Study on maternal mortality and neonatal morbidity in Africa
Authors/Editors: Emmanuel Dzadeyson
Publisher/Journal: Rural Integrated Relief Service-Ghana
Publication date: 2007
Many African countries have been hit by an exodus of medical personnel to overseas destinations in recent years. "Only 42% of births in the African region are attended by skilled personnel," Emmanuel Dzadeyson at the National lconference on maternal and new-born health in Ghana, emphasised. Unsafe abortions are also high among adolescents, according to Emmanuel Dzadeyson Experts, who are drawn from various international organisations, are examining the extent of the problem on the continent and will suggest ways of reducing the death rates among mothers and infants. African governments' health budgets were also identified as inadequate to deal with obstetric cases. "The percentage of GDP (gross domestic product) devoted to health in sub-Saharan Africa remains at between one percent and 3,7% compared to the large percentage spent on arms," they conveyed. "If nothing is done to arrest the trend (of high and growing maternal and child deaths), it is estimated that there will be 2.5 million maternal deaths, 2.5 million child deaths and 49 million maternal disabilities in the region over the next 10 years, Emmanuel Dzadeyson noted. He states that more than half of the 600,000 women who die every year from pregnancy-related causes were in the African region which constitutes only 12% of the world's population and 17% of its births. Maternal mortality ratio in Africa remains the highest in the world with the average actually increasing from 870 per 100,000 live births in 1990 to 1,000 per 100,000 live births in 2001. According to a WHO-sponsored study made available at the National l workshop on improving maternal and neonatal health in Ghana, neonatal morbidity and mortality rates is currently estimated at 45 deaths per 1,000 live births and contribute about 50% of the infant mortality rate in the Sub-sahara Africa. The findings of the study, presented by Elliot Hammond, a Consultant Neonatologist to the Rural Integrated Relief Service-Ghana, also show that stillbirths and deaths within the first seven days of life in Sub-sahara Africa was estimated at 76 per 1,000 live births. He also indicated that 70% of deliveries take place in the community where maternal and newborn births are usually not recorded. Eight countries were covered by the study conducted between February 2001 and August 2007. Its goal was to develop or recommend evidence-based strategic interventions and establish sustainability in the institutionalization and implementation of identified remedial measures.
The study documents some of the causes of death as provided by health providers and facility records. These include: birth asphyxia (suffocation during birth), 40%; prematurity and low birth weight, 25%; infections, 20%; congenital defects, 10%, and acute surgical conditions, 3%. Other findings relate to unavailability of basic supplies and equipment, staff shortages and low morale, bad roads and long distances between referral points, continued use of traditional birth attendants (who are still popular and highly regarded) and preference of mothers to deliver in health facilities, although these are still largely perceived as not user-friendly.
The aim of the Initiative was to ensure that women and their newborns have access to the care they need through the strengthening of health systems and appropriate community-level actions." He stated that in spite of the harsh economic environment prevailing in Africa, the application of appropriate policies by governments would lead to improvements in the outcome of pregnancies irrespective of the economic status of countries. According to him, it was now time for African governments to focus on the availability of and accessibility to emergency obstetric care because emergencies constituted a major risk for maternal mortality in Africa. Other essential interventions, he said, were the reorganization of health systems, the strengthening of midwifery skills, and increasing the number of skilled birth attendants. He further concluded his presentation with a four-pronged call for action: action to place maternal and newborn health high on the agenda of governments and partners; to review policies, guidelines and programmes; to allocate and release resources and action to harness resources from communities and partners.
In an presentation made at the national conference on maternal and new-born health the Ghana, Rural Integrated Relief Service-Ghana called for a greater involvement of men in caring for their spouses during pregnancy, basic education, improved health systems and the use of skilled birth attendants are key to reducing maternal and newborn mortality in Africa. The Millennium Development Goals call for a 75% reduction in maternal mortality by in the African Region within the next decade. She notes that other factors crucial to attaining the goal included greater empowerment of women, allocation of adequate human and financial resources to the health sector, and greater availability of user-friendly information to improve individual, family and community knowledge of danger signs during pregnancy and labour. Emmanuel Dzadeyson emphasized that maternal deaths due to pregnancy-related complications were preventable. In another presentation to the meeting, the UNFPA Maternal Health Adviser outlined some of the reasons why African countries have failed to reduce maternal mortality. These include: lack of national commitment, financial support, coordination and partnership; increasing poverty and the low status of women; the adverse effects of HIV/AIDS, tuberculosis and malaria, and the use of inappropriate strategies to stem the growing tide of maternal mortality. He stated that UNFPA's vision and strategy for maternal mortality reduction was based on three pillars: family planning, skilled attendance at all births and the availability of, and accessibility to, emergency obstetric careMothers, newborns, and children are inseparably linked in life and in health care needs. In the past,maternal and child health policy and programmes tended to address the mother and child separately, resulting in gaps in care which especially affect newborn babies. How can these gaps be addressed, especially during birth and the first days of life, when most mothers and newborns die, and at home, where most newborn deaths in Africa occur?
Policy and programme attention is shifting towards a maternal, newborn, and child health (MNCH) continuum of care. Instead of competing calls for mother or child, the focus is on universal coverage of effective interventions, integrating care throughout the lifecycle and building a comprehensive and responsive health system. The MNCH continuum of care can be achieved through a combination of well defined polices and strategies to improve home care practices and health care services throughout the lifecycle, building on existing programmes and packages. What is the current coverage of MNCH essential packages along the continuum of care, and how can these be strengthened to increase coverage, equity, and quality of care? Which interventions within the continuum of care would save newborn lives? Are there specific opportunities that could be seized?