Tag Archives: Maternal health

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 crises 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 Series: 2017

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 

This new seminar series will take place at the London School of Hygiene and Tropical Medicine (LSHTM) in collaboration with the Global MDSR Action Network and LSHTM’s Health in Humanitarian Crises Centre and The Centre for Maternal, Adolescent, Reproductive, and Child Health (MARCH). Continue reading

National Report EFY 2006-7 (2013-15)

This is the first national report on data from Ethiopia’s Maternal Death Surveillance and Response (MDSR) system. The report includes data from 387 maternal deaths between 2006 and 2007 Ethiopian Financial Year (2013-15). It is intended to be used to guide Ethiopia’s efforts to reduce maternal mortality.

Background

Image_National Report_PostThe national Maternal Death Surveillance and Response (MDSR) system was established in 2006 Ethiopian Financial Year (EFY) (2013-14) and formally integrated into the Public Health Emergency Management (PHEM) data collection systems in 2007 EFY (2014-15). The objective of the MDSR system is to document, count and review maternal deaths in order to identify causes and contributing factors, and to put in place interventions to prevent future deaths.

Methods

In the Ethiopian MDSR system, community-based and facility-based maternal deaths are noted in weekly reports. Community-based deaths are then investigated further through a Verbal Autopsy (an interview with someone close to the woman to establish the circumstances and symptoms leading up to her death) and reviewed at health centre level by a committee. Maternal deaths in facilities are also investigated then reviewed by a team. During each review, a case-based Maternal Death Reporting Form is completed, summarising key information from the Verbal Autopsy or facility review and noting the woman’s cause of death.

This report represents the first time MDSR data has been compiled at national level. It covers 387 anonymised deaths occurring during a 20 month period across 2006 and 2007 EFY (2013-15). The data come from five regions (Amhara, Oromiya, Tigray, SNNP and Harari) and two city administrations (Addis Ababa and Dire Dawa). It presents a summary of progress in implementing the MDSR system, the results of the data analysis, and recommendations for preventing future maternal deaths.

Key findings

  • The integration of the MDSR into the PHEM system is a good example of collaboration within the health system
  • Early lessons from the MDSR experience in Ethiopia show that the information gained from the MDSR system gives communities and health workers real information about maternal death and encourages focused change to improve maternity services
  • Over half of the reviewed deaths occurred in health facilities (54%) while 25% died at home and 19% on the way to a facility. This reflects both the fact that data collection on maternal deaths is easier in facilities, and also the fact that women are more likely to be taken to a facility after becoming critically ill at home
  • 69% of deaths occurred to women with no education
  • 60% of deaths occurred after labour/delivery, while 20% occurred prior to labour/delivery and 15% occurred during labour/delivery period.
  • 83% of deaths were caused by direct obstetric causes, 15% were indirect causes and 2% were unknown
  • Haemorrhage (excessive bleeding) was the major cause of death (accounting for 58% of the causes listed), accounting for about half of maternal deaths, followed by other causes such as hypertension (high blood pressure) , sepsis (from infections), obstructed labour (when the baby’s head gets stuck during delivery) and anaemia (low levels of iron in the blood, putting women at risk of haemorrhage)
  • Delay 1 (deciding to seek care) was reported for 66% of maternal deaths, delay 2 (accessing care) was reported for 38% of deaths and delay 3 (receiving care at a facility) was reported for 36% of cases. In around half of cases the death had multiple delays.
  • Haemorrhage was more common in women who had more than four children – women with more than for children accounted for 46% of haemorrhage deaths
  • Delays in making the decision to seek care were linked to the majority of haemorrhage deaths

Recommendations

For the MDSR system:

  • The strengthening and scale up of the MDSR system is needed
  • The MDSR system needs to be embedded in the PHEM to further improve communication
  • MDSR support should be integrated with the supportive supervision system for health workers at all levels
  • Regular performance monitoring of the MDSR system at regional and zonal is required
  • A regional annual meeting to feedback to communities and facilities and showcase good practice should be planned
  • MDSR data should be used to inform the community, health workers and decision makers to improve the health status of the population of Ethiopia.
  • All health facilities should be active participants in the system by setting up an MDSR committee

To address obstetric haemorrhage:

  • All health facilities should have trained staff and equipment to deal with obstetric haemorrhage
  • All women should be encouraged to access antenatal care and should be offered iron in pregnancy
  • Women with more than four children should be offered family planning, particularly long-acting reversible methods (like the implant or intrauterine device) or a permanent method (sterilisation)

Whilst the deaths included in this report represent the tip of the iceberg, it is hoped that the lessons learnt from the loss of these 387 women can help guide Ethiopia’s efforts to reduce maternal mortality.

Click here to download the report (PDF).

A Story of a Pregnant Mother in Ethiopia

“This short film highlights the value of Ethiopia’s maternal death surveillance and response – MDSR – system by bringing to life the benefits this can generate for pregnant women and all in our society.

In the Ethiopian Ministry of Health MDSR is one of our flagship programmes. Using the data generated by the MDSR system, we have the power to make evidence-based decisions that improve quality of care and target responses to where they will be most effective in saving lives. We support a no-blame culture necessary for successful MDSR. A no-blame culture is important because we need everybody to feel supported in reporting maternal deaths when they occur whether it is in a facility or at home. Then our teams will review and report into the system on each death.

Most importantly, we are taking action in response to every death – from the community to the national level. This nationwide system has the power to save maternal lives now and for generations to come.”

Prof Yifru Berhan,
Minister of Ministry of Health of Ethiopia

The film was produced by the Ethiopian Ministry of Health, Evidence for Action, the World Health Organization and the University of Aberdeen.

News updates: Global Financing Facility

Global Financing Facility (GFF): the Country Powered Investments report supporting Every Woman, Every Child, was launched 20 September. Four new countries – Guatemala, Guinea, Myanmar and Sierra Leone – have also recently become eligible to access GFF funding. For more information about the GFF, visit the website here.

 

 

The Lancet Maternal Health Series

On 18 September, The Lancet launched the 2016 maternal health series in New York City on the opening day of the United Nations’ General Assembly, following a decade since the maternal survival Series was published. The new Series comprises of six papers discussing the diversity and divergence of poor maternal health, the extremes of maternal care (too little, too late and too soon, too much), childbirth care, women centred care in high-income countries, future external factors and health-system innovations, and a call to action to presenting five key targets to ensure that the Sustainable Development Goals are met.