Countries of the world, South Africa included are expected to report progress made towards millennium development goals (MDGs) 2014. Government through various departments must audit progress and monitor obstacles towards achieving these MDGs. Department of Health is expected to lead the implementation and improvement of MDG four, five and six these being:
* Infant and child morbidity and mortality
* Maternal morbidity and morbidity
* HIV and AIDS
These three MDGs are so interrelated that by improving one of them, there is a significant contribution to the improvement of the other. Maternal outcome determines infant and perinatal outcomes. It is also directly relates to less than five mortality.
It therefore means if one were to improve maternal outcome, one would positively impact to perinatal, infant and under five mortalities and morbidities. This therefore influenced the MEC of Health KwaZulu-Natal, Dr Sibongiseni Dhlomo to call for SAVE the nation workshop on 24 April 2010.
The guest speakers to this workshop were:
* Professor Jack Moodley, Chairman of National Committee on Confidential Enquiry into Maternal Mortality (NCCEMD)
* Professor Sithembiso Velaphi: Chairman of National Enquiry on Perinatal Mortality
* Dr Mckerrow, Chairperson: Committee on Morbidity and Mortality in Childhood
* Mrs Dolly Nyasula
* Professor Rachel Gumbi
* Professor Philpott
* Professor M Adhikhari
The attendance included heads of department of various departments from University of KwaZulu Natal viz: perinatal healthcare and paediatrics, district managers, hospital chief executive officers, medical managers, Midwifery Society, senior nursing managers, Professor Nzimande.
Purpose
* To get a snapshot summary of the extent of maternal deaths in KwaZulu-Natal
* To accelerate recommendations that will have significant impact in the short term while planning for implementation of recommendations that are long term.
There has to be a process of continuing professional education with respect to training of health professionals both doctors and nurses, to overcome the deficiencies identified by the assessment of maternal deaths.
Women and their families should be empowered to participate in all aspects of health system after all health is a societal issue.
The NCCEMD makes recommendations based on the confidential study of maternal deaths. It is hoped that the implementation of those recommendations would result in the reduction in the maternal mortality.
Recommendation will include those that will focus on support of civic society and those that will focus on health care professionals and health institutions.
* Teenage pregnancy should be addressed as woman less than 20 years of age are at greater risks of dying due to complications (hypertension, age)
* Non attendance and delayed attendance at the health institutions are the most common patient oriented problems. Up to 20 to 25 percent of pregnant women have not attended antenatal clinic by 20 weeks (five months) of pregnancy.
* Poor transport facilities are the major administrative problem.
There is a need for community involvement and empowerment regarding maternal, neonatal and reproductive health in general. This can be incorporated into flagship programme. KwaZulu-Natal reports more maternal death than any other province the increase in deaths reported is probably due to a combination of better reporting and an actual increase in deaths.
In fact it should be noted that most maternal deaths that occur outside of health institutions are not reported to be NCCEMD. We should find a way not only to report those maternal deaths taking place in the community but to monitor recently discharged mothers from hospitals not to develop complications unnoticed, flagship should consider this part.
Death of a mother giving or having given birth because of shortage of blood is partly a societal issue. The lack of blood transfusion has increased dramatically 2005 to 2007 from 9,2 percent to 19 percent of cases requiring blood. We need to mobilise civic society to donate blood because by so doing we save lives.
Of the ten key recommendations of saving the mothers seven are partly or wholly societal these are:
1. All pregnant women should be identified in the community, be offered all necessary information and support by society, family and government departments.
2. Transport arrangements must be made for pregnant women close to term or alternative accommodation (half way house) be considered.
3. Involve civic society to strengthen postnatal care. 27 percent of women who died due to pregnancy related sepsis following viable pregnancy were reported to have delayed in seeking help. If these women were seen within six days of discharge their deaths might have been prevented.
This must be included as an indicator to be monitored in our flagship program. Detection of excessive bleeding signs of anaemia and change of temperature can be trained to all South Africans. We must establish a mechanism were women who have delivered and discharged are seen daily by community "health" worker for the first six days.
4. Blood for transfusion must be available at every institution that performs caesarean section. For this to happen, South Africans must be encouraged to donate blood. Prominent leaders in the society must donate and make calls for blood donation.
All pregnant women must be encouraged by society to take (Fe) iron supplements right through their pregnancy-that can prevent unnecessary emergency when giving birth.
5. Women should plan their pregnancies and avoid unwanted pregnancies especially teenagers.
The World Health Organisation (WHO) made a statement that any woman who is less than 18 years of age and is pregnant is likely to have adverse maternal outcomes.
6. Government has provided facilities for termination of pregnancy that is safe and convenient but some woman still use illegal and unsafe methods of terminating pregnancies; this has a negative impact to maternal outcomes.
7. Women, families and communities at large must be empowered, involved and participate in activities, projects and programmes aiming at improving maternal and neonatal health as well as reproductive health in general.
Patient related avoidable factors are quite significant in maternal deaths. We need appropriate information, education and communication material. Behaviour change could also play a crucial role.
The workshop then resolved to prioritise matters relating to:
Quality assurance, improvement and supervision
To address these issues we would need to:
* Define standards and develop norms for maternal, women, newborn and child health services for each service delivery mode and level of care
* Introduce standardised tools (ward admission registers, clinical records, and transfer logs), protocols and practices
* Implement an accreditation system for neonatal nurseries and children's wards in health facilities at all levels of care
* Introduce structured weekly unit management meetings in maternity and paediatric services
* Adopt a minimal set of quality improvement activities, monthly perinatal and child audits and annual clinical audit
* Facilitate compliance and strengthen support and supervision by the appointment of clinic supervisors and the development of outreach teams and experiential learning sites.
Thank you.
Contact:
Chris Maxon
Cell: 083 285 0567
