Why are Mothers and Babies Dying?

photo by Scott McLeod shared through cc by 2.0

Wednesday, October 14, 2015

Hundreds of preventable maternal and neonatal deaths occur every day across the globe. A novel geographical mapping program in northern Ghana may challenge the way we think about treatment and solutions.

The University of Michigan (UM) has a decades-long relationship with Ghanaian partners in working together to solve local health-related problems, especially within the realm of maternal and neonatal care. Starting in the 1980s, Dr. Tim Johnson, UM Chair of Obstetrics and Gynecology (OBGYN), united with several universities in Ghana to cultivate and promote post-graduate OBGYN medical training. This involvement has resulted in a training and retention rate of 140/142 former trainees who are now practicing and holding leadership positions in Ghana. It has also opened numerous doors for UM and Ghanaian students, faculty, researchers, and physicians to collaborate on multiple healthcare issues both in the US and in Ghana.

It is because of this strong foundation that Cheryl Moyer, UM Assistant Professor in the departments of Learning Health Sciences and Obstetrics & Gynecology and Associate Director for Global REACH, began partnering with colleagues in Northern Ghana more than ten years ago. During a research collaboration on the Stillbirth And Neonatal Death Study at the Navrongo Health Research Centre (NHRC), she realized that not only were social and cultural factors important to understanding neonatal and maternal deaths, but they seemed to vary by location and circumstance.  

This concept formed the basis for a US Agency for International Development grant proposal and a subsequent $1.44M award to Dr. Moyer and her UM and NHRC co-investigators. Funded in fall of 2014, Preventing Maternal And Neonatal Deaths (PreMAND) examines the social, cultural, and behavioral factors influencing maternal and neonatal mortality, as well as ‘near-miss mortality’, in four districts within three northern regions of Ghana. Near-misses are cases where mothers or babies suffer a life-threatening complication but ultimately survive.

The first phase of the project involves data collection in the field to identify all deaths and near-misses in the four project districts, including detailed interviews with mothers or family members. This technique, known as “social autopsy”, attempts to uncover some of the non-medical factors that may have contributed to a death or near-miss. Over the next two years, these events will be mapped and linked to possible predictive factors. The last phase will provide tailored feedback to communities within Ghana to help create local solutions and address relevant issues in regard to maternal and neonatal near-misses and deaths.

Traditionally, research and programmatic efforts to address maternal and neonatal health have focused almost exclusively on medical factors. But in many part of the developing world, there are social and cultural factors that cannot be ignored, says Moyer.

“For example, we know that a large percentage of newborns die from neonatal asphyxia,” says Moyer. “But why? Is it because the health care providers don’t know how to do neonatal resuscitation? Or is it that women give birth at home and don’t recognize their baby needs help? Or is it because traditional medicine is the normal course of action, long before a baby would ever arrive at a hospital?”

The combination of social autopsy and geographic mapping may help communities, individually and collectively, focus more on the “Why.” According to Moyer, “Until we can answer this question and disaggregate some of these factors, we will never be able to completely address maternal and neonatal mortality in the ways necessary. We hope PREMAND will be an important step in that direction.”

Dr. Moyer is shown (first row, second from right) with PreMAND steering committee members in the photo at right.

Link to Navrongo Health Research Centre: http://navrongo-hrc.org/

 

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