Rapid reduction of maternal mortality in Uganda and Zambia through the saving mothers, giving life initiative: results of year 1 evaluation

Serbanescu, Florina; Goldberg, Howard I.; Danel, Isabella; Wuhib, Tadesse; Marum, Lawrence; Obiero, Walter; McAuley, James; Aceng, Jane; Chomba, Ewlyn; Stupp, Paul W.; Morrissey Conlon, Claudia; Conlon, Claudia Morrissey
January 2017
BMC Pregnancy & Childbirth;1/19/2017, Vol. 17, p1
Academic Journal
journal article
Background: Achieving maternal mortality reduction as a development goal remains a major challenge in most low-resource countries. Saving Mothers, Giving Life (SMGL) is a multi-partner initiative designed to reduce maternal mortality rapidly in high mortality settings through community and facility evidence-based interventions and district-wide health systems strengthening that could reduce delays to appropriate obstetric care.Methods: An evaluation employing multiple studies and data collection methods was used to compare baseline maternal outcomes to those during Year 1 in SMGL pilot districts in Uganda and Zambia. Studies include health facility assessments, pregnancy outcome monitoring, enhanced maternal mortality detection in facilities, and population-based investigation of community maternal deaths. Population-based evaluation used standard approaches and comparable indicators to measure outcome and impact, and to allow comparison of the SMGL implementation in unique country contexts.Results: The evaluation found a 30% reduction in the population-based maternal mortality ratio (MMR) in Uganda during Year 1, from 452 to 316 per 100,000 live births. The MMR in health facilities declined by 35% in each country (from 534 to 345 in Uganda and from 310 to 202 in Zambia). The institutional delivery rate increased by 62% in Uganda and 35% in Zambia. The number of facilities providing emergency obstetric and newborn care (EmONC) rose from 10 to 25 in Uganda and from 7 to 11 in Zambia. Partial EmONC care became available in many more low and mid-level facilities. Cesarean section rates for all births increased by 23% in Uganda and 15% in Zambia. The proportion of women with childbirth complications delivered in EmONC facilities rose by 25% in Uganda and 23% in Zambia. Facility case fatality rates fell from 2.6 to 2.0% in Uganda and 3.1 to 2.0% in Zambia.Conclusions: Maternal mortality ratios fell significantly in one year in Uganda and Zambia following the introduction of the SMGL model. This model employed a comprehensive district system strengthening approach. The lessons learned from SMGL can inform policymakers and program managers in other low and middle income settings where similar approaches could be utilized to rapidly reduce preventable maternal deaths.


Related Articles

  • Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda Pearson, L.; Shoo, R. // International Journal of Gynecology & Obstetrics;Feb2005, Vol. 88 Issue 2, p208 

    Unlabelled: The article summarises the baseline assessments of emergency obstetric care (EmOC) carried out in Uganda, Kenya, Southern Sudan, and Rwanda in 2003 and 2004.Objectives: Our objectives were to: (1) set up program baselines on the availability and utilization...

  • Program note: applying the UN Process indicators for emergency obstetric care to the United States Lobis, S.; Fry, D.; Paxton, A. // International Journal of Gynecology & Obstetrics;Feb2005, Vol. 88 Issue 2, p203 

    Abstract: The United Nations Process Indicators for emergency obstetric care (EmOC) have been used extensively in countries with high maternal mortality ratios (MMR) to assess the availability, utilization and quality of EmOC services. To compare the situation in high MMR countries to that of a...

  • Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya. McCarthy, Katharine J.; Blanc, Ann K.; Warren, Charlotte E.; Kimani, James; Mdawida, Brian; Ndwidga, Charity // Journal of Global Health;Dec2016, Vol. 6 Issue 2, p1 

    Background: Tracking progress on maternal and newborn survival requires accurate information on the coverage of essential interventions. Despite widespread use, most indicators measuring maternal and newborn intervention coverage have not been validated. This study assessed the...

  • Attention to the parturient adolescent: access and reception - a descriptive study. Jormanna Pereira Silva, Thais; Veraci de Oliveira Queiroz, Maria; Herculano Campos Neto, Francisco; Peixoto dos Santos Pennafort, Viviane // Online Brazilian Journal of Nursing;Dec2013, Vol. 12 Issue 4, p872 

    Aim: To analyze the access and reception of adolescent mothers in the parturition stage in obstetrics emergencies. Method: This is a descriptive study, with data collected through the interviewing and observation of twelve adolescent mothers, in the Sector of Obstetrics in a tertiary hospital of...

  • The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review. Nwolise, Chidiebere Hope; Hussein, Julia; Kanguru, Lovney; Bell, Jacqueline; Patel, Purvi // Health Policy & Planning;Sep2015, Vol. 30 Issue 8, p946 

    Objective Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing...

  • Stimulating policy debate on blood transfusion services through the work of an emergency obstetric care project in Nepal Clapham, S.; Kafle, G.; Neupane, R. // International Journal of Gynecology & Obstetrics;Feb2005, Vol. 88 Issue 2, p194 

    Purpose: To improve the quality and accessibility of emergency obstetric care (EmOC) at district level.Methods: As the availability of safe and reliable blood transfusion services is a critical component of EmOC, financial and management support was provided to the...

  • Elective cesarean section for preterm intrauterine growth retarded fetuses Gezer, A.; Şimşek, Y.Ö.; Gani, H.; Simşek, Y O // International Journal of Gynecology & Obstetrics;Feb2005, Vol. 88 Issue 2, p138 

    No abstract available.

  • Emergencies Associated With Pregnancy and Delivery: Peripartum Hemorrhage. Kainer, Franz; Hasbargen, Uwe // Deutsches Aerzteblatt International;9/11/2008, Vol. 105 Issue 37, p3 

    The article focuses on the study of peripartum hemorrhage which was known to be associated with pregnancy and delivery. The said medical case has been regarded as one of the leading cause of maternal morbidity and mortality worldwide especially to those patients who have undergone a cesarean...

  • Comparison between the maternity policy and clinical practice in China and the Netherlands. Li Wang; Merién, Ashley; Oei, Guid; Tian Ying; Li Ying // Journal of Chinese Clinical Medicine;2009, Vol. 4 Issue 10, p575 

    Objective The aim of this study was to evaluate the difference and similarity in delivery policy and clinical practice of the two countries, to discuss the experience in reducing maternal mortality in the Netherlands and to provide information which can improve clinical practice and maternity...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics