“The causes of neonatal death globally are multifactorial and also include social factors such as education, sanitation, improved nutrition and political will. However, access to healthcare is of extreme importance and while maternal mortality rates have been improving across the globe, more needs to be done to improve the lives of newborns. Better systems are urgently needed to record these deaths and once these are in place, measures can be taken to reduce these high figures.” Professor Alan Cameron, Vice President for Clinical Quality at the Royal College of Obstetricians and Gynaecologists (RCOG) UK
In developing countries, many women have no access to maternity services due to distances to health facilities, cost for medical services and products, and local customs, often resulting in unhygienic delivery conditions that increase rates of infant and maternal tetanus and other life-threatening infections.
According to WHO, a newborn dies from infection every second in Sub Saharan Africa among other places. This success of this initiative will also impact the attainment of the Sustainable Development Goals (SDGs). In particular goal 3, which seeks to ensure healthy lives and promote wellbeing for all at all ages. Goal 3 of the SDGs has the following targets;
3.1 : By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
3.2 : By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
As of 2015, the region with the highest MMR (maternal mortality ratio) is sub-Saharan Africa. At the country level, Nigeria and India are estimated to account for over one third of all maternal deaths worldwide in 2015, with an approximate 58 000 maternal deaths (19%) and 45 000 maternal deaths (15%), respectively. Sierra Leone is estimated to have the highest MMR at 1360 (UI 999 to 1980). Eighteen other countries, all in sub-Saharan Africa, are estimated to have very high MMR in 2015, with estimates ranging from 999 down to 500 deaths per 100 000 live births: Central African Republic (882; UI 508 to 1500), Chad (856; UI 560 to 1350), Nigeria (814; UI 596 to 1180), South Sudan (789; UI 523 to 1150), Somalia (732; UI 361 to 1390), Liberia (725; UI 527 to 1030), Burundi (712; UI 471 to 1050), Gambia (706; UI 484 to 1030), Democratic Republic of the Congo (693; UI 509 to 1010), Guinea (679; UI 504 to 927), Côte d’Ivoire (645; UI 458 to 909), Malawi (634; UI 422 to 1080), Mauritania (602; UI 399 to 984), Cameroon (596; UI 440 to 881), Mali (587; UI 448 to 823), Niger (553; UI 411 to 752), Guinea-Bissau (549; UI 273 to 1090) and Kenya (510; UI 344 to 754).
The two countries with the highest estimated lifetime risk of maternal mortality is Sierra Leone with an approximate risk of 1 in 17, and Chad with an approximate risk of 1 in 18. The estimated lifetime risk of maternal mortality in high-income countries is 1 in 3300 in comparison with 1 in 41 in low-income countries.
The objectives of the Mum & I initiative
- To provide information to women, men and their communities on the importance of childbirth in a clean space.
- To provide Mum & I Kits to all women who deliver in health centres/units, at home and elsewhere in the community.
- To build capacity amongst or anyone assisting with a
delivery, including: mothers delivering alone;
- Trained and untrained birth Attendants
- Occasional birth attendants such as relatives or neighbours
- To promote clean and safe delivery for all women.
- To establish a monitoring and evaluation system for ascertaining the efficacy of the Mum & I birth Kit initiative.
Why Are Safe birth kits Important?
The use of a Mum & I kit cuts the risk of infection especially in rural and Peri- urban areas. It has been reported that 60 million women worldwide give birth at home on the floor without clean water. The Mum & I kits provide the six essential ‘Cs’ outlined by WHO, and they are;
- Clean hands – soap or sanitising wipes. Wash hands with clean water and soap, once before delivery and once before cord cutting.
- Clean perineum or birth canal – gauze wipes.
- Clean birthing surface – folded plastic drop cloth or padded blood absorbent sheet. A plastic sheet for mothers to lie on during delivery maintains a clean birth canal and perineum, and protects the newborn from potential sources of infection.
- Clean cord cutter – sterile razor blade or scalpel. A new razor blade in its original packing is sterile and can prevent the transmission of tetanus-causing spores and other pathogenic organisms via the umbilicus to the infant.
- Clean cord tying thread. The use of clean thread or narrow tape to tightly tie the umbilicus helps keep the stump healthy.
- Clean cord ointment or antiseptic powder. Applying antiseptic such as chlorhexidine to the cord stump to prevent infection is the best care.
Sanitary pads and plastic gloves are very useful additions to the kit. The kit should have pictorial directions for use of the various listed items.
The Mum & I initiative promotes clean delivery practices;
- Reduction of maternal sepsis;
- Reduction of neonatal tetanus, sepsis, cord infection
Research suggests that women who use safe delivery kits are substantially less likely to develop genital tract infections. Their infants were substantially less likely to develop umbilical cord infections
What are the contents of the Mum & I kit
Plastic sheet, transparent, 2m x 2m 2 pieces
Surgical gloves, sterile, latex 3 pairs
Cotton wool, roll, 200g 2 pieces
Gauze, absorbent, 90cm x 5m 3 pieces
Cord band ligature 1 piece
Razor blades, sterile, size 22 2 pieces
Antiseptic Soap bar, 100g 1 piece
Sanitary pad 3 pieces
Padded blood absorbing sheet 1piece
Clean cord ointment or antiseptic powder 1 piece
Explanatory flyer 1 piece
In areas where it’s allowed, the kit would include Misoprostol which sells for less than a dollar per dose. This drug treats post-birth bleeding and haemorrhage. Excessive bleeding after delivery, called postpartum haemorrhage, is the single biggest direct cause of maternal deaths – more than 220 women die of it every day. Misoprostol if taken immediately after delivery significantly decreases a woman’s risk of postpartum haemorrhage. It does not require refrigeration or injection, making it possible for a woman to take it after a home delivery without a trained attendant.