CLEVER new plan to save lives of babies and moms
System to manage women during labour has helped reduce deaths eightfold in five districts in Tshwane
A new programme announced on Wednesday has the potential to reduce deaths of babies from lack of oxygen significantly.
The programme, CLEVER, is a system to manage women during labour. It has helped reduce deaths eightfold in five districts in Tshwane, and reduced mother deaths by at least 17% compared with five districts without the programme.
The term CLEVER stands for: Clinical care.
Labour ward management.
Emergency obstetric simulation training.
Respectful care. It is about improving how labour wards are run, how nurses are allocated tasks, and how patients are triaged to give the most serious care first.
It is set to be rolled out to more districts on the country, with a $1m grant from a pharmaceutical company, it was announced in Midrand on Wednesday.
“Despite significant progress made over the past few years, South Africa’s maternal mortality figures remain very high at 116.9 per 100,000,” said Sunet Jordaan, project manager for the Foundation for Professional Development’s MSD for Mothers.
SA has a very high maternal mortality rate for a middle-income country and the health department realised new interventions were required to save the lives of more mothers.
In 2009, 190 women per 100,000 died in childbirth in SA. New figures released this year showed that by 2016 the rate dropped 30 % to 134 per 100,000, but no further improvement has been made since.
“It has plateaued and we need to bend the curve,” said deputy director in the department of health Yogan Pillay .
Women dying in childbirth is often seen as preventable, while the World Health Organisation views it as a measure of a health system’s success.
To put SA’s rate into context, there are about 68 deaths of mothers per 100,000 in East Asia and about 25 per 100,000 in Europe.
The rollout of ARVs to pregnant HIV-positive mothers led to a dramatic drop in deaths of moms and babies.
But now more needs to be done, said Pillay. “We haven’t been able to decrease deaths from hypertension in pregnancy.”
University of Pretoria professor in the department of obstetrics and gynaecology Bob Pattinson said as deaths reduced due to treatment for HIV, focus has to be on other causes of maternal deaths. “As more problems have become apparent, our priorities must change.”
He explains that women now die less from HIV-related complications, but primarily from bleeding after birth and complications related to high blood pressure ( pre-eclampsia).
Pattinson and colleagues decided to work how best to solve the problem.
Using a modelling tool called Lives Saved Tool (LiST), developed at the Johns Hopkins Bloomberg School of Public Health, they calculated that the most effective intervention to save lives could be improving care in delivery in the labour ward, and if done properly across the country it would save 9,000 lives a year.
The tool shows health experts which interventions offer “more bang for the buck”.
Better care during labour was far more effective than resuscitating babies, giving women folic acid in pregnancy and other interventions.
The team then trialed a way to improve care during labour in five health districts in Tshwane and compared the deaths of mothers and babies with five districts in Tshwane without the intervention. This showed the intervention worked, they said.
Training in how to manage obstetric emergencies has also been rolled out to staff. Using this system allows care to improve despite shortages of resources. “The CLEVER package was developed to reorganise the way in which obstetric care is provided at district level and to support and mentor midwives and other clinical staff to render high-quality, respectful obstetric care,” said Cathy Bezuidenhout, manager at the Research Centre for Maternal, Foetal, New-born & Child Health Care Strategies at the University of Pretoria. “We are excited about this important and much-needed programme and the impact it can have on saving the lives of women and newborns. No woman should die in childbirth.”