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The CMNH blog is a space for our academics and PhD students to showcase their research projects and areas of interest for the wider community to read and enjoy!

Each post will include the contact details of our featured writer. We encourage you to get in touch with them for further discussion of the topics raised. If you would like to write a blog post for the website please contact Tim Garner.


“Mum, what are we getting for dad on Fathers’ Day?”

Two years ago, whilst I was working with the World Health Organisation (WHO), I visited a shopping mall just five days to Fathers’ Day 2015. To my utmost surprise, many of the gift hampers in the shops were leftovers from the Mothers’ Day celebration with bold notices of massive sales on them. In my quickly-assembled, barely-comprehensible French vocabulary, I asked the attendant why there were no Fathers’ Day sales. Typical of Genevoises, she merely smiled and said nothing – maybe she did not even understand my “terrible” French or she had no explanation. I began to ask myself many questions: “What have fathers done so wrong to society? Why don’t fathers deserve to be celebrated? Is it true that even children do not appreciate their fathers?”

Father and sonBut is it the fathers’ fault? I recalled my experiences in Kintampo (rural central Ghana). We conducted the Newhints Intervention Study that trained community-based health volunteers (called CBSVs), who were predominantly males, to make five focused home visits to pregnant women - 2 in pregnancy and 3 in the first week after birth. They, among other things, encouraged facility attendance for pregnant women, assessed newborns for key “danger signs” and referred them to health facilities for care.

In my supervisory visits, I encountered families where immediately the CBSV introduced the purpose for the visit, fathers referred us to their wives and in-laws because “pregnancy and childbirth were issues for women to handle”. Our trained CBSVs convinced them to join the discussions and they did so, reluctantly to start with and then started enjoying the discussions. They joined because CBSVs explained to them that men have roles to play in the physical and emotional support of women during pregnancy, decision-making around what to do to get the best outcome from the pregnancy, emergency preparedness (saving and arranging transport) and the rewards in knowing their contribution pay off in adding a precious member to the family. Fathers then started consulting CBSVs (“village doctors”) to come and “check” their babies even after their scheduled visits had ended. Over 86% of women whose babies were found to have danger signs sent them to health facilities for care – more than three times the prevailing postnatal clinic attendance rate.

I have learned empirically that when men are made to understand their roles as fathers, they can be reliable “partners” in securing the best outcomes for mothers and babies. But do they need to be made to understand their roles? That is why there are no Fathers’ Day hampers! The answer is NO!

As fathers, we should be men who plan and make every effort to support our women through pregnancy and childbirth; we should vow that none of our women should die or become disabled when pregnant or giving birth; we should be bold to stay in the delivery suite with them, share in their pain, provide that hand of support and smile with them when the healthy baby comes.

This outcome requires fathers’ involvement during the pregnancy to get the best care possible. And then, when the first cry of the newborn baby is interspersed with the voice of the father in the background, the bond is established to chart the course to a truly happy Fathers’ Day. Fathers should support mothers to care for the child in the crucial first four weeks when the babies are most likely to die than any other time, support to seek care when they are sick and then on Fathers’ Day, our daughters will ask, “Mum, what are we getting for dad on Fathers’ Day?” and fathers shall receive gifts borne out of love that they will be convinced they truly deserve. A woman and a child must first survive birth to ask this question. The CBSVs in Ghana were men and they did it for their communities; the poor farmers in the villages did it!
Real fathers need to begin to stand and be counted as they join hands to ensure that every pregnancy and every newborn life counts. Men and fathers as partners in maternal and newborn health, I wish us a very happy Fathers’ Day.

About the author

Dr Alexander Manu is a father and a Senior Clinical Research Associate at the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, with interest in newborn health, health systems strengthening for quality of care and child development as well as equity issues around these.


 

Day of the African Child 2017: Improving maternal health, a strategic pathway to child survival, education and sustainable development

The Day of the African Child (DAC) has been celebrated on 16 June every year since 1991. It was launched in memory of the student uprising in Soweto, South Africa, where children marched to protest against poor quality education and demanded to be taught in their own languages. It serves to remember those children, some of whom were killed and many more injured, to celebrate children in Africa, and to inspire a deep reflection that will spur action towards addressing the complex challenges facing children in Africa.

DAC was founded on the 11 of July 1991 by the Assembly of Heads of State and Government of Organisation of African Unity (now the African Union).

Child in KenyaThe Africa Committee of Experts on the Rights and Welfare of the Children selected the theme for 2017 as “Accelerating protection, empowerment and equal opportunities for children in Africa by 2030”. This theme is closely aligned with Sustainable Development Goals 1 (End poverty), 2 (Zero hunger), 3 (Good Health and Well-being), 4 (Quality education), 6 (Clean Water and Sanitation), 16 (Peace, Justice and Strong Institutions) and 17 (Partnerships for the Goals).

Globally, 5.9 million children die every year before their 5th birthday and 80% of these deaths are occurring in sub-Saharan Africa and South Asia. In 2015, the under-five mortality rate in low-income countries was 76 deaths per 1000 live births, about 11 times the average rate in high income countries (7 deaths per 1000 live births). 45% of all under 5 deaths occur in the first 28 days of life (neonatal period). 75% of deaths in the neonatal period occur in the first week of life (early neonatal deaths) and 36% of all neonatal deaths occur in the first day of life. Women and children are more vulnerable during humanitarian crises including deadly epidemics such as Ebola, compromising health care and education.

Interventions to ensure quality maternal and early newborn care are critical to reducing under-5 mortality. Maternal education is critical for child survival and for getting children to school age. There is also evidence that educated adolescent mothers are more likely to use Antenatal Care (ANC) services and skilled attendance at delivery. Improving the knowledge and skills of maternity care providers, establishing systems for quality improvement including relevant indicators to monitor quality of care provided, are important elements of improving maternal health. Understanding the causes of and factors associated with stillbirths also contributes to the design of interventions towards perinatal mortality reduction. Therefore, a healthy mother is crucial for child survival and the chances of having a good education.

The Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine, a World Health Organisation collaborative Centre for Research designs and evaluates interventions to improve the quality of care for mothers and their newborn babies. As we renew our efforts to end preventable maternal and child mortality, every effort should be made to ensure that more children have opportunities for good quality and affordable education. This means that every boy and girl should have the opportunity for and complete at least primary and secondary education. This will not only be a significant investment by governments toward equitable and sustainable global development, but also leave a lasting legacy!

About the author

Dr Charles Ameh is a Senior Clinical Lecturer at CMNH. He is a member and fellow of several professional organisations, including Fellowship of the International College of Surgeons and a Fellow of the Royal College of Obstetricians and Gynaecologists.