GlobalHealthAfrica

Supporting Senegalese Midwives and Birth Attendants – a lesson from the African Midwives Collective

In Healthcare, Maternal and Child Health, Midwives on June 7, 2014 at 6:48 pm

Julia Nakad, Hesperian blog coordinator, for the African Birth Collective, describes how the African Birth Collective collaborates with communities to support healthy mothers and newborns in Senegal.

“Midwives provide amazing services to our communities. Aside from assisting with births, they’re a great resource for reproductive health, family planning, and STD information. They are well connected with communities, and distribute critical health information.” – Kaya Skye, African Birth Collective

A Senegalese midwife performing a prenatal checkup

A Senegalese midwife performing a prenatal checkup

When Kaya Skye moved to the northern Mboro region of Senegal in 1996 to research topics in medical anthropology, she found herself fascinated by the state of maternal health. She observed that healthcare workers were being pushed to adopt western birthing practices, but the government- sponsored training was not explaining the rationale for certain actions. For example, health workers were taught how to take blood pressure, but not why it’s important or how high blood pressure could affect a pregnant woman. “But these women are incredibly intelligent and capable of understanding and doing so much more,” says Kaya. She also noticed that along with the westernization of birth care, the more natural approach that had underpinned the work of local midwives for centuries was being lost. Now, instead of natural births, midwives have “rushed births by overusing drugs such as Pitocin,” said Kaya, “which has been a major source of infant mortalities.”

Over the past 18 years, Kaya and a diverse group of health workers and midwives from the United States and Senegal have pioneered midwifery trainings that fuse modern medical advances with traditional Senegalese practices. The African Birth Collective has designed an exchange program between Senegalese and North American midwives to observe and learn from each other’s work. This approach has led to “more sustainable change – midwives will ask each other why they adopt certain practices, and then we’ll have long meetings where we debate these processes and come to a better understanding about these issues. It allows for a longer lasting change in knowledge and practice.”

Traditional Midwives in Kabar with their medicinal herbs

Traditional Midwives in Kabar with their medicinal herbs

The African Birth Collective has also helped to coordinate the construction of Kassoumay Traditional Birth House, and works with different clinicians all over the country to improve the quality of birthing care, encouraging conversations between traditional birth attendants and clinicians. Their work has resulted in improved in birth outcomes, and increased participants’ overall understanding of the birth process. Instead of overusing medications, which Kaya says “focuses on pushing the baby out,” midwives have reclaimed the more traditional roles as “supporters who wait for the process to happen if all the vital signs are fine.”

The African Birth Collective has also undertaking a translation of Hesperian’s A Book for Midwives into French. A long list of midwives from the Congo, Burkina Faso, Haiti, Guinea, and other francophone locations eagerly await its publication. The Collective anticipates it will have “a massive impact on midwifery practices,” since there are very few French language training materials available that are suited for rural birth attendants. Unlike other resources, A Book for Midwives is simply written, easy to use, and contains many helpful illustrations that reinforce difficult concepts and valuable skills.

In addition to the comprehensive pregnancy and birth information in A Book for Midwives, the general health content (on topics such as nutrition, HIV, STDs, and how to perform pelvic exams) will help strengthen larger public health campaigns. Kaya stresses the importance of midwives in Senegal, saying that “often, outside public health projects will publish brochures and make billboards, but this doesn’t usually change people’s behaviors. They want to hear medical advice from someone they know and trust in the community, like their local midwives. The more effective these people are, the better these public health campaigns can be.”

Find out more about the work of the African Birth Collective and their partner, Mother Health International.

Blood Screenings: How much is too much to prevent Hepatitis C?

In Diseases, Medicine on June 1, 2014 at 4:01 pm

Global Health Africa blogger, Udo Obiechefu, discusses the impact of Hepatitis C in Africa and the crucial role that blood screening can play in HCV prevention.

With the recent introduction of Solvaldi and Olysio as high efficacy treatment options for newly acquired cases of the hepatitis C virus (HCV), now is an important time to visit the hepatitis C landscape on the African continent. The global prevalence of hepatitis C is currently estimated at 3%.Sub-Saharan Africa is estimated to have hepatitis C prevalence between 0-14 percent. There is a dearth of data available on HCV in Africa and this lack of information is due to low reporting rates and inefficient surveillance.

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Image by Associated Press (AP)

The cost of care associated with medications is high with little use for those chronically infected with the virus. Although the recent advent of both Solvaldi and Olysio are promising (Solvaldi exhibits a 90% cure rate for those recently infected), there is still an almost insurmountable barrier to care. A twelve-week treatment of Solvaldi costs roughly $84,000. Olysio comes in at a slightly more economical rate of $66,000 per twelve-week course. With these figures in mind, one may see the task of addressing HCV in economically depressed regions as near impossible. Although treatment therapies for those living and recently infected on the African continent may be difficult, it is important to take note of the efforts that can be made in prevention of the virus.

Stronger measures must be made in blood screening efforts since blood transfusions have proven to be the primary method of infection on the African continent. We have to look no further than the high HCV rate (17%) among those with sickle cell anemia in Africa. Hladik et al. investigated HCV prevalence utilizing a set of 2592 plasma donations in Central Uganda. Over 4% of specimens proved positive for HCV. Screening for hepatitis C can be a costly investment, with an estimated cost of $782 per screening. More must be done to close the financial gap to make HCV screening for blood donations in Africa a regularity, as opposed to a scientific interest for potential journal submissions. $782 is not worth a lifetime of chronic illness, especially with treatment options limited and costs high.

Elimination of Child Labor in Africa – An Ongoing Challenge

In Child Labor, Children on May 26, 2014 at 5:47 pm

In Part 1, GHA Contributor Neha Ahmed called attention to the multitude of health hazards child gold miners faced in Tanzania. In Part 2, Neha explores viable solutions that could possibly eliminate child labor in Africa.

Moving wood for the family, for the economy. Image by  IamNotUnique

Moving wood for the family, for the economy. Image by IamNotUnique

June 12 commemorates World Day Against Child Labor, which was first launched in 2002 by the International Labour Organization (ILO) to draw attention to the practice of child labor around the world. The eradication of all forms of child labor has been a major aim of the ILO since its inception in 1919. Yet, the 2014 UN report on the State of the World’s Children acknowledges that more than fifteen percent of the world’s children are currently engaged in child labor. This translates into one in every 6 children in the world today being involved in some form of work.

Although child labor is thoroughly global and affects every part of the world, Sub-Saharan Africa continues to be the region with the highest proportion of children engaged in child labor, with over 21% of the child population or 51 million children, still doing work that meets the definition of child labor. Although there has been a drop in the prevalence of child labor since the early 1990s, the world remains far from the goal of eliminating child labor.

The phenomenon of child labor in Africa is complex and is closely linked to poverty, inequality and global economic forces. The need to make ends meet forces children to seek work, often at the expense of their education as well as their health. The prevalence of child labor differs significantly between countries in Africa, as shown in the table below. There are also major differences in the conditions and pathways that are thought to lead to child labor as well as the kinds of work children are engaged in. In many parts of Sub-Saharan Africa, increases in poverty and the devastating effects of HIV/AIDS have led to more children being pushed into the workforce.

In Kenya, for instance, children are engaged in some of the worst forms of child labor, including working in mines, tea plantations, construction and as domestic servants. There are reports that children are used to traffic drugs and weapons. Children are also especially vulnerable to human trafficking and all forms of abuse. It is estimated that up to 18,000 children in Kenya are engaged in commercial sexual exploitation. In countries such as Somalia, which continue to experience conflict, children are often systematically conscripted for armed groups and militias. Child labor in Egypt, on the other hand, appears to be concentrated in the agricultural sector, where children may have to work long hours and be exposed to hazardous chemicals and pesticides.

The last few years have seen some progress towards eliminating child labor, particularly in its worst forms. However, the recent global economic crisis is thought to have had a detrimental effect on child labor. By increasing unemployment and pushing more families into poverty, the economic downturn forced children to turn to work in order to assist their households. Although the enforcement of labor laws and the creation of policy initiatives are an important aspect of addressing the problem of child labor, there is considerable skepticism that these factors alone will improve the lives of children. Given that complex global economic forces shape the lived reality of populations around the world, the elimination of child labor must be tied to more fundamental changes to global trade relations and the distribution of wealth.

Click here to access data on child labor in African countries.

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