Tag Archives: Data

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.

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.

Seminar 2: Applying maternal death surveillance and response in crisis settings

Watch the live recording of the event here!

Event information

Date and Time: Thursday 23rd March 2017, 5:30 pm – 7:00 pm, followed by refreshments

Location: John Snow Lecture Theatre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK

LSHTM & MDSR AN Seminar 2_event advert_imageOverview:

Mothers and their babies face greater risks to their survival during humanitarian crises. However, there is a dearth of evidence about how best to apply reproductive health interventions effectively in crisis settings. Understanding why women and their babies die in these specific circumstances is pivotal to designing appropriate interventions to prevent deaths from similar causes.

This seminar will explore tools and approaches to maternal death surveillance and response (MDSR) in crisis settings with presentations on the following:

  • Value of MDSR data and systems in crisis settings, and in contributing to achieving  sexual and reproductive health rights
  • Approaches to measuring maternal mortality in refugee settings and responding to findings
  • Participatory ethnographic evaluation research (PEER) as a tool to triangulate MDSR findings in crisis settings

Speakers:

  • Rajat Khosla, Human Rights Adviser – Sexual and Reproductive Health and Rights, World Health Organization, Geneva
  • Nadine Cornier, Humanitarian Adviser – Reproductive Health & Head of Office, UNFPA, Turkey
  • Eleanor Brown, Technical Specialist – Options, London

Moderator: Sarah Moxon, Research Fellow, the March Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM

This event is a collaboration between the Health in Humanitarian Crises Centre, the Global MDSR Action Network and the MARCH Centre for Maternal, Adolescent, Reproductive and Child Health

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 live stream recording is available here.

Watch this space for additional recordings of the event and access to supplementary materials.


Read more about the seminar series here.

Find out more about the first seminar of the series: Innovations to improve maternal and newborn death surveillance to respond to future Ebola outbreaks here.

Sierra Leone | Investing in MDSR

In Sierra Leone, significant investments have been made to move MDSR-related work forward over the last quarter. The National MDSR Committee held a meeting in June 2016, chaired by the Director of Reproductive and Child Health, with representatives from UNICEF, UNFPA, WHO as well as a representative of other health NGOs including Options, to assess progress and propose strategies for the next quarter. The meeting highlighted to following achievements and activities:

  • MDR committees at district level which had operated before the Ebola outbreak have been restructured and adapted to MDSR committees and inaugural meetings have been completed in all districts except Western Area.
  • In some districts, the process of actively reviewing deaths has begun.
  • Social media platforms are being used to support the multi-professional communication needed to sustain and grow the MDSR system through WhatsApp groups for District Medical Officers, Midwife Investigators, M&E Officers, Disease Surveillance Officers and other stakeholders. The World Health Organization has supported the development of an MDSR database using EpiData and training material including presentations on MDSR to support collection, inputting and analysis have been developed.
  • UNFPA is supporting a pilot regional blood collection campaign in response to findings from reviews of maternal deaths from haemorrhage between June and July 2016, as well as providing desktop computers to all districts for MDSR activities and supporting educational discussion programmes on maternal and child health on radio and television.

The meeting provided a good opportunity to plan further consultative meetings, for example, with Paramount chiefs in June and religious and women’s groups at later dates, to ensure wide stakeholder buy-in to the system and maximum impact for MDSR data in the future.

Acknowledgements: This country update was informed and approved by Bockarie Sesay, M&E Advisor for Options-PMEL, in Freetown, Sierra Leone.

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).

Trends in Maternal Mortality: 1990 to 2013

The recent report on MMR estimates for 2013 that was released by the UN agencies – Trends in Maternal Mortality: 1990 to 2013 – shows a 45% decline in global maternal deaths between 1990 and 2013. The burden and risk of maternal death remains the highest in sub-Saharan Africa and South Asia with these regions accounting for 62% and 24% of the deaths, respectively. Whilst absolute numbers show that India and Nigeria account for one third of all global maternal deaths, country level MMR estimates show that Sierra Leone records the highest (1100), and Chad and Somalia have the highest lifetime risk of maternal death. Giving birth is becoming safer, but not yet at the rate at which it should to meet the MDG targets in several countries. Continue reading

Towards elimination of maternal deaths: maternal deaths surveillance and response

This paper, written by a number of maternal health experts from academic institutions and international agencies, argues that current methods for estimating maternal mortality lack precision and are not suitable for monitoring progress in the short run.

National maternal mortality ratios alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur.

In response to this, the paper calls for the establishment of MDSR systems, noting that they are not yet established in most countries, despite their potential value for policy making and accountability. The paper usefully highlights fundamental parts of and steps in establishing a MDSR system. It is argued that establishing an MDSR system will help to achieve MDG 5, improve quality of maternity care, and eliminate maternal mortality.

Sennen Hounton, Luc De Bernis, Julia Hussein, Wendy J Graham, Isabella Danel, Peter Byass, Elizabeth M Mason. Towards elimination of maternal deaths: maternal deaths surveillance and response. Reproductive Health, 10(1) (open access)