An estimated 590 maternal deaths occurred in the Gambia in 2015 and 2,168 newborn deaths in 2013. Out of a population of less than two million, these deaths contribute to excessively high maternal and newborn mortality rates.
Almost 50% of The Gambia’s population live below the national poverty line. This contributes towards the high maternal mortality ratio of 706 maternal deaths per 100,000 live births.
The Gambia had made progress towards Millennium Development Goals 4 and 5 – reducing child mortality and improving maternal health, however, it failed to reach its target of 263 maternal deaths per 100,000 live births by 2015 and an infant mortality rate of 42 deaths per 1000 live births. Much work remains to continue the progress made and contribute to the new Sustainable Development Goals and the target of a global maternal mortality ratio of less than 70 maternal deaths per 100,000 live births by 2030.
Maternity Cleanliness Champions Initiative
The “Maternity Cleanliness Champions Initiative” (MCCi) was established by Soapbox, the Horizons Trust Gambia, and the Gambian Ministry of Health. The aim of the MCCi is to reduce health-care associated infections in childbirth and related maternal and newborn deaths through improved infection prevention and control on labour and maternity wards.
Representatives from six participating Western Region health facilities attended training in mid-2013 led by Soapbox and NHS Grampian’s Scottish Patient Safety Programme Manager with an update meeting held in March 2014.
Clean Birth Kits
A feasibility study of Clean Birth Kits (CBKs), initiated towards the end of 2014, was conducted in collaboration with the Medical Research Council (MRC) in the Upper River Region of the Gambia. In the first phase of the project, CBKs, which included soap, a clean blade, and a clean plastic sheet, were given to women in the final months of their pregnancies. In the second phase, CBKs were given to women when they arrived at a facility to give birth. Comparisons were drawn between the two phases with regard to the popularity and use of the kits.
Training Manual Pilot
Soapbox needs assessments have revealed an alarming lack of formal training of cleaning staff in our focus countries. In response, Soapbox has developed an infection prevention and control and environmental hygiene training manual targeted towards low-literate cleaning staff. The manual was piloted in the Gambia in April 2016. The pilot included the adaptation of the manual to the local context and the development of a comprehensive training package. A ‘training the trainers’ workshop was conducted followed by roll out of the training to cleaning staff in four focus facilities. An evaluation of the pilot was conducted simultaneously.
Various student projects including a hand hygiene audit looking at hand hygiene practices on the maternity ward, a study of sick newborns at the major referral hospital revealing that 43% were admitted with sepsis, and a clinical audit on the management of sepsis, have been conducted.
The MCCi update meeting and workshop allowed participants to share their experiences and challenges following the first workshop and to discuss the next steps for the MCCi. Cleaning practices had improved across facilities and several facilities reported strengthening existing policies and training in IPC. The shortage of gloves and other essential supplies, however, remained a common challenge across these facilities.
Since then, further MCCi workshops have been held, led by our Gambian colleagues, evidencing both capacity building and awareness raising of the importance of clean safe care at birth and the effectiveness of this initiative.
The results of the Clean Birth Kits study are being used to inform future use of CBKs in the Gambia and their most effective method of distribution.
The feedback received regarding the IPC and environmental hygiene training was overwhelmingly positive. The participatory nature of the training ensured that the previously untrained, primarily low-literate participants gained a full understanding of the topics covered. Reports received stated that many participants had no idea their practices were harmful and improvements have since been seen across facilities:
“We are very happy after because, for me, to be frank enough, they surprised me. Because me, I don’t know that they are so much talented… I underrate them… but the time I stood in front of them to teach them, the ideas they bring out and their understanding level is very fast” – Trainer, Serrekunda Major Health Centre
Results of student projects have been fed back to colleagues both in the Gambia and internationally with the ultimate aim of improving practice. Further student projects are planned for later in the year.
- The Horizons Trust
- Gambian Ministry of Health and Social Welfare
- Epidemiology Disease & Control Unit
- IPC Task Group
- NHS Grampian
- University of Aberdeen