Using Technology to Improve Maternal Health Outcomes in Mozambique

James Brown25-4-12

Baseline Data

•Antenatal care:

– 92% (<1 visit)

– 53% (<4 visits)

•Skilled attendant at birth: 55%

•Maternal mortality rate: 550/100 000

•Neonatal mortality rate: 39/1000 live births

Where are the opportunities for having a health impact?

Stage of pregnancy:

Family planning – Antenatal – Delivery – Postpartum

Improving maternal health is more than just addressing deaths during childbirth

Addressing Acute Complications During Delivery

34%

19%

9%

21%

17%

Maternal Mortality

Haemorrhage HypertensionInfection Other directIndirect

35%

24%

17%

24%

Neonatal Mortality

Prematurity Birth asphyxiaInfection Other

What are the problem areas we could address?

•Limited access to trained staff

•Limited capacity of frontline staff to deal with acute emergencies:

– Training

– Drugs

– Medical equipment

•Delays in referring emergency cases

Birthing Simulator

• Low cost training for birth attendants

• Supports training for Basic Emergency Obstetric interventions (eg PPH)

• Maintenance by trainer

• Costs $100

• Other low cost models in testing

Neonatal Resuscitation Simulator

• Costs $50

• Allows realistic training for health workers

• Available since 2009

Mobile Phones

• Connecting frontline healthcare providers to specialists

• Reduces delay in diagnosis

• Custom applications such as frontline sms may provide the ability to diagnose over text message

• Requires minimal training

Prefilled Auto-disable Injection System

• May allow minimally-trained health workers to administer Oxytocin to mothers

• Time-temperature indicator for monitoring cold chain

• Available since 1998

• Costs vary by drugs

• Limited training required

• Cannot be reused – prevents disease transmission

• Creates minimal waste

Emergency Neonatal Suction Device

• Addresses birth asphyxia

• Available since April 2010

• Costs $3 USD

• Limited training required

• Requires regular disinfection by boiling

Motorcycle Ambulance

• Can reduce transfer time from remote areas to healthcare facilities

• Increases attendance at health centres

• Reduces number of emergency operations required

• Up to 19 motorcycle ambulances may be bought for the price of a Landcruiser

• Fuel efficient

Technology is not enough…

•Political support

•Community support

•Family acceptance

•Training to use and maintain equipment

•Ongoing sustainable funding

•Collaboration with other programmes

•Availability of skilled technicians and spare parts

Conclusion

Technological approaches can be valuable in improving outcomes in maternal and neonatal health, but their efficacy

relies on the wider programme approach.

UNICEF (2009) ‘Mozambique National Child Mortality Study’UNICEF (2012) ‘Preventing mother to child transmission’ available online at

unicef.org/mozambique/hiv_aidsUNDP (2012) ‘Mozambique, Causes of Mortality: Situation and Trends’Michael MacHarg (2010) ‘For Mother's Day: Celebrating Innovations in Maternal Health’ available online at

nextbillion.netJames Pfeiffer (2003) ‘International NGOs and primary health care in Mozambique: the need for a new

model of collaboration’ Social Science & Medicine 56, 725–738VeroniqueFilippi et al. (2006) Maternal health in poor countries: the broader context and a call for actionThe Lancet, 368, 1535 – 1541L Jamisse et al. (2004) Reducing maternal mortality in Mozambique: challenges, failures, successes and

lessons learned, International Journal of Gynecology & Obstetrics, 85:2, 203–212C Santos et al. (2006) ‘Improving emergency obstetric care in Mozambique: The story of Sofala’

International Journal of Gynecology & Obstetrics, 94: 2, 190–201G. Benagiano (2003) ‘Safe motherhood: the FIGO initiative’

International Journal of Gynecology & Obstetrics82:3, 263–274World Health Organisation (2011) ‘Compendium of new and emerging health technologies’

Targeting delivery is not enough…

•By engaging at the antenatal stage women are more likely to understand and accept

•~4% of maternal deaths are due to abortions

•Contraception prevalence is 16%

Where are the opportunities for having a health impact?

Stage of pregnancy

•Family planning

•Antenatal

•Delivery

•Postpartum

Locations

•Households

•Communities

•Primary healthcare

•Referral healthcare

Improving maternal health is more than just addressing deaths during childbirth