The document discusses maternal and child health challenges in Sub-Saharan Africa. It provides background information on Africa and outlines the problem statement of high rates of maternal and child mortality. Over 289,000 women died in 2013 due to pregnancy complications and 6.3 million children under age 5 died. The main contributing factors are discussed as poor health infrastructure, lack of access to services, and infectious diseases. The document also summarizes global actions taken like the Millennium Development Goals and progress made with a 45% reduction in maternal deaths and 49% reduction in under-5 mortality, though rates remain high in Sub-Saharan Africa. It concludes with an update on the Ebola epidemic in West Africa.

1. MATERNAL AND CHILDREN HEALTH CHALLENGES
IN SUB SAHARAN AFRICA
Luke M. Nkinsi, MD, MPH & TM

2. OUOTULTINLEINE
I. Background on AFRICA
II. Purpose of the presentation
III. Problem statement
IV. Contributing factors
V. Global actions to reduce preventable maternal and child deaths
VI. Results and progress made
V. Update on Ebola Epidemic in West Africa
a. Background
b. Symptoms
c. Risk factors
d. Prevention
e. Diagnosis
VI. Q & A session

3. I-BACKGROUND ON AFRICA
 54 countries
 Total population:
1,099,755,000
(July 2013 projection)
 Percentage of rural
population: 62.7%
(from 71.9% in 1990)
 5 most populated
countries
1. Nigeria: 177,096,000
2. Ethiopia: 86,614,000
3. Egypt: 84,605,000
4. DR Congo: 74,618,000
5. South Africa: 52,982,000
AFRICA

4. Africa is more than 30 million sqkm
Ten largest countries
1. China 1,349,585,838
2. India 1,220,800,359
3. USA 316,668,567
4. Indonesia 251,160,124
5. Brazil 201,009,622
6. Pakistan 193,238,868
7. Nigeria 174,507,539
8. Bangladesh 163,654,860
9. Russia 142,500,482
10. Japan 127,253,075
Africa

5. BABCAKCGKRGORUONUDND ON AFRICA

6. BBAACCKKGGRROOUUNNDD ON AFRICA

7. BBAACCKKGGRROOUUNNDD ON AFRICA
 About 36.8 per cent of
Africa’s workforce are
youth.
 Africa is the world’s
youngest continent (in
2010, 70% of Africa’s
population was aged
below 30)
 African youth: Great asset
for Africa’s development,
provided that appropriate
investments in health and
human capital are made.

8. Purpose of my presentation
All lives have equal value and every person deserves the opportunity to
lead a healthy and productive life (Bill and Melinda Gates)
 Raise awareness about high
maternal and child mortality
rates in Africa
 All women deserve to give
birth safely, and all children —
no matter where they are born
— deserve the same chance to
survive and thrive.

9. Children standing by their
mother’s grave, South Africa
Problem Statement
 In 2013, 289,000 women died
due to complications of
pregnancy and child birth.
 62% of these deaths occurred
in sub-Saharan Africa alone
(179,000 deaths)
 24% of these deaths occurred
in southern Asia
 Two countries (India and
Nigeria) accounted for 30% of
all global maternal deaths

10. A jumbo jet crash
Problem Statement (continued)
 800 women died every day in
the world in 2013
 About 496 women died in sub-
Saharan Africa alone every
day
 Three Boeing 777-300 carrying
each 280 (max. seating capacity)
pregnant women crashing
every day in the world
 Two Airbus A330-300 carrying
each 250 pregnant women
(max. seating capacity) crashing in
AFRICA every single day

11. Most of these deaths could have been prevented
Main cause: Hemorrhage (bleeding)
Causes of maternal deaths

12. A father buries his child
Problem Statement (continued)
 6.3 million children under age five
died in 2013
 About 50% of these deaths
occurred in only five countries:
India, Nigeria, DR Congo and
China
 India and Nigeria together account
for more than 30% of under-five
deaths worldwide
 44% of under-five deaths occur in
their first 28 days of life
 83% of these deaths were caused
by infectious, neonatal or
nutritional conditions

13. Key Arena, Seattle
Capacity: 17,459
Problem Statement (continued)
 Nearly 17,000 children under
age five died in the world every
day in 2013
 About 7,000 of these deaths
occurred in sub-Saharan Africa
 Key Arena full of children 0-5
years old perishing every day

14. Causes of deaths among children under age 5
aths (2013)

15. Examples of local initiatives to support maternal & children health
Advocacy for a stronger political commitment and community ownership
The ‘Champions’ for a HIV-Free Generation in Africa ‘Gogo’ Misikiya and other ‘Gogo’s, South Africa

16. Contributing factors: Combination of several factors
Factors that affect human development in a country also affect
infant & maternal rates mortality rates and vice-versa
 Poor health infrastructure
 Harmful traditional practices
 Lack of women empowerment
 Lack of political commitment
 Policies and legislations that
create barriers to accessing
services
 Poor/low access to quality
health care services
 Two-thirds of children who die
each year could be saved by
low-tech, evidence-based,
cost-effective interventions:
 vaccines
 antibiotics
 micronutrient supplementation
 insecticide-treated bed nets
 improved family care
 breastfeeding practices
 oral rehydration therapy

17. Example: the ‘Four Delays’
Emergency Obstetrical Care (EOC)
1. Delay in recognizing the
signs of danger
2. Delay in decision-making
process
3. Delay in transportation
to health centers/clinics
4. Delay in delivery of
quality health services

18. Examples of community-based initiatives
Community Tricycle

19. Examples of global actions to reduce preventable deaths
The Eight Millennium Development Goals (MDGs) by 2015
 Goal 4: Reduce child mortality rates
 Target: Reduce by two-thirds,
between 1990 and 2015, the under-five
mortality rate Under-five
mortality rate
 Goal 5: Improve maternal health
 Target: Reduce by three quarters,
between 1990 and 2015, the
maternal mortality ratio Maternal
mortality ratio
 Target: Achieve by 2015, universal
access to reproductive health
Contraceptive prevalence rate

20. Examples of global actions to reduce preventable deaths (continued)
• June 2012, Ethiopia, India, and
the United States, in
collaboration with UNICEF,
hosted the “Child Survival: Call
to Action.”
• Single, comprehensive, and
achievable goal: To end
preventable child deaths by
2035.
• More than 175 countries and
over 400 civil society and faith
organizations signed a pledge in
support

21. Examples of global actions (continued)
June 25, 2014, USAID unveiled an action plan:
"Acting on the Call: Ending Preventable Child and Maternal Deaths"
 Goal: To save the lives of 15 million
children and nearly 600,000 women
by 2020 in 24 priority countries
 Evidence-based Interventions
 Newborn care
 Immunization
 Prevention and Treatment of
Childhood Illness
 Nutrition
 Maternal Health
 Family Planning
 Ensuring Healthy Behaviors
 Water, Sanitation, and Hygiene

22. ADVOCACY
The Clinton Foundation The Eastern Congo Initiative (ECI)

23. Progress made in maternal mortality
45% decrease of number of maternal deaths
 The number of women dying
due to complications during
pregnancy and childbirth has
decreased by 45% between
1990 and 2013 (from an estimated
523,000 in 1990 to 289,000 in 2013)
 Notable progress but the
annual rate of decline is less
than 5.5% (required annual
decline to reach the MDG
target)
average annual decline of 2.6%

24. Progress made in maternal mortality (continued)
C-section, Kikwit General Hospital, 1985
 Optimal range of Cesarean
section rates: 5–15% (WHO)
 C-section estimated range in
sub-Saharan Africa: 1-2%
(Medecins Sans Frontieres)
 Most common indications:
 obstructed labor
 poor presentation
 previous C-section
 fetal distress
 uterine rupture
 antepartum hemorrhage

25. Progress made in children mortality
Globally, under-five mortality has decreased by 49%,
 In 1990: 90 deaths per
1000 live births
 In 2013: 46 deaths per
1000 live births
 The average annual
rate of reduction in
under-five (4%) remains
insufficient to reach
MDG 4 target

26. Progress made in children mortality (continued)
The number of under-five deaths worldwide has declined from
12.7 million in 1990 to 6.3 million in 2013
 About 50% of under-five
deaths in 2013 still occurred in
only five countries: India,
Nigeria, Pakistan, DRC, China
 India and Nigeria together
account for more than a third
of under-five deaths worldwide

27. Progress made in children mortality (continued)
Progress is unequally distributed
 WHO Africa Region, still has
an increasing share of
under-five deaths.
 By 2050
 37% of the world’s
children under age five
will live in Sub-Saharan
Africa
 Close to 40% of all live
births will take place in
Africa

28. Update on Ebola Epidemic
 Ebola hemorrhagic fever is a rare View of Ebola River, Equateur province, DR Congo
and deadly disease caused by
the Ebola virus
 Ebola was first identified in 1976
in Yambuku, near the Ebola river
in what is now the Democratic
Republic of the Congo (DRC)
 The natural reservoir host of
Ebola virus remains unknown.
However, bats are the most likely
reservoir.

29. Symptoms
Ebola only spreads when people are sick

30. How do you get the Ebola virus?
Direct contact with:
1.Body fluids of a
person who is sick or
has died from Ebola
(blood, vomit, stools,
sweat, semen, spit ,
other fluids)
2.Objects contaminated
with the virus (needles,
medical equipment)
3.Infected fruit bats or
primates (apes and
monkeys)

31. Prevention
There is no FDA-approved vaccine available for Ebola yet.
Careful hygiene:
 wash your hands
with soap and
water or an
alcohol-based
hand sanitizer
 avoid contact with
blood and body
fluids.

32. Prevention (continued)
AVOID DIRECT CONTACT
• Do not handle items that may
have come in contact with an
infected person’s blood or
body fluids (such as clothes,
bedding, needles, and medical
equipment).
• Avoid funeral or burial rituals
that require handling the body
of someone who has died from
Ebola.
• Avoid contact with bats and
nonhuman primates or blood,
fluids, and raw meat prepared
from these animals.

33. Diagnosis
Confirmation: Ebola virus is detected in blood (ELISA, PCR)
 Suspect cases:
 Early symptoms of Ebola
 Recent history of contact
 with the blood or body
fluids of a person sick
with Ebola;
 with objects
contaminated with the
blood or body fluids of
a person sick with
Ebola;
 with infected animals

34. Treatment
The 2014 Ebola epidemic is the largest in history
 Symptoms of Ebola
and complications are
treated as they appear.
 Provide intravenous
fluids (IV) and
electrolytes (body
salts).
 Maintain oxygen status
and blood pressure.
 Treat other infections if
they occur.

35. A young Ebola patient (22 months
old) is being discharged from
Ebola Treatment Center, Liberia
Treatment (continued)
 Recovery from Ebola
depends on good supportive
care and the patient’s
immune response.
 Experimental vaccines and
treatments for Ebola are
under development
 People who recover from
Ebola develop antibodies
that last for at least 10 years,
possibly longer

36. Total cases of Ebola (as of November 28, 2014)
1 in 2 people who get Ebola in this outbreak have died

37. The END
Thank you, Merci beaucoup, Aksanti sana, Matondo
mingi, Botondi, Ke a leboga, Siyabonga, O seun
“It always seems
impossible until it’s done”
Nelson Mandela