NONYE SOLUDO MATERNAL, PERINATAL AND CHILD MORTALITY REDUCTION STRATEGIES

Suggestions/Recommendations from the inaugural meeting:

1. Sustained advocacy to Government for improved budgetary allocation and social mobilization to communities.
2. Increased community and public awareness on issues concerning maternal and child health care to address type 1 delay through the development, printing and dissemination of information, education and communication (IEC) materials.
3. Capacity building of health workers on the various maternal and child health interventions.
4. Integrated services for maternal, newborn and child health (IMNCH)
5. Strengthening of Primary Health Care and effective referral systems.
6. Training and retraining of birth attendants: (Faith based, Community and Traditional).
7. Effective supervision of Community and Faith Based Organizations.
8. Linking of community-based ambulances with the State Ministry of Health.
9. Reorientation of health workers on interpersonal communication.
10. Promotion of Public-Private Partnership and community financing.
11. Financing of the Maternal and Child Health activities through the State’s Health Financing options.
12. Rapid assessment of the existing obstetric services for establishment of a baseline for monitoring and evaluation.
13. Effective supervision, monitoring and evaluation of services and programs.
14. Promotion of research on reproductive health issues.

Based on the findings and recommendations of the committee, a 3-year work-plan (attached as Annexure A) was developed for the implementation of the above-mentioned findings, the implementation modalities for the developed work plan luminated in the Project termed ‘The Nonye Soludo Maternal and Child Mortality Reduction Strategies.

THE NONYE SOLUDO MATERNAL AND CHILD MORTALITY REDUCTION STRATEGIES[NSMCMRS]

GOAL:

The Nonye Soludo Maternal and Child Mortality Reduction Strategies. [NSMCMRS] was established to map out strategies

for the reduction of the high mortality indices in the State. The overarching goal was to reduce the maternal and child mortality rates in line the SDGs 3.

OBJECTIVES OF THE NSMCMRS PROGRAM.

To improve the health seeking behaviors of women of child bearing age in the state.

To increase the quality of care provided to pregnant women and children.

To improve the knowledge and skills of health providers to provide qualitative maternal and child health services.

To increase utilization of the Public Health Facilities in the State.

Prior to commencement of the NSMCMRA Strategies, an assement was conducted to serve as a baseline for program implementation. The assessment gave a guide to the present status of the maternal mortality ratio in the State, and also assisting in knowing the commonest causes of maternal mortality.

The assessment was conducted by Reproductive unit of Anambra State Ministry of Health. The results which were state and LGA specific gave the maternal mortality ratio in Anambra State as 286 per 100,000 live births.

Hence a huge gap was seen in maternal health of the state.

PROCESS/METHODOLOGY.

The 3-year plan of action contained various strategies/activities aimed at addressing the short -term impacts of maternal mortality.

1. Advocacy/sensitization campaigns:

This is aimed at creating awareness to members of the Community and Women of child bearing ages of the problems associated with pregnancy, delivery and postnatal period. It also serves to inform them of the services available at the Primary Heath Care Centres and the need for prompt referral. Since the commencement of the program, several community dialogues/sensitization meetings have been held with key members of the community.

SENATORIAL DISTRICT TOWN HALL MEETINGS:

Town Hall meetings to be held across the three Senatorial Districts in the State. The meetings will record in attendance market women, community leaders, traditional and religious leaders, women of child bearing ages etc.

LGA TOWN HALL MEETINGS:

Town hall meetings will be held in different LGAs, to reduce high number of unavoidable deaths within communities arising from quackery.

Upgrading of existing Public Health Facilities to provide basic and comprehensive emergency care by renovation and provision of equipment.

Emergency Obstetric Care Equipment

Primary Health Care Centres in each of the 21 LGAs/LCDAs will be provided with basic emergency obstetrics equipment (names of PHCs attached as Annexure C) to ensure optimal functionality in the provision of basic obstetrics care.

With the revitalization of the Primary Heath Care Services there will be provision of not only basic obstetrics services, but also treatment of non-communicable diseases. This is in line with the ‘bringing PHC under one roof’ strategy of the Federal Government instituted in 2011 to integrate management of PHC and end fragmentation in the health sector and thus ensure essential health services gets to the grassroots where they are most needed.

Blood Banking Equipment.

In 2022, after the maiden maternal mortality review in the state, twenty-two secondary Health Facilities were also provided with a few blood banking Equipment to ensure functionality as Comprehensive Emergency Obstetrics Care Centres.

Infrastructural development and provision of supplies including basic obstetric drugs (misoprostol and magnesium sulphate) for health facilities.

Anti-shock Garments:

Anti-shock garment consists of articulated neoprene segments that close tightly with Velcro, over a foam compression ball, shunting blood from pressure and increasing preload and cardiac output. Anti-Shock garments prevents shock related morbidity and mortality during obstetric delays and make recommendations. Anti-shock garment (ASG) has been found to be very effective in management and control of hemorrhage. It is excellent in central circulation resuscitation as it diverts blood from the lower extremities of the body to the vital organs like the brain, the heart and the kidneys.

This results in translocation of 1 to 1.5 liters of blood from the lower body to the vital organs. It also reduces hemorrhage in the body by overcoming the pressure in the capillary and venous system (15-25mmHg).

From January to June 2022, there were 20 maternal deaths in the state and from the maternal mortality review conducted, 60% of those deaths occurred as a result of post-partum hemorrhage. The Anti-Shock garments are reusable and washable. It requires change only when it is worn out.

sixty percent of maternal death are from obstetric hemorrhage. Evidence based studies have shown that the use of anti-shock garment reduces blood loss in pregnant women by 65 percent, mortality by 60 percent and morbidity, by 35 percent by stabilizing the pregnant women whilst other life-saving interventions are conducted on her.

In an effort to reduce death from the commonest cause of maternal mortality, in April 2017 a total of 63 NASG were procured and distributed by UNICEF to the Public and private facilities Health Facilities in the State. most of these anti shocks are worn out and requires replacement. Anambra State has up to Two thousand three hundred and thirty-four (2,334) Health Facilities where delivery services occur (578 public and 1,756 private facilities). Hence procurement of 350 Anti-shock garment is expected to reduce maternal mortality in the state by 45%.

This would then be used appropriating when the need arises to help as indicated in controlling bleeding and preventing/treating shock. The use will reduce maternal mortality enabling the attainment of SDG 3 by 2030

Manual Vacuum Aspirators:

Death from complications of unsafe abortion accounts for 8% of maternal deaths. Pregnant women should have access to quality post abortal services and to guarantee this, the Ministry should procure and distribute at least 500 manual vacuum aspirators for the management of women who needs post abortion care in primary and secondary health facilities in the State.

Drugs for essential obstetric care:

The drugs are essentially misoprostol and magnesium sulphate. Misoprostol is used prophylactically for the reduction of haemorrhage during and after delivery, stored at a temperature of 2-8*C and should be made available in all facilities. Magnesium sulphate is used for the treatment of eclampsia which accounts for 11 percent of maternal mortality worldwide. To reduce the morbidities and mortalities arising from pregnancy complications, on a yearly basis, the Ministry of Health is yet to procure the drugs at no cost, for distribution to the Public Health Facilities in the State.

Mama-kits.

The Mama-Kit is an all-in-one kit that contains everything needed to provide clean and safe delivery. It contains all the necessary requirement needed for normal delivery such as cotton wool, gauze, surgical gloves, delivery mat, mackintosh. surgical blades, cotton wool (gauze pad), soap, cord clamp. chlorhexidine gel; etc. It also serves as a motivating factor for utilization of the PHCs by the pregnant women. This is provided free to all pregnant women who deliver in the Primary Health Care Centres in the State. Since the launch of the MPDSR Program, the State has procured 3,365 mama-kits and distributed to the 617 Primary Health Care Facilities. In February 2023 UNICEF procured 1,212 mama kits only to10 Flood-affected LGAs   in the state. This covers only 18% of deliveries had in the state this quarter

Neonatal Resuscitation Bags.

Neonatal mortality in recent years has increased in developing countries with Nigeria having the third highest neonatal mortality in the world. Presently with the integrated Maternal and Newborn and Child Health (IMNCH) strategy, rolled out by the Federal Government, to accelerate reduction in SDGs 3, there is an increase focus on the neonates, which account for 40 percent of children under five years of age, and have unfortunately been neglected in recent times.

Newborn infants resuscitated during the golden hour i.e the first hour of birth, have a greater chance of surviving. Provision of basic resuscitation equipment at the primary health care centers can reduce death of the newborn during the first 2hours of birth. The resuscitation bag known generically as a manual resuscitator or “self-inflating bag” is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately.

To address this, the State Government should procure and distribute at least 450 neonatal resuscitation bags to Primary Health Care Centres offering maternal and child health services.