CMNH Scientific Conference for end of Making it Happen Programme
In May 2016 CMNH announced the results of their Making it Happen (MiH) programme, at the start of a three day International Conference on Maternal and Newborn Health hosted at LSTM.
It is estimated that nearly 6,000 stillbirths have been avoided and over 1,000 mothers’ lives have been saved across nine of the 11 countries since the programme began in sub Saharan Africa and south east Asia in 2012. The aim of the programme has been to reduce maternal and newborn mortality and morbidity by increasing the availability and improving the quality of Skilled Birth Attendance (SBA) and Emergency Obstetric and Newborn Care (EmOC&NC). It also works to strengthen data collection and data use in health facilities and promotes Quality Improvement using audit methodology.
MiH utilised a network of over 300 volunteer midwives and obstetricians from the UK who worked with colleagues in country to deliver a ‘skills and drills’ EmOC&NC training package over five days or less, to at least 80% of the healthcare providers working in maternity care in facilities across the programme areas in all 11 countries. Testing before and after the training shows that over 84% of health care providers demonstrated improved knowledge while 99.5% demonstrated improved skills after the course. With capacity building and sustainability at the heart of the programme, there are now 1,681 master trainers available to provide in-service and ‘on-the job’ skills and drills training and support. Up to 70% of healthcare facilities had increased the availability of EmOC&NC within 12 months of the MiH programme beginning.
The results were announced at the conference which included over 100 delegates from 16 countries. The conference was opened by the Head of CMNH, Professor Nynke van den Broek, who welcomed everyone and paid tribute to those partners of CMNH who had travelled from far and wide. The three days consisted of presentations, plenary discussions and workshops led by CMNH staff, along with some in country staff and representatives from partners such as the WHO as well as the main funder for the MiH programme, the Department for International Development (DFID/UKAID).
Professor van den Broek, was delighted with results. She said: “These results speak to the hard work of the CMNH team, the volunteers involved and our healthcare colleagues and partners in country for their determination to improve the chances of survival for women and their newborn babies. It was fantastic to announce this at the conference, which sees so many of our partners from the Making it Happen programme all together in one place".
Dr Meena Gandhi, a DFID/UKAID Health Advisor London described MiH as: “innovative – a short practical course that utilised UK expertise, worked with local institutions and built capacity into the health systems without shying away from the harder issues.”
The conference was concluded with Professor Monirul Islam, Representative of the WHO in Namibia, calling for all those present to continue the movement for change and to be the voice of those people who have no voice at all.
CMNH Volunteer Survey- have your say!
It has been over one year since the CMNH won the Women’s Health Category of the 2015 BMJ awards with the particular acknowledgement of the dedication of UK volunteers who participated in the training across different countries.
At the time Professor van den Broek said: “We are abso
lutely delighted to have won such a prestigious award. The panel of judges were particularly impressed by CMNH’s huge database of UK based doctors and midwives who go out to the countries we work in to teach the EOC course. They work with us as volunteers, and without their time and commitment we would not be able to deliver this life saving training”
As a follow on from this award, we are very interested to hear more about your views and experiences regarding the benefits and challenges with facilitating on the CMNH-LSTM Life Saving Skills- Essential Obstetric Care and Early Newborn care courses.
Please may we encourage you to fill in the survey regarding the volunteering experience that will be sent out by email.
Thank you in advance.
Development of a Perinatal Death review Smartphone App
Perinatal mortality refers to number of stillbirths and deaths in the first week of life. Globally, it is estimated that 2.6 million stillbirths occur annually, and that another 2.8 million babies die in the first week of life each year, making perinatal mortality estimates at 5.4 million babies annually (WHO, 2015). Most cases of perinatal mortality are preventable through provision of quality emergency obstetric and newborn care.
Perinatal death audit, if used correctly, could prove an effective way of improving quality of care. However, mortality audit could be a tedious process, and because of the subjective nature of assessments during reviews, inter-observer bias exists. Eliminating human interference in information analysis could help reduce such bias, and make the process easier.
In line with this view, CMNH is working in collaboration with the World Health Organisation (WHO) to develop and Android smartphone app to help healthcare providers in low and middle income countries to review cases of perinatal mortality with a view to finding solutions and preventing such deaths.
The app will perform the following functions:
- Provide a quick reference guide on how to conduct perinatal death reviews.
- Assign cause of death for perinatal mortality.
- Automatically apply the new WHO International Classification System for Perinatal Mortality (ICD-PM).
- Report elements of poor quality of care, and provide useful information to inform strategies and action for improvement in care.
The app, which is expected to be released by the end of this year, will be piloted in at least two African and two Asian countries.
CMNH present results on stress and resilience study in Sierra Leonean health care workers during the Ebola epidemic
The study assessed the stress and resilience levels amongst health care workers providing maternal and newborn care during the Ebola epidemic.
CMNH researchers in Liverpool and Sierra Leone worked with chartered psychologist and AFBPS Dr Judith Ormrod from the University of Manchester who provided technical expertise and gave the presentation on behalf to the team.
The study found that healthcare workers in general received good support from their peers, but a lack of control in their working environment and the intensive pace of work were the main risk factors for developing stress. The findings have been incorporated by the Ministry of Health and Sanitation into the induction programme for new health workers to help improve their resilience in managing work place stress.
Dr Ormrod said “The conference paper and poster were very well received and questions relating to working in collaboration with staff and providing support for those working in challenging situations led to further discussion amongst the delegates".
B!RTH- Born in Exile
CMNH is delighted to have been invited to be involved with an upcoming arts festival, B!RTH in Manchester from 19th-22nd October 2016. B!RTH is an international theatre festival developed in creative partnership by the Royal Exchange Theatre, Manchester and The Oglesby Charitable Trust to provoke debate on a global scale regarding the vast inequality in maternal healthcare across the world. The Royal Exchange Theatre has commissioned seven leading female playwrights from across the globe (Brazil, China, India, Kenya, Syria, UK and USA) to explore this issue through their country’s approach to childbirth.
These plays will all be available for charities & educational organisations to use free of charge for the next 3 years to raise awareness and encourage debate in the field.
As part of Manchester’s year as European City of Science 2016, B!RTH is a series of theatrical events and debates bringing together leading voices from the world of science, art, academia, politics and charities, at the Royal Exchange, the UK’s Regional Theatre of the Year.
CMNH will be working with collaboration with the B!RTH creative team to provide technical assistance for the content of the plays and will be panel members for the debates at the festival.
Get involved: CMNH will be also be writing a number of blogs for the B!RTH website and we invite you to get involved in the birth debate. If you would like to contribute to a blog please get in contact by email: CMNH@lstmed.ac.uk
Link to website: http://www.birthdebate.com
CMNH concludes that Health Transition Fund in Zimbabwe saved lives.
The Health Transition Fund was a pooled funding mechanism supported by various bilateral donors and managed by UNICEF, conceived to sustain essential maternal, newborn and child health interventions in Zimbabwe, from 2012 to 2015.
CMNH was contracted to carry out the external evaluation of the Health Transition Fund since 2013.
Within the evaluation design, CMNH used a number of different methods including health facility surveys, key informant interviews and focus group discussions alongside the analysis of available secondary data.
“The Health Transition Fund is largely a success story,” says CMNH's, Luigi D’Aquino, team leader of the external evaluation, “we are pleased to see that trends in maternal and child health have improved significantly since the beginning of the HTF, after a period of crisis in Zimbabwe and of worsening health outcomes.”CMNH presented the results of their evaluation in Mutare, Zimbabwe during a stakeholders meeting from 27 June – 2 July 2016.
CMNH’s evaluation showed that the design of the HTF had a good degree of relevance, effectiveness and flexibility to respond to emerging needs with a catalytic approach to health system strengthening. The evaluation highlighted some areas of improvement particularly related to opportunities to maximise efficiency in implementation and a need to focus on equity in the future, as well as to engage more comprehensively at community level.
New CMNH Website
The Centre for Maternal and Newborn Health (CMNH) has launched a new look website, to highlight our research and life-saving work in developing countries.
You can find the new site at: http://www.cmnh.lstmed.ac.uk/
The design of the site is simple and easy to navigate, integrating content with the main LSTM site. The information is presented in terms of themes, programmes and research work.
We would welcome your feedback about the site, as we continue to develop and improve it.
You can email us at: email@example.com
Continuing CMNH involvement in the post Ebola recovery plan in Sierra Leone
LSTM Master’s student Rie Takahashi is currently in Sierra Leone conducting research into why health care workers continued to provide maternal and newborn care at the height of the Ebola epidemic despite the risks to themselves and their families.
Rie is conducting the research for her dissertation in the Masters in Public Health supervised by the Centre for Maternal and Newborn Health (CMNH) which has been working with the Government of Sierra Leone to improve maternal and newborn health in the country since 2009.
Previous research by CMNH has shown the negative impact of Ebola on the uptake of maternal and newborn health care, which resulted in a 30% increase in maternal deaths and a 24% increase in newborn deaths. The Ebola epidemic also caused the deaths of 221 health care workers, who were dedicated to continuing to provide care for their patients despite the risks to themselves. Rie will be interviewing health care workers from health facilities in the Western Area of Sierra Leone centred on the capital of Freetown. Results from Rie’s research should be available in August 2016 and will help further our understanding of how best to support health care workers to continue to provide vital patient care during humanitarian crisis.
“It was my great pleasure to meet all the amazing people working so hard to save lives, especially to improve condition of maternal and child health. I do hope my research will contribute to improve the situation of human resource for health in Sierra Leone, for those people who work hard most on the ground.”
Dr Mary McCauley winner of the Recognition by national Award by the Northern Ireland Medical and Dental Training Academy (NIMDTA)
Dr Mary McCauley is a senior registrar in Obstetrics and Gynaecology and a trainee with the NIMDTA. She is currently on a three year secondment at with CMNH while studying for her PhD, and received the award from NIMDTA, which is recognition for the trainee who has won the most prestigious national award for their work, because she was instrumental in CMNH winning the Women’s Health team at the British Medical Journal (BMJ) annual awards in 2015. Leading on the writing of the proposal for the BMJ award Dr McCauley also presented the details of the excellent work CMNH do with the ‘Making it Happen’ programme in front of a panel of judges, resulting in CMNH’s Emergency (Essential) Obstetric Training being declared the winner in the Women’s Health Category at the national BMJ awards.
She was nominated for this latest award by the Head of NIMDTA, Professor Keith Gardiner and her success was announced at an event earlier week in Belfast, Northern Ireland, entitled NIMDTA Educational Excellence - Dare to Excel.
“I am thrilled to have been presented with this award, especially given that there were other really strong candidates that had been nominated.” said Dr McCauley: “I think that this is a further award that reflects the importance of the work that is carried out by the whole team at CMNH, in particular the life-saving work of the Making it Happen programme, which requires not only significant dedication from our UK volunteers, but also on the ground co-operation from our in-country teams.”
Head of CMNH, Professor Nynke van den Broek “We are really proud of the hard work that the whole team at CMNH carry out every day to benefit women and their babies in some of the world’s poorest communities. Mary is an integral member of that team and it is fantastic that she has been recognised among her peers for the talent and dedication that she has shown.”
CMNH is pleased to announce several papers which are now published and available online highlighting the work that we have undertaken.
Dr Juan Dewez and Professor Nynke van den Broek undertook a review of the current literature examining the effectiveness of continuous positive airway pressure (CPAP) compared to standard care (oxygen) in newborns with respiratory distress and describe existing CPAP systems. CPAP is an effective intervention for respiratory distress in newborns and widely used in high-income countries. Following the development of simple, safe and relatively inexpensive CPAP devices, there is potential for large-scale implementation in the developing world
Dewez JE, van den Broek N. Continuous positive airway pressure (CPAP) to treat respiratory distress in newborns in low- and middle-income countries. Tropical Doctor. 2016;epub ahead of print. doi: 10.1177/0049475516630210
In of the third published mini-commentary in BJOG, Dr Mary McCauley and Professor van den Broek comment on recently published literature examining the progress towards the elimination of the congenital syphilis in the United Kingdom and how the lessons learnt can inform global strategy.
McCauley M, van den Broek N. Eliminating congenital syphilis—lessons learnt in the United Kingdom should inform global strategy. BJOG. 2016;epub ahead of print. doi: 10.1111/1471-0528.14038
New projects at CMNH
Improving maternal and newborn health in Cambodia
CMNH has recently started a technical assistance project to improve maternal and newborn health in Cambodia. The project is funded by GIZ, and is being implemented in partnership with GFA Consulting, the Ministry of Health and in-country partners.
The project will run until the end of 2018, and targets four provinces – Kampot, Kep, Kampong Thom and Kampong Speu.
Our technical assistance is focused on two areas:
- Improving the qualifications of EmONC health professionals – by establishing Skills Laboratories at each of the provincial referral hospitals.
- Supporting structures and processes to improve the quality of EmONC – by gaining an in-depth understanding of existing QI structures and making recommendations for strengthening them.
Our two consultants are Terry Kana, leading on the Skills Labs, and Dr Claudia Hanson, leading on QI. They are currently in Cambodia conducting the initial scoping visit and meeting key stakeholders.
Continuous Positive Airway Pressure in Newborn Units in India
The assessment of the use of Continuous Positive Airway Pressure in Newborn Units in India is ongoing. Assessors from Safdarjung Hospital and Lady Hardinge Medical College have been trained in Delhi in May and June 2016.
So far, 66 out of 160 Newborn Units from Kerala, Andhra Pradesh, Uttar Pradesh, Tamil Nadu, Madhya Pradesh, Bihar, West Bengal and Rajasthan have been assessed. The results of the study will provide a better understanding of the challenges of implementing new technologies to reduce newborn mortality and morbidity in a middle-income country. The study is expected to be completed in September.
Evaluation of the community health programme in Rwanda
This evaluation will provide and independent assessment of the Community Health Programme in Rwanda.
We aim to determine whether the programme has achieved its intended objective, which is to improve the health status of the population by ensuring universal accessibility to quality health services for all Rwandans.
The UNICEF funded project began in January 2016, and has involved close collaboration with the Ministry of Health (MoH). The main data collection phase will take place during August and September, and will include:
- Interviewing key stakeholders at central and district level, including MoH staff at health facilities and community health workers (CHWs).
- Conducting surveys at health facilities.
- Holding focus group discussions with CHWs at community level.
The findings and final report will be submitted in November. It envisaged that this will inform the improvement and refinement of the design and delivery of the intervention nationwide.
For further information please visit http://cmnh.lstmed.ac.uk/ or call 0151 705 3707