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Mobile Clinics in Laos

I want to learn more about these mobile clinics in Laos … and perhaps contribute to the mission vis a vis clean birth kits.

http://www.k4health.org/toolkits/communitybasedfp/country_experiences/mobile-rh-clinics_laovillages

Mobile Reproductive Health Clinics Make Motherhood Safer in Remote Lao Village

Source: United Nations Population Fund [UNFPA], 2005

Working in cooperation with the the Lao Women’s Union, UNICEF and others, the mobile clinic teams vaccinate children and provide a range of reproductive health services, information and counselling for adults and adolescents 15 and older—including family planning, prenatal care, treatment of sexually transmitted infections and education on HIV/AIDS prevention. Over two days, one team will provide services for everyone who needs them. The team will stay overnight in the village, showing health education videos in the evening.

Save the Children’s Facts on Health in Laos

Here’s a quick look at Laos health stats thanks compliments of Save the Children.

The health situation of women and children in Laos is amongst the poorest in Southeast Asia; Infant mortality rate is 70 per 1000 live births and under five mortality claims 98 per 1000 live births1.

Every day 36 children under-five die due to preventable and treatable diseases.

Percentages of underweight children have been almost unchanged between 1990 and 2006 (40% and 37.1%) and the prevalence of stunting in under-fives is up to 40.4%.

According to UNICEF/WHO official estimate (2007), immunisation coverage has declined—only 27% of children by their first birthday have received all eight recommended vaccinations2.

Maternal mortality remains very high at 405/100,000 live births, approximately 800 deaths per year or 2 deaths per day.

A high percentage of children (71.5%) are born to mothers who received no antenatal care and 84.8% of pregnant women give birth at home3 .

These are clear indicators of low health service utilization and poor quality health services/facilities.

1 Lao Reproductive Health Survey 2005, this is the official figure and most reliable for reference – the 2008 survey, although it quotes lower figures is not ‘official’

2 Strategy and Planning Framework for the Integrated Package of Maternal Neonatal and Child Health Services 2009 – 2015

3 Lao Reproductive Health Survey 2005

Research on Maternal and Infant Sepsis

In Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-Saharan Africa, Seale et al find gaps in the research on maternal and newborn sepsis.  I just read the summary here http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(09)70172-0/abstract.  Their work seems to substantiates providing clean, antiseptic conditions for birth.

Bolstering the argument for preventing sepsis following birth, they find that:

Although existing published data suggest that sepsis causes about 10% of all maternal deaths and 26% of neonatal deaths, these are likely to be considerable underestimates because of methodological limitations.  Successful intervention strategies in resource-rich settings and early studies in sub-Saharan Africa suggest that the burden of maternal and early onset neonatal bacterial sepsis could be reduced through simple interventions, including antiseptic and antibiotic treatment.

Women and Children First: Good Practice Guide

This Women and Children First Good Practice Guide details a project, focused on community involvement and education to improve the health of mothers and babies.   The project was administered by Ekjut in India and the Perinatal Care Project of the Diabetic Association of Bangladesh (BADAS) in Bangladesh (with the the University College London Centre for International Health and Development and Women and Children First.)

In India, the project resulted in a 45 per cent reduction in newborn deaths and a reduction in maternal deaths, as well as a 57 per cent reduction in moderate maternal depression. In Bangladesh, the project resulted in an increase in uptake of health services. In both India and Bangladesh, the project resulted in a significant improvement in hygienic delivery practices, including use of delivery kits, and an increase in exclusive breastfeeding.

Some effective measures:

Emergency funds to cover transport and medical fees, providing pregnant women with advice and support and, in some Community Mobilisation through Women’s Groups to Improve the Health of Mothers and Babies: Good Practice Guide cases, promoting the use of clean delivery kits for home birth. Women’s groups also held community meetings to raise awareness of maternal and newborn health problems, discuss their proposed strategies and provide feedback to the community on actions and progress.

Blood Mat + Misoprostol + Clean Birth Kits = Saved Lives

Postpartum hemorrhage (PPH) is responsible for around 25% of maternal mortality worldwide (WHO, 2007).   Clean Birth Kit can/should include a blood mat and Misoprostol. Here’s more from Maternova’s site:

CCDRB with Pathfinder and others conducted a large operations research study to determine the efficacy and acceptability of the blood mat and misoprostol as additions to ‘clean delivery kits.’ They found that women were able to use the mat to identify postpartum hemorrhage and administer the misoprostol to themselves. 96% of the women interviewed after the study had used the Quaiyum blood mat to identify postpartum hemorrhage and would use it again.

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