Category Archives: Child Health

Syria: Mass Polio Immunization Campaign

Syrian children receive vaccination against polio at a Syrian refugee camp in Lebanon, Nov. 7, 2013.

 

Syria 13 Nov 2013:
The The largest-ever immunization campaign in the Middle East is under-way to stop an outbreak of polio in Syria from spreading throughout the region.

 
In mid-October, 22 suspected cases of polio were detected in north east Syria.  The virus has left 10 children paralysed.  But U.N. health agencies warn hundreds of thousands of children across the region are at risk of contracting this crippling disease. 
 
Now, The World Health Organization and U.N. children’s agency are joining forces to immunize more than 20 million children in seven countries and territories during the coming six months.
 
WHO Polio Eradication Program Spokeswoman Sona Bari notes the virus has been circulating in the region for some time, notably in Egypt, Israel and the West Bank and Gaza.  But she says the outbreak in Syria, a country that had been polio-free for 14 years, has accelerated this emergency response in the region.
 
Bari says emergency immunization campaigns to prevent transmission of polio and other preventable diseases have vaccinated more than 650,000 children in Syria.  She says this includes 116,000 in the highly contested north-east Deir-ez Zor province where the polio outbreak was confirmed a week ago. 
 
According to Bari the campaigns fanning out throughout the region aim to vaccinate 22 million children.
 
“This is a sustained six-month effort.  There will be repeated campaigns over this period of time.  It is going to need quite an intense period of activity to raise the immunity in a region that has been ravaged both by conflict in some parts, but also by large population movements.  So, the virus is moving throughout the region,” she said.
 
The WHO reports in the past few days, nearly 19,000 children under age five in Jordan’s Zaatari refugee camp have been vaccinated against polio.  And, it says a nationwide campaign is currently under way to reach 3.5 million people with polio, measles, and rubella.  It says a vaccination campaign has started in western Iraq and soon will begin in the Kurdistan region. Lebanon, Turkey and Egypt also plan campaigns this month. 
 
The polio virus usually infects children in unsanitary conditions through faecal-oral transmission.  It attacks the nerves and can kill or cause paralysis.  There is no cure for polio, but it can be prevented through immunization.
 
Bari says 12 suspected cases of polio are under investigation.  She says preliminary evidence indicates the polio virus circulating in the region is of Pakistani origin. 
 
There have been media reports that Pakistani fighters brought the polio virus into Syria but the WHO spokeswoman said that is unlikely. 
 
“We are never going to know exactly how it arrived in Syria.  What we do know is that we have seen a virus that is very similar in Egypt, in the West Bank and Gaza, and in Israel over the past 12 months.  We also know that adults tend to have a much higher level of immunity already developed.  So, it is unlikely that adults brought this in.  It is probably more likely some other route.  But, we will never really know for sure.  All we can say for certain is that it is of Pakistani origin and that it has been in this region for a little while,” she said.
 
Pakistan, Nigeria and Afghanistan are the last three endemic countries in the world, so it is from there that polio will continue to spread.  Since WHO began its polio eradication campaign in 1988, vaccination has reduced this crippling disease by more than 99 percent globally.
 
Despite this setback, Bari says the World Health Organization remains optimistic the outbreak can be stopped and polio, eventually, will be eradicated.

[Courtesy of VOA]

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Uganda: Paediatric Vaccine Crisis

KAMPALA, 20 May 2013  – Ugandan children are going unimmunized as the country grapples with persistent and widespread vaccine shortages, the result of insufficient funds and inefficient procurement and supply systems, officials say.

“We are getting reports and calls from all the districts about the stock-outs of all types of anti-immunization vaccines. They don’t have anti-TB [tuberculosis] vaccines, anti-tetanus, polio [vaccines]. The ministry is faced with inadequate funding for most of our programmes,” Asuman Lukwago, permanent secretary in the Ministry of Health, told IRIN.

“The current major problem on the vaccines is the distribution issue. We are working around the clock to have the problem solved and sorted out immediately.”

Most of the health centres across the country are facing critical shortages of vaccines to protect against tuberculosis, polio, tetanus, diphtheria, rotavirus and pneumonia, putting children at risk of largely preventable diseases.

Health officials now fear these frequent shortages could prevent mothers from bringing their children in for immunizations.

“You can’t [ask] mothers to move to health facilities three to four times and they don’t find vaccines. This practice discourages some of them to go back to the hospitals,” said Huda Oleru Abason, chairperson of the Parliamentary Forum on Immunization.

Procurement woes

In 2011, the government of Uganda shifted the procurement of vaccines and drugs from the Uganda National Expanded Programme on Immunization (UNEPI), under the Ministry of Health, to the National Medical Stores (NMS), an autonomous government corporation. The move was intended to inject efficiency into the country’s drug procurement system, but the drug shortages have continued.

Yet officials at NMS are blaming the shortages on late requisitions for vaccines by UNEPI. The procurement of drugs is the responsibility of NMS.

“Placing of orders is not the responsibility of NMS, it’s [the job of] UNEPI,” Dan Kimosho, a spokesperson at the NMS, told IRIN. “So if they don’t put request in time or under-quantified for the supplies, it’s not our problem. Our responsibility is to procure, store and deliver the requested vaccines. We can’t begin delivering vaccines to districts and health [facilities] if the orders have not been placed to us. We have the competency to deliver the requested drugs and vaccines.”

An estimated 48 percent of children under age five in Uganda are either unimmunized or under-immunized, meaning they do not complete their immunization schedules, according to the 2011 Uganda Demographic and Health Survey.

Uganda has recently experienced a decline in immunization levels, in part due to inadequate funding, health staff shortages and  [parents’]poor adherence to vaccination schedules.

In April 2013, the government launched a countrywide rotavirus and pneumococcal vaccination program targeting over 1.7 million children.

In an interview with IRIN, Director General of Health Services Ruth Achieng noted that, “Uganda is not doing very well in [its] immunization programme… We don’t want our children to die from preventable diseases. We need to act now. Otherwise, we shall get an outbreak of polio and tetanus.”

Uganda’s budget support for the Expanded Programme on Immunization, EPI, – which had been hailed for increased vaccination coverage between 2000-2007 – decreased by more than half in recent years, falling from 7.7 percent in the 2006-2007 financial year to 3.6 percent in 2009-2010.

Officials say the government has plans to revitalize the country’s immunization programs.
“We have worked out the revitalization plan, and if implemented well, we shall be able to change the low status of immunization in Uganda. The government has mobilized some funds and, with support from GAVI, everything is revisable. We are going to embark on [an] aggressive campaign to ensure there are no vaccine stock-outs in the country and ensure all the children are immunized,” the Ministry of Health’s Lukwago said.

There is also a legal push to improve immunization. An immunisation bill currently pending in parliament will make it illegal for parents and guardians to fail to have their children immunized. It also seeks to punish health officials who fail to offer immunization services to children.

[Courtesy of IRIN)

Somalia: Building health systems from scratch.

MOGADISHU, 26 April 2013  – Lul Mohamed, director of the paediatric ward at Banadir Hospital in the Somali capital, Mogadishu, treated five children after two bomb attacks killed 30 people on 14 April. “And they were shooting last night. One died, a bullet in his liver,” she said of an eight-year-old boy.

Yet these are conditions of relative peace in Mogadishu. While the conflict is not over, insecurity has diminished since the withdrawal of insurgent group Al-Shabab in 2011. This relative security is allowing Mohamed to focus on preventative healthcare, a luxury she did not have two years ago.

In March 2013, she admitted 26 cases with measles, 19 with tuberculosis, 14 with tetanus and nine with meningitis. She is frustrated because all of these diseases are immunizable. Six of the children admitted that month died.

Mohamed hopes this year to immunize 1,000 children per month in the hospital’s tiny but brightly painted vaccination room. Two volunteers sit at a desk, another monitors those coming in and out. They say they became volunteers when donors pulled out and staff were let go. By 1pm that day, they had vaccinated 28 children.

“A huge improvement in a short time – if peace holds,” Mohamed said.

Vaccination

Coinciding with World Immunization Week, the Somali government announced on 24 April its intention to vaccinate all children under the age of one with a new five-in-one vaccine, known as a pentavalent vaccine, funded by the GAVI Alliance, with the UN Children’s Fund (UNICEF) and the UN World Health Organization (WHO) as implementing partners.

“Children in Somalia are dying of diseases that are prevented in the rest of the world,” said Maryam Qasim, the Minister of Development and Social Affairs, speaking at the vaccine’s launch. “Introducing this vaccine is a milestone in history.”

President of Somalia Hassan Sheikh Mohamud also presided over the launch, showing unprecedented support for improving child and maternal health in Somalia, two of the eight UN Millennium Development Goals. He also announced that his government would consider co-financing the vaccination programme, as other countries do, in the future.

Currently, fewer than half of children in Somalia have received the mandatory diphtheria, tetanus and pertussis (DTP) vaccine, a rate that Anne Zeindl-Cronin, senior programme manager at the GAVI Alliance, describes as “incredibly low”. Only 7 percent of children in Puntland and 11 percent of children in Somaliland receive the required three doses by their first birthday, according to a joint UNICEF and government survey.

The pentavalent will protect immunized children against these three diseases, as well as heptatitis B and Haemophilius influenzae type b.

Health system strengthening

“Coming from such a low base, if we have system strengthening, we should see a huge improvement in a short time – if peace holds,” Zeindl-Cronin said.

The pentavalent has taken 18 months to go from the country’s decision to use it to implementation, but she recognizes that GAVI’s implementing partners still have a difficult task ahead. “It’s easy to come here and put [the vaccines] in [a] fridge. It’s getting them into the children that’s the challenge.”

There is not a great deal of infrastructure to rely on. Somalia has suffered close to 25 years of civil war. Its health system is fragmented, supported by an unregulated pharmaceutical industry and dominated by private practitioners who offer help only to those who can afford it. Private doctors in Somalia are earning up to US$10,000 per month.

A legal framework for healthcare is absent, and the federal state, which includes the semi-autonomous regions Somaliland and Puntland, raises questions about how any system might be structured.

“Normally, there is one food and drug administration. But where? Is it in Mogadishu? Or in each of the zones [south-central Somalia, Somaliland and Puntland]?” said Marthe Everard, WHO’s representative for Somalia.

In addition to the systemic and infrastructural challenges of delivering healthcare in Somalia, large areas of the country are still controlled by Al-Shabab; others are inaccessible due to armed groups that have filled the vacuum left by Al-Shabab. Omar Saleh of WHO estimates that 30-40 percent of southern Somalia is accessible to external healthcare providers at any one time.

Risk persists

In his speech at the pentavalent launch, President Mohamud condemned Al-Shabab for blocking access: “In the certain areas they control, there have been no vaccinations at all in the past few years. Al-Shabab needs to understand that they are not only killing people through explosions, but every child that misses vaccinations they have practically killed.”

The pentavalent vaccine launch is being accompanied by an awareness-raising campaign. Sikander Khan, UNICEF Somalia Representative, hopes that, once demand is created, the vaccine will reach women even in areas that Al-Shabab controls. “There is no parent in the world who doesn’t care about the well-being of their child,” he said.

F[ourtesyarhiyo Mohamed, who has six children, brought her youngest to an outpatient clinic in Benadir, Mogadishu, to receive the pentavalent at no cost. The mother says she visited the clinic when Al-Shabab was still in the city, but that it was dangerous to do so. “Al-Shabab would question you when you came back. Today, we are happy,” she said.

While prospects are improving, inequitable access remains a major challenge. Paediatrician Mohamed, at Benadir Hospital, calls for a three-pronged commitment, not only from the government, but also the community and health workers. She says motivating and engaging private and public sector workers is critical to improving the reach of healthcare, and the reach of vaccines in particular.

[Courtesy of IRIN]

Nigeria polio: Immunising the vaccine fears

Usman Al Hassan and his children, including on his lap Abubarkar who contracted polio in 2013, on their home in the outskirts of Nigeria's capital, Abuja

Two-year-old Abubarkar Al Hassan has the unfortunate tag of being Nigeria’s first polio victim of 2013.

“It’s quite upsetting to see that my son cannot play with his friends when they come here,” says his father Usman Al Hassan, who lives on the outskirts of Nigeria’s capital, Abuja.

“He cannot move unless someone carries him. This makes him cry.”

As Mr Al Hassan strokes his son’s legs, some of his daughters sit around and one of his two wives prepares a meal in a tiny kitchen off the courtyard.

“I have 14 children and 13 of them are vaccinated; it is very unfortunate that when the vaccinators came around this area they missed my house and my son was not vaccinated,” he says, looking at his son who is sitting on his lap.

In the long winding alleys of this community, houses are packed close together.

Open gutters like streams run like central veins carrying household waste water from homes.

Passers-by leap over them to avoid the dirty greyish sludge.

Nigeria has been making some strides in the battle against the polio, which can cause lifelong paralysis, but the task has been slow and fraught with challenges.

The West African nation is only one of three countries where polio is endemic – Afghanistan and Pakistan being the other two.

Journalists Arrested

Last year, 122 cases of the virus were reported and the government is hoping to keep the numbers down this year.

“We still continue to miss too many children. In a campaign where you aim to reach 32 million children house-to-house there are number of challenges,” says Melissa Corkum spokesperson for the UN children agency’s polio campaign in Nigeria.

“In Nigeria there are a lot of nomadic populations on the move… there is no fixed address where you can knock on their door during the campaign,” she says.

“This leads to many children being… missed.”

Together with the government of Nigeria, Unicef is running nationwide immunisation campaigns.

Polio cases in Nigeria are mostly found in the mainly Muslim north of the country.

In the past few months there have been violent attacks against health workers believed to be connected with polio vaccination drives.

In the most recent attack nine female health workers killed in Kano state.

It is possible that these attacks were the result of religious and political leaders who have opposed the vaccine, saying it is a Western plot to sterilise Nigerian Muslims.

Suspicions about vaccination programmes were fuelled in part by the Pfizer scandal in 1996 when the US drugs firm used an experimental drug during a meningitis outbreak in Kano. Eleven children died and dozens became disabled as a result.

In 2003, these fears and conspiracy theories led to the suspension of vaccination campaigns in Kano, leading to a high number of children contracting the disease.

Then earlier this year, a Muslim cleric and two journalists from Kano were arrested for broadcasting a report saying the vaccines were not safe.

Not all religious leaders are of this school of thought and some regret the harm caused by their colleagues.

“The problem was caused by those who were preaching against it,” says Alhaji Attahiru Ahmad, the Emir of Anka in the northern-western state of Zamfara.

‘Attitudes Changing’

He blames the slow response by the government to the statements.

“They allowed them to have a field day before the intervention, and you know it’s difficult to repair damage,” the emir said.

He and other traditional rulers in the area have been trying to counter criticism of the vaccine.

During the last polio campaign in this area, a father refused to have his child immunised.

He was brought to the emir who convinced him to immunise his child.

However the talk of polio remains a very sensitive subject and many in these communities shy away from talking about refusing immunisation.

But the Nigerian government says they are making strides in reducing suspicion among vulnerable communities.

“People are becoming more aware and are realising that in fact the vaccine is safe, it’s efficacious, and that other parts of the world have actually used it to eradicate this disease,” says Dr Ali Pate, Nigeria’s junior minister of health who also heads the presidential campaign against polio.

“This [is a] collective effort. For the first time, you have the entire global community focusing on a single disease, after smallpox, to eradicate.”

Part of the government campaign has involved community mobilisation workers who talk to people about the benefits of the vaccine.

In the case of Abubarkar, his contracting polio has had a positive effect on his neighbours.

“People are aware, now they know that the disease is real,” says Yakubu Yahaya, a social mobilisation officer.

He has in the past had difficulties convincing the people in that community that polio as a disease was a reality.

“They were saying it is either politics or religion or because they want to make their children infertile,” he says.

“So they are really now ready to comply with all the vaccinators.”

For Abubarkar and his father, the lesson learnt has been a harsh one.

“I do not blame the vaccinators for missing my son, what has happened was God’s will,” says Mr Al Hassan.

“At least because of him, others can now take this seriously and immunise their children.”

Those working on the government’s drive against polio, will also be hoping that lessons can be learnt and they can indeed make strides towards eradicating the disease by 2014.

[Courtesy of BBC News]

 

165 million children under the age of five globally malnourished.

Hunger kills more people worldwide than HIV, tuberculosis, and malaria combined, and children are the most vulnerable. According to the World Health Organization, an estimated 104 million children around the world are undernourished and 175.5 million suffer from stunted growth because their bodies do not have enough nutrients. Malnutrition and hunger-related diseases account for 35 percent (3.1 million) of the 8.8 million deaths of children younger than five each year. Malnutrition is a complex disease that can be caused by lack of adequate food, illness, and poor caring practices – but it is preventable and curable.

Stunting can lead to irreversible brain and body damage in children, making them more susceptible to illness and more likely to fall behind in school. Based on UNICEF’s report, IRIN has put together a round-up of the nutrition situations in six East and Central African countries that are among 24 countries with the largest burden and highest prevalence of stunting.

Burundi: Under-five mortality in this small central African country dropped from 183 deaths per 1,000 live births in 1990 to 139 per 1,000 live births in 2012. This is far short of the 63 deaths per 1,000 live births necessary for the country to achieve UN Millennium Development Goal (MDG) 4, which aims to reduce child mortality by two-thirds by 2015. An estimated 58 percent of children under age five are stunted, compared with 56 percent in 1987, according to demographic and health surveys from those years.

According to the UNICEF report, Burundi has made “no progress” on MDG 1, which aims to eradicate extreme poverty and hunger.

Central African Republic (CAR): An estimated 28 percent of under-five deaths in CAR occur within the first month of a child’s life; the biggest killers of children under five are malaria, diarrhoea and pneumonia. The percentage of children under age five who are stunted has changed little since 1995, standing at 41 percent in 2010, as has the percentage of children who are underweight, which has remained at about 24 percent for the last 18 years.

There has, however, been significant progress in the number of mothers exclusively breastfeeding their infants. In 2010, 34 percent of infants under six months old were breastfed, compared to just 3 percent in 1995. According to UNICEF, infants who are not breastfed in the first six months of life are “more than 14 times more likely to die from all causes than an exclusively breastfed infant”.

Democratic Republic of Congo: Africa’s second-largest country bears 3 percent of the global stunting burden, with 43 percent of children under age five suffering from stunting and 24 percent being underweight. Stunting is significantly higher (47 percent) in rural areas than it is in urban areas (34 percent).

The percentage of children who are underweight dropped from 34 percent in 2001 to 24 percent in 2010. DRC’s progress towards MDG 1 is described as “insufficient”.

Ethiopia: The Horn of Africa nation, which bears 3 percent of the global stunting burden, has seen a steep drop in stunting levels, from an estimated 57 percent in 2000 to 44 percent in 2011. The percentage of underweight under-fives has also dropped significantly, from 42 percent in 2000 to 29 percent in 2011. Between 2000 and 2011, under-five mortality was cut from 139 deaths per 1,000 live births to 77 per 1,000 live births – within striking distance of its MDG 4 target of 66 per 1,000.

A national nutrition programme launched in 2008 has been key to reducing national food insecurity, a major cause of stunting. The country’s health service extension programme has also played a role in bringing nutritional interventions to villages.

Rwanda: Community interventions – such as kitchen gardens and increasing the availability of livestock, as well as measures to boost healthy infant feeding practices like exclusive breastfeeding and the provision of nutritional supplements – saw the percentage of underweight under-fives in Rwanda drop from 20 percent in 2000 to 11 percent in 2010. Enhanced data collection and analysis has also enabled the government to improve its planning and monitoring of child malnutrition.

The report describes the country as “on track” to meet MDG 1.

Tanzania: Bearing 2 percent of the world’s stunting burden, Tanzania has made significant strides in improving child nutrition. An estimated 50 percent of infants under six months old were breastfed in 2010, compared to 23 percent in 1992. The country has also brought under-five stunting levels down from 50 percent in 1992 to 42 percent in 2010, but continues to suffer significantly higher stunting in rural children (45 percent) compared to urban children (39 percent).

Tanzania’s under-five mortality rate dropped from 158 per 1,000 live births in 1990 to 68 deaths per 1,000 live births in 2010, putting it close to its MDG 4 target of 53 deaths per 1,000 live births. UNICEF’s report says the country is “on track” to meet its MDG 1 targets.

[Courtesy of IRIN]

HEALTH: TB response failing children

 

The global fight against tuberculosis (TB) has failed children: most TB programmes under-diagnose, under-treat or completely leave children with TB out, despite the increase in paediatric TB, and rising numbers of children who are infected with drug-resistant forms of TB strains, according to new research.

A new report, released by Médecins Sans Frontières (MSF), found that 93 percent of children who are tested for TB using the most commonly used testing method, are deemed not to have the disease, despite later being confirmed to have it.

The study, presented at the Union World Conference on Lung Health in Kuala Lumpur, draws upon data collected over three years from over 2,000 children with TB in 13 MSF projects across six countries, including Myanmar and Zimbabwe.

Children co-infected with HIV and TB were at a greater risk of dying than children with TB, and while more than half the whole cohort had pulmonary TB, only 6.4 percent had tested positive for TB with the most commonly-used test (coughing up a sample of sputum to be checked under the microscope for bacteria).

A tricky diagnosis

But the report acknowledged that diagnosing TB in children is far more problematic. Most children, especially the youngest, cannot produce enough sputum for these tests. And even when they can, sputum-based tests do not detect paucibacillary or extrapulmonary TB that occurs more frequently in children.

“In an attempt to get adequate samples, health workers are forced to use invasive and painful measures, involving forcing vapour into their lungs to make them cough up sputum, or sucking out sputum from their stomach,” said Martina Casenghi, scientific advisor for MSF’s Access Campaign.

“The ideal test for children would be a test that does not rely on sputum… The ideal test would be something not requiring laboratory infrastructure [something like a urine pregnancy test] and that uses an easy to obtain sample such as urine, stool, finger prick blood test, etc. This ideal is not specific to children as it would help diagnose other difficult cases such as HIV co-infected or extrapulmonary TB,” Grania Brigden, TB adviser for MSF’s Access Campaign, told IRIN/PlusNews.

Although new diagnostic tools such as the GeneXpert test could mean much more rapid diagnosis of paediatric TB, it still has its limitations as it also relies on sputum samples, the report noted.

Nevertheless, “GeneXpert is a start, as it is an improvement from smear microscopy, especially if you use it on samples obtained from nasopharahgeal aspirate or induced sputum, and for that reason although it is not the perfect test we still feel that it has a role to play in improving diagnosis in children. It also can potentially aid in the diagnosis of drug-resistant TB in children,” Brigden added.

According to the report, one of the main barriers to developing a TB test that works in children has been the lack of a gold standard to assess performance of new diagnostic tools. “However, consensus on the methodological approaches to follow for evaluating new diagnostic tests in children has recently been reached… These new approaches should be implemented rapidly so that the rate of progress can be accelerated.”

Getting the dosage right

To make things worse, paediatric drug formulations and international treatment guidance for children remain inadequate, MSF found. In 2009, the World Health Organization (WHO) released revised dosage guidelines for TB in children, but the formulations available on the market today are still not tailored to deliver the new dosages.

“And a slow response on the part of WHO to release recommended drug strengths and the composition of new fixed-dose combination (FDC) drugs has meant that, despite two years having passed since new dosage guidelines were issued, no new FDC drugs for children have been developed to correspond to the new doses. Until that happens, treatment providers are struggling to provide children the new doses through complex interim dosing recommendations,” the report noted.

MSF urged WHO to provide clear guidance to drug manufacturers on needed fixed-dose combinations of first-line drugs to support implementation of the new WHO-recommended dosages.

TB affects nearly a million children globally every year, and up to 130,000 die annually from this preventable and curable disease.

Courtesy IRIN News

SOUTH SUDAN: Highest Global Maternal Mortality Rate

 

 

South Sudan has the worst reported maternal mortality rate in the world.

“More women die in child birth, per capita, in South Sudan, than in any country in the world,” says Caroline Delany, a health specialist with the Canadian International Development Agency (CIDA) in South Sudan which is funding a raft of maternal health programmes.

A 2012 report entitled Women’s Security in South Sudan: Threats in the Home by Geneva-based think-tank Small Arms Survey (SAS) says a national survey carried out in 2006 indicating 2,054 deaths per 100,000 live births may have been an underestimation.

“Many deaths are not reported, in part because 90 percent of women give birth away from formal medical facilities and without the help of professionally trained assistants,” it said.

Childbirth and pregnancy, rather than conflict, are the nation’s biggest killers of girls and women.

“One in seven South Sudanese women will die in pregnancy or childbirth, often because of infections (from puerperal fever and retained placenta), haemorrhaging, or obstructed births, with a lack of access to healthcare facilities playing a large role in their deaths,” SAS found.

“When we talk about security in South Sudan there is a tendency to focus on issues such as guns and militia groups. But real human security means protection from anything that threatens health and wellbeing. In South Sudan there is nothing that poses greater threat to a woman’s life than getting pregnant,” says SAS researcher Lydia Stone.

Lack of midwives

“Midwives can prevent up to 90 percent of maternal deaths where they are authorized to practice their competencies and play a full role during pregnancy, childbirth and after birth,” the UN Population Fund (UNFPA) in South Sudan said in a May report on maternal mortality.

At the maternity ward in Juba Teaching Hospital, staff members say there are not enough (or the right) drugs, and never enough trained staff.

Midwife Julia Amatoko is one of three registered midwives at the country’s ramshackle and constantly overcrowded hospital in the capital.

“We are just a few and a lot of mothers are coming. And beds are not enough for the mothers. We have just eight beds for the first stage of labour and for the post-natal mother,” she said.

According to UNFPA, South Sudan has just eight registered midwives and 150 community midwives.

Amatoko said the lack of professional midwives working alongside traditional birth attendants (TBA) and community midwives caused needless death. “Those who are TBA’s are not able to cope with the serious cases, like when the mothers have post-partum haemorrhage.”
Giving birth even at the country’s leading hospital is a lottery, especially at night. “I’ve been here for three months, and two mothers died, in the night,” she said, due to a lack of human resources.

“Midwives are the backbone for reduction of maternal mortality… but here, with all the midwives and birth attendants put together, there are only around 20,” said consultant obstetrician and gynaecologist Mergani Abdalla.

“If you have professional midwives that can provide basic obstetric care – once South Sudan can deploy those, they can expect progress, but it will happen slowly,” said midwifery specialist for UNFPA Gillian Garnett.

UNFPA is looking forward to the graduation of around 200 midwives next year.

Treatment delays

Many women come to the hospital late, when they are already in the throes of a difficult labour, said Abdalla.

“There are delays at the community level, with a lot of cultural and other kind of issues; there are delays in getting to the hospital because of the transport infrastructure, the lack of ambulances, the roads; and then there are delays in the hospital as well,” said Garnett.

Mariam Kone, a medical coordinator for a Médecins Sans Frontières (MSF) hospital in Aweil, Northern Bahr-el-Ghazal, echoed the problem. “We are receiving ladies at a really late stage… They’re usually in a septic condition or they’re anaemic, and many have malaria,” she said.

MSF admits around 6,000 people a year to the maternity ward and had 18 deaths last year, mainly due to postpartum haemorrhage, septicemia and eclampsia.

Blood, scissors and gauze

At Juba hospital, UNFPA is supplying kits for mothers, surgical instruments and life-saving drugs such as oxytocin to stop bleeding, but Amatoko bemoans the lack of basics: “We need scissors for delivery, and browns for packing. We don’t have even cottons in the ward; gauze-we don’t have.”

The nation’s first blood bank has been built but not filled at the hospital, which only has a family-size fridge full of blood (mostly allocated by relatives for patients due for surgery).

“The biggest need is blood transfusion, because most of the [maternal mortality] cases are due to post-partum haemorrhage”, said Abdalla.

Garnett says that if these were normally healthy women, blood loss would not be so tragic, but a combination of poor health and the delays at community and hospital level to seek health care puts most women at risk even before they go into labour.

In a country where girls are often married off in their early teens, the number of children they have is often not up to them.

“A married woman of childbearing age is expected to become pregnant at least once every three years, and to continue until menopause,” the SAS report found.

[Courtesy of IRIN]