maternal and newborn health in the african region

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


Structure of this PresentationStructure of this Presentation

Way ForwardWay Forward

Coverage of key interventions

Coverage of key interventions

Facts on MNH Facts on MNH


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


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


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


Causes of Under five Deaths, WHO/AFRO, 2008

Source: World Health Organization. The Global Burden of Disease: 2004 update. World Health Organization, Geneva, 2008.


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


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


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


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


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


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


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%


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, %


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, %


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


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


Way ForwardWay Forward

we know…we know……what we must do……who

is at risk…

…where they live…

…and how to do it.


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


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


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


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


Care for Care for everyone…everyone…

… … and and by by

everyoneveryonee


Thank you

maternal and newborn health in the african region

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