maternal health

A woman receiving antenatal care in South Sudan. {Photo credit: J. Warren/Save the Children.}Photo credit: J. Warren/Save the Children.

On a dark August night in rural South Sudan, Linda Kenneth felt the swift kick of labor pains begin. Having previously delivered five children, Linda recognized the pains and immediately called for the nearby skilled birth attendant, as it was too late in the evening for her to travel safely to the health facility. In her previous two pregnancies, she had experienced heavy bleeding after delivering, and worried similar complications might arise this time.

South Sudan has the world’s worst maternal mortality ratio (2,054 deaths per 100,000 live births), and roughly one third of these deaths can be attributed to postpartum hemorrhage (PPH). Administration of misoprostol or another uterotonic (a drug that reduces bleeding after childbirth) could prevent the majority of these deaths. Misoprostol does not require a cold supply chain, and is cheap and effective, making it a perfect candidate for community-based interventions.

Upon the birth attendant’s arrival, Linda presented the three misoprostol pills she had recently been given by a home health promoter. Several days prior, a home health promoter had visited Linda and discussed with her a birth preparedness plan, informing her of the benefits of taking misoprostol immediately after delivery to prevent excessive bleeding.

Nehema Bubake, seen recovering here at the Kaziba General Reference Hospital, is full of optimism now that her fistula has been repaired. {Photo credit: MSH.}Photo credit: MSH.

In the Democratic Republic of Congo, many women suffer complications during pregnancy and delivery, including obstetric fistula. Prolonged labor may result in a hole (“fistula”) between a woman’s birth canal and bladder or lower intestine, resulting in chronic leaking of urine or feces. This, in turn, leads to social isolation as the women can’t keep themselves clean, are ashamed of their condition, and withdraw from society. Many women and their families believe that this condition is due to a curse, leading to further separation from the community.

Senegal {Photo credit: Galdos/MSH.}Photo credit: Galdos/MSH.

Crossposted on Maternal Health Taskforce's mhtfblog as part of the Maternal Health Commodities Blog Series.

Despite a decade of significant progress reducing maternal mortality rates, very few countries are on target to meet Millennium Development Goal of reducing the maternal mortality ratio by three-quarters by 2015.

AIDSChat 2012AIDSChat 2012

USAID and partners are hosting a Twitter chat in preparation for the 19th International AIDS Conference. The began at 10 am EDT and continues throughout the day.

Management Sciences for Health (MSH) will be co-hosting from 2:00 - 2:30 pm on the topic of prevention of mother-to-child transmission (PMTCT) of HIV with Scott Kellerman, MD, MPH, tweeting from .

Ramatu Fullah now ekes out a decent living selling acheke; her two children stand by her side. {Photo credit: ACEPT staff/MSH.}Photo credit: ACEPT staff/MSH.

Ramatu Fullah is a 27-year-old woman in the Pujehun district of Sierra Leone.  She comes from a poor family and, for years, had to earn her living as a sex worker to take care of her two children. Recently, Ramatu learned skills that enabled her to change her trade through an awareness-raising campaign supported by the USAID West Africa Regional Health Office's Action for West Africa Region II (AWARE II) project, managed by Management Sciences for Health (MSH). Today, Ramatu sells acheke, a local delicacy, on the streets of Sierra Leone.

Women and HIV & AIDS in Sierra Leone

Three Afghan children. {Photo credit: MSH.}Photo credit: MSH.

About 7.6 million children under age five die each year of preventable causers; 3 million — 40 percent — are newborns (under 28 days old). Ninety-nine percent of these occur in developing countries; three-quarters are mainly due to preventable causes such as neonatal conditions, pneumonia, diarrhea, malaria, and measles. Many of these under-five deaths could be averted by known, affordable, low-technology interventions.

Any preventable child death is one too many.

Here are 10 important interventions for child survival --- a list that is by no means exhaustive:

  1. Exclusive breastfeeding

    Could keep 1.3 million infants from dying (including by preventing pneumonia)

  2. Long-lasting, insecticide-treated bednets

    Would save more than 500,000 children by preventing malaria

  3. Vaccines, such as PCV, Hib, and rotavirus

    Would help prevent common childhood illnesses, such as measles, and save children’s lives

  4. Micronutrient supplements, such as vitamin A and zinc

    Would fight malnutrition. (While not a direct cause of death, malnutrition contributes indirectly to more than one-third of these deaths.)

Sophia is now the go-to person for family planning and reproductive health services at Rwesande health center IV in western Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

Sophia is a humble woman. She has been working as a nurse for 10 years, and is currently one of five nurses posted at Rwesande health center IV in the hills of western Uganda.

When I arrived I was impressed by the number of services the health center offers, and the general appreciation felt around the compound. Rwesande health center IV has a maternity ward to safely deliver babies; counseling areas for family planning, reproductive health, and HIV; a general ward, a surgery theater, and health education space.

Family planning counseling and services now available

As Sophia shows me her meticulously-kept record books I can see the pride she takes in her work. She explained how women are now coming and asking for family planning services.

Not too long ago clients were not coming, and the nurses didn’t have proper training on methods to offer clients.

Trained in kangaroo mother care by Dipeta health center staff, Imukalayi snuggled tiny Mardochet to her bare chest, then wrapped herself and her son in a cloth pagne, and held him there for hours, shifting him only when he needed to nurse. Mardochet's weight stabilized just three weeks later. {Photo credit: MSH.}Photo credit: MSH.

Honor your mom today by supporting MSH's work to help support healthy mothers---like Imukalayi Eponga (right)---and their children around the world.

Support healthy moms and their kids.

Imukalayi was trained on "kangaroo mother care" by MSH in the Democratic Republic of the Congo. Kangaroo mother care is a simple technique that emphasizes human contact to keep the baby warm.

This year, 7.5 million children will die - 99 percent in developing countries. In Africa alone, 1 in 8 children will die before their 5th birthday. Two-thirds of these deaths are preventable.

For over 40 years, MSH has seen that when mothers receive low-cost, high-impact interventions-like kangaroo mother care training-their children will likely survive until age 5 and beyond.

A physician assesses a mother and children for malaria at a health center in Bujumbura, Burundi. {Photo credit: Rima Shretta/MSH.}Photo credit: Rima Shretta/MSH.

Today, April 25th, Management Sciences for Health (MSH) joins the global community marking World Malaria Day. "Sustain Gains, Save Lives: Invest in Malaria" -- the theme of this year's World Malaria Day -- recognizes this crucial juncture in the global fight against malaria.

Significant gains have been made in the last ten years; since 2000, malaria mortality rates have decreased 25 percent globally, and 33 percent in Africa. However, progress could be reversed unless malaria continues to be a priority for global, regional, and national decision-makers and donors.

Burundi, Democratic Republic of the Congo (DR Congo), South Sudan, and Uganda are among several MSH countries commemorating World Malaria Day with malaria awareness activities and events, including health talk sessions at football (soccer) games and drama activities with kids.

A woman and baby rest at St. Josephs' Health Center -- the only health institution in Abricots, Haiti. {Photo credit: MSH.}Photo credit: MSH.

Suzanna Ile, a 26-year-old woman from South Sudan, lost her first two babies in childbirth. Suzanna did not have a nurse or midwife to tell her that her pelvis was dangerously small for childbirth; nor was there a safe place for a caesarian section even if she had known the risk.

Suzanna’s experience is typical of what women have faced in South Sudan, the newest country in the world. South Sudan is home to 10 million people, spread across an area about the size of France. The people have experienced civil war off and on for five decades --- hardly anyone remembers a time without conflict. In places like the capital city of Juba, the infrastructure has been seriously damaged. The conflicts have devastated the economy and disrupted the education system.

South Sudan has some of the worst health indicators in the world. Health facilities are grossly understaffed as health workers fled the country: only ten percent of staff positions are appropriately filled. There are less than two doctors for every 100,000 people. A woman in South Sudan is five-hundred-times more likely to lose her life giving birth than a woman in Europe. Forty-five percent of children suffer from physical stunting due to malnutrition.

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