GlobalHealthAfrica

Posts Tagged ‘Children’

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.

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Midwives: A Key Partner in Reducing Maternal Death

In Healthcare, Maternal and Child Health, MDGs on May 3, 2014 at 3:48 pm

Midwives are key partners in reducing maternal and newborn deaths in Africa. GHA contributor, Leigh Bernstein Reardon, makes a case for increased support for midwife training programs.

A quick Google search revealed that there are dozens of trained OB-GYNs in the 0.5 square-mile zip code where I work in New York City. Comparatively, Malawi, for example, has less than 20 trained OB-GYNs in the entire county. Another quick Google search led me to this statistic: a woman’s lifetime risk of dying as a result of pregnancy or childbirth is 1 in 39 in Sub-Saharan Africa, as compared to 1 in 4,700 in industrialized countries. Leaving behind (for now) all of the obvious disparities that these facts represent, what comes to my mind first is that these figures—the number of trained health care providers and maternal deaths—are inextricably linked. Recognizing the dangerous combination of limited physician training programs and the high prevalence of brain drain the African continent faces, global health experts are calling for increased support for midwife training programs.

Midwives can provide critical care in places where no other health infrastructure exists. According to the United Nations Population Fund (UNFPA), “Midwives can help avert two thirds of all maternal deaths and half of newborn deaths, provided they are well-trained, well-equipped, well-supported and authorized.” They not only deliver care during pregnancy, labor, and postpartum, but can provide front-line access to family planning and HIV/AIDS services. Midwives can also help reduce the need for emergency care by managing complications before they become critical. Importantly, midwives can be trained in 2-3 years, as compared to the 8-9 years it can take to train doctors, meaning they can provide more immediate care to women in need.

UNFPA’s State of the World’s Midwifery Report 2011 is the first comprehensive analysis of midwifery services and issues in countries where midwives are needed the most. Based on data and information from over 50 countries, the report highlights current issues facing the midwifery profession and urges governments, the international community, regulatory bodies, and training facilities to invest in the health of its mothers. Among the report’s key findings is that the global community lacks as many as 350,000 skilled midwives in order to meet the needs of women globally. The report also notes the importance of including midwives in costed maternal and child health plans, and health care policies. State of the World’s Midwifery Report 2014 will be published in June.

One movement working to increase the number of trained midwives is Amref’s Stand Up for African Mothers Campaign. Launched in 2011, the campaign seeks to help African nations meet Millennium Development Goals 4 and 5 by training 15,000 midwives in 13 countries by 2015. According to their website, Amref has trained over 5,000 midwives using a mix of conventional and distance learning techniques. In an effort to bring to the forefront the estimated 250,000 women who die from complications of pregnancy and childbirth each year, the Stand up for African Mothers Campaign has created a petition to nominate Esther Madudu, a midwife from Uganda, for the Nobel Peace Prize. The goal of the campaign is to have the global community recognize these needless deaths and the important role that midwives play in saving the lives of mothers and children worldwide.

This week, the world will celebrate International Day of the Midwife. In honor of this day, check out a video of Edna Adam Ismail, a former midwife and UN diplomat, giving a TedX talk on the value of midwives and the notion that progress can be made in even the most seemingly desperate situations.

Tackling the Health and Economic Risks of Child Marriage

In Healthcare, Youth on March 29, 2014 at 3:52 pm

What will it take to end child marriage? GHA blogger, Sophie Okolo, points out the recent change in dialogue and highlights the health and economic risks of child marriage in Africa.

Early this year, the conversation about child marriage shifted from human rights to that of health and education. Child marriage is still a hot button issue in many African countries hence this change was significant. By shifting the conversation, public health professionals can address this issue in a tactful way since cultural beliefs are difficult to change. Like any important issue of our time, finding creative ways to address such issues can lead to a change of heart and eventually, cultural transformation.

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Despite recent condemnation of child marriage in many African countries, tradition and beliefs continue to ruin young lives in remote regions. For example, child marriage is prohibited under Nigeria’s Child Rights Act (enacted in 23 of 36 Nigeria’s 36 states), which bans marriage or betrothal before the age of 18. But federal laws compete with age-old customs, as well as a decade of state-level sharia law in Muslim states. Last year, the Nigerian Senate came under attack for failing to include the age at which girls can get married thereby condoning child marriages. These customs and laws should be challenged although health information can go a long way in addressing this critical issue. For instance, girls who marry too young are denied the educational opportunities of their peers and are put at greater health risks, such as HIV and teen pregnancy. Teen pregnancy may lead to a difficult and prolonged labor which can result in a fistula, an abnormal connection between an organ, vessel, or intestine and another structure that causes uncontrolled urination or defecation. According to Dr Mutia, one of two practicing fistula surgeons in Zamfara, Nigeria, “fistulas can happen to anyone, but are most common among young women whose pelvises aren’t at full capacity to accommodate the passage of a child.” In the development community, studies have shown that child marriage is also linked to poverty. Rachel Vogelstein, a Fellow for Women and Foreign Policy at the Council on Foreign Relations, states that “Recent research suggests that families in crisis situations are more likely to marry their daughters early, either to preserve resources by offloading economic responsibility for their girl children or in an attempt to ensure their daughters’ safety from conflict-related sexual violence.” Clearly, child marriage is a complex issue.

Although the number of global child marriages is declining, rates are staggering in countries like Chad, Niger and the Central African Republic. More than two out of every three girls are married before eighteen. Roughly half of the girls married early in Niger do so before turning fifteen. Since there is no magical solution to child marriage, combined efforts may help women and girls lead healthy and successful lives. The goal is to help African societies fully comprehend the seriousness of the issue.

Autism in Africa

In Mental Health on November 10, 2012 at 4:02 am

Autism is a popular topic in developed countries. My perception was that it was a phenomena confined to the West with little or no occurrence in Africa. Therefore, I was surprised to watch a TED video of someone, who I suspect to be originally from Nigeria, share her experience with Autism. I was intrigued  to learn more about this disorder and its impact on Africans.

Autism is a developmental disorder which usually manifests in early childhood. Children with autism exhibit repetitive behaviour  patterns and interests, and obvious deficits in communication and social interaction. The earliest research on autism in Africa was carried out by Victor Lotter as far back as 1978. His research was carried out in 6 African countries. The result of his research was a low prevalence of autism. However, his research methods appeared to be flawed. Since then, not a lot of a studies has been carried out on this disorder. The prevalence rate in the various countries on the continent is unknown. Outside the African continent, it has been observed that children born to Africans immigrants in Europe exhibit a higher prevalence of autism compared to the indigenous population.

There is a need for research to be carried out to determine the burden of Autism in Africa. Also, it is important that health care providers are trained to identify and address cases. Policymakers also need to focus on providing the necessary infrastructure to manage this condition. In the video below, Faith Jegede shares her experience of living with 2 brothers with Autism.

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