Transcript Address on maternal and newborn health in Africa, Pyande

Maternal and Newborn Health
in the African Region
Africa Regional Meeting on Interventions for
Impact in Essential Obstetrics and Newborn Care
21-23 February 2011 Addis Ababa
Dr P. Mongi
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Structure of this Presentation
Facts on MNH
Coverage of
key interventions
Way Forward
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Maternal Health Situation In Africa
• Each year in Africa at least 30 million women
become pregnant
• Every year 204,000 African mothers die of causes
related to pregnancy and childbirth- 3/5 of the global
figure
• Each year 1.16 million newborn babies are dying in
the first month of life
• There are strong links between maternal deaths,
stillbirths and newborn deaths
• Majority of these deaths could be easily prevented
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Very Little Progress Towards Achieving the
MDG 5 Goal of Reducing Maternal Mortality
2008
620
African Region
228
320
Eastern Mediterranean Region
95
240
163
South-East Asia Region
Americas Region
66
32.5
Western Pacific Region
51
30
21
9.75
European Region
Global
MDG Target
260
107.5
Maternal mortality ratio (per 100,000 live births)
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
4
Very Little Progress Towards Achieving the
MDG 5 Goal of Reducing Maternal Mortality
MMR in the African Region (2008) :
620 per 100,000 live births
MDG 5 target :228
2 Countries are on track
20 Countries making progress
13 Countries have insufficient progress
7 Countries have no progress
No data/unclassified
No AFRO
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
75% of maternal deaths are due to
direct obstetric complications
Maternal
hem orrhage
24%
Indirect
causes
27%
Maternal
sepsis
12%
Other direct
causes
10%
Abortion
14%
Hypertensiv
e disorders
8%
Obstructed
labor
5%
Underlying causes
 Delay in decision
making at home;
 Delay in
transportation to facility;
and
 Delay in getting the
appropriate treatment at
H/Facility
Causes of maternal death in the African Region, 2004
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Causes of Under five Deaths,
WHO/AFRO, 2008
Source: World Health Organization. The Global Burden of Disease: 2004 update. World Health Organization, Geneva, 2008.
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Coverage of key MNH Interventions,
African Region, 2000-05 and 2006-08
The hours and days of highest
risk have lowest coverage
Source: WHO-World Health Statistics 2006, 2007 and 2010
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Countries and within country levelhigh inequality in the coverage of
interventions
• Geographical disparity
– rural versus urban
• Social/Economic disparity
– Rich versus poor,
– Education status
– Adolescents
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Niger 2006
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Sub-Saharan Africa
North Africa/West
Asia/Europe
South & Southeast Asia
Haiti 2005
Colombia 2005
Dominican
Republic 2002
Urban
Bolivia 2003
Honduras 2005
% of childbirths assisted by a Skilled Birth Attendant
Bangladesh 2004 (3)
Viet Nam 2002
Indonesia 2002/2003
Cambodia 2005
Nepal 2006
Armenia 2005
Moldova Republic
of 2005
Philippines 2003
Jordan 2002
Egypt 2005
Malawi 2004
Congo
(Brazzaville) 2005
Morocco 2003-2004 (2)
Nigeria 2003
Madagascar 2003/2004
Rwanda 2005
Zimbabwe 2005/06
Kenya 2003
Lesotho 2004
Cameroon 2004
Ethiopia 2005
Uganda 2006
Tanzania 2004
Mozambique 2003
Chad 2004
Ghana 2003
Senegal 2005
Zambia 2001/02 (1)
Eritrea 2002
Guinea 2005
Burkina Faso 2003
%
Access to Skilled Care at Birth
by urban and rural areas
(N=34, DHS 2001-2006)
Rural
100
90
80
70
60
50
40
30
20
10
0
Latin America &
Caribbean
Skilled Birth Attendant
by women's socioeconomic status
Access to Skilled Care at Births by women's socioeconomic status
120
Poorest
Poorer
Middle
Richer
Richest
100
80
60
40
20
Pe
ru
G
ui
ne
a
20
05
20
04
-2
00
8
N
ig
er
ia
20
03
G
ha
na
20
03
C
am
bo
di
a
05
Se
ne
ga
l2
Ph
00
i li
5
pp
M
in
or
es
oc
co
20
03
20
03
-2
00
4
H
(2
on
)
du
ra
s
20
C
05
am
er
oo
n
M
20
oz
04
am
bi
qu
e
20
03
Bo
l iv
ia
20
03
H
ai
ti
20
05
U
ga
nd
a
20
Ta
01
nz
M
an
ad
ia
ag
20
as
04
ca
r2
00
3/
20
04
Et
hi
op
ia
20
05
N
ep
al
20
06
0
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Mauritius
Namibia
Zimbabwe
Niger
Congo
Cape Verde
Nigeria
Mozambique
Cameroon
Guinea
United Rep of Tanzania
Chad
Madagascar
Swaziland
Dem Rep. of the Congo
Kenya
Zambia
Eritrea
Malawi
Gabon
Burkina Faso
Burundi
Benin
Lesotho
Mali
Mauritania
Senegal
Ethiopia
Ghana
Liberia
Rwanda
Uganda
Algeria …
Angola …
Botswana …
Central African Rep…
Comoros …
Côte d'Ivoire …
Equatorial Guinea …
Gambia …
Guinea-Bissau …
SaoTome & Principe …
Seychelles …
Sierra Leone …
South Africa …
Togo …
4
Unmet need for Family Planning (%)
7
13
Source: WHO-World Health Statistics 2010
16
16
17
17
18
20
21
22
23
24
24
24
25
27
27
28
28
29
29
30
31
31
32
32
34
34
36
38
41
No data
African Region
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
24
Geographical Disparity in Delivery at
Health facilities
Nigeria - 2008: Delivery in Health Facilities, %
100
80
59.4
60
35
40
24.7
20
0
Urban
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Rural
Total
Percentage of births in facilities by
region: Ethiopia
70%
63%
60%
48%
50%
34%
40%
30%
17%
20%
9%
10%
7%
6%
5%
5%
4%
2%
2%
Be
nis
h
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
ali
m
So
Af
fa
r
NP
SN
iya
m
Or
o
Am
ha
ra
uz
um
G
ul-
an
g
Na
t io
na
l
ra
y
Ti
g
be
la
Ga
m
wa
Da
Ha
ra
ri
Di
re
Ad
dis
Ab
ab
a
0%
Kenya 2009: Skilled Birth Attendant
by wealth quintile, %
90
81.4
80
70
60
52.9
50
41.9
40
30
31.3
20.4
20.9
20
10
0
Lowest
Lowest
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Second
Middle
Fourth
Highest
Zambia 2007: Skilled Birth Attendant
by mother's education, % 97.8
100
90
80
69.8
70
60
50
41.8
40
30
23.4
20
10
0
No education
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Primary
Secondary
More than
secondary
Global and Regional Commitments
• In 2000 MDGs 4 and 5
• Roadmap adopted by all MOH Ministers of
the Africa Region by resolution AF/RC/54/R9
at the 54th session in 2004
• The CARMMA-23 countries launched
• WHO/AFRO Strategic Directions 2010-2015
– SD 3 -Putting the health of Mothers and Children first
• The UN SG Global Strategy for Women and Children• AU Head of State Meeting July 2010 in Kampalacommitment on MNCH
Despite all efforts and commitment of governments and partners, very few
countries have the necessary resources and support to fully implement their
MNH Road Maps towards universal access to key interventions
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
The Challenge
• Governance and Leadership
• Weak health systems
– Human resource crisis.
– Inadequate infrastructure,
medicines and equipment.
– Inadequate funds for universal
coverage of interventions.
– Inadequate management and
use of health information.
• Poor Coordination
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Way Forward
we know…
…who
is at
risk…
…where
they
live…
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
…what we
must do…
…and
how to
do it.
Scale up effective interventions
• Access to skilled attendants at birth,
combined with prompt referral in case of
complications
• Scaling up emergency obstetric &
newborn care
• Strengthening Family Planning
• Reducing pregnancy in adolescents
• Stronger links between HIV/AIDS and
reproductive health
• Stronger links between malaria and
maternal health-can reduce 10% MMR
• Empowering women, families, and
communities to make timely decisions
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Key Interventions for newborn
survival
Many Newborn lives could be saved by use of
simple low technological interventions like:
• Supporting breastfeeding
• Providing adequate warmth
• Ensuring good hygiene and cord care
• Recognizing early signs of danger &
providing prompt treatment
• Giving extra care to small babies and
• Having skilled health care attendance for
mothers and babies at delivery and
immediate post-partum period
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Maternal deaths per 1000000 live births
The higher the proportion of deliveries attended by
skilled attendant in a country, the lower the
country’s maternal mortality ratio
2000
1800
R2 = 0.74
1600
Y
Log. (Y)
80
90
1400
1200
1000
800
600
400
200
0
0
10
20
30
40
50
60
% skilled attendant at delivery
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
70
100
As, WHO what is our role to scale up
these high impact interventions
Advocacy
– For increased domestic and external funding
and better utilization of existing funds
– For important policy decisions (task shifting,
women empowerment )
Policy Strategy &development
– Decentralization & reaching vulnerable
population
– Health care financing & social protection
– Integrated MNCH service delivery
– Human resource development (skilled
birth attendance…)
Capacity building
- Skilled birth attendance
- Emergency Obstetric & Newborn Care
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Care for
everyone…
… and by
everyone
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa
Thank you
Africa Regional Meeting on Interventions for Impact in EmOC
21-23 Feb 2011, Addis Ababa