Presentations

Ebola, and maternal and newborn health and mortality

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It was an honour to have hosted a seminar co-organised by the Global MDSR Action Network and the London School of Hygiene and Tropical Medicine’s Centre for Maternal, Adolescent, Reproductive, and Child Health and Health in Humanitarian Crises Centre where three speakers shared their experiences working in maternal health during the Ebola outbreak in Sierra Leone: Dr Chris Lewis, a general practitioner by training and Health Advisor with Department for International Development during the outbreak; Laura Sochas, a Global Health Researcher with the London School of Economics  formerly with Options;  and Dr Benjamin Black, an obstetrician and gynaecologist with vast experience in crisis settings, who was working with Médecins Sans Frontières in Sierra Leone at the time of the crisis.

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Sierra Leone is estimated to be one of the riskiest places in the world to be pregnant and deliver a baby, where a woman has a 1 in 17 lifetime risk of dying from a pregnancy-related cause.  My experience in Sierra Leone working on mother and newborn health programmes since 2012 highlighted some of the challenges in being able to count the real number of maternal and newborn deaths. Through research, I heard health workers explain how the deaths of women occurring outside of health facilities may be undocumented and how the lack of even minimal budgets to hold meetings hampered their ability to conduct reviews of maternal deaths. Interviews with communities revealed how during the Ebola outbreak, women in labour were turned away from or did not attend facilities because they were worried about contracting Ebola.

A key theme in the seminar was data and how the lack of available, open and quality data has implications in responding to the causes of Blog_LSHTM January seminar_Image_BBmaternal and newborn death. This becomes exacerbated in a crisis. In September 2014, Options started to look at the use of health services – such as antenatal care, facility delivery and postnatal care – and found evidence of a decline in usage. Building on this work, Laura Sochas discussed how she was then able to project the number of maternal deaths. In one year of the epidemic, Laura estimated the number of indirect maternal deaths during the Ebola outbreak was around 4,000 due to reduced uptake of services. This is roughly the same number as those who died directly from maternal deaths before Ebola.

It’s important to pause on this statistic and what it means for women and their families in Sierra Leone. And just as important was the reality – as Dr Benjamin Black explained – that pregnant women during the Ebola outbreak were often dying from the same things women die from in any context.

However, there are opBlog_LSHTM January seminar_Image_LSportunities. As Dr Chris Lewis explained we need to be proactive in the disclosure of information, especially as the secondary consequences of a crisis are so important. Data can help build resilience, help us to understand a problem, and justify and plan a response. It’s also important that we look closely at communities’ understanding and their barriers to action. Dr Benjamin Black emphasised in his talk the impact of the lack of trust between the community and health workers before, during and after the crisis and why the causes of this lack of trust need to be addressed to have an adequate response to maternal deaths.

Involving the community is a key aspect of maternal and perinatal death surveillance and response. The ability of communities to contribute to improving maternal and newborn health is immense – we must strive to build maternal and perinatal surveillance and response systems where communities are truly involved. Shocks and crises will happen but what makes a system resilient is being prepared with tools, data, knowledge and information to roll-out an integrated response.

To find out more, click on the links below to read about:

  • A presentation by Dr Chris Lewis about the UK Government’s response to Ebola in Sierra Leone and what opportunities there are to strengthen resilience of the health system, available to download here.
  • A method to estimate maternal and newborn mortality during a crisis, as presented by Laura Sochas. Click here to download.
  • A presentation by Dr Benjamin Black on how MSF’s maternal health programme adapted to respond to Ebola and his reflections on MDSRs, available to download here.

Acknowledgements: This blog was written by Sara Nam, Seminar Moderator, Technical Specialist at Options and Manager of the MDSR Action Network.

Midwives: Unique contributors to MDSR

Midwives are vital to ensuring women and their babies not only survive pregnancy and childbirth, but live healthy lives.

We know from the Lancet Midwifery series that:

What do we know about the role of midwives in maternal death surveillance and response (MDSR) systems?

Midwifery blog_N.Cornier_Image 1In 2016, we asked six experts in MDSR or similar models for their opinion. Experts agreed that midwives can make a unique contribution to MDSR being familiar with the medical and sociocultural factors relevant to each case. Their unique insights are meaningful in the investigation of and response to a maternal death. However, midwives are not always involved in the review of a maternal death and in some cases may have a low status within a health system.

In this blog, written for International Day of the Midwife on 5th May 2017, we turn our gaze to northern Syria where midwives are being trained in maternal and newborn care. We look at the challenges, benefits and opportunities in involving midwives in maternal care, in particular MDSR.

In March 2017, Nadine Cornier, a trained midwife and reproductive health Humanitarian Advisor at UNFPA in Turkey, gave a presentation at a seminar we co-organised at the London School of Hygiene and Tropical Medicine. She discussed her research and experience in measuring maternal mortality in humanitarian settings and responding to findings. Watch the live recording.

Her current work in Northern Syria involves re-training midwives in “life-saving capacities and competencies” as set out in the International Confederation of Midwives (ICM) Essential Competencies for Basic Midwifery Practice to raise their skill sets from an assistant midwife to a qualified midwife.

While Nadine Cornier describes this as a large task, maximising the competencies of midwives is invaluable in a setting where hundreds of health workers have been killed and numerous have fled the country. It is also important to note that accordingly assessments of maternal deaths have not been carried out in this area because of the security risks to health workers and health facilities.

For the panel discussion, Nadine Cornier was joined by Rajat Khosla, Human Rights Adviser in sexual and reproductive health and rights at the World Health Organization, and Eleanor Brown, Technical Specialist at Options.

When asked about the role of professional associations, especially professional midwifery associations, Eleanor Brown shared her work experience in Nigeria. She tells us that the Society for Obstetricians and Gynaecologists of Nigeria is integral to the maternal death review process and in instilling a culture of no blame. Eleanor Brown further states:

“The professional association for midwives plays quite an important role in other [Options] maternal health programmes as champions, particularly for getting people to have the political will to address maternal mortality”.

N.Cornier_presentation slideImage caption: Slide from Nadine Cornier’s seminar presentation

Let us celebrate the work of midwives as champions in maternal and newborn care around the world. Let us also reaffirm that midwives can play an important part in MDSR as they can uniquely contribute to making effective decisions to improve the quality of maternal and newborn care.

To watch the live stream of the seminar at LSHTM, Applying Maternal Death Surveillance and Response in Crisis Settings, click here.

To download Nadine Cornier’s presentation, click here.

This seminar is part of a series. To read about the seminar series including the first seminar which took place in January 2017, click here.

Read this blog by UNFPA to learn more about Nadine Cornier’s work with midwives in northern Syria.

Acknowledgements: This blog was written by Jenna de St. Jorre, Evidence for Action-MamaYe Technical Assistant at Options.

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Value of data: Sexual and reproductive health and rights in crisis settings

Summary_Rajat Khosla presentation_IDMHR_11.4.17The World Health Organization (WHO) says it is crucial for women to have access to quality health care throughout their pregnancy, childbirth and postpartum period and overall life course at any time and in any place, including humanitarian and crisis settings. Enabling environments that are rights-based, equitable and legally protective can help ensure quality health care is available to women and girls.

Last month, Rajat Khosla, a trained lawyer and Human Rights Adviser in Sexual and Reproductive Health and Rights (SRHR) at the WHO, gave a compelling presentation about sexual and reproductive health, and the value of maternal death surveillance and response (MDSR) data and systems in crisis settings, at a seminar we co-organised at the London School of Hygiene and Tropical Medicine (LSHTM). Watch the live recording here. Continue reading

Seminar 1: Innovations to improve maternal and newborn death surveillance to respond to future Ebola outbreaks

Event information

Date and Time: Tuesday 17 January 2017, 5:30 pm – 7:00 pm

Location: John Snow Lecture Theatre, LSHTM, Keppel Street, London, WC1E 7HT, UK

seminar-1-photoRecently, the Ebola outbreak in West Africa hit the poorest hardest. The three countries most affected by the crisis were amongst the top 11 countries in Africa with the highest maternal mortality (click here to see data).

In Sierra Leone, which holds the highest maternal mortality in the world, systems to count and investigate maternal deaths were hampered.

This seminar will explore:

  • limited data availability affecting operations in maternal and newborn health through a donor lens;
  • an innovative method to quantify the indirect mortality effects of the crisis; and the
  • changing landscape of maternal health response, including implications for maternal death surveillance and response and how will we react in the future.

Speakers:

Moderator: Dr Sara L Nam, Global MDSR Action Network – Evidence for Action, Options

Admission and registration: It is free to attend this seminar, but registration is required. Registration is now closed.

To learn more about the seminar series, Innovations in Maternal and Perinatal Health in Humanitarian Settings: Exploring Evidence and Innovations to Improve Maternal and Newborn Survival among Populations Affected by Humanitarian Crises, click here.

Email: mdsr@evidence4action.net

Twitter: @E4AMamaYeAfrica #MDSR

The seminar will be filmed. The recording will be available on this page after the event.


Please watch this space for updates on Seminar 1.

Click here to read a blog on the seminar, click here.

Click on the links below to read and download:

  • A presentation by Dr Chris Lewis about the UK Government’s response to Ebola in Sierra Leone and what opportunities there are to strengthen resilience of the health system, available here.
  • A method to estimate maternal and newborn mortality during a crisis, as presented by Laura Sochas, click here.
  • A presentation by Dr Benjamin Black on how MSF’s maternal health programme adapted to respond to Ebola and his reflections on MDSRs, available here.

Read more about the seminar series here.

Find out more about the second seminar: Applying maternal death surveillance and response in crisis settings here.

Feedback from Evidence for Action about ESOG and AFOG conferences

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Evidence for Action (E4A) Ethiopia were honoured to take part in the Second Annual Conference of the African Federation of Obstetrics and Gynaecology (AFOG), and 25th Annual Conference and Silver Jubilee Celebration of the Ethiopian Society of Obstetricians and Gynaecologists (ESOG) on 2-4 February, 2017 in Addis Ababa, Ethiopia.

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They were joined by Dr Tunde Segun, the E4A Country Director in Nigeria. Collectively, the E4A team provided support to a satellite session, gave five presentations and hosted a booth on behalf of the MDSR Action network. We share some reflections on the event here.

The conference was attended by around 400 participants from across Africa and included representatives from Ministries of Health, United Nations partners and non-governmental organisations. Continue reading

Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi

At a MDSR Action Network event at Options, Dr Tim Colbourn from the University College London (UCL) Institute for Global Health presented the findings of his co-authored paper: Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi. Continue reading

Improving data improving health: Verbal autopsy for health systems strengthening 

A recent event at University College London (UCL) will be of interest to those working on maternal death surveillance and response. The seminar, Improving Data, Improving Health: Verbal Autopsy for Health Systems Strengthening, was organised by the University of Aberdeen’s Centre for Global Development and UCL’s Institute for Global Health. The half-day event in October 2016 featured six speakers from the World Health Organization, Umeå University, UCL, Malaria Consortium, University of Aberdeen and the Africa Health Research Institute. Continue reading

Resources from the 2015 MDSR workshop in Vancouver

On 4th October 2015, an MDSR workshop took place at the FIGO World Congress  led by the World Health Organization and UNFPA in collaboration with FIGO (the International Federation of Gynecology and Obstetrics). The workshop aimed to identify opportunities to strengthen MDSR implementation and the contribution of MDSR to Ending Preventable Maternal Mortality beyond 2015 by:

  • Providing a forum to discuss and identify the opportunities and challenges facing MDSR implementation post-2015
  • Sharing lessons from the field on selected key topics relevant to sustained MDSR implementation
  • Identifying mechanisms and activities to strengthen global collaboration in MDSR implementation.

The workshop included presentations and “marketplace” discussion sessions on five themes. Please follow links to resources available from, or associated with, these sessions.

Death notification:

Data, communication and advocacy:

  • Role of civil society in MDSR: experiences from India. Presented by Subha Sri (CommonHealth, India). Click here to read a related civil society report on maternal deaths in India from CommonHealth.
  • How to communicate the message? Role of advocacy in communicating in MDSR. Presented by Sara Bandali (E4A).
  • Data innovations and visualization: Using scorecards to measure the strength of Maternal Death Review (MDR) systems in Nigeria and inform MDSR in Sierra Leone. Hosted by Tunde Segun (E4A) and Mohamed Yilla (E4A)
  • Data innovation and communication: Experiences from India. Hosted by Ajey Bhardwaj (Federation of Obstetric and Gynaecological Societies of India). Click here to read a related article on the development of an electronic MDR system in India. 

Funding agencies:

  • The role of funding agencies in MDSR support.  Presented by USAID. 

Professional society involvement:

  • The role of professional bodies and government agencies in MDSR: The Malaysia Experience. Presented by Dr Ravichandran Jeganathan (Ministry of Health, Malaysia).
  • Professional society involvement: The UK experience. Hosted by Dr Paul Fogarty (Royal College of Obstetrics and Gynaecologists). The Royal College of Obstetrics and Gynaecologists (RCOG) works to improve women’s health care across the world. Founded in 1929, the RCOG now have over 13,500 members worldwide and works with a range of partners both in the UK and globally to improve the standard of care delivered to women, encourage the study of obstetrics and gynaecology (O&G), and advance the science and practice of O&G. Click here to read more about the Royal College of Obstetrics and Gynaecologists.

Scaling up:

  • Going to scale: experiences from Tanzania and Ethiopia (see implementation coverage for 2014 and 2015).  Hosted by Moke Magoma (E4A) and Azmach Hadush (E4A).