THE UGANDA SAFE-BIRTH ORGANISATION (TUSBO)

18 May 2011

DON'T GROPE AROUND: HERE ARE INTERVENTIONS THAT HAVE PROVEN IMPACT ON MATERNAL HEALTH

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Large-scale successes in reducing maternal mortality
What interventions reduce maternal deaths?
In the following analysis, find a breakdown of what interventions should be prioritized if mothers are to be saved at birth.
One illustrative case study in Millions Saved: Proven Successes in Public Health is devoted to the reduction of maternal mortality in Sri Lanka. Since 1950, Sri Lanka has reduced maternal deaths "from between 500 and 600 maternal deaths per 100,000 live births in 1950 to 60 per 100,000”. Levine (2007) attributes this decline to four major factors:
  1. Universal access to a strong and functional health system.
  2. Training and recruiting more midwives.
  3. Strengthening the HMIS and using it to make decisions.
  4. Implementing quality improvements to vulnerable groups.

Evidence on other specific interventions

Training traditional birth attendants

There is very little strong evidence that training TBAs is an effective program for reducing maternal mortality. The available evidence suggests that TBA training increases knowledge among TBAs and may reduce infant mortality, but does not have impact on maternal mortality.

There are a number of reasons why training TBAs may fail to reduce maternal mortality. These include:
  1. Lack of medical services to which to refer women with major complications.
  2. Barriers to learning due to lack of formal education among TBAs.
  3. TBAs training are insufficient to give them skills to perform life-saving interventions.
In view of this, the World Health Organization recommends that every birth must be attended by a skilled birth attendant—a doctor, midwife, or nurse who has received formal education in the management of pregnancy and childbirth.

Skilled birth attendants

The World Health Organization advocates for expanded use of skilled birth attendants to reduce maternal mortality. Challenges to expanding the use of skilled attendants include:

1.    The inadequate supply of midwives and doctors,

2.    Lack of health facilities to which to refer complicated cases,

3.    And reluctance among women to use such services

Antenatal care

Antenatal care is comprised of a number of interventions administered to women during pregnancy, including screening tests, immunizations, and treatment for identified complications. A 2001 evaluation of the effectiveness of antenatal care in preventing maternal deaths was sparse.
The World Health Organization has suggested some reasons why antenatal care may fail to improve maternal outcomes. These reasons include:
  1. Difficulty in predicting birth complications during pregnancy.
  2. Lack of communication between antenatal and delivery care personnel.
  3. Poor quality of antenatal services.

Community mobilization

A recent review of community-level interventions to reduce maternal mortality found one randomized controlled study that did not focus on training of traditional birth attendants or antenatal care models (see above). The study, conducted in Nepal, examined the effect of "facilitator-led women's groups to improve perinatal care practices”.
It attributed a large, statistically significant reduction of maternal mortality to this community-based intervention.

Clean delivery kits (Mama Kit)

According to the World Health Organization, 15% of maternal deaths are due to infection. Programs that provide clean delivery kits hope to reduce infections among mothers delivering at home and in health centers, as well as among their infants. Kits include such items as soap for washing of hands and vagina, clean razors and cord ties for cutting the umbilical cord, plastic sheets for creating a clean delivery surface, and a pictorial instruction sheet for directing mothers and their attendants on how to use the items in the kit.
A study in Tanzania found significant reductions in infections among women who used the kits and were taught World Health Organization recommended hygienic procedures, and an even larger reduction among their infants.
To recap, four interventions: skilled birth attendance, family planning, clean birth kits, and innovative community mobilization within a strong and functional health system are the essential for safe motherhood.




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