Luke M. Nkinsi, MD, MPH & TM

MATERNAL AND CHILDREN HEALTH CHALLENGES

IN SUB SAHARAN AFRICA

I. Background on AFRICA

II. Purpose of the presentation

III. Problem statement

IV. Contributing factors

V. Global actions to reduce preventable maternal and child deaths

VI. Results and progress made

V. Update on Ebola Epidemic in West Africa

a. Background

b. Symptoms

c. Risk factors

d. Prevention

e. Diagnosis

VI. Q & A session

OUTLINEOUTLINE

I-BACKGROUND ON AFRICA

54 countries

Total population:

1,099,755,000 (July 2013 projection)

Percentage of rural

population: 62.7% (from 71.9% in 1990)

5 most populated

countries

1. Nigeria: 177,096,000

2. Ethiopia: 86,614,000

3. Egypt: 84,605,000

4. DR Congo: 74,618,000

5. South Africa: 52,982,000

AFRICA

Ten largest countries

1. China 1,349,585,838

2. India 1,220,800,359

3. USA 316,668,567

4. Indonesia 251,160,124

5. Brazil 201,009,622

6. Pakistan 193,238,868

7. Nigeria 174,507,539

8. Bangladesh 163,654,860

9. Russia 142,500,482

10. Japan 127,253,075

Africa

Africa is more than 30 million sqkm

BACKGROUND ON AFRICABACKGROUND

BACKGROUND ON AFRICABACKGROUND

About 36.8 per cent of

Africa’s workforce are

youth.

Africa is the world’s

youngest continent (in

2010, 70% of Africa’s

population was aged

below 30)

African youth: Great asset

for Africa’s development,

provided that appropriate

investments in health and

human capital are made.

BACKGROUND ON AFRICABACKGROUND

All lives have equal value and every person deserves the opportunity to

lead a healthy and productive life (Bill and Melinda Gates)

Raise awareness about high

maternal and child mortality

rates in Africa

All women deserve to give

birth safely, and all children —

no matter where they are born

— deserve the same chance to

survive and thrive.

Purpose of my presentation

Children standing by their

mother’s grave, South Africa

In 2013, 289,000 women died

due to complications of

pregnancy and child birth.

62% of these deaths occurred

in sub-Saharan Africa alone

(179,000 deaths)

24% of these deaths occurred

in southern Asia

Two countries (India and

Nigeria) accounted for 30% of

all global maternal deaths

Problem Statement

A jumbo jet crash

800 women died every day in

the world in 2013

About 496 women died in sub-

Saharan Africa alone every

day

Three Boeing 777-300 carrying

each 280 (max. seating capacity)

pregnant women crashing

every day in the world

Two Airbus A330-300 carrying

each 250 pregnant women

(max. seating capacity) crashing in

AFRICA every single day

Problem Statement (continued)

Most of these deaths could have been prevented

Main cause: Hemorrhage (bleeding)

Causes of maternal deaths

A father buries his child

6.3 million children under age five

died in 2013

About 50% of these deaths

occurred in only five countries:

India, Nigeria, DR Congo and

China

India and Nigeria together account

for more than 30% of under-five

deaths worldwide

44% of under-five deaths occur in

their first 28 days of life

83% of these deaths were caused

by infectious, neonatal or

nutritional conditions

Problem Statement (continued)

Key Arena, Seattle

Capacity: 17,459

Nearly 17,000 children under

age five died in the world every

day in 2013

About 7,000 of these deaths

occurred in sub-Saharan Africa

Key Arena full of children 0-5

years old perishing every day

Problem Statement (continued)

aths (2013)

Causes of deaths among children under age 5

Advocacy for a stronger political commitment and community ownership

The ‘Champions’ for a HIV-Free Generation in Africa ‘Gogo’ Misikiya and other ‘Gogo’s, South Africa

Examples of local initiatives to support maternal & children health

Factors that affect human development in a country also affect

infant & maternal rates mortality rates and vice-versa

Poor health infrastructure

Harmful traditional practices

Lack of women empowerment

Lack of political commitment

Policies and legislations that

create barriers to accessing

services

Poor/low access to quality

health care services

Two-thirds of children who die

each year could be saved by

low-tech, evidence-based,

cost-effective interventions:

vaccines

antibiotics

micronutrient supplementation

insecticide-treated bed nets

improved family care

breastfeeding practices

oral rehydration therapy

Contributing factors: Combination of several factors

Emergency Obstetrical Care (EOC)

1. Delay in recognizing the

signs of danger

2. Delay in decision-

making process

3. Delay in transportation

to health centers/clinics

4. Delay in delivery of

quality health services

Example: the ‘Four Delays’

Community Tricycle

Examples of community-based initiatives

The Eight Millennium Development Goals (MDGs) by 2015

Goal 4: Reduce child mortality rates

Target: Reduce by two-thirds,

between 1990 and 2015, the under-

five mortality rate Under-five

mortality rate

Goal 5: Improve maternal health

Target: Reduce by three quarters,

between 1990 and 2015, the

maternal mortality ratio Maternal

mortality ratio

Target: Achieve by 2015, universal

access to reproductive health

Contraceptive prevalence rate

Examples of global actions to reduce preventable deaths

Examples of global actions to reduce preventable deaths (continued)

• June 2012, Ethiopia, India, and

the United States, in

collaboration with UNICEF,

hosted the “Child Survival: Call

to Action.”

• Single, comprehensive, and

achievable goal: To end

preventable child deaths by

2035.

• More than 175 countries and

over 400 civil society and faith

organizations signed a pledge in

support

June 25, 2014, USAID unveiled an action plan:

"Acting on the Call: Ending Preventable Child and Maternal Deaths"

Goal: To save the lives of 15 million

children and nearly 600,000 women

by 2020 in 24 priority countries

Evidence-based Interventions

Newborn care

Immunization

Prevention and Treatment of

Childhood Illness

Nutrition

Maternal Health

Family Planning

Ensuring Healthy Behaviors

Water, Sanitation, and Hygiene

Examples of global actions (continued)

The Clinton Foundation The Eastern Congo Initiative (ECI)

ADVOCACY

45% decrease of number of maternal deaths

The number of women dying

due to complications during

pregnancy and childbirth has

decreased by 45% between

1990 and 2013 (from an estimated

523,000 in 1990 to 289,000 in 2013)

Notable progress but the

annual rate of decline is less

than 5.5% (required annual

decline to reach the MDG

target)

average annual decline of 2.6%

Progress made in maternal mortality

C-section, Kikwit General Hospital, 1985

Optimal range of Cesarean

section rates: 5–15% (WHO)

C-section estimated range in

sub-Saharan Africa: 1-2%

(Medecins Sans Frontieres)

Most common indications:

obstructed labor

poor presentation

previous C-section

fetal distress

uterine rupture

antepartum hemorrhage

Progress made in maternal mortality (continued)

Globally, under-five mortality has decreased by 49%,

In 1990: 90 deaths per

1000 live births

In 2013: 46 deaths per

1000 live births

The average annual

rate of reduction in

under-five (4%) remains

insufficient to reach

MDG 4 target

Progress made in children mortality

The number of under-five deaths worldwide has declined from

12.7 million in 1990 to 6.3 million in 2013

About 50% of under-five

deaths in 2013 still occurred in

only five countries: India,

Nigeria, Pakistan, DRC, China

India and Nigeria together

account for more than a third

of under-five deaths worldwide

Progress made in children mortality (continued)

Progress is unequally distributed

WHO Africa Region, still has

an increasing share of

under-five deaths.

By 2050

37% of the world’s

children under age five

will live in Sub-Saharan

Africa

Close to 40% of all live

births will take place in

Africa

Progress made in children mortality (continued)

View of Ebola River, Equateur province, DR Congo Ebola hemorrhagic fever is a rare

and deadly disease caused by

the Ebola virus

Ebola was first identified in 1976

in Yambuku, near the Ebola river

in what is now the Democratic

Republic of the Congo (DRC)

The natural reservoir host of

Ebola virus remains unknown.

However, bats are the most likely

reservoir.

Update on Ebola Epidemic

Ebola only spreads when people are sick

Symptoms

Direct contact with:

1.Body fluids of a

person who is sick or

has died from Ebola

(blood, vomit, stools,

sweat, semen, spit ,

other fluids)

2.Objects contaminated

with the virus (needles,

medical equipment)

3.Infected fruit bats or

primates (apes and

monkeys)

How do you get the Ebola virus?

There is no FDA-approved vaccine available for Ebola yet.

Careful hygiene:

wash your hands

with soap and

water or an

alcohol-based

hand sanitizer

avoid contact with

blood and body

fluids.

Prevention

AVOID DIRECT CONTACT• Do not handle items that may

have come in contact with an

infected person’s blood or

body fluids (such as clothes,

bedding, needles, and medical

equipment).

• Avoid funeral or burial rituals

that require handling the body

of someone who has died from

Ebola.

• Avoid contact with bats and

nonhuman primates or blood,

fluids, and raw meat prepared

from these animals.

Prevention (continued)

Confirmation: Ebola virus is detected in blood (ELISA, PCR)

Suspect cases:

Early symptoms of Ebola

Recent history of contact

with the blood or body

fluids of a person sick

with Ebola;

with objects

contaminated with the

blood or body fluids of

a person sick with

Ebola;

with infected animals

Diagnosis

The 2014 Ebola epidemic is the largest in history

Symptoms of Ebola

and complications are

treated as they appear.

Provide intravenous

fluids (IV) and

electrolytes (body

salts).

Maintain oxygen status

and blood pressure.

Treat other infections if

they occur.

Treatment

A young Ebola patient (22 months

old) is being discharged from

Ebola Treatment Center, Liberia

Recovery from Ebola

depends on good supportive

care and the patient’s

immune response.

Experimental vaccines and

treatments for Ebola are

under development

People who recover from

Ebola develop antibodies

that last for at least 10 years,

possibly longer

Treatment (continued)

1 in 2 people who get Ebola in this outbreak have died

Total cases of Ebola (as of November 28, 2014)

Thank you, Merci beaucoup, Aksanti sana, Matondo

mingi, Botondi, Ke a leboga, Siyabonga, O seun

“It always seems

impossible until it’s done”

Nelson Mandela

The END