Maternal Care Accessin Sudan

Geneva Foundation for Medical Education and Research

GFMER Sudan 2012Forum No: ( 1 )

Name of presenterName Position Institution

Sawsan Mustafa Abdalla Associated Professor National Ribat University

Name Position Institution

Sawsan Mustafa Abdalla Associated Professor National Ribat University

Name of contributors

Content of the presentation

Background

RH services current status

National monitoring indicators

Health status

Safe motherhood: A human right yet to be fulfilled

Previous studies

References

Maternal Care Access

The International Conference on Population and Development, drawing on the WHO definition of health, defined reproductive health as a ‘state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes’(1).

Reproductive health

Maternal Care Access

The availability of good quality reproductive health (RH) services is a vital social and

economic investment.

provision of efficient, equitable and quality reproductive and sexual health services will go a long way in improving the health of the population.

Maternal Care Access

the national policy of RH Stated that: shall provide maternity and child care and medical care for pregnant women’.

Maternal Care Access

The policy document provides direction to Sudan national health system setting an agenda for reforms assuring the reproductive health services are available not only throughout a woman’s life-cycle but ensuring her the right to survive pregnancy and childbirth and enjoy a good family life

Maternal Care Access

Maternal mortality figures for Sudan are one of the highest in the world. On average, according to Sudan Household Health Survey (2006), every day about forty women die due to causes associated with birth

Maternal Care Access

While in certain parts of country, situation could even be worse, these figures might only be a tip of the iceberg due to underreported maternal deaths and or incorrectly attributed and classified as cause. High maternal mortality is also an indication of high infant mortality

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Maternal Mortality Ratio in the EMR: 2006

National monitoring indicators

• % pregnant women who have at least one antenatal visit 94.8%

• % of pregnant women who have a trained attendant at delivery 89%

• % of pregnant women immunized against tetanus 74%

National monitoring indicators

Contraceptive prevalence rate 20%

% of infants weighing less than 2500 g at birth

prevalence of female genital mutilation 70.3%

Maternal mortality ratio 1107/100.000

Health status

-Sudan is lagging behind the target for achieving MDGs, particularly for the health

related MDGs.

-The national maternal mortality ratio averages 1,107 deaths per 100,000 live births with wide interstate variations

Health status

The infant mortality rate is estimate at 81 per 1000 live births and about half of these are neonatal deaths (41/1000 live birth)

occurring during the first month of life (SHHS, 2006).

Under 5 mortality is 105 and 126 per 1,000 live births in north and south respectively, while comparable figures for infant mortality are 70 and 89.

Health status

Sudan has three layers of care provision.At the apex of pyramid are the teaching, general

and specialist hospitals rendering secondary and tertiary care

For primary care, the rural hospitals are first referral care with indoor and diagnostic facilities.

Health status

Primary care is provided through a variety of outlets:

PHC unit:- staffed by a community health worker. dressing station:-staffed by a trained nurse or

experienced community health worker. Dispensary:-staffed by a medical assistant and a nurse, and

provide PHC services.

Health status

The health centers:- which are referral for primary health care facilitiesstaffed by two medical officers, and paramedics,

i.e. medical assistant, health visitor, nutrition instructor and vaccinator

Health status

45-65% of population has access to PHC services, i.e. on average, 1 facility serves

12,000 people.

Health status

The policy supports comprehensive reproductive health care which is accessible, affordable, appropriate, efficient and effective; and for that purpose, it can be delivered through

The Reproductive Health PackageSafe motherhood services family planningharmful practices unwanted pregnancyunsafe abortion reproductive tract infections including sexually

transmitted diseases and HIV/AIDS gender-based violence infertility reproductive tract cancersViolence against women Women empowerment

Health status

it can be delivered through:Integration of reproductive health services with

mainstream primary health care

The neglected tragedy of maternal mortality

Safe motherhood: A human right yet to be fulfilled

• “When reporting on the right to life protected by article 6, States Parties should provide data on …..pregnancy and childbirth-related deaths of women……..”

UN Human Rights Committee, General Comment 28 (2000): Equality of rights between Men and Women (Article 3). 10

Safe motherhood: A human right yet to be fulfilled

• Mothers have a right to life

• Maternity is not a disease

• Motherhood can be made safer

• Millions of women are denied exits from the maternal death road

• A question of how much a woman’s life is considered worth

Motherhood can be made safer

The interventions that make motherhoodsafe are known and the resources needed areobtainable. The necessary Services are neither sophisticated nor very expensive, and reducing maternal mortality is one of themost cost-effective strategies available in the area of public health.

Message from WHO Director-General, World Health Day, 1998

Previous study

• A cross-sectional community-based study was carried out in Kassala, eastern Sudan.

• The aim of this study was to investigate coverage of antenatal care and identify factors associated with inadequacy of antenatal care in Kassala, eastern Sudan

Previous study

811(90%) women had at least one visit. Only 11% of the investigated women had ≥ four antenatal visits, while 10.0% had not attended at all. Out of 811 women who attended at least one visit, 483 (59.6%), 303 (37.4%) and 25 (3.1%) women attended antenatal care in the first, second and third trimester, respectively.

Previous study

Antenatal care showed a low coverage in Kassala, eastern Sudan. This low coverage was associated with high parity and low husband education.

References

1-Programme of Action of the International Conference on

Population and Development (ICPD), New York, United Nations,

1994

2-National health policy, Sudan 2007

3-UNDP, MDGs in Sudan, http://www.sd.undp.org/mdg_sudan.htm accessed on 27

March, 2010

4-Federal Ministry of Health (2007), Annual Health Statistical Report, 2007, National

Health Information Centre, Federal Ministry of Health Khartoum