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Tracking Sick, Small Newborn and Zero Dose to End Preventable Deaths in Children in Cross River

In December 2024, the Child’s Rights Bureau of the Federal Ministry of Information and National Orientation in collaboration with the United Nations Children’s Fund UNICEF convened a media dialogue in Calabar themed ‘Sick, Small Newborn and Zero Dose’ aimed at tracking Sustainable Development Goal 3.2 which targets ending preventable deaths of newborn and children under five years of age, by 2030. Esther Oluku reports.
The year 2025 marks a significant year in tracking the Every Newborn Action Plan ENAP, a strategy chaired by the United Nations Children’s Fund and the World Health Organisation aimed at reducing sick, small new born and still births worldwide. The charter, first enacted by the United Nations Assembly (UNA67.10) in 2014, and endorsed by 194 countries targets reducing newborn deaths to as low as 12 or less per 1000 live births by 2030. To achieve this global target, participating countries are enjoined to localise policies towards reducing maternal and child mortality at the national and district levels which aligns with the global goal.
The four indicators to look out for at the national level are that (I) 90 per cent of countries should have 70 per cent of pregnant women with at least four times or more antenatal visits; (ii) 90 per cent of countries should have 80 per cent births attended by skilled health personnel; (iii) 90 per cent of countries should have 60 per cent mother and new born early routine post natal care within two days of life, and at a global level that (iv) 80 per cent of countries have a national implementation plan that is being implemented in at least half the country, with an appropriate number of
functional level-2 inpatient units linked to level-1 units to care for small
and sick newborns, with family-centred care.
However, at the sub-national level, the following recommendations were reached: (I) 80 per cent of districts have greater than 70 per cent of her pregnant women with four or more antenatal visits; (ii) 80 per cent of districts should have greater than 80 per cent births attended by skilled health personnel; (III) 80 per cent of districts should have greater than 60 per cent early routine post natal care; and that (iv) 80 per cent of districts (or equivalent sub-national unit) have at least one level-2 inpatient unit to care for small and sick newborns, with respiratory support including provision of continuous positive airway pressure.
In Nigeria, the federal and state ministries of health have developed the Nigeria Every Newborn Action Plan to accelerate response to this challenge with the localisation of the Nigeria Every Newborn Action Plan to end preventable newborn deaths by expanding access to essential, comprehensive and community-based newborn care.
This entails improving level-1 newborn corners at primary health care centres and establishing level-2 newborn units – also known as Special Baby Care Units (SBCUs) – at secondary health facilities.
UNICEF: Tracking progress
As part of efforts to track progress in Cross River state, the Child Rights Bureau of the Federal Ministry of Information and National Orientation in collaboration with UNICEF convened a media dialogue in December 2024.
The Health Manager, UNICEF Nigeria, Mr. Martin Dohlsten, citing a 2021 UNICEF statistics said that Nigeria ranked second highest in under-five mortality, second highest in mortality of children between one and 59 months, and highest in new born mortality in West and Central Africa, hence, a deliberate action towards improving sick and small newborn health is urgent. In his presentation titled: “State of the newborns in Nigeria,” Dohlsten stated that if Nigeria hopes to meet up with the SDG 3.2 goal of reducing preventable deaths of newborn and children under-five by 2030, Nigeria must rapidly accelerate under five mortality reduction from 1.8 per cent to 16.5 per cent yearly.
Dohlsten opined that this would avert 3,597,700 deaths by 2030. As part of the simultaneous approach towards achieving this, he harped on the need for a convergence of purpose where mothers understand the need to use the healthcare services of Primary Healthcare Centers, Primary Health Centers are equipped with adequate capacity to deliver optimum health services to patients and the prioritisation of immunisation as a solution to fighting preventable diseases.
He said: “In terms of antenatal coverage, 67 per cent of pregnant women went to at least one visit with the health care provider but the recommendation is that during pregnancy, the mother should at least have four to eight visits and the number of mothers that had four or more visits was around 57 per cent. We know that if a lot of these women don’t get this ante-natal care, they will not be checked on the health of the baby. Antenatal is also an opportunity for information sharing and empowerment of pregnant women.
“If a mother delivers at a skilled health attendant’s, that is also a strong indication that we are moving into the right direction. But then simultaneously, we know it’s not enough to bring them to the facilities, we have to ensure that the quality of the services are good enough. When women reach the facility, the quality of the care that would be provided need to be of a specific standard. These are some key critical interventions that we know will indicate if a country is on the right track.”
Importance of immunisation to children’s health
With the 2021 statistics on under-five mortality showing a high prevalence in Nigeria, Health Specialist, UNICEF Enugu Field Office, Dr Olusoji Akinleye, opined that immunisation, when engaged as recommended by the national vaccination schedules, can help the body fight off diseases. He stated that immunisation occupies an integral aspect of health care which empowers the body to fight off diseases. While acknowledging that immunisation is a medical intervention which has helped the civilization of the world by preventing millions of deaths over the years, he stated that in the last five years there has been a decline in immunisation.
He also added that there exists a relationship between immunisation and poverty, education, and exposure to primary healthcare services such that lack of access to one may have an effect on access to the other.
“Immunisation is a medical intervention that works very well. Lack of immunisation deprives the system of the much-needed vaccines. Unfortunately, in the last couple of years, especially in the last decade, but much, much more, in the last three, four, five years, the world has seen some decline in immunisation.
“Lack of immunisation could be a marker for so many other deprivations. For instance, zero-dose could be a marker of household poverty because it’s been shown that two-thirds of zero-dose children live in households surviving on less than $2 a day. It’s also a marker of gender education, maternal health, and access to PHC services.
“The relationship between zero-dose and multidimensional poverty and of course, the work we can do together as UNICEF and the media is changing the narrative and eliminating zero-dose in our communities.”
Progress Report in Calabar, Cross River state
The Director General, Akwa-Ibom state Primary Healthcare Development Board, Dr. Vivien Otu, explained that as part of the progress made thus far, the state Governor, Senator Prince Bassey Otu, has released the counterpart funding for the revitalisation of primary healthcare centers in the state.
“The Cross River state Governor, Senator Prince Bassey Edet Otu, has released N100 million for the counterpart funding and the state is now part of the IMPACT Project. We are hoping that with the IMPACT project, we’ll be able to revitalize our facilities, renovate them, add solar, and give pumping machines.
“The phase one of the Impact Project only covers 82 of our basic healthcare facility. And apart from having 196 basic healthcare facility, we have over 1,000 other health facility which covers whether it’s primary care health center, health posts and others.
“For this first phase, we are revitalizing 82 facilities across the 196 wards in the state. We are hoping that by the next batch we would be able to do the 196 wards in Cross River state. We took mainly the big primary cares that are around so our target is to ensure that at least we have one functioning primary care center per ward at the end of the day.
“The Impact Project will revitalize 82 facilities, the national primary healthcare board will take care of (revitalize) seven facilities and the state government counterpart funding will take care of three facilities so we have a total of 93 that we will be revitalizing in the next 3 months.”
Over 80,000 children still unvaccinated
Otu who stated that Akpabuyo local governments is one of those local governments with high numbers of zero dose children, attributed this situation to vaccine stock out resulting in missed opportunity on the part of the facility and lack of information on the part of mothers.
She mentioned that in 2023, the state recorded a total of over 101,000 zero dose children but have been able to vaccinate about 30,000 children between 2023 and 2024 leaving the current number of unvaccinated children at around over 80,0000.
“UNICEF supported the zero dose campaign during the Optimize Maternal and Child Health we had a few months ago. In 2023, we had about over 101,000 zero dose. But currently what we have is about 80 something thousand.”
Otu further stated that a majority of these unvaccinated children are refugees from the Cameroon border and children delivered by Traditional Birth Attendants. She added that the state is reaching out to communities through outreaches and sensitization exercises to ensure that the number of unvaccinated children is reduced.
Funding as challenge to staffing, training of Health workers
According to Otu, funding represents a major challenge in staffing and training of healthcare works. She noted that although UNICEF had assisted with training of health workers in the north and central part of the state, health workers in the southern of the state are yet to be trained on essential newborn care.
“Staffing is a problem and I can tell you for not only Cross River state. I’ve written proposals to the Governor with my estimate and he said it’s not about employing but paying them. This has been a challenge since I came on board. The National Primary Healthcare Development Board, Doctors without Borders and some partners have brought some volunteers for us.
“UNICEF helped us to train healthcare workers on essential newborn care but the fund was not enough to cater for all local governments in the state so we did that of north and half of central. There was supposed to be a phase two, which we have not done. So the whole of the south have not been trained.”
Logistics as barrier to equitable distribution of vaccines
Otu said that logistics challenges are most times responsible for vaccine stock out in the state thus leading to cases of missed opportunity. “The problem with antigen stock out in Cross River state is logistics. There is vaccine at the national level but the problem we have is logistics. They are going from state to state to distribute and the distance is far.
“If there is a logistics challenge at the national level, and the state can pull it’s vaccines, those are things that we are looking at. To meet with the Governor, can you give us some funds such that in our own way when these vaccines are about finishing, we can pull the vaccines instead? We need support.”
The challenge of electricity
During a field trip to Ikot-Offiong PHC Akpabuyo, Otu said that lack of electricity was one of the major challenges affecting primary health care facilities in satellite communities in the state: “The light situation here is very poor and so this facility urgently needs to be solarized.”
Speaking on how the facility comes with this situation, Nurse midwife at Ikot-Offiong, Mrs. Inah Ubana, shared that birth attendants assisting mothers to deliver their babies at night use either phone flashlights or kerosene lamps.
Ubana said: “We don’t have light here. We use our phone torch. When we have a woman in delivery, to see that side of the vagina, one has to hold one’s phone with ones mouth. If my phone is down and the patient has, we use her own. That is the situation here.”
Strengthening awareness
The media dialogue called on journalists to amplify the gains of achieving the global targets, promote children’s right to life, empower the public with information while highlighting the progress made. The dialogue spotlighted factors such as social, economic, religious and institutional barriers which may constitute limiting factors for families while acknowledging the critical role of the media in public enlightenment.
Through media engagements, the meeting hopes to mobilize caregivers and communities, educate the public with the correct messages, disseminate timely and useful information addressing barriers to achieving the global goals, inspire trust through positive testimonials of real humans, advocate to policymakers and serve as accountability partners to policymakers towards achieving the global targets by 2030.