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Preventing Under Five Mortality

When I was working on the Thai-Burma border, there was a group bringing backpacks full of medical supplies.  So when I saw this interview on under 5 mortality between Andrea Mitchell of MSNBC and USAID Administrator Raj Shah, I thought it was worth sharing.

Cheap solutions to prevent 7mn under 5 deaths, including:

Diarrhea vaccine

Sweet potatoes — has Beta Karo-tine for vitamin A

Zinc tablets — for diarrhea and used with deydration salts

Bed nets — 220,000 children saved each year — cost $6

Mask to help new babies breathe

Study Low Birth Weight Babies in Lao PDR

This study (Nagoya J. Med. Sci.  72. 51 ~ 58, 2010) shows that mother’s health and nutrition are factors in babies being born with low birth rates.

Mothers who demonstrated a good grasp of nutrition and health delivered LBW infants 10.1 less frequently than mothers who showed more limited knowledge…

While considering the health status of mothers, it was found that those in poor health had LBW infants 3.4 times more often than healthy mothers.

Other issues like family support also play a role:

…In the traditional society of Lao PDR, women have little independence to decide their own future. For a pregnant mother to get medical support, she must wait for the decision of her husband or other family members before consulting a medical doctor for a check-up of her pregnancy status. The necessity of a nutritious diet and the extent of its availability is, except in some rare situations, again dependent on the wishes of the family.

“Hypertension and proteinuria leading to pre-eclampsia” was found in the study to be the cause of 20-25% of prenatal mortalities.

Conclusions:

The results of this study showed that the maternal factors significantly associated with LBW infants included the mother’s age and occupation, her knowledge and health status, and the family’s income. It may not be possible to address all these issues at once, but early and regular antenatal visits by prospective mothers and conducting awareness programs through the mass
media focusing on proper care during pregnancy could alleviate many of these problems.

Lao PDR celebrates the month of midwives

Great article about the Month of Midwives in Laos (Lao PDR).  I am so pleased to see the commitment to increased midwifery training!
Date: 15/06/2012

Every day in Lao PDR, more than two women die because of complications during pregnancy and childbirth. For every woman who dies many more suffer from illness or disability from complications during pregnancy or childbirth. Most of these deaths and illnesses can be prevented when mothers have access to skilled care at birth.

As part of the strategy to reduce maternal mortality in Lao PDR, the Ministry of Health (MoH) with support from the United Nations Population Fund, (UNFPA) and other development partners, specifically UNICEF WHO and the World Bank, is implementing the National Skilled Birth Attendance (SBA) plan that supports the delivery of the national Integrated Package of Maternal, Neonatal and Child Health Services. Specifically the SBA plan includes production and deployment at community level (Health Centre and Hospital Type-B) of trained professional Midwives that are currently being produced in 7 Provincial health schools all over the country.

Normally, all over the world, the International day of the Midwives is celebrated on 5th May each year, but in Laos, in order to ensure that all provinces can take part in the celebrations, MoH have designated the whole month of June as the “Month of Midwives”, because in June the country will see the graduation of the second batch of community midwives. Over the whole month, MoH in collaboration with UNFPA and other development partners is organizing a number of events, the first of which was in Luang Namtha on June 7th, where a health promotion day for mothers and babies in Viengphouka District was held. Two other events are in Savannaketh on 15th and Oudomxay 22nd June, where MOH will present the graduating midwives from the south and north respectively, their certificate of licence to practice as a midwife.

All activities are focused on keeping mothers and babies safe and healthy through access to birth spacing, use of professional midwives before, during and after pregnancy and childbirth and ready access to emergency obstetric care. To make this possible, it is acknowledged that midwives working at the community level must have an unbroken supply of essential supplies and medicines, and must work closely with the community, especially village leaders, in order to promote the key messages and to encourage more men to take proactive action to save the lives of their wives, mothers and daughters.

The main event of the month was the celebration in Savannaketh. The High-level event in Savannaketh on 15th June, saw MoH award the national midwifery certificates of accreditation of competences to the 80 midwives in second batch trained in Khammouane, Champasack and Vientiane Province. The event brought together senior level officials from MOH at central and Provincial level, including the Vice Minister, Associate Prof. Dr. Som Ock Kingsada, as well as representatives from key line ministries such as the Ministry of Planning and Investment (MPI) and the Ministry of Education and Sports, as well as the Lao Women’s Union and government officials from UN supported districts.

“Midwives can provide much more than family planning and skilled care at birth. They can be the link between the community and the health services. They can work together with local leaders to plan and implement actions to improve the quality of life in the community. They can save mothers and babies lives. If people make use of their services, if communities provide them with support and information and local leaders involve them in the planning and decision-making, Midwives can help to make healthier and more productive communities. The work of midwives is the foundation for healthy families, healthy communities and a prosperous nation” said Dr. Esther Muia, UNFPA Representative.

The Vice Minister of Health, Associate Prof. Dr. Kingsada said “In many parts of the world, and now in Lao PDR, midwifery is seen as a very important and gratifying profession. This is why we would like to encourage educated girls and women from the community to consider becoming midwives. We would also like to ask the community and its leaders to identify and encourage girls in particular to become midwives. Every community needs to have its own professional midwife to work with community leaders, families and individual women and adolescent girls to improve knowledge of safe pregnancy, childbirth and care of mothers and babies after birth, but also to provide quality services”

During the event a 15 minutes documentary about the Community Midwives Programme in remote areas of Lao PDR was presented. The video, recorded in Xiengkouang Province and produced by UNFPA’s Asia Pacific Regional Office in collaboration with the Country Office Lao PDR, shows how having skilled birth attendants is helping to improve the health of mothers and babies in these communities.

The training of community midwives is part of the Joint Maternal, Neonatal, Child Health and Nutrition (MNCHN) programme developed and implemented by the MoH and the United Nations. This programme combines the skills and expertise of UNFPA, UNICEF, WFP and WHO and is made possible through a co-financing agreement of more than 8-million euros over five years between 2011-2015, signed between the Grand Duchy of Luxembourg, MoH and the UN.

Contact information:
Diego De La Rosa, Tel.: (+856 21) 315547, Mobile: (+856) 20 59936509, drosa@unfpa.org

Dads Matter to Birth Outcomes in Bangladesh

A very interesting study conducted in Bangladesh which shows that husbands play an important role in the care that mothers receive in pregnancy and birth.

The findings presented in this paper suggest that the level of social support provided by the husband to his wife and the husband’s perception of social norms related medical intervention during childbirth are both associated with the type of provider utilized during childbirth. The husband’s perception of social norms related to professional care is important to the type of advice and support he will give his wife during pregnancy and childbirth, which has important implications for the development of future maternal health interventions.

Areas of fruitful future research include the further elucidation of the types of social support provided by the husband and the critical social norms related to childbirth in Bangladesh. This and future research could be used to create valid and reliable measures to assess the quantitative impact of social support and social norms on the utilization of professional maternal health services using a more representative sample. These findings may also be useful to program planners, who should pursue culturally sensitive ways to involve the husband in maternal health interventions and assess the effectiveness of education strategies targeted at husbands.

Countdown to 2015 report: Look at Laos

Countdown to 2015 released country profiles today.

The 2012 Report, Building a Future for Women and Children, highlights country progress—and obstacles to progress—towards achieving Millennium Development Goals 4 and 5 to reduce child mortality and improve maternal health.

Lao PDR is a mixed bag.  Significant progress has been made in water and sanitation, malaria prevention, and immunizations. However there is much, much more to be done. Two biggies that I see: only 26% of infants <6 are exclusively breastfed (up from 23% in 2000) and only 20% of births have a skilled attendant (up from 19% in 2000).  Antenatal care is still bleak — with 35% attended once in pregancy by a provider — up from 27% in 2000.  Density of doctors, nurses and midwives stands at 12.4 per 10,000 population.

My summary: keep funding clean birth kits, community health workers and midwifery training.

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