In this interview with SADE OGUNTOLA, Ms. Cristian Munduate, the UNICEF representative for Nigeria, discusses difficulties affecting Nigerian children and the role that communities, the government, and mothers need to play in achieving the best possible outcomes for them.
What has to be altered to guarantee that Nigerian children receive high-quality medical care?
A: We really need to amplify attention on primary health care, not only from the government but also from religious and traditional leaders and communities, so that they can step in. They can take action so that children can receive preventive health care. Therefore, vaccination is essential; it’s crucial. Nutrition is needed. Food security in the nation is a complex issue, but mothers should take their children to health facilities to access care promptly. At the ward level, these primary health care clinics can also screen children to make sure they are okay. Those who are not well can also receive therapeutic food so that they can survive.
Open defecation is another issue that needs increased attention. People need to understand that open defecation contributes highly to the deaths of not only children but also adults. People can catch cholera from open defecation, and it can be fatal. It is impossible to have access to healthcare services and a clean environment apart. They collaborate with each other. Thus, every community ought to endeavour to construct latrines in order to have a sanitary facility at the very least. Of course, having more modern sanitary facilities is desirable, but in many communities, this is not the reality. However, the practice is unacceptable.
What are the major contributory factors to the major health challenges you’ve noticed in Nigeria?
The issue is a dearth of ward-level health centres. You must have the service for a nation the size of 200 million people, where 8 million kids are born annually. Without this service, these children will not be able to survive. Furthermore, if parents and the community do not realise and accept that using primary health care facilities is necessary to guarantee that children receive the recommended vaccinations, there is no chance the children will survive.
Nigeria is one of the poorest countries in the world, with children not being immunised or partially immunized. It can be argued that this falls under the purview of the government’s duties. However, many people have false notions, and some people choose not to vaccinate their children. After becoming ill, some of them die.
About 6.2 million Nigerian children have either missed their vaccination or have not even received it at all. To help close this gap, we must insist and push the political will to increase budgetary allocation to education. This is the only way. It is an urgent task that needs to be completed. Not only must people be informed, but all stakeholders must be mobilised to make a sincere commitment.
Last year, we had a diphtheria outbreak in Nigeria. Normally, children have diphtheria before five years of age. However, every child who contracted diphtheria the previous year was between the ages of 8 and 12. These were kids who had never received a vaccination. That means that parents also have some of the responsibility.
Nigerian children are the worst for malnutrition; how can mothers make a difference?
The best way to keep nourishing your child in the first two years of life is by breastfeeding. However, a lot of women choose not to breastfeed for a variety of unproven reasons. Exclusive breastfeeding for the first six months and then complementary breastfeeding for one and a half to two years guarantee that a child is immunized. Breast milk from a mother aids with a child’s nourishment and immunisations. In actuality, throughout the first six months of life, no other diet can match the nutrients that mother milk offers. Breast milk ensures that the child grows healthily and thrives because of the micronutrients the milk contains. And they will become very tall.
Myths and misconceptions are preventing mothers from bringing their daughters for HPV vaccination. Some revolve around moral questions; how do you see this?
The principles with which the child is raised come from the family. So the HPV vaccine has nothing to do with all these misconceptions that this is enabling early practice of sexual relations. But the truth is that once the girl reaches adulthood, there is a possibility of her getting exposed to HPV. In Nigeria, when girls get married, they cannot tell how many other sexual partners their husbands might also have. Having multiple sexual partners is the best way through which HPV gets transmitted in the community. This is the best way to get cervical cancer. Cervical cancer is the only thing that the HPV vaccine prevents. Additionally, nursing also lowers the risk of breast cancer.
In Nigeria, we have bad health indexes; what do you think contributed to these bad rates?
Well, low budgetary allocation to health is contributing to it. It has been a long since we had a census in Nigeria. Because of this, it is challenging to properly prepare for what is required in each ward and local government region given the size of the nation. The census is the only exercise that can give accurate information.
Now the question is, in a country with 200 million people and eight million babies being born every year, we don’t need to have an excuse that we don’t have data. Because by the time we have data and we can have good plans, but if they are never implemented, it doesn’t make a difference. Lives will still be lost. So we need to take action. So, right now we need to speak about results for children. We need mobilise so we must engage with the state authorities and the federal authorities to mobilize information so people can understand what the issues are.
We need to speak about results for children. Can you explain what that means?
Results, like ensuring all children get immunized. Nigeria has less than 51% immunisation against diphtheria, tetanus, and pertussis. Other countries in this region have over 80%, even countries that have political complications. The DRC and Burkina Faso, for example, are smaller countries with a smaller population. Despite the complex political situation, they are keeping the gains and the results. So we need to accelerate results.
Women at the grassroots, including in hard-to-reach areas, lack access to newborn care services like the Level 2 Newborn Units donated by the United Nations Children’s Fund (UNICEF) and others at Jericho Specialist Hospital in Ibadan. How do you see this?
Yes, it is because some wards do have primary health facilities. The midwives and nurses can determine whether the woman will experience birth issues if she visits the health centre for prenatal care. They can then refer to a higher level of care with such facilities as the newborn unit. This is not an acceptable justification because better primary health care services might fill this gap. Because Nigeria is a country where children cannot wait, the federal government is currently working on a sector-wide approach to properly organise the health system. We hope this may begin its implementation as soon as feasible. But still, we want all women to look for prenatal care to ensure safe mothers and healthy babies.
Despite progress made in childhood diseases, pneumonia, malaria, and diarrhoea still remain major problems and the leading killers of children. What other strategies do you think we should begin to apply?
Since diarrhoea, malaria, and pneumonia all kill children, they are related problems. Good sanitation is also important for their control in communities and public institutions. Dirty ponds are breeding sites for mosquitoes. I was with the Benue State governor and vice governor. Their priority for Benue State is malaria. So, we will engage with them. Additionally, they have pledged funding for studies and initiatives like searching unvaccinated children’s homes door to door. A lot of individuals believe that a vaccination against malaria will soon be available in Nigeria. This is already the case in a few African nations. We have to see if this is decreasing the malaria incidence rate. The gap has been for a long time; it did not appear a year ago. Since young adults present both the greatest opportunity and the greatest risk from illegal substances, criminality, and other issues, we must truly support all Nigerians in their development and survival. This support should specifically focus on children and young adults. Young people are affected because they lack opportunities.
Children are coming into contact with heavy metals more often. What is your opinion on this?
Once more, children are exposed since there is no oversight over the mining extractors—either reputable firms or unlicensed individuals—who remove these metals from the ground. Thus, we need to implement regulations, pass legislation banning illicit mining and extraction, and even prosecute individuals. This is the only way.
Climate change issues affect children’s health. What is your opinion on this: that children may be safe and live in good health?
Well, the effects of climate change are felt globally, and international news outlets discuss them as well. In my country, we used to have a temperature between 15 and 37 degrees Celsius throughout the year. Now, we have temperatures as high as 47 degree Celsius. What happened in my country? People are not conscious of the use of plastic bags and bottles. There is air pollution from the exhausts of vehicles and other activities of men, such as bush burning. All these contributed to the depletion of the ozone layer. The world is at a point where it is really difficult to reverse the changes made to the environment. So, all you need to do is at least change, but that won’t heal. That will only sustain the problem, but it won’t make it worse, either. It is rare to find recycling companies here in Nigeria. Plastic bags and bottles are ubiquitous. Everything is contained in a plastic bag. This should be prohibited. If you want plastic bags, pay for them. If there is a high cost for plastic bags, will people stop using them?
Based on your professional experience in Nigeria, what do you expect from Nigerian mothers in terms of child care?
Motherhood is set by nature, and there is a bond. So, we really need to put in more effort to take care of our children. I must say I’ve been in some health facilities where I’ve seen babies that are thriving, which are very small for their age and very ill. But the mother is healthy. So, at times, it’s not poverty. At times, it’s a lack of commitment and appropriate information. So, health workers, including the media, have to expand the message about why it is important for mothers to breastfeed their children. They just need to drink water and, of course, eat well. There’s no need to drink anything else. And then the milk is produced. They don’t need to expend extra money. Once they are well hydrated, they can produce sufficient breast milk for their babies.
They also need to go to the health facility to get, for example, doses of vitamin A and micronutrients. Last year, UNICEF fortified almost 32 million children, including adolescents, with vitamin A. Vitamin A is good to prevent and cure anemia. They should insist on getting vitamin A at the health posts and facilities as it is free.
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