Improving Maternal and Neonatal Health Outcomes in Mozambique


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In Mozambique maternal mortality rates are 550 per 100,000 and neonatal mortality is 39 per 1000 live births. This presentation was the output of a short research project looking at the ways in which technology might be used in development programming to improve maternal and neonatal health outcomes.

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  • I am going to argue that it is possible to improve maternal and neonatal health outcomes by focussing interventions at the delivery stage of pregnancyDelivery stage is where most value can be found in a technological approachI am going to outline the problems faced at this stage, the technological approaches we could take to tackle these problems, and the wider holistic programming that would be required to ensure that these interventions are successful.
  • Mozambique is currently one of the most dangerous places in the world to give birth0.03 Doctors per 1000 peopleDespite political will
  • The causes of maternal mortality during delivery are generally due to acute complications which cannot be fully addressed without skilled personnel and equipment.4% Maternal mortality due to abortions
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  • In Malawi, the bikes nearly doubled the number of women giving birth in health facilities, and cut the number needing emergency operations by half, according to UNICEF statistics.  In some areas of Malawi nineteen motorcycle ambulances can be bought for the price of one Toyota land cruiser car ambulance, creating a greater coverage area, huge economic advantages for job creation and better fuel efficient costs for patients and local health facilities.
  • Improving Maternal and Neonatal Health Outcomes in Mozambique

    1. 1. Using Technology to Improve Maternal Health Outcomes inMozambiqueJames Brown25-4-12
    2. 2. Baseline Data• Antenatal care:– 92% (<1 visit)– 53% (<4 visits)• Skilled attendant at birth: 55%• Maternal mortality rate: 550/100 000• Neonatal mortality rate: 39/1000 live births
    3. 3. Where are the opportunities for having a health impact?Stage of pregnancy:Family planning – Antenatal – Delivery – PostpartumImproving maternal health is more thanjust addressing deaths during childbirth
    4. 4. Addressing Acute Complications During Delivery34%19%9%21%17%Maternal MortalityHaemorrhage HypertensionInfection Other directIndirect35%24%17%24%Neonatal MortalityPrematurity Birth asphyxiaInfection Other
    5. 5. What are the problem areas we could address?• Limited access to trained staff• Limited capacity of frontline staff to deal with acute emergencies:– Training– Drugs– Medical equipment• Delays in referring emergency cases
    6. 6. Birthing Simulator• Low cost training for birth attendants• Supports training for Basic EmergencyObstetric interventions (eg PPH)• Maintenance by trainer• Costs $100• Other low cost models in testingNeonatal ResuscitationSimulator• Costs $50• Allows realistic training for health workers• Available since 2009
    7. 7. Mobile Phones• Connecting frontline healthcare providers tospecialists• Reduces delay in diagnosis• Custom applications such as frontline smsmay provide the ability to diagnose over textmessage• Requires minimal training
    8. 8. Prefilled Auto-disable Injection System• May allow minimally-trained health workers toadminister Oxytocin to mothers• Time-temperature indicator for monitoringcold chain• Available since 1998• Costs vary by drugs• Limited training required• Cannot be reused – prevents diseasetransmission• Creates minimal waste
    9. 9. Emergency Neonatal Suction Device• Addresses birth asphyxia• Available since April 2010• Costs $3 USD• Limited training required• Requires regular disinfection by boiling
    10. 10. Motorcycle Ambulance•Can reduce transfer time from remoteareas to healthcare facilities• Increases attendance at health centres• Reduces number of emergencyoperations required• Up to 19 motorcycle ambulances may bebought for the price of a Landcruiser• Fuel efficient
    11. 11. Technology is not enough…• Political support• Community support• Family acceptance• Training to use and maintain equipment• Ongoing sustainable funding• Collaboration with other programmes• Availability of skilled technicians and spare parts
    12. 12. ConclusionTechnological approaches can be valuable in improving outcomes inmaternal and neonatal health, but their efficacy relies on the widerprogramme approach.
    13. 13. UNICEF (2009) ‘Mozambique National Child Mortality Study’UNICEF (2012) ‘Preventing mother to child transmission’ available online (2012) ‘Mozambique, Causes of Mortality: Situation and Trends’Michael MacHarg (2010) ‘For Mothers Day: Celebrating Innovations in Maternal Health’ available onlineat nextbillion.netJames Pfeiffer (2003) ‘International NGOs and primary health care in Mozambique: the need for a newmodel of collaboration’ Social Science & Medicine 56, 725–738VeroniqueFilippi et al. (2006) Maternal health in poor countries: the broader context and a call foractionThe Lancet, 368, 1535 – 1541L Jamisse et al. (2004) Reducing maternal mortality in Mozambique: challenges, failures, successes andlessons learned, International Journal of Gynecology &Obstetrics, 85:2, 203–212C Santos et al. (2006) ‘Improving emergency obstetric care in Mozambique: The story of Sofala’International Journal of Gynecology &Obstetrics,94: 2, 190–201G. Benagiano (2003) ‘Safe motherhood: the FIGO initiative’International Journal of Gynecology & Obstetrics82:3, 263–274World Health Organisation (2011) ‘Compendium of new and emerging health technologies’
    14. 14. Targeting delivery is not enough…• By engaging at the antenatal stage women are more likely to understand and accept• ~4% of maternal deaths are due to abortions• Contraception prevalence is 16%
    15. 15. Where are the opportunities for having a health impact?Stage of pregnancy• Family planning• Antenatal• Delivery• PostpartumLocations• Households• Communities• Primary healthcare• Referral healthcareImproving maternal health is more than just addressing deaths during childbirth