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    LET US WIPE IT OUT AND MAP IT: THE HEAVY BURDEN OF HIGH MATERNAL MORTALITY: A focus on NIGERIA, sub-Saharan Africa.

    by Taiwo Lawoyin 10/10/2017 07:55 AM BST

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      1.0  INTRODUCTION

      In 2015 the UN General Assembly formally accepted a new set of 17 measurable Sustainable Development Goals (SDGs).1 

       

      These include:

      1. Eradicate poverty in all its forms
      2. End hunger, achieve food security, improve nutrition and promote sustainable agriculture
      3. Ensure healthy lives and promote well-being at all ages
      4. Ensure inclusive and equitable quality education & promote lifelong learning opportunity for all.
      5. Achieve gender equality and empower all women and girls.
      6. Ensure availability and sustainable management of water and sanitation for all.
      7. Ensure access for affordable, sustainable and modern energy for all
      8. Promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all.
      9. Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation.
      10. Reduce inequality within and among countries.
      11. Make cities and human settlements inclusive, safe , resilient and sustainable
      12. Ensure sustainable consumption and production patterns
      13. Take urgent action to combat climate change and its impacts.
      14. Conserve and sustainably use the ocean, seas and marine resources for sustainable development.
      15. Protect, restore and promote sustainable use of terrestrial ecosystem, sustainably Manage forest, combat desertification, halt and reverse land degradation and halt biodiversity loss.
      16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build and effective, accountable and inclusive institutions at all levels.
      17. Strengthen the means of implementation and revitalize the global partnership for sustainable development.

      ranging from ending world poverty to achieving gender equality and empowering women and girls by 2030. These are to succeed the Millennium Development Goals (MDGs), a set of eight measurable goals which were signed in September 2000.

       

      Linking survey cluster location data to other conditions in the communities at state and national level is very useful for understanding and explaining why unfavorable  conditions continue to occur at high rates in spite of expensive interventions.   An example is the incidence of meningitis  and rainfall, and seasons of the year.

       

      1.1 GEOGRAPHIC INFORMATION SYSTEM [GIS]

      These are indicators which can be obtained easily from community, state and national geographic information system [GIS].   Moreover, small communities, state  and national comparisons can be achieved with these data.

      GIS2,3  lets us visualize, question, analyze and interpret data so we can better understand relationships, the patterns  and the trends.  It displays after analysis geographic and spatial  data. It is   very valuable tool that can be used to visualize spatial data or to build decision support systems for use.

      GIS can potentially identify locations anywhere on earth and compare data by geographical location and by its characteristics including population demographic characteristics. 

      GIS can locate by:

      1. District and territorial maps
      2. Circular buffer areas with similarities in character
      3. Areas of influence
      4. Demographic characteristics
      5. Hot spots mapping
      6. Cost calculation
      7. Access capability in locations
      8. Area measurements
      9. Desire or spider lines which will allow us to visualize flow.

       

       

      2.0  JUSTIFICATION:
      Achieving the MDGs4 produced a success story particularly in many developed areas.  However,  targets  were not always met in developing countries particularly for child mortality and maternal health.    For this reason,  this study will focus on target 3. Innovative ways to reduce morbidity and mortality will be articulated in a full proposal.    Successful    intervention is  possible when the cultural, political  and societal norms are carefully considered.  

       

      3.0  GENERAL OBJECTIVES:

      To Reduce the maternal mortality ratio [MMR]  to less than 70 per 100,000 live births in Nigeria by   2030 .   Target indicators as specified by SDG will be used for this exercise.  Regional data will be collected.  Data will be mapped by GIS.

      3.1  SPECIFIC OBJECTIVES:

       TARGETS INDICATORS : output interest  in  REGIONS

       Reduce the National, State, and local  maternal mortality ratio [MMR]  to less than 70 per   100,000 live births by

      1. Reducing the number of deliveries at extremes of maternal age [<15 and >40 years].  This is done by behavioral counselling, increasing care of surviving children &  availability of family planning that is acceptable and affordable.   Other proximate determinants will be considered.

       

      1. Increasing the proportion  of mothers that receive HIV screening and counseling   in pregnancy, and at immunization clinics  so that mothers can receive anteretrovirals early in order to reduce maternal morbidity and mortality. 

       

      1. Encouraging breastfeeding. This reduces maternal  deaths from breast cancer and  reduces deaths in early childhood of their babies.   Reducing  the infant & child deaths will reduce the incentive for mother to replace the lost child at all cost and at increasing age which also increases risk of morbidity and mortality.

       

      1. Ensure Delivery at a facility and  providing community acceptable,  community based standard prenatal / post natal care will also reduce  maternal deaths.

       

      1. Maternal education has been a significant indicator of survival.  Improving maternal education  will improve maternal survivor.

       

      All clusters with global  MMR more than or equal to 70 per 100,000 live births   In sub-Saharan Africa -  Nigeria , will be identified.      In addition,   GIS will provide demographic and population specific information about the clusters.    Water supply,   Available antenatal /prenatal clinics, immunization effort,     place of delivery ,  mean maternal age ,   years of education;  succeeding  and preceding  birth interval;  age at first birth,  mean parity ;  number of antenatal visits if any and mean gestation at first presentation to health care.   Information on the level of care available will also be mapped.   Baseline data will be collected  and mapped.   HIV  screening and prevention of vertical transmission in pregnancy and  especially at delivery;  and  condom  use5-9 will be obtained from DHS  files  and   every 4.5 years  with intervention.   MMR will be assessed in the focus clusters  to see if the goals  are being met.  Final assessment will  be made  for the year 2030 assessment.

      3.2

      End preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births :  All clusters  with IMR higher than 12 per 1000 will be easily identified and mapped by GIS.  Demographic & population specific data will be obtained to further help tract progress towards achieving the goal and also will provide basis for ongoing intervention to meet the stated goal.   Information  for 3.1 and 3.2  are  generally collected together. By 2030 final assessment will be made to see if goal are achieved.

      Targets 3.3; 3.4; 3.5; 3.6; 3.7; 3.8; 3.9 and 3a,b,c can be done in a similar manner

      By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases

      3.4

      By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being 

      3.5

      Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

      3.6

      By 2020, to halve the number of global deaths and injuries from road traffic accidents 

      3.7

      By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs

      3.8

      Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all 

      3.9

      By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination 

      3.a

      Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate 

      3.b

      Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all 

      3.c

      Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States 

      3.d

      Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks

       

       REFERENCES

      1. un.org/sustainabledevelopment/sustainable-development-goals/ Accessed Sept 25, 2017
      1.  Clarke, K. C., 1986. Advances in geographic information systems, computers, environment and urban systems, Vol. 10, pp. 175–184.
      2.  Maliene V, Grigonis V, Palevičius V, Griffiths S (2011). "Geographic information system: Old principles with new capabilities". Urban Design International. pp. 1–6..
      1. The Millenium Development Goal. 2015. UN, New York 2015.
      2. Lawoyin TOOlawuyi JFOnadeko MO.. Factor associated with exclusive  Breast feeding in Ibadan, Nigeria.  J Hum Lact. 2001  Nov;17(4):321-5.

       

      1. Olopade, F.E. and Lawoyin, T.O. Maternal mortality in a Nigerian maternity hospital.   African Journal of Biomedical Research, Vol. 11 (2008); 267 – 273.

       

      1. Adegoke, A. A., Campbell, M., Ogundeji, M. O., Lawoyin, T. O., & Thomson, A. M. (2013). Place of birth or death: an evaluation of 1139 maternal deaths in Nigeria. Midwifery.   November 2013  Volume 29, Issue 11, Pages e115–e121. 

       

      1. Lawoyin TO. Infant and maternal deaths in rural south west Nigeria: A prospective study. Afr J Med Med Sci 2007;36:235-41.  

       

      1. Maternal mortality in 1990-2015. WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division, Maternal Mortality Estimation Inter-Agency Group, Nigeria.
            
      Co-authors to your solution

      Ayodele Jibowu2 and Olusheyi Lawoyin1 1Frontline Research & Training in Reproductive and Family Health, USA. Registered in the State of Maryland USA & Nigeria. 2 Environmental Planner/GIS Specialist, P.O. Box 540072, Houston Texas 77254. toolawoyin@yahoo.com

      Link to source code or original files

      GIS Policy Maps will be utilized

      Please enter a link to your solution (working demo)

      GIS will provide demographic and population specific information about the clusters. Water supply, Available antenatal /prenatal clinics, immunization effort, place of delivery , mean maternal age , years of education; succeeding and preceding birth interval; age at first birth, mean parity ; number of antenatal visits if any and mean gestation at first presentation to health care. Information on the level of care available will also be mapped. Baseline data will be collected and mapped. HIV screening and prevention of vertical transmission in pregnancy and especially at delivery; and condom use5-9 will be obtained from DHS files and every 4.5 years with intervention. MMR will be assessed in the focus clusters to see if the goals are being met. Final assessment will be made for the year 2030 assessment.

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        Approval 12/28/2017 Completed
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