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Conclusions
The first year of the SMGL initiative (Phase 1) resulted in dramatic reductions in maternal deaths and improved maternal and perinatal health outcomes in SMGL-affiliated facilities in both Uganda and Zambia.
In both countries, important gains were reported in the following areas: Numbers and proportions of deliveries taking place in health facilities, including the proportion of births in EmONC facilities. Routine use of AMTSL at delivery in facilities. Met need for EmONC services for direct obstetric complications. C-section rates. Survival of mothers who were treated for direct obstetric complications (declines in CFRs). Maternal survival and reduced MMRs. Overall perinatal survival and reduced PMRs.
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The magnitude of the change in these key usage and quality of care indicators, which in turn led to a significant reduction in maternal mortality, lead to the conclusion that the SMGL initiative was successful. The findings also demonstrate that Obstetric care in health facilities, particularly EmONC facilities, in
Uganda and Zambia has improved. An increasing number of women with obstetric complications are seeking care in health facilities. Thus, the met need for EmONC is increasing. At the same time, the CFR from direct obstetric complications has decreased, contributing to substantial declines in
MMRs in health facilities. Improvements in quality of care, as reflected by greater use of AMTSL and higher C-section rates, likely contributed to the decreased CFR and MMR.
The SMGL initiative also led to improvements in perinatal outcomes. The PMR decreased in both countries, suggesting improvements in the quality of obstetric care at delivery. This conclusion was further substantiated in Uganda, where the fresh stillbirth rate decreased by 27%.
Perinatal data for both Uganda and Zambia showed Decreases in overall rates of perinatal mortality. Decreases in total stillbirth mortality.
Another achievement was improved processes for identification, notification, and review of maternal deaths at the district level. This change helped local decision makers understand the underlying causes of these deaths so they can find ways to prevent them. By increasing awareness among health care providers and policy makers, this change could also lead to the development of maternal death surveillance and response systems.
