First 1000 Days Of Life: How to lay foundation for health, well-being

Women with their babies
Women with their babies

Child mortality has risen in Nigeria in the past few years, despite efforts to combat the menace. The rate measured at 87 per 1000 births in 1990 rose to 100 per 1000 in 2003.

According to a publication by WHO, under-five mortality ratio in Nigeria is 201 per 1000 live births; meaning that one in five Nigerian children never live up to five years. Infant deaths, which account for half of the child mortality, have increased from what they were in 1990. With a 13 per cent immunisation rate for children between 12-23 months, Nigeria has the lowest vaccination rate in Africa.

The Multiple Indicator Cluster Survey (MICS) 2016-2017 also provides a graphic picture. The survey, the most comprehensive by the Nigerian government and other health partners, shows that Nigeria has 39 per 1,000 of neonatal mortality rate, 31 per 1,000 post-neonatal mortality rate, 70 per 1,000 infant mortality rate, 54 per 1,000 child mortality rate and 120 per 1,000 under-five mortality rate.

Rates in the MICS are expressed as death per 1000 live births, except in the case of child mortality, which is expressed as death per 1000 of children surviving to age one, and post-neonatal mortality, which is the difference between infant and neonatal mortality rate.

The survey revealed that child mortality remains high in Nigeria. This can partly be explained by the low numbers of births occurring in health facilities or attended by trained healthcare service providers.

In 2003, two third of childbirths in Nigeria occurred at home. In addition, only slightly more than one-third of births are attended by doctors, nurses, or midwives.

It is thus apparent from the elevated mortality rates that the lack of access to or use of quality delivery services should be of immense importance to Nigeria.

Aside the needed improvement in these services, much can be done in the first 1000 days of life to ensure not just survival of infants but also their well-being long afterwards.

According to authorities, the first 1,000 days on earth, spanning between conception and second birthday is a unique period for laying the foundations of optimum health, growth, and neurodevelopment, based on nutrition and immunisation.



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Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information and the support of their family, the health care system and society at large.

Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the new-born, and feeding should be initiated within the first hour after birth.

Exclusive breastfeeding (breast-milk) is an important source of energy and nutrients in children aged six–23 months. It can provide half or more of a child’s energy needs between the ages of six and 12 months, and one-third of energy needs between 12 and 24 months.

It is also a critical source of energy and nutrients during illness and reduces mortality among children who are malnourished. Children and adolescents who were breastfed as babies are less likely to be overweight or obese.

Longer durations of breastfeeding also contribute to the health and well-being of mothers: it reduces the risk of ovarian and breast cancer and helps space pregnancies–exclusive breastfeeding of babies under six months has a hormonal effect which often induces a lack of menstruation.

Exceptionality in feeding

Families and children in difficult circumstances require special attention and practical support. Wherever possible, mothers and babies should remain together and get the support they need to exercise the most appropriate feeding option available.

HIV can pass from a mother to her child during pregnancy, labour or delivery, and also through breast-milk. The evidence on HIV and infant feeding shows that giving antiretroviral treatment (ART) to mothers living with HIV significantly reduces the risk of transmission through breastfeeding and also improves her health.

Mothers living in settings where morbidity and mortality due to diarrhoea, pneumonia and malnutrition are prevalent and national health authorities endorse breastfeeding should exclusively breastfeed their babies for six months, then introduce appropriate complementary foods and continue breastfeeding at least for two years.


Immunisation is one of the most essential public health interventions and a cost-effective strategy to reduce childhood morbidity and mortality.

Vaccine-preventable diseases remain the most common cause of childhood mortality with an estimated three million deaths each year.

Childhood immunisation is the initiation of immunity through application of vaccines. It is considered important for improving child survival. Although about three quarters of the world’s child population is reached with the required vaccines, only half of the children in Sub-Saharan Africa get access to basic immunization, data shows.

Children below age two are vulnerable to illnesses due to weak immune system. They should be regularly immunised with booster doses especially of polio and measles during the national or sub-national immunisation days. In Nigeria, vaccination is given on routine and outreach bases.

Immunisation Schedule For Mothers, Babies

According to the Expanded Programme on Immunisation (EPI), a routine vaccination schedule for children is given in Nigeria, starting from birth, and is completed before one year of life. BCG and OPV0 are administered at birth, while three doses of OPV and pentavalent vaccines (which protect against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B diseases) are given at a four-week interval – at six, 10 and 14 weeks, and measles vaccine is given at the age of nine months.

However, aside from the EPI, some states have invested in the State Immunization Plus Days programme (SIPDs) to enhance the coverage of the immunisation from birth to five years, to reduce child mortality.

Experts speak

Adesoji Abiona, a lead paediatrician at the Adeoyo Hospital, Ibadan in Oyo State, said the “first 1,000 days on earth is the foundation for the baby’s optimum survival”

“Exclusive breastfeeding is a major way to build the baby’s immune system against infectious diseases. Mothers’ nutrition matters a lot as well because a malnourished mother might not have the complete nutrient in the breast milk for the baby to suck,” he said.

He added that many mothers are working class, so after six months they introduce their babies to complimentary or family diet, which include mashed yam and mashed potatoes.

He said there are exceptions in the recommendation of breastfeeding. If the mother is on drugs or is suffering from a sickness like cancer, HIV among others, this can hinder the baby being breastfed.

Tavershima Adongo, a medical doctor with the Premium Times Centre for Investigative Journalism, said “the first 1000 days is the period of development in a baby when both the mental and physical part develops.

“The mother’s breast milk contains more nutritional elements than any other substitutes,” Mr Adongo said. He added, however, that during the weaning period, food with enough nutritional element should be given to the baby to compliment the breast milk.

(Materials for this report sourced largely from: )


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