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General - February 13, 2018

MPDSR: Taming Maternal and Perinatal Mortality in Rural Kano

Lack of access to quality healthcare services for pregnant women, newborns and children as a result of poor service delivery is blamed for the high rate of maternal mortality in Northern Nigeria including Kano State. Amongst others, diseases like severe anemia, eclampsia, and bleeding are responsible for majority of maternal deaths in the state.

Anti-shock garments at the maternity ward in Wudil General Hospital; donated by MNCH2
Anti-shock garments at the maternity ward in Wudil General Hospital; donated by MNCH2

It was in a bid to arrest the trend of high maternal mortality in Kano State that DFID-funded the Maternal, Newborn and Child Health (MNCH2) programme helped set up facility-based MPDSR committees to track and review maternal and perinatal deaths across the state.

The review is aimed at continuously providing accurate information to the government; development partners other stakeholders in the public health sector in relation to how many women and newborns died, where and how they died across the state, for speedy action and as a guide to future interventions.

The establishment of active Maternal and Perinatal Death Surveillance and Response (MPDSR) committees across various secondary and primary healthcare facilities in the state is doubtlessly changing the indices of women and newborns dying of pregnancy-and-childbirth-related complications in Kano State.

For example, in the period between September to December, 2017, effective implementation of MPDSR action plans in facilities such as the Gaya General Hospital, Wudil General Hospital, and Sumaila General Hospital as well as Garko Cottage Hospital and Takai NYSC Hospital have led to substantial outcomes in terms of taming maternal and perinatal deaths, thanks to the religious implementation of the MPDSR guidelines in the facilities.

“Implementation of the MPDSR process has led to a lot of improvement in terms of reducing maternal mortality; our system has been strengthened and staff’s commitment to saving lives increased,” says Dr Daniel Okorie, the Medical Officer and Chair of MPDSR Committee at Garko Cottage Hospital. “We no longer have electricity challenge; our generator which was faulty is now functioning properly, thanks to advocacy to the Interim Management Officer (IMO) of Garko LGA by the MPDSR committee.”

Having faced electricity challenges, the MPDSR Committee at Garko had reached out to the LGA’s IMO who helped fixed the generator and is also providing fuel to power the generator. The Committee had also conducted a similar advocacy to the district head of Garko who also ensures that whenever there is urgent need for blood for pregnant women; community members are promptly mobilized to donate blood.

The outcome is that as a result of constant availability of blood, Post-Partum Hemorrhage (PPH) is no longer cause of maternal deaths at Garko facility. And now that the facility’s generator is functioning properly, the staff of the maternity ward can at any time (day and night) sterilize their equipment and attend to women in critical conditions. As a result of this positive development, in the last quarter, zero maternal deaths were recorded in the facility.

The story is the same at neighboring Sumaila General Hospital where the Medical Officer and Chair of MPDSR Committee, Dr Salau Isiaka said active implementation of the MPDSR process had “improved our knowledge, opened our eyes to many factors leading to maternal mortality and how to tackle them including, for example, the use of partograph and oxygen resuscitator for the resuscitation of newborn babies.”

Thanks to series of advocacies by the facility’s Hospital Friends Committee and MPDSR Committee, the Sumaila General Hospital was recently renovated by MNCH2, which has helped improved working condition at the facility. Again, MNCH2 has just recently supplied mattresses as well as a delivery bed to the facility’s maternity ward.

The outcome of these interventions is that only 2 maternal deaths were recorded in the previous quarter, which was a significant improvement compared to the previous quarters and the deaths were even caused by severe anemia, for which there was little the hospital staff could do, according to Dr Isiaka. The use of partograph at Sumaila now means maternal mortality resulting from PPH is now a history.

At Wudil General Hospital which is a referral centre, implementation of the MPDSR action plan has also helped tamed maternal mortality in the facility, according to Dr Solomon Okoro, the Medical Officer and Chair of MPDSR Committee at the facility. Like Garko, not a single maternal mortality was recorded in the period between September and December 2017 at the Wudil General Hospital.

“As a result of the implementation of our MPDSR Action Plan, blood is now available in our maternity ward’s blood bank 24-hours a day; we now also have a drug box with all essential drugs like Magnesium Sulphate which we use in treating cases of eclampsia. Again, through series advocacies, we were able to secure 3 anti-shock garments; 2 of which were donated to us by MNCH2 while the third was donated by CHAI. As a result we had zero maternal mortality in the previous quarter,” said Dr Okoro.

In neighboring Gaya General Hospital, a huge success was recorded regarding electricity supply in the facility which had grappled with serious power challenges throughout the past 10 years. This development has helped improved maternal healthcare in the facility, thanks to the effort of the MPDSR Committee in the facility.

As a result of the efforts of the hospital’s leadership , electricity has now been restored to the facility  – which had been off-grid for the past 10 years – after the resolution of a long lingering dispute between the facility and PHCN. Again, two power generators have been acquired which ensure constant supply of electricity in the facility as a result of which maternal and perinatal mortality has reduced significantly.

The story is the same at Takai NYSC hospital where the effective implementation of the MPDSR process has led to in improvement in “how we manage pregnant women during pre and post-natal periods including during complications,” according to Mahmud Musa, the Secretary of the facility’s MPDSR Committee.

“Until we began implementing the MPDSR guidelines we didn’t have the capacity to sit down and identify potential maternal and perinatal challenges and take measures to avert such challenges. The outcome is that we now record as low as 0 or 1 maternal deaths in a month, unlike in the past when we used to record up to 10 maternal deaths in just a month,” says Mahmud.

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