africa regional meeting on interventions for impact in emoc 21-23 feb 2011, addis ababa maternal and...
Post on 14-Jan-2016
216 Views
Preview:
TRANSCRIPT
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Maternal and Newborn Health in the African Region
Africa Regional Meeting on Interventions for Africa Regional Meeting on Interventions for Impact in Essential Obstetrics and Newborn CareImpact in Essential Obstetrics and Newborn Care
21-23 February 2011 Addis Ababa21-23 February 2011 Addis Ababa Dr P. Mongi
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Structure of this PresentationStructure of this Presentation
Way ForwardWay Forward
Coverage of key interventions
Coverage of key interventions
Facts on MNH Facts on MNH
Africa Regional Meeting on Interventions for Impact in EmOC21-23 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 EmOC21-23 Feb 2011, Addis Ababa 44
VeryVery Little Progress Towards Achieving the Little Progress Towards Achieving the MDG 5 Goal of Reducing Maternal MortalityMDG 5 Goal of Reducing Maternal Mortality
Maternal mortality ratio (per 100,000 live births)Maternal mortality ratio (per 100,000 live births)
620
320
240
66
51
21
260
228
95
163
32.5
30
9.75
107.5
African Region
Eastern Mediterranean Region
South-East Asia Region
Americas Region
Western Pacific Region
European Region
Global
2008 MDG Target
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Very Little Progress Towards Achieving the MDG 5 Goal of Reducing Maternal Mortality
MMR in the African Region (2008) :
620 per 100,000 live birthsMDG 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 EmOC21-23 Feb 2011, Addis Ababa
75% of maternal deaths are due to direct obstetric complications
Other direct causes
10%
Hypertensive disorders
8%Obstructed
labor5%
Indirect causes
27%
Maternal hemorrhage
24%
Abortion14%
Maternal sepsis
12%
Causes of maternal death in the African Region, 2004
Underlying causesUnderlying causes
Delay in Delay in decision decision making at home; making at home; Delay in Delay in transportation to facility;transportation to facility; and and Delay in getting the Delay in getting the appropriate treatment at appropriate treatment at H/FacilityH/Facility
Africa Regional Meeting on Interventions for Impact in EmOC21-23 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 EmOC21-23 Feb 2011, Addis Ababa
Coverage of key MNH Interventions, African Region, 2000-05 and 2006-08
Source: WHO-World Health Statistics 2006, 2007 and 2010
The hours and days of highest risk have lowest coverage
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Countries and within country level- high 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 EmOC21-23 Feb 2011, Addis Ababa
Access to Skilled Care at Birth by urban and rural areas
(N=34, DHS 2001-2006)% of childbirths assisted by a Skilled Birth Attendant
0
10
20
30
40
50
60
70
80
90
100N
iger
200
6
Bur
kina
Fas
o 20
03
Gui
nea
2005
Erit
rea
2002
Zam
bia
2001
/02
(1)
Sen
egal
200
5
Gha
na 2
003
Cha
d 20
04
Moz
ambi
que
2003
Tan
zani
a 20
04
Uga
nda
2006
Eth
iopi
a 20
05
Cam
eroo
n 20
04
Leso
tho
2004
Ken
ya 2
003
Zim
babw
e 20
05/0
6
Rw
anda
200
5
Nig
eria
200
3 M
adag
asca
r 20
03/2
004
Mal
awi 2
004
Con
go(B
razz
aville
) 20
05
Mor
occo
200
3-20
04 (
2)
Egy
pt 2
005
Jord
an 2
002
Arm
enia
200
5 M
oldo
va R
epub
licof
200
5 P
hilip
pine
s 20
03
Nep
al 2
006
Cam
bodi
a 20
05
Indo
nesi
a 20
02/2
003
Vie
t Nam
200
2
Ban
glad
esh
2004
(3)
Hon
dura
s 20
05
Bol
ivia
200
3
Hai
ti 20
05
Col
ombi
a 20
05
Dom
inic
anR
epub
lic 2
002
Sub-Saharan Africa North Africa/WestAsia/Europe
South & Southeast Asia Latin America &Caribbean
%
Urban Rural
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Skilled Birth Attendant by women's socioeconomic status
Access to Skilled Care at Births by women's socioeconomic status
0
20
40
60
80
100
120Poorest Poorer Middle Richer Richest
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
713
16161717
1820
222324242425
2727282829293031313232
3434
3638
41
24
4
21
MauritiusNamibia
ZimbabweNiger
CongoCape Verde
NigeriaMozambique
CameroonGuinea
United Rep of TanzaniaChad
MadagascarSwaziland
Dem Rep. of the CongoKenya
ZambiaEritreaMalawiGabon
Burkina FasoBurundi
BeninLesotho
MaliMauritania
SenegalEthiopia
GhanaLiberia
RwandaUganda
Algeria …Angola …
Botswana …Central African Rep…
Comoros …Côte d'Ivoire …
Equatorial Guinea …Gambia …
Guinea-Bissau …SaoTome & Principe …
Seychelles …Sierra Leone …South Africa …
Togo …
African Region
No data
Unmet need for Family Planning (%)Source: WHO-World Health Statistics 2010
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Geographical Disparity in Delivery at Health facilities
Nigeria - 2008: Delivery in Health Facilities, %
59.4
24.735
0
20
40
60
80
100
Urban Rural Total
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Percentage of births in facilities by region: Ethiopia
63%
48%
34%
17%
9% 7% 6% 5% 5% 4% 2% 2%
0%
10%
20%
30%
40%
50%
60%
70%
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
20.4 20.9
31.3
41.9
52.9
81.4
0
10
20
30
40
50
60
70
80
90
Lowest Lowest Second Middle Fourth Highest
Kenya 2009: Skilled Birth Attendant by wealth quintile, %
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
23.4
41.8
69.8
97.8
0
10
20
30
40
50
60
70
80
90
100
No education Primary Secondary More thansecondary
Zambia 2007: Skilled Birth Attendant by mother's education, %
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Global and Regional Commitments
• In 2000 MDGs 4 and 5In 2000 MDGs 4 and 5• Roadmap adopted by all MOH Ministers of Roadmap adopted by all MOH Ministers of
the Africa Region by the Africa Region by resolution AF/RC/54/R9 resolution AF/RC/54/R9 at the 54th session in 2004at the 54th session in 2004
• The CARMMA-23 countries launchedThe CARMMA-23 countries launched• WHO/AFRO Strategic Directions 2010-2015WHO/AFRO Strategic Directions 2010-2015
– SD 3 -Putting the health of Mothers and Children firstSD 3 -Putting the health of Mothers and Children first• The UN SG Global Strategy for Women and Children-The UN SG Global Strategy for Women and Children-• AU Head of State Meeting July 2010 in Kampala-AU Head of State Meeting July 2010 in Kampala-
commitment on MNCHcommitment on MNCHDespite all efforts and commitment of governments and partners, very few Despite all efforts and commitment of governments and partners, very few
countries have the necessary resources and support to fully implement their countries have the necessary resources and support to fully implement their MNH Road Maps towards universal access to key interventionsMNH Road Maps towards universal access to key interventions
Africa Regional Meeting on Interventions for Impact in EmOC21-23 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 EmOC21-23 Feb 2011, Addis Ababa
Way ForwardWay Forward
we know…we know……what we must do……who
is at risk…
…where they live…
…and how to do it.
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Scale up effective interventionsScale 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 EmOC21-23 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 EmOC21-23 Feb 2011, Addis Ababa
R2 = 0.74
0
200
400
600
800
1000
1200
1400
1600
1800
2000
0 10 20 30 40 50 60 70 80 90 100
Y Log. (Y)
The higher the proportion of deliveries attended by skilled attendant in a country, the lower the
country’s maternal mortality ratio
% skilled attendant at delivery% skilled attendant at delivery
Mat
erna
l dea
ths
per
1000
000
live
birt
hsM
ater
nal d
eath
s pe
r 10
0000
0 liv
e bi
rths
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
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 EmOC21-23 Feb 2011, Addis Ababa
Care for Care for everyone…everyone…
… … and and by by
everyoneveryonee
Africa Regional Meeting on Interventions for Impact in EmOC21-23 Feb 2011, Addis Ababa
Thank you
top related