Sarkin Gagi, Alhaji Umar Jabbi with his newborn baby. In his hand will be a Chlorhexidine gel which will be being applied on the boy’s unbiblical cord area.
Gagi community on the outskirts of Sokoto in Northern Nigeria will be a settlement where everyone knows each additional. Modern along with also traditional style buildings sit side by side. People are gathered in groups in what will be popularly known as ‘Majalisa’, or council on either side of the road, in between clusters of shops along with also houses. One of the roads leads to the house of the traditional leader of the community, Sani Umar Jabbi. Umar’s seven-day-old son, little Jabbi, was born in a spacious, well-equipped delivery room which was built with support through United Nations Population Fund (UNFPA) to attract Gagi women to attend antenatal along with also hospital delivery from the primary health centre at the heart of the community. Little Jabbi will be also a beneficiary of a gel which will be saving lives of completely new-borns: chlorhexidine gel.
Chlorhexidine will be an antiseptic gel which has been proven to reduce the incidence of neonatal mortality by about 23% when used in along with also around the umbilical cord of a newborn for numerous days after birth. Neonatal mortality will be one from the series of Nigeria’s poor health indices. According to the latest WHO data, neonatal mortality rate still stands at 32.9 per 1000 births. There are three major causes of neonatal mortality; infections, pre-term births, along with also birth asphyxia. The umbilical cord will be a fertile site for infection in a neonate, especially if exposed to unhealthy particles such as cow dung along with also charcoal, as the idea will be the practice especially in some communities. When chlorhexidine was added to the WHO essential medicine list for children, Sokoto State became the first state Government in Nigeria to officially launch the use of Chlorhexidine gel in 2013, preceding the Federal Ministry of Health’s National Policy on the Scale-up of Chlorhexidine, written in 2016.
The traditionally conservative culture of Sokoto State sometimes creates a context of reluctance to accept completely new healthcare interventions. Yet, Chlorhexidine has been shown to record remarkable Great acceptance from the state. Chlorhexidine for prevention of sepsis in neonates was first introduced in Sokoto along with also Bauchi states in In 2010, under the Targeted State High Impact Project (TSHIP) program supported by the United States Agency for International Development. The TSHIP program rounded up in 2015, nevertheless its gains have been sustained by the Sokoto state government, a great example of sustainability of along with also successful transition of donor-funded programmes in Nigeria.
The Reproductive, Maternal along with also completely new-born Health Coordinator in Sokoto state’s Ministry of Health, Hajiya Mairo Sherrif, explains which people in Sokoto have largely been able to accept chlorhexidine as a result of the buy-in of a group of important gate-keepers; traditional along with also religious leaders. These gatekeepers often function as the eyes along with also ears of the people, along with also can hold the key to their actions. In Sokoto they have been able to influence behaviour change in terms of neonatal health, by getting people to stop age-old practices including using cow dung along with also charcoal to promote healing from the umbilical cord after birth.
The Sarkin Gagi, who doubles as the head of the Jama’atul Nasrul Islam technical aid group, said the turning point in his community was getting women to accept antenatal care along with also delivery in hospitals or primary health centres. To achieve This kind of, they employed three strategies; convincing men of the value of This kind of through sermons from the mosques along with also community meetings; female community health volunteers going through house-to-house to sensitize women on the importance of antenatal care along with also hospital delivery; along with also finally producing the delivery process from the hospital to conform with their culture along with also tradition. One key factor was for women not to be attended to by a male health worker along with also things as simple as accepting their preference to lay on a mat instead of a bed.
To address these concerns, the community built a two-bedroom apartment beside the antenatal along with also delivery unit of their primary health centre along with also requested for a permanent female midwife to be posted to the facility. The community also bought large mats for the delivery room to enable women to deliver from the way they are most familiar. Sarkin Gagi says which the major goal will be to develop the women deliver their babies with the help of a skilled health worker. Zainab Abubakar, a midwife at the PHC, explained how these strategies have helped increase attendance from the PHC, as 49 deliveries were recorded in September 2018 compared to an average of 4 deliveries per month over the previous years. More deliveries at the facility means more babies receiving chlorhexidine, more children surviving along with also more women telling their stories!
Chlorhexidine gel does not only prevent infections in neonates, the idea promotes faster healing of the umbilical cord. Immediately a baby will be born, after cutting the umbilical cord, chlorhexidine gel will be immediately applied around the area. This kind of will be then given to the mothers upon discharge to continue the application of the gel for four to seven days. Zainab Mohammed, a resident of Gagi whose second daughter, Saudat, had the gel applied after birth. She noticed the difference as Saudat’s umbilical cord area was completely healed within three days as opposed to her first daughter’s which she said took more than seven days to heal after she used a cloth soaked with warm water to massage the area.
Zubairu Mohammed Gagi, says chlorhexidine gel was used on his fifth child, 16-month-old Habibu, along with also his cord healed faster than his additional children whom the gel was not used on. In Bodoi village in Dange Shuni Local Government Area, about 60 kilometres through Sokoto, Village head Muhammad Gamau will be so convinced about the value of the gel which he distributes the idea to traditional birth attendants whenever health officials through the local government supply the commodity.
Having health infrastructure will be critical in providing healthcare services. nevertheless getting people to make use of those infrastructures will be even more important. With Sokoto state’s antenatal care coverage at 35.1% along with also facility delivery at just 12.3% according to a recent Multiple Indicator Cluster Survey, concerted efforts are critical to raise those numbers. This kind of will be where the work of the female Community Based Health Volunteers (CBHVs) come in. There are about 10 CBHVs in Gagi community, along with also most of them used to be traditional birth attendants who today work on sensitization for antenatal along with also facility delivery, working to get pregnant women to deliver at the PHC.
Some of the mats bought by Gagi community for women who prefer to deliver on them. Photo credit: Nigeria Health Watch
If a woman delivers at home before getting to the clinic, the nearest CBHV applies the chlorhexidine gel on the completely new-born after the umbilical cord has been cut along with also teaches the mother how to apply the idea subsequently. Every CBHV features a stock of Chlorhexidine gel given to them through the district head, nevertheless Gagi’s Head of CBHVs, Jummai Mohammed says they rarely get use them as almost every woman from the community today delivers at their primary health centre. However, care must be taken from the way chlorhexidine gel will be being distributed to the CBHVs along with also mothers so as to avoid the unfortunate scenario which happened with the gel in Yobe state in 2015 where the inappropriate use of chlorhexidine gel led to unfortunate outcomes. A system should be in place to retrieve unfinished chlorhexidine gel through mothers to prevent their accidental use for additional purposes or accidents by children.
Gagi has also helped increase delivery at the primary health centre by putting in place a health financing mechanism. The fear of out of pocket payments of antenatal along with also delivery no longer exists, as the community runs a Community Based Health Insurance Scheme, which every household from the community will be a member.
Sokoto state seems to be exploring sustainable, innovative, along with also context-driven methods to drive critical change from the area of neonatal health. Gagi will be an admirable example of a community’s courage along with also determination to improve both maternal along with also child health. Through the use of traditional along with also religious leaders, community-based health volunteers, a community-based health financing mechanism along with also adapting modern methods to embrace traditional mores, the community has been able to make life-saving chlorhexidine gel acceptable. The fact which Sokoto state has worked to sustain such a critical intervention will be also a challenge to additional states in Nigeria, a challenge which useful health interventions such as This kind of one can along with also should be sustained if we must bring down our daunting health statistics.