West Africa Insight

Monthly News on Democratic Governance, Gender, Peace and Security

Vol 1 No 6 June 2010

January 2010

Maternal Health
A Publication of the Centre for Democracy and Development with Support from Rockefeller Foundation
 Table of Contents
Nigerian Vision on Key Opportunities
for Safe Child Bearing
Questioning the Quality of Cote d’
Ivoire’s Maternal Services
Monitoring Success in Benin’s
Maternal Health Sector
Strengthening Pro-poor Healthcare
Initiatives for Pregnant Women in
Rural Guinea
Risks of Child Birth in Sierra Leone and
Liberia
Sources
Monthly News and Current Affairs 10
Hurdles to Better Maternal and Child
Health: An Overview
Editorial Team
Editor in Chief
- Jibrin Ibrahim
Editor
- Okon Akiba
Associate Editor
- Okechukwu Ibeanu
Project Officer
- Daniel Nengak Gondyi
Project Officer (Technical)
- Terfa Hemen
Researchers
Uche Idoko
Mercy Ezehi
Olufumilayo O. Omoyemi
The Rockefeller Foundation is
not responsible for views
expressed in this publication
2
Editorial
Maternal Health
3 Even as reproductive condition is vastly improving for women in Western
countries, the recently concluded International Conference on Maternal Health
(Washington, USA, June 9, 2010) confirms in its distress communiqué to G8/G20
4 governments that both maternal and child mortality rates in West Africa are on
the rise and among the highest in the world roughly 225 women and 1200
children die every day from complications in childbirth. Scientific studies on
5 Benin, Mali, Burkina Faso, Cote d'Ivoire, and Nigeria show hemorrhage (30
percent), Sepsis (18 percent), Eclampsia (13 percent), and Abortion (10 percent)
are dominant causes (85 percent) of all childbirth deaths.
Keeping this in perspective, the World Health Organization (WHO) says
7
access to basic obstetrical resuscitation units is central to eliminating this public
health problem; and in this regard success requires multidisciplinary approaches
8 to prevention and management of cases. Health policy initiatives at the global
level and advocacy efforts must also compliment community based support
9
systems designed specifically to eliminate infra-structural obstacles to delivering
quality maternal services, such as limited access to healthcare due to high costs,
lack of trained staff and midwifery services, inadequate basic medical supplies,
poor transportation, and insufficient information about nutrition and general
11 wellness.
Persistent cultural norms are also slowing progress. For instance, girls in
most Francophone countries forced into early childbearing at age 10-15
frequently suffer premature delivery, with death rates of 1000 per 100, 000
births. The United Nations Population Fund (UNFPA) wants this primitive
tradition abolished, because it violates international human rights standards and
induces untold psychological and physical traumas, which victims can perhaps
contain if empowered to delay their first birth through the use of contraceptives.
Indeed, family planning can minimize abortion related fatalities in countries
where the pill is outlawed and unprepared pregnancies are handled with deadly
consequences by quack doctors.
Maternal mortality needs to be tackled at all its multiple levels and several
pilot programs and legal enforcement mechanisms are already in place for that
purpose: The West African Health Organization (WAHO), the health appendage
of the Economic Community of West Africa States (ECOWAS), is harmonizing
policies among Health Ministries across the region and ensuring transfer of
appropriate technical support for capacity building among professionals in
healthcare.
Among scores of regionally based organizations in the sector, the Action for
West Africa in Reproductive Health (AWARE-RH) is constructing integrated
models for managing childhood illness and leveraging external donor sources
toward managing obstetric complications. Despite scarce resources, a number
of governments (The Gambia and Benin) are testing promising interventions to
ensure women's reproductive health requirements are integrated well into
national development planning. Caring for the health of mothers strengthens
the foundation of constituent communities and yields political dividends fo
societyr leaders and public officials.
Okon Akiba
Nigerian Vision on Key Opportunities for
Safe Childbearing
“No woman should have to pay with her life for giving life” … on my travels around the world, particularly to its poorest
and most troubled places, I have learned that it is mothers who keep families together indeed, who keep entire
societies intact. Mothers are society's weavers. They make the world go round … Yet too often, the world is letting
mothers down.” Ban Ki Moon, UN Secretary General, on the rate of maternal deaths in Sub Sahara Africa.

N igeria stands out as one of

the richest countries in
Africa due to its oil resources, but
ironically the country has one of the
worst maternal death rates in the
region, with more than 55% of its
population living in relative poverty.
According to the most recent Multi
Indicator Cluster Survey (MICs)
conducted by the National Bureau
for Statistics in 2007, maternal
mortality ratio is estimated at 800
deaths per 100,000 live births. This
research also found a significantly
higher rural urban Maternal
Mortality Ratio to the tune of 823 to
531. The North East has the highest
ratio 1,549 per 100,000 live births A typical scene in a maternity ward in a Nigerian hospital www.forwarduk.org.uk
compared to 165 in South West
Nigeria. Some of the factors driving
In recent years, starting from 2006 the C e n t r e s , i m p r o v e m e n t o f
maternal mortality in Nigeria
Fe d e ra l G o ve r n m e nt o f N i ge r i a emergency and obstetrics care unit
include: low quality of health
recognizing the significant through the upgrading of facilities
delivery, poor attitude to In order to risks of missing the a n d s t a f f i n g , t r a i n i n g a n d
ante natal and post address maternal mortality, health related deployment of retired and fresh
natal care, delay in the Nigerian government ought to Millennium graduates from midwifery
s e e k i n g commit 15 percent out of its total annual Developme i n st i t u t i o n s to r u ra l a re a s ,
professional budget as a replacement for the current 5 n t G o a l s distribution of insecticide treated
services and percent being expended. Some interventions like the
( M D G s ) nets which serve as incentives
h a r m f u l free ante natal services, midwifery service scheme and to visiting pregnant women, and
appears
c u l t u r a l other safe motherhood interventions should be scaled
t o h av e advocacy and campaign in rural
practices. up to benefit more rural communities; and there is
accorded a r e a s o f t e n l e d b y N o n
Some of the urgent need to strengthen the data system in rural
m o r e Governmental Organisations.
most common areas in order to generate accurate and reliable
attention to On the other hand, many civil
statistical information base necessary for
medical causes of
planning. m a t e r n a l society organisations and religious
maternal deaths in
health than in groups are making tremendous
Nigeria include:
the previous years. contribution to halt maternal
h e m o r r h a g i n g , u n s a fe
Some of the strides taken mortality in Nigeria: In addition to
abortion, anemia, malaria, toxemia
i n c l u d e t h e c o n s t r u c t i o n a n d providing health care services to
and sepsis.
rehabilitation of Primary Health Care community members, there is also

32
 increased demand for ministry of health or its designated office should serve as a reference point for data
accountability on the part of the on maternal health in Nigeria; the anti graft agencies must begin to check corrupt
government and that all related practices in the health sector which should be tied to result based budget
organs should be more transparent performance and erring officers or contractors should be punished in ways which
and accountable to the citizens on adequately serve as deterrence against unacceptable bureaucratic practice. .
the health sector expenditure. In In conclusion, Nigeria has an obligation under its constitution and ratified
spite of the efforts mentioned human right instruments to protect and guarantee the rights and well being of its
above, there has been a constant citizens irrespective of their sex or status. There is no excuse not to meet these
increase in the rate of maternal commitments, especially regarding the specific case of marginalized women
death since 2000. Current statistics seeking basic healthcare. -Ezehi M.
s h o w t h at t h e s i t u at i o n i s
worsening, projecting a worrisome Questioning the Quality of
figure of 1,064 per 100,000 instead
Cote d'Ivoire's Maternal
of the target of 176 by 2015.
In order to tackle these challenges,
Services
health sector concerns have been
incorporated into the long term
development policy of the present
government, which is called the
Nigerian vision 20:20:20. The
ministry of health, with support
from donor agencies, has
developed a number of multi
sectoral policies and frameworks to
address the health sector
challenges, key among them are:
the National Reproductive Health
Policy / Framework developed in
2001 and 2002, National Policy on
Sustainable Development (2004),
and the Birth Prepared Plan
launched in 2005. As good as these
policies may appear, what is lacking
is the political will and the resources
A group of women at a maternity centre in Cote d’ Ivoire www.msf.org.au
to implement them.
In order to address maternal Maternal Mortality rates are on the mortality. The maternal mortality
mortality, the Nigerian government rise in most developing countries, with rate went from 597/100,000 live
ought to commit 15 percent out of the highest rates recordings in Sub- births in 1994 (EDS 1994) to
its total annual budget as a Saharan countries and Cote d'Ivoire 690/100,000 live births in 2000
replacement for the current 5 provides a mirror into the extents of the (annual report UNFPA 2005),
percent being expended. Some problem. Maternal mortality rates are making Côte d'Ivoire a country with
interventions like the free ante natal relatively high in this country, with six one of the highest maternal
services, midwifery service scheme deaths per 1,000 births, according to the mortality rates.
and other safe motherhood UNDP. On average, 35 percent of infant The main, direct causes of
interventions should be scaled up to deaths occur during the neonatal period. maternal deaths in Côte d'Ivoire are
benefit more rural communities; Neonatal mortality is estimated at 62 hemorrhages (34 percent),
and there is urgent need to deaths for 1000 live births, while infant infections (21 percent), risky
strengthen the data system in rural mortality is 125 per 1000 (MICS 2006). abortions (18 percent),
areas in order to generate accurate Infections, low birth weight, respiratory hypertensive illnesses (16 percent)
and reliable statistical information problems and cerebral anoxia are the and dystocia (11 percent),
base necessary for planning. The major causes of this high neonatal compounded by indirect causes

4
such as malaria, anemia, over age 39 and those of high parity, will act as pregnancy monitors, and
malnutrition, hepatitis and help to reduce maternal mortality. The provide referral services for
H I V/ A I D S . T h e w e a k lack of services, both human and physical, pregnant women with
p r e g n a n c y results in many readily avoidable complications to health care
surveillance rate maternal deaths in Côte facilities. Doctors and nurses should
(36 percent), d'Ivoire, particularly among train to acquire skills essential to
the little the rural poor. This unmet cope with obstetric emergencies,
number of need requires that and traditional births attendants
d e l i ve r i e s emergency obstetric (TBAs) should be trained in basic
assisted by services be extended and hygiene to prevent infection. Health
a qualified t h at t h e q u a l i t y o f facilities in this country should be
b i r t h services be improved. renovated and upgraded as well as
attendant (45 In order to help mobilize increase the supply of clinical
percent), the weak such obstetric and equipment needed to integrate
assistance during gynecological services, integrated reproductive health within existing
obstetrical complications (42 approaches can be implemented by both primary health care facilities.
percent), and the little use of government and international donor Integrated approaches to
caesarians (0.78 percent) all agencies. The programmes can make use healthcare are found in small
contribute to this high mortality of traditional and popular media to create measures in Gabon, Niger, Nigeria
rate. The health system, although awareness about the importance of and Uganda.
reactivated in 2005, still lacks family planning and of ante- and -Idoko, U.
qualified personnel. Côte d'Ivoire's postnatal care, and attended deliveries as
infant and under-five mortality essential means of improving
rates are among the highest in the r e p ro d u c t i v e h e a l t h . Vo l u n t e e r
world. practitioners and full time health workers
Cote d'Ivoire's civil war wiped help in training lower level health care
out the health sector in the rebel- providers to distribute contraceptives,
held north, dramatically reducing
the number of available doctors
and health workers. The departure
of health staff and the decline of
functioning clinics and hospitals
are believed to have led to an
increase in maternal mortality rate
in the country. A study said that in
addition, nearly 80 percent of
health facilities in rebel territory
were looted or destroyed and
remaining clinics lacked equipment
and essential drugs.
In general, high levels of
maternal mortality indicate
weaknesses in the coverage and
quality of reproductive health
services, including family planning
A mother showing off her set of twins after a successful delivery http://farm5.static.flickr
in Côte d'Ivoire. Improving access
to, and availability of, quality family
planning information and services,
particularly among high-risk
groups such as teenagers, women

5
 Monitoring Success in Benin's Maternal
Healthcare Sector
M aternal mortality, also
known as obstetrical
death, is the death of a woman
during or shortly after pregnancy. In
2000, the United Nations estimated
global maternal mortality at
529,000, of which less than 1
percent occurred in the developed
world and their causes have been
medically preventable for decades.
Maternal mortality rates in Africa
are roughly 200 times higher than in
developed countries.
By way of a background, Benin
Republic is located in the Gulf of
Guinea and its population is rather
young, with 49 percent aged less
than 15 years. Mean reproduction
rate is 5.7 children, which means
that the fertility rate is high with
implications that maternal mortality
is apparently high. However, one
third of the people live under the
poverty line. The economy is based
on agriculture, which is a source of
income for 56 percent of the
population. Benin is ranked 163rd
out of a total of 177 countries
surveyed, according to the United
Nations Human Development
Index (2006).
In Benin, there is a
slight drop in child
mortality but
maternal mortality
and morbidity
indicators are
i n c r e a s i n g ,
notwithstanding a
satisfactory provision of
maternal and adolescent
health care. According to data from
the World Health Organization
(WHO), 9 out of 10 pregnant women
65
in Benin use antenatal consultation
services. About 22 percent of childbirths
still occur at home especially in the
northern parts of the country; in the rural
areas the figure of unattended
homebirths is 26 percent and 43 percent
in the poorest rural households.
Infrastructures needed for satisfactory
emergency obstetrical care are still
poorly developed, and harmful practices
such as female genital mutilation still
occur and pose grave challenges to the
health of women and young girls.
Looking beyond direct causes, there are
A woman and children attending a clinic in Benin
Www.endpoverty2015.org
subsidiary, indirect environmental factors
accelerating the high rates of maternal
mortality in Benin: communicable
disease such as malaria remains the first
cause of medical consultations in health
establishments, followed by acute
respiratory infections, and
gastro intestinal
d i s o r d e r s .
Hypertension, obesity,
t o b a c c o
consumption,
alcoholism, and
physical inactivity are
a d d i t i o n a l fa c t o rs .
Concerning sanitation and
environment facilities, 66
percent of households have access to
drinkable water, but only 38 percent of
households are equipped with modern
sanitary details for sewage disposal.
Air pollution is high, with a daily
emission of 83tons of carbon
monoxide in the major towns of the
country. The development of health
services is adequate: 77 percent of
the population live at less than 5km
from a health establishment,
though only 44 percent are believed
to be making use of available
facilities, perhaps due to high
cultural norms that in part prohibit
women from seeing male doctors
and many prefer herbalists and
p ra c t i t i o n e rs o f t ra d i t i o n a l
medicine.
Female genital mutilation is still
practiced in Benin, with deadly
consequences for women. The first
reliable evidence indicating that
female genital mutilation can
adversely affect birth outcomes was
shown in a study conducted by
leading African and international
researchers in the National Centre
for Epidemiology and Population
Health at the Australian National
University. The study involved
28,393 women in 28 obstetric
facilities in six countries: study
results showed that in Burkina Faso,
Ghana, Kenya, Nigeria, Senegal and
Sudan, women who have had
Female Genital Mutilation (FGM)
are significantly more likely to
experience difficulties during
childbirth. For Benin, eradicating
the practice of female genital
mutilation will be a first important
step toward reducing maternal
mortality.
-Omoyemi, O.O.
Strengthening Pro-poor Healthcare
Initiatives for Pregnant Women in Rural
Guinea
W est Africa has perhaps the
highest rates of maternal
mortality in the world, and the
condition is most severe in poorer
countries such as Guinea, in which
one woman dies in every 100 live A cheerful mother
births, and women in rural areas are and her baby.
at particularly higher risk than their www.endpoverty
counterparts in the urban areas. In 2015.org
view of high maternal mortality
rates, the government in Guinea
has designed a programme that
offers free cesarean procedures to
help pregnant women give birth.
However, health workers are
concerned with the lack of
transportation (or lack of resources southeastern Guinea have found an impact in the community. He said
to secure transportation), which is innovative solution that is proving to be they can now reach pregnant
most likely to undermine the effective in combating both maternal and women in even the farthest villages.
prospects of poor families availing child mortality. They are using a system of This access to healthcare would not
themselves of government's 'motorcycle ambulances;' these are have been possible without the
generosity in terms of the offer of three-wheeled motorbikes outfitted with motorcycles. Thanks to them, he
free medical operations for difficult small trailers that can carry one health says, more women and babies are
pregnancies. worker and a reclining patient. A regional
alive.
Nevertheless, Mariam Balde, a hospital in Kissidougou performs as many
The motorcycle ambulance
20-year old mother of twins is a as 30 cesareans each month all paid for
service commenced in 2008 and is
happy beneficiary of this scheme. by the Government of Guinea.
Motorcycle ambulances are usually provided as part of an initiative by a
She says she had to have an
parked at rural health centers around the local health co-operative called
operation because the babies were
region ready, day or night, to pick up M U R I G A . T h e f i rst M U R I G A
in the wrong position and they
pregnant women from interior programme was established in 1997
could have died without the
villages and bring them to as a collaboration between
operation. She did not know what a
h e a l t h c e n te rs fo r the government of
cesarean was or that she needed
medical attention and Guinea and the
one, but that she is grateful. She
if it becomes United Nations
now encourages all women to get
necessary, to take Children and
their prenatal checkups and to
them on to the Education Fund
come to the hospital immediately if
regional hospital. (UNICEF).
they are having complications with
And this ride is Noting that the
their pregnancy or childbirth.
free. high cost of
As stated earlier, infrastructural
One practitioner, prenatal care was
problems such as impassable roads
Mory Sano, who is the discouraging poor
during rainy seasons in rural areas
do limit access to healthcare chief medical officer at the women from seeking
facilities. In the face of this rural health center in treatment, MURIGA
challenge, some rural communities Fermissedou, says their motorcycle proposes a yearly membership fee
in the Kissidougou region of ambulance has had a profound positive of about $3.00 and the association

7
 will cover all the health care costs
associated with a member's
pregnancy. MURIGA hopes to
extend its insurance coverage to all
children under the age of 5 in the
Kissidougou region. If this is done
successfully, it will greatly reduce
child mortality rates in the region,
which is currently high by
international standards.
Risks of Childbirth in Sierra
Leone and Liberia
M aternal mortality is
defined as the death of a
woman during pregnancy or within
42 days following birth due to
causes directly or indirectly
associated with the pregnancy. To
deal with this problem, the
Millennium Development Goals
(MDGs-5) seeks specifically to
'improve maternal health, reduce
related death rates by three
quarters, between 1990 and 2015,
and increase the number of births
attended by skilled health
personnel.
In Sierra Leone, there are 2100
deaths per 100,000 live births; this is
the highest rate of maternal
mortality in the world. Estimates
reveal that 1 in 8 women dies during
pregnancy or childbirth in Sierra
Leone compared to the recorded 1
in 76 average in the rest of the
developing world and 1 in 8,000 in
the developed world. In Sierra
Leone, less than 1 in 5 births are
carried out in health facilities while
only 30 percent of Liberian mothers
give birth with skilled health
workers in attendance. According to
The Lancet, maternal mortality rates
in Sierra Leone are 2,100 times
higher than the rates in the Republic
of Ireland where maternal mortality
is 1 per 100,000 births and only 1
8
C o m m e nt i n g o n t h e M U R I G A
initiative, the UNICEF country
representative in Guinea, Julien Morcom-
Harneis, commended the initiative saying
they “have achieved extraordinary
success and I hope we can find ways to
replicate this system around the country.”
It is hoped that the elections in Guinea
this month will usher in a government
out of 47,600 pregnant women is likely to
die. In China, maternal mortality is 45 per
100,000 births and only 1 out of 1300
women who gives birth is likely to die in
China. If you were a child born in Sierra
Leone today, you have a more than 25
percent chance of not living to cut your
fifth birthday cake. In Liberia, the story is
not very different. Results from the most
recent survey conducted in 2007 show
that for every 100,000 births, 994 women
died (compared to 578 deaths per
100,000 in 1987 before the civil war).
Between 2007 and 2010, not much has
improved; in February 2010, officials of
the Liberian Ministry of Health revealed
that maternal mortality figures have gone
up from the 2007 findings. Maternal
mortality rates in Liberia are only second
to figures recorded in neighbouring Sierra
Leone.
There are a few who argue that the
current statistics and figures do not
indicate deterioration in the situation but
improvements in data collection
methods. However, the general
consensus is that with 994 deaths per
100,000 births, in Liberia and 2100 deaths
per 100,000 births in Sierra Leone,
mothers are endangered species in these
countries unless drastic measures are
undertaken. In Sierra Leone, about 50-
60% of the complications that occur
during childbirth are due to blood loss or
chronic anemia; and poor nutrition is the
that will consolidate this scheme
and support initiatives like MURIGA
across the country. Perhaps
combating maternal mortality could
grow to become a success story that
Guinea can share with other West
African countries.
-Nengak, D.
-
leading cause of anemia. This is very
indicative of the general situation in
the region since dieting habits are
poor.
This alarming trend in Sierra
Leone and Liberia is being
accelerated by a myriad of factors:
both countries are post-conflict
states in which governments have
failed to reconstruct the healthcare
facilities destroyed in the war. Like in
other poor countries, there is severe
shortage of all-season roads, lack of
trained health personnel (in part
due to brain drain during the war)
and general high level of poverty. In
Liberia, only 2 of the 4 medical
training institutions in existence
prior to the war are functional and
about 1400 qualified midwives are
needed in the country a far cry
from the current 300 available.
According to UNICEF, the key to
reducing the high rates of maternal
mortality is better healthcare during
pregnancy, delivery and in the
period immediately after childbirth.
Healthcare interventions including
antenatal care, HIV testing, skilled
attendance at birth, emergency
obstetric care and post-partum care
are crucial, but virtually not
available to women in Liberia and
Sierra Leone
Africare Liberia, the Liberian
Prevention of Maternal Mortality
(LPMM), and Equip Liberia are
organisations working to alleviate
the situation.
-Nengak, D.
 Sources
Nigerian Vision on Key Opportunities for Safe Childbearing

-http: // www.uncief.org / infobycountry/Nigeria statistics.html

-http://www.un.org/apps/news/story
-www.nigerianstat.gov.ng
-http://www.un.org/apps/news/story
-http/wharc.freehosting.net
-Mid Point Assessment of the Millennium Development Goals in Nigeria OSSAP MDGs, UNDP
-National Mid term report of the monitoring of the Debt Relief Gains in Nigeria by GPCand CDD
-National HIV/AIDS and Reproductive Health Survey (NARHS)
Questioning the Quality of Cote d'Ivoire's Maternal Services

-Kabba T. Joiner West African Health Organisation Stratégic Plan for the Reducing Of Maternal and Prenatal Mortality
in West Africa. Assembly of Ecowas Health Ministers. Accra 28-29th Oct 2004 (s)
-http://www.plusnews.org/report.aspx?ReportId=39611
-CDI website: http://ochaonline2.un.org/cotedivoire
-Www.maternalmortalitydaily.wordpress.com/
-IRIN News website: http://www.irinnews.org/Africa-Country.aspx?Country=CI
-Www.unicef.org/.../WCARO_CI_Prog_En_ReducingMaternalNeonatalMortality.
-Www.unicef.org/har08/files/har08_CotedIvoire_countrychapter.pdf

Monitoring Success in Benin's Maternal Healthcare Sector

-Http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_ben_en.pdf

Strengthening Pro-poor Healthcare Initiatives for Pregnant Women in Rural Guinea

-http://www.unicef.org/infobycountry/guinea_50063.html
-http://www1.voanews.com/english/news/health/Rural-Guinea-Communities-Find-Creative-Ways-to-Fight-Maternal--
-Deaths-94847499.html
-Http://www.uneca.org/mdgs/MDGs_in_Africa.pdf

Strengthening Pro-poor Healthcare Initiatives for Pregnant Women in Rural Guinea

H t t p : / / w w w. u n i c e f. o r g / i n f o b y c o u n t r y / g u i n e a _ 5 0 0 6 3 . h t m l
http://www1.voanews.com/english/news/health/Rural-Guinea-Communities-Find-Creative-Ways-to-Fight-Maternal-
Deaths-94847499.html
http://www.uneca.org/mdgs/MDGs_in_Africa.pdf

Coverpage picture www.voa1.org

9
 Monthly News and Current Affairs
The United States government
recently expressed its readiness
to work with the Economic
Community of West African
States (ECOWAS), to enhance
security in the Gulf of Guinea.
The US ambassador to Nigeria,
Robin Sanders, told journalists
on May 30 that the approach so
far adopted by the United States
“has been not only to work with
ECOWAS on Gulf of Guinea
security but also to make sure we
have a comprehensive approach
with the other countries along
the coast; we see ECOWAS' key
role as a regional leader and a
re g i o n a l re p re s e n t a t i v e ,”
Sanders said.
Www.punchng.com/Articl.aspx?
theartic=Art201005313223295
The 2010 Annual Meetings of
the African Development Bank
(AFDB) Group opened on
Thursday, 27 May 2010 in
Abidjan, Cote d'Ivoire. The
meeting brought over 2000
delegates together in the city
of Abidjan, which remains the
institution's statutory
Headquarters, though the
Bank was forced to temporarily
relocate to Tunis, Tunisia
following outbreaks of violent
in Cote d'Ivoire. The meeting
had in attendance Governors
representing 53 African and 24
10
non-African shareholders. The
meeting also re-elected the Bank
Group's President, Donald
Kaberuka, for a second five-year
term, and increased the
institution's number of
constituency chairs from 18 to 20.
http://allafrica.com/stories/20100
5300003.html
Seven alleged drug traffickers on
the United States' most wanted list
have been arrested at Liberia's
Roberts International Airport in a
joint operation by Liberian and US
security operatives on Wednesday
June 2nd 2010. According to the
authorities, the accused persons
were from Russia, Sierra Leone,
Nigeria and Ghana. Liberia's Defense
Minister, Brownie Samukai, said the
alleged traffickers were trying to
transport the drugs to the United
States using Liberia as a transit point.
The operation, he said, would have
brought into Liberia 4,000 kilograms
of cocaine with a street value of
US$100 million dollars.
Http://www.afriqueavenir.org/en
/2010/06/02/suspected-
int%E2%80%99l-drug-traffickers-on-
us-wanted-list-arrested-in-liberia/l
In a rare interview since taking power
in Niger on 18 February, General Salou
In a rare interview since taking
power in Niger on 18 February,
General Salou Djibo has spoken
about the bloodless coup that
ended Mamadou Tandja's rule.
Djibo confirmed that he will hand
over power by 1 March next year
after conducting elections. He
spoke to the media at the France-
Africa summit in Nice, France.
Defending the core reasons for
army intervention in civilian
politics, he detailed as follows:
"You know very well that it was a
very difficult moment for Niger,
the political situation was
critical. We decided to take
responsibility to put an end to
the drifting of the institutions
that could have brought about
disasters. That's the reason why
we, the defense and security
forces, sacrificed ourselves.”
http://allafrica.com/stories/201
006011135.html
The United States government
will expand its support for the
Nigerian Federal Government's
post-amnesty programme in the
Niger Delta, the US ambassador to
Nigeria, Ms Robin Rene Sanders,
said in Abuja on May 30. She made
the pledge while answering
q u e st i o n s a t a fo r u m w i t h
journalists, during which she also
said that the two countries can find
ways to develop policies in periods
following post-amnesty in the Niger
Delta.
Http://www.apanews.net
Hurdles to Better Maternal and Child
Health: An Overview
N umerous reports on the
condition of expectant
mothers in West Africa have
explored the range of clinical,
economic and cultural factors
promoting high rates of maternal
and child mortality: young age and
the low social status of women in
society often means they have little
or no say regarding the frequency of
pregnancy and the number of
children they will have to bring forth
as mothers. Their husbands also
eschew family planning, given the
social prestige that many children
supposedly bestows on them as
fathers; in part this explains why the
region has one of the highest fertility
rates in the world estimated at
roughly 5.5 births per women. This
is not necessarily a good thing
because it is clinically determined by
the United Nations Children and
Education Fund (UNICEF) that the
fifth pregnancy is always bound to
be more fatal for the woman than all
her preceding four pregnancies put
together.
Gynaecologists and reproductive
health expects also condemn the
cultural norms supporting girl
marriage, which they say increases
mortality: children between the
ages of 15 and 19 are two times
more likely to die during pregnancy
or childbirth than women aged 20-
24 because their physical disposition
at those early ages are not fully
formed to cope with the biological
strains and responsibilities of
motherhood. The life of the
pregnant mother and that of the
unborn child are equally in jeopardy
in those conservative societies
where tradition, culture, and religion
prohibit wives to have qualified male
doctors present during child delivery;
they would rather depend on the services
of traditional female birth attendants
untrained in handling serious pregnancy-
related complications such as
hemorrhages, known to claim many lives
during childbirth.
The calamities besetting poor and
conservative households can also be
measured from the point of view of
child mortality in the region: Drawing
from Francophone countries alone, it
is estimated that more than 20
percent of children will die before
they are 5 years old for
c o m p a ra t i v e p u r p o s e s , c h i l d
mortality in industrialized countries is
4-5 child deaths per 1, 000 children.
High child mortality rates in these
instances are organically linked to the
poor health status of mothers and the
socio-economic burdens inherent in
being women. Bad sanitation and
malnutrition place children at high
risks of preventable and treatable
diseases from which hundreds die
each year these conditions also
impact negatively upon the
productive capacities of many poor
households, minimizing the prospects
of children's future growth into
healthy adult citizens.
Remarkable as this may sound,
another nutritional factor endangering
the lives of children is the practice of
forced feeding: more than 70 percent of
mothers surveyed by the Helen Keller
International in the agricultural
communities of Niger admitted to feeding
their new born babies solid food of
millet to induce sleep so they can
have extra time for additional farm
work. Sadly, babies are deprived
the therapeutic, life-giving qualities
of breast milk and so about 300, 000
of them die every year due to
nutritional hazards. Current reports
show that more than one million
babies in West Africa can be saved
every year through improved
breastfeeding practices.
In addition to all these, war,
AIDS, and famine have brought to
West African women and children
new life-threatening experiences
that must be urgently addressed
jointly by both the international
community and local health
institutions.
At the very elementary levels of
intervention, the Ministries of
Health in Senegal, Ghana, Benin,
and Nigeria are doubling official
efforts to improve access to clean
and safe water supply in many rural
areas. It is hoped that solving the
water problem will encourage many
professionals such as health
workers, to stay and work in
marginal communities, thus
impacting positively on the
provision of local services. There
are additional expected dividends
from explorations for improved
access to safe water supply:
providing hygiene training for
community members and mothers
via regular meetings will bolster
community awareness about
sanitation and reduce the spread of
water borne diseases.
-
11
Conversation
Maternal Health in West Africa
Excerpts from a conversation with Dr. Terna Nomwhange,MBBS,MSc(LSHTM),DTM&H(RCP), held on the 15th June 2010. He is an
International Health Consultant with EnnyNite Emergencies & Medical Services Abuja, Nigeria. ( The interview was conducted by the
editorial team).
West Africa Insight: We need clarity
for the term 'maternal mortality.'
Dr.Nomwhange:This simply means
the death of a woman while
pregnant or within 42 days of
t e r m i n a t i o n o f p r e g n a n c y,
irrespective of the duration and site
of the pregnancy, from any cause
related to or aggravated by the
pregnancy or its management but
not from accidental or incidental
causes. Another term commonly in
use to describe this condition is
'maternal deaths.'
West Africa has the highest rates of
maternal mortality in the world. But
some quarrel about the precision of
the estimates.
According to available data, this
s e e m s to b e a s p re c i s e a s
scientifically possible at the
moment. Various measures have
been accepted by international
experts concerning maternal
mortality. Maternal Mortality Ratio
is defined as the number of maternal
deaths in a population divided by
the number of live births; thus, it
depicts the risk of maternal death
relative to the number of live births.
By contrast, the Maternal Mortality
Rate is defined as the number of
maternal deaths in a population
divided by the number of women of
reproductive age; thus, it reflects
not only the risk of maternal death
per pregnancy or per birth (live birth
or stillbirth), but also the level of
fertility in the population.
Major causes of maternal mortality
should include infra-structural and
cultural factors.
From public health perspective, the
major causes of maternal mortality
can be stated in terms of the 4-
Delays (4Ds): delays in deciding to
seek health care, transporting client
to health facility, delays in reception
Centre for Democracy and Development,4 Kikuyu Close, Off Nairobi Street, Wuse II Abuja.Tel:+234(0)9 6716454
Website:www.westafricainsight.org
Dr Terna Nomhwange
MBBS,MSc(LSHTM),DTM&H(RCP)
At the health facility and delays in
instituting treatment needed at the
hospital. From a clinician /physician point
of view (which is based on aetiology) the
f i ve m o st co m m o n ca u s e s a re :
hemorrhaging(bleeding) before or after
delivery of the baby; sepsis(usually
during or after delivery; Eclampsia
(seizures associated with increased blood
pressure before, during or after delivery);
Prolonged and obstructed labor
(especially where trained health
personnel are not available); and Unsafe
abortions(termination of pregnancies
before 20 weeks in unclean settings by
untrained personnel) An estimated 74
per cent of maternal deaths are
preventable.
Compared to Western countries how are
West African countries doing?
Western countries have conditions that
are more advanced than those existing in
West Africa, so a comparison is unfair;
they have better trained professionals
and quite advanced systems in terms of
modern health facilities, equipment and
technology. Considering the healthcare
systems in place in West Africa, I feel
progress is being made in a few countries
but achievements are not uniformly
spread across the region.
The differences in performance may be
Email:cddabv@cddwestafrica.org
measured in terms of regional
variations in their Maternal
Mortality Ratios (MMR): West Africa
956 deaths /100,000 live births;
Africa (900); the Americas (99);
South-east Asia (450); Europe (27);
Eastern Mediterranean (420);
Western Pacific (82).
In these circumstances the reader
would want to know the extents to
which National Governments, Civil
Society and family units are
collaborating to nudge in the
direction of change.
I think there is considerable effort
being made to in sub-Saharan Africa
and in West Africa too to reduce
maternal mortality, in line with the
Millennium Development Goals of
the United Nations, specifically Goal
5. Also, it has encouraged foreign
and domestic increases in funding
and technical support to developing
countries in terms of health system
reforms, training, and health
education. Equally, traditional birth
attendants are being trained to take
deliveries safely (clean deliveries)
and also to be able to detect what
we call “danger signals,” which must
prompt timely transfer of a women
to the nearest health facility.
In the long run, something must be
done to effectively combat maternal
mortality in the region.
Simply put, the issues that need to
be addressed in the long term are
women empowerment, better
health care systems, reduction in
poverty rates, provision of water,
improvements in sanitation, and
elimination of harmful cultural
practices such as child marriage, and
female genital mutilation.
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