Sodiq Ojuroungbe
A professor of Obstetrics and Gynaecology, John Sotunsa, has called for a shift in approach to tackling maternal mortality in Nigeria.
He stressed the importance of a holistic strategy that takes into account the demand side of healthcare, as well as patient preferences and behaviours.
Speaking exclusively with PUNCH Healthwise shortly after delivering the 49th inaugural lecture at Babcock University, Ilishan, Ogun State, the maternal health expert stressed the importance of integrating the demand aspect of healthcare into health policy planning and implementation.
Citing data from the World Health Organisation, the physician said 95 per cent of maternal deaths occurred in Low and Lower-Middle-Income Countries, of which Nigeria is included.
He added that every day in 2020, about 800 women die due to pregnancy-related conditions across the world.
According to him, neglecting the demand aspect can lead to underutilisation of healthcare services, despite infrastructure, training, and equipment investments.
The professor noted that many patients in Ogun State prefer traditional birth attendants over standard hospitals, citing perceived respect and care as reasons.
He added that many people opt for TBAs and chemists instead of hospitals due to long delays and communication barriers.
Sotunsa explained that in Northern Nigeria, cultural practices hinder acceptance of hospital services, even when offered for free.
The gynaecologist stressed that healthcare providers’ attitudes play a significant role in shaping patients’ 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 urged policymakers to consider the demand aspect of healthcare, including patient preferences and behaviours, to enhance healthcare utilization and improve health outcomes.
The professor also emphasised the crucial role of education, nutrition, and community-based approaches in improving healthcare outcomes.
He cited the success of the Abiye project in Ondo state, which demonstrated the effectiveness of a holistic approach to healthcare.
Sotunsa further highlighted the need to address loneliness and isolation, which he described as a significant challenge in healthcare.
He noted that loneliness is a significant challenge in healthcare, particularly in rural areas where people may feel isolated and lack access to healthcare services.
The maternal health expert emphasized the need for preventive measures, including correcting anaemia through basic nutrition, to mitigate the risk of 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.
Earlier in his inaugural lecture, the professor underscored the need for a multifaceted strategy that addresses the social, cultural, and economic determinants of health.
While listing obstructed labour, sepsis, hypertensive disease in pregnancy, and haemorrhage as major causes of maternal mortality, he said the Maternal Surveillance Network need to engage in a nationwide survey to evaluate the burden of maternal death and identify what can be done to prevent them by learning from cases of women who would have died but either through providence, medical expertise and or sheer miracle, survived.
He added, “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’.”
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