Latest Health research news from the around the globe: Improving maternity care in Africa

Improving maternity care in Africa
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admin on 27 September, 2009 02:09:00
 
The findings of the study by Dr Christina Pagel (UCL Clinical Operational
Research Unit), Professor Anthony Costello (UCL Institute of Child Health) and
colleagues appear in The Lancet.
Maternal mortality ratios have changed little since 1990 and progress towards
Millennium Development Goal 5 – to improve maternal health – is far off
track in sub-Saharan Africa: the maternal mortality rate has fallen by only 16
deaths per 100,000 since 1990 (921 per 100,000 livebirths in 1990 to 905 per
100,000 in 2005).
Dr Pagel, Professor Costello and colleagues developed a mathematical model to
assess the extent to which a combination of improving health facilities and
community-based access to life-saving drugs could reduce maternal mortality due
to post-partum haemorrhage or sepsis.
Three possible ‘packages’ of improvements were studied:
Package 1 – ensuring that health facilities are supplied with oxytocin – a
hormone that plays an important role in giving birth – to prevent post-partum
haemorrhage and antibiotics to treat sepsis.
Package 2 – package 1 combined with improved drug provision via antenatal-care
appointments and community health workers. Drug provision entailed distribution
of misoprostol (and instructions on how to take it) to women attending outreach
antenatal-care appointments, provided that the drug was in stock. Misoprostol is
a heat-stable drug that can prevent post-partum haemorrhage and is easily given
in tablet form. This package also included distribution of antibiotics by
community health workers to women presenting with signs of postnatal infection.
Package 3 – packages 1 and 2 combined with additional access to misoprostol
and antibiotics via female volunteers in villages, to ensure maximum coverage of
these interventions, especially in rural areas.
Using the model the researchers estimated that of 2,860 maternal deaths from
post-partum haemorrhage or sepsis per year in Malawi, intervention package one
could prevent 210 (7%) deaths, package two 720 (25%), and package three 1,020
(36%).
In sub-Saharan Africa, the authors estimated that of 182,000 such maternal
deaths per year, these three packages could prevent 21,300 (12%), 43,800 (24%),
and 59,000 (32%) deaths, respectively. The estimated effect of community-based
drug provision was greatest for the poorest women.
Professor Costello said: “Our model shows that in Malawi (even under
pessimistic coverage estimates) and across sub-Saharan Africa, improved access
to misoprostol and antibiotics through feasible community interventions could
have substantial benefit in reduction of maternal deaths due to post-partum
haemorrhage or sepsis after delivery.”
The study calls for formal assessment and investigation to gain strong evidence
of the effect of improved access to drugs in community settings and information
about their appropriate use and side-effects.
Image: mother and child in sub-Saharan Africa
UCL context
UCL’s research strategy defines Grand Challenges as areas in which the
university is facilitating cross-disciplinary interaction – within and beyond
UCL – and applying its  collective strengths, insights and creativity to
overcome problems of global significance. The first of these is the Grand
Challenge of Global Health.
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