Improving Maternal Survival and Health in Uganda

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(No Transcript)
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Maternal Survival and Health A Pathway to
Development in Uganda
Application of the REDUCE Model in Uganda
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Uganda Sustained Economic Growth
US
186
Annual per Capita Income
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Uganda Sustained Economic Growth
US
330
186
Annual per Capita Income
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Uganda An Inspirational African Success Story
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Uganda An Inspirational African Success Story?

• Total fertility rate (TFR) 6.9
• Infant mortality rate (IMR) 97
• Child mortality rate (CMR) 147
• Child stunting at 2 years of age 45
• Full vaccination at 2 years of age 44
• Access to safe water in rural areas 47
• Primary education completion 34

HDI 158/174
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Maternal Death
(WHO, 1980)

• The death of a woman during pregnancy, delivery,
  or the six weeks following the birth of her
  baby.

UNICEF/C-55-10/Watson
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Maternal Mortality Ratios in Africa
Maternal Deaths/100,000 Live Births
Source UNFPA, 1999
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Maternal Mortality Ratios in Africa
Maternal Deaths/100,000 Live Births
Source UNFPA, 1999
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Mothers Index

• The Mothers Index ranks Uganda
  76 out of 106 countries

UNICEF/Pirozzi
Source Save the Children, 1999
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Maternal Mortality a Small Part of a Larger
Problem
Maternal Mortality
UNICEF/C-79-53/Goodsmith
Poor Health and Disability
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Womens Participation in the Labor Force
Womens economic contribution is crucial to
reduce poverty
UNICEF/C-79-53/Goodsmith
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(Ugandan Labor Survey, 1998)
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Population Living in Absolute Poverty
Poor maternal health reduces dramatically the
capacity of Ugandan women to grow out of poverty
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(Source UNICEF, 1999)
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Investing in Safe Motherhood in Uganda

• Increases Survival
• Improves Health
• Reduces Poverty

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Major Causes of Maternal Mortality in Uganda
HIV/AIDS Malaria Anaemia
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Womens Low Status

• Lack of access to and control of resources
• Limited access to education
• Lack of decision-making power

Jorge Moreiro
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Inadequate Attention to Adolescent Reproductive
Health
Percentage of Ugandan women who experience their
first pregnancy by the age of 19
70
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REDUCE a Model on Maternal Health and Survival
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Estimating the Consequences of Poor Maternal
Health
Data on Maternal Health
Reduce Model
Impact on Survival and Productivity (2001-2010)
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REDUCE Data Used

• Uganda 1995 Demographic and Health Survey
• WHO Global Burden of Disease
• Uganda Safe Motherhood Costing Study
• 1991 Demographic Projections
• Sexual and Reproductive Health Minimum Package
• Other local literature and surveys

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Survival
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Maternal Deaths (2001-2010)
61,000 Maternal Deaths!
Jorge Moreiro
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Infant Deaths per 1000 Life Births
(Bangladesh)
Infant Deaths/1000 Life Births
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Infant Deaths Resulting from Maternal Deaths
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Jorge Moreiro

• 40,000 Infant Deaths

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Infant Deaths Resulting from Maternal Poor
Health During Pregnancy

• Neonatal Tetanus 38,000 Infant Deaths
• Maternal Iodine Deficiency 31,000 Infant Deaths
• Maternal Malaria and Anemia 220,000 Infant
  Deaths

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Maternal Deaths (2001-2010)
61,000 Maternal Deaths!
Jorge Moreiro
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Older Children
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Orphaned Children

• More vulnerable to rights
  violations

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Disabilities
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Maternal Mortality a Small Part of a Larger
Problem
1 Woman Dies
20-30 Women Suffer Short and Long Term
Disabilities
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Maternal Mortality a Small Part of a Larger
Problem

• 110,000 women will become infertile
• 1,200,000 women will suffer
• Inability to breastfeed
• Anaemia
• Incontinence due to fistulae
• Chronic pelvic pain
• Emotional depression
• Physical weakness
• Reduced productivity

(2001-2010)
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Economic Consequences
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Present Value of Productivity Losses
(2001-2010)

• 47
• 353
• 400

million US
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Iodine Deficiency during Pregnancy
Iodine is necessary for the normal development
of the babys brain during pregnancy
UNICEF/C-79-39
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Iodine Deficiency during Pregnancy

• Translates into reduced
• Learning ability
• School performance
• Retention rates
• in School-Age Children

Permanent!
UNICEF/C-56-19/Murray-Lee
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Present Value of Productivity Losses
(2001-2010)

• 47
• 353
• 400

408
million US
808
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Recommendations
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Three Delays

• Delay in deciding to seek appropriate care
• Delay in reaching a treatment facility
• Delay in receiving adequate treatment at the
  facility

UNICEF/C-55-10/Watson
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Maternal Mortality Ratios in Africa
Maternal Deaths/100,000 Life Births
Source UNFPA, 1999
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Maternal Mortality Ratios in Africa
Maternal Deaths/100,000 Life Births
Source UNFPA, 1999
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The Six Pillars of Safe Motherhood in Uganda
Safe Motherhood
Family Planning
Obstetric Care
Ante-Natal Care
Post-Natal Care
STD-HIV Control
Post-Abortion Care
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1. Family Planning

• Increase number service delivery points
• Encourage adolescents to delay first pregnancy
• Encourage couples to space births
• Update service providers skills
• Contraceptive technology
• Counseling

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2. Ante-Natal Care

• Provide ironfolic acid supplements
• Conduct immunization against tetanus
• Conduct routine deworming
• Provide presumptive treatment for malaria
• Screen for risk factors

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3. Skilled Obstetric Care at Birth

• Increase the number of midwives
• Update providers life saving skills
• Monitor labor using a partograph
• Provide essential obstetric care
• Improve referral system
• Mobilize ambulance/transportation services
• Provide vitamin A supplement after delivery

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4. Post-Natal Care

• Identify and manage danger signs
• Counsel and provide family planning services
• Counsel on maternal nutrition during lactation
• Promote good traditional social support
• Conduct maternal mortality audits and review
  meetings

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5. Post-Abortion Care

• Train and equip personnel to offer MVA
• Counsel and provide family planning services
• Start prompt treatment for sepsis

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6. STD/HIV Control

• Offer voluntary testing and counseling
• Screen pregnant women for syphilis
• Manage cases and their complications
• Continue and expand ongoing successful prevention
  activities

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The Six Pillars of Safe Motherhood in Uganda
Safe Motherhood
Family Planning
Obstetric Care
Ante-Natal Care
Post-Natal Care
STD-HIV Control
Post-Abortion Care
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The Six Pillars of Safe Motherhood in Uganda
Safe Motherhood
Family Planning
Obstetric Care
Ante-Natal Care
Post-Natal Care
STD-HIV Control
Post-Abortion Care
Communication for Behavior Change
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The Six Pillars of Safe Motherhood in Uganda
Safe Motherhood
Family Planning
Obstetric Care
Ante-Natal Care
Post-Natal Care
STD-HIV Control
Post-Abortion Care
Communication for Behavior Change
P r i m a r y H e a l t h C a r e
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The Six Pillars of Safe Motherhood in Uganda
Safe Motherhood
Family Planning
Obstetric Care
Ante-Natal Care
Post-Natal Care
STD-HIV Control
Post-Abortion Care
Communication for Behavior Change
P r i m a r y H e a l t h C a r e
E q u i t y a n d E d u c a t i o n f o r W o
m e n
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Benefits of Action
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Maternal Mortality Ratios in Africa
Maternal Deaths/100,000 Life Births
Source UNFPA, 1999
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Maternal Mortality Ratios in Africa
Maternal Deaths/100,000 Life Births
Source UNFPA, 1999
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Program Implementation 2001-2010
Percentage Reduction in MMR
Year of Implementation
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Benefits of Action

• Estimated for
• Better ante-natal care
• Better obstetric care
• Reduction of
• Malaria
• Anaemia
• Iodine deficiency
• Not Estimated for
• Better neonatal care
• Better family planning
• Reduced incidence of STDs/HIV

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Lives Saved and Disabilities Averted
(2001-2010)

• 12,500 lives of women

60,000 lives of children
253,000 women spared from disability
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Productivity Gains
(2001-2010)
90 million US
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Conclusion
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Womens Right to Life and Health

• Thousands of lives of women and children saved
• Large increase in womens productivity and income
  generating ability

UNICEF90-070/Lemoyne
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Four Conditions are Needed
1. A strong commitment to maternal health and
survival by our political leaders and decision
makers
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Four Conditions are Needed
2. A clear focused national maternal health and
survival strategy
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Four Conditions are Needed
3. A realistic, appropriate, and sufficient
investment in the maternal health and survival
strategy
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Four Conditions are Needed
4. An implementation framework with clearly
defined supervision, monitoring, and evaluation
mechanisms
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Uganda, An Inspirational African Success Story
in the Fight against HIV/AIDS

• Commitment
• Strategy
• Investment
• Implementation

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Uganda can Lead the Fight against Maternal Death
and Disability
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Enable Ugandan Women to

• Fully enjoy their rights
• Fully contribute Ugandas
• Social
• Economic, and
• Political Development

JHU/PhotoShare
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Thanks for Your Attention
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• The REDUCE analysis in Uganda was undertaken
  under the leadership of the Ministry of Health,
  Reproductive Health Division, in collaboration
  with
• The Regional Center for Quality of Health Care
• The Commonwealth Regional Health Community
  Secretariat
• The Makerere University, Dep. of Obstetrics and
  Gynecology
• The Makerere University, Dep. of Women and Gender
  Studies
• The Institute of Public Health, Makerere
  University,
• The Mukono District Health Team
• with support from USAIDs Africa Bureau
  through the SARA Project and USAIDs Global
  Bureau through the Quality Assurance Project

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Produced by the REDUCE Team in Uganda

• Ominde J. Achola, Commonwealth Regional Health
  Community Secretariat (ECSA)
• Grace Bantebya-Kyomuhendo, Makerere University,
  Dep. of Women and Gender Studies
• Dan Kaye, Mulago Hospital Dept. of Obstetrics
  and Gynecology
• Essau. F. Katumba, Ministry of Health
• Sarah Katumba , Mukono District Health Team
• Sarah Kibuka, Commonwealth Regional Health
  Community Secretariat (ECSA)
• Florence M. Mirembe, Makerere University, Dep. of
  Obstetrics and Gynecology
• Michael Mubiru, Makerere University,
• Edirisa Musisi, Mukono District Health Team
• Twaha S. Mutyaba, Mulago Hospital, Dep. of
  Obstetrics and Gynecology
• Susan W. Wandera , Mukono District Health Team
• Christine Zirabamuzaale, Institute of Public
  Health
• Joachim M. Zziwa, Mukono District Health Team

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