In Mozambique maternal mortality rates are 550 per 100,000 and neonatal mortality is 39 per 1000 live births. This presentation was the output of a short research project looking at the ways in which technology might be used in development programming to improve maternal and neonatal health outcomes.

1. Using Technology to Improve Maternal Health Outcomes in
Mozambique
James Brown
25-4-12

2. Baseline Data
• Antenatal care:
– 92% (<1 visit)
– 53% (<4 visits)
• Skilled attendant at birth: 55%
• Maternal mortality rate: 550/100 000
• Neonatal mortality rate: 39/1000 live births

3. Where are the opportunities for having a health impact?
Stage of pregnancy:
Family planning – Antenatal – Delivery – Postpartum
Improving maternal health is more than
just addressing deaths during childbirth

4. Addressing Acute Complications During Delivery
34%
19%9%
21%
17%
Maternal Mortality
Haemorrhage Hypertension
Infection Other direct
Indirect
35%
24%
17%
24%
Neonatal Mortality
Prematurity Birth asphyxia
Infection Other

5. What are the problem areas we could address?
• Limited access to trained staff
• Limited capacity of frontline staff to deal with acute emergencies:
– Training
– Drugs
– Medical equipment
• Delays in referring emergency cases

6. Birthing Simulator
• Low cost training for birth attendants
• Supports training for Basic Emergency
Obstetric interventions (eg PPH)
• Maintenance by trainer
• Costs $100
• Other low cost models in testing
Neonatal Resuscitation
Simulator
• Costs $50
• Allows realistic training for health workers
• Available since 2009

7. Mobile Phones
• Connecting frontline healthcare providers to
specialists
• Reduces delay in diagnosis
• Custom applications such as frontline sms
may provide the ability to diagnose over text
message
• Requires minimal training

8. Prefilled Auto-disable Injection System
• May allow minimally-trained health workers to
administer Oxytocin to mothers
• Time-temperature indicator for monitoring
cold chain
• Available since 1998
• Costs vary by drugs
• Limited training required
• Cannot be reused – prevents disease
transmission
• Creates minimal waste

9. Emergency Neonatal Suction Device
• Addresses birth asphyxia
• Available since April 2010
• Costs $3 USD
• Limited training required
• Requires regular disinfection by boiling

10. Motorcycle Ambulance
•Can reduce transfer time from remote
areas to healthcare facilities
• Increases attendance at health centres
• Reduces number of emergency
operations required
• Up to 19 motorcycle ambulances may be
bought for the price of a Landcruiser
• Fuel efficient

11. Technology is not enough…
• Political support
• Community support
• Family acceptance
• Training to use and maintain equipment
• Ongoing sustainable funding
• Collaboration with other programmes
• Availability of skilled technicians and spare parts

12. Conclusion
Technological approaches can be valuable in improving outcomes in
maternal and neonatal health, but their efficacy relies on the wider
programme approach.

13. UNICEF (2009) ‘Mozambique National Child Mortality Study’
UNICEF (2012) ‘Preventing mother to child transmission’ available online at
unicef.org/mozambique/hiv_aids
UNDP (2012) ‘Mozambique, Causes of Mortality: Situation and Trends’
Michael MacHarg (2010) ‘For Mother's Day: Celebrating Innovations in Maternal Health’ available online
at nextbillion.net
James Pfeiffer (2003) ‘International NGOs and primary health care in Mozambique: the need for a new
model of collaboration’ Social Science & Medicine 56, 725–738
VeroniqueFilippi et al. (2006) Maternal health in poor countries: the broader context and a call for
action
The Lancet, 368, 1535 – 1541
L Jamisse et al. (2004) Reducing maternal mortality in Mozambique: challenges, failures, successes and
lessons learned, International Journal of Gynecology &Obstetrics, 85:2, 203–212
C Santos et al. (2006) ‘Improving emergency obstetric care in Mozambique: The story of Sofala’
International Journal of Gynecology &Obstetrics,94: 2, 190–201
G. Benagiano (2003) ‘Safe motherhood: the FIGO initiative’
International Journal of Gynecology & Obstetrics
82:3, 263–274
World Health Organisation (2011) ‘Compendium of new and emerging health technologies’

14. Targeting delivery is not enough…
• By engaging at the antenatal stage women are more likely to understand and accept
• ~4% of maternal deaths are due to abortions
• Contraception prevalence is 16%

15. Where are the opportunities for having a health impact?
Stage of pregnancy
• Family planning
• Antenatal
• Delivery
• Postpartum
Locations
• Households
• Communities
• Primary healthcare
• Referral healthcare
Improving maternal health is more than just addressing deaths during childbirth