Nigerian Journal of Paediatrics 2012;39(1):1- 6
COMMENTARY
Yakubu Alhassan M.
Child Health Care in Nigeria: Historical
background
DOI: http://dx.doi.org/10.4314/njp.v39i1.1
Received: 5th November 2011
Before delving into the Western or Scientific medical
Accepted: 5th November 2011
perspectives of health care services to children I need
to say a word or two about the Nigerian traditional
YakubuAlhassan M.
( )
care of the sick. Organised social structure existed
College of Health Sciences ECWA Bingham
before the Western civilization one of which is health
University Jos Campus-Nigeria.
care system. The health care system before advent of
orthodox or Western medicine traditional care
Paper presented at the Faculty of Paediatrics
centered around individual knowledge not widely
Symposium - 35 Annual General and Scientific
th
publicized, but confined to nuclear family. Specialist
Meeting of West African College of Physicians
services existed in form of traditional birth
(Nigeria Chapter), Lagos. 12 14 July, 2011
th
th
attendants, bone setters etc.
Infertility remedies
abound. Herbalists took centre stage and are now
Introduction
being accorded recognition.
Protocol
Protective measures for children against witchcraft
included use of charms etc.
Use of cow’s urine
Child care is a natural instinct of all animals, human
among certain ethnic group to arrest convulsion,
beings inclusive; however, the highest level of care
revival acts using hot objects application on the body
of health of the child is that of the mother because of
of a convulsing child were used as forms of remedies.
the love and devotion given to children by mothers.
Similarly, cow dungs for treatment of umbilical cords
It is the mother that is endowed with special
of newborns were some of the accepted practices in
knowledge of her child, and she provides a wide
child health care.
Female genital mutilation was
spectrum of services to her children. Historically
recognized forms of therapeutic measures while
therefore, where do we start with this discussion? Is
infanticides were used to rid children with congenital
it before the introduction of Western Scientific
malformations such as hydrocephalus. High infant
Medicine or are we talking about the modern
mortality rate was a strong motivator to having more
scientific medicine? I made several assumptions in
children to make up for the wastage. Many of these
attempting to interpret this topic.
practices were injurious.
First, I assume that it is the orthodox scientific
Concept of Child Health Care
medicine as it relates to the well being of children
that is referred to.
Secondly, why history to
Child health care refers to the total package of the
paediatricians or physicians involved in child care?
wellbeing of a child in a holistic manner through
Well, history is not merely a biographical account of
preventive, to keep the child away from adverse
the previous years. It is a vital link that connects the
effects of all disorders, promotive, curative and
past and the present, the present and the future. In
rehabilitative measures when curative measures fail.
this context the history of child health is relevant
To a Paediatrician the ultimate goal is to provide the
because it enables us understand the changing
optimum care for the child through the cycle of life
economic, political and sociological medical factors
from conception to adulthood in perfect state of
at play on which we can construct models based on
HEALTH as defined by the World Health
the present situation of the state of child health, the
Organization.
levels of care provided and possibly predict the
future trend of child care.
2
Definition
(1789 - 1815) when it was widely recognized that
children needed special care because of the high
The Federal Ministry of Health, Nigeria defined a
infant mortality. Before then it was considered that
child “as a person aged from birth to 18years”
sickness in infancy was normal developmental
adopted from convention on the Right of the Child.
process. Paediatric services evolved to curb out child
malnutrition and to prevent infectious diseases hence
Historical perspectives of evolution of medical
the development of first generation vaccines namely
health services in Nigeria
smallpox, tetanus, typhoid, diphtheria and BCG.
Virtually all the pioneers in paediatrics cropped up
Modern scientific medicine was introduced into
from adult medicine.
This development led to
Nigeria by the Portuguese for the Portuguese traders
establishment of Paediatrics Teaching as
and sailors to the West Coast of Africa as far back as
specialization followed by establishment of children's
the 15 century but the traditional systems of care of
th
hospitals in Europe.
the sick as practiced by the indigenous populations
were not tampered with.
By the 16 century the
th
Paediatric services and training in Nigeria
British and Scotish traders joined the Portuguese
explorers for purpose of trade. These groups were
Services and training are inseparable.
At
also accompanied by doctors who looked after the
independence and shortly thereafter paediatrics
sailors and traders exclusively. As the voyages of
services were started in Lagos, the first Children's
discovery by Europeans intensified in Nigeria the
Hospital was established at Massey Street in Lagos.
process of colonization run paripasu, with doctors
Nigerian pioneers in these fields included Drs.
looking after both traders and colonial masters at the
Animashaun, Ajenifuja, Fadahunsi and Ekpechi.
exclusion of the local population.
With the
Tertiary service started in UCH Ibadan followed by
establishment of colonial rule the civil servants came
LUTH, Lagos. Prominent names at LUTH included
on board.
Professor Collis and expatriate with Nigerians like
Olukoye Ransome-Kuti.
At UCH the pioneers
The colonial administration extended its services to
included Drs. Hendrickse, Antia, Effiong etc. For
the military, traders, sailors and the European Civil
more details the reader is referred to Faculty of
Servants.
Missionaries then came in and started
Paediatrics Lecture 2001 by Dr. Okehialam.
establishing medical institutions. With passage of
time Nigerians became aware of the benefits of these
In Ahmadu Bello University, the Department of
services and demanded the same.
The colonial
Paediatrics was created in the Faculty of Medicine in
masters grudgingly granted modified medical
1969 when the pioneer batch of medical students
services to the indigenous population by first
entered into the clinical years of their training.
providing them services, through auxiliaries with
Hitherto, children were lumped into female wards.
little knowledge or skill.
Secondly, colonial
The pioneer staff to whom I like to pay great tribute
government started developing African Hospitals
included Professor Sinette an African American who
distinct from European Hospitals. A third feature of
was the first head of Department, for a super brief
colonial government health care to indigenous was
period.
He was succeeded by Professor Richard
the establishment of medical schools to train
Dobbs with whom were Professor Huggey, Dr.
assistant medical officers who in turn were expected
Duggan later joined by other Britons, Dr. Brueton,
to provide care to the indigenous population.
In
Hargreaves, Nesbit and others.
Professor M. B.
Nigeria these were built in Kano andYaba but phased
Abdurrahman was the first Nigerian Head of
out later.
Department from whom Professor Kunle Ijaiya took
over. It is instructive that the first and second batch of
The Missionaries on the other hand brought
the ABU Medical School produced paediatricians in
European medical services to the indigenous
the persons of Professor Ogala from the first batch
population in addition they built dispensaries and
and my humble self from the second batch of
General Hospitals.
By the time of Nigeria's
graduates. After my graduation in 1973 I enrolled
independence in 1960 the general hospitals and some
into Residency Programme in 1975 - 1979 and was
elements of specialist care like the Messey Street
appointed Consultant Paediatrician in February 1980
Children's Hospital in Lagos and elements of tertiary
following my success in the Part II final in May 1979.
care were in place.
Paediatric training
Evolution of Paediatrics and Child Health Care
services
Decree No. 67 of September, 1979 gave full legal
backing to the National Postgraduate Medical
Evolution of Paediatric services in Nigeria followed
College of Nigeria (NPMCN) to function as a
the same pattern as those in Europe. In Europe these
College.
started in the 19 century after the French Revolution
th
3
The College actually started operation in 1969 under
to the regional University. This saw the emergence of
the joint supervision of Medical and Dental Council
the Institute of Child Health in Benin, Enugu, and
of Nigeria and the Federal Ministry of Health.
Ibadan in addition to the existing one in Lagos. That
Special tribute must be paid to the following pioneer
of Zaria never saw the light.
Nigerian teachers, Drs. O. Ransume-Kuti
Animashaun, Ajenifuja, Antia, Kaine, Okehialam,
The Civilian Administration of Shagari in 1980
Lesi, Effiong among others.
approved in principle the buildings of six specialist
children hospitals in various parts of the Federation.
At commencement the curriculum for the Primary
This plan was terminated in 1983 by the coming in of
examination involved general common medical
another military government under Gen. Buhari.
science for all candidates irrespective of specialty.
National Hospital Abuja originally conceived for
Paediatrics Faculty following the promulgation of
women and children now serves for both adults and
Decree 67 which gave Faculties power to develop
children, men, women inclusive.
their curriculum opted to basic clinical science
relevant to paediatrics. Assessment for Part 1 was
Child survival strategy
based on written papers and clinical examinations
until 1990 when practical was added to the part 1
In 1983, far away in Manila at the International
examination. There was one year period of clinical
Paediatric Association Conference, James Grant the
attachment abroad after passing the Part I.
I
Executive Directors of UNICEF launched the Child
benefitted from this from October 1977 to November
Survival Revolution with emphasis on Growth
1978.
Monitoring, Oral Rehydration Therapy, Breast
feeding, Immunization and Female Education and
Until 1985 when General Paediatrics was included in
Family Spacing.
Nigerian Government actively
Part II examination which hitherto had only
dissertation presentation and defense.
participated in implementation of these:
The West African Postgraduate Medical College
Oral RehydrationTherapy;
By 1993 the oral
followed suit.
The West African Postgraduate
rehydration therapy, one of the components of
Medical College was established in 1975 through a
Child Survival Strategy not only became a house
Treaty, later through the West African Health
hold word but death from severe dehydration due
Community (ECOWAS) protocol to train post
to diarrhoeal disease declined. An example of
graduate medical doctors.
this success story was recorded in Yola, General
Hospital in the then Gongola State.
An ORT
Preventive and Promotive Health Care services
Demonstration Unit was established in May
for children in Nigeria
1985. Between May and November 1984, the
hospital recorded, 4,045 cases of childhood
In 1960 the year of Nigeria's independence,
diarrhoea admitted in the hospital for treatment.
Professor Collis an expatriate professor of
Of this number 1,755 received intravenous fluid
paediatrics working in Lagos proposed the
therapy and 79 died. In a comparable period May
establishment of Institute of Child Health in Nigeria.
1985 and November 1985 after the establishment
This proposal was approved by the Federal
of Diarrhoea Treatment Unit and the advocacy
Government of Nigeria. Unilever donated Institutes
and campaign for the use of ORT, 4,229 cases of
of Child Health to be established in the three regions
childhood diarrhoea were recorded and treated
of Nigeria.
These were established in Kaduna,
using Oral Rehydration Therapy. The number of
northern region, Aba in the eastern region. These
admissions for diarrhea cases was reduced to 105
were later converted to schools for the training of
while death from diarrhoeal illness was down to
community midwives.
The western region was
21 translating to 94% and 7% respectively. It is a
given the sum of fifty thousand sterling pounds to
statement of fact that ORT has become a
build the same but this was never to be.
The
household word and severely dehydrated children
allocation that was meant for Cameroon was
due to diarrhoeal diseases are hardly seen at the
transferred to Lagos when Cameroon seceded from
tertiary hospitals these days.
Nigeria.
The campaign for Breast feeding was intensive
through Baby Friendly Initiative, media
Following the military intervention in 1966 another
campaign, posters, seminars and workshop
attempt at establishing ICH was made in 1972. The
enlightening the public.
then Federal Military Government decided to
Immunization:
establish Institute of Child Health in every state of
Nigeria's attempt at immunization against six killer
the Federation. This decision was later revised when
diseases took off under the Expanded Programme
the Federal Military Government directed that the
on Immunization in 1976 in South-Western
Institute of Child Health be established in every
Nigeria in Owo Local Government.
Teaching Hospital in Nigeria and was to be affiliated
4
Drawing from the success of this pilot project, a
World Summit for Children
national plan of operation of the EPI was drawn
in 1978.
The World Summit for Children of September, 1990,
Lessons learnt from this implementation included:
held in New York was attended by Nigeria's Military
Lack of community participation
Vice-President. This summit attended by 71 heads of
Lack of funds
states and government set targets to be achieved in the
Frequent power failure affecting the cold
following areas for child's health:
chain
Eradication of polio
Political instability resulting in numerous
Elimination of neonatal tetanus (by 1995)
strikes by health professionals.
90% reduction in measles cases and a 95%
reduction in measles death to pre
The revised EPI in 1984 took cognizance of some of
immunization
these factors in particular improvement in the cold
Halving child death caused by diarrhoea and
box technology. The Federal Government ensured
25% reduction in incidence of diarrheal
regular supply of vaccines and it is on record that in
disease
1990 Nigeria achieved 80% vaccination coverage.
One-third reduction of deaths caused by
Nigeria has expanded the immunization to include
acute respiratory infections
HBV, yellow fever under the National Programme on
Elimination of guinea worm
Immunization (NPI).
Elimination ofVitaminAdeficiency
Reduction of low birth weight
Promotion of growth monitoring
National population policy for development
Nigeria's attempt in actualizing these goals yielded
In the 1980s demographic data revealed among other
below expectations except for Vitamin A
things high infant mortality rate among the low
fortifications and iodine salt.
socio-economic group, and high fertility rate. The
Federal Military Government reasoned that:
Odds against survival
Empirical evidence from economically well
There had and still are many odds against survival
nations showed that family planning was a
of the Nigerian child. These include poor health
motivator for high child survival.
status revealed by poor health and social indicators:
Fig. 1
Emancipation of women through few numbers of
IMR and U5MR from 1960 - 2006
children will provide these women more
30 0
U5MR
opportunity to pursue formal education which
25 0
will afford them opportunity to get gainful
employment, and therefore empower them to
20 0
IMR
look after their children better.
15 0
10 0
It therefore declared four children per mother . This
MDG 71
declaration did not gain acceptability nationwide.
50
0
Nigerian Government formulated a refined
1960
1970
200 3
2004
2005
2006
population policy in 2001 after the Cairo
International Conference on Population and
Years
Development.
The policy states inter alia “ That
Health Indicators Infant Mortality Rate
couples
have
rights
to
decide
freely
and
o High under five mortality rate
responsibly the number, spacing and timing of
o High maternal Mortality Rate
their children and to have the information and
o Low life Expectancy
means to do so, the rights to make decisions
Social Indicators
concerning reproduction free of discrimination,
o High rate of Population growth
coercion and violence as expressed in human
o Low gross Domestic Product
rights document” ( principle 7.3 of ICPD POA).
This policy incorporates reduction in both mother
o Low adult Literacy rate by gender
and infant morbidity and mortality.
Provision of Essential and Utilization Health
Care Indicators
o Inadequate water supply
o Low access to health facilities
o Low immunization coverage
o Poor prevention and control of epidemic
5
Other factors militating against child survival include
Table 1: from Federal Office of Statistics depicting
political instability, poverty etc.
poverty trend in Nigeria 1980 - 1996
Poverty
Year
Poverty
Estimated
Level(%)
population
Population at
Nigeria is a land of paradox rich in oil and minerals.
Million
Poverty million
The World Bank Report in 2000 titled “2000 Bank
Atlas” ranked Nigeria as the 12 poorest country in
th
1980
27.2
65
17.7
the world with GNP per capita of 740 dollars at 1998,
placing Nigeria in the category of ABSOLUTE
1985
46.3
75
34.7
POVERTY ( fig 2). This report was in tandem with
Federal Office of Statistics records captioned in table
1992
42.7
91.5
39.2
1 below showing the magnitude of poverty.
1996
65.6
102.3
67.1
Fig 2: Trend of Per Capita Income for Nigeria (1981 - 2006)
Source: World Bank
In the 1960s agriculture was the main stay of
Nigeria's economy. There was a dramatic increase in
oil prices in 1973 - 4. Between 1981 and 1984 oil
Conclusion
price collapsed when Nigeria became over dependent
on oil. StructuralAdjustment Programme was a child
Paediatric services in Nigeria started at Nigeria's
of the external shock of oil policy. Food production
Independence following similar pattern with that of
stagnated at around 3% lower than population growth
Europe. Despite various Administrations efforts at
rate of 3.02%.
improving child health care the journey so far has
remain unimpressive.
Several factors such as
Low income accelerates level of poverty, food
poverty, political instability, have contributed
becomes unaffordable to the majority of the
significantly to poor measurable health indicators in
populace.
Malnutrition in childhood becomes
Nigeria. The rest of current situation and solutions
rampant. Now it contributes over 50% of causes of
will be taken by subsequent speakers.
childhood deaths.
I thank you warmly.
6
References
1. James P. Grant. Beyond
5. Abdurahman MB. Paediatric
8.
Yakubu AM, Ifere OAS,
Child Survival, Towards a
Medical Education in Nigeria
Ogala WN, Aikhionbare
World that Truly cares. Rode
Recollection, Reflection, and
HA. Awareness and use of
Janeir Brazil, 7 Sept. 1992.
Reappraisal. Faculty of
Salt Sugar Solution in the
2. Fed. Republic of Nigeria
Paediatrics Lecture National
Management of Diarrhoea
National Reproductive
Post graduate Medical
disease in a Rural
Health Policy and Strategy
College of Nigeria, 1989.
Community of Ikara. Nig.
FMOH Abuja, 2001.
6. Olukoye Ransome Kuti. That
Med. Pract. 1995;30:11-4.
3. National Child Health
our children will not die Part
9. Schram R. History of
Policy. FMOH Abuja Dec.
II Lagos University Inaugral
Nigerian Health Services.
2006.
lecture series.
Ibadan University press
4. Okehialam T C. Reflections
7.
Yakubu AM. The Impact of
1971.
on four decades of
ORT in some northern parts
Paediatrics and Child Health
of Nigeria. Paper presented at
in Nigeria. Faculty of
the Annual General Meeting
Paediatrics Lecture National
and Scientific Conference of
Post graduate Medical
Paediatrics Association of
College of Nigeria, 2001.
Nigeria, Onitsha, 1989.