2020 is the International Year of the Nurse and Midwife. Melbourne Children’s Global Health hosted two speakers tackling the topic of maternal and newborn health – Professor Caroline Homer AO, Co-Program Director, Maternal, Child and Adolescent Health at the Burnet Institute and Dr Maeve Hume-Nixon, Senior Study Coordinator and PhD Candidate at Murdoch Childrens Research Institute (MCRI) and Royal Children’s Hospital (RCH).
Why midwives matter for maternal and newborn health in low-to-middle-income countries (LMICs)
300,000 women die every year of pregnancy related issues. Ninety-nine percent of these deaths are in LMICs and almost all are preventable. The Lancet Series on Midwifery (2014), to which Professor Homer contributed, notes that midwives can help avert over two thirds of newborn deaths and disabilities when competent and supported by a functional health system.
The UNFPA State of the World’s Midwifery Report (2014) estimates that there are global shortages of midwives. This cadre, she noted, needs to be equipped to provide quality care. They need to be consulted, respected, properly incentivised, renumerated and well supported at all levels of an integrated health system.
Professor Homer also outlined an analysis by UNFPA in the South Pacific region, where the smallest island nations can meet almost all of their Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) workforce needs, yet struggle with large workforce planning challenges. Larger Pacific Island countries, such as Papua New Guinea, only meet around 25% of their RMNCAH needs.
The next State of the World’s Midwifery report will be released in mid-2021. For more information on the Pacific, please see The State of the Pacific’s RMNCAH Workforce 2019 Report.
Strategic and Technical Advisory Group of Experts (STAGE) for Maternal, Newborn, Child and Adolescent Health and Nutrition
Professor Homer went on to introduce the WHO’s Strategic and Technical Advisory Group of Experts (STAGE) for Maternal, Newborn, Child and Adolescent Health and Nutrition, of which she is the chair. STAGE provides advice on matters relating to Maternal, Newborn, Child, Adolescent Health, and Nutrition and will inform the WHO Primary Health Care (PHC) and Universal Health Coverage (UHC) agendas, with a focus on maximising country impact as well as coordinated global leadership. Professor George Patton and Professor Trevor Duke from Melbourne Children’s Global Health are both members of STAGE.
Bulabula MaPei: examining the effect of a single oral dose of azithromycin given to women in labour in Fiji
Dr Maeve Hume-Nixon described the Bulabula MaPei (Preventing infections in young infants with azithromycin in labour (PreYIAL): a blinded placebo-controlled randomised controlled trial) study, examining the effect of a single oral dose of azithromycin given to women in labour in Fiji. The study builds on existing research, particularly from Gambia, which found that administration of Azithromycin during labour can reduce maternal pathogen carriage and lower infection risk in both mother and infant. Fiji has high rates of neonatal infection, particularly Impetigo, a bacterial skin infection bacteria that can be a portal for more invasive disease.
The trial started in mid-July 2019 and is ongoing, after a brief interruption due to COVID-19. Adapting to the pandemic has led to a number of innovative modes of delivery, including telephone follow up and camera imaging for participant observation.
Similar trials are being conducted concurrently in other low- and middle-income countries, with hopes the results can be synthesised.