UP researchers have been working with the South African government to collect data on mother, newborn and child deaths across the country since 1997. Now all this data is being put to good use as the Research Centre for Maternal, Fetal, Newborn and Child Health Care designs and implements interventions to save lives and improve the quality of care in South African hospitals and clinics.
The data collected by the Centre pointed to a crisis in the field of maternal and child health in the country and highlighted several causes of preventable death in mothers and babies. These included health concerns like blood loss, infections and HIV, as well as a skills shortage in certain regions and facilities.
Having identified areas for improvement, the Centre is pioneering several initiatives that are already making a difference - saving lives, increasing the skills of health workers, and helping to deliver more healthy infants than ever before.
The newly launched Research Centre for Maternal, Fetal, Newborn and Child Health Care at the University of Pretoria has collected expertise and data on maternal and child health over two decades. The Essential Steps in Managing Obstetric Emergencies (ESMOE) project is one of many initiatives run under the auspices of the new Centre, aimed at improving primary and secondary maternal and infant healthcare by providing health workers with the necessary skills to handle difficult births.
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Premature babies all over Africa and in developing countries around the world have a greater chance of survival today thanks to the work of University of Pretoria researchers. Prof Anne-Marie Bergh and colleagues have been tirelessly promoting the benefits of Kangaroo Mother Care for almost 20 years, by training nurses and doctors in this low-tech solution that is saving premature and low birth-weight infants.
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Researchers at the University of Pretoria have just finished testing a device that could prevent thousands of still births every year. The Umbiflow is a low-cost, low-tech device that detects problems with pregnancies in otherwise healthy women, and ensures that they get the care they need for a healthy birth, before it’s too late.
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For most doctors in training, obstetrics is hectic and too busy, but for Dr Felicia Molokoane it is a calling. Her bold career choice has led to her being part of groundbreaking research on the effects of HIV treatment on the growth of babies.
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After 20 years of contributing to the lives of pregnant women, newborn babies and infants; the South African Medical Research Council's (MRC’s) Maternal and Infant Health Care Strategies Unit has become a fully fledged Centre at the University of Pretoria (UP). A vision of Prof Robert Pattinson, the Research Centre for Maternal, Fetal, Newborn and Child Health Care under the Department of Obstetrics and Gynaecology today boasts a treasure trove of experts and knowledge gathered since the unit’s inception in 1997.
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The newly launched Research Centre for Maternal, Fetal, Newborn and Child Health Care at the University of Pretoria (UP) has access to a treasure trove of expertise and data gathered over the last two decades. The Essential Steps in Managing Obstetric Emergencies (ESMOE) project is one of many initiatives run under the auspices of the new Centre and aimed at improving primary and secondary maternal and infant healthcare.
The new Centre succeeds the South African Medical Research Council's Maternal and Infant Health Care Strategies Unit at the University of Pretoria, which has been gathering data on the care of mothers and infants since 1997. From 20 years of knowledge and experience, experts at the Unit have found that a lack of adequate skills and training is contributing to the high prevalence of maternal deaths in South Africa.
The ESMOE programme aims to improve the emergency management of pregnant women and their infants by developing and implementing a training package for emergency care. To do this, researchers collaborated with the Liverpool School of Tropical Medicine to develop an SA-specific training programme for healthcare professionals and students to improve in this area.
A report on a survey led by the director of the Maternal and Infant Health Care Strategies Unit, Professor Robert Pattinson, looked at basic emergency obstetric and neonatal care in 12 South African health districts. Pattinson reports that in the 12 districts surveyed, the required level of emergency obstetric care was not available in most community healthcare centres and in only a quarter of district hospitals.
“We found that less than half the clinics could get their patients with complications to the appropriate hospital in less than an hour,” says Pattinson. “Safe maternity care was not consistently available at many facilities conducting births.”
This survey showed that a concerted effort was needed to train midwives and doctors in vacuum deliveries, manual removal of the placenta and manual vacuum aspiration of the uterus for incomplete miscarriage. ESMOE is specifically designed to meet these needs, among many others.
The training has been a marked success, with a one-third reduction of maternal deaths after training, and an almost 20% reduction in deaths due to blood loss during and after childbirth.
The training programme also exists as a digital platform with myriad resources to help train healthcare workers in subjects such as a surgical safety checklist, guidelines on maternity care, and miscarriage scenarios, among others.
ESMOE has been so impactful that it has caught the attention of the European Union (EU) which has helped the Unit expand ESMOE training from the original 12 districts to all 52 districts in South Africa.
The ESMOE programme continues to provide training for healthcare professionals at South African healthcare centres to help put maternal health at the centre of national plans and support women’s right to safe motherhood.
Premature babies all over Africa and in developing countries around the world have a greater chance of survival today thanks to the work of University of Pretoria (UP) researchers. Drs Anne-Marie Bergh, Elise van Rooyen and colleagues have been tirelessly promoting the benefits of Kangaroo Mother Care for almost 20 years, training nurses and doctors in this low-tech solution that is saving premature and low birth-weight infants.
“Globally, 35% of neonatal deaths are due to conditions related to prematurity - problems with temperature control, breathing, and the cardiovascular system,” says Bergh, who oversees education aspects of public health projects for the SAMRC Unit for Maternal and Infant Healthcare Strategies at UP. “In our study, the introduction of Kangaroo Mother Care in South Africa was associated with a 30% reduction in neonatal mortality. It is now recommended by the World Health Organisation as a key intervention around the world.”
Kangaroo Mother Care (KMC) was originally developed in Colombia in 1979 as a solution to overcrowding in a neonatal unit in Bogotá, but was only taken up in other countries in the 90s after more than a decade of research. In essence, mothers and other caregivers are taught to carry their babies skin-to-skin, between the breasts, for 20 or more hours per day. This helps the baby maintain a regular temperature, enhances breastfeeding and dramatically improves a baby’s chance of survival.
In the absence of sophisticated care for small and sick newborns, KMC is a life-saving strategy for keeping the baby warm and reducing the chance of infection. Skin-to-skin care is also used worldwide to help premature babies bond with their parents. But that’s not all: Bergh says studies are starting to show the positive effects of KMC on long-term brain development.
Bergh and Van Rooyen first started working to implement KMC in South Africa in 1999. They started at Kalafong hospital in Pretoria where Van Rooyen heads the KMC unit, and over the next 10 years developed multimedia training materials, techniques and methods for sustainable implementation, as well as tools to evaluate the success of their efforts.
“When we started working with KMC, it was a new thing,” says Bergh. “Nobody knew how to implement it.”
Now, Bergh and Van Rooyen are world experts in getting KMC to work, regardless of the context. Since 2007, when they evaluated a project implementing KMC in Malawi, they have worked with African countries like Ghana, The Gambia, Mali and Rwanda (to name a few), as well as Asian countries like Indonesia, India and Bangladesh. This work, often in partnership with development agencies and ministries of health, either involves helping countries assess the needs of the country, implement a KMC programme, or review the success of such an implementation.
Bergh says that KMC is gaining ground globally as an important life-saving intervention in newborn care.
“Since 2014, the Every Newborn Action Plan has put its focus more strongly on initiatives to save premature and low birth-weight babies,” she says. “Each country has its own specialised plan, but KMC is in there as a key intervention - it’s been identified as high impact, life-saving, and cost-effective.”
In SA, KMC is in place in hospitals all over the country, and it forms part of the newborn care taught to new doctors and nurses. Bergh says that it might not always be implemented in the same way - the methods are designed to be adaptable to different situations, skill levels and institutions - but the outcome is the same: newborn lives are saved.
The newly launched Research Centre for Maternal, Fetal, Newborn and Child Health Care at the University of Pretoria (UP) has access to a treasure trove of expertise and data gathered over the last two decades. The Essential Steps in Managing Obstetric Emergencies (ESMOE) project is one of many initiatives run under the auspices of the new Centre and aimed at improving primary and secondary maternal and infant healthcare.
The new Centre succeeds the South African Medical Research Council's Maternal and Infant Health Care Strategies Unit at the University of Pretoria, which has been gathering data on the care of mothers and infants since 1997. From 20 years of knowledge and experience, experts at the Unit have found that a lack of adequate skills and training is contributing to the high prevalence of maternal deaths in South Africa.
The ESMOE programme aims to improve the emergency management of pregnant women and their infants by developing and implementing a training package for emergency care. To do this, researchers collaborated with the Liverpool School of Tropical Medicine to develop an SA-specific training programme for healthcare professionals and students to improve in this area.
A report on a survey led by the director of the Maternal and Infant Health Care Strategies Unit, Professor Robert Pattinson, looked at basic emergency obstetric and neonatal care in 12 South African health districts. Pattinson reports that in the 12 districts surveyed, the required level of emergency obstetric care was not available in most community healthcare centres and in only a quarter of district hospitals.
“We found that less than half the clinics could get their patients with complications to the appropriate hospital in less than an hour,” says Pattinson. “Safe maternity care was not consistently available at many facilities conducting births.”
This survey showed that a concerted effort was needed to train midwives and doctors in vacuum deliveries, manual removal of the placenta and manual vacuum aspiration of the uterus for incomplete miscarriage. ESMOE is specifically designed to meet these needs, among many others.
The training has been a marked success, with a one-third reduction of maternal deaths after training, and an almost 20% reduction in deaths due to blood loss during and after childbirth.
The training programme also exists as a digital platform with myriad resources to help train healthcare workers in subjects such as a surgical safety checklist, guidelines on maternity care, and miscarriage scenarios, among others.
ESMOE has been so impactful that it has caught the attention of the European Union (EU) which has helped the Unit expand ESMOE training from the original 12 districts to all 52 districts in South Africa.
The ESMOE programme continues to provide training for healthcare professionals at South African healthcare centres to help put maternal health at the centre of national plans and support women’s right to safe motherhood.
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