intervention also recorded engagement of volunteer health workers, visits to HTR communities, among others.
The nine teams attended to over 90,900 under 5 children and over 8,500 pregnant women, that benefitted from one or more of the integrated services provided.
The HTR projects in Katagum and Misau local government areas, recorded successes.
Alhaji Suleiman Hassan, the village HTR mobiliser who is also the Head of Jabbal village, described the activities of EU/UNICEF to his people as a “miracle.”
Ibrahim Musa of Garin Mallam Barka, corroborated his Jabbal counterpart, saying  “the ailments that my people were known for before the coming of this project is gone.
“Though in the beginning, we were sceptical and thought it was another gimmick towards another means of birth control and rejected all the medications.
“With persuasion and enlightenment campaigns from the council headquarters and the team managers we accepted it and today it has become a blessing to us,” he said.
Ibinola, disclosed that the team had treated 12,259 pregnant women and children below five years of age in 16 settlements in Bidir, Madara and Magunshi wards all in the hinterland between October 2018 and December 2019.
She said that they were treated of cases of malaria, pneumonia, diarrhoea and pregnancy related problems, while others with serious problems were referred to Kuskuri health facility and Federal Medical Centre, Azare.
One of the volunteers, Malam Adamu Umar, who conducted NAN correspondent round, said that at the beginning, the communities were so sceptical and unwilling to accept the programme.
Umar said that the communities embraced the programme when they saw the benefits.
The community heads of Jabbal and Garin, Malam Barka, Messrs Suleiman Hassan and Ibrahim Musa, commended EU and UNICEF for the gesture, which according to them, have improved the health status of their women and children.
“Before the coming of EU/UNICEF, we conveyed our pregnant women and sick ones on donkey, ox-drawn trucks or motorcycles to nearby health facilities which is about 15km and 20km,”  Hassan said.
“Our pregnant women who have hitherto had no knowledge of antenatal, post natal care and child diseases were being taken care of by the team.
“Though the team visit us once in a month, the services rendered by this group are tremendous and wonderful,” Musa said.
The leaders who are also the village mobilisers of the programme, called on the state government to provide good roads, health facilities and other amenities in the area.
Hajiya Fatima Mohammed, 40; Malama Adama Suleiman, 30; and Madam Hajara Yakubu, 35; said that they had never attended antenatal care except with the introduction of the programme.
They called on EU/UNICEF to sustain and scale up the programme and urged the state government to ensure continuity.
The team leader of the programme in Misau council, Hajiya Amina Abdu, said that between April 26, 2019, and Oct. 22, 2019, the team treated 11,937 patients in 16 settlements of Sarma, Dunkurmi and Kafin Sule wards.
Abdu, who is a retired nurse and midwife, disclosed that the team also treated 10,289 patients between May 2019 and November 2019 in another 16 settlements under Ajali, Sirka and Beti wards.
Mr Abdullahi Musa, a volunteer, said that when the team started, most of the parents were sceptical and preferred alternative medicine, but the situation changed later.
Some communities in the council areas say they use donkeys and ox-drawn trucks to transport pregnant women and sick people to hospitals due to lack of motorable roads.
The heads of settlements, Malam Magaji Abdu and Alhaji Ahmadu Garba, disclosed that the only means of transporting pregnant women and sick ones to health facilities were donkeys and ox-drawn trucks.
“This is due to the hard to reach nature of our settlements, coupled with lack of road networks and distance from health facilities.
“If a woman developed obstructed labour or any delivery complications, as well as sick ones who cannot be conveyed on motorcycles, the last option is to use either donkeys or ox-drawn trucks.
“This is done over a distance of 20km or 15km depending on the location of the settlements and health facilities,” Abdu said.
The community leader, however, thanked God that in 2018, the EU/UNICEF introduced a health programme, where a medical team visits their settlements once a month, to conduct antenatal on pregnant mothers and children below five years.
With declaration of state of emergence in the health sector by Gov. Bala Mohammed and sustained programme like the Hard to Reach, the mortality rate in Bauchi State would be greatly reduced. (NANFeatures)

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