by Norman Wetterau, MD and Lwabanya Marx, MD
Image courtesy of Unsplash
The American Church is concerned about saving the lives of pregnant mothers, babies, and preventing neonatal deaths by discouraging abortions. In central Africa, many newborns die, and mothers die from childbirth often.
This article is an introduction to the issue of neonatal deaths, with an additional article that will follow later this year. There is much development in this area, including in some of our Free Methodist hospitals and clinics overseas. We welcome comments and additional writers.
Maternal mortality ratio (modeled estimate, per 100,000 live births)
Data Courtesy of: WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division. Trends in Maternal Mortality 2000 to 2020. Geneva, World Health Organization, 2023
Worldwide, the maternal mortality ratio was 339 per 100,000 births in 2000, however currently the ratio is 223 per 100,000. In many developed countries the rate is under 20. In Canada, it is 11. The rates for 4 countries where we have Free Methodist Hospitals are: Rwanda 259, Haiti 350, Burundi 494 , and Democratic Republic of Congo; 547. These are the incidence of mothers dying from Childbirth. Rates for infant death will be presented later next year.
The Gates Foundation is making this a major project, and they published a report Sept 12, 2023 This report can be downloaded from the internet and presents several initiatives. Their report had seven recommendations:
1. A bundle of interventions that can reduce postpartum hemorrhage, the No. 1 cause of maternal death, by 60% for less than $1 per package
2. Bifidobacteria (B. Infantis), a new probiotic supplement that, when given to an infant alongside breastmilk, combats malnutrition—one of the leading causes of newborn deaths
3. Multiple micronutrient supplements (MMS) that boost survival rates for babies by helping replete nutrient stores in pregnant women and ensuring those vital nutrients are transferred to the baby
4. A new one-time infusion of IV iron for women that replenishes iron reserves during pregnancy, protecting against and treating anemia, a condition that is both a cause and effect of postpartum hemorrhage and affects almost 37% of pregnant women
5. Antenatal corticosteroids (ACS), which are given to women who will give birth prematurely to accelerate fetal lung growth, providing several weeks of maturation in just a few days
6. Azithromycin, which reduces maternal infections during pregnancy and prevents infections from spiraling into sepsis—the cause of 23% of maternal deaths in the United States—and reduces mortality when given to infants in high-mortality settings.
7. An AI-enabled portable ultrasound that empowers nurses and midwives to monitor high-risk pregnancies in low-resource settings to ensure that risks are diagnosed and addressed early
In the Nundu area of Eastern Congo most deliveries are being done by midwives and in some cases by totally untrained midwives. At-risk mothers are supposed to be referred to our hospital where there are physicians. The first problem is lack of trained midwives, but on the positive side, our nursing school there is training midwives and wants to enlarge their student body and building to make midwife training a major goal of the school.
Secondly, Dr. Marx has already instituted a program where midwifes can call by cell phone the hospital to discuss cases and get telephone consultations. For this publication he has sent the report, included below. In our next issue he can share more and we can provide more details on the midwife school.
MATERNAL AND NEWBORN HEALTH IN CONGO
by: Lwabanya Marx MD
The Deaconess Nundu Hospital, a free Methodist Facility is actively involved in the effort to provide quality care to the underprivileged community in the rural area of Nundu, Eastern Congo.
In the last five years, more effort has been dedicated to improving maternal and newborn health care. This includes and not limited to the following:
Setting up a neonatal intensive care unit, with basic equipment to provide quality health care, including two incubator, CPAP, Oxygen, blue light, radiant warmers, Infusion pumps and monitors, etc.
Short training of general nurses to provide basic neonatal care,
Short training of general practitioner doctors and nurses in comprehensive emergency obstetrics and neonatal care.
Despite the above-mentioned effort maternal and newborn mortality has been oscillating and haven’t yet been close to the SDG -3.
To address that situation, several new interventions has been initiated at Deaconess Nundu Hospital in collaboration with multiple partner organizations:
Mobile Clinic, two mobile nurses are able to organize field trip in the community and reach out mothers and infant facing financial barriers, they perform clinical assessment and provide medications for common conditions like malaria, diarrhea, pneumonia, etc Children found in critical ill condition are immediately transferred to the Deaconess Nundu Hospital for appropriate care where all the care are provided for free because their bill are covered by patients care funds from CAHO.
Community Health Workers (CHWs); one supervisor nurse from the Deaconess Nundu Hospital and 10 CHWs are actively involved in supporting served community to prevent common maternal and infant conditions by encouraging antenatal care visit, post-natal visit, sensitizing on hand hygiene, nutrition and contraceptive methods. The Community Health Workers program helped identify several high-risk pregnancies and decisions were made on time.
Master Trainer program: as noted in many of our report late referral, poor knowledge of health providers at health centers especially in newborn resuscitation, management of common post-partum emergencies like PPH, etc. The Deaconess Nundu Hospital initiated a program to address knowledge gap at the health centers in the Nundu health District. The model is assess-train- assess- re-train. The program is supported by the Gould Family Foundation and focus on helping baby breath, essential care of small babies, essential care of every baby and helping mothers survive.
The DRC government has also initiated free-of-charge health care to women delivering and newborn started October 1st, 2023. This program is dedicated to easier the financial burden of maternal and sick newborn. We don’t know yet what will be the next outcome.