Transcript Dr. Carla Chibwesha

Emergency obstetric and newborn care
signal functions and health facility
capacity: Baseline evaluations of the
Saving Mothers, Giving Life pilot
districts in Zambia
Carla Chibwesha, MD MSc
Centre for Infectious Disease Research in Zambia
For the Saving Mothers, Giving Life Study Group
Acknowledgements
The Saving Mothers, Giving Life Study Group thanks:
• The conference organizers
• CDC and USAID for funding support
• Co-authors:
• Davidson H. Hamer, BU & ZCAHRD
• K. Cherry Liu, UNC & CIDRZ
• Michelle Wallon, MCHIP
• Fatima Soud, CDC Zambia
• Don Thea, BU & ZCAHRD
• Namwinga Chintu, CIDRZ
• Daniel Williams, CDC
• Fernando Carlosama, CDC
• James McAuley, CDC Zambia
Acknowledgements
Ministry of Health
Zambia
Background
• Every 60 seconds a woman dies from
preventable causes related to pregnancy and
childbirth
• Globally, a woman’s lifetime risk of dying during
pregnancy and childbirth is 1 in 180
• In Zambia, lifetime risk of death during pregnancy
and childbirth is 1 in 27
• Zambia’s neonatal mortality rate is 30 per 1,000
WHO, 2012
Zambia’s MMR 1990 – 2008 and 2015
MDG target
Skilled attendance at delivery by quintile
of wealth
What skills and services are important?
• Most maternal deaths occur during labor, delivery,
or the first 24 hours postpartum
• Although most complications can be prevented or
treated they cannot be predicted
• Interventions to treat major direct obstetric
complications may reduce maternal and newborn
morbidity and mortality
Causes of maternal mortality
Hemorrhage
Hypertensive disorders
5.4
16.7
33.9
Sepsis
Obstructed labour
15
6.2
4.1
9.1
9.7
HIV/AIDS
Other direct causes
Other indirect causes
Unclassified
Kahn, 2006
Basic
EmONC functions
Comprehensive
EmONC functions
1. Parenteral antibiotics
Basic functions +
8. Blood transfusion
9. Cesarean delivery
2. Uterotonics
3. Anticonvulsants
4. Assisted delivery
5. Removal of retained
placenta
6. Removal of retained
products of
conception
7. Neonatal resuscitation
Assessment of obstetric and newborn
health services in SMGL pilot districts
• Goals:
• To obtain accurate information on the availability and quality of
maternal and newborn health services
• To identify gaps in service provision
• To revise program goals and objectives to reflect realities on the
ground
• Target:
• 121 health facility is 4 districts
• 8 hospitals, 94 health centres, and 19 health posts
SMGL pilot districts
Eastern Province:
• Nyimba district
• Lundazi district
Luapula Province:
• Mansa district
Southern Province:
• Kalomo district
Assessment tool
• M1: Identification and infrastructure
• M2: Human resources
• M3: Pharmacy services
• M4: ANC/PNC medications, equipment, and
supplies
• M5: Essential drugs, equipment, and supplies
• M6: Lab and blood bank services
• M7: EmONC signal functions
• M8: Case summaries
• M9: Community mobilization
Facility staffing and availability of
electricity, water, communication, and
transportation
SMGL pilot districts
All clinical sites
121
Open 24 hours
86 (71%)
At least one skilled staff member
111 (92%)
Electricity
71 (59%)
Water source
106 (88%)
Functional radio or telephone
56 (46%)
Emergency transport for referral
76 (63%)
EmONC services
SMGL pilot districts
All clinical sites (prior 3 months)
Administration of parenteral antibiotics
Administration of oxytocics
121
93 (81%)
106 (92%)
Administration of anticonvulsants
53 (46%)
Manual removal of placenta
45 (40%)
Removal of retained products
22 (19%)
Assisted vaginal delivery
13 (11%)
Neonatal resuscitation
32 (28%)
Cesarean sections*
4 (5%)
Blood transfusions*
8 (7%)
*CEmONC functions
Stockouts of EmONC supplies
SMGL pilot districts
All clinical sites (prior 12 months)
121
Parenteral antibiotics
93 (77%)
Oxytocics
25 (21%)
Anticonvulsants
90 (74%)
Conclusion
• Unmet need for lifesaving obstetric and neonatal care
services is substantial
• Health facilities are not commonly staffed with adequately
trained providers
• Essential EmONC services and supplies are not widely or
consistently available
• A comprehensive, sustainable approach to strengthening
human resources, clinical skills, physical infrastructure,
and essential supplies and equipment is needed