Maternal Care Access in Sudan Geneva Foundation for Medical Education and Research GFMER Sudan 2012 Forum No: ( 1 )
Name of presenterName Position InstitutionSawsan Mustafa Abdalla Associated Professor National Ribat University Name of contributorsName Position InstitutionSawsan Mustafa Abdalla Associated Professor National Ribat University Asharaf Ahmed
Content of the presentation Background RH services current status National monitoring indicators Health status Safe motherhood: A human right yet to be fulfilled Previous studies References
Maternal Care AccessThe International Conference on Population and Development, drawing on the WHO definition of health, defined reproductive health as a ‘state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes’(1).
Maternal Care AccessThe availability of good quality reproductive health (RH) services is a vital social andeconomic investment.provision of efficient, equitable and quality reproductive and sexual health services will go a long way in improving the health of the population.
Maternal Care Accessthe national policy of RH Stated that: shall provide maternity and child care and medical care for pregnant women’.
Maternal Care AccessThe policy document provides direction to Sudan national health system setting an agenda for reforms assuring the reproductive health services are available not only throughout a woman’s life-cycle but ensuring her the right to survive pregnancy and childbirth and enjoy a good family life
Maternal Care AccessMaternal mortality figures for Sudan are one of the highest in the world. On average, according to Sudan Household Health Survey (2006), every day about forty women die due to causes associated with birth
Maternal Care AccessWhile in certain parts of country, situation could even be worse, these figures might only be a tip of the iceberg due to underreported maternal deaths and or incorrectly attributed and classified as cause. High maternal mortality is also an indication of high infant mortality
Maternal Mortality Ratio in the EMR: 20061800 16001600160014001200 11071000800600 546 465 395 350 366 370400 294 227200 68 104 0 0 7 13 18 21 23 37 40 41 45 65 0 KUW UAE EGY JOR SUD TUN LEB IRQ AFG DJI BAA SYR IRA MOR PAK QAT LIY YEM SOM OMA SAA PAL AVG(90) AVG(00) AVG(04)
National monitoring indicators• % pregnant women who have at least one antenatal visit 94.8%• % of pregnant women who have a trained attendant at delivery 89%• % of pregnant women immunized against tetanus 74%
National monitoring indicatorsContraceptive prevalence rate 20%% of infants weighing less than 2500 g at birthprevalence of female genital mutilation 70.3%Maternal mortality ratio 1107/100.000
Health status -Sudan is lagging behind the target for achieving MDGs, particularly for the healthrelated MDGs.-The national maternal mortality ratio averages 1,107 deaths per 100,000 live births with wide interstate variations
Health statusThe infant mortality rate is estimate at 81 per 1000 live births and about half of these are neonatal deaths (41/1000 live birth)occurring during the first month of life(SHHS, 2006).Under 5 mortality is 105 and 126 per 1,000 live births in north and south respectively, while comparable figures for infant mortality are 70 and 89.
Health statusSudan has three layers of care provision.At the apex of pyramid are the teaching, general and specialist hospitals renderingsecondary and tertiary careFor primary care, the rural hospitals are first referral care with indoor and diagnostic facilities.
Health statusPrimary care is provided through a variety of outlets:PHC unit:- staffed by a community health worker. dressing station:-staffed by a trained nurse or experienced community health worker.Dispensary:-staffed by a medical assistant and a nurse, and provide PHC services.
Health statusThe health centers:- which are referral forprimary health care facilitiesstaffed by two medical officers, and paramedics, i.e. medical assistant, health visitor, nutrition instructor and vaccinator
Health status45-65% of population has access to PHC services, i.e. on average, 1 facility serves12,000 people.
Health statusThe policy supports comprehensive reproductive health care which is accessible, affordable, appropriate, efficient and effective; and for that purpose, it can be delivered through
The Reproductive Health Package Safe motherhood services family planning harmful practices unwanted pregnancy unsafe abortion reproductive tract infections including sexually transmitted diseases and HIV/AIDS gender-based violence infertility reproductive tract cancers Violence against women Women empowerment
Health statusit can be delivered through:Integration of reproductive health services with mainstream primary health care
The neglected tragedy of maternal mortalitySafe motherhood: A human right yet to be fulfilled• “When reporting on the right to life protected by article 6, States Parties should provide data on …..pregnancy and childbirth- related deaths of women……..”UN Human Rights Committee, General Comment 28 (2000): Equality of rights between Men and Women (Article 3). 10
Safe motherhood: A human right yet to be fulfilled• Mothers have a right to life• Maternity is not a disease• Motherhood can be made safer• Millions of women are denied exits from the maternal death road• A question of how much a woman’s life is considered worth
Motherhood can be made saferThe interventions that make motherhoodsafe are known and the resources needed areobtainable. The necessary Services areneither sophisticated nor very expensive,and reducing maternal mortality is one of themost cost-effective strategies available in thearea of public health. Message from WHO Director-General, World Health Day, 1998
Previous study• A cross-sectional community-based study was carried out in Kassala, eastern Sudan.• The aim of this study was to investigate coverage of antenatal care and identify factors associated with inadequacy of antenatal care in Kassala, eastern Sudan
Previous study 811(90%) women had at least one visit. Only11% of the investigated women had ≥ fourantenatal visits, while 10.0% had not attendedat all. Out of 811 women who attended atleast one visit, 483 (59.6%), 303 (37.4%) and25 (3.1%) women attended antenatal care inthe first, second and third trimester,respectively.
Previous studyAntenatal care showed a low coverage inKassala, eastern Sudan. This low coverage wasassociated with high parity and low husbandeducation.
References1-Programme of Action of the International Conference onPopulation and Development (ICPD), New York, United Nations,19942-National health policy, Sudan 20073-UNDP, MDGs in Sudan, http://www.sd.undp.org/mdg_sudan.htm accessed on 27 March, 20104-Federal Ministry of Health (2007), Annual Health Statistical Report, 2007, National Health Information Centre, Federal Ministry of Health Khartoum