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‘Roadmap for care’ aims to improve maternal and newborn survival in Cameroon

© UNICEF Cameroon/2009/Holtz
Nurse and midwife Gisèle Abanda uses a simple stethoscope to listen to a baby’s heart during a prenatal consultation in the paediatric ward at Saint Luc Hospital, Mbalmayo, Cameroon.

By Raymond Mbouzeko

AKONOLINGA, Cameroon, 5 May 2009 – At Saint Luke Hospital in Mbalmayo, Nadege, 21, has gone into labour just 26 weeks into her pregnancy. Midwife Gisèle Abanda uses a simple stethoscope to listen for signs of life in utero, but finds none. A few hours later, Nadège delivers her fifth premature, stillborn baby.

Nadège’s story is all too common in Cameroon – especially in remote rural areas. Neonatal and infant mortality rates in the country are among the highest in the world, and almost every hour a woman in Cameroon dies from complications related to pregnancy and childbirth.

“Bleeding during pregnancy and delivery is the cause of one in four maternal deaths,” says Odette Abessolo, who is in charge of monitoring and evaluating maternal and neonatal activities for the Ministry of Public Health. “Other causes are infections, abortions, obstruction during labour, and also anaemia and malaria.”

Lack of access and knowledge
Such causes could be well addressed if a trained midwife and other medical personnel accompanied each pregnant woman before, during and after childbirth. Yet nearly 40 per cent of births in Cameroon are unattended by trained health care providers.

Poverty, poor access to health centres and a general lack of knowledge lead many women in rural areas to seek out traditional birth attendants.

“Women come to me at the onset of labour. I prepare them some traditional concoctions from plants like hibiscus and others to ease delivery,” says Marion Bissa, 52, a traditional birth attendant in Akonolinga. “The women usually give something in appreciation, like 1,000 francs or some soap.”

Fees in the health centres are high and very often out of reach for rural women, which explains why so many of them – almost 20 per cent – never attend a single antenatal class in a centre. This is troubling in that antenatal care is instrumental to lowering the risks of complications related to pregnancy and childbirth.

Emergency obstetric and newborn care
“During antenatal consultations, we detect and treat pregnancy-related complications, such as tetanus and anaemia. We also prevent mother-to-child transmission of HIV,” says Suzanne Akamba, a midwife at the Freeman Health Centre.

“It’s also the opportunity to prepare the future mother for the delivery and the care of the newborn,” she adds.

To address these issues, the government – with support from UNICEF – has adopted a roadmap for emergency obstetric and newborn care. The goal is to equip all health districts with adequate material and trained personnel to manage complications related to childbirth. It also entails training traditional attendants to recognize the signs of potentially fatal risks and to refer women for proper medical care.

“UNICEF significantly supports the Ministry of Public Health in implementing this roadmap,” says UNICEF Cameroon Chief of Young Child Survival Dr. Béchir Ould Aounen. “Yet at this stage, less than 10 per cent of the health districts are adequately equipped in materials and trained staff. Addressing maternal and newborn mortality requires the engagement and mobilization of all actors.”



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