John Sotunsa, a professor specializing in Obstetrics and Gynaecology, has advocated for a change in the approach towards reducing maternal mortality rates in Nigeria.
He emphasized the necessity of adopting a comprehensive strategy that considers both the healthcare demand side and patient preferences and behaviors.
As reported by Wakadaily, during the 49th inaugural lecture at Babcock University in Ilishan, Ogun State, the maternal health expert highlighted the significance of incorporating the demand aspect of healthcare into the planning and execution of health policies.
Referring to statistics from the World Health Organisation, the doctor pointed out that 95 percent of maternal deaths occur in Low and Lower-Middle-Income Countries, including Nigeria. He further mentioned that approximately 800 women worldwide die each day in 2020 due to pregnancy-related complications.
Neglecting the demand side may result in underutilization of healthcare services, despite investments in infrastructure, training, and equipment, Sotunsa warned.
The professor observed that many individuals in Ogun State prefer traditional birth attendants over conventional hospitals, citing perceived respect and care as contributing factors. He also noted that long wait times and language barriers lead many people to choose traditional birth attendants and chemists over hospitals.
In the context of Northern Nigeria, he highlighted how cultural traditions impede the acceptance of hospital services, even when provided at no cost.
Sotunsa underscored the significant influence of healthcare providers’ attitudes in shaping patients’ healthcare experiences.
He said, “The best approach is that it should be an all-inclusive approach. We need to start from the grassroots, maximising our potential and not too much grammar. We understand and use all those that are in the baseline. And then gradually, we now grow up to a higher level where we need them.
“So, we are saying come down to the grassroots, let’s have an all-inclusive approach that respects the level of understanding and comprehension of the people. And when we do that, our health system will be very effective.
“A positive pregnancy and delivery experience can encourage more women to patronise healthcare facilities.”
Sotunsa emphasized the importance of policymakers considering patient preferences and behaviors in healthcare to improve utilization and outcomes.
He also stressed the significance of education, nutrition, and community-based methods in enhancing healthcare results. The Abiye project in Ondo state was used as an example of a successful holistic healthcare approach.
Additionally, Sotunsa highlighted the issue of loneliness and isolation in healthcare, particularly in rural areas where access to services may be limited.
He also discussed the importance of preventive measures like addressing anaemia through proper nutrition to reduce complications during childbirth.
“We need to promote basic education and nutrition to empower individuals to take charge of their health. Simple measures like correcting anaemia through basic nutrition can significantly reduce the risk of complications during childbirth,” he added.
Professor Sotunsa emphasized the importance of a comprehensive approach that considers the social, cultural, and economic factors influencing health in his inaugural lecture.
He identified leading causes of maternal mortality, including obstructed labor, sepsis, and hemorrhage, and stressed the need for a nationwide survey by the Maternal Surveillance Network to assess the scope of maternal deaths and identify strategies for prevention by studying cases of women who survived near-fatal experiences due to fortunate circumstances, medical expertise, or unexpected good fortune.
He noted, “The variation in various states and institutions may not enhance the development of appropriate intervention that will improve the dwindling prospect of maternal survival in Nigeria and Africa. The lessons learnt when a woman dies were rightly labelled “one calamity too many”.
“Therefore, it is better prevented than cured. This was the justification of a nationwide study of maternal mortality and severe maternal outcomes in 42 tertiary institutions across the 6 geopolitical zones of Nigeria between June 1, 2012, to August 14, 2023, which was carried out by a group of researchers including myself.
“At the end of the study, 91,724 live births and 5,910 stillbirths were reported. On severe maternal outcomes (SMO), 1451 near-misses and 998 maternal deaths occurred (MMR =1,088 per 100,000 live births). About 91.8 per cent of the SMOs were critical on admission with a mortality index of 40.8 per cent.
“The leading cause of SMO were hypertensive disease in pregnancy (pre-eclampsia/eclampsia) 23.4 per cent and postpartum haemorrhage 14.4 per cent.
“In over one-fifth of cases, it took over four hours to initiate intervention after diagnosis. The factors identified as major contributors to deficiencies of care were late presentation (35.3 per cent), lack of health insurance (17.5 per cent), and lack of availability of blood/blood products (12.7 per cent).
“In summary, we can keep our women alive if we look inward and maximise our opportunities. What we have, what we know, and what we can do, can prevent the majority of maternal deaths existing in Nigeria if we are available, consistent, ingenious, committed and sacrificing. Let us harness the knowledge of our colleagues, for this will increase our team spirit and efficiency. It is the achievable antidote to ‘Japa’. It is the prescription that will engender ‘Japada’.”
