Pediatric Public Health: How much are we doing for the children?

Whenever I start to think about pediatric health care in Nigeria, my thoughts quickly veer toward obstetrics, neonatal care and immunization. The host of baby formula and child immunization campaigns has seen some success, evident in the steady improvement in infant mortality rates. UNICEF statistics indicate that Under-5 mortality rates in Nigeria have declined by 35% since 1990 and by 27% since 2000. In addition, about 74% of routine vaccines were funded by the government in 2009. These numbers, although far from being perfect, suggest that we are moving in the right direction with infant health care.

The question then is what happens after infancy? What are these under-5 statistics hiding that statistics about different age groups (say under-10 or 5-15yrs) would expose? A recent interview with Dr. Efunbo Dosekun in The Guardian newspaper hints at inconsistencies in continuity of care for Nigerian pediatric patients. Dosekun, the Chief Medical Director at Outreach Children’s Hospital, Lagos believes that Nigeria has focused a little too much on immunization and neonatal care, what she describes as “public health initiative.” In her words,

“We seem to have forgotten that if you save a child from having diarrhea with an immunization, there are still other illnesses he/she has not been immunized against […] It makes more sense to prevent first and then put into place centers where the child can go when he/she falls sick.”

In the rest of the interview, Dosekun points out that even with our immunization programs, Nigeria’s overall child mortality statistics are dismal. One in six children does not make it to adulthood, putting us at par with many war torn countries. Of those who survive, the number that are significantly disabled as a result of childhood illnesses is staggering. The 48 year life expectancy of the average Nigerian is further testament to the fact that many children will not lead full, fruitful lives. Is this the best that Nigeria can do?