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Healthcare Centers in Madagascar During COVID-19

healthcare centers in MadagascarSince the coup in 2009, Madagascar’s newly elected government has been working with outside organizations, such as Project HOPE, to improve healthcare centers in Madagascar. In 2020, the country partnered with the Ministry of Public Health and the United Nations Population Fund to provide free transportation for pregnant women during the COVID-19 pandemic.

Healthcare Centers in Madagascar

USAID reported that more than 60% of Madagascar’s population — 27.7 million people — lives more than five kilometers from a healthcare center. This distance takes about one hour to walk. According to the World Bank, the cost of treatment and transportation to healthcare centers can be a barrier for people in poverty to access healthcare. The World Bank reported that about 75% of Madagascar’s population lives below the international poverty line, on less than $1.90 per day. This directly impacts the ability of people to access and pay for treatment at healthcare centers. UN Women statistics show that 75.9% of employed women in Madagascar are below the international poverty line, compared to 73.7% of men.

Released in 2017, a Project HOPE study examined the effects of removing fees at health centers in Madagascar. According to the study, citizens located within five kilometers became more likely to seek treatment. They account for 15-35% of those who reported illness. Fee exemptions for certain medicines and treatments likewise increased the use of healthcare services for maternity consultations by 25%.

Impacts of Limited Transportation

In a report from June 2018, the World Bank wrote that many rural citizens of Madagascar are disconnected from main roads, which limits their access to healthcare centers. Madagascar has a low road density. This means the country’s complete network of roads is small compared to the country’s total land area. As a result, 25% of healthcare centers in Madagascar are located more than five kilometers from the road network.

According to the World Bank report, poor road conditions in rural areas also impact network connectivity. Transportation of medical supplies can be unreliable, specifically during rainy seasons, when roads can be flooded and hard to cross. This makes it difficult for health centers to consistently send supplies to those who cannot access the centers.

Lack of access to transportation can also contribute to keeping people in poverty. The World Bank and the Department for International Development wrote that isolation due to difficulty accessing roads and transportation can limit the ability of people in poverty to participate in local markets. This decreases their economic opportunity.

The Effects of COVID-19

With 908 confirmed cases and six total deaths from COVID-19, the Centers for Disease Control and Prevention has classified Madagascar as warning level three for the pandemic. The country is in partial lockdown. On April 5, President Andry Nirina Rajoelina announced that only vehicles transporting goods were allowed to circulate in the three regions impacted by COVID-19 — Matsiatra, Ambonym Analamanga and Atsinanana. All other public transport was suspended. For some, without public transport, the nearest health center is two hours away.

Solutions

The United Nations Population Fund reported that 44% of women in Madagascar give birth with the help of healthcare professionals. Madagascar’s maternal death rate is 353 for every 100,000 births. According to UNFPA, this rate is high compared to the global average of 216 maternal deaths for every 100,000 births.

The Ministry of Public Health and the UN Population Fund partnered to help pregnant women access healthcare centers in Madagascar. These organizations are providing free, 24-hour transportation for women living in the cities of Antananarivo and Toamasina during COVID-19. By the end of Madagascar’s partial lockdown, this free transportation is projected to help around 5,000 pregnant women.

Poverty impacts peoples’ ability to access healthcare centers in Madagascar due to restricted transportation and high fees. Statistics show this lack of accessibility impacts women slightly more than men. With even fewer transportation options during COVID-19, free transportation for pregnant women is making a positive impact on healthcare accessibility.

– Melody Kazel 
Photo: Flickr

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Addressing Disparity Gaps in Women’s Health in Mali

How Emergency Transportation Has Addressed Disparity Gaps in Women's HealthIn September 2017, the United States Agency for International Development’s (USAID) High Impact Health Services Project constructed emergency transport systems in Tienfala, a small community located in Mali, which has allowed for pregnant women to be transported to health facilities in order to give birth. This project was a part of USAID’s efforts to increase health outcomes around the world and close the consistently widening disparity gaps in women’s health.

According to USAID, the completion of the emergency transport systems were in large thanks to a community effort. People from the small Tienfala community worked together in order to help increase the health outcomes of pregnant women in their community. USAID’s project in Tienfala is very promising for the promotion of women and girls in developing countries.

Many other organizations have placed a focus on increasing the health outcomes of women and girls in developing countries in order to address the widening disparity gaps in women’s health around the world. In fact, the aim of the United Nations International Children’s Emergency Fund (UNICEF), in regards to women and girls, is to “promote the equal rights of women and girls and to support their full participation in the political, social and economic development of their communities.”

Like UNICEF, USAID has placed a value on promoting women’s health in developing countries like Mali. Specifically, according to USAID, the focus of the High Impact Health Services Project is to decrease the incidence of maternal and child deaths, and the construction of the emergency transport systems in Tienfala has greatly helped reduce such mortality rates.

Kadia Coulibably, a woman from Tienfala, lacked any sort of prenatal care during her fourth pregnancy, reports USAID. However, the emergency transport systems allowed Coulibably to experience an organized, healthy childbirth. Without the valuable help of U.S. foreign aid through the governmental agency USAID, Coulibaly may have faced complications during her childbirth due to the lack of proper care.

Of course, a focus on the health of women and girls in developing countries is incredibly vital to the empowerment of women in their respective communities. When pregnant women can receive accessible, adequate health care, they can thrive happily and healthily. Thus, the construction of the emergency transport systems for pregnant women in Mali is a step in the right direction for the advancement of women’s health.

– Emily Santora

Photo: Flickr

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Maternal and Child Health in Mali

Maternal and Child Health in MaliMali is a country located in western sub-Saharan Africa with the third-highest fertility rate in the world at an average of six children per woman. Infant mortality stands at 100 deaths for every 1,000 live births, giving Mali the second highest infant mortality rate in the world.

Maternal and child health in Mali remains among the poorest in sub-Saharan Africa for many reasons. Limited access and adoption of family planning, early childbearing (the mean age of first birth is 18.8 years), and short birth intervals are among the major reasons. Other important factors are female genital cutting, infrequent use of skilled birth attendants and lack of emergency obstetrical and neonatal care, which is often uncomfortable for women when used.

Despite these statistics, many important changes are taking place to improve maternal and child health in Mali. Lowering fertility is essential for poverty reduction, improving food security and developing human capital and the economy. Having fewer children creates less housework and healthier children, and mothers are able to contribute and benefit economically.

Women are often revered in Malian culture; however, legal status, health and economic opportunities favor males. Only two out of 10 women make decisions regarding their own health. Domestic violence is largely considered acceptable by society. Mamadou Ben Diabete is a Malian griot who is trying to change some of these problems.

Griots are Malian storytellers, poets and musicians, carrying on a tradition dating back to the 13th century. They hold large influence in many parts of Malian society. Diabete felt that influencing improvements to women’s health was part of his calling. He attended training workshops on RAPIDWoman, an interactive software modeling system that teaches users how investing in reproductive health, girls’ education and maternal health programs can increase quality of life. Diabete and a colleague then presented the model to nearly 70 people from the government of Mali, NGOs, women’s associations and local media and held followup discussions. These organizations remain dedicated to prioritizing the health and happiness of women throughout Mali.

USAID’s Maternal and Child Survival Program (MCSP) includes Mali in one of their 25 countries of focus in the improvement of maternal and child health. MCSP recognizes critical health system constraints such as geographical access, availability of human resources and financial affordability. The organization then finds interventions that are most important, such as handwashing with soap and having a skilled attendant at delivery, an intervention that saw the greatest gains.

Other specific measures that can be taken to improve maternal and child health in Mali are outlined by UNICEF and include preventive malaria treatment for pregnant women, strengthening medical evacuation programs, promoting prenatal HIV testing and providing pediatric treatment. With the help of nonprofits and international aid programs, we can improve maternal and child health in Mali.

– Phoebe Cohen

Photo: Flickr

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How Malnutrition Affects Pregnant Women in Developing Countries

Malnutrition-and-Pregnancy-Global-Poverty

Malnutrition is a significant problem in developing countries. Without substantial resources, many men, women and children go to bed hungry. Tackling malnutrition should be a priority for everyone, especially pregnant women.

A woman’s nutritional intake impacts both her health during pregnancy and the health of her baby. Without proper care, she is susceptible to illnesses and her baby’s health is at risk. Malnutrition during pregnancy can cause devastating results.

In many countries, tradition forces women to be the last to eat at meals, which may result in them receiving smaller portions. This notion severely impacts pregnant women.

A woman that is undernourished at the time of conception is at risk of serious health issues for both herself and her baby. Not only is it unlikely that her nutritional status will improve throughout the pregnancy, but her body also experiences additional demands due to the growing baby. Without enough food, she will most likely lose weight, which increases the risk of maternal mortality.

When her body is unable to obtain or store enough nutrients required to support embryo growth, the cells may not divide properly, resulting in a chance that the fetus’ development will be impaired. The placental cells, which support the fetus’ growth during pregnancy, are more likely to surround the fetus in large numbers, forcing the fetus to become smaller than it should be. This leads to the baby being born at a low birth weight, which in turn often leads to severe cognitive and developmental deficits.

A baby’s organs develop during the first five weeks of pregnancy. In order for the organs to grow properly, it is imperative for women to be healthy and have food supplies readily available.

A woman’s caloric needs increase with pregnancy. An additional 150 calories per day is needed to support the baby in the first three months of the pregnancy. In month four, the additional calories needed increase to 300 per day.

In addition, women must have the proper nutrients in their diet, such as foods with folic acid, iron calcium, protein, vitamin B12, vitamin D and vitamin A. According to the World Food Programme, half of all pregnant women in developing countries are anaemic (having an iron deficiency), which causes around 110,000 deaths during childbirth per year.

Without enough nutrients, a baby is at higher risk of neural tube defects, brain damage, premature birth, underdevelopment of organs, death and more. If a child becomes malnourished in the womb, the damage can be permanent.

Improving nutrition is an investment that could save the lives of women around the world; it will also decrease the number of birth defects and disabilities seen in newborns and young children. In many developing countries, nutrition is essential to promoting a happy and healthy lifestyle where no person goes to bed hungry.

– Kelsey Parrotte

Sources: Livestrong, Mother and Child Nutrition, Virtual Medical Center, World Food Programme
Photo: The Visible Embryo

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Ketamine Enables Life-Saving C-sections for Women in Developing Regions

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“Every minute of every day, a woman dies somewhere as a result of pregnancy or childbirth,” says Thomas Burke, chief of Massachusetts General Hospital’s Division of Global Health and Human Rights.

Ketamine, an inexpensive anesthetic, is a solution to the global crisis of maternal death due to pregnancy, enabling women to undergo C-sections rather than facing death or serious injury.

Each day, 1,400 women die from causes relating to pregnancy. Pregnancy is the second largest killer of women, behind only HIV/AIDS. And for each woman that dies from pregnancy, 50 to 100 are disabled or suffer from disease. Pregnancy related death affects around 15 to 20 million women every year.

A major cause of death and injury during pregnancy is obstructed labor and a lack of availability of a cesarean section. When labor is obstructed and no C-section is available, women frequently die, suffer from postpartum hemorrhage (which can also cause death), or suffer from fistula (where the bladder and rectum walls erode and are permanently connected to the vagina).

Many clinics and hospitals in developing countries lack the ability to perform C-sections because no anesthesia or anesthesiologists are present, which are necessary for this intensive surgery. This lack of anesthesia services presents a global problem, as anesthesia can potentially save countless lives of women.

Massachusetts General Hospital is addressing this crisis. They created an innovative way to provide anesthesia services to remote, extremely impoverished regions. Their initiative is called The Every Second Matters for Mothers and Babies—Ketamine for Painful Procedures and Emergency Cesarean Section (ESM-Ketamine). Ketamine is an extremely inexpensive anesthetic; it has been used without any formal procedure around the world for over 40 years, and has a near perfect safety record even with little equipment.

C-sections are the most common worldwide operation. One study of 49 countries estimates that if there was an increase in C-sections (by 2.8 million), 59,100 cases of obstetric fistula and 16,800 maternal deaths would be prevented.

The ESM-Ketamine initiative’s goal is to train clinicians that have no background in anesthesia. The Ketamine initiative offers four days of training for mid-level and above healthcare providers for C-sections and emergency surgeries, using Ketamine as an anesthetic, when no professional anesthetist is available.

Most anesthesia training programs require around four years of training, which is simply not feasible in these developing communities, nor an immediate solution to a crisis that is happening now.

The World Health Organization estimates that 10-15% of births require a C-section. Kenya Demographic Health Survey recently reported that C-section rates in many parts of Kenya are lower than one percent of births. A 2011 Kenya Ministry of Health study also found that only 18 anesthetists exist in the Nyanza region, which has a population of 5.8 million.

Since May 29, 2015, ESM-Ketamine initiative has trained healthcare providers in various hospitals across Kenya, resulting in 231 safe, life-improving surgeries. The program’s initial success demonstrates the powerful potential that Ketamine has for making previously impossible surgeries accessible to women in developing nations, women that provide deeply-rooted social and economic stability to their communities.

When a mother dies or is disabled, her entire community is impacted, and quality of life diminishe—child death rate increases, child education decreases, and both families and communities become more economically unstable.

The maternal mortality rate (MMR), or the ratio of the number of women that die per 10,000 births, was 11.7 in the United States in 2005. In 2014, there are still places on earth where one in six women die from pregnancy related causes; in South Sudan, Afghanistan, and Sierra Leone, the MMR is as high as 2,054.8.

The ESM-Ketamine program provides an inexpensive solution that allows women to undergo cesarean sections, rather than dying or becoming seriously disabled. Healthy women enable a healthy, stable community.

– Margaret Anderson

Sources: Massachusetts General Hospital, World Journal of Surgery, Harvard H Policy Review
Photo: Massachusetts General Hospital