Healthcare successes in BurundiIn Burundi, over 65% of people live in poverty. The country has the highest rates of malnutrition in the world, the presence of disease is widespread and only 32% of children make it through the equivalent of middle school. Despite these statistics, recent healthcare successes in Burundi are creating many improvements for the country.

5 Healthcare Successes in Burundi

  1. USAID providing health services. Burundi’s health systems aren’t adequate for the 11.5 million people living there. Fortunately, outside organizations are supporting the country. USAID has backed efforts in Burundi that assist with child and maternal services, HIV/AIDS, malaria and malnutrition. By providing support for the Government of Burundi’s plan for HIV/AIDS prevention, USAID has also assisted in expanding control for and education about HIV. Besides HIV, there is currently a malaria epidemic in Burundi. Since 2019, there have been six million cases, but USAID has introduced treatment, prevention and testing options to the country, helping to combat malaria and trace the spread of infections. About 56% of children in Burundi live without access to the necessary amount of food, but USAID hopes to curb these numbers. The organization offers supplements and nutrition lessons to pregnant mothers and young children to assist with malnutrition. The services that USAID provides help the Burundi healthcare systems in multiple aspects. They have allowed for improved service delivery, better treatment for childhood diseases and viruses and more accessible medicine and assistance during pregnancy.
  2. A $5 million grant in response to COVID-19 from the International Development Association. On April 14, 2020, this grant was approved by The World Bank and gave Burundi the chance to build up its health services as the COVID-19 pandemic began. Burundi was originally not in a position economically to handle this pandemic. The grant has given the country more access to testing, equipment, facilities and health professionals. Along with this, it has helped to reduce the spread of the virus through strategies that improve communication and tracking within the country.
  3. Improved financial access to healthcare in Burundi. In 2002, Burundi implemented a policy to perform cost recovery and provide financial relief to citizens that can not afford necessary healthcare. This exemption allows more citizens to get proper treatment and not be concerned about being forced further into poverty because of medical bills.
  4. The Global Alliance for Vaccines and Immunizations. The Global Alliance for Vaccines and Immunizations was launched at The World Economic Forum in January 2000. This alliance includes the World Health Organization, The Gates Foundation, UNICEF and many similar organizations. It aims to provide more access to new vaccines to children in countries like Burundi. Between 2005 and 2008, the Alliance donated $800 million to 72 underdeveloped countries to help increase vaccinations, fund health systems and provide healthcare services. This assistance created many new healthcare successes in Burundi. For example, Burundi has trained more people in midwifery, meaning there has been an increase in safe, assisted births. The country has received an average of $3.26 million annually from the Global Alliance for Vaccines and Immunizations. Additionally, healthcare workers have received more training and there has been increased coverage of immunizations.
  5. Reduced HIV/AIDS and new health ministries. From 2000 to 2013, HIV infections decreased by 46%. Civil conflict in Burundi between 1993 and 2003 caused the rapid spread of HIV in the country and a fractured health system. The government initially divided the health and HIV/AIDS ministries, causing political turmoil. But then non-governmental organizations stepped in, started HIV-specific clinics and offered incentives to health personnel working with HIV.

What Does This Mean for Poverty in Burundi?

These healthcare successes in Burundi are creating economic, social and physical improvement for the country. Malnutrition, the rate of disease and poverty are all decreasing. These operations expand beyond just healthcare, though. They reach every aspect of living in Burundi. They create opportunities for more children to thrive in school and more people to go to work. Ultimately, these opportunities lead to economic growth and a more sustainable country.

– Delaney Gilmore
Photo: Flickr

Neonatal disorders in TanzaniaIn Tanzania, neonatal disorders are the leading cause of death. Each year, 51,000 babies die within the first month. Nearly 66% of neonatal disorders in Tanzania are avoidable with proper access to essential care for both the child and mother. Recognizing this, Tanzania has plans in place to reduce both maternal and child mortality rates in the country.

Causes of Neonatal Deaths

The hospitals and pharmacies in Tanzania lack access to the proper equipment for cleaning, sterilization and treatment. Roughly 37% of pharmacies and 22% of health facilities do not have access to injectable antibiotics. Furthermore, about 60-80% of pharmacies and health facilities do not have resources for sterilization. In addition, 50% of health facilities do not have access to soap, water or hand sanitizer and 20% do not have disinfectant products.

This lack of resources has a significant impact on neonatal disorders in Tanzania. Infections are common among newborns and difficulties are frequent among mothers without proper attention and treatment in a sanitary medical facility. In Tanzania, asphyxia accounts for 22.3% of early neonatal deaths, respiratory distress accounts for 20.8%, preterm birth accounts for 12% and sepsis accounts for 11.6% of neonatal deaths. Furthermore, malaria, meningitis and pneumonia contribute to 7.4% of neonatal deaths. The added risk of maternal complications cause 8.6% of deaths among newborns.

How Poverty Impacts Care

Throughout the country of Tanzania, there are vast disparities in healthcare in different regions. This variance is because of varying economic development throughout the country. Areas that are more developed and advanced, with less poverty, can provide better assistance to patients because the areas have more resources to rely on. At the same time, mothers and children with improved chances of survival are able to economically contribute to decreasing poverty.

Tanzania aims to lower its neonatal mortality rate. Doing this will put the country at a lower risk of overpopulation and will reduce the 27.2% poverty rate, which affects hospitals’ abilities to care for and protect their patients. The health facilities cannot provide the necessary treatment, medical resources and medical staff without the necessary funds. Tanzania recognizes that an increase of neonatal deaths means the country will continue to struggle with poverty. The only way to address this is to focus on improving conditions for mothers and children.

One Plan II

Announced in 2016, the Tanzanian One Plan II places access to reproductive health services and reducing infant and maternal deaths as the priorities for the country. The ultimate objective of this plan is to improve the welfare and success of the country by improving neonatal healthcare. The original One Plan began in 2008 and established many of these same goals to be met by 2015.

The One Plan established the goal to lower the neonatal mortality rate to 19 out of 1,000 births by 2015, but this was not achieved. In 2015, neonatal mortality stood at 22%. However, there was progress in other areas as the number of women giving birth in the presence of a qualified professional increased from 43% in 2004 to 51% in 2010. At the same time, the number of women giving birth in proper health facilities also increased. In 2014, the maternal mortality rate was 574 deaths per 100,000 births.

A Hopeful Future

Since the start of the One Plan II and other similar plans, neonatal disorders in Tanzania have declined. The latest neonatal mortality rate is now 20 deaths per 1,000 live births. Additionally, the maternal death rate has continued to decline to 524 deaths per 100,000 live births in 2017. As the country makes this progress, it also hopes to see progress economically. Vaccinations, sanitization efforts and health facility progress allows Tanzania to not only improve survival rates but also fight the widespread poverty in the country.

– Delaney Gilmore
Photo: Flickr

Spreading Awareness About Fistulas in ZambiaFistulas in Zambia are still a devastating problem for impoverished, young mothers despite being preventable. An obstetric fistula occurs when a mother endures prolonged (oftentimes up to five days long) labor in which obstruction occurs. This obstruction then cuts off the blood supply and causes tissue death. Tissue death leads to holes between the vagina and bladder or rectum. Without treatment, fistulas can mean a woman will “uncontrollably leak urine, stool or sometimes both” for a lifetime. The Fistula Foundation and other organizations seek to help women suffering from fistulas in Zambia.

The Cost of Fistula Surgery

The fistulas come with a myriad of infections and chronic pain and can even cause nerve damage to the legs. While fistulas in Zambia are completely preventable and treatable, there are significant barriers to care for mothers. The surgical costs range from $100-400, an expense that is often far higher than what the majority of patients can afford.

4 Factors That Increase the Risk of Fistulas

  1. Malnutrition: Persistent malnutrition is linked to the development of a smaller pelvis, which increases the risk of an obstructed delivery, potentially leading to the formation of a fistula.
  2. Child Marriage: Early motherhood means the narrower pelvises of underdeveloped girls make an obstructed delivery more likely.
  3. Lack of Education: When young women are pulled out of school for marriage and childbearing without proper knowledge about their bodies, the delivery process and their reproductive systems, health consequences ensue. A lack of proper reproductive health education leads to a lack of awareness about the preventability and treatability of fistulas.
  4. Poverty: Poverty augments the chance of food insecurity, younger marriage, childbearing and sacrificing a woman’s education for family duties. Even more importantly, poverty makes access to healthcare that much more difficult. Fistulas are also more prevalent in births that take place outside of medical facilities as women undergoing an obstructed delivery are unable to get a C-section or emergency medical assistance.

In wealthier countries that properly address these four issues, fistulas are virtually unheard of, showing that poor health outcomes and poverty are inextricably linked.

Stigmatization of Fistulas in Zambia

While the medical ramifications of fistulas are devastating, these consequences come in conjunction with complete social ostracization and shame. Husbands often view the typically stillborn births that come with fistulas as a failure of the mother. It is very common for husbands to shame and abandon their wives, labeling the woman’s medical issues as personal failures.

Doctors often do not adequately inform women with fistulas that they have a legitimate medical issue. The abandonment from their husbands is soon joined by the same treatment from family and friends. The isolation and stigma increase the risk of depression among women suffering from fistulas. Lack of proper awareness and education means fistulas have become a source of shame. Hence, many women suffer in silence for decades, even until death.

Spreading Awareness Through Radio

In 2017, the Fistula Foundation, a nonprofit dedicated to providing impoverished young women with proper and free medical attention for fistulas, launched a radio program to educate communities about fistulas in Zambia. The program reached extensively into many provinces of Zambia and mobilized many women to seek proper medical care to repair their fistulas at the six Zambian fistula care centers the organization established to perform the reconstruction surgery for free.

In 2019 alone, the Fistula Foundation performed 319 fistula repair surgeries, all free of charge. In total, the Foundation has aided in the provision of 774 surgeries. The Fistula Foundation also partnered with the famous Zambian singer Wezi to air a song about the dangers of fistulas. The spread of this song, through both radio and CDs, has created a surge in Zambian women seeking treatment. As a direct result of Wezi’s song, 56 women have sought treatment.

Grassroots Activism

In conjunction with the awareness campaigns and Wezi’s song, the Fistula Foundation has encouraged grassroots movements like the Safe Motherhood Action Group (SMAG) to work with community volunteers to spread awareness to help prevent fistulas and end stigma. SMAG leads discussions within communities about the dangers of child marriage with regard to the increased rates of fistulas in young mothers, the necessity of keeping girls in school and the importance of delivering children in medical facilities. SMAG has implemented more than 3,000 community outreach programs, reaching more than 90,000 people with crucial information about fistulas and interconnected social issues.

The Fistula Foundation heavily relies on community leaders to spread the word, designating them the “entry points” to communities and change. The organization’s work highlights the importance of creative community engagement and education initiatives in promoting proper care and destigmatization of fistulas in Zambia.

Jaya Patten
Photo: Flickr

Postnatal Care in Kenya
Postnatal care in Kenya lacks proper recognition, however, it is rapidly changing. When it comes to looking after newborn babies and their mothers, the right type of postnatal care is crucial to assure wellbeing. According to the Maternal Health Task Force, more than 60% of the world’s maternal deaths occur during the postnatal period, which is about six weeks after delivery. However, the International Journal of Africa Nursing Sciences reports that this period is the most ignored aspect of maternal care globally. Because of the lack of global acknowledgment, countries suffering from widespread poverty have an even harder time implementing postnatal care policies.

Postnatal Care in Kenya

Kenya tried setting up plans for assistance in the past decades with little success. In 2005, the Ministry of Health in Kenya implemented guidelines increasing the way in which it assesses childcare during the postnatal period. Even though about 80% of the country’s hospitals offer postnatal care, only 42% of Kenyan women give birth in a healthcare facility. This leads to high unreported maternal mortality rates in Kenya. In sub-Saharan Africa, every woman has a one in 16 chance of dying during pregnancy or childbirth.

In order to improve this aspect of the maternal care system, multiple approaches have been proposed as potential solutions to advancing postnatal care in Kenya.

Community-Based Care

Because of these facts, Community Health Workers (CHW) are starting to play a crucial role in healthcare. CHWs can reduce maternal deaths and improve the delivery of healthcare services. Unlike hospitals, CHWs are normally the first point of intersection between the healthcare system and communities. They have more access to mothers who may not be able to afford a hospital birth and can provide them with postnatal care.

Communities select the workers who then serve to give home-based counseling and care services. Because they are well-trained at recognizing diseases, CHWs are held in high regard and receive significant respect in health-related manners. This gives the community the knowledge to know to demand better health services. Additionally, these community workers help link citizens to higher-tier resources.

Better Midwives

In at-home births, midwives are key to ensuring that the whole process occurs smoothly. The Journal of Africa Nursing Sciences states that there should be improved and more professional midwife selections.  There should also be supervision of midwives by supportive initiatives in order to ensure qualifications.

These initiatives support work at all levels of postnatal care while providing midwives with positive encouragement. Strong human resources are also necessary for effectively employing these midwives and securing an improved quality of maternal and neonatal care.

Looking Forward

Access to good postnatal care relates to many broad social issues such as poverty and gender equality. However, many are working for advances in postnatal care in Kenya, laying down the plans to make sure maternal services improve. Hopefully, this will lead to healthier children and fewer deaths during childbirth.

– Jack Parry
Photo: Flickr

African Doulas
African doulas have been gaining popularity in a variety of ways in recent years. Doula Wambui Wanguhu Wanjau, a native Kenyan, trained as a nurse in Sweden and became a traveling nurse in Australia. While she was there, she met doulas: trained professionals who provide emotional, physical and informational support. Doulas play a role throughout a woman’s pregnancy, labor, delivery and postpartum period. When Wanguhu Wanjau returned to Kenya and personally experienced a difficult pregnancy and delivery, she realized that Kenya needed doulas. Doula Wambui then pursued training from Doulas of North America International (DONA), the world’s leading doula training and certification organization. Doula Wambui began her doula practice slowly. Initially, Kenyan women did not understand a doula’s role and why they had to pay someone to labor with them. As women began to realize the benefits of having a pregnancy, childbirth and postpartum coach, Doula Wambui’s practice grew steadily.

Doulas have slowly been gaining popularity in low- and middle-income countries (LMIC) in Africa during the last decade. Among them are Kenya, Uganda, Senegal and South Africa.

Benefits of Doulas

In 2016, the World Health Organization (WHO) developed a Safe Childbirth Checklist. This checklist includes having the presence of a doula at births. WHO asserted that the globe could avoid many of the 303,000 maternal deaths, 2.6 million stillbirths and 2.7 million newborn deaths that occur annually with the support of doulas.

WHO reported that mothers who have a childbirth attendant (family member, friend or doula) in the room during labor need fewer pain medications and have more vaginal births and fewer cesarean, vacuum or forceps births which have more complications. Doulas recognize danger signs in the labor process or in the newborn and alert medical staff. Newborns whose moms have doulas have stronger Apgar scores and bond better with their moms.

Doula Wambui believes that when a doula is present, patients are more likely to avoid a cesarean section. She noted that women with doulas have shorter births. According to Wambui, doulas help them relax so that their bodies can produce oxytocin which is necessary to progress labor.

African Doulas in Uganda and Senegal

Laura Wando, a doula in Kampala, Uganda, shared in a 2016 Daily Monitor article that during the first prenatal visit she discusses birth experience expectations and preferences. She guides the family on what to look for on a hospital tour. On the second visit, she uses a checklist to discuss birth planning. This includes discussion on the various stages of labor, medication and labor positions. During the third prenatal visit, she reviews comfort choices. Doula Wando is on-call two weeks before the due date and visits the family about four days after the birth.

While most African doulas are female, a new movement in Senegal is introducing male doulas to guide men during their partners’ pregnancies. Traditionally, Senegalese pregnancy and childcare are strictly female responsibilities; men do not accompany their partners as birthing partners. The Senegalese version of a doula, a “Bajenu Gox,” or “Godmother” in Wolof, guides women into motherhood. According to a 2021 Euronews story, a group of Bajenu Gox realized that men would benefit from doulas of their own and promoted the idea of male doulas. Now 54 male doulas called “Nijaayu Gox,” or “Godfathers” in the Dakar area go door-to-door talking to men about ways to involve themselves in their partners’ pregnancies and guide them into fatherhood.

The COVID-19 Pandemic and African Doulas

The COVID-19 pandemic has altered the doula role by restricting the number of people allowed in the labor room. Because most African doulas receive the “non-essential” classification, they have had to perform their duties virtually. A 2021 Frontiers in Sociology research report shared the experiences of a South African doula whose client had to choose between her partner and her doula as the one non-essential person accompanying them. Because the doula’s role is different than that of the partner, she implied that the lack of her presence led to an unnecessary cesarean birth.

The researchers shared that as 2020 continued, most doulas adapted to the restrictions and used technology. Many doulas have attended births virtually during the pandemic. One South African doula had her client wear earphones during labor so she could hear her encouragement and guidance. The report explained that doulas themselves disagree about wanting others to consider them essential and allowing them in the labor room. The report concludes, “Now more than ever we need to recognize and support the essential work that doulas do, as well as invest in strategies that increase access to doula care for women worldwide in sustainable ways.”

When the pandemic is over, Doula Wambui plans to seek funding to train community doulas in Kenya. She hopes that more pregnant women will receive emotional, physical and informational support during their pregnancy, childbirth and the postpartum period.

– Shelly Saltzman
Photo: Flickr

Emergency Maternal Transport in Developing Countries
In 2017, across the globe, 810 women died each day from preventable pregnancy and childbirth-related complications. Sub-Saharan Africa has the highest maternal mortality rate in the world. Women face 15 times the risk of dying from pregnancy and childbirth complications compared with women in developed countries. In this region, over half of the women do not have access to emergency obstetric care during labor, citing financial concerns or issues with accessing emergency maternal transport to hospitals. Vodafone and Transaid are organizations working to mitigate the barriers pregnant women encounter in accessing emergency maternal transport in Africa.

During an obstetric emergency, every second a pregnant woman experiences a delay in skilled care, the higher the risks of stillbirth, neonatal or maternal death. Many cases of maternal mortality are due to severe bleeding after childbirth, postpartum infection and blood pressure disorders. All of these are preventable and treatable with timely and skilled care. Urgent emergency maternal transport to adequate health facilities can be the difference between life and death.

Accessing Emergency Maternal Transport in Africa

Demography and Health Survey data from more than 40 countries revealed that while 50% of women cite finances as the primary obstacle for seeking obstetric care and 37% reported transportation challenges. In addition, 37% cited distance to be their main barrier. Access to mobilized vehicles in developing countries is incredibly rare. For example, only one vehicle is available for every 3,000 people. For comparison, in the U.S., there is one vehicle per 1.19 persons.

A study in rural Ghana found that 65% of women use public transport, 29% walk, 4% use personal cars and 1.6% ride by motorbike. However, much of this transportation is inaccessible because of high costs. The distance to an adequate healthcare facility is highly determinant of maternal outcomes, especially in rural areas of developing countries. A study in Southern Tanzania by Lancet Global Health found that “living more than 35 km away from a health care facility has a much higher likelihood of maternal mortality compared with those only living at a distance of only 5 km.”

Even when vehicles are available and distance is not a barrier, insufficient and dangerous road systems inhibit transport to hospitals. In developing countries, poor road networks make access to skilled healthcare challenging, especially for remote, rural areas. With road conditions unsuitable for many vehicles, women have few viable options.

Effective Interventions: Transaid

Organizations involved in transportation interventions often include direct provision of transportation or monetary schemes. This eliminates the financial burden on families seeking emergency maternal healthcare. Dependent on each community, organizations tailor the intervention to best support the residents.

Transaid, in partnership with the National Union of Road Transport Workers, has implemented emergency maternal transport interventions in Nigeria for more than a decade. Transaid’s project “focuses on training and encouraging local taxi drivers to transport pregnant women to health centers.” Drivers are incentivized to volunteer because they receive permission to park in front of the loading queue. This can “potentially save many hours of waiting for passengers.” Transaid has also had a huge impact through its More Mamaz campaign in rural Zambia. The More Mamaz campaign has trained 236 drivers and safely transferred more than 3,500 women to health facilities. The percentage of women delivering at health facilities rose from 64% to 89% from 2014 to 2017.

Vodafone

Vodafone, a mobile technology company, working in conjunction with Touch Foundation, created the m-mama program, a mobile technology program that connects women in rural Tanzania to local taxi drivers acting as “taxi ambulances.” The 24/7 dispatch center is called in an obstetric emergency and the dispatcher skillfully assesses the patient’s condition and connects them to a network of more than 100 taxi drivers responding to emergency calls. Upon arrival at the health center, drivers receive their pay instantly via Vodafone’s mobile money transfer system. Additionally, the service has also trained over 250 community health workers in the Sengemera and Shinyanga states of Tanzania. Vodafone’s successes have led to a partnership with the Lesotho Ministry of Health in South Africa to expand this program.

The Impact of Emergency Maternal Transport in Africa

The results of interventions have been promising. When South Africa issued 18 dedicated vehicles for maternity care, there was a “sustained reduction in mortality.” Similarly, in the Gambia, a “freely available ambulance service in connection with women’s obstetric needs correlated with substantially reduced pregnancy-related mortality.”

In an effort to provide safe, timely and reliable emergency maternal transport to specialized obstetric care, organizations have shown great innovation in how they train, incentivize and mobilize communities to improve outcomes for pregnant mothers.

– Brittany Granquist
Photo: Flickr