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

doi:10.9745/ghsp-d-18-00343

Abstract

Saving Mothers, Giving Life (SMGL), a 5-year initiative implemented in selected districts in Uganda and Zambia, was designed to reduce deaths related to pregnancy and childbirth by targeting the 3 delays to receiving appropriate care at birth. While originally the "Three Delays" model was designed to focus on curative services that encompass emergency obstetric care, SMGL expanded its application to primary and secondary prevention of obstetric complications. Prevention of the "first delay" focused on addressing factors influencing the decision to seek delivery care at a health facility. Numerous factors can contribute to the first delay, including a lack of birth planning, unfamiliarity with pregnancy danger signs, poor perceptions of facility care, and financial or geographic barriers. SMGL addressed these barriers through community engagement on safe motherhood, public health outreach, community workers who identified pregnant women and encouraged facility delivery, and incentives to deliver in a health facility. SMGL used qualitative and quantitative methods to describe intervention strategies, intervention outcomes, and health impacts. Partner reports, health facility assessments (HFAs), facility and community surveillance, and population-based mortality studies were used to document activities and measure health outcomes in SMGL-supported districts. SMGL's approach led to unprecedented community outreach on safe motherhood issues in SMGL districts. About 3,800 community health care workers in Uganda and 1,558 in Zambia were engaged. HFAs indicated that facility deliveries rose significantly in SMGL districts. In Uganda, the proportion of births that took place in facilities rose from 45.5% to 66.8% (47% increase); similarly, in Zambia SMGL districts, facility deliveries increased from 62.6% to 90.2% (44% increase). In both countries, the proportion of women delivering in facilities equipped to provide emergency obstetric and newborn care also increased (from 28.2% to 41.0% in Uganda and from 26.0% to 29.1% in Zambia). The districts documented declines in the number of maternal deaths due to not accessing facility care during pregnancy, delivery, and the postpartum period in both countries. This reduction played a significant role in the decline of the maternal mortality ratio in SMGL-supported districts in Uganda but not in Zambia. Further work is needed to sustain gains and to eliminate preventable maternal and perinatal deaths.

Highlights

IntroductionAddressing the First Delay in Uganda and Zambia www.ghspjournal.org with 99% of these deaths occurring in developing countries.[1] Approximately 2 million newborns die during their first week of life each year, and an additional 2.6 million are stillborn from complications during pregnancy or delivery.[2,3] Effective interventions exist to prevent the majority of these deaths; these interventions are often unavailable or inaccessible in many countries in sub-Saharan Africa where the greatest burden lies.[4,5,6]
Three Delays That Contribute to Maternal MortalityGlobally, more than 300,000 women die each year due to complications of pregnancy and childbirth, Global Health: Science and Practice 2019 | Volume 7 | Supplement 1 S48Addressing the First Delay in Uganda and Zambia www.ghspjournal.org with 99% of these deaths occurring in developing countries.[1]
Data for Zambia activities were derived from annual performance reports to United States Agency for International Development (USAID), Communications Support for Health’s final report, and the “Mothers Alive Campaign” Change Champions assessment

Summary

Introduction

Addressing the First Delay in Uganda and Zambia www.ghspjournal.org with 99% of these deaths occurring in developing countries.[1] Approximately 2 million newborns die during their first week of life each year, and an additional 2.6 million are stillborn from complications during pregnancy or delivery.[2,3] Effective interventions exist to prevent the majority of these deaths; these interventions are often unavailable or inaccessible in many countries in sub-Saharan Africa where the greatest burden lies.[4,5,6]. Ending preventable maternal and perinatal deaths while ensuring health and well-being and enabling environments (i.e., survive, thrive, and transform) are the main priorities for the United Nations’ Sustainable Development Goals and Global Strategy for Women’s, Children’s, and Adolescent’s Health (2016–2030).[7,8] equitable access to emergency obstetric and newborn care (EmONC) remains a challenge in many countries, where fertility and mortality levels are high. Since pregnancy complications are often unpredictable, timely access to quality EmONC is essential to reducing maternal and perinatal deaths.[10,11]

Methods

Results

Conclusion