Newsletter, October 2016



Tribute to Dr Juan Ortiz- Iruri
A+ rating for Making it Happen programme
B!RTH- Born in Exile
Training healthcare workers in Gadaref, Sudan
Quality Improvement Workshop in Nigeria
A New Classification for Stillbirth and Neonatal Death Launched
Sharing the results of the ‘Making it Happen’ programme in Pakistan
Improving the Quality of Care for Mothers and Babies in Tanzania
CMNH contributes to the latest issue of the British Journal of Obstetrics and Gynaecology
Digital Interventions for Maternal and Newborn Health in Kenya
Publications Update
New projects at CMNH


Tribute to Dr Juan Ortiz-Iruri

Three years after his tragic death, LSTM remembers Dr Juan Jesus Ortiz-Iruri, who was among those killed during the terrorist attack on the Westgate Shopping Centre in Nairobi, Kenya on 21st September 2013.

Professor Nynke van den Broek, Head of CMNH, said: “Our thoughts remain with Juan’s family on the anniversary of his death and he continues to be an inspiration for our efforts to improve the lives of mothers and babies across the world.”

Dr Ortiz had been working with the CMNH as a consultant in Kenya for about nine months before his death and was, within days, due to take up the post of Senior Technical Officer for CMNH in Liverpool. Dr Ortiz had a long and distinguished career as a public health consultant and with UNICEF, dedicating his life to improving health systems in Africa and Asia, particularly in the fields or maternal, child and newborn care.



A+ rating for Making it Happen programme

CMNH is delighted to have received an A+ rating in its latest and final review for the Making it Happen (MiH) programme. The rating has been given by the project’s initial and main funder, the Department for International Development (DFID).


MiH utilising the skills of UK based midwives, obstetricians and gynaecologists to deliver training to local health workers in order to increase the availability of skilled birth attendance and make delivery safer for women and their babies. The project begun in 2013 and involved work across 11 countries in Africa and Asia.

The project was is made up of three different work packages: Delivering a ‘skills and drills’ emergency obstetric and neonatal care (EmONC) training packages, so that more woman have access to safe birth attendance; strengthening data collection and use to better understand and evaluate healthcare provision and outcomes; strengthening quality improvement methodology to improve care at health facility level.

Since it began in 2013 the programme has scored very highly in its progress reviews, scoring A+ previously. Throughout the life of the project it is expected that over 9,000 maternal lives will have been saved, nearly 200,000 maternal disabilities avoided as well as over 12,000 stillbirth averted and the lives of over 10,000 newborns saved.

Professor Nynke van den Broek, Head of CMNH said: “We are delighted that our final DFID review is another A+ rating and is testament not only to the dedication of our staff and volunteers but also the determination of in country staff to make a real difference to the women and babies that they serve. Making it Happen is an important project and we are excited that ongoing funding has already been secured for the work to continue in six out of the 11 countries.”

The success of the programme is in no small part due to the fact that CMNH have always worked directly in partnership with ministries of health and other government departments in the project countries. Building capacity locally by training over 17,000 health care workers and 1,000 ‘master trainers’ who are able to continue providing training beyond the programme.


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(link is external), 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 2016B!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:
Link to website:


Training healthcare workers in Gadaref, Sudan

A number of CMMH Staff were recently invited by the UNited Nationa Population Fund to a meeting in Khartoum, the capital of Sudan. 
UNFPA is a member of the United Nations (UN) Development Fund and is the lead UN agency for delivering a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.

The meeting concentrated on how to develop solutions of how to improve the Emergency Obstetric and Newborn Care (EmONC) knowledge and skills of healthcare providers in Sudan.

Sudan is a low income country that has made good progress in reducing maternal and newborn mortality in Sudan. However nationally, skilled birth attendance is still very low.

Furthermore, an UNFPA assessment in 2012 found that only 15% of medical officers had received in-service EmONC training, 85% did not use a partograph and only 8% of newborn resuscitation was satisfactory.

Against this background, CMNH will train over 200 Ministry of Health (MoH) staff in the Gadaref state of Sudan. The training would include an initial demonstration of the CMNH EmONC course with senior staff from Sudan’s 18 states attending.

The project will also include Training the Trainer courses to help to build in-country capacity.  The CMNH team are now working with partners to develop the project in Sudan and to secure high level funding.

“Interventions to improve the quality of EmONC training and skilled birth attendance are urgently needed in Sudan, where many women continue to die during and after childbirth.” Dr Charles Ameh, Deputy Head of CMNH.

Quality Improvement workshop in Nigeria 

CMNH recently conducted a two day workshop on quality improvement (QI) in maternal and newborn health under the support from Johnson and Johnson in Kwara state in Nigeria. This is the first of two workshops introducing methods to improve quality of maternal and newborn care. The workshops aim to strengthen capacity among facility staff to conduct maternal and perinatal death audit and standards based audit.  The workshop took place from 1st to 2nd September, 2016 and involved midwives, nurses, obstetricians and other staff from twelve facilities in four Local Government Areas in Kwara state that are participating in the project. 

Nigeria is one of the countries which contributes 19% of global maternal deaths according to the most recent World Health Organization estimates. With more women accessing health services and giving birth in facilities, a greater proportion of avoidable maternal and perinatal mortality and morbidity has moved to health facilities. However, the quality of care receive often falls short of expected standards, is not evidence-based or women and baby friendly. Poor quality of care (QoC) in many facilities has become a roadblock in improving maternal and newborn outcomes. The CMNH has partnered with the Ministry of Health (MoH) and Wellbeing Foundation Africa in Nigeria to provide training in quality improvement  approaches and methods to strengthen capacity at facility level to improve the care of women and newborns. The four day QI package focuses on: the concept of quality of care; maternal death audit (MDA) and perinatal death audit (PDA) applying the new maternal and perinatal death cause classification (ICD-MM and ICD-PM); and standards-based audit – developing standards, facilitating clinical audit.

A multidisciplinary group of 32 health workers ranging from managers, doctors, nurse-midwives and community health workers attended the training. The workshop was officially opened by Dr. Luther-King Faseun the country Director of Wellbeing Foundation Africa an NGO that works in partnership with LSTM on the project. In his remarks, Dr. Faseun highlighted the need for making quality of care an integral component to improve health outcomes of mothers, and newborns in Nigeria. He urged participants to seriously utilize knowledge gained during the deliberations to improve of care of mothers and babies in their health facilities to save lives.

The workshop was facilitated by in-country LSTM Technical Officer, Dr Hauwa Mohammed from Nigeria and LSTM UK Senior Research Associate, Dr Florence Mgawadere.

The majority of participants reported that the workshop was extremely useful and pertinent to their workplace. Each facility team developed an action plan with post workshop activities to strengthen existing MDA teams and to establish quality improvement committees in their health facilities.

A New Classification for Stillbirth and Neonatal Death Launched

In August 2016, The World Health Organisation (WHO) launched and released a new classification framework for stillbirth and neonatal death.

The new framework, called “The WHO Application of ICD-10 to Deaths during the Perinatal Period” (abbreviated ICD-PM for International Classification of Diseases for Perinatal Mortality), classifies cause of stillbirth and neonatal death according to the familiar codes of ICD-10.

Although ICD-PM covers both stillbirth and early neonatal death, it could be applied to late neonatal mortality as well. It classifies death broadly according to time: antenatal, intrapartum and postnatal deaths, as well as deaths due to maternal conditions.

Also launched on the same date is the new WHO guidelines for audit and review of stillbirth and neonatal mortality and a report on the global implementation of maternal death surveillance and response (MDSR).

CMNH is proud to be associated with these milestones in perinatal care through contributions made by its staff, namely: Dr Mamuda AminuProf Mathews Mathai and Prof Nynke van den Broek.


Sharing the results of the ‘Making it Happen’ programme in Pakistan

Professor Nynke van den Broek has been in Islamabad, Pakistan last week to deliver a dissemination conference to share the results of the Making it Happen programme in Pakistan.

The conference was hosted by Professor Shamsa Rizwan, our research collaborator working at Child Advocacy International, Islamabad. Attendees included representatives from the Ministry of National Health Services, UNFPA, UNOPS, UNISEF, GIZ, DFID, and WHO.  Consultant Obstetricians and Gynaecologists from local hospitals also attended to share their experiences of the implementation of the Making it Happen programme.

Since 2012 through the Making it Happen programme, CMNH have trained more than 800 healthcare providers in Pakistan to improve the availability and quality of care covering the major causes of maternal death - haemorrhage, sepsis, eclampsia, obstructed labour and complications of abortion and the signal functions of Comprehensive Emergency Obstetric Care and Newborn Care (CEmONC) and Basic Emergency Obstetric Care and Newborn Care (BEmONC).

Immediate post training assessment revealed a significant improvement in both knowledge and skills among staff.

Improving the Quality of Care for Mothers and Babies in Tanzania

CMNH has been awarded a contract by the United Nations Children's Emergency Fund (UNICEF) Tanzania office to provide refresher Emergency Obstetric and Newborn Care (EmONC) training courses in two regions ofTanzania.


UNICEF is a United Nations program that provides long-term humanitarian and developmental assistance to children and mothers in low and middle income countries. 

The CMNH team, Dr Charles Ameh and Dr Mselenge Mdegela, will deliver a package of sustainable, high quality maternal and newborn interventions in Mbeya and Njombe regions. Within these two regions the CMNH team will work in 11 districts to increase the knowledge and skills of healthcare providers working in 44 different healthcare facilities.  The project will take place over 18 months with the aims to:

•          Train 288 healthcare providers, 20 of those will go on to be Master Trainers

•          Work with the healthcare facilities to implement a Quality Improvement package

•          Provide supportive supervision and mentoring for healthcare providers

•          Provide expertise in monitoring, documentation and reporting of outcomes

The project is designed to support and strengthen the local capacity of the healthcare providers, with an emphasis on sustainability and value for money. The CMNH team will work in close collaboration with UNICEF and with Reproductive and Child Health Services in the Ministry of Health, Community, Development, Gender, Elderly and Children in Tanzania.

CMNH are delighted to work with UNICEF Tanzania, and to be able to expand our work into Mbeya and Njombe. This sustainable programme will help to strengthen local healthcare providers’ knowledge and skills ultimately improving the quality of care provided to mothers and babies.


CMNH contributes to the latest issue of the British Journal of Obstetrics and Gynaecology

The latest issue of BJOG was published on Thursday 1st September 2016 and the CMNH has two contributions:

Mgawadere F, Unkels R and van den Broek N (2016) 'Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (INTERVA-4). ', BJOG, vol. 123, no. 10, pp. 1647-53. doi: 10.1111/1471-0528.13969

The article can be accessed on the link below and is available to download is external) 

Professor van den Broek has been invited to write 3 mini commentaries and first is available in final form: 

van den Broek N (2016) 'Content and quality – integrated, holistic, one-stop antenatal care is needed for all', BJOG, vol. 123, no. 4, pp. 558. doi: 10.1111/1471-0528.13937

The article can be accessed on the link below and is available to download


Digital Interventions for Maternal and Newborn Health in Kenya

In August 2016, the Danish Royal Embassy in Nairobi and Maternity Foundation convened cross-sector partners working to reduce maternal and newborn mortality in Kenya to discuss to the need, potential, and impact of existing and new mHealth interventions for maternal and newborn health in Kenya, including Maternity Foundation’s Safe Delivery App.

Danish Ambassador to Kenya, Mette Knudsen, welcomed guests and panelists, and Dr. Patrick Amoth, Head Division of Family Health at the Ministry of Health Kenya addressed attendees with reflections on progress and remaining work to be done in maternal, newborn health in Kenya.

The panel discussion began with Anna Frellsen, CEO Maternity Foundation, who shared the creation of the Safe Delivery App, promising evidence from the randomized control trial of the app in Ethiopia, and plans for the future to implement and scale-up the app through partnerships and integration into existing programs and systems.

Diana Mukami, eHealth Programme Manager of AMREF Kenya, gave an overview of AMREF’s ground-breaking work in e- and m-Health and learning. She shared how skilled birth attendants are using the Safe Delivery App in the Samburu Region in the Uzazi Salema Initiative as part of their BEmONC training.

Dr. Charles AmehSenior Clinical Manager and Deputy Head of CMNH, shared preliminary results from baseline surveys conducted in Sierra Leone, Kenya and Nigeria on the availability and use of smart phones among skilled birth attendants. Key takeaways from Dr. Ameh’s initial findings include the majority of skilled birth attendants – 74% have smart phones, 98% are interested in the SDA, and most use their smart phones for purposes that indicate they would easily utilize a learning application. Dr. Ameh also revealed a number of potential barriers of downloading and utilizing the App, which LSTM in partnership with Maternity Foundation with systematically work to address in future implementations.

Finally, Prof Dr. Marleen Temmerman, Director, Centre of Excellence Women and Child Health, Aga Khan University East-Africa presented on the transition from the MDGs to the SDGs, the progress made and the work that remains to be done to achieve the new goals to reduce the global maternal mortality ratio to less than 70 per 100,000 live births and end preventable deaths of newborns, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births by 2030. She highlighted the need to focus on scaling up access to contraceptive services, safe abortion and preventing stillbirth, and emphasized the need to high quality pre-service training.

The panel discussion concluded with excellent input and questions, and a networking reception. 


Publications Update

 The Centre of Maternal and Newborn Health two contributed two articles to the September issue of BJOG:

Mgawadere F, Unkels R and van den Broek N (2016) 'Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (INTERVA-4). ', BJOG, vol. 123, no. 10, pp. 1647-53. doi: 10.1111/1471-0528.13969


Professor van den Broek has been invited to write 3 mini commentaries and first is available in final form:

van den Broek N (2016) 'Content and quality – integrated, holistic, one-stop antenatal care is needed for all', BJOG, vol. 123, no. 4, pp. 558. doi: 10.1111/1471-0528.13937


As part of the Centre’s ongoing research in Quality Improvement, a study examining what lessons can be learned from verbal autopsy in Bangladesh. The results highlight the most common causes of death in the neonatal period which need to be understood in order to reduced neonatal mortality. The majority of parents accessed and received care from a qualified healthcare provider indicating that quality of care needs to improve in order to reduce neonatal mortality and the reach the new targets by 2030.

Halim A, Dewez JE, Biswas A, Rahman F, White S and van den Broek N (2016) 'When, Where, and Why Are Babies Dying? Neonatal Death Surveillance and Review in Bangladesh', PloS One, vol. 11, no. 8, pp. e0159388. doi: 10.1371/journal.pone.0159388

Please feel free to share these articles with your contacts.


New project at CMNH

Technical Assistance to Develop a MNH Strategic Plan for 2017-2020

Sri Lanka is developing its strategic plan for improving maternal and newborn health services. While maternal and neonatal mortalities in this country is significantly lower than most countries in the region, the government is committed to eliminate preventable maternal and newborn mortality by 2030. In addition to reviewing several key reports documenting progress over the years, I had meetings with senior managers in the Ministry of Health, UN agencies, professional organizations, civil society organizations and health workers at various levels of the public health system. A draft plan to end preventable maternal and newborn deaths and stillbirths between 2017 and 2030 was presented to the Director General of Health for review. A larger stakeholder consultation will be held in October prior to finalization. It is expected that the strategy will be published in December 2016. 



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