Doctors

with Africa

CUAMM

Annual report 2014

Doctors with Africa CUAMM Annual Report 2014p. 14 Report on Africa/Angola

09An Angolan woman weaving a straw basket in Chiulo (CUAMM Archive)

10Searching for water in Cunene province(CUAMM Archive)

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p. 15 Report on Africa/Angola

FLASH

392,750Inhabitants involved by the intervention

3,263Assisted normal deliveries

9,400People reached by HIV awareness-building activities

Political profile*

Surface area 1,246,700 sq km

Population 21,472,000

Capital Luanda

Average age of the population

16

Average number of children per woman

5.9

Human Development Index Rank (UNPD)

149th out of 187 countries

Healthcare profile*

Number of doctors 1.7 per 10,000 population

Number of nurses/widwives

16 per 10,000 population

Neonatal mortality 47 per 1,000

Under-5 mortality 167 per 1,000 live births

Maternal mortality 460 per 100,000 live births

Prevalence of HIV/AIDS (between 15 and 49 years)

2.4%

Life expectancy (m/f) 50/52

* Source of surface area data: World Bank (2014) Source of Human Development Index Rank: UNDP (2014) Source of all other data: WHO website (2014)

www.doctorswithafrica.org/angola

Damba

Chiulo

Luanda

Uige

Cunene

Uige

OndjivaMunicipality

of Ombadja

ANGOLA

Doctors with Africa CUAMM Annual Report 2014p. 16 Report on Africaa/Angola

15Aerial view of Chiulo hospital

16Portrait of Marisa Ferrari, a CUAMM nurse who died after a traffic accident

11Disabled patients at Negage hospital

12CUAMM doctor Enzo Pisani holding a training course for midwives in Uige

13Paediatric patients at Negage hospital

14CUAMM doctor Enzo Pisani working at Negage hospital

199

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Intervention by Doctors with Africa CUAMM in Angola

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July 1975Start of the civil war.

2002End of the civil war, with general armistice leading to the signing of peace treaties.

November 1975Declaration of independence from Portugal.

Events in Angola

1997First interventionsby CUAMM atthe hospitals ofUige and Negage.

2004CUAMM supports the healthcare system in the delicate transition from emergency to development status, extending its intervention to the hospitals of Songo, Maquela do Zombo, Damba and Chiulo.

The CUAMM nurse Marisa Ferrari is killed in a traffic accident in Chiulo.

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OUR HISTORY

p. 17 Report on Africa/Angola

17Portrait of Maria Bonino, a CUAMM doctor who fell victim to an outbreak of Marburg fever

18A mother breastfeeding her baby in Kilamba, in the province of Luanda

19A newborn baby with its mother at Damba hospital

20Children smiling and playing in Kilamba, in the province of Luanda

All photos are from the CUAMM Archive

2014

CUAMM focuses its activities in three geographic areas (the capital Luanda and Uige and Cunene provinces) in the field of the mother-child health and in the fight against HIV/AIDS and tuberculosis.

The organization is implementing an innovative project on the diagnosis of diabetes and hypertension associated with tuberculosis patients.

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2005An epidemic outbreak of haemorrhagic Marburg fever strikes Uige province.

2005The CUAMM paediatrician Maria Bonino loses her life caring for the children admitted to Uige during a dramatic outbreak of Marburg fever.

2012The “Mothers and Children First” project gets underway to guarantee access to safe child delivery and newborn care in 4 African countries (Angola, Ethiopia, Tanzania and Uganda).

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Doctors with Africa CUAMM Annual Report 2014p. 18 Report on Africa/Angola

Villages per quarter 30

Doctors with Africa CUAMM provides technical assistance to the Angolan Ministry of Health in implementation of the National Programme for the Prevention and Treatment of Tuberculosis in Angola. The intervention is accompanied by an innovative approach designed to contribute to improving the diagnosis of diabetes and hypertension among tuberculosis patients: all cases with suspected tuberculosis attending the four main Directly Observed Therapy (DOT) centres of Luanda are also tested for these chronic pathologies.

UIGE PROVINCE

In this province CUAMM organized numerous courses for health centre staff, focussing particularly on mother-child care and HIV and malaria prevention and treatment. The organization guaranteed the supply of material and medicines for the area’s dispensaries and community-level activities were promoted in the municipality of Damba through mobile clinics. Visits were carried out in two villages per week, to promote health education for the population and preventive care and epidemiological surveillance with the municipal Health Department. In the municipality of Damba, the diocesan hospital Rainha Santa was reinstated and equipped to be a mother-child health centre. The facility is awaiting government authorization to start activities.A midwife joined and supported local municipal hospital staff in improving the quality of antenatal visits during community-based activities. Hospitality and care was provided to pregnant women from the remotest areas at the Maria Bonino waiting house.

ResultsLUANDA

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Luanda

13Health workers trained to monitor and screen for diabetes in TB patients

3911

Patients with tuberculosis screened for diabetes

Training

Prevention

Uige Province

Visits Antenatal visits in the municipality of Damba

925 +15.7%

Results2

Prevention

Over 4,000 Children benefitted from immunizations during the visits to the villages

Care

84Women received hospitality at Maria Bonino waiting house during 2014

1 From August 2014 to 31 January, 2015

2 The percentage values refer to variations between 2013 and 2014

21Check up of a woman with tuberculosis, in Luanda (CUAMM Archive)

22A child being vaccinated during visits to the villages of Damba municipality (CUAMM Archive)

23A mother during an ultrasound scan at Chiulo hospital (CUAMM Archive)

24A CUAMM doctor giving a toy to a child admitted to Chiulo hospital (CUAMM Archive)

25Two newborns with their mother at Chiulo hospital (CUAMM Archive)

p. 19 Report on Africa/Angola

Municipality of Ombadja, Angola

1Parenteral administration of antibiotics

5Neonatal resuscitation with ambu bag and mask

6Parenteral administration of anticonvulsants

7Vaginal delivery with vacuum or forceps

8Blood transfusion

2Parenteral administration of oxytocin

9C-section

4Manual removal of the placenta

3Pemoval of retained conception products

Chiulo hospital

Mukope health centre

Okanautoni health centre

Onepolo health centre

Shangalala health centre

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Within the framework of the “Mothers and Children First” project, Doctors with Africa CUAMM is committed to contributing to the reduction of maternal and newborn mortality in the municipality of Ombadja, providing skilled delivery care free of charge, both at Chiulo hospital and in the local health centres.Operational research into improving care provision is an integral part of the project. A study conducted in 2014 to assess coverage of emergency obstetric and newborn care in

the peripheral health centres revealed a lack of basic services to manage safe child delivery. Over the coming months, the onus will be on stepping up availability in the area of intervention and on improving the capacity of the peripheral health centres to deliver these services.

CUNENE PROVINCE

Service not available

Service introduced in 2014

Basic emergency obstetric and newborn care services3

3 Tool applied: Need assessment of emergency and neonatal care. Columbia University. AMDD 2011

Doctors with Africa CUAMM Annual Report 2014p. 20 Report on Africa/Angola

A second study explored equity of access to care at Chiulo hospital. This second survey revealed that the majority of women who deliver at hospital belong to the lowest population quintile, i.e. the weakest socioeconomic group. Other investigations are warranted to establish the applicability of the tool in this setting since there may be difficulties in correctly distinguishing social classes, probably because the hospital is located in a particularly poor area. The outcome of the study is nonetheless encouraging since it shows that accessibility to safe childbirth services is also guaranteed to the least privileged population groups.

Besides the programme to guarantee access to assisted child delivery, CUAMM’s work involved the fight against HIV/AIDS in Cunene, a province with one of highest prevalence rates in the country.Community-based awareness-building and local staff training activities were carried out, most notably on HIV prevention and the treatment of AIDS patients. The intervention was completed by the promotion and production of information at community level on treatment and prevention methods.

Cunene Province

Visits Antenatal visits

13,700 +225%

Visits Antenatal visits

3,249 -19.8%

Paediatric admissions

1,675

Chiulo Hospital

Deliveries Assisted deliveries

1,028 +23.11%C-sections

90 -3.2%

Results4

Mortality Neonatal mortality rate (intrapartum and at 24 hours of delivery). Lower than the countrywide mortality rate of 4.7%

1%

Hospital maternal mortality due to direct obstetric causes. Standard <1%

2.6%

4 The percentage values refer to variations between 2013 and 2014

CUNENE PROVINCE

Qu

inti

le 1

Qu

inti

le 2

Qu

inti

le 3

Qu

inti

le 4

Qu

inti

le 5

49,1

2,1

30,7

9,4 8,610%

0%

po

ore

r

ric

he

r

20%

30%

40%

50%

Hospital Survey 2014

97Women monitored for HIV prevention in the newborn

over 1,500 peopleHiv testing

Hiv/Aids

Municipality of Ombadja

Deliveries Assisted deliveries

1,377 +20.36%Coverage of total expected deliveries

22% +20.2%