Insight

Saving African mothers and children through science

Andrea Meyer, ASSAF

Approximately four million women, newborns, and children in sub-Saharan Africa could be saved every year if high-quality, affordable health care was made available to 90 percent of families says a joint report released at the African Science Academy Development Initiative (ASADI) conference held in Ghana from 10-12 November.

The report is the product of a joint effort by the Academy of Science of South Africa (ASSAf) and several other African science academies within the African Science Academy Development Initiative (ASADI), in conjunction with the US National Academy of Sciences.

The report, titled SCIENCE IN ACTION: SAVING THE LIVES OF AFRICA'S MOTHERS, NEWBORNS, AND CHILDREN, encourages partnerships between scientists, health care providers, policy-makers, and development agencies to search for ways to use the latest evidence to fill the gap between the discovery of new interventions and their delivery to the neediest families. It urges policy-makers and other stakeholders to use a scientific approach when setting priorities to improve maternal, newborn, and child health. In particular, local data should be used to identify and prioritise strategic, evidence-based, and essential health interventions that would have the greatest impact on saving lives.

The report cites several statistics that emphasise the urgency of the problem. Each year, half of the world's maternal and child deaths occur in sub-Saharan Africa: 265 000 mothers die during pregnancy or childbirth, 1.2 million babies die in their first month, and an additional 3.2 million do not reach the age of five. More than 880 000 stillbirths go largely unnoticed by global researchers and policy-makers.

The UN's Millennium Development Goals call for the reduction of under-five mortality by two-thirds (MDG4) and maternal mortality by three-fourths (MDG5) by 2015. While some African nations are not on track to meet the goals in the projected time, the report highlights noteworthy exceptions such as Eritrea, having achieved an annual 4 percent rate of reduction in under-five mortality since 1990, Tanzania and Ghana having experienced up to 30 percent declines since 2000, and Malawi recently declaring itself on track for MDG4.

An innovative modelling software package, named the LIVES SAVED TOOL (LIST), was used to estimate the number of lives that would be saved by increasing coverage of a range of essential maternal, newborn, and child health interventions. The analysis suggests that if, by 2015, 90 percent of children under five years old and mothers were covered by already well-known and essential health interventions, about 4 million lives would be saved annually. This would avoid an estimated 85 percent of current maternal, newborn, and child deaths, and would exceed the MDGs for maternal and child health.

Some of the most effective interventions include increased availability of contraception, skilled attendance at childbirth, neonatal resuscitation and improved newborn care, case management of pneumonia, and promotion of breastfeeding, malaria prevention, and immunisation. Another intervention which has been implemented in South Africa with great success is that of kangaroo care (KMC) – this entails preterm babies being secured to the mother’s front to promote breastfeeding and warmth. Hospitals that have introduced this have reported a 30% reduction in neonatal mortality for babies weighing 1-2kg.

Authors of the report recognised that different interventions would have different effects in various health systems, and so they have shown how many lives could be saved by selected priority interventions in different contexts. For example, in settings with few medical facilities, increasing family planning is feasible, saves many lives, and is relatively low cost. The estimated cost of these priority interventions is "extremely affordable" on a per capita basis, the report notes. In fact, the average cost for increasing these selected high-impact interventions to achievable levels in the nine example countries within two years is less than $2 per capita.

Based on the evidence, priorities for maternal, newborn, and child health in sub-Saharan Africa include making childbirth safe, giving newborn babies a healthy start, and preventing and managing infections in newborns and young children, the report says. The evidence also shows that high-impact interventions are most effective and efficient when integrated into existing health delivery systems, yet more research is needed on how to deliver care closer to home and reach populations living in remote areas – a widespread problem both in South Africa and other African countries.

ASADI is an initiative of the United States National Academies of Science that aims to strengthen African science academies and improve their ability to provide evidence-based scientific advice to policy-makers. The initiative is funded by the US National Academies.

More information:

www.assaf.org.za 

About the Academy of Science of South Africa (ASSAf)
The Academy of Science of South Africa (ASSAf) is the official national academy of science and represents the country in the international community of science academies. As collective resource, the Academy enables the generation of evidence-based solutions to national problems.

The strategic priorities of the Academy are closely matched to those of the nation, focusing particularly on the need for the greatly enhanced availability of high-level human capital and an increased use of the country’s best intellectual expertise in generating evidence-based policy advice that is practical and feasible.

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