BLOG - CleanBirth - Saving Mothers and Babies in Laos

Mar 11 2012

“Laos plan to reverse region’s worst maternal mortality rates”

Here’s more on the new batch of midwives and on-going in Laos. http://www.radioaustralia.net.au/international/radio/onairhighlights/laos-plan-to-reverse-regions-worst-maternal-mortality-rates

This is an interview with: Dr Monir Islam, Director, Family Health and Research Program, World Health Organisation, South-East Asia Regional Office; Della Sherrat, Field Birth Attendant Co-ordinator, United Nations Population Fund (UNFPA), Laos; Boathip Phongsavath, Program Officer for Laos, United Nations Population Fund (UNFPA); Magdalen Drani, International Nurse-midwife Trainer, United Nations

Mar 11 2012

Laos: First Midwives Trained in 22 Years

The first class of new midwives finished their training in Dec 2010 — it had been 22 years since the last midwives were trained. Read more here: http://www.irinnews.org/Report/91339/LAOS-Midwife-training-resumes-after-20-years

There are 100 midwives nationwide who trained 20 years ago and are still working. Even if the government can continue annual training programmes, reaching an additional 160 health workers every year, it would take another decade to staff each of the country’s 825 health centres and 122 district hospitals with at least one trained midwife, said the deputy general director of health personnel at the Health Ministry, Phouthone Vangkonevilay.

And training is just part of the equation he added. “Our biggest challenges are how to equip centres with enough medical supplies and how to motivate these new workers with incentives to stay in and improve performance in remote areas.”

Hmmm…medical supplies needed. Wonder how CBKs can contribute to the mission?

Mar 10 2012

Laos: Reducing Maternal Mortality

Another informative article from Dr. Donald Marsden of FRANZCOG– this one about maternal deaths in hospitals in Laos, largely due to hemmorage. http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/436-vol-11-no-3-spring-2009-complete-issue.html

I found this part of particular interest, as I research how Clean Birth Kits (CBKs) might aid in the effort to lower maternal and infant mortality after birth. It seems that a Australian nurse, Carol Perks of Save the Children, has produced dramatic falls in maternal mortality.

A report published in 2005 shows that the comprehensive district managed primary healthcare program introduced 12 years earlier resulted in a life expectancy increase of 12 years, a 48 per cent decrease in crude mortality rate, a 30 per cent decrease in crude birth rate, a 70 per cent decrease in infant mortality and a maternal mortality ratio of 110/100,000. The cost of the project was uS$4 million over 12 years, roughly uS$1 per person in the province per year. The reduced maternal mortality in the province was related to increasing use of contraception to space births. Modern contraceptive use rose from 12 per cent of women in 1997 to 67 per cent in 2003. The proportion of pregnant women attending three or more antenatal visits in Sayaboury province rose from 24 per cent to 58 per cent over the same period. Obviously, even very cheap interventions can have major benefits on health indicators in these poor societies.

Citation for the report:

Perks C, Toole MJ, Phoutonsy K. District health programmes and
health sector reform: case study in the Lao Peoples Democratic
Republic. Bulletin of the World Health Organisation, 2006. 84: 132-
138.

Mar 10 2012

Homebirth in Laos

80% of women in Laos choose home birth — with only 20% attended by “skilled health personnel” — over hopsital birth despite maternal mortality rate of 400 per 100,000 live births.

Why?

Cost — hospital charges (50-80% hospital income from user fees/sale of pharmacueticals), transportation, lost labor (mother and family accompanying)

Distance to hospital — increases cost, makes hard for family to be present

Cultural practices ignored –Family must be present, trained health workers don’t respect traditional practices, no baths/saunas, no “rest over fire,” burial of placenta at home

Negative aspects of hospital care — Embarrassing birth position (high bed, on back), episiotomy, lack of privacy, rise in (costly) C-sections

Influence of mothers/grandmothers — They delivered at home

The author, Dr. Donald Marsden, concludes:

However, it is obvious that until many of the social and cultural issues are addressed, homebirth is likely to be favoured by a large proportion of the population into the foreseeable future, despite the manifold dangers.

Read the full article here: http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/774-48-homebirth-in-laos.html

Mar 10 2012

CBKs May Improve Neonatal Outcomes following Home Births

Research showing that for women with limited access to healthcare clean birth kits improve neonatal outcomes. Nadine Seward and Audrey Prost from the University College London analyzed data from three pre-exisiting studies to:

investigate the links between neonatal mortality, the use of clean delivery kits, and individual clean delivery practices in almost 20 000 home births in rural areas of India, Nepal, and Bangladesh. The researchers found that use of the birth kits was linked to a dramatic drop (48%) in neonatal mortality with a further drop (16%) in neonatal mortality with each additional clean delivery practice used.

According to http://www.medpagetoday.com/OBGYN/Pregnancy/31457 reporting on the analysis:

Further research should explore the context of kit use in order to develop and test locally appropriate promotion strategies, as well as examine the potential of kits to improve neonatal survival in the context of increasing institutional delivery rates,” they wrote.

>>>

But, the authors noted, “while the kit can be considered a low-cost intervention, there have been no studies on willingness to pay for kits, and these costs may still be prohibitive for the poorest women.

Pin It on Pinterest