Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study (6) GHSP: Saving Mothers, Giving Life: A Systems Approach to Reducing Maternal and Perinatal Deaths in Uganda and Zambia

18 March, 2019

Dear Elisabeth and HIFA colleagues,

We are all saddened to know that a mother in a low-income country has a 50 times incresed risk of death from caesarean section than a mother in a high-income country. The situation is actually even *worse* than this for maternal mortality as a whole. Sierra Leone tops the list with a maternal mortality rate of 1,360 deaths per 100,000 births. This compares with Iceland, where the maternal mortality is 3 per 100,000 births. In other words, the average woman in Sierra Leone is a whopping 450 times more likely to die than a woman in Iceland.

https://www.indexmundi.com/g/r.aspx?v=2223

Back in the early 1990s I was asked to help prepare a presentation on maternal mortality for IPPF and I was appalled to learn the numbers and the astounding inequity they reveal. Many of us have been strongly motivated by such statistics to pursue a career in global health.

Meanwhile, the open access journal Global Health: Science and Practice has a timely theme issue on 'Saving Mothers, Giving Life: A Systems Approach to Reducing Maternal and Perinatal Deaths in Uganda and Zambia'. March 2019 | Volume 7 | Issue Supplement 1

All the papers are freely available here: http://www.ghspjournal.org/content/7/Supplement_1?etoc

EDITORIALS

Saving Mothers, Giving Life: A Systems Approach to Reducing Maternal and Perinatal Deaths in Uganda and Zambia

Lois Quam, Angeli Achrekar, Robert Clay

'The 5-year public-private partnership boldly addressed maternal mortality in Uganda and Zambia using a systems approach at the district level to avoid delays in women seeking, reaching, and receiving timely, quality services. This supplement provides details on the Saving Mothers, Giving Life partnership and approach, including the model, impact, costs, and sustainability.'

SYNTHESES

Saving Mothers, Giving Life: It Takes a System to Save a Mother

Claudia Morrissey Conlon, Florina Serbanescu, Lawrence Marum, Jessica Healey, Jonathan LaBrecque, Reeti Hobson, Marta Levitt, Adeodata Kekitiinwa, Brenda Picho, Fatma Soud, Lauren Spigel, Mona Steffen, Jorge Velasco, Robert Cohen, William Weiss,

'A multi-partner effort in Uganda and Zambia employed a districtwide health systems strengthening approach, with supply- and demand-side interventions, to address timely use of appropriate, quality maternity care. Between 2012 and 2016, maternal mortality declined by approximately 40% in both partnership-supported facilities and districts in each country. This experience has useful lessons for other low-resource settings.'

ORIGINAL ARTICLES

Impact of the Saving Mothers, Giving Life Approach on Decreasing Maternal and Perinatal Deaths in Uganda and Zambia

Florina Serbanescu, Thomas A. Clark, Mary M. Goodwin, Lisa J. Nelson, Mary Adetinuke Boyd, Adeodata R. Kekitiinwa, Frank Kaharuza, Brenda Picho, Diane Morof, Curtis Blanton, Maybin Mumba, Patrick Komakech, Fernando Carlosama, Michelle M. Schmitz, Claudia Morrissey Conlon,

'Through district system strengthening, integrated services, and community engagement interventions, the Saving Mothers, Giving Life initiative increased emergency obstetric care coverage and access to, and demand for, improved quality of care that led to rapid declines in district maternal and perinatal mortality. Significant reductions in intrapartum stillbirth rate and maternal mortality ratios around the time of birth attest to the success of the initiative.'

Addressing the First Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Approaches and Results for Increasing Demand for Facility Delivery Services

Florina Serbanescu, Mary M. Goodwin, Susanna Binzen, Diane Morof, Alice R. Asiimwe, Laura Kelly, Christina Wakefield, Brenda Picho, Jessica Healey, Agnes Nalutaaya, Leoda Hamomba, Vincent Kamara, Gregory Opio, Frank Kaharuza, Curtis Blanton, Fredrick Luwaga, Mona Steffen, Claudia Morrissey Conlon,

'The Saving Mothers, Giving Life initiative used 3 coordinated approaches to reduce maternal deaths resulting from a delay in deciding to seek health care, known as the “first delay”: (1) promoting safe motherhood messages and facility delivery using radio, theater, and community engagement; (2) encouraging birth preparedness and increasing demand for facility delivery through community outreach worker visits; and (3) providing clean delivery kits and transportation vouchers to reduce financial barriers for facility delivery. These approaches can be adapted in other low-resource settings to reduce maternal and perinatal mortality.'

Addressing the Second Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Reaching Appropriate Maternal Care in a Timely Manner

Thandiwe Ngoma, Alice R. Asiimwe, Joseph Mukasa, Susanna Binzen, Florina Serbanescu, Elizabeth G. Henry, Davidson H. Hamer, Jody R. Lori, Michelle M. Schmitz, Lawrence Marum, Brenda Picho, Anne Naggayi, Gertrude Musonda, Claudia Morrissey Conlon, Patrick Komakech, Vincent Kamara, Nancy A. Scott,

'The Saving Mothers, Giving Life initiative employed 2 key strategies to improve the ability of pregnant women to reach maternal care: (1) increase the number of emergency obstetric and newborn care facilities, including upgrading existing health facilities, and (2) improve accessibility to such facilities by renovating and constructing maternity waiting homes, improving communication and transportation systems, and supporting community-based savings groups. These interventions can be adapted in low-resource settings to improve access to maternity care services.'

Addressing the Third Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Ensuring Adequate and Appropriate Facility-Based Maternal and Perinatal Health Care

Diane Morof, Florina Serbanescu, Mary M. Goodwin, Davidson H. Hamer, Alice R. Asiimwe, Leoda Hamomba, Masuka Musumali, Susanna Binzen, Adeodata Kekitiinwa, Brenda Picho, Frank Kaharuza, Phoebe Monalisa Namukanja, Dan Murokora, Vincent Kamara, Michelle Dynes, Curtis Blanton, Agnes Nalutaaya, Fredrick Luwaga, Michelle M. Schmitz, Jonathan LaBrecque, Claudia Morrissey Conlon, Brian McCarthy, Charlan Kroelinger, Thomas Clark,

'Saving Mothers, Giving Life used 6 strategies to address the third delay�receiving adequate health care after reaching a facility�in maternal and newborn health care. The intervention approaches can be adapted in low-resource settings to improve facility-based care and reduce maternal and perinatal mortality.'

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