Putting mothers and infants first with with antenatal training courses in Somaliland.

A young mother in a rural village

Deka, a 20 year old woman, belongs to a nomadic family and lives in a small village in thenorth west of Somaliland, about 40km away from Boroma, the nearest main town. No health facility is available in the place where she lives. The nearest village with any maternal child health services is 10-15km away.

Her first pregnancy had ended in the loss of twins born prematurely at 27 weeks. Her second pregnancy was poorly monitored as she had attended ante natal care only very occasionally. Nevertheless, she thought that her baby was healthy. However, one day, at a time when she was close to term (close to the end of her pregnancy), having completed her usual morning routine she suddenly fell ill. She felt an acute pain in her abdomen and suddenly began convulsing before losing consciousness. Her family became very frightened by her condition and immediately made arrangements to transport her to the hospital in Boroma. She arrived, 12 hours later at Borama GeneralHospitalin a coma, having had several convulsions on the journey[1].

Life saving treatment

She was admitted to the maternity ward and examined by an intern who had recently graduated fromAmoudUniversityin Boroma. He correctly diagnosed that she had eclampsia; a life threatening complication in pregnancy and a major cause of maternal death inSomaliland. He gave her appropriate medication to stop convulsions and lower her blood pressure. The baby was found to be alive and the progress of her labour was accelerated. Within eight hours, Deka was holding a healthy baby girl. Thanks to the quality of care and appropriate treatment, Deka made a full recovery and went home five days later. Without this care, the mother would almost certainly have died.

 The doctor who treated Deka had received training from visiting specialists fromKingsCollegeHospitaland had participated in Life Saving Skills in Essential Obstetric and Newborn Care course run by the Royal College of Obstetricians and Gynecologists International Office (RCOGIO). This training support was made possible through the Health System Strengthening Programme, funded by DFID.

Helping improve antenatal care

For some mothers, the risk of life-threatening complications such as eclampsia may be reduced with ante natal care. With support from the HSS programme funded by DFID, a multidisciplinary team of undergraduate nursing students[2], their supervisors and an intern attend maternal and child health centres in Boroma once a week to provide antenatal care. During these visits nursing students identify high risk patients who are then reviewed by the medical intern. The intern institutes treatment and recommends referral to the Boroma Hospital after confirming the diagnosis. Patients like Deka may have been picked up during antenatal care with pre-eclampsia, necessitating treatment and early referral before eclampsia develops. Eclampsia is one of the five most common causes of maternal deaths in developing countries. Antenatal care provided by the team also promotes birth preparedness, iron and folic acid supplementation, treatment of anaemia and administration of tetanus toxiod. By identifying and managing complicated cases at maternal and child health centres, and encouraging referral to the nearest General Hospital the visiting team thanks to support from the DFID programme can help more mothers like Deka.

[1]Boroma GeneralHospital isAmoudUniversity’s Teaching Hospital and the main referral hospital in the region

[2] Third year nursing students from the faculty of nursing at Amoud University.