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Lagos — Despite some progress, Nigeria is lagging behind its peers in reducing deaths among children under five. The mortality rate remains worryingly high for newborn infants - 700 children less than 28 days old die in the country every day.

Nigeria has made progress in reducing deaths among children under five. Though there is still a long way to go to meet Millennium Development Goal targets, the mortality rate for this age group has fallen by about a fifth since 1990.

A new report published by Nigeria's Ministry of Health however acknowledges that the mortality rate for children has fallen by about a fifth since 1990, but this progress has been unevenly spread - with important implications for health policy.

Saving newborn lives

The report, titled "Saving Newborn Lives in Nigeria", finds that each year, 241,000 babies die within a month of being born.

"Several factors are responsible for this," says Dr Abimbola Williams of international NGO Save The Children, which was a partner in the research. "Poverty has a big role to play. Many families cannot afford the services at the health facilities which are sometimes not even there, and where you find them, the quality of service is so low."

A first edition of the study was published in 2009; the latest report significantly updates the findings with new nation-wide data that shows a wide variation in mortality rates between urban and rural areas.

Dr Azebi Korikiye, who has spent several years working as a doctor in rural areas, says pregnant women outside urban centres face major disadvantages.

"People in the rural areas are far away from health facilities, unlike those in urban areas. Pregnant women in rural areas are less likely to attend antenatal clinics and they are more likely to end up in the hands of untrained traditional birth attendants."

More than one-half of the 700 newborns who die each day in Nigeria, do so at home. Nearly two-thirds of women give birth at home in Nigeria, according to the country's 2008 demographic and health survey.

Despite the known risks, there has not been a significant increase in the proportion of births which take place in health facilities.

Policy and practical changes needed

Save the Children's Williams is optimistic that the newly-published report can help guide Nigeria towards achieving its goal of reducing child mortality.

"You need this kind of data to plan. You also need it to have a shift in policy. It will help us focus on the necessary interventions."

Nigeria has under-performed compared to other countries in Africa. Despite per capita incomes of less than $500 - a third that of Nigeria - Burkina Faso, Uganda and Tanzania have newborn mortality rates of less than 35 per 1,000 live births. Nigeria's under-five mortality rate is 157 per 1,000 live births.

The country's rate of improvement also lags behind - the likes of Cameroon and Kenya Cameroon and Kenya have reduce newborn deaths by around 40 percent over the past decade; Nigeria's rate has dropped too, but by only 15 percent.

Williams says the first edition influenced a major shift in health policy in 2009, steering government towards a renewed focus on newborns.

"The government developed the Integrated Maternal, Newborn, and Child Health strategy - it was the first time that the government singled out newborns as a critical area to focus on," she said.

But Azebi says beyond formulating policies at the national level, the Nigerian government must ensure that state authorities implement them.

"Some of the hospitals run by the state governments are no better than mortuaries," he says "The federal government should monitor them effectively so as to enforce standards," he says.

Save the Children is calling on the government to meet its 2001 pledge to allocate 15 percent of the national budget to health. The organisation is also advocating the use of local data to guide decision-making, training to improve community practices around childbirth, the promotion of better management of newborn infections, and of interventions like kangaroo care - where low birth weight babies benefit from skin-to-skin contact with their mothers: especially useful where incubators and regular power supply are absent.

Representatives of professional associations of obstetricians, paediatricians and midwives have responded to the study with a stated commitment to improving communication and colalboration amongst themselves, and supporting advocacy, data collection and task-shifting to make best use of available personnel.

The country's health ministry has pledged to create a specific budget line for newborn care. Newly-designated resources will go to support training at the community level, six regional centres to promote care of low-birth-weight infants, among other things. The ministry has also pledged to report on progress annually.