The Institute of Maternal and Child Health is the only one of its type in Nigeria. It was established to provide services that will improve maternal and child health indices in the Niger Delta region. The Niger Delta Region covers mainly the South-South geopolitical zone with 6 States (Akwa Ibom, Bayelsa, Cross River, Delta, Edo and Rivers), the South-East Zone (Abia and Imo States) and Ondo State in the South-West giving a total of nine States. The Region comprises 185(23.9%) of Nigeria’s 774 Local government Areas with a total population of 31,225,367 (22.3%). Fig. 1 and Tables 1 and 2 below show the coverage area of the Institute and their population distribution. Access to the communities in the Niger Delta is difficult because of the terrain and the need to use mainly water transportation. The health indices in the region are among the poorest in Nigeria with poor access to health services and health care seeking behaviour for mothers and under-fives being very common(NDHS 2008). These poor indices highlight the need to focus on strategies that will contribute to their improvement and the attainment of the Millennium Development Goals and other national health goals.
THE INSTITUTE OF MATERNAL AND CHILD HEALTH AND ITS MANDATE
The Senate of the University of Port Harcourt at its 269th Extra Ordinary meeting held in September 2002 approved the establishment of the Institute of Maternal and Child Health with the following objectives:
•To undertake research into the area of reproductive health in communities in the Niger Delta and to disseminate results of such research through seminars, conferences, etc. Top priority here will be given to improving perinatal outcome in these and other communities within the entire Niger Delta.
•To identify factors that are responsible for maternal deaths in the Niger Delta and to take appropriate actions to ameliorate these factors
•To critically examine problems of adolescent education and health in communities in the Niger Delta with a view to improving their aptitude to productivity.
•To provide basic data on the nutritional status of under-five children in communities in the Niger Delta with a view to planning informed intervention strategies within the area.
•To rejuvenate the School Health Programme in communities within the Niger Delta with the aim of highlighting the pivotal role of primary and secondary schools in inter-sectoral collaboration in the given communities.
•To provide facilities for training for undergraduate and post-graduate health care personnel.
Following this approval the Institute became functional from 2005 and has since been involved in activities aimed at fulfilling its mandate.
The members of staff deployed from the Administrative Unit of the University stay longer in the IMCH while the academic staff are deployed for periods of 1-2 years from different departments. The current members of staff are:
Prof.Alice Nte -Director and Consultant Paediatrician(outgoing- awaiting replacement)
Dr.Vaduneme Oriji-Obstetrician and Gynaecologist, Lecturer I and Research Fellow
Dr.Augustina Okpere-Paediatrician, Lecturer I and Research Fellow
Mrs.Eme Asuquo-Pubic Health Specialist, Lecturer II and Research Fellow
Non Academic staff
Mr. Matthew Temple-Administrative Officer -deployed in 2008
Mrs. Ruth Odigi-Typist-deployed in 2008
Mrs. Blessing Owhonda-Caretaker-has been a foundation member of IMCH
Mr. Johnson Onwukwe-Caretaker-has been a foundation member of IMCH
Mr. Inemesit D. Udourom-Driver –employed in 2009
Previous Research Fellows:
Dr. Preye Fiebai-Consultant Obstetrician and Gynaecologist- Lecturer I
Dr. Dorka Awi- Consultant Paediatrician and Lecturer I
March 2008-Feb. 2009
Dr. Tamunoemi Nyengidiki-Consultant Obstetrician and Gynaecologist- Lecturer I
Dr. Gracia Eke- Consultant Paediatrician –Lecturer I
Dr. Mezie- Okoye Consultant Community Physician-Lecturer I
March 2009-Feb 2010
Dr. Rosemary Ogu-Consultant Obstetrician and Gynaecologist- Lecturer I
Dr. Balafama Alex-Hart- Consultant Paediatrician –Lecturer I
Dr. Bliss Moore- Lecturer II –Community Medicine Department
March 2010-Feb 2011
Dr. John Ojule-Consultant Obstetrician and Gynaecologist- Lecturer I
Dr. Tamunopriye Jaja- Consultant Paediatrician –Lecturer I
Dr. Foluke Adeniji- Senior Lecturer- Community Medicine Department
THE ADMINISTRATIVE STRUCTURE OF THE INSTITUTE
The Senate approved the following administrative structure for the Institute:
Organisational structure of the Institute
The Institute is established to operate as a directorate under the leadership of the Director. The functional activities of the Institute are to be undertaken in five main sections; namely academic/research and laboratory services, training, non-therapeutic and field services; the nutrition education/ rehabilitation unit (NERU) and the Nursing services. These main sections are yet to be established for reasons such as staffing, funds, space, etc.
THE ACTIVITIES OF THE INSTITUTE
The Institute, to actualise its mandate, has carried out the following activities:
Training of manpower:
The Institute has been involved in capacity building for programmes related to maternal and child health within and outside the Niger Delta. Examples of such trainings include:
•Training on Kangaroo Mother Care for Community Health Workers at Gokana local government area – a three day workshop held from 4thto 6th July, 2005 and sponsored by the Shell Petroleum Development Cooperation (SPDC) in collaboration with the Institute of Maternal and Child Health, University of Port Harcourt, Port Harcourt.
•Two Training of Trainers course on Combined Breastfeeding Counselling and HIV and Infant Feeding Counselling for the States in the UNICEF’s A Field Office and Delta and Edo States in August and September 2007(funded by UNICEF). This produced a core of trainers for 12 States.
•Training of the University of Port Harcourt Teaching Hospital Staff on HIV and Infant Feeding Counselling and Breastfeeding Counselling in collaboration with the BFHI Committee of the University of Port Harcourt Teaching Hospital-2007
•The Training of Trainers’ Course on Community Based Care for Mothers and Newborns for the A Field Office States in August 2008 (Funded by UNICEF). This training produced a core of trainers for the ten States in UNICEF A Field Office.
•Training of Community Health Extension Workers and Gokana LGA PHC staff on Home Based Care for Mothers and Newborns for the implementation of the West African Health Organisation’s Demonstration Project- January-May 2009.
•Training of UPTH staff onBreastfeeding and Lactation Management in collaboration with the BFHI Committee-September 2009.
•Capacity building for the Research Fellows through their involvement in different activities- e.g. proposal writing, development and implementation of different researches, paper presentation skills, etc.
•Maintenance of a library on maternal and child health
Education on different aspects of maternal and child health:
The Institute, in collaboration with the Rivers State Television Authority, Africa Independent Television, Nigeria Television Authority and Treasure FM Radio Stations has continued to enlighten the public on a number of health related issues such as immunisation, breastfeeding, maternal, newborn and child morbidities and mortalities. Currently, the Institute, in partnership with the Rivers State Television Authority, is running a television programme series tagged Consult your Doctor- the programme seeks to improve the health care seeking behaviour of the public, especially with reference to maternal, newborn and child health.
Advocacy meetings with stakeholders in health:
The Institute has carried out advocacy activities in health especially in Rivers State. These include meetings with the Commissioners of Health and Women Affairs, Permanent Secretaries (Ministries of Health and Women Affairs), Programme Managers in the Ministry of Health,Gokana LGA Council and the Council of Chiefs in Bodo, B’Dere, K’Dere, Mogho and Nwebiera communities in Gokana LGA.
In collaboration with the West African Health Organisation, the Institute organised a Stakeholders’ Meeting in August 2008 in Rivers State to discuss issues related to maternal, newborn and child health and the integration of Community Case Management of Childhood Illness into the West African Health Organisation’s Demonstration Project. During these meetings, different Programme Managers in the Ministry of Health committed themselves to integrate their work to improve the output of their services.
The Demonstration Project:
In 2005, the West African Health Organisation visited the Institute of Maternal and Child health and urged her to adopt a community for the modelling of best practices for improved maternal and newborn health. The K’Dere Primary Health Centre and Bodo General Hospital were selected as the primary and secondary health facilities for the project while the University of Port Harcourt Teaching Hospital would serve as the tertiary centre. These sites were visited and evaluated. The general objective of the Project was
To decrease maternal and perinatal mortality through the improvement of access to care in general and in particular to improve access to skilled attendance at delivery through the implementation of the community linkage programme at these target community centres.
The specific objectives were:
•Strengthen Health workers’ capacity through competence based approach to address the requisite health needs at this level of care.
•Support sustained Advocacy and media interventions over a drawn out period in this strategy to effect reproductive health behavioural change in these targets
•Equip personnel with the relevant skills to access the communities
•Provide the specific deficient equipments and basic laboratory tools to community centres-This level should be equipped with the skills to offer Basic emergency obstetric and newborn care (BEONC) services.
•Promote Community mobilization and support / education activities for:
Community outreach Antenatal care activities (focused ANC/ including Birthing Preparedness, Repositioning of Family Planning; Prevention of STIs and HIV
Organization of Emergency Obstetric and Newborn Care
Community transport mechanisms
Community audit mechanisms (maternal/perinatal mortality enquires)
Community Health insurance Schemes
Community communication systems, that include the process of Behavioural change communication (BCC)
Ensure stimulation of interests of the secondary and tertiary health care providers in the provision of the needed partnership to sustain the linkage programme.
The implementation of the Demonstration commenced in five communities in Gokana LGA-Bera, Bodo, K’Dere, Mogho and Nwebiera in August 2008 with the launching of the Project. The implementation involved advocacies to community leaders and health workers, the needs assessment of the facilities, facility supportwith equipment and renovation and capacity development for health staff at the Primary and secondary health care levels in the LGAon Home Based Care for Mothers and Newborns. The monitoring and evaluation of the project demonstrated its impact on the target communities with improved utilisation of the health services, early detection and referral for danger signs and increased commitment to health care delivery. These findings were confirmed during the one year review meeting held with the stakeholders in August 2009. A follow-up advocacy meeting held with religious leaders to solicit their support in encouraging their members to use health services for maternal and newborn health care has also yielded positive results. The Project, initially scheduled for a scale up to other communities in Gokana LGA has ended because the funding period is over. The LGA is however expected to sustain the activities of the Demonstration Project which have been shown to impact on their health services.
Currently arrangements are being made to start the implementation of the Project in Andoni LGA.
The School Health Programme
To rejuvenate the School Health Programme in the catchment States the Institute has done the following:
a. Organisation of stakeholders’ fora on School Health Programme: Two stakeholders’ fora on School Health Programme (SHP) were held in April and May 2009 for participants from the Niger Delta States. Following these meetings sponsored by the Rivers State Ministries of Health and Women Affairs, the University of Port Harcourt and the University of Port Harcourt Teaching Hospital, Nigeria Liquefied Natural Gas(NLNG), Shell Petroleum Development Company Ltd (SPDC), Bayelsa State Ministry of Education and individuals, materials to promote the sustainable implementation of SHP were distributed to the States. Some States have bought into the programme- e.g.in Delta State SHP implementation has commenced in selected schools and sites; in Abia State, a Medical Officer was appointed to coordinate SHP.
b. Promotion of medical examination for school children and staff: The Institute developed and distributed prototype medical examination forms for the students and staff at school entry and employment. These are being adapted for use in some of the States.
c. Creation of awareness on Child sexual abuse and violence among school children: this was a television enlightenment programme supported by the Rivers State Television Authority.
d. Conduct of research on bullying in schools: This is an ongoing programme aimed at determining the burden of bullying, the types, risk factors, its impact on the school child and how to prevent/reduce it. The findings are expected to be used to develop Information, Education and Communication materials on bullying for use by the school population. The pilot survey was conducted in July 2010 and the full survey is scheduled for January 2011.
e. Advocacy for the establishment of multisectoral school health programme committees in target states: The Institute has continued to advocate to the States for the establishment of a multi-sectoral School Health Programme Committee.
f. Advocacy for the involvement of women groups in School Health Programme: Proposal for the sensitisation of women groups on their roles inthe sustainable implementation of School Health Programme has been submitted to Rivers and Abia State Ministries of Women Affairs for joint implementation.
Researches on maternal and child health issues in the Niger Delta Region:
The Institute has coordinated a number of research projects for data collection on maternal and child health in the region. Data collection is ongoing and preliminary reports have been presented at different national and international conferences. These research works include:
•A survey of the current practices of Traditional Birth Attendants in Gokana LGA-This confirmed that with or without training, traditional birth attendants could not offer skilled delivery services and therefore should not be included as caregivers for mothers and their newborns.
•Birth Defect Surveillance-This Institute coordinatedmulti-departmental activity maintains surveillance on birth defects to identify possible risk factors. Data on affected children are collected, collated and analysed. Preliminary analysis indicates that pre-natal alcohol consumption by women of child bearing age is the strongest potential risk factor in the development of birth defects in the Niger Delta. The following papers have been presented from these surveillance data:
Pattern of birth defects in newborn babies seen at the University of Port Harcourt Teaching Hospital Nigeria: Do environmental factors play a role? Presented at the Birth Defects meeting in Brazil July 2007.
Pattern of birth defects in neonates seen at the University of Port Harcourt Teaching Hospital, Nigeria presented at the Paediatric Association of Nigeria’s Annual General and Scientific Meeting held at Lagos, January 2008.
A survey of risk factors during pre- and post- conception periods in mothers of babies with birth defects seen at the University of Port Harcourt Teaching-accepted for presentation at the 1st Central and Eastern European Summit on Preconception Health and Prevention of Birth Defects-August 27-30th 2008.
Additionally a Cleft Palate Team which in collaboration with the Smile Train has been established. This team has led to increased repair rates for persons with cleft defects from the Niger Delta.
•Studies on maternal and newborn health in Gokana LGA using the Demonstration Project implementation-Data collected for 3 years (2008-2011). Data collection suspended because of security threats in project site
•Studies into the problems of violence and bullying in secondary schools in Rivers State. Pilot study concluded- State level survey still pending
•Research into the problems of adolescent reproductive health using the following research titles:
A study on teenage pregnancies at the University of Port Harcourt Teaching Hospital
Utilisation of family planning services of the University of Port Harcourt Teaching Hospital by teenagers
A Study on the Knowledge, Attitudes, Belief and Practices concerning utilization of family planning services by teenagers amonghealth workers at the University of Port Harcourt.
A Study on the Knowledge, Attitude, Belief and Practice of family planning services among teenagers in Port Harcourt
The Institute has collaborated with a number of partners in her activities. These partners have provided different levels of support. Examples of such collaborations and the activities involved include:
•UNICEF:-the Finalisation of the documentation for the Community Based Information System in two states in the A field Office States of UNICEF in March 2008
•The Federal Ministry of Health:-The review the final draft of the Communication Strategy for the Implementation of Community IMCI (CIMCI) in Nigeria, in October 2008.
•The West African Health Organisation (WAHO), Federal Ministry of Health and the Rivers State Ministry of Health and Women Affairs:
The WAHO Project Demonstration at K’Dere in Gokana LGA from 2005 to date-
Stakeholders’ meeting for the improvement of maternal and child health services in Rivers State in August 2008
Stakeholders meeting on Repositioning Family Planning in Rivers State-this was held at the Nigerian Bar Association Law Centre in Port Harcourt on 7th November 2008. The establishment of the Advocacy Committee for the Repositioning of Family Planning in Rivers State was facilitated by the Institute. The Committee made a press release titled Implementing the Rivers State Reproductive Health Services Law will save the lives of mothers and children- in the Hard Truth of November 13-19th 2008.
WAHO has agreed to fund the scale up of the Demonstration Project to Andoni LGA from 2012. It is awaiting the completion of the Memorandum of Understanding with the LGA by IMCH.
•Other State governments: The Institute has been collaborating with the governments of the Niger Delta States in activities related to maternal and child health. The Institute is in the process of finalising the Memorandum of Understanding for the implementation of the Demonstration Project in Andoni LGA.
•Other partners- The Institute has partnered with the following Multinational companies -the Nigerian Liquefied Natural Gas and the ShellPetroleum Development Cooperation. The Institute and the Rotary Club of Uniport are finalising arrangements for the implementation of strategies for improved maternal and child health indices in Emuoha, Ikwerre and Obio Akpor LGAs(Proposal has been submitted to Rotary for implementation).
Prof. Alice R. Nte
Institute of Maternal and Child Health,
College of Health Sciences,
University of Port Harcourt,
P.M.B.5323 , Choba,