How an Integrated MNCH program has reduced infant and child mortality in Northern Nigera

Northern Nigeria's infant and child mortality rates have been stagnant or rising since 2005. In 2009 we became part of a partnership program to improve maternal, newborn, infant and child care in 4 Northern Nigeria states. Control local government areas (LGAs) received less-intense statewide policy changes , while the intervention zones received these state policies plus integrated interventions at primary health care posts and development of a community- based service delivery. We assessed changes in MNCH care and services by comparing data from a baseline survey of 7422 women in 2009 and a 2010 follow-up survey of 3080 women. Chi-square and t-tests document significant improvements in several maternal newborn, infant, and child care practices. Pregnant women with ANC visit during the most recent pregnancy increased from 25% to 53% in the intervention areas and 45% in the less intensive “control” areas. Those having a skilled birth attendant increased from 11% at baseline to 15% in the intervention area and 18% in the less-intense control areas. Prior to the intervention, only 40% of women had their husband's standing permission to seek health care, and this rose to 67% and 80% in the control and intervention areas, respectively. The proportion knowing multiple danger signs of pregnancy and delivery, rose from virtually zero at baseline knowing the critical danger signs of swelling, convulsion or excess bleeding to 40% knowing these danger signs after participating in the intervention.