The newly launched Research Centre for Maternal, Fetal, Newborn and Child Health Care at the University of Pretoria (UP) has access to a treasure trove of expertise and data gathered over the last two decades. The Essential Steps in Managing Obstetric Emergencies (ESMOE) project is one of many initiatives run under the auspices of the new Centre and aimed at improving primary and secondary maternal and infant healthcare.
The new Centre succeeds the South African Medical Research Council's Maternal and Infant Health Care Strategies Unit at the University of Pretoria, which has been gathering data on the care of mothers and infants since 1997. From 20 years of knowledge and experience, experts at the Unit have found that a lack of adequate skills and training is contributing to the high prevalence of maternal deaths in South Africa.
The ESMOE programme aims to improve the emergency management of pregnant women and their infants by developing and implementing a training package for emergency care. To do this, researchers collaborated with the Liverpool School of Tropical Medicine to develop an SA-specific training programme for healthcare professionals and students to improve in this area.
A report on a survey led by the director of the Maternal and Infant Health Care Strategies Unit, Professor Robert Pattinson, looked at basic emergency obstetric and neonatal care in 12 South African health districts. Pattinson reports that in the 12 districts surveyed, the required level of emergency obstetric care was not available in most community healthcare centres and in only a quarter of district hospitals.
“We found that less than half the clinics could get their patients with complications to the appropriate hospital in less than an hour,” says Pattinson. “Safe maternity care was not consistently available at many facilities conducting births.”
This survey showed that a concerted effort was needed to train midwives and doctors in vacuum deliveries, manual removal of the placenta and manual vacuum aspiration of the uterus for incomplete miscarriage. ESMOE is specifically designed to meet these needs, among many others.
The training has been a marked success, with a one-third reduction of maternal deaths after training, and an almost 20% reduction in deaths due to blood loss during and after childbirth.
The training programme also exists as a digital platform with myriad resources to help train healthcare workers in subjects such as a surgical safety checklist, guidelines on maternity care, and miscarriage scenarios, among others.
ESMOE has been so impactful that it has caught the attention of the European Union (EU) which has helped the Unit expand ESMOE training from the original 12 districts to all 52 districts in South Africa.
The ESMOE programme continues to provide training for healthcare professionals at South African healthcare centres to help put maternal health at the centre of national plans and support women’s right to safe motherhood.
Specialised training developed at UP has provided 11 000 healthcare workers with the skills required to deliver complicated births, saving mothers and newborns in the process.