Tag Archives: Maternal Health

Pakistan: Unsafe drinking water causes disability among children worldwide

9 April 2014 KARACHI:

Toxically germ-infested unsafe drinking water is causing different form of disability among children globally, mainly caused by teratogens. 

The excessive use of medication and consuming polluted water results in the development of abnormal cell tissue in unborn as well as newly born babies particularly during foetal growth, yielding a multiplex of physiochemical defects in the foetus. Improper and untreated disposal of sanitary water and untreated industrial waste is resulting in contamination of sub soil water threatening the nature. 

Principal Investigators of South Asian Association for Regional Cooperation (SAARC) Sector’s Academic Alliance for Subsoil Water Toxicity Research Initiative Prof Qadhi Aurangzeb Al Hafi and Pro-Vice Chancellor of Dow University of Health Sciences (DUHS) Prof M Umar Farooq were of the view this was the first time Pakistani researchers’ study has been recognised at United Nations (UN) and Pakistan takes the historic edge of launching the first ever model of Terato-kinetc Research in the recorded history of medical sciences.The groundbreaking research document has been primed for over 1,700 international esteemed universities of the globe, in accordance with the UN mandates and conventions on the subject. 

The first categorical research model was demonstrated at Higher Education Commission (HEC) Pakistan in continuum of the multi academia polygonal scientific colloquia the UN ‘International Observance Day for Disability’, at Dow University of Health Sciences Karachi followed by its academic sessions and scientific symposia at Punjab University and Higher Education Commission of Pakistan. The multi-academic colloquia consist of 9 scientific orientations, 17 confluences, 10 symposia and 19 demonstrations worldwide. 

[Courtesy of Daily Time]


Uganda: Mothers in New HIV Campaign

16 November 2013
Uganda’s first lady, Janet Museveni will join the Kampala Capital City Authority (KCCA) to launch a new campaign to end mother-to-child transmission of HIV/Aids.

The campaign is coordinated by the Uganda Aids Commission. UAC Director General David Kihumuro Apuuli said last week, over 1.5 million people in Uganda were living with HIV/Aids, most of them the result of the mother-to-child transmission.

He told journalists in Kampala the campaign was critical to inform HIV-positive women that they could give birth to HIV-negative children. According to 2012 national HIV/Aids indicator survey, at least 16,000 babies were born with HIV in 2011 alone.

Kihumuro hopes that with the campaign, this number will reduce, in the next year. According to the commission, 140,000 people were infected with HIV between 2011 and 2012, down from 160,000 in 2010/2011, a 13 per cent reduction.

Dr Sarah Zalwango, the HIV/Aids focal person at KCCA, said a number of activities such as male circumcision, cancer screening and counselling would take place on that day and urged people to come in huge numbers.
[Courtesy of AllAfrica News]]

Uganda’s midwives struggle to meet demands


8 April 2013  – Despite the significant role midwives play in Uganda’s maternal health programmes, they face numerous challenges, including lack of training, inadequate facilities and poor pay.

According to the Africa Medical Research Foundation (AMREF) just 38 percent of Uganda’s estimated 11,759 midwives are either registered or have a college education. Yet they attend to 80 percent of all births in the country’s urban areas and 37 percent of all births nationally.

Esther Madudu, a midwife in Uganda’s rural Soroti District, explained to IRIN that many go to great lengths to help women deliver.

“Health centres lack electricity, water and other essential medical commodities to assist in delivery. In the past, I used to [hold] my cell phone in my mouth [and use its] torch to [assist delivering] mothers at the health centre,” she said.

A 2009 analysis by the UN Population Fund (UNFPA) found Uganda’s health system “unsupportive to midwives, as characterized by poor remuneration, poor health service infrastructure, lack of essential equipment and supplies, eg, gloves, drugs – especially in public health facilities – inadequate protection from infections, high workload owing to few qualified staff” and lack of supervision or training opportunities.

Maternal deaths

Uganda grapples with high rates of pregnancy-related complications and maternal deaths, consequences of poor healthcare investment by the government, low education levels and an unmet need for reproductive health services.

Uganda’s 2011 Demographic and Health Survey showed the maternal mortality rate at between 310 and 480 deaths per every 100,000 live births.

According to the Ministry of Health, 24 percent of these deaths are the result of severe bleeding, and many are due to infection, unsafe abortion, hypertensive disorders and obstructed labour.

Experts say much more must be done if Uganda is to meet Millennium Development Goals 4 and 5 – the goals on reducing child and maternal mortality and achieving universal access to reproductive healthcare – by the 2015 deadline.

“Death resulting from pregnancy-related [complications] is a big issue in Uganda that requires urgent attention,” health commissioner Anthony Mbonye said, noting that these deaths are preventable “with improved access to [quality] healthcare to the population and… positive attitudes towards… health workers.”

Too few health workers

Midwives say their small number has them struggling to meet demand. They have called on the government to recruit more midwives.

“We are only three midwives working day and night with [the] assistance of two nursing assistants,” said Lydia Tino, a health supervisor and midwife working at a centre with 20 maternity beds in the rural Gulu District.

In 2006, the government stopped midwifery trainings, arguing that nurses could be given additional skills to take up the roles played by midwives. This has not happened.

And the few who have midwifery skills often leave the country.

“Uganda has trained many midwives, but [the] majority opt to work in places outside the country where facilities and remuneration are better,” Mary Gorettie Musoke, senior midwife and trainer, told IRIN.

n a progress report by Uganda’s Ministry of Health, tabled before a parliamentary committee in February, the government indicated that it had employed an additional 5,707 health workers to help plug the gap.

But many rural health facilities are still unable to perform either basic or comprehensive emergency obstetric and newborn care.

Government obligation

Government officials told IRIN it plans to carry out a countrywide maternal health audit as part of its efforts to deal with the problem.

“We are under obligation to perform our duties, so the government doing everything possible to address problem,” said Sarah Kataike, the health minister.

While government health facilities in Uganda are supposed to provide free services, they are understaffed and lack essential medical supplies. At times, patients are forced to pay extra fees before they can receive services.

Florence Akio, 34, had to be transported to a private facility some 45km away after failing to receive any assistance at a nearby government facility.

“My labour started in the middle of the night, but I couldn’t make to Atiak Health Center III. I waited until morning, when my husband borrowed a bicycle and carried me to the health centre. But, reaching the health centre, there was no sight of any staff to attend to me,” she told IRIN.

In a landmark 2011 case, civil society organizations sued the government over the high maternal mortality rate, but the case was dismissed. The organizations had argued the government had failed to provide essential medical commodities and services to pregnant women.

[Courtesy of IRIN]

In Iraq’s disputed territories, a health services vacuum

7 April – At 9 am in the northern Iraqi village of Kandal, female residents are gathering in the leafy courtyard of the local mosque. But they have not come to pray; they are here to see the doctor – a rare opportunity in this part of the country.

Kandal sits on a busy main road connecting Erbil, capital of the northern autonomous Kurdish region of Iraq, to Kirkuk, one of several disputed territories. Located in Makhmour District, in Kirkuk Governorate, the land Kandal sits on is claimed by both the central government in Baghdad and the Kurdish Regional Government (KRG).

Although the status of the disputed territories was supposed to be resolved by a referendum before the end of 2007, the vote still has not taken place. Meanwhile, their residents have been caught in between, with neither side willing to provide basic services.

“This place is not a country,” said Jwan Abdullah, an English teacher at the small village school. “We have no government; there is no doctor, no hospital. We don’t have a [phone] number for emergencies, and we need this.”

There is only one small clinic in the nearby town of Makhmour to service the area’s nine villages, which have a total population of around 300 families. The clinic is a small general practice, ill-equipped to handle many cases.

“My son broke his arm playing football,” said the local mukhtar, or village leader. “And they just gave him a pain killer and said we had to go to the emergency hospital in Erbil,” some 100km away.

Falling between the cracks

KRG would like to build a permanent hospital in the area, says Raad Najmadeen, director of medical services at the Erbil Directorate of Health. But the political situation in the region means any attempt to do so would be seen as a land grab.

“The problem is, as I see it, if you build a health centre, this land will be allocated to the [KRG] Ministry of Health, so you will make this land permanently for the ministry… They may see that we are taking the land by this process. So it’s sensitive.”

Instead, these villages depend on visits from KRG’s mobile hospital – which has an operating unit, a dental unit, a lab, an x-ray, and ultrasound and gynaecological support – and a mobile team with ambulances stocked with simple medication and equipment. But these visits occur only once or twice a year.

The Kurdish government has plans to set up an emergency unit halfway between Makhmour and Erbil that would service the district and give residents access to an emergency number and to ambulances.

But in the meantime, the lack of any emergency services means transportation is a problem, particularly for women in Kandal, none of whom knows how to drive.

One woman, Berivan, said the Makhmour clinic had diagnosed her with a kidney infection and told her to return for follow-up treatment, but she has been unable to make the 10km journey.

“My husband is a peshmerga [member of the Kurdish security forces] and he isn’t here to take me. Without a car, you have to stand on the side of the road and wait for someone to pick you up.”

The journey to the hospital in Erbil can take over an hour – sometimes the difference between life and death. Berivan’s aunt’s experience is a case in point.

“One morning she was very short of breath, so we took her to the clinic in Makhmour,” Berivan said, “but they said she had to go to Erbil. In the car on the way, she just stopped breathing and died.”

Mobile care for women

Because of the particular challenge women face in reaching healthcare, START, a women’s empowerment organization, teamed up with the Kurdistan Ministry of Health to provide mobile health services in the area, focusing on women and children. With French embassy funding, the NGO will send a general practitioner to one of six villages in the area every week for the next three months to provide basic healthcare and respond to gynaecological needs.

“We follow [up with] the women about their family planning. Here they have many kids, so we examine and provide for them – condom, contraceptive tablet, intra-uterine device… Everything is portable. We have all types of medicines,” said Afifa Sayid, a doctor with the visiting medical team.

This is the second such programme by START, and the Iraqi government has a similar programme in other disputed areas. But when funding for such programmes runs out, residents here will be back to square one.

The poor, high-sugar diet also takes a toll on local health, Sayid says, and the local pharmacists are an inadequate substitute for trained medical care.

“Here they have chronic disease: high blood pressure, diabetes. Their general condition is not good. It’s very important to have a hospital in the same place to follow-up with them every day. I went to five villages before this village: No hospital. It should be that in every village you have a health centre or every day a portable centre. Every day, not every week.”

By lunchtime, Sayid had seen 55 women.

One patient, who requested anonymity, suffered from conjunctivitis. “She was given the wrong medicine” by a local pharmacist, Sayid said, “and now her eye is bleeding.”

The health programme also raises awareness about women’s health issues, like breast cancer and female genital mutilation, which is practiced in Iraqi Kurdistan, and it trains girls on first aid and the use of medicine. “These girls will be the focal points of any health services and any awareness campaign,” said START director Safin Ali.

The programme also aims to reveal the area’s health needs.

“[A reason for] bringing the KRG staff members and their buses and their staff members is to draw their attention to the fact that this area needs a hospital. A mobile medical unit can help in the short term but in the long term, they need to build a hospital here.”

[Courtesy of IRIN]


MAKO – The Global Fund to Fight AIDS, Tuberculosis and Malaria today signed an accord with the United Nations Development Programme (UNDP) to resume a full-scale HIV program including delivery of life-saving HIV treatment to tens of thousands of people in Mali.

Under the accord, the Global Fund approved funding for EUR 58 Million (US$75 million) for HIV screening, prevention and treatment in Mali over the next three years.  Some 50,000 people in Mali are currently living with HIV.

“The signing of this agreement involving the Global Fund, the UN Development Programme and Mali brings hope for many of our citizens who can now say they have not been forgotten,” Mali’s Minister for Foreign Affairs Tiéman Coulibaly said.

The program targets key populations at higher risk and one of its priorities is to intensify efforts to reduce the risk of HIV transmission from mother to child and support more systematic voluntary screening of pregnant women.

The Global Fund and its partners took steps to restore confidence in grant management in Mali after mismanagement of funds was discovered.

As a temporary measure, the scope of the Global Fund’s grant was reduced in 2011 to funding of essential services to ensure continuity of treatment for 25,288 people in Mali who were receiving antiretroviral therapy with Global Fund support. Under the arrangement, it was also possible to start new patients on treatment and the total number on treatment has now risen to 30,000.

UNDP was asked by the Mali Country Coordinating Mechanism to take over managing the HIV program grant.

The Global Fund has since 2011 scaled up mechanisms for management and oversight of grants, while UNDP has further strengthened safeguards against fraud and expanded access by the Global Fund to UNDP internal audits of programs financed by the Global Fund.

“The new funding to expand HIV programs in Mali is a major step forward and underscores the Global Fund’s commitment to support life-saving work in the country particularly at a time when the humanitarian situation requires special attention.  More than 30,000 people in Mali now get regular treatment and another 20,000 people rely on quality care. We expect these numbers to increase,” said Mark Edington, Head of the Global Fund’s Grant Management division.

UN Resident Coordinator and UNDP Resident Representative for Mali, Aurélien A. Agbénonci, welcomed the new partnership and said it would be consistent with the country’s national development strategy.

“We also place this intervention in the context of a larger vision and long-term investment in capacity-building, to encourage a national response strategy less dependent on foreign aid in the long-run and therefore more sustainable,” Mr Agbénonci said.

The Global Fund, an innovative public-private partnership, has played a key role in the global response to the three pandemic diseases through a range of partnerships, including with the United Nations. It is the largest international channel of support for work on these diseases, which disproportionately affect the world’s least developed countries.

UNDP acts as Principal Recipient for about one-tenth of the Global Fund’s overall portfolio, mainly in uniquely challenging environments such as in countries emerging from crises.

UNDP’s partnership with the Global Fund has brought treatment to more than 26 million cases of malaria and 700,000 cases of tuberculosis from Southern Sudan and the Democratic Republic of Congo to Liberia, Belarus, Haiti, and Tajikistan.

Since its creation in 2002, the Global Fund has become the main financier of programs to fight AIDS, TB and malaria, with approved funding of US$ 22.9 billion for more than 1,000 programs in 151 countries. To date, programs supported by the Global Fund are providing AIDS treatment for 3.6 million people, anti-tuberculosis treatment for 9.3 million people and 270 million insecticide-treated nets for the prevention of malaria.

The Global Fund has been funding programs in Mali since the December 2003 and has disbursed approximately US$ 90 Million, to provide ARV treatment to 30’000 patients, to detect and treat 17’000 smear positive TB patients and to distribute 720’000 LLINs to population in Mali. In the coming months, the Global Fund expects to sign one Malaria and one TB grant.

A decade ago, virtually no one living with HIV in developing countries had access to life-saving antiretroviral therapy. Now more than 8 million people do.

UNDP works with countries to understand and respond to the development dimensions of HIV and health, and promotes ownership of the response effort by the government and the people, to make it sustainable.

Courtesy AllAfrica News

NAMIBIA: HIV-Positive Women Sterilized

The Namibian High Court has ruled that the human rights of three HIV-positive women were violated when they were coerced into being sterilized while they gave birth, but the judge dismissed claims that the sterilization amounted to discrimination based on their HIV status.

“This decision is a victory for HIV-positive women throughout Namibia, as it reaffirms their right over what is done to their body,” said Priti Patel, deputy director and HIV programme manager at the Southern Africa Litigation Centre (SALC), a legal aid group that supported the women. “This judgment makes clear that obtaining consent while a woman is in labour or in severe pain violates clear legal principles.”

The case – the first of its kind in southern Africa – was filed in 2009. The women chose to have caesarean sections at public hospitals to reduce their chances of passing the HI virus on to their children, but said the doctors told them they could only have the procedure if they agreed to be sterilized at the same time.

The judgment allows the women to seek damages from the government. “All medical personnel must obtain informed consent from HIV-positive women prior to any medical procedure,” Patel told IRIN/PlusNews. “This includes, but is not limited to, informing them of the nature of the procedure, the impact of the procedure, and gives the women enough time to consider the information before making a decision.”

The ruling that the women failed to show they were discriminated against based on their HIV status, made the win somewhat bittersweet.

“We were not very happy with the judge’s decision on discrimination – maybe it’s the way we presented the case, focusing more on informed consent than on discrimination – we will talk to our lawyers and strategize on whether to appeal or accept the judgment,” said Jennifer Gatsi-Mallet, executive director of the Namibian Women’s Health Network, which assisted in bringing the case to court.

Gatsi-Mallet told IRIN/PlusNews that her organization had 16 similar cases pending, and had recorded dozens more while conducting research. “We hope the Ministry of Health will now review its policies, providing information circulars on sexual and reproductive health to women in public hospitals so that we don’t see such cases brought up again,” she said.

SALC’s Patel noted that the judgment would have an impact beyond Namibia. She said there were anecdotal reports of similar practices in Swaziland, and documented cases in South Africa, in which SALC was involved.

“This case does have implications in other countries,” Patel said. “It brings the issue to the attention of countries in southern Africa, allowing them to take the necessary steps to ensure the practice isn’t happening in their country, and if it is, that the practice is stopped”

[Courtesy IRIN plus 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]