The COVID-19 pandemic is making it increasingly difficult to access adequate maternal and child care in some rural areas of Kano, thereby risking an increase in the rate of maternal and child mortality amidst lockdowns restricting movement across the State.
Although rural Kano does not have many confirmed positive COVID-19 cases, factors such as financial restrictions, psychological tendency, mobility and excesses by law enforcement operatives are obstacles faced by pregnant women and nursing mothers in a bid to get maternal health care.
Nigeria has the fourth highest maternal mortality rate in the world after Sierra Leone, Chad and South Sudan with about 914 deaths per 100,000 live births while Kano with a population of about 15million has 576 deaths per 100,000 live births and a Child mortality rate of 103 deaths per 1,000 live birth.
With the prevailing barriers in accessing care, known figures of deaths per live births are likely to increase.
The Mobility Impasse
Some pregnant women and nursing mothers who spoke to this reporter at the Mariri Primary Healtcare Center, Kumbotso Local Government Area of the State revealed that transportation among other obstacle is indeed a challenge. One of the nursing mothers who confirmed that she came from Farawa on foot, admitted that she almost gave up under the scorching sun.
Another pregnant woman who came all the way from Tudun Tsamiya on foot said, “I suffered a lot while coming especially with this fasting, I seriously felt like going back, so you can imagine the number of women who may have been put off as a result of what I endured.”
Speaking to this reporter, the Officer in charge of Antenatal Care (ANC) at the Mariri Primary Healtcare Center, Aisha Ibrahim confirmed that the rate of women coming for ANC at the center has drastically reduced since the pandemic.
“Hospital deliveries are fairly okay compared to ANC where only two out of 10 women now come for Antenatal. Mostly those that are living far away cannot make it to the hospital because of transportation issues. It is only those that stay close by, such as Mariri and Farawa, most of whom even trek to the hospital that are able to come.”
Also speaking, Aisha Ibrahim Shehu an ANC staff at the Bunkure Primary Healthcare Center confirmed that apart from the fact that more clients are consciously staying away from the public due to the Coronavirus crisis, many of them lack mobility to bring themselves to access health care at the PHC.
“Before, we use to get between seventy to eighty clients in a day but today we barely did twenty-six as reflected on our register. So because of those who are still attending, we still try to make ourselves available even during weekends.” She said.
Aisha also revealed that despite the fact that she was not the one in charge of labour, she can confirm that the facility usually takes between four to ten deliveries per day but with the prevailing COVID-19 situation they barely take two deliveries in a day.
It’s Also Psychological – PHC
While transportation is an issue, another factor that is affecting the low turn up at the PHCs, is the share fact that some clients are making up thoughts in their minds about the pandemic.
A Head of Department at the Mariri PHC, Mahmud Umar who decried the decrease in the rate of women attending ANC at the hospitals said it is not unrelated to fears by clients that they may contract the dreaded COVID-19 virus when they mingle with other patients at the hospital or the mere thought by them that primary health workers may not be at work as a result of the ongoing health sector crisis.
“Before the crisis, we use to log in between seventy to eighty attendance per day but that number has drastically reduced right now although we saw a slight increase today (Monday) and I am sure it’s due to concerted efforts in putting in place preventive measures and creating the awareness that PHCs are still fully functional.” He said
Law Enforcement Excesses
Salisu Ahmad Adamu who brought his wife for ANC at the Mariri PHC revealed that being the first time he was bringing his wife to the hospital, he faced challenges with upto five law enforcement officers who quizzed him in an embarrassing manner. “This is enough to dissuade others from coming because they sometimes hiss at you and humiliate you pleasurably.” He said.
Reacting, Bashir Abdullahi Minjibir, Primary Health Care Coordinator, Kumbotso Local Government Area who corroborated Mr. Adamu said, “People are afraid of coming out because some of the roads were closed, armed personnel are everywhere at the junctions, no mobility to convey clients and so forth but in this second week of lockdown, I think that firmness is gradually easing because with proper identification and convincing explanation the enforcement officers allow clients passage to come to the hospital.”
At the Rano Primary Healthcare Facility in Rano Local Government Area, apart from normal fluctuations in figures of clientele which is not directly related to COVID-19, women are still accessing maternal and child care in their numbers.
“All the patients we are used to getting every Monday we got them today. Our women are still coming to the hospital as usual.” Says …a Laboratory Scientist at the facility.
However, due to financial constraints, there is a limit to the kind of services they can access at the PHC.
“Unless for the financial angle because their men have to go out before they can make money. Usually when they come we run them through certain tests some requires a fee some are free some are paid for. These days, they can’t afford the ones that comes with a fee, some of their husbands don’t have the money to give them to come to the hospital because the lockdown has affected their finances. A lot of them complained today (Monday) that they don’t have money for these tests so we ran only the free tests for them. But for this COVID-19 situation we don’t usually experience this, this is the kind of situation that can be linked as an indirect effect of the virus, but attendance for ANC and other women related services is still intact.” He stated.
Probed further on the nature checks that requires a fee or otherwise, …said, “Women that comes to ANC we usually do free HIV screening for them. But others test like PCB or Urinalysis we charge a fee for that.
On how much these tests could cost that most of the women couldn’t afford it, …said, “PCB and Urinalysis for example just cost only 100 naira but despite its not much they always complain that their husbands earn daily wages as a result of which they don’t have money now due to the lockdown. Although there are some exceptional cases we compromise and help them out with some test just to save dire situation.”
As far as taking birth delivery goes, …confirmed that birth reception is also normal. “Sometimes, we take two to three deliveries per day, sometimes none at all but this is normal since before the pandemic especially since we have a general hospital close by.”
Not Affected by Lockdowns – NPHCDC
The general public, especially parents and caregivers have been informed that all Primary Health Care Centres, PHCs, remain open throughout the country, including states with lockdown order.
The Executive Secretary and Chief Executive Officer of the National Primary Health Care Development Agency, NPHCDC, Dr. Faisal Shuaib announced this in a statement, Friday 10th April, 2020.
Dr. Shuaib, who noted that “the outbreak of COVID-19 in the country should not affect the routine services provided by the PHCs. Governments at the national, state and local levels have put in place measures for safe delivery of all Primary Care services at the PHC centres.”
He urged parents and caregivers to continue, as usual, to take their children to the PHCs closest to them for immunization, growth monitoring, antenatal care, childbirth, and all other PHC related service delivery.
Rising Above the Challenge
Despite these challenges, health authorities in Bunkure Local Government Area are refusing to allow the situation overwhelm them.
This crew caught up with the Primary Health Coordinator of Bunkure Local Government Area, Sani A. Muhammad Burum Burum during a routine Immunization (RI) meeting with a team of health workers at the Council’s secretariat.
Mr. Burum Burum explained that the (RI) usually holds every month to find out solutions to gaps or lapses during previous routine immunization, noting that the main challenges they face especially under the prevailing COVID-19 pandemic is on two front.
“First, some clients use to say they are afraid whether if they come to the facility, maybe they cannot find a staff who is going to take care of their problems, once we heard this, we took a solution by telling the village heads and ward heads that the facility is open. This curfew because I can call it curfew of coronavirus, does not affect the health facilities so whoever have a problem should rush to the facility at Bunkure Local Government, they would find somebody who will take care of them.” He explained.
Speaking further, he assured that the COVID-19 situation has not disrupted their health services as they are still “seventy to eight percent” functional pointing out that the second challenge which has to do with staff mobility is being addressed.
“Though there are limiting factors such as transportation for some of our staff. Some of them are mobile, some are not. So in a situation where there is restriction of movement and a staff who is not mobile stays close by, I use to provide a means of transport like fueling a machine and sending it for pick up at their homes and when we close, we take them back. But those who are far away, we usually do not have much option so sometimes they look for lift and drop somewhere close by and call me then I send someone to pick them up. So this is basically the strategy we use to make health workers available for services at our centers.”
Speaking on the matter, Dr. Abdulaziz Tijjani Bako, a Doctoral Candidate at the Indiana University Richard M Fairbanks School of Public Health said that it is quite dangerous for those with abnormal pregnancy or even those who are not sure of the status of their pregnancy to stop attending antenatal clinics.
Elaborating further, he said, “A woman can have a condition that will predispose her to excessive bleeding before birth such as abnormal location of the placenta. Other common abnormalities in pregnancy is abnormal presentation or positioning of the baby, hypertension in pregnancy, gestational diabetes and pre-eclampsia. All these require that the pregnancy should be closely monitored so that timely intervention can be instituted before things get worse. Consequently, patients who don’t know they have this conditions because they are not coming for antenatal visits will be faced with high likelihood of experiencing dangerous complications that can result in the death of the expectant mothers.”
While lockdown is an essential strategy to curb spread of the dreaded virus, many aspect of women sexual health and reproduction are directly or indirectly endangered as they run the risk of losing their lives as a result.
It is therefore important for government to re-evaluate lockdown protocols and allow for accommodation of certain measures that will ease the strain on women needing to access health care, while intensifying, aggressively, contact tracing and isolation in order to defeat the pandemic in real time and return to normalcy.
This measures should include adequate provision of Personal Protective Equipment (PPE) for primary health workers, orientation for law enforcement operatives on how to be civil with women and their spouses on the way to accessing healthcare, provision of direct complaint channel in case of law enforcement excesses, enablement and accreditation of health transport riders with identifiable stickers on their tricycles to enable them roam and convey patients under strict adherence to precautionary measures such as wearing face masks and roaming with hand sanitizers.
There should also be concerted effort to intensify public enlightenment at grassroots level about the safety and precautionary protocols put in place at PHCs to stem community spread of COCID-19.