Abstract
Maternal and perinatal mortality is a global development priority that continues to present major challenges in sub-Saharan Africa. Saving Mothers, Giving Life (SMGL) was a multipartner initiative implemented from 2012 to 2017 with the goal of improving maternal and perinatal health in high-mortality settings. The initiative accomplished this by reducing delays to timely and appropriate obstetric care through the introduction and support of community and facility evidence-based and district-wide health systems strengthening interventions. SMGL-designated pilot districts in Uganda and Zambia documented baseline and endline maternal and perinatal health outcomes using multiple approaches. These included health facility assessments, pregnancy outcome monitoring, enhanced maternal mortality detection in facilities, and district population-based identification and investigation of maternal deaths in communities. Over the course of the 5-year SMGL initiative, population-based estimates documented a 44% reduction in the SMGL-supported district-wide maternal mortality ratio (MMR) in Uganda (from 452 to 255 maternal deaths per 100,000 live births) and a 41% reduction in Zambia (from 480 to 284 maternal deaths per 100,000 live births). The MMR in SMGL-supported health facilities declined by 44% in Uganda and by 38% in Zambia. The institutional delivery rate increased by 47% in Uganda (from 45.5% to 66.8% of district births) and by 44% in Zambia (from 62.6% to 90.2% of district births). The number of facilities providing emergency obstetric and newborn care (EmONC) rose from 10 to 26 in Uganda and from 7 to 13 in Zambia, and lower- and mid-level facilities increased the number of EmONC signal functions performed. Cesarean delivery rates increased by more than 70% in both countries, reaching 9% and 5% of all births in Uganda and Zambia districts, respectively. Maternal deaths in facilities due to obstetric hemorrhage declined by 42% in Uganda and 65% in Zambia. Overall, perinatal mortality rates declined, largely due to reductions in stillbirths in both countries; however, no statistically significant changes were found in predischarge neonatal death rates in predischarge either country. MMRs fell significantly in Uganda and Zambia following the introduction of the SMGL interventions, and SMGL's comprehensive district systems-strengthening approach successfully improved coverage and quality of care for mothers and newborns. The lessons learned from the initiative can inform policy makers and program managers in other low- and middle-income settings where similar approaches could be used to rapidly reduce preventable maternal and newborn deaths.
Highlights
More than 300,000 maternal deaths due to complications of pregnancy and childbirth occurredGlobal Health: Science and Practice 2019 | Volume 7 | Supplement 1 S27Impact of SMGL Approach on Decreasing Maternal and Perinatal Deaths www.ghspjournal.orgAccess to emergency obstetric and neonatal care (EmONC) remains a global challenge, with only 20% of pregnant women experiencing pregnancy complications receiving emergency obstetric care.in 2015, 201,000 of which occurred in subSaharan Africa.[1]
The maternal mortality ratio (MMR) in SMGL-supported health facilities declined by 44% in Uganda and by 38% in Zambia
Reductions in maternal and neonatal mortality and stillbirths have been prioritized in the United Nations Sustainable Development Goals (SDGs) 3.1 and 3.2 that promote targets of fewer than 70 maternal deaths per 100,000 live births, 12 or fewer neonatal deaths per 1,000 live births, and 12 or fewer stillbirths per 1,000 births by 2030.5 These targets are echoed in the updated World Health Organization (WHO) Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) to advance progress toward reaching the SDGs.[6]
Summary
More than 300,000 maternal deaths due to complications of pregnancy and childbirth occurredGlobal Health: Science and Practice 2019 | Volume 7 | Supplement 1 S27Impact of SMGL Approach on Decreasing Maternal and Perinatal Deaths www.ghspjournal.orgAccess to EmONC remains a global challenge, with only 20% of pregnant women experiencing pregnancy complications receiving emergency obstetric care.in 2015, 201,000 of which occurred in subSaharan Africa.[1]. Despite an annual reduction of 2.5% per year from 1990 to 2015, the maternal mortality ratio (MMR) of 546 maternal deaths per 100,000 in sub-Saharan Africa remains the highest regional MMR in the world.[1] the neonatal mortality rate of 28 neonatal deaths per 1,000 live births is the highest globally and its 2% annual decline rate is the lowest.[7] A large proportion of women and infants die because they do not receive appropriate routine care and do not have support to address the “3 delays”: (1) delayed recognition of a pregnancy complication and decision to go to a facility, (2) delays in reaching an emergency obstetric care facility, and (3) delays in receiving adequate and appropriate obstetric and neonatal care at a health care facility.[8]. The initiative accomplished this by reducing delays to timely and appropriate obstetric care through the introduction and support of community and facility evidence-based and district-wide health systems strengthening interventions
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