Life For Mothers Analyzing Data from Phase I of Pilot Project

The staff at Life for Mothers is currently analyzing the data gathered during Phase I of our pilot project. We hope to complete our analysis in the next few weeks and prepare it for publication. All results from our analysis will be made available on the Life For Mothers website by the end of the year. Be sure to check it out!

Once the analysis is completed, Life For Mothers will begin planning Phase II of the pilot project. The results attained from the initial data collection in Phase I will guide our planning process and help us determine what types of methods will enable us to attain our goal of reducing infant mortality through improved family planning and antenatal care.

To keep up-to-date on Life for Mothers planning phases and projects, be sure to keep checking our blog and sign up for our newsletter at our website.

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New York Times: Maternal Deaths Focus Harsh Light on Uganda

July 29, 2011

About 80 percent of the world's maternal deaths occur in just 21 nations, 15 of which are in sub-Saharan Africa, according to a 2010 study on maternal mortality by the University of Washington. Uganda was among them. About 5,200 women died from pregnancy related causes here in 2008, the researchers estimated.

ARUA, Uganda — Jennifer Anguko was slowly bleeding to death right in the maternity ward of a major public hospital. Only a lone midwife was on duty, the hospital later admitted, and no doctor examined her for 12 hours. An obstetrician who investigated the case said Ms. Anguko, the mother of three young children, had arrived in time to be saved.

Her husband, Valente Inziku, a teacher, frantically changed her blood-soaked bedclothes as her life seeped away. “I’m going to leave you,” she told him as he cradled her. He said she pleaded, “Look after our children.”

Half of the 340,000 deaths of women from pregnancy-related causes each year occur in Africa, almost all in anonymity. But Ms. Anguko was a popular elected official seeking treatment in a 400-bed hospital, and a lawsuit over her death may be the first legal test of an African government’s obligation to provide basic maternal care.

As the United States and other donors have given African nations billions of dollars to fight AIDS and other infectious diseases, helping millions of people survive, most of the governments have reduced their own share of domestic spending devoted to health, shifting to other priorities.

It also raises broader questions about the unintended impact of foreign aid on Africa’s struggling public health systems. As the United States and other donors have given African nations billions of dollars to fight AIDS and other infectious diseases, helping millions of people survive, most of the African governments have reduced their own share of domestic spending devoted to health, shifting to other priorities.

For every dollar of foreign aid given to the governments of developing nations for health, the governments decreased their own health spending by 43 cents to $1.14, the University of Washington’s Institute for Health Metrics and Evaluation found in a 2010 study. According to the institute’s updated estimates, Uganda put 57 cents less of its own money toward health for each foreign aid dollar it collected.

Rogers Enyaku, a finance expert in Uganda’s Health Ministry, disputed the assertion, saying the country’s own health spending had increased, “but not that substantially.” Still, the government set off a bitter domestic debate this spring when it confirmed that it had paid more than half a billion dollars for fighter jets and other military hardware — almost triple the amount of its own money dedicated to the entire public health system in the last fiscal year.

Poor people surged into Uganda’s public health system when the government abolished patient fees a decade ago. Increasingly, African countries are adopting similar policies, and experts say that many more people are getting care as a result. But Uganda’s experience illustrates the limits of that care when a system is poorly managed and lacks the resources to deliver decent services, experts say.

A woman in labor rested in the maternity ward at Arua Hospital. At regional hospitals like this one, more than half the positions for doctors are vacant, part of a broader shortage that includes midwives and other health workers.

At regional hospitals like the one here in Arua, more than half the positions for doctors are vacant, part of a broader shortage that includes midwives and other health workers. A majority of clinics and hospitals reported regularly running out of essential medicines, while only a third of facilities delivering babies are equipped with basics like scissors, cord clamps and disinfectant, according to a 2010 Health Ministry report.

The hospital where Ms. Anguko died handles obstetric emergencies for a region of almost three million people, but it recently had no sutures in stock to sew up women after Caesarean sections. Dr. Emmanuel Odar, the hospital’s sole obstetrician, said that even in childbirth emergencies, families must buy missing supplies themselves, typically at nearby pharmacies. Patients without money must beg or borrow it, Dr. Odar said.

“We are overwhelmed with cases of people looking for free services, and they expect a lot despite supplies not there, human resources lacking and the beds not enough,” he said.

Dr. Olive Sentumbwe-Mugisa, a Ugandan obstetrician and adviser with the World Health Organization, participated in the Health Ministry’s investigations of the deaths of both Ms. Anguko and Sylvia Nalubowa, a second woman named in the lawsuit against the government, and concluded that both women arrived in time to be saved.

“We are in a state of emergency as far as maternal services are concerned,” Dr. Sentumbwe-Mugisa said. “We need to focus on the quality of care in our hospitals and address it in the shortest period of time. That will mean more resources. We cannot run away from that.”

In its lawsuit filed in March, the Center for Health, Human Rights and Development, a Ugandan nonprofit group, contended that the government violated the two women’s right to life by failing to provide them with basic maternal care.

The attorney general’s office replied that the “isolated acts” cited in the case “cannot be used to dim the untiring efforts in the Health Sector.” It also noted competing priorities for “the meager resources at the state’s disposal.”

But the government has come in for tough questioning since April, when its spending on the Russian-made fighter jets became public, helping fuel protests.

Officials in President Yoweri Museveni’s government say the jets are critical to protecting Uganda in a region with a history of conflict, especially as the country develops its oil fields. “The enemies of Uganda don’t want us to have those jet fighters,” said Tamale Mirundi, a spokesman for Mr. Museveni.

But opposition leaders denounced the spending in a nation at peace, with huge social needs.

“You are talking about investing in jets? Come on!” exclaimed Christine Bako, a lawmaker from Ms. Anguko’s district, during a debate in Parliament. “This is now a matter of conscience.”

As her due date approached, Ms. Anguko left her village to live with relatives near the big hospital in Arua, 300 miles northwest of the capital, Kampala. In preparation, she and her husband bought the supplies they knew the hospital lacked: latex gloves, cotton wool, a razor blade to cut the umbilical cord.

On a Sunday morning last year, after praying in church, Ms. Anguko felt abdominal pains and went to the hospital. That afternoon, her husband, standing just outside the ward, heard her urgently calling. She told him that she was bleeding and that no one was attending to her, he said. He and his wife’s cousin, Jane Adiru, 33, said they repeatedly approached the nurses for help over the following hours, but were ignored.

The hospital’s own account depicted a nightmarish day of complicated emergencies with only one midwife for both the day and evening shifts. Women arrived with ruptured uteruses, a stillbirth, an obstructed labor, an incomplete abortion and a bleeding cancer of the cervix.

The lawsuit also raises broader questions about the unintended impact of foreign aid on Africa's struggling public health systems. Nurses and a relative attended to an expecting mother at Arua Hospital, where Mrs. Anguko died.

No doctor examined Ms. Anguko until about 12 hours after she was admitted, according to the hospital’s own account. Another hour passed before she finally got into surgery. By then it was too late. She and the baby died.

“Arua Hospital is not happy with what happened and regrets the whole thing,” the hospital’s superintendent wrote to angry leaders of the district council on which Ms. Anguko had served.

As Africa’s population swells, so will demand for emergency obstetric care. The United Nations recently estimated that Uganda’s population will almost triple to 94 million by 2050, with tens of millions more babies to be delivered.

As it is, about 80 percent of the world’s maternal deaths occur in just 21 nations, 15 of which are in sub-Saharan Africa, according to the University of Washington study. Uganda was among them. About 5,200 women died from pregnancy-related causes in the country in 2008, the researchers estimated.

Dr. Rafael Lozano, a professor at the university, said that except for recent gains in saving the lives of H.I.V.-positive pregnant women with antiretroviral treatments largely financed by donors, “you see basically almost no progress in maternal deaths in Uganda.”

When Ms. Nalubowa, 40, a peasant farmer and a mother of seven, arrived at the decrepit hospital in Mityana, said her mother-in-law, Rhoda Kukkiriza, nurses demanded a bribe of about $24 and more money to buy airtime for a cellphone call to the doctor, accusations the nurses have denied. Ms. Kukkiriza said she had less than a dollar left after spending $2.40 to buy a razor blade, gloves and other items the hospital lacked. Unable to pay the bribe, Ms. Nalubowa was taken to the maternity ward and left unattended, her mother-in-law said.

“As she pushed with the labor pains, all that came out was blood,” Ms. Kukkiriza said. “Sylvia called out, ‘I’ll sell all my pigs, I’ll sell my chickens, my goats — please, nurses, come help me.’ ”

Even if a doctor had arrived promptly, the hospital staff would have struggled to save Ms. Nalubowa, who bled to death. Dr. Vincent Kawooya, the hospital’s medical superintendent, said there was only one small unit of blood for a child in stock that night.

The health minister himself toured the hospital after Ms. Nalubowa’s death incited demonstrations, but Dr. Kawooya said the minister refused to set foot in the operating room, with its moldy walls and leaky ceiling, saying it should be condemned. The roof of the maternity ward was a home to bats, and droppings come down its inner walls.

Vincent Nyanzi, a governing party lawmaker from the area, said he introduced Ms. Nalubowa’s mother-in-law and husband to President Museveni when he visited a nearby district.

The president’s secretary gave them an envelope containing about $190, the family said. In their brief audience with the president, Ms. Kukkiriza said, he told them: “ ‘I’m sorry. It’s really a pity.’ ”

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Life For Mothers Releases Preliminary Results from its Pilot Project (Phase l) Completed May 2011

Maternal/neonatal mortality rate is unacceptably high in rural Uganda where 90% of the population lives. Poverty, low education levels, and high rates of childbirths characterize this population with almost 7 births per woman, minimal family planning (FP), and lack of infrastructure making access to health services extremely difficult.

A project was undertaken to verify various baseline need assessments, prior to implementing a holistic strategy for improving maternal/neonatal health (MNH). Simultaneously, we created an electronic health database by enrolling 1600 women of reproductive age (WRA) and their families. The use of a cell phone network and mHealth technology affirmed the value of gathering real-time data by the community health workers (CHWs) and overcoming communication gaps between community residents and the health center.

To test our initial hypotheses, we recruited and trained 50 CHWs from 25 villages from Busujju County in Mityana. A 10-day intensive workshop was conducted for CHWs in FP, HIV/AIDS, MNH, and child survival.  The initial pilot was completed in three weeks with 5500 residents registered.

The data revealed huge gaps in health delivery including the lack of HIV testing (70%) and FP (86%) in WRA who were never pregnant. Pregnant WRA also lacked postnatal care (79%) and mosquito nets (39%). 91% of children under 5 were never tested for HIV, 27% were not fully immunized and 46% did not use any mosquito nets. 46% of husbands/partners never used condoms, 70% were never counseled on FP, 43% were not tested for HIV, 66% of them did not attend antenatal care with their wives, and lastly 52% did not use any mosquito nets.

The realistic portrait indicates major gaps in health delivery. Our hypothesis is that CHWs using mHealth technology to monitor patients in real time will improve outcomes facilitating a cost-effective, replicable and sustainable model to strengthen health systems.

Additional data analysis is forthcoming and will be made available on the website and be submitted for publication.

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Life for Mothers Announces Completion of its Pilot Project in Rural Uganda

Life For Mothers (LfM) recently completed its Pilot Project in Busujju County, Mityana, Uganda. The project involved going to 25 villages using 25 Village Health Teams (2 community health workers per team) and enrolling the household into an electronic database. In addition, information was given to the households in the following areas–HIV/AIDs, Maternal/Reproductive Health, Child Survival and Family Planning. LfM enrolled almost 6000 residents from the 25 villages as well as almost 1600 women of reproductive age. LfM also registered husbands/partners, newborns, women over 50, children over 5 and almost 1100 children under the age 5. Using mobile health technology (cell phones were loaded with questionnaires), the CHWs were trained to use the phones and upload data as soon as it was collected in the field. The data is currently being analyzed to identify the population’s need for interventions surrounding family planning, HIV testing and birth practices. From this analysis, Life for Mothers will implement strategies for the next phase of the project to increase women and children’s access to services (antenatal visits, immunizations, giving birth at the Health Center, etc) in order to demonstrate improved health outcomes. These results will be published as soon as possible. Lastly, the VHTs were given exit questionnaires to measure quantitative knowledge and understanding of their work as well as their satisfaction with the Pilot Project. We have many people to thank–most importantly, Winnie Namirembe, our Project Manager and a Peace Corp Volunteer assisting with project implementation. We look forward to sharing our findings as results become available.
Did you know?
Almost every minute, a woman dies related to complications related to pregnancy and childbirth.
Source:United Nations Department of Public Information

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Pilot Project Underway

Following multiple training sessions on using mobile phones for data collection as well as formal workshops on HIV/AIDS, Family Planning, Reproductive/Maternal Health and Child Survival, Village Health Teams have been dispatched into the field to register and collect data from households in their respective villages. Data is being collected on six questionnaires developed by LFM to capture data on children over five with women not of reproductive age, children under five, newborns (28 days or less), husbands/partners, women over the age of 50 and lastly women of reproductive age. The Pilot Project is presently ongoing. To date, over 3500 patients have been registered along with over 1000 women of reproductive age.

Village Health Teams practice data entry during training.

Village Health Teams practice data entry during training.

Health workers receive training on using phones.

Health workers receive training on using phones.

CHW collects health information in the field.

CHW collects health information in the field.

Entering data on women and children

Entering data on women and children.

Male health workers are an important component of our model.

Male health workers are an important component of our model.

Health worker visits women at their homes.

Women educating women

Women helping women.

Registration continues.

Health worker conducts registration interview.

Family registered into LFM's program.

Family registered into LFM's program.

Children in one of our villages

Children in one of the pilot villages.

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Log, March 14th to March 18th

Monday, March 14th

The 25 VHTs continued the intensive HIV/AIDS/Family Planning training course with AIC which began on Friday, March 11th. AIC affiliates led the training. As with the previous training days, lunch was provided and once training had finished, the VHTs were compensated for their travel expenses. I later met with software programmers regarding openxdata.

Lunch Held for Trainees


Hon. Sylvia Ssinabulya speaks at VHT training session

Tuesday, March 15th

The VHTs continued their HIV/AIDS/Family Planning training. I also met with Dr. Eddie Emukooyo from the Ministry of Health (Health Information & Knowledge Management) to further discuss the pilot project in relation to his work on the ICT4MPOWER project.

VHT Training Session

Wednesday, March 16th

With the HIV/AIDS training course successfully completed, the VHTs began their Reproductive Health and Family Planning training workshop led by Wilberforce Mugwanya (in place of Dr. Olive Sentumbwe-Mugisa), under the auspices of WHO.

Family Planning/Reproductive Health Training

Thursday, March 17th

The VHTs finished their Reproductive Health/Family Planning training. Winnie and I procured Certificates of Completion of the intensive training workshops from AIC.

Friday, March 18th

I spent the day preparing for my departure before attending a meeting at MTN headquarters with Mr. Anthony Katamba, General Manager of Legal & Corporate Services. There, we discussed MTN’s partnering with LfM’s pilot project. We discussed the submission of LfM’s project proposal along with LfM’s specific needs (phones, etc.) to complete the pilot project. 

I also coordinated with Winnie her duties as Program Manager while I am away. Specifically, she will ensure the VHTs are prepared to start working in the pilot project’s 25 respective villages immediately upon my return. After a final dinner with Winnie and Patrick (LfM’s driver) I then left for the airport. I will be returning to Uganda in early April to further implement the pilot project.

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Log, March 7th-12th

Monday, March 7th
On Monday, LfM had a meeting with Mr. Anthony Katamba (General Manager of Legal & Corporate  Services) at MTN headquarters where I made a formal presentation of the pilot project to his team. He was enthusiastic regarding the project proposal and suggested I return on Wednesday to obtain a letter of commitment from MTN and to work out details as to when their IT team could visit the Health Center IV in Mwera.

Tuesday, March 8th
Tuesday was International Women’s Day, a national holiday in Uganda. I spent the day with Wini orienting her regarding LfM’s work in rural Uganda and her responsibilities as the new Program Manager. She will be the main link between our VHTs and LfM’s partners in Uganda, as well as LfM’s Uganda liaison when I return to New York. Some of her duties will include aiding in the acquisition of mobile phones, ensuring they are loaded with LfM’s software, distributing them to the VHTs, helping in the training and usage of the mHealth technology and handling project logistics before beginning the pilot which will happen upon my return to Uganda in three weeks time.

Program Manager, Winifred

Mid-wife, Immaculate, who co-organized the VHT lunch

Wednesday, March 9th
Wini and I worked out details regarding further screening of the VHTs for Thursday (March 10th), to complete the full complement of VHTs who will be assigned to the 25 respective villages* represented in the pilot project. I informed Mr. William Nabangi we needed at least 3 CHWs from each new village to be screened to complete the number of VHTs needed to execute the pilot. We also scheduled the VHTs’ formal training with the AIDS Information Centre (AIC) and Dr. Olive Sentumbwe-Mugisa from WHO, who will conduct a reproductive health training workshop after AIC completes their 5-day HIV/AIDS training course next week. AIC’s training will begin this Friday, March 11th.

VHT candidates being shown LfM's mobile health technology with Program Manager Winifred

Thursday, March 10th
As we had not completed recruiting all 25 VHTs, I went up to Mwera to do further screening of potential candidates. We ultimately screened 120+ people to fill fifty positions. We successfully screened and selected approximately 10 more teams, giving us a total of 23 VHTs. As we had 46 CHWs (just 4 short of the 50 required), I coordinated with Wini and Immaculate (resident mid-wife) to organize daily lunches that would begin Friday and continue for 6 days.

Friday, March 11th
Trainers came up from the AIDS Information Centre that morning. They divided our VHTs into two groups: one assigned to Community Hall, and the other to outside the maternity clinic of the Health Center IV. While training commenced, I completed the screening of the final VHTs, who were then sent to join the other trainees. All 25 VHTs positions are now filled and the HIV/AIDS and Family Planning training course, which will be followed by WHO’s reproductive health training, is underway. After instruction, we had a group lunch. Before dispersing, everyone was compensated for their transport needs and time.

Hon. Sylvia Ssinabulya introducing 1st day of VHTs' HIV/AIDS training course with AIC

1st day of VHT's HIV/AIDS training with AIC

1st day of VHTs' HIV/AIDS training with AIC

Community Hall, where one of the two group sessions took place

Lunch during Training

Saturday, March 12th
I again traveled to Mwera to ensure the VHTs were all accounted for and still participating in the training (no absentees, etc.). The VHTs were all present and the trainers’ feedback regarding their motivation and adeptness was extremely positive. Wini, our Program Manager, is currently staying in Mwera to oversee the 6 day-training.

Upon my return home later that night, I had further meetings regarding the development of LfM’s mobile health technology software. I met with Dr. Eddie Emukooyo from the Ministry of Health, who was a chief developer of ICT4MPOWER. This conceptual model is extremely similar to the structure of LfM’s project pilot currently being implemented in rural Uganda. He was very supportive of our work and told me he wanted to “harmonize our efforts.” We will be in contact as to how he can assist LfM’s efforts in the future.To learn about the ICT4MPOWER project, click here.

*25 villages: Bananze, Bubangi, Bukundugulu, Bullenge, Bumbugwe, Butayunja, Butegaya, Kafumbirwango, Kakindu Church Zone, Kakindu Malwa, Kakindu Town Council, Katebere , Kireku Bugol, Kitebere, Kiwande, Mawanda Kyengeza, Mwera, Mwera Mukadde, Nabwiri Kaggungu, Namanddwa, Nawanjiri, Ngandwe, Nsambya, Vvumbe

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