Improvement of Maternal and Child Health
The Rotary project "Improvement of Maternal Health - Prevention and Treatment of Obstetric Fistula" (2005-2010) in Kano and Kaduna State, northern Nigeria, brought forth remarkable results and gives hope towards achieving the UN Millennium Development Goals (MDGs) 4 and 5. In a comprehensive approach, it included treatment and prevention of obstetric fistula* and the widely spread diseases malaria and AIDS, introduced quality assurance in obstetrics in ten selected hospitals and improved the quality of care in the surrounding communities. Satellite projects from Rotary Clubs and stakeholders supplemented the project increasing the project's total volume to 3 Million US$.
*Obstetric Fistula is a break in the wall between the bladder, vagina, and rectum which occurs when there is protracted labor. It most often occurs in young mothers under age 20 who are not fully developed. As a result, the baby dies and the mother is left with holes (fistulas) which become infected. Most such women are ostracized and even abandoned by their husband and families. About 1 million women suffer from this condition just in Nigeria.
The core project was funded with a total amount of USD $1,240,000 broken down as follows:
- USD $450,000 Matching Grant from the Rotary Foundation ($150,000 TRF and $300,000 from clubs and districts)
- USD $390,000 from the Adventis Foundation
- USD $20,000 from IAMANEH (International Association of Maternal and Neonatal Health)
- USD $380,000 from the German government (German Ministry for Economic Cooperation and Development)
The basis of the project was the information of the population through awareness campaigns and a close collaboration with traditional/religious leaders, state governments and local authorities as well as stakeholders. The awareness campaigns included community dialogues and a series of soap opera radio dramas discussing subjects such as family planning, obstetric fistula, female genital mutilation (FGM) and how to tackle these issues.
In a second step ten rural hospitals were selected (five in Kano State and five in Kaduna State) and their obstetric departments were equipped. In two of the hospitals, specialized fistula wards were established including rehabilitation facilities. The health personnel in the ten hospitals were trained including specialized fistula surgeons and ward nurses. About 400 Community Health Workers (CHEWS) and Traditional Birth Attendants (TBAs) were provided with information about family planning/child spacing and trained in obstetric services in order to ensure qualified attendance of home deliveries. They were equipped with delivery kits and anti-shock garments.
Within the hospitals a system of quality assurance was implemented in which anonymized data from the obstetrical departments is collected and monitored. With this method risk factors and main causes of maternal and child mortality are documented and steadily removed in a review process with semiannual review meetings.
Due to these measures the project results were remarkable:
- Introduction and anchoring of quality assurance in ten selected hospitals achieving a
reduction of maternal mortality in these hospitals by more than 50% - 1,500 fistula patients were successfully treated (500 more than planned) and rehabilitated; many of them also got vocational training and microcredits to built up their own small businesses
- Seven doctors were trained as fistula surgeons and 15 ward nurses were trained in fistula care
- 43 doctors, 344 nurses and midwives, 200 CHEWS and 197 TBAs were trained in obstetric services
- 24,000 mosquito nets were provided to the ten selected hospitals and surrounding communities (satellite project)
- Hospitals lacking theses facilities were provided with water and solar energy (satellite project)
- Hospitals were provided with drugs for Preventing Mother-to-Child Transmission (PMTCT) of HIV (donation from Boehringer Ingelheim); 3,000 IUDs were distributed to the selected hospitals (donation from Bayer Schering)
- TBAs were equipped with delivery kits and anti-shock garments (satellite project)
Stakeholders and state governments of Kano and Kaduna State found that this project provides a model for reducing maternal and fetal mortality needs to be replicated in other hospitals. The governments of the states within the project area have been continuing the project since the end of its duration in March 2010. They committed themselves to maintain the created structures and enhance the positive results of the project. We continue with the monitoring and will start a scaling up later in 2010, which will then run until 2013.
The aims of this scaling up are further reduction of the maternal and fetal mortality in the ten selected hospitals and surrounding communities in Kano and Kaduna State and prove the replicability of the model in the rural areas of the Federal Capital Territory (FCT) Abuja. Apart from the audit process within the quality assurance in the selected hospitals there will also be a documentation and examination of maternal and child deaths in the communities in order to identify their causes and eliminate them.
Download Maternal and Child Health Hospital – Report 2009 (PDF - 1.41 MB)
View Improvement of Maternal and Child Health - Part 1 (Video - 7:35 minutes)
View Improvement of Maternal and Child Health - Part 2 (Video - 6:02 minutes)
For more information, visit http://www.maternal-health.eu/ or email Robert Zinser at robert.zinser@t-online.de.
Page Updated: July 12, 2010
