Perinatal approaches and challenges for facility-based care in Medecins Sans Frontieres’ programmes
Kara Blackburn Medical Advisor - Women’s Health MSF Australia Project Unit Médecins Sans Frontières Australia – www.msf.org.au
Today’s presentation Implementing antenatal care, and specific issues Natural disaster impact on Women and Children Emergency Obstetric and Newborn Care Approaches to neonatal care
Médecins Sans Frontières Australia – www.msf.org.au
Sexual and Reproductive Health 2011
Médecins Sans Frontières Australia – www.msf.org.au
Antenatal care in MSF projects Gold standard (WHO): 4 antenatal visits Same standard in MSF ANC protocols …..in reality achieve 1-2 visits
Current issues
Micronutrients and Iron-folic acid Syphilis Testing
Médecins Sans Frontières Australia – www.msf.org.au
Multiple micronutrient supplementation Vast recent literature Positive outcomes
modest but around 10% reduction in small for gestational age, compared to iron-folic acid (RR 0.87; 95% CI 0.81-0.95)
Negative outcomes
increased risk of neonatal mortality where the majority of births occurred at home (4 studies, RR = 1.47, 95% CI: 1.13-1.92), but no adverse effect where ≥ 60% of births occurred in facility settings (5 studies, RR = 0.94, 95% CI: 0.81- 1.09) no significant effect on maternal anemia in third trimester compared to iron-folic alone (anemia prevalence often >40%)
Vitamin D deficiency
Médecins Sans Frontières Australia – www.msf.org.au
Syphilis testing in pregnancy Point of care (rapid) test (SD-Bioline-treponemal test) Positive in any-stage syphilis and with Yaws PNG, Congo-Brazzaville, Madagascar
Added RPR (non-treponemal) to help differentiate women with active syphilis Now trialing a POC (rapid) test that can detect treponemic/nontreponemic antibodies on same cassette
Médecins Sans Frontières Australia – www.msf.org.au
Haiti Earthquake 2010
Médecins Sans Frontières Australia – www.msf.org.au
Médecins Sans Frontières Australia – www.msf.org.au
EMERGENCY OBSTETRIC AND NEWBORN CARE (EmONC)
Picture of field: Obstetrics 1
Médecins Sans Frontières Australia – www.msf.org.au
Médecins Sans Frontières Australia – www.msf.org.au
Obstetric challenges Caesarean section: maternal and foetal indications? Maternal life-saving indications 1-2% of all expected deliveries
Foetal life-saving indications 5-15 % of all expected deliveries
Implications of C-sections in a resource-limited setting subsequent pregnancies (in a high fertility area) will women have access to C-s after we leave? can the unit provide more complex newborn care? Médecins Sans Frontières Australia – www.msf.org.au
Antenatal care
Labour and delivery care
Neonatal care linked with obstetric care
Immediate newborn care
Postpartum care for mother and newborn
Newborns
Médecins Sans Frontières Australia – www.msf.org.au
Reducing neonatal deaths Asyphxia Sepsis Prematurity/Lbw Resuscitation at birth Routine care of newborn Identification of babies at risk KMC for well, little babies Care of sick babies
Médecins Sans Frontières Australia – www.msf.org.au
HBB
Simple and evidence-based Low-cost and effective Easy to integrate
Médecins Sans Frontières Australia – www.msf.org.au
Kangaroo Mother Care KMC for small babies Evidence of reduction (Cochrane) 40% post-discharge mortality 80% hypothermia 60% infections
Médecins Sans Frontières Australia – www.msf.org.au
Neonatal Care Unit Infection ( sepsis, meningitis ) Respiratory distress syndrome Convulsions Post-asphyxia
IV fluids Parenteral antibiotics Apnoea monitoring Warmth Increasing trained staff
Médecins Sans Frontières Australia – www.msf.org.au
Neonatal challenges ELBW ( 1 kg) Poor outcomes Death Neurological sequelae O2 dependency Long hospital stay
No resuscitation, palliative care
Severe congenital malformation
Palliative care or refer to other NGO
Médecins Sans Frontières Australia – www.msf.org.au
Ivory Coast 2012: Neonatal Care Unit mortality reduced from 45% to 24% in 4 months Hygiene Temperature control Feeding Human resources
Médecins Sans Frontières Australia – www.msf.org.au