Inadequate manpower! Nigeria has 600 paediatricians for 40million children

Eleven per cent of the children that die in the world yearly are from Nigeria. Bukola Adebayo writes on the issue involved

 Tunminu had been feeling feverish for the past two days, and her mother, Shade Akintayo, had been giving her some anti-malaria drugs for treatment.

Akintayo, a nursery school teacher, who is used to managing sick children in her school, thought her three-year-old daughter’s condition was really nothing to fret about.

However, three days after the fever started, Tumininu’s case grew worse, as she developed diarrhoea and was also vomiting blood in the night.

The agitated single mother called on her neighbours, who assisted her to take the ailing child to a private hospital in Surulere where they lived.

The nurse on duty  told Akintayo that there was no doctor around,adding that it would take some time before the physician would come to attend to the child.

The doctor showed up two hours later and, after examining Tumininu, he advised them to rush her to the general hospital.

She said, “After waiting for two hours for the doctor, she started convulsing but the nurse reassured us that we would take care of her, all for him to tell us to take her to the Lagos University Teaching Hospital in Idi-Araba or the general hospital in our area. They did not have the facilities or the specialist to diagnose what was wrong with her. He also refused to give us a referral letter.”

Akintayo, who narrated her story to our correspondent in LUTH, on  Thursday, said they opted for the general hospital that was closer to their area.

She said on getting to the hospital around 5am, there were other women with their sick children waiting to see doctors.

A nurse advised them to take her to LUTH if they wanted quick intervention because there were 15 children on emergency.

Akintayo rushed her sick daughter to LUTH.

“She was already gasping by the time we were leaving the general hospital.There was no ambulance. Tumininu had begun gasping for breath before we got to the hospital. But as we were taking her into the emergency unit in there, she died,” she says.

So, Tumininu’s was taken to the mortuary.

The overwhelmed doctors said the child died of acute diarrhoea.

Yet, about 13 children under the age of five-like Tumininu- die every minute in Nigeria due to lack of immediate care and basic medical interventions.

According to the World Health Organisation, 6.9 million children under five years of age died in 2011 globally.

It also estimated that 19, 000 children die each day and; almost 800 every hour.

What is troubling about these statistics is that though other countries have made remarkable progress in reducing the number of children dying in their countries, Nigeria still records an unbelievably high death rate of children under the age of five.

For example, after India, Nigeria is second on the list of countries with the highest infant deaths in the world.

Why are these children dying? Doctors and caregivers, who spoke with our correspondent at three-day training for doctors in Nigeria by the Imperial College Faculty, London,  said dearth of trained health personnel at all the primary health care centres, poor child care workforce and lack of emergency paediatric response facilities in our hospitals were reasons for high infant mortality rate in the country.

For instance, a  consultant paediatrician, Dr. Dayo Ajayi-Obe, said Nigeria, with a population of 70million children under the age of 18 ,has only  600 trained consultant paediatricians. Out of this 70 million children, over 40 million are under the age of five.

“The United Kingdom has 3,084 trained consultant paediatricians and 1,184 associate paediatric specialists for its 20 million children and it does not include the 3,174 paediatricians in training. That is how much importance that is placed on children. We have just 600 paediatricians to 70 million children and most of them are in Lagos and Abuja. Some  states do not even have a single paediatrician!,” she adds.

Ajayi-Obe notes that Nigeria has yet to make any significant progress in reducing infant deaths because its health system is still redundant.

She states that infectious diseases and respiratory ailment such as diarrhoea, pneumonia and measles, malnutrition and ill-prepared responses to emergencies in children contributed to about 90 per cent of child deaths in the country.

She adds, “Child care is inadequate in Nigeria and there are gaps. It reflects in our health indices of 145 per 1,000 births.  I found out that the vacuum I left in the system 30 years ago still exists, it is the same diseases, and infections that are still killing people now.”

Other experts argue that all the three tiers of government in the country should invest more in the implementation of health policies that could reverse the trend, otherwise more Nigerian children would be lost.

They express fears that the situation pose a major challenge to the possible achievement of the Millennium Development Goals 1,2,4,5 ,which aim at significantly reducing hunger(malnutrition), infant and maternal deaths by 2015.

Ajayi-Obe, therefore, calls for a review of the referral system such that health workers could quickly refer babies who would need specialist care to the secondary health facilities where they have more experts in emergency cases.

She says, “ A situation whereby you are taking a child from one hospital to another in an emergency would not help us at all. Our referral system is faulty; we must be able to quickly assess a baby at the primary health care to know where she can get help immediately. The hospital they are going should also be prepared to take the baby. We have to be ready for emergencies,especially for children all the time.”

Also, a specialist in paediatric medicine with the Imperial College Faculty, Dr. Gareth Tudor- Williams, adds that transmission of the HIV/AIDS, hepatitis B and C virus from mothers to their children is also responsible for the high infant mortality rate.

“HIV in children is not under control in Nigeria, especially its transmission from mothers to their children. The country has a long way to go and they need help. Also, the rate of infections of Hepatitis B and C is high in children;they get this through their mothers. That is why you see young people developing liver failure because they contacted hepatitis B, a vaccine preventable disease at a young age.

“Government, doctors and caregivers must recognise that we protect children against these diseases by vaccination, early diagnosis and provision of drugs. A child that is not vaccinated is open to all diseases. Our experts should be able to,  in a matter of seconds, diagnose a sick child. There are diseases that mimic fever and measles in children which, if not properly diagnosed or treated, kill a child in an hour,” Tudor-Williams adds.

Also, Ajayi- Obe argues that adoption of self-medication approach by parents and delay in seeking proper medical care for sick children are counter-productive.

“A baby is having fever for the past two days, you keep giving him analgesic and when the child is about giving up, you rush him to the clinic.Lets not forget that doctors are not magicians. The baby may need to go to the intensive care unit, which many cannot afford. Parents must never wait till the health of their children get out of hand before they come to the hospital,” she advises.

Ajayi- Obe calls for more training on new practices in child medicine for doctors, nurse and caregivers to ensure that they have the skills to quickly detect and treat children, especially those under the ages of five.

She notes, “It is time for government and our caregivers to know that medicine grows every day. We must improve the quality of training available to our young doctors and keep training experts, specialist and nurses. The quality of training available to our health workers must improve.”