Guest blog post by Sandeep Bathala, Wilson Center
This post is cross-posted on the New Security Beat.
Photo Credit: “Saving lives at birth,” courtesy of the Bill & Melinda Gates Foundation.
On day three of the 2013 Global Maternal Health Conference here in Arusha, Tanzania, I was joined by the Global Health Initiative’s partners to present the results of the Wilson Center’s four-year-old Advancing Dialogue on Maternal Health Series. This series is unique in its convening power, helping to bring together experts and policymakers from around the world to collaborate on a shared goal: healthier mothers and children.
From 2009 to 2012, the Global Health Initiative co-convened 22 public meetings and three private workshops with the Maternal Health Task Force and United Nations Population Fund to identify challenges and discuss strategies for moving the maternal health agenda forward. In 2011, we collaborated with the African Population and Health Research Center (APHRC) to host two simulcasted videoconferences in Nairobi, Kenya, and Washington, D.C., which allowed maternal health experts and officials from both countries – including several Kenyan Parliament members affiliated with the Health Committee and Network for Population and Development – to share experiences and best practices. In partnership with the Population Foundation of India, we are planning a similar dialogue with local, regional, and national decision-makers on effective maternal health policies and programs in New Delhi, India, this year, as well as more D.C.-based meetings.
By convening both in Washington, D.C., and globally, the goal of the series is to create a platform for fieldworkers, policymakers, program managers, media, and donors to share research, disseminate lessons learned, and address concerns related to policy, institutional, and organizational capacity building. These are many of the same themes being discussed at the Global Maternal Health Conference here in Tanzania.
Ruthpearl Wanjiru Ngángá, APHRC’s communications manager, highlighted some of the results that emerged from the videoconferences.
Broadly, she said they found that connecting maternal death to economic loss is a powerful and effective strategy, and it’s important to increase accountability by addressing the gap between what policymakers say and what they actually do to improve maternal health.
All the policymakers attending pledged to do something based on what they learned at the meetings, ranging from building maternal health shelters and lobbying to working to unify the Ministry of Health in Kenya, which is currently split between ministers of public health and medical services (duplicated funds would be used to strengthen the Division of Reproductive Health).
Participants also established dialogue between the ministries of health and finance to jointly identify priority areas and to ensure that 15 percent of the Kenyan national budget goes to health efforts, as per the Abuja Declaration.
Perhaps the most striking pledge was made by a member of Parliament who did not attend the videoconferences but was motivated after hearing about them: He pledged to coordinate a day once a month where pregnant women in remote areas could consult with Nairobi-based doctors through e-medicine.
And the commitments, it turns out, were not empty. Since the meetings concluded Ruthpearl said they have seen additional outcomes including a parliamentary retreat on maternal, newborn, and child care; increased press coverage, especially highlighting maternal and child health statistics and reporting on fatalities; and elevated interest in maternal health issues in general, including becoming a priority for the Kenya Women Parliamentary Association.
“Where I come from, husbands are delivering their wives,” Hon. Sophia Abdi Noor who represents the Somali region of northern Kenya, said later in a follow-up meeting.
And Hon. Farah Maalim, deputy speaker of the National Assembly, said at the parliamentary retreat that “we are running out of time towards the MDG deadline. There is need to reactivate the agenda on women and children’s health at the national level…the new constitution of Kenya declares health as a basic right for all Kenyans. Parliament has a pivotal role to play in ensuring the realization of this right.”
Moving forward, Ruthpearl said APHRC intends to focus on advancing public-private health sector partnerships in urban slums and to start a pilot study on improving maternal, newborn, and child care services for slum residents. She also said they are working to improve engagement with Kenya’s National Division of Reproductive Health on research and technical working groups and to improve the visibility of research in policy and program formulation in general.
Alongside Ruthpearl and I, Crystal Lander and Dr. Steve Solter of Management Sciences for Health also spoke on the panel, about their work with the Afghan Ministry of Public Health.
Dr. Luc de Bernis, senior maternal health adviser at UNFPA and one of the collaborating partners in this series, concluded the session by expressing his hope that these dialogues were contributing to a swelling global advocacy movement for improved maternal health outcomes. The audience in Arusha couldn’t have agreed more.
Learn more about the conference and access the conference presentations at www.gmhc2013.com.
Join the conference conversation on Twitter: #GMHC2013
Malaria and maternal health: Treating pregnant women reveals need for integration
Posted on February 5, 2013 by Samantha Lattof
Guest blog post by Lauren Herzer, Wilson Center
This post is cross-posted on New Security Beat.
Photo Credit: "Woman and child recover from malaria in Burundi," courtesy of Maria Cierna/United Nations Development Program
Ten years ago, a study was conducted in Mozambique to determine the impact of a new medicine for pregnant women with malaria. Over 1,000 women participated in a controlled trial of intermittent preventative treatment with sulphadoxine-pyrimethamine – half received a placebo, the other half received the actual drug. All were given an insecticide-treated net.
The study found that for those women that received the medicine, there was a 61.3 percent reduction in neonatal mortality; 51 percent reduction in fetal anemia; and 40 percent reduction in the incidences of clinical malaria episodes. The treatment was also found to be highly cost effective, especially after the savings from reduced anemia, oftentimes a result of malaria during pregnancy, were factored in.
The infants born to the women who did not receive the treatment experienced a significantly higher death rate.
A Compound Global Health Challenge
The presentation of this study, in the midst of countless technical presentations at the recent Global Maternal Health Conference in Arusha, prompted a rare emotional response from the audience. One woman asked, “How do you address the ethical implications of the difference in mortality experienced by the placebo group, which experienced a 60 percent increase in mortality?”
The presenter and researcher, Clara Menéndez, responded thoughtfully. “Ethical issues are critically important in any research,” she said. But at the time of the study, there was little or no information on the additional effectiveness of intermittent treatment over treated nets to protecting women from malaria during pregnancy.
Malaria in pregnancy is a massive and compound global health problem. The World Health Organization (WHO) estimates that each year, 50 million women become pregnant in malaria-endemic countries around the world and “an estimated 10,000 women and 200,000 of their infants die as a result of malaria infection during pregnancy.” Anemia – a lack of healthy red blood cells that can lead to death – is the biggest risk but low birth rate, neonatal death or stillbirth, and spontaneous abortion are also more likely.
The WHO now recommends a combination of intermittent preventive treatment with sulphadoxine-pyrimethamine and insecticide-treated nets as an effective means to preventing and treating malaria in pregnancy.
But, Menéndez said, the study was done in 2003:
In 2006, after the results the trial, Mozambique did implement the WHO’s policy of intermittent preventative treatment alongside treated nets.
Many and Varied Barriers to Care
Despite these breakthroughs – and the hard choices made to achieve them – there are still many barriers to the delivery, access, and use of intermittent preventative treatment for both healthcare providers and the millions of pregnant women with malaria today.
A recent study conducted by the Malaria in Pregnancy Consortium attempted to do a systematic review of these barriers in sub-Saharan Africa. They found that many pregnant women lacked knowledge of the benefits of intermittent preventative treatment and insecticide-treated nets; had unwarranted fears regarding perceived side effects; and/or did not attend routine antenatal care visits to healthcare providers, which are required for the treatment to be administered. Healthcare providers, on the other hand, were sometimes confused about the timing and dosing of treatments; lacked basic supplies, such as water cups; and/or were sometimes out of stock of the treatment.
Understanding this context – one where education is rare, misconceptions common, agency low, and supplies scarce – is key to removing barriers to care. Recognizing this, the WHO has suggested improving integration between reproductive health and malaria programs to concentrate resources and try to create single access points for women’s health.
In a presentation on the panel in Arusha, Viviana Mangiaterra of the WHO and Roll Back Malaria, highlighted the importance of this point. “Harmonization of national policies, guidelines and training materials between [reproductive health] and malaria control, as well as strong commitment to national level coordination, can ensure effective implementation of malaria in pregnancy programming,” she said. “This can lead to one point of care which ultimately simplifies care for the patient, minimizes dropout, supports the continuity of care, promotes a comprehensive approach to women’s health, and leads to improved outcomes.”
While significant gains in malaria control have been made in the last decade, global funding for malaria prevention and control has leveled off in recent years, sparking a concern that some of the gains made could be lost. According to Mangiaterra, most countries have not achieved country or global targets for intermittent preventative treatment, insecticide-treated nets, or effective case management – the three-pronged approach recommended by the WHO.
Indeed, included in the WHO’s latest recommendations is a specific urging to national health authorities in Africa to correct misconceptions and confusion about intermittent preventive treatment in order to reverse slowing efforts to make the treatment more widely available.
Knowing what treatments work is a crucial step forward in preventing and treating malaria in pregnancy. But local cultural and social contexts need to be accounted for too. Integrating reproductive health and malaria programs will strengthen the ability of healthcare providers to reach this vulnerable population.
Learn more about the conference and access the conference presentations at www.gmhc2013.com.
Join the conference conversation on Twitter: #GMHC2013
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