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Posts Tagged ‘Maternal death’

Improving Maternal Health

Posted by African Press International on November 15, 2013

Ethiopia Approves Plan to Improve Maternal Health

NEW YORK, November 14, 2013/African Press Organization (APO)/ – The Ministry of Health has approved plan to accelerate progress on improving maternal health in Ethiopia in an effort that is expected to address the concern over the so far slow progress the country has made on meeting the Millennium Development Goal on maternal health (MDG 5) .

“Advancing better health is a gateway to development progress, lifting economies and societies. Meeting a woman’s need for sexual andreproductive health services will increase her chances of finishing her education, and breaking out of poverty,” saidUN Resident Coordinator and UNDP Representative Mr Eugene Owusu, emphasising the importance of fast-tracking actions for reducing maternal mortality in Ethiopia.

Recent data and trends placeEthiopia as one of the countries with the highest maternal mortality ratios in the world.

The 2010/11 Demographic and Health Survey indicates that Ethiopia has made limited progress over the last decadeto reduce maternal deaths but there is some concern that the trend might be reversing. The maternal mortality ratio declined from 871 deaths per 100,000 births in 2000to 673 in 2005; howeverthe maternal mortality ratio marginally increased between 2005 and 2010, to 676 per 100,000 live births in 2010.

The Ministry of Heath has undertaken measures to reduce maternal mortality through the provision of clean and safe delivery services at the health post level, skilled delivery and emergency obstetric care at facility level and family planning services at all levels of the health care system. To up-scale these efforts, experts drawn from the Government and various UN agencies have been able to adapt the MAF methodology to the Ethiopian context, and to identify systematically bottlenecks and prioritize acceleration solutions to speed up progress on MDG 5.

For women in the reproductive age (15-49 years), reproductive health problems constitute the leading cause of ill health and death. And because women are often the backbones of their families, these problems can affect the well-being of the whole family.Universal access to family planning; access to pre- and antenatal care; skilled attendance at all births; and timely emergency obstetric care when complications arise can prevent almost all maternal mortality and greatly reduce injuries of childbearing. Access to family planning alone can reduce unwanted pregnancies, unsafe abortion and maternal death and disability, saving women’s lives and the lives of their children.

The MDG Accelerated Action Plan on Improving Maternal Health in Ethiopia was validated and endorsed by the Ministry of Health at a national conference in Addis Ababa on 8th of November 2013. The plan is based on the MDG Acceleration Frameworkand takes into account the fact that the rate of achieving MDG 5 varies across geographic regions and socio-economic groups in Ethiopia.

The MDG Acceleration Framework (MAF) is an important tool increasingly used by countries to identify and remove barriers to MDG achievement. The MAF was developed by UNDP in 2010 and is supported by UN Development Group. Around 50 countrieshave applied the MAF to help them drive efforts to overcome the bottlenecks preventing progress in achieving the Millennium Development Goals.

 

SOURCE

United Nations Development Programme (UNDP)

 

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Cutting down maternal deaths – Space-age technology to apply

Posted by African Press International on June 26, 2013

Lifewrap demonstration

KUALA LUMPUR,  – Space-age technology, neoprene (the same material used for wet suits) and Velcro have gone into an experimental garment health experts hope can treat postpartum haemorrhage, the leading cause of maternal mortality worldwide.

A non-pneumatic anti-shock garment (NASG) – also called a “lifewrap” – is a half-body suit that is strapped onto a woman’s lower legs and abdomen to slow bleeding and prevent shock due to blood loss.

“It [the lifewrap] works in two ways: it compresses the blood vessels in the lower part of the body, reversing shock by giving back oxygen to the heart, lungs and brain which are very oxygen-dependent tissues,” said Suellen Miller, director of the Safe Motherhood Programme/Bixby Centre for Global Reproductive Health at the University of California San Francisco (UCSF) in the USA.

If it works as intended, pressure on the abdomen decreases the radius of the blood vessels and reduces overall bleeding.

According to the World Health Organization (WHO), postpartum haemorrhage – the loss of 500-1,000ml or more of blood within 24 hours after birth – accounts for nearly a quarter of maternal deaths globally and is the leading cause of maternal mortality in most low-income countries.

Maternal death tracks the inequity between countries. Death from postpartum bleeding is nearly unheard of in the developed world,” said Kate Gilmore, deputy executive director of the UN Population Fund (UNFPA).

The lifewrap, which evolved from a suit originally researched and developed by the US National Aeronautics and Space Administration (NASA) for their space programmes, was demonstrated to health experts at a recent maternal health conference in Kuala Lumpur, Malaysia.

Buying time

The lifewrap is not designed as a final solution to save women, but only a stabilizing measure to buy her time to be transferred to a health facility for surgery or blood transfusion.

According to US-based reproductive research body the Guttmacher Institute, in developing countries most women in remote communities give birth at home. The proportion of births in health facilities varies widely across the globe, according to the institute, from 50 percent of deliveries in eastern and western Africa to 99 percent in East Asia.

In 2010, the institute recorded 284,000 women in developing countries dying from pregnancy and childbirth complications.

“A woman has maybe two hours [from the onset of bleeding] before she suffers from lack of oxygen to her vital tissues and bleeds to death. Delays are killers,” said Miller.

“Working in parts of the world where distance is the difference between life and death demands solutions that can begin in the community or in the home,” said Purnima Mane, president and CEO of Pathfinder International, a US non-profit family planning and reproductive health organization.

Driving down costs

Clinical trials and studies on the use of the lifewrap were conducted by the Univeristy of California, San Francisco (UCSF) in Nigeria, Egypt, Zambia, Zimbabwe and India from 2004-2012. During that period, it was noted that use of the lifewrap decreased maternal death by up to 50 percent.

Though cautious not to attribute the drop to these wraps alone, and recognizing that multiple interventions may have been responsible for the decline, experts were encouraged by the correlation.

“Initial results from the testing of the garment are promising. We already have the [supporting] WHO policies. Now we want to encourage countries to review their maternal health protocols regarding postpartum haemorrhage and integrate the use of the lifewrap into their designed interventions,” said Amie Batson, PATH chief strategy officer.

WHO guidelines on the management of postpartum haemorrhage call for timely medical intervention, which include administering drugs like oxytocin and misoprostol during the third and final stage of labour.

These drugs help contract the uterus, expedite delivery of the placenta and reduce blood loss.

In the event these drugs do not work, WHO published in 2012 guidelinespromoting uterine compression, and the use of NSAGs specifically, as a temporary measure until appropriate care is available.

The lifewrap can be used up to 40 times and washed by hand with regular laundry detergent after each use. From an original cost of US$300 per garment, negotiations with manufacturers have driven down the cost to nearly $65.

Thus far, research and development of the wrap has been pursued jointly by UNFPA, Pathfinder International, UCSF, the US-based John D. and Catherine T. MacArthur Foundation and PATH.

as/pt/cb source http://www.irinnews.org

 

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Pakistan is one of only three countries where polio is endemic

Posted by African Press International on May 19, 2013

Pakistan is one of only three countries where polio is endemic

LAHORE/DUBAI, – Hamza Mazhar, a 35-year-old teacher from Pakistan’s eastern city of Lahore, says he never wants to see the inside of a government hospital again.

“My mother was taken to the hospital with an upper respiratory tract infection in February this year and doctors said she needed care in the hospital’s Intensive Care Unit (ICU),” he told IRIN.

But the doctors in charge wanted the family to pay a bribe to get into the ICU, which had plenty of spare beds. They could not afford to pay. His mother was unable to get the treatment she needed and in March she died.

Health care in Pakistan is identified as one of the country’s most corrupt sectors, according to surveys by Transparency International; general surveys suggest the majority of Pakistanis are unhappy with the health services they are offered.

This is just one of the many challenges facing Pakistan’s health system, as identified in the first ever comprehensive assessment of the sector, published in the medical journal The Lancet and launched today in Islamabad.

Entitled Health Transitions in Pakistan, the series of articles says Pakistan’s health sector lags behind 12 countries in the region with cultural, economic and geographic similarities.

Pakistan has no national health insurance system and 78 percent of the population pay health care expenses themselves. It is the only country in the world without a National Health Ministry.

The report authors say the recently elected government has a unique opportunity to push through reforms and take advantage of recent constitutional changes that devolve health care to the provinces.

The findings are not entirely negative. Progress has been made on all health indicators in the past 20 years. The rates of child deaths and maternal mortality have fallen, and the community-based Lady Health Workers programme is singled out for praise.

But improvements have been much slower coming than in other similar countries. IRIN picked out four major challenges from the health assessment.

1. Avoidably high child and maternal mortality

The assessment’s authors describe Pakistan’s progress towards meeting the Millennium Development Goals for reducing child and material mortality (4&5) as “unsatisfactory”.

Pakistan, with its population of 180 million, has more child, foetal and maternal deaths than all but two of the world’s nations.

The report calls child survival “the most devastating and large-scale public health and humanitarian crisis Pakistan faces”.

An estimated 423,000 children under-five die each year, almost half of them new-born babies. Family planning options are also limited and nearly a million women attempt unsafe abortions each year.

Simple measures like training more nurses and midwives (currently outnumbered by doctors 2:1) could save more than 200,000 women and child lives in 2015, the report’s authors say.

2. Nutrition

A lack of adequate nutrition for children contributes to the high number of child and maternal deaths. Nearly 40 percent of children under-five areunderweight and more than half are affected by stunting.

Poor nutrition weakens the body’s natural defence mechanisms.

But the report also says that malnutrition affects the Pakistani economy, with estimates that it costs the country 3 percent of GDP every year, particularly through reduced productivity in young adults.

3. “Lifestyle diseases

In Pakistan, as more widely throughout south Asia, non-communicable diseases like cancer, diabetes and heart problems have replaced communicable diseases like malaria and diarrhoea in the past two decades as the leading causes of death and morbidity.

This general trend has not been matched by an adaptation in the Pakistani health system or government policy. Poor road safety, cheap cigarettes and high-levels of obesity (one in four adults) all lead to preventable deaths.

So-called “lifestyle diseases” could cost the country nearly US$300 million in 2025, according to the report’s authors.

They say the right government action, including higher excise taxes on cigarettes, new legislation, and information campaigns could cut the premature mortality rate from cardiovascular diseases, cancers, and respiratory diseases by 20 percent by 2025.

4. Low public spending

Humanitarian crises provoked by earthquakes, flooding and conflict over the past decade have mobilized large sums of money both internationally and within the country.

But corresponding sums have not been spent on underlying health services, which have the potential to save many more lives.

Public health spending has declined from 1.5 percent of GDP in the late 1980s to less than 1 percent, according to the report – equivalent to less than 4 percent of the government budget.

That has left Pakistanis with little support for medical costs, which are responsible for more than two-thirds of major economic shocks for poor families, according to the Ministry of Social Welfare and Special Education.

Rapid population growth only makes what resources are spent on health care produce ever smaller results.

kh/jj/cb source http://www.irinnews.org

 

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Uganda’s midwives struggling

Posted by African Press International on April 18, 2013

Trained midwives are needed for Uganda’s maternity wards

GULU/SOROTI,  – Despite the significant role midwives play in Uganda’s maternal health programmes, they face numerous challenges, including lack of training, inadequate facilities and poor pay.

According to the Africa Medical Research Foundation (AMREF) just 38 percent of Uganda’s estimated 11,759 midwives are either registered or have a college education. Yet they attend to 80 percent of all births in the country’s urban areas and 37 percent of all births nationally.

Esther Madudu, a midwife in Uganda’s rural Soroti District, explained to IRIN that many go to great lengths to help women deliver.

“Health centres lack electricity, water and other essential medical commodities to assist in delivery. In the past, I used to [hold] my cell phone in my mouth [and use its] torch to [assist delivering] mothers at the health centre,” she said.

2009 analysis by the UN Population Fund (UNFPA) found Uganda’s health system “unsupportive to midwives, as characterized by poor remuneration, poor health service infrastructure, lack of essential equipment and supplies, eg, gloves, drugs – especially in public health facilities – inadequate protection from infections, high workload owing to few qualified staff” and lack of supervision or training opportunities.

Maternal deaths

Uganda grapples with high rates of pregnancy-related complications and maternal deaths, consequences of poor healthcare investment by the government, low education levels and an unmet need for reproductive health services.

Uganda’s 2011 Demographic and Health Survey showed the maternal mortality rate at between 310 and 480 deaths per every 100,000 live births.

According to the Ministry of Health, 24 percent of these deaths are the result of severe bleeding, and many are due to infection, unsafe abortion, hypertensive disorders and obstructed labour.

Experts say much more must be done if Uganda is to meet Millennium Development Goals 4 and 5 – the goals on reducing child and maternal mortality and achieving universal access to reproductive healthcare – by the 2015 deadline.

“Death resulting from pregnancy-related [complications] is a big issue in Uganda that requires urgent attention,” health commissioner Anthony Mbonye said, noting that these deaths are preventable “with improved access to [quality] healthcare to the population and… positive attitudes towards… health workers.”

Too few health workers

Midwives say their small number has them struggling to meet demand. They have called on the government to recruit more midwives.

“We are only three midwives working day and night with [the] assistance of two nursing assistants,” said Lydia Tino, a health supervisor and midwife working at a centre with 20 maternity beds in the rural Gulu District.

In 2006, the government stopped midwifery trainings, arguing that nurses could be given additional skills to take up the roles played by midwives. This has not happened.

And the few who have midwifery skills often leave the country.

“Uganda has trained many midwives, but [the] majority opt to work in places outside the country where facilities and remuneration are better,” Mary Gorettie Musoke, senior midwife and trainer, told IRIN.

“…In the past, I used to [hold] my cell phone in my mouth [and use its] torch to [assist delivering] mothers at the health centre.”

In a progress report by Uganda’s Ministry of Health, tabled before a parliamentary committee in February, the government indicated that it had employed an additional 5,707 health workers to help plug the gap.

But many rural health facilities are still unable to perform either basic or comprehensive emergency obstetric and newborn care.

Government obligation

Government officials told IRIN it plans to carry out a countrywide maternal health audit as part of its efforts to deal with the problem.

“We are under obligation to perform our duties, so the government doing everything possible to address problem,” said Sarah Kataike, the health minister.

While government health facilities in Uganda are supposed to provide free services, they are understaffed and lack essential medical supplies. At times, patients are forced to pay extra fees before they can receive services.

Florence Akio, 34, had to be transported to a private facility some 45km away after failing to receive any assistance at a nearby government facility.

“My labour started in the middle of the night, but I couldn’t make to Atiak Health Center III. I waited until morning, when my husband borrowed a bicycle and carried me to the health centre. But, reaching the health centre, there was no sight of any staff to attend to me,” she told IRIN.

In a landmark 2011 case, civil society organizations sued the government over the high maternal mortality rate, but the case was dismissed. The organizations had argued the government had failed to provide essential medical commodities and services to pregnant women.

ca/ko/rz source http://www.irinnews.org

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