This Week's News 7-11 June 2010

3

21 Kenyan women die daily at childbirth

The Standard, Kenya

04/06/2010

By Elizabeth Mwai
Kenya is among Sub-Saharan African countries with the highest deaths of women during childbirth.
The countries record two million deaths involving mothers and newborns annually.
The Countdown Report shows nearly 50 per cent of women from the 68 countries in Sub-Saharan African and South Asia still deliver at home and without the help of a trained midwife. And only ten of them have increased the rate of skilled care at childbirth by at least ten per cent since 1990.
In Kenya, nearly 21 women die daily from childbirth complications.
Releasing the report yesterday, the Aga Khan University, Pakistan Managing Director Zulfiqar Bhutta said skilled childbirth care could reduce the death toll and complications.
"All women and their newborns need skilled care at birth and access to emergency care in case of complications," said Bhutta.
The report puts infant mortality at 414 deaths in 100,000 live births. It decries a global shortage of midwives with an estimated 700,000 new ones needed among other trained personnel to care for pregnant women.
The Global Health Workforce Alliance says Africa needs an additional 1.5 million health workers, nearly double of the current workforce of 1.6 million.
Angola, Burkina Faso, Pakistan, Rwanda, Bhutan, Laos, Nepal, and Peru have shown the most impressive gains in reducing infant and maternal mortality.
Bolivia, Ivory Coast, Liberia, Malawi, Nigeria, Somalia, Swaziland and Zimbabwe made no progress between 2000 and 2008.
At home

In Kenya, nearly 7,000 maternal mortalities are reported annually, majority having delivered under the care of traditional birth attendants, a practice that has not changed in the last seven years.

Former Kenya World Health Organisation Country Director David Okello decried the high rate of maternal mortality with only about 44 per cent giving birth in hospitals.
Women and children under five years still die from preventable or treatable conditions like pneumonia, diarrhoea and malaria.
At the same time, many mothers miss post-natal care, including family planning and immunisations

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News from WHO and partners

1

Women Deliver + Countdown Conferences open with promises for women + children

WHO

07/06/2010

7 June 2010 | Washington DC - The United Nations Secretary–General Ban Ki-moon and Foundation head Melinda Gates were part of the high-level speakers who helped open the Women Deliver and Countdown Conferences in Washington with commitments to women’s and children’s health. Mr Ban urged all delegates to ‘Invest in the health of women: it pays.’ Mrs Gates pledged $1.5 billion over five years to support maternal and child health.
The UN Secretary-General and Mrs Gates were speaking at some of the Women Deliver Conference opening sessions, which included other speakers of note, including:

· former President of Chile, and Women Deliver co-chair, Michelle Bachelet

· Dr Fred Sai, an internationally re-known Ghanaian physician and advocate

· Thoraya Abaid, Executive Director, UN Population Fund (UNFPA)

· Gamal Serour, President of FIGO

· Ngozi Okonjo-Iweala, Managing Director, World Bank

Three Countdown to 2015 sessions took place on the first day of the Conference Countdown to 2015 at Women Deliver, which also released the new 2010 Countdown to 2015 Decade Report. The three sessions included:
· Human resources for maternal, newborn and child health

· Equity in Reproductive, maternal, newborn and child health

· Community approaches for increasing coverage of child health interventions: Malawi
Please link to the Countdown to 2015 site for more details and information
Ban Ki-moon: Joint Action Plan (JAP)

Secretary-General Ban spoke of the importance of saving women and children lives and achieving MDGs 4 and 5. He spoke about the Plan and its accountability framework, pointing to the need for all constituencies to adopt the JAP, to ensure that everyone is aligned in their efforts and that progress is made. Holding a copy of the Draft JAP in his hand, Mr Ban urged all to go the Consultation later that day.

Gates Foundation commits $1.5B

At the conference Monday, philanthropist Melinda Gates announced that the Bill & Melinda Gates Foundation will spend $1.5 billion over five years to support maternal and child health projects such as family planning, nutrition and health care for pregnant women, newborns and children in India, Ethiopia and other countries.

"Policymakers in both rich and poor countries have treated women and children, quite frankly, as if they matter less than men," Gates said. "They have squandered opportunities to improve the health of women and babies."
Below, find related links and texts of speeches, as they become available.

:: Countdown to 2015 website, sessions and presentations

:: Press release: United Nations Secretary General Ban Ki-moon [pdf 324kb]
:: Speech: United Nations Secretary General Ban Ki-moon [pdf 138kb]
:: Speech: Melinda Gates [pdf 257kb]

2

Consensus Forged on a Strategy to Strengthen Midwifery in Developing Countries

UNFPA

07/06/2010

WASHINGTON, D.C. — Some 200 midwives, policymakers, UN agencies and other donors came together last weekend to galvanize support for strengthening midwifery services and increasing the number of midwives in developing countries. This is considered a key to meeting Millennium Development Goals on maternal and child health.
“This is history in the making,” said Vincent Fauveu of UNFPA, after the moving and energizing closing session. “Midwives and the importance of midwifery skills to reach the MDGs have never been acknowledged like this before at the global level.”
The Symposium to Strengthen Midwifery was co-hosted by UNFPA and the International Confederation of Midwives in the lead up to the Women Deliver conference, the G-8 and -20 Summits and the MDG+10 Summit this September.
During the symposium, Norway and Sweden announced continued support to the UNFPA-ICM Midwifery programme, and practicing midwives were honoured, acknowledged, and empowered in an unprecedented way.
A global Call to Action adopted at the symposium encourages governments to focus on the specific steps needed to strengthen midwifery services. These include: improving education and training; strengthening laws, regulations and midwifery associations; and enhancing the recruitment and retention of midwives. During the two days of knowledge-packed presentations and intense audience engagement -- 15 people or more lined up to give comments to virtually every panel -- these steps were the dominating themes. Participants called attention to positive developments, such as the decreasing maternal mortality rates in many countries as indications that strengthened midwifery services work to save lives of women and newborns.
Mary Issaka, a midwife from Ghana, exemplifies the multiple roles midwives can play in the maternal and child health challenge. In addition to delivering babies, her work has contributed to a dramatic decrease the number of unattended home births and adolescent pregnancies in her district. For this she was awarded with Johns Hopkins Program for International Education in Gynecology and Obstetrics first annual midwifery award.
“I see myself as a link between the communities and the policy makers. I go to the villages and listen to the women and see their needs, and encourage them to go to the clinic and not risk their lives by delivering on their own,” Ms. Issaka said in a comment to her award. “I think this symposium has empowered us as midwives, so we can go home and get more involved in the decision making process,” she continued.
The most important conclusion from the symposium was probably that participants need to ensure that the Call to Action leads to concerted action and further investments in the midwifery work force – and that skilled midwives are empowered to become agents of change.
A key could be to start with the math. “We need to liaise more with economists to get the calculations right and then present cost-benefit analyses to policymakers, so they know exactly what the gains are, considering that midwives can provide reproductive health services that integrate HIV prevention, family planning and safe deliveries,” said Anneka Knutsson of SIDA, the Swedish International Development Agency.
The symposium participants strongly agreed that the fight for strengthened midwifery is closely linked to the fight for increased gender equality.

3

UNFPA and CARE Announce Partnership to Improve Maternal Health Globally

UNFPA

07/06/2010

WASHINGTON, D.C.—Leaders from UNFPA, United Nations Population Fund, and CARE International announced today at the Women Deliver Conference an agreement to enhance collaboration on maternal health programs in more than 25 countries. This unique collaboration will bring together UNFPA’s effective work with national governments and CARE’s expertise in engaging local communities.
"No woman should die giving life. Through collaboration we can make a bigger impact to improve the health of women and girls. UNFPA partners with governments, other UN agencies and civil society to advance the health and rights of women and girls, and we welcome this new partnership with CARE," said Thoraya Ahmed Obaid, Executive Director of UNFPA, when signing the agreement at the Women Deliver Conference in Washington, DC.
Both CARE and UNFPA work hard to reduce maternal death and disability and have launched successful initiatives to speed-up progress towards achieving Millennium Development Goal 5, to improve maternal health.
“This partnership will fortify the life-saving work of CARE and UNFPA by leveraging our collective knowledge and experience working with women and their families in the poorest communities around the world,” said CARE President and CEO Dr. Helene Gayle. “Together, we will strengthen access to and delivery of maternal and reproductive health services.”
Through the Mothers Matter Program, CARE aims to reduce maternal death by improving access to safe pregnancy and delivery services for 30 million women by 2015. Similar to the work of UNFPA, this signature program will focus on family planning, skilled attendance at birth and emergency obstetric care within the context of a functioning health system. The Mothers Matter strategy is to empower communities and civil society organizations to advocate for and participate in improved maternal health care; to mobilize local governments and civil society to ensure access to responsive health systems; and to promote supportive policy action while advocating internationally for greater global commitment and investment of resources.
UNFPA supports advocacy, policy dialogue and health systems strengthening, including reproductive health supply chains, to ensure universal access to reproductive health. Support focuses on the three pillars of reducing maternal mortality: family planning, skilled attendance at birth, and emergency obstetric care. UNFPA also promotes women’s empowerment and gender equality.
Additionally, CARE has significant strength and experience in community and civil society work that complements UNFPA’s ability to work closely with governments, particularly ministries of health.
About CARE: Founded in 1945, CARE is one of the world’s largest humanitarian aid agencies. Working side by side with poor people in 72 countries, CARE helps empower communities to address the greatest threats to their survival. Women are at the heart of CARE’s efforts to improve health, education, and economic

development because experience shows that a woman’s achievements yield dramatic benefits for her entire family. CARE is also committed to providing lifesaving assistance during times of crisis and helping rebuild safer, stronger communities afterward. Visit www.care.org to learn more.
About UNFPA: UNFPA, the United Nations Population Fund, is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.
UNFPA – because everyone counts

4

Maternal Mortality: Is It Yet Time For Sub-Saharan Africa To Celebrate? AMREF’s Position on The New Lancet Estimates

AMREF

04/06/2010

On April 12, 2010, Margaret C Hogan, Kyle J Foreman and their colleagues published new estimates for maternal mortality in an article in the online version of The Lancet entitled “Maternal mortality for 181 countries, 1980 – 2008: a systematic analysis of progress towards Millennium Development Goal 5” (DOI: 10.1016/S0140-6736(10)60557-8).
The findings indicate that maternal deaths worldwide have fallen from a 1980 estimate of 526,300 ((uncertainty interval 446,400 to 629,600) to an estimated 342,900 (CI 302,100 – 394,300) in 2008. The global maternal mortality ratio was reported to have declined from an estimate of 422 (358 – 505) in 1980 to 251 (221 – 289) per 100,000 live births in 2008.
Since the publication of the article, great excitement and optimism has built around the new information as this is the first time in decades that estimated maternal deaths have declined from around the half a million mark which has appeared so intractable for decades. And of course this is great news as maternal death remains the biggest challenge in public health as it arises from mostly preventable causes, not to mention the devastation that visits families that lose a mother, especially in poor communities where the mother is the main determinant of child survival as well.
Indications from G8 countries are that this optimism might go as far as proposals for reduced funding towards maternal health programmes in developing countries. While such thinking is logical for any other problem that seemed to be on the verge of being solved, it would not only be the wrong response to this good piece of scientific work, but disastrous for maternal and women’s heath in Africa, as well. There is good justification for this conclusion. First, any number of maternal deaths, let alone 342,900 deaths of women from mainly preventable causes, is still a great tragedy.
Secondly, the global estimates mask very major differences in estimated reductions in various regions of the world. It is also important to note that while the data used may have improved in many countries, serious weaknesses remain in registration of vital events in most of Sub-Saharan Africa. AMREF acknowledges and recognises the great effort made to collect and validate the data used, but would like to point out that the authors did not comment on any change in quality of data from Sub-Saharan Africa, which has been a major issue in previous estimates.
Examination of the regional data presented in the article shows that there was in fact hardly any reduction in maternal mortality in Sub-Saharan Africa. The table below, abstracted from the Lancet article, shows the estimated reductions in various regions of Africa and other previously high mortality regions, compared to low mortality regions in Europe. The table speaks for itself – overall reduction in Sub-Saharan Africa was tiny at 3.3% between 1990 and 2008, and in fact there were increases in maternal mortality in at least two regions, quite sharp in the case of Southern Africa, due to the impact of HIV and AIDS. Three of the six countries that contribute about 50% of global maternal mortality – Nigeria, Democratic Republic of Congo, and Ethiopia – are the most populous countries of Africa. Continued
Full-text: http://www.amref.org/news/maternal-mortality-is-it-yet-time-for-subsaharan-africa-to-celebrate-amrefs-position-on-the-new-lancet-estimates/

5

ICN celebrates the courage and determination of outstanding nurses who strive to offer quality care for patients with TB and MDR-TB

International Council of Nurses

28/05/2010

Geneva, Switzerland, 28 May 2010 – The International Council of Nurses acknowledges the impact nurses have on stemming TB and MDR-TB through the ICN/Lilly Award for Nursing Excellence in TB/MDR-TB. The recent 63rd World Health Assembly progress report on tuberculosis control recognised that while considerable progress has been made, TB continues to be a major public health threat. The ICN/Lilly Award celebrates the advances that have been made and the essential work of TB nurses, while stressing that more investment and support is needed to enable nurses to reach their potential. Nursing Excellence in TB and MDR-TB (www.icn.ch/projects/awards/) showcases the stories and work of these award-winning nurses on the frontline of TB prevention and care.
The ICN/Lilly TB award recognises the work of these nurses, and thousands like them, who are crucial to the effort to provide universal access to the diagnosis and treatment of TB and MDR-TB. They work in extremely difficult circumstances with poor resources and very high patient numbers, putting themselves at risk of infection in order to care for others. ICN is very concerned about the risks faced by nurses and patients who are exposed to TB and MDR-TB in the absence of effective infection control.
The award is one element of the ICN TB/MDR-TB project and part of the Lilly MDR-TB Partnership. Through this project, ICN is working with national nurses associations and ministries of health to build global nursing capacity in the care, prevention and detection of TB and M/XDR-TB. Since 2005, 852 nurses in 14 high burden countries in Africa, Asia, and Eastern Europe have been trained as trainers and they in turn have capacitated 18,000 nurses and allied health workers to meet the needs of often very vulnerable citizens.
It is essential that nurses are properly skilled, educated and supported to promptly identify patients with TB and ensure that they get all the support and treatment they need to make a full recovery. If patients do not have good care from well equipped staff, even basic tools are useless and new tools will not be properly implemented. ICN and the Lilly MDR-TB Partnership recognise the crucial role that nurses play and encourage local, national and international organisations and funding bodies to develop strategies for real investment in the nursing workforce for involvement of nurses at every level of TB and HIV programmes.

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Africa & Middle East

1

21 Kenyan women die daily at childbirth
The Standard, Kenya

04/06/2010

By Elizabeth Mwai
Kenya is among Sub-Saharan African countries with the highest deaths of women during childbirth.
The countries record two million deaths involving mothers and newborns annually.
The Countdown Report shows nearly 50 per cent of women from the 68 countries in Sub-Saharan African and South Asia still deliver at home and without the help of a trained midwife. And only ten of them have increased the rate of skilled care at childbirth by at least ten per cent since 1990.
In Kenya, nearly 21 women die daily from childbirth complications.
Releasing the report yesterday, the Aga Khan University, Pakistan Managing Director Zulfiqar Bhutta said skilled childbirth care could reduce the death toll and complications.
"All women and their newborns need skilled care at birth and access to emergency care in case of complications," said Bhutta.
The report puts infant mortality at 414 deaths in 100,000 live births. It decries a global shortage of midwives with an estimated 700,000 new ones needed among other trained personnel to care for pregnant women.
The Global Health Workforce Alliance says Africa needs an additional 1.5 million health workers, nearly double of the current workforce of 1.6 million.
Angola, Burkina Faso, Pakistan, Rwanda, Bhutan, Laos, Nepal, and Peru have shown the most impressive gains in reducing infant and maternal mortality.
Bolivia, Ivory Coast, Liberia, Malawi, Nigeria, Somalia, Swaziland and Zimbabwe made no progress between 2000 and 2008.
At home

In Kenya, nearly 7,000 maternal mortalities are reported annually, majority having delivered under the care of traditional birth attendants, a practice that has not changed in the last seven years.

Former Kenya World Health Organisation Country Director David Okello decried the high rate of maternal mortality with only about 44 per cent giving birth in hospitals.
Women and children under five years still die from preventable or treatable conditions like pneumonia, diarrhoea and malaria.
At the same time, many mothers miss post-natal care, including family planning and immunisations.

2

Tuberculosis in Children Neglected
IPS-Africa

03/06/2010

By Kristin Palitza
DURBAN, South Africa, Jun 3, 2010 (IPS) - Even though tuberculosis (TB) is a major cause for illness and mortality in children, South Africa lacks the political will to tackle the disease, health experts say.
And the country’s health system is not up to scratch to diagnose and treat children who have contracted the bacteria.
"TB in children is neglected, and we need to urgently redress this," said Health Systems Trust senior researcher Dr. Tsholofelo Mhlaba at the 2nd TB Conference, held in Durban from Jun. 1-4. "To do this, we would basically need an overhaul of the health system and allocate major finances for childhood TB programmes."
About nine million people get infected with TB each year, a third of them live in Africa, according to the World Health Organisation. Up to 15 percent, or 450,000, are African children.
There are no detailed statistics available for the number of paediatric TB cases in many African countries, including South Africa. This makes it extremely difficult to develop effective health programmes to control the epidemic, experts say. "Until we know how many children are infected and where, we won’t be able to appropriately intervene," cautioned Mhlaba. "We need much more research in South Africa and better reporting and recording systems."
She said the national department of health (DoH) has neglected to focus on children up until now because children – unlike adults – rarely transmit TB: "That’s why paediatric TB is not seen an emergency issue and sidelined."
In South Africa, 75,000 children die before the age of five, and health experts believe that about six percent of these deaths are due to TB. "If we want to improve child health, we have to look at TB," urged Ben Marais, researcher at the department of paediatrics and child health at the University of Stellenbosch. "Children are severely affected, and the younger the child, the more severe the disease."
Medical experts are now pushing for dedicated childhood TB programmes to be made part of countries’ existing, national TB programmes. "(The research community is) finally at a point to realise how critical TB in children is. But (paediatric) diagnosis, care and treatment are very complex and complicated, even without considering HIV and TB co-infection or (multi) drug resistant TB," said Peter Vranken, Swaziland director of United States public health agency Centres for Disease Control and Prevention.
In children, TB can manifest in many different symptoms compared to adults, for instance as acute pneumonia. This means that a lung X-ray might not necessarily show the infection in a child. Additionally, if a child is too small to cough, health workers are unable to conduct a sputum test (test of the secretion from lungs and bronchi to identify bacteria) to diagnose the illness. All this leads to paediatric TB being left undiagnosed and untreated.
TB is particularly common in HIV-infected children due to their compromised immune system – 40 to 60 percent of them have at least one incident of TB in their lives. And when children are HIV-positive, the diagnosis for TB is even more difficult.
"Their test results are not as clear and it is difficult to differentiate TB from other opportunistic lung infections in children," explained Prakash Jeena, professor of paediatrics and child health at the University of KwaZulu-Natal in Durban.
"Paediatric TB is poorly studied and both clinical and radiological diagnosis systems are unreliable," agreed Heather Zar, chair of the department of child health at the Red Cross Children’s Hospital in Cape Town. She says that paediatric TB should receive the same amount of budget and attention as adult TB programmes and that the same diagnosis standards should be applied.
To change this, it will be crucial to provide additional training to health workers to ensure they have better skills to diagnose and treat childhood TB – not only in the country’s key hospitals but also in public clinics in peri-urban and remote rural areas.
As a first step towards to this goal, international medical aid organisation Médecins Sans Frontières (MSF) launched a pilot programme in 2009 with a patient-centred and decentralised approach to TB treatment in Khayelitsha, South Africa’s third-largest township, 35 kilometres outside of Cape Town.
As part of the programme, MSF paediatricians teach primary health workers how to diagnose and treat TB, multiple drug resistant (MDR) TB and extremely drug resistant (XDR) TB in children.
"Because TB screening of children is often neglected, we knew it’s high time to bring diagnosis and treatment closer to the people," said MSF Khayelitsha field team coordinator Andiswa Vazi.
Since patients usually have to get to their nearest hospitals for TB diagnosis, many who live outside of urban centres and are too poor to pay for public transport, are unable to regularly access treatment and care. The results are high drop-out rates, which in turn leads to high levels of unsuccessfully treated cases as well as drug resistance.
"This is particularly important in the case of children, who rely on a caregiver in terms of care, adherence to treatment and follow-up visits," Vazi explained. "If they can access all this at their local clinic, there’s a far higher likelihood that caregivers will take children (for treatment), that children are treated and that they survive."