Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kampala, Uganda.
Glob Health Sci Pract. 2019 Mar 13;7(Suppl 1):S27-S47. doi: 10.9745/GHSP-D-18-00428. Print 2019 Mar 11.
Maternal and perinatal mortality is a global development priority that continues to present major challenges in sub-Saharan Africa. Saving Mothers, Giving Life (SMGL) was a multipartner initiative implemented from 2012 to 2017 with the goal of improving maternal and perinatal health in high-mortality settings. The initiative accomplished this by reducing delays to timely and appropriate obstetric care through the introduction and support of community and facility evidence-based and district-wide health systems strengthening interventions.
SMGL-designated pilot districts in Uganda and Zambia documented baseline and endline maternal and perinatal health outcomes using multiple approaches. These included health facility assessments, pregnancy outcome monitoring, enhanced maternal mortality detection in facilities, and district population-based identification and investigation of maternal deaths in communities.
Over the course of the 5-year SMGL initiative, population-based estimates documented a 44% reduction in the SMGL-supported district-wide maternal mortality ratio (MMR) in Uganda (from 452 to 255 maternal deaths per 100,000 live births) and a 41% reduction in Zambia (from 480 to 284 maternal deaths per 100,000 live births). The MMR in SMGL-supported health facilities declined by 44% in Uganda and by 38% in Zambia. The institutional delivery rate increased by 47% in Uganda (from 45.5% to 66.8% of district births) and by 44% in Zambia (from 62.6% to 90.2% of district births). The number of facilities providing emergency obstetric and newborn care (EmONC) rose from 10 to 26 in Uganda and from 7 to 13 in Zambia, and lower- and mid-level facilities increased the number of EmONC signal functions performed. Cesarean delivery rates increased by more than 70% in both countries, reaching 9% and 5% of all births in Uganda and Zambia districts, respectively. Maternal deaths in facilities due to obstetric hemorrhage declined by 42% in Uganda and 65% in Zambia. Overall, perinatal mortality rates declined, largely due to reductions in stillbirths in both countries; however, no statistically significant changes were found in predischarge neonatal death rates in predischarge either country.
MMRs fell significantly in Uganda and Zambia following the introduction of the SMGL interventions, and SMGL's comprehensive district systems-strengthening approach successfully improved coverage and quality of care for mothers and newborns. The lessons learned from the initiative can inform policy makers and program managers in other low- and middle-income settings where similar approaches could be used to rapidly reduce preventable maternal and newborn deaths.
孕产妇死亡率是全球发展的重点，在撒哈拉以南非洲地区仍然存在重大挑战。拯救母亲，赋予生命（SMGL）是一项多方合作伙伴倡议，于 2012 年至 2017 年实施，旨在改善高死亡率地区的孕产妇和围产期健康。该倡议通过引入和支持社区和机构基于证据的、全地区卫生系统强化干预措施，减少及时和适当的产科护理的延误，从而实现这一目标。
乌干达和赞比亚的 SMGL 指定试点地区采用多种方法记录基线和期末孕产妇和围产期健康结果。这些方法包括卫生设施评估、妊娠结局监测、加强设施中孕产妇死亡率的检测，以及在社区中以人群为基础确定和调查孕产妇死亡。
在 SMGL 倡议的 5 年期间，基于人群的估计记录显示，在乌干达和赞比亚，SMGL 支持的全地区孕产妇死亡率（MMR）分别下降了 44%（从每 10 万活产儿 452 例降至 255 例）和 41%（从每 10 万活产儿 480 例降至 284 例）。SMGL 支持的卫生设施中的 MMR 下降了 44%在乌干达和 38%在赞比亚。乌干达的机构分娩率上升了 47%（从 45.5%上升到 66.8%），赞比亚的机构分娩率上升了 44%（从 62.6%上升到 90.2%）。提供紧急产科和新生儿护理（EmONC）的设施数量在乌干达从 10 个增加到 26 个，在赞比亚从 7 个增加到 13 个，低级别和中级别的设施增加了 EmONC 信号功能的数量。两国的剖宫产率均增加了 70%以上，分别达到乌干达和赞比亚地区所有分娩的 9%和 5%。乌干达因产科出血导致的产妇死亡人数下降了 42%，赞比亚下降了 65%。总体而言，围产期死亡率下降，主要是由于两国的死产减少；然而，在这两个国家，分娩前新生儿死亡率都没有统计学意义上的变化。
在引入 SMGL 干预措施后，乌干达和赞比亚的 MMR 显著下降，SMGL 全面的地区系统强化方法成功提高了母亲和新生儿的护理覆盖率和质量。该倡议中吸取的经验教训可以为其他中低收入国家的政策制定者和方案管理者提供信息，在这些国家可以采用类似的方法来迅速降低可预防的孕产妇和新生儿死亡。
