Transcript Dr. Nicholas Muraguri

ENDING PREVENTABLE MATERNAL
AND NEWBORN DEATHS IN
KENYA
Dr. Nicholas Muraguri
OGW, MD, MPH, MBA , MDS, PhD(C)
Director Medical Services
Ministry of Health
Monday, April 19 2010
OVERVIEW
• Background
• Current situation
• Why women and
newborns die in Kenya
• What we can do to
reverse the trends
BACKGROUND
• Global commitments
● UN international conventions and declarations
● Millennium Development Goals (MDGs)
● UN Global strategies for Women’s and Children's
health (Every Woman, Every Child Initiative)
● Post MDG sustainable development goals
BACKGROUND
● Regional Commitments
● Maputo protocol
● Maputo plan of action for Sexual and Reproductive Health
● Campaign for Accelerated Reduction of Maternal Mortality
in Africa (CARMMA)
● Abuja Declaration
Global maternal mortality
But, we are not track
‘On track’ for MDG 4 only, not for MDG 5a (21)
‘OnBotswana,
track’ for MDG
only,
Bolivia,
Brazil,4 Ethiopia,
Guatemala,
not for MDG 5a (21)
Indonesia, Iraq, Korea DPR, Kyrgyz Republic,
Bolivia,
Botswana, Brazil,
Ethiopia,
Guatemala,
Liberia,
Madagascar,
Malawi,
Mexico,
Morocco,
Indonesia, Iraq, Korea DPR, Kyrgyz Republic,
Niger, Peru, Philippines, Rwanda, Solomon Islands,
Liberia, Madagascar, Malawi, Mexico, Morocco,
Tanzania and Zambia
Niger, Peru, Philippines, Rwanda, Solomon
Islands, Tanzania and Zambia
‘On track’ for MDG 5a only,
‘On track’
forMDG
MDG45a(2)
only,
not for
not for MDG 4 (2)
Eritrea and Equatorial Guinea
Eritrea and Equatorial Guinea
‘On track’ for both
‘OnMDGs
track’4for
both
and
5a (7)
MDGs 4 and 5a (7)
Bangladesh,
Bangladesh,
Cambodia,
Cambodia,
China,
China, Egypt, Lao PDR,
Egipt, Lao PDR,
Nepal and Vietnam
Nepal and Vietnam
CURRENT STATUS:
Women & children die from preventable illnesses
• 108,0000
Kenyan children die before their 5th
birthday
• ≈ 40% die within the 1st month after
birth
• 13,000
new HIV infections per year
Over
6,000
Kenyan women die every
year due to
pregnancy related causes
Deliveries in public health facilities
90,000
Strike
Strike
80,000
71,057
70,000
60,000
59,963
50,000
40,000
84,221
56,107
50,126
40,000
30,000
20,000
10,000
Apr 2013
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun 2014
-
Where do these deaths occur?
10 Counties with the highest
number of maternal deaths
Mandera
1,454
Turkana
509
Wajir
416
Nairobi City
249
Migori
231
Nakuru
224
Siaya
217
Kisumu
216
Homa Bay
210
Kakamega
196
10 Counties with the highest
Maternal Mortality Rate
Mandera
3795
Wajir
1683
Turkana
1594
Marsabit
Isiolo
1127
790
Siaya
691
Lamu
676
Migori
673
Garissa
646
Taita Taveta
603
Direct Causes of Maternal Mortality, 2003-2005
Abortion/miscarriage
17%
Obstructed labor
5%
Rupture
2%
Pueperal sepsis
15%
Antepartum
hemorrhage
8%
Ecclampsia
8%
Postpartum
hemorrhage
26%
Other complications
(preg.Post & delivery)
19%
Meghna D, Penelope A et al (2013). An Analysis of Pregnancy-Related Mortality in Health and Demographic Surveillance Sytestem in Western
Kenya. PLOS One July 2013 | Volume 8 | Issue 7 | e68733
Indirect Causes of Maternal Mortality,2003-2005
TB
10%
Othere
15%
Anemia
9%
Malaria
13%
Other
infections
8%
HIV/AIDS
related
conditions
45%
Meghna D, Penelope A et al (2013). An Analysis of Pregnancy-Related Mortality in Health and Demographic Surveillance Sytestem in Western
Kenya. PLOS One July 2013 | Volume 8 | Issue 7 | e68733
When do mothers die in Kenya?
2-6 weeks after
delivery
5%
2-7 days after
delivery
20%
During
pregnancy
25%
≥ 24 hrs after
delivery
50%
Source: UNICEF. 1999. Programming to safe motherhood. Guidelines for maternal and neonatal survival
Why are mothers and newborns dying?
• No chance to decide when to give birth
• Limited access to antenatal care
• Not delivering under qualified health
personnel
What is needed to save more lives
Family planning
services
High Impact interventions-Family Planning
Pregnant by choice not by chance
What needs to be done- Priority Actions
WHEN
Focus on care during labor, birth and day after birth - the time to save
lives of women, newborns, & prevent stillbirths.
WHAT?
Prioritize high coverage of high impact interventions for women and
babies, addressing context specific and intervention specific bottlenecks.
HOW?
Quality of care matters as much as coverage and requires investment,
especially for effective care at birth. Skilled workers are the key to
change.
WHO?
Achieve universal coverage and equity reaching every girl, every
women, every newborn including the poorest
PEOPLE
POWER?
Harness the power of parents, families and communities to mobilize
change.
COUNTING?
Measurement, oversight and accountability, improve and use the data.
ACTION?
Action by all – leadership, political will and financing
Sustain investment
It helps women and
children realize their
human rights
It stimulates economic
productivity and
growth
It is cost effective
It reduces poverty
 People are entitled to the highest
attainable standard of health
 Maternal and newborn deaths slow growth
leading to annual global productivity losses
of US$15 billion
 Essential health care prevents illness and
disability, saving billions of dollars annually
in treatment costs
 Healthy women are more productive and
earn more throughout their lives
“Women are not dying because of diseases
we cannot treat. They are dying because
societies have yet to make the decision that
their lives are worth saving.”
Prof. Mahmoud Fathalla
Former President of the International Federation of Gynaecology
and Obstetrics Professor of Obstetrics and Gynaecology
Assiut University, Egypt.
Campaign by
Her Excellency,
Margaret
Kenyatta,
First Lady of the
Republic of Kenya
“I have decided to run to raise awareness and
mobilize resources to be used for prevention of
maternal and child deaths, because I care.”
THE KENYA WE WANT
HAPPY ENDING FOR EVERY PREGNANCY AND DELIVERY
Do you care enough
to make a
difference?