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Why pregnant women with previous CS shouldn’t use PHCs for antenatal care

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Maternal health experts have urged pregnant women with a history of two caesarean sections to register and receive antenatal care in secondary and tertiary health facilities rather than in Primary Healthcare Centres.

They noted that pregnant women with such a history have a high-risk pregnancy and need expert care and facilities that the PHCs do not have.

The gynaecologists, in separate interviews with PUNCH Healthwise, emphasised that early antenatal registration at the appropriate centre would help to prevent delays and complications, which could be life-threatening for both mother and baby.

The reproductive health experts also urge expectant mothers with hypertension, diabetes before or during pregnancy or a history of miscarriages to register and attend antenatal care in higher-level facilities such as general and tertiary hospitals.

They urged every pregnant woman to register and attend antenatal care in registered hospitals to ensure they receive the best care and prevent avoidable complications and deaths.

PUNCH Healthwise reports that pregnant women should register and begin antenatal care as soon as pregnancy is confirmed with a positive test, ideally within the first eight to 12 weeks.

PUNCH Healthwise also reports that expectant mothers who have undergone two caesarean sections should not attempt vaginal birth to prevent the rupture of the uterus and bleeding.

Severe bleeding after childbirth is the leading cause of maternal mortality worldwide, according to the World Health Organisation.

High blood pressure disorders during pregnancy, infections and complications from unsafe abortions are contributors to maternal deaths.

The 2018 National Demographic and Health Survey puts Nigeria’s maternal mortality rate at 512 deaths per 100,000 live births.

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Speaking with PUNCH Healthwise on the matter, a professor of Obstetrics and Gynaecology at the University College Hospital, Ibadan, Oyo State, Chris Aimakhu, explained that while low-risk pregnancies could be safely managed at primary healthcare facilities, women with high risk pregnancies, including those who have previously undergone caesarean deliveries, need specialist care, which is available in general and tertiary healthcare centres.

Aimakhu said, “Every pregnant woman should access antenatal care. But those with high-risk conditions such as previous CS, hypertension or diabetes must be managed in facilities that can handle emergencies. A primary health centre does not have the capacity to perform a caesarean section. If such women are booked there, it puts both mother and child at serious risk.”

He noted that many primary healthcare centres, especially in rural communities, are poorly staffed and often run without doctors, midwives or round-the-clock services, leaving them unequipped to handle obstetric emergencies.

“In situations where a woman with a previous CS registers in a PHC, and complications arise, delays in referral may lead to avoidable maternal or neonatal deaths,” the don added.

The gynaecologist further asserted that antenatal care was not optional, lamenting that Nigeria still records high maternal mortality due to preventable causes such as postpartum bleeding and pregnancy-induced hypertension.

The maternal expert, however, clarified that not all pregnant women need to register at teaching hospitals, stating that women who register in PHCs and are in need of specialist care should be immediately referred to the appropriate centres.

“Low-risk patients can safely receive care in PHCs or secondary hospitals if those centres know what they can handle. But once a patient has a history of caesarean deliveries, she belongs to the high-risk category.

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“The key is not only access but timely access. If a facility knows it cannot handle a case, it must not keep the woman until it is too late,” Aimakhu asserted.

Also, the president of the Association for Fertility and Reproductive Health, Professor Preye Fiebai, dispelled the notion that all pregnant women must seek antenatal care in tertiary hospitals, stressing that well-equipped primary health centres can effectively manage uncomplicated pregnancies.

“Antenatal care doesn’t have to be in a tertiary hospital. If we have good primary health care, you can start from there. Ideally, the essence of primary care is to identify those who require higher care and then refer them, but most people go straight to the teaching hospital. However, you can still receive good antenatal care if the setup of your primary healthcare system is good and you have qualified people to run it, and you can start from there.

“Mind you, some people go to private hospitals also and if you can afford it, why not?” the reproductive health expert said.

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Nigeria’s ambassador-designate to Algeria, Lele, dies at 50

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The Federal Government has announced the death of Nigeria’s ambassador-designate to Algeria, Mohammed Mahmud Lele, who died at the age of 50.

The Ministry of Foreign Affairs disclosed this in a statement issued in Abuja on Wednesday by its spokesperson, Kimiebi Ebienfa.

According to the ministry, Lele died in the early hours of April 19, 2026, in Ankara, Türkiye, after a protracted illness.

The ministry described the late diplomat as a dedicated officer who served the country with distinction.

“The late Ambassador Lele, until his death after a protracted illness, was the Director in charge of the Middle East and Gulf Division in the Ministry of Foreign Affairs.

“Ambassador Lele, a career diplomat, was recently appointed by President Bola Ahmed Tinubu as Ambassador-designate to the People’s Democratic Republic of Algeria, following the Nigerian Senate’s confirmation of his nomination,” the statement said.

Born in Gamawa, Bauchi State, in 1976, Lele studied Economics at Bayero University, Kano, and went on to serve in Nigerian missions in Berlin, Lomé and Riyadh.

“Ambassador Lele was known for his intellectual depth, strategic insight and commitment to the advancement of Nigeria’s foreign policy objectives,” the statement added.

The Permanent Secretary of the ministry, Dunoma Umar Ahmed, who received the remains of the late diplomat at the Nnamdi Azikiwe International Airport, Abuja, described him as “a hardworking, humble and fine officer, who will be sorely missed by the ministry.”

The ministry added that his death “is a monumental loss not only to his immediate family but also to the entire Foreign Service community and the Federal Republic of Nigeria.”

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Lele was buried on Wednesday in Kano in accordance with Islamic rites.

The ministry extended condolences to his family, associates, and the government and people of Bauchi State, praying for the peaceful repose of his soul and strength for those he left behind.

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Governor Amuneke reveals party officials offered him dollars to alter anti-govt skits

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Comedian Kevin Chinedu, popularly known as Kevinblak, has revealed that officials of a political party offered him dollars to change his satirical skits criticising politicians and governance.

He made the disclosure on Monday in an interview on ARISEtv’s Arise 360 programme, where he spoke about the pressures facing content creators who hold public officials accountable through humour.

Chinedu, known for his character Governor Amuneke, said the approach came at a particularly vulnerable moment, shortly after his wife had a Caesarean section and he was under financial strain.

“They said they were going to change my life, that I’m earning crumbs, you know, give me dollars. They mentioned that my colleagues are in the game and all of that,” he said.

He declined to name the party, saying only that it was “Amuneke’s party”, a reference to the fictional political figure in his skits, and cautioned against any attempt to identify it publicly.

“Don’t mention names, trust me, don’t mention names,” he said.

Despite the financial pressure, the comedian said he turned down the offer, recalling how the officials had tried to lure him to Abuja with the promise of a life-changing sum.

“I had a lot of bills on my head and I just heard come, come to Abuja, let’s change your life. Dollars upon dollars,” he said.

He said he ultimately held firm, guided by a personal code he had maintained throughout his career.

“I looked at it, I said, no, I am who I am. I’ve been here for a long time, and I’ve never been in any illegal thing, and I’ve never been somewhere, you know, I’m doing something because I’m being influenced, because of money.

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“If I want to do it, it should be something I’m doing because I want to do it. So, you know, it is what it is,” he said.

When asked whether friends had urged him to accept the money, Chinedu said his inner circle was equally principled, and had themselves been approached and refused.

“I don’t have friends that are easily overwhelmed with money. I have people who have principles because they have, you know, approached them, they themselves. So, we always have that conversation,” he said.

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Over 4,600 Nigerian doctors relocate to UK in three years – Report

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Nigeria’s already fragile healthcare system is facing renewed strain as no fewer than 4,691 doctors have relocated to the United Kingdom since President Bola Tinubu assumed office on May 29, 2023, fresh data from the General Medical Council shows.

The UK GMC is a public official register detailing the number of practising doctors in the UK alongside other details such as their areas of speciality, country of training, among others.

The mass migration represents not just a human resource crisis but a significant economic loss.

With the Federal Government estimating that it costs about $21,000 to train a single doctor, Nigeria has effectively lost at least $98.5m in training investments within less than two years.

The figure put the total number of Nigeria-trained doctors currently practising in the UK to about 15,692, making Nigeria one of the largest sources of foreign-trained doctors in Britain, second only to India.

As of May 28, 2025, official records showed that the number of Nigerian-trained doctors in the UK was a little over 11,000. The figure has grown significantly since then.

The exodus of doctors comes as Nigeria’s doctor-to-population ratio hovers around 3.9 per 10,000 people, far below the minimum threshold recommended by the World Health Organisation.

For many health experts, the numbers confirm what has long been visible: a system gradually losing its most critical workforce.

The Nigerian Medical Association has repeatedly warned that poor remuneration, unsafe working conditions, and inadequate infrastructure are pushing doctors out of the country.

“Our members are overworked, underpaid and exposed to unsafe environments daily. Many are simply burnt out,” the NMA said in one of its recent statements addressing workforce migration.

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Similarly, the National Association of Resident Doctors has consistently highlighted the toll on younger doctors, who form the backbone of Nigeria’s tertiary healthcare system.

“Doctors are leaving because the system is failing them—irregular salaries, excessive workload, and lack of training opportunities,” NARD noted during one of its nationwide engagements.

Ironically, the doctor exodus persists even as Nigeria continues to spend heavily on healthcare abroad.

While official foreign exchange data shows only modest spending on medical tourism in recent years, broader estimates suggest Nigerians still spend hundreds of millions of dollars annually seeking treatment overseas.

For instance, a recent report by The PUNCH revealed that foreign exchange outflow for health-related travel by Nigerians surged to $549.29m in the first nine months of 2025, a 17.96 per cent increase from $465.67m in the same period of 2024, according to official data by Nigeria’s apex bank.

A public health expert, Dr David Adewole, noted that the Federal Government’s national policy on health workforce migration, aimed at curbing the growing trend of health professionals leaving the country—commonly referred to as ‘Japa’—is a good initiative, but may not do much to address the fundamental problems of the shortage of skilled healthcare professionals in Nigeria, particularly in rural and underserved areas.

According to him, many of the push factors for health professionals emigrating to greener pastures, like insecurity, emolument and lack of basic amenities like potable water, health facilities, cost of living and constant electricity, persisted.

He stated: “To make healthcare workers stay here, let the salaries be enough so that what you earn will be much more than the multiples of what you need for basic needs, like food, power supply, housing, and so forth.

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“People still look at life after retirement. You might have a good policy, but its implementation is the issue. For example, you are retired, and for your retirement package, you don’t need to know anyone for it to be processed promptly.

“Then subsequently, your monthly pension, without pressing anybody, should be paid. Those things are not here.

“And when you go to the hospital abroad, if you tell them that you are in a hurry, you go to your home; they’ll bring the medicines to your doorstep.”

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