Rapid reduction of maternal mortality in Uganda and Zambia through the saving mothers, giving life initiative: results of year 1 evaluation

Abstract

BackgroundAchieving maternal mortality reduction as a development goal remains a major challenge in most low-resource countries. Saving Mothers, Giving Life (SMGL) is a multi-partner initiative designed to reduce maternal mortality rapidly in high mortality settings through community and facility evidence-based interventions and district-wide health systems strengthening that could reduce delays to appropriate obstetric care.MethodsAn evaluation employing multiple studies and data collection methods was used to compare baseline maternal outcomes to those during Year 1 in SMGL pilot districts in Uganda and Zambia. Studies include health facility assessments, pregnancy outcome monitoring, enhanced maternal mortality detection in facilities, and population-based investigation of community maternal deaths. Population-based evaluation used standard approaches and comparable indicators to measure outcome and impact, and to allow comparison of the SMGL implementation in unique country contexts.ResultsThe evaluation found a 30% reduction in the population-based maternal mortality ratio (MMR) in Uganda during Year 1, from 452 to 316 per 100,000 live births. The MMR in health facilities declined by 35% in each country (from 534 to 345 in Uganda and from 310 to 202 in Zambia). The institutional delivery rate increased by 62% in Uganda and 35% in Zambia. The number of facilities providing emergency obstetric and newborn care (EmONC) rose from 10 to 25 in Uganda and from 7 to 11 in Zambia. Partial EmONC care became available in many more low and mid-level facilities. Cesarean section rates for all births increased by 23% in Uganda and 15% in Zambia. The proportion of women with childbirth complications delivered in EmONC facilities rose by 25% in Uganda and 23% in Zambia. Facility case fatality rates fell from 2.6 to 2.0% in Uganda and 3.1 to 2.0% in Zambia.ConclusionsMaternal mortality ratios fell significantly in one year in Uganda and Zambia following the introduction of the SMGL model. This model employed a comprehensive district system strengthening approach. The lessons learned from SMGL can inform policymakers and program managers in other low and middle income settings where similar approaches could be utilized to rapidly reduce preventable maternal deaths.

The use of facilities for labor and delivery: the views of women in rural Uganda

“… 24 This highlights the importance of not only providing facilities, but also encouraging women to use then, and insuring they are adequate quality, concurring with the findings of this study. 24 …”

“…The recently published intervention study Saving Mothers, Giving Life supports this approach, with comprehensive interventions to improve access to and quality of care, which were built upon existing health strategies, resulting in a 30% reduction in population based MM in Uganda over one year. 24 This intervention design used the three delays model, which splits factors that stop effective FBD into delays in seeking appropriate services, delays in reaching those services and then delays in receiving timely and quality care at the facilities. 24 This highlights the importance of not only providing facilities, but also encouraging women to use then, and insuring they are adequate quality, concurring with the findings of this study.…”

“… 24 This intervention design used the three delays model, which splits factors that stop effective FBD into delays in seeking appropriate services, delays in reaching those services and then delays in receiving timely and quality care at the facilities. 24 This highlights the importance of not only providing facilities, but also encouraging women to use then, and insuring they are adequate quality, concurring with the findings of this study. 24 …”

“…Again, 1 the success of the Saving Mothers, Giving life intervention initiative, which aimed to provide evidence-based interventions in facilities, with facilities upgraded with medical equipment and staffing, showed that MMR fell by 35%, confirming that good quality facilities is essential to effectively reduce neonatal and maternal mortality. 24 …”

Women’s Decision-Making Autonomy and ICT Utilization on Access to Antenatal Care Services: Survey Results From Jinja and Kampala Cities, Uganda

“…Maternal mortality is still high and remains a big public health issue among countries situated in Sub-Saharan Africa [1,2]. It is estimated that 358,000 women (830 deaths everyday) died worldwide in 2008, as a result of preventable causes related to pregnancy and childbirth [3].…”