In recent years, Cambodia has received international praise for improvements in maternal and child health. The Ministry of Health (MOH), however, has recognized that tremendous challenges still persist in the area of newborn health. In particular, preterm birth—a live birth that occurs before 37 completed weeks of pregnancy—remains a prominent issue due to its direct link with high rates of mortality and morbidity among newborns. With the country’s preterm birthrate at 10.5%1 and a neonatal mortality rate of 27 deaths per 1,000 live births, Cambodia’s MOH has committed itself to improving newborn health and decreasing newborn mortality.
This week, numerous officials from the Government of Cambodia, USAID, MCHIP and other stakeholders attended a national dissemination meeting in Phnom Penh to share the results of an MCHIP supported study that calls for increased coverage of antenatal corticosteroids (ACS) in the management of the country's preterms. ACS are one of the most effective interventions for improving preterm survival, reducing death by 31% by augmenting maturation of the premature fetus’ lungs.
Dr. Tung Rathavy and Dr. Keth Lysotha—Director and Deputy Directory, respectively, of the National Maternal Child Health Center (NMCHC)—were in attendance, along with USAID’s Sheri-Nouane Duncan-Jones (Director, Office of Public Health and Education), and USAID/Cambodia’s Robin Mardeusz (Maternal and Child Health Team Leader, Office of Public Health & Education).
The lessons learned from the intervention have substantial implications for reducing the country's newborn mortality. Directed by the MOH, NMCHC, and the sub-technical working group on maternal child health, the study sought to improve the quality of care given to pregnant women at risk of imminent preterm birth in six different Cambodian facilities. (Human Development Research Cambodia (HDRC) worked closely with NMCHC on local research, and MCHIP provided overall technical support).
The intervention called for increased coverage of dexamethasone—the most commonly found ACS—to these women in order to reduce complications of prematurity among preterm newborns. The drug is recommended for women with preterm labor, because it is known to improve health outcomes for premature newborns by reducing the chances of related complications if administered before birth.
In just a short time (less than one year), the overall coverage rates of dexamethasone in the facilities across Cambodia dramatically increased from 34.9% at baseline to 86.1% at endline. Rapid increase in utilization even took place at facilities that had limited knowledge and use of the drug prior to the intervention. Dexamethasone is inexpensive and widely available in hospitals throughout Cambodia, so with increased guidelines and technical supervision, the neonatal intervention was able to produce substantial results even in the most limited facilities.
These results are promising because they demonstrate that when strong technical leadership and clinical governance in facilities are combined, the ability of simple, evidence-based interventions—such as increasing the rate of administration of dexamethasone—can be effectively scaled up Cambodia. Providers could alter their behaviors and increase utilization because strong buy in from facilities and increased technical support created an environment that was conducive for implementing correct practices.
The dramatic increase in coverage of dexamethasone in such a short period of time is an incredibly encouraging outcome. With continued emphasis on stronger clinical guidelines and additional technical supervision, increases in the utilization of ACS could be replicated more extensively in other facilities within Cambodia. If the MOH sustains its commitment to scale-up the use of dexamethasone and other interventions for preterm birth, major progress towards reductions in neonatal mortality and morbidity are possible.
This blog was originally published on World Moms Blog. Elizabeth Atalay traveled with the International Reporting Project on a New Media Fellowship to report on newborn health. This post was part of a series of stories from the ground. Read posts from fellows Jennifer James and Nicole Melancon.
We had just spent the night at the source of the Blue Nile River. Lake Tana sits in Bahir Dar, Ethiopia, and as our caravan of Land Cruisers wove through the countryside from Bahir Dar to Mosebo I took in deep gulping breaths of sweet fresh Ethiopian air. The lush colors of our surroundings looked to me like they had been enhanced in Photoshop in the way that everything seemed to pop. How could I feel this emotional connection to place that was never mine? A place I had never been?
Though this is my first time in Ethiopia, the verdant landscape brought me back to other rural parts of Africa I’d traveled through in my youth, similar topographies that had stayed with me ever since. This time I’d returned to the continent as a new media fellow with the International Reporting Project to report on newborn health. World Moms Blog Editor Nicole Melancon of ThirdEyeMom is a fellow on the trip as well, and last week wrote about our initial overview of maternal and newborn health in Ethiopia. Now we were heading to one of the villages housing a Health Post, which serves the local and surrounding population of approximately 3,500 people.
Mosebo Village is part of Save The Children’s Saving Newborn Lives program, and as such is looked to as a model village in the Ethiopian Government’s plan to reduce maternal and newborn mortality. Mosebo is a rural agrarian community that produces wheat, teff and corn. There I met seven-year-old Zina whose mother, Mebrate was about to give birth. Through our translator Mebrate estimated her age to be around 26, and told us that Zina was her first child. For economic reasons she and her husband had waited to have a second. When she had Zina, Mebrate had gone to her parent’s home to give birth, as women in Ethiopia often do. It is estimated that 80% of Ethiopian mothers will give birth in their home, often without a trained health care attendant. Towards the end of Mebrate’s first pregnancy she went to live with her parents as her family instructed, until after the baby was born. In that way her mother could help her deliver, could care for her and the baby, and feed her the traditional porridge after birth. Although there were no complications during her delivery, sadly, many young mothers giving birth at home are not as fortunate. The time period during and around birth are the most vulnerable for the lives of both the mothers and babies. The Saving Newborn Lives Program aims to reduce maternal and newborn mortality beginning with awareness programs and antenatal care on the local level at Health Posts like the one we visited in Mosebo.
We had met Tirgno and Fasika, the two Health Extension Workers at the Mosebo Health Post earlier that day as they showed us the two room interior, and explained their role in improving maternal and newborn health. They work to raise awareness in the community about the importance of antenatal care, and the potential dangers of giving birth at home for both mother and child. Newborn health is interdependent with maternal health, and the most prevalent causes of newborn mortality, infection, Asphyxiation, pre-maturity or low birth weight, and diarrhea can often be avoided with proper care. These days in Mosebo after receiving antenatal care at the Health Post women are then referred to the regional Health Center for deliveries.
Zina shyly smiled when we ask her how she felt about having a new sibling, she stood straight and tall listening intently as we asked her mother about the babies’ arrival. When Mebrate goes into labor this time, with her second child, she will embark on the walk along rural dirt roads for around an hour to the nearest Health Center to give birth.
Elizabeth Atalay was reporting from Ethiopia as a fellow with the International Reporting Project (IRP). This is a promotion of the original post written for World Moms Blog. You can follow all IRP reports by World Moms Elizabeth Atalay & Nicole Melancon at #EthiopiaNewborns
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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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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