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Cameroon: promoting skilled attendance at child birth to avert maternal and newborn deaths

© UNICEF/Cameroon/2009/Holtz
The nurse and midwife Gisèle Abanda is using her old stethoscope to listen to the nine-month baby’s heart during prenatal consultation at the pediatric ward of a the Saint Luc Hospital, Mbalmayo town.

Akonolinga, Cameroon, 5 May 2009 – At Saint Luke Hospital in Mbalmayo, 50 kilometers from Yaoundé, Nadege, 21, is admitted at the maternity for premature delivery. She is 26 weeks into her pregnancy.

Midwife Gisèle Abanda, uses an old style stethoscope to check on the baby, and it is not good. Some hours later, Nadège will deliver her fifth premature, stillborn baby.

The case of Nadège is not isolated in Cameroon. There are many others, especially in remote rural areas. Maternal deaths are numerous: 1000 women die per 100000 live births. And newborn are not spared, the neonatal mortality ratio is at 74 out of 1000, amongst the highest in the world.

Every 2 hours in Cameroon, one woman and 6 newborn babies die from the complications relating to pregnancy and child-birth.

“Bleeding during pregnancy and delivery is the cause of 1 in 4 maternal deaths”, says Odette Abessolo, in charge of monitoring and evaluation of maternal and neonatal activities at the Ministry of Public Health. “Other causes are infections, abortions, obstruction during labour but also anemia and malaria.”

37 per cent of  bithrs in camerron are unattended by trained staff.The vital role of midwifes
Those causes could be well addressed if trained midwife and personnel were accompanying each pregnancy before, during and after childbirth. Yet, nearly forty per cent of births in Cameroon are unattended by trained staff and almost one pregnant women in five never attends antenatal consultations.

Poverty, distance from health centers and ignorance are compounding factors that increase the risk of maternal deaths. As a consequence, women are also more inclined to resort to traditional birth attendance. 

“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, a 52 year-old traditional birth attendant in Akonolinga. “The women usually give something in appreciation...a thousand francs, some soap”, she added.

Fees in the health centers are high and very often out-of reach for the women. This also explains why so many women – almost 20 per cent, don’t attend antenatal classes in health centers. Yet, antenatal care is instrumental to lowering the risks of complications related to pregnancy or child birth.

Preventing complications
“During antenatal consultations, we detect and treat pregnancy-related complications, such as tetanus and anemia. We also prevent mother-to-child transmission of HIV/AIDS”, 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. A pregnant woman needs to know in which health centre she will deliver and keep aside some money for last minute emergencies”.
To address the lack of progress and event the increase in maternal deaths, the government, with support from partner like UNICEF, 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 matron to recognize the signs of risks and to refer the women for medical attendance.

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





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