Report of the Project Activities With a Focus on Safe Motherhood

Transcription

1 Report of the Project Activities With a Focus on Safe Motherhood April 8, Bunkyo Civic Hall, Tokyo, Japan Yoko Chiba, RM. RN. MPH Former Technical Advisor on Maternal Care 1

2 Outline of Today s Presentation Global Safe Motherhood Issue Safe Motherhood Maternal Mortality Ratio / Rate Maternal Mortality Ratio / Maternal Death in the World Regional Disparity of the MMR Causes of Maternal Death Coverage of Maternal Health Services Skilled Birth Attendants Community Maternal Health / Care in Kisii and Kericho Findings from the Community Baseline Study Approach by the SAMOKIKE Picture Slide Show 2

3 Safe Motherhood Safe Motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth. (Source: Safemotherhood.org website) 3

4 Maternal Mortality Ratio / Rate Maternal mortality rate: The number of deaths per 100,000 women in the age group, measure the impact of maternal deaths on the population of women as a whole, not just on pregnant women. Maternal mortality ratio: The number of maternal deaths per 100,000 live births measures the risk of maternal death among pregnant or recently pregnant women. 4

5 Maternal Mortality Ratio / Maternal Death in the World Region Maternal Mortality Ratio Maternal Deaths Maternal Mortality Ratio Maternal Deaths World Total , ,000 Developed Regions 20 2, ,800 Developing Regions , ,000 Africa ,000 1, ,000 * Northern Africa 130 4, ,200 * Sub-Saharan Africa ,000 1, ,000 Asia , ,000 Latin America and the Caribbean , ,000 Oceania Source: WHO

6 Regional Disparity of the MMR Source: WHO

7 Causes of Maternal Deaths * other direct causes include ectopic pregnancy, embolism, anaesthesia-related ** indirect causes include: anaemia, malaria, heart disease, HIV/AIDS. Source: WHO & WB

8 Coverage of Maternal Health Services Source: WHO

9 Skilled Birth Attendants Source: WHO

10 Community Maternal Health / Care in Kisii and Kericho Community Baseline Study by the SAMOKIKE Project July Key Informant Interviews Assistant chief, Chairman of the HC Management Committee, and TBA 1 Key Informant Interview: Representative of the NGO and Faith Based Organizations working in Kisii and Kericho 3 Focus Group Discussions: Elder women, women of reproductive age, and adult men 2 Individual interviews: Women with a child aged one year or below and antenatal clients Subcontract with a local consulting firm: Language issue Challenge and constraints: many qualitative questions and small sample size 10

11 Land Area and Population Kisii: Land Area: Km 2 Population: 491,780 (Female: 52.3%) Kericho: Land Area: 2,110.6 Km 2 Population: 468,493 (Female: 49.2%) Source: SAMOKIKE Community Baseline Study (Original sources appear in the report.) 11

12 Education Kisii % of Enrollement % of Drop-Out Level # of Schools Male Female Male Female Pre-primary Primary Secondary Kericho % of Enrollement % of Drop-Out Level # of Schools Male Female Male Female Pre-primary NA NA Primary Secondary Source: SAMOKIKE Community Baseline Study (Original sources appear in the report.) 12

13 Health Care Seeking Behavior 98 percent of the women seek ANC services. 50percent of the deliveries occur at home. 70 percent of the births occur between the ages years. More than 50 percent of the women make decisions on where to deliver. 42 percent of the women would prefer a different health staff if they were to have another child in future. TBAs and health staff play a major role in referring mothers where to deliver. 13

14 Health Care Seeking Behavior (Cont d) Cost of delivery and transport are major limiting factors on where to deliver. Availability of ambulance, vehicles, equipment, water, electricity, and telephone play a leading influence in health seeking behavior. General environment of facilities (e.g. state of buildings, attitude of staff and perceived skills) determines where delivery takes place. It takes from two to three hours to get a vehicle incase of need and emergencies. 14

15 Advantage to Deliver at Hospital Skilled staff who can handle any complications is available; Staff can refer for specialized care elsewhere; Staff can prevent transmission of infections e.g. mother to child transmission of HIV; Access to immunization is secured; Clean and sterile equipment is used; and Blood can be transfused incase of severe bleeding. 15

16 Disadvantage to Deliver at Hospital Babies are either exchanged or stolen; Staff are hostile, rude, and not available all the time; Trainees are left to do the work; Health care providers carry out unnecessary and hurried caesarian sections; There are high costs incurred; and There is fear of tests that may reveal HIV status. 16

17 Approach by the SAMOKIKE District Health Mgmt. Team HC Maternal Care at HC Drug Management Record Keeping Improve the Capacity of HC i/c Waste Management (include human resource arrangement) Community Maternal Care at Community 17

18 Sources HANDS / JICA / MoH SAMOKIKE Project, Final Report: community Baseline Study of the HANDS / JICA / MoH SAMOKIKE Project. Safemotherhood.org. What is Safe Motherhood? Safemotherhood org Website. (Accessed on April 6, 2006) UNFPA. Glossary of Selected Terms. UNFPA website. (Accessed on April 6, 2006) WHO, Coverage of Maternal Care: A Listing of Available Information, Fourth Edition". World Health Organization, Geneva, (Accessed on April 2, 2006) WHO, World Bank, Maternal Health Around the World poster. (Accessed on April 2, 2006) WHO, Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA. Department of Reproductive Health and Research, World Health Organization, Geneva, WHO, The World Health Report 2005: Make every mother and child count. World Health Organization, Geneva, (Accessed on April 2, 2006) 18