This blog was originally published on ONE. ONE Mom Nicole Melancon traveled with the International Reporting Project on a New Media Fellowship to report on newborn health. This post was a continuation of the ONE series of stories from the ground. This post was part of a series of stories from the ground. Read posts from fellows Jennifer James and Elizabeth Atalay.
Reaching Mosebo village, about 42 kilometers outside of Bahir Dar in rural Ethiopia is not for the faint at heart. It requires a land cruiser, patience, and a bit of adventure to cover the hour and a half drive on bumpy, muddy roads to reach Mosebo and see how over 90% of Ethiopians live. If it starts to rain, as it frequently does during Ethiopia’s three month rainy season, the road becomes dangerous and impassable.
I visited Mosebo village as a International Reporting Project Fellow to learn more about the miraculous success Ethiopia has made by reducing child mortality rates and the work that needs to still be done in reducing newborn deaths, particularly within the first 28 days of life which are the most dangerous days to be alive.
Per Save the Children’s “Ending Newborn Deaths Report”, every year one million babies die on their first and only day of life, accounting for 44% of all deaths for children under the age of five. Nearly two million more children will die within their first month. Four out of five of these deaths are due to preventable, treatable causes such as preterm birth, infections and complications during childbirth.
We arrived at Mosebo village to the sounds of children cheering and herders curious, gentle smiles. At the village, we were introduced to Tirigno Alenerw and Fasika Menge, two of Ethiopia’s 34,000 trained Health Extension Workers, who work at the Health Post located in Mosebo.
Mosebo is a model village run by Save the Children’s Saving Newborn Lives Program and represents the best case scenario for health care coverage and services for Ethiopia’s rural people.
The Mosebo Health Post covers 3,700 patients in the community which encompasses an area of up to an hour and a half on foot each direction. The Health Post has morning office hours from 8-10 am where Tirigno and Fasika see patients for a wide variety of services such as family planning, pre and post natal care, vaccinations, treatment of minor health issues, and education and consultation on health issues.
The rest of the day is spent on foot visiting patients in other villages at their home. Tirigno and Fasika also consult expectant mothers about the importance of delivering in a hospital, exclusive breastfeeding, and family planning. They contribute the lower maternal, child and newborn deaths to their services and over the six years they have worked within the community there have been no maternal deaths.
We had the chance to meet Fasika Dores and her nine-day old baby. Her baby is her fourth child, and has not been named yet which is common in Ethiopia given the high newborn mortality rates. However Fasika and her husband Minwiyelet plan on naming their child Ketema which means “city” in Amharic as he was their first child born at a hospital in a city.
As a nation, it is estimated that 80-90% of women still give birth at home without a trained assistant in Ethiopia, which significantly contributes to Ethiopia’s high newborn and maternal deaths. In Mosebo, 50% of the women now give birth at a hospital thanks to the advice and work of the Health Extension Workers.
Although maternal mortality rates have decreased, the rates are still way too high, and newborn mortality rates have shown little progress. Getting more villages like Mosebo and training Health Extension Workers as midwives would significantly reduce maternal and newborn mortality rates in Ethiopia.
As we left Mosebo village, the children ran after our cars smiling and waving goodbye. It was a happy place, and all we can hope is that more villages will have access to better maternal, child and newborn care.
ONE Moms Elizabeth Atalay and Nicole Melancon are both traveling as IRP Fellows in Ethiopia. You can find out more about their journey and ways to follow here.
In June, the USAID ASSIST-supported Salud Materno Infantil (Maternal and Infant Health) Kangaroo Mother Care (KMC) Community of Practice hosted its second virtual discussion forum in Spanish on "Experiences in startup and early consolidation of Kangaroo Mother Care (KMC) activities in hospitals in Latin America: favorable aspects, constraints and lessons learned.” As a pediatrician and director of the USAID ASSIST Project in Nicaragua, I was honored to moderate the forum.
During the nine days of this forum, from June 16th through the 25th, participants from Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, Paraguay and the Dominican Republic shared valuable experiences and insights about the successes and challenges to implementing KMC programs in their respective countries, and shared innovative ways in which challenges were overcome.
Themes discussed during the virtual forum included the importance of having a well-trained team that is committed to KMC and ensuring that there is buy-in and support from hospital management. Involving all personnel at the hospital with more emphasis on the staff working in maternal and newborn health was revealed as a best practice, as was the importance of promoting the scientific evidence about the benefits of KMC for newborns among medical staff so as to overcome pushback from staff who don’t fully understand its importance and feasibility.
The conversation also addressed the limitations to expanding KMC in Latin America, including lack of adequate financial and human resources and infrastructure. Forum participants mentioned creative ideas to increase support from the Ministry of Health, civil society, and NGOs, international organizations and medical societies. Among the most pertinent lessons learned included the importance of working with hospital management to implement guidelines, track indicators, and to ensure that relevant information, including the benefits of KMC, is shared with mothers, families, and the community and that parents are supported to perform KMC.
We also shared results from cost effectiveness studies of KMC in Nicaragua and Ecuador, which show that KMC actually saves money for hospitals that implement it. As hospitals realize KMC improves health outcomes for premature newborns and is cost effective, they will be more open and excited to implement KMC.
Thiago de Oliveira, pictured with his daughter, Agate Victoria, who was born at 6 months’ gestation, Rocha Faria State Hospital in Campo Grande, Brazil. Photo credit: Edna Galvão. View full article.
A summary of the steps to introduce KMC to a health facility was also shared and discussed. Discussions also include guidelines, indicators and URC’s experience with respect to the application of KMC for premature and underweight babies in four countries in Latin America.
Discussions also included the importance of couples’ counseling as a much more effective method to achieving enrollment and retention in the KMC program than targeting pregnant women alone. Husbands often hold decision-making power within families in Latin America, and from a gender perspective, it’s important to educate fathers about the importance of KMC, so that they are aware of its benefits and support their wives to use the KMC method. Promoting fathers’ participation in KMC, at the discretion of the mother, can relieve mothers from some of the pressure of being the sole partner to carry out the skin-to-skin contact and can strengthen the bond between father and child, which can set the tone for the rest of the child’s life.
This was my first experience moderating a virtual forum, and it afforded me the opportunity to interact with health care professionals from all across Latin America. Some had general questions, others asked for help to resolve a specific problem, while some participants simply wanted to share the KMC context in their country. In reflecting on the forum, it is clear that we all face similar issues and challenges across Latin America. We can help and support each other and learn from our failures and successes.
The virtual forums and webinars hosted by our USAID ASSIST KMC community of practice team are critical because they offer a user-friendly platform for health professionals working in KMC to connect with one another at no cost, to share learning, best practices, and what doesn’t work about implementing and expanding KMC in Latin America. Forum participants echoed this sentiment, acknowledging the utility of the forum as a place to experiences between countries, strengthening their links and allowing each one to learn from others, in effect collectively strengthening all of our KMC work.
For more information about the KMC Community of Practice, visit the USAID ASSIST-supported Salud Materno Infantil (maternal and infant health) Spanish language website or join our upcoming webinar, “Scientific Evidence and Recent Developments that support the benefits of the KMC method” which will be held on July 22nd. For more information about Kangaroo Mother Care and its implementation, visit the Healthy Newborn Network’s KMC Information Page.
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- Fewer than ten newborn deaths per 1,000 live births and ten stillbirths per 1,000 total births in and within each country by 2035, resulting in a global average of seven newborn deaths per 1,000 live births and eight stillbirths per 1,000 total births by 2035.
- 95% of women to give birth with skilled attendance by 2025.
- 75% of babies who do not breathe at birth to be resuscitated; 75% of preterm babies to receive kangaroo mother care; and 75% of newborn babies with bacterial infection receiving antibiotics by 2025
- 90% of women and newborns to receive good-quality postnatal care within two days of birth by 2025, with tracking of content and outcomes such as 50% exclusive breastfeeding.
- R. Horton, O. Astudillo. The power of midwifery
- C.Sakala, M.Newburn. Meeting needs of childbearing women and newborn infants through strengthened midwifery
- W. Stones, S. Arulkumaran. Health-care professionals in midwifery care
- J. Shamian. Interprofessional collaboration, the only way to Save Every Woman and Every Child
- L. Freedman, M. Kruk. Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas
- M. Renfrew, A. McFadden, M. Bastos, et al. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care
- C. Homer, I. Friberg, M. Bastos Dias, et al. The projected effect of scaling up midwifery
- W. Lerberghe, Z. Matthews, E.Achadi, et al. Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality
- P. Hoope-Bender, L. de Bernis, J. Campbell, et al. Improvement of maternal and newborn health through midwifery
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Photo: Greg Funnell/Save the Children
The release of the Roll Back Malaria (RBM) Partnership’s report, “The Contribution of Malaria Control to Maternal and Newborn Health,” made yesterday, July 10th, 2014, an important day for malaria in pregnancy research and programming. Pregnancy was previously identified as a particularly vulnerable time to contract malaria for both mom and baby, but this is the first time the RBM Partnership has released a thematic report specifically dedicated to how malaria affects pregnant women and their newborns.
The report was launched during the United Nations Economic and Social Council (ECOSOC) in New York by UN health and development leaders. The purpose of the report launch was to forge new partnerships and strengthen existing ones to expand malaria services to one of the most vulnerable populations, pregnant women.
An existing solution, with poor delivery
Intermittent preventative treatment during pregnancy (IPTp) and insecticide-treated mosquito nets (ITNs) have long been the standard for malaria prevention in pregnancy. In 2012, the World Health Organization (WHO) updated these standards by increasing the number of IPTp doses to four during pregnancy. This treatment, delivered during antenatal care (ANC), has existed for decades, but delivery is still poor. Although 77% of pregnant women receive at least one ANC visit in most countries, rates of IPTp and ITN use by pregnant women fall far below global and national targets.
Why is malaria prevention part of maternal health?
Malaria is both a direct and indirect cause of maternal mortality. Each year 10,000 pregnant women die of malaria infection. In addition, malaria is a major cause of anemia, which puts a woman at greater risk for post-partum hemorrhage, the number one cause of maternal death. WHO’s recommended treatment, four doses of IPTp and use of an ITN, can reduce severe maternal anemia by 38% and perinatal mortality by 27%. The treatment’s effectiveness plays a significant role in leading global progress on decreasing maternal mortality. But malaria prophylaxis saves not only women’s lives, but newborn lives as well.
Protecting health before birth
IPTp and use of ITNs can reduce a newborn’s risk of dying from malaria by 18% in the first 28 days of life; it also provides a 21% decrease in low birth weight, a risk factor for neonatal death. Every year, 75,000 to 200,000 infants die because of a malaria infection during pregnancy. Also, an additional 100,000 neonatal deaths, or 11% of global neonatal mortality, are due to low birth weight resulting from Plasmodium falciparum, or malaria, infections in pregnancy.
Although scale-up of IPTp and ITNs did not meet the global coverage target of 80%, malaria prevention efforts between 2009 and 2012 saved about 94,000 newborns. If global targets had been met, this number could have tripled, with 300,000 neonatal deaths prevented. In addition to preventing neonatal deaths, IPTp and ITNs can reduce miscarriages and stillbirths by 33%.
Although the WHO has given clear guidelines through Focused Antenatal Care (FANC), there is often fragmentation across ANC delivery platforms. Fragmentation makes it difficult to effectively deliver prophylactic malaria interventions through ANC. Solutions to this problem include integration of both funding and service-delivery for malaria, ANC, and maternal health interventions. In addition, countries must harmonize malaria control and maternal health efforts in national policies, guidelines, and funding. Malaria prevention is not just an addendum to current maternal and newborn health interventions, it ensures maternal and newborn health. With integration we can save lives.
This blog was originally written and published by Jennifer James on SocialGoodMoms.com, a global coalition of 2000+ mom bloggers who spread good news about the work non-profit organizations and NGOs are doing around the world. Ms. James recently led a trip to Ethiopia as part of The International Reporting Project (IRP). The IRP provides opportunities for journalists to report internationally on critcal issues that are under covered in the news media. The blog below was written during her trip.
It may seem a little quiet around SocialGoodMoms.com, but for good reason. I am co-leading a group of journalists throughout Ethiopia who are reporting on newborn health with the International Reporting Project. Putting together a robust itinerary for the journalists has been a capstone to all of the knowledge I have gained since learning about the importance of saving newborns.
The timing of this trip is perfect in the midst of such important achievements for newborns including the adoption of the Every Newborn Action Plan and the Partners’ Forum that will take place at the beginning of July in Johannesburg.
Thus far the journalists have seen Kangaroo Mother Care and the best NICU in the country at Black Lion Hospital, Addis Ababa’s largest hospital. They have seen how orphaned newborns are placed in homes with SOS Children’s Villages. They have also looked at obstetrics services and family planning with Marie Stopes’s largest clinic and community-based Blue Star clinics in urban areas. Yesterday, we spent a full day with Save the Children in Mosebo village (about 43 kilometers from Bahir Dar) and how they are advocating for Kangaroo Mother Care in rural areas as well as ways in which they are working with Health Extension Workers to save more newborns and their mothers.
The trip goes ended on June 27th. See more about the journalists at #EthiopiaNewborns and stay tuned for more blogs from the IRP journalists.
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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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