Figures & Tables
Figures
- FIGURE 1
Saving Mothers, Giving Life Theory of Change Model
Abbreviations: EmONC, emergency obstetric and newborn care; MCH, maternal and child health; MPDSR, maternal and perinatal death surveillance and response; MMR, maternal mortality ratio; NMR, neonatal mortality rate; PEPFAR, U.S. President's Emergency Plan for AIDS Relief; SMGL, Saving Mothers, Giving Life; USG, U.S. Government.
Source: Adapted from Saving Mothers, Giving Life.57
- FIGURE 2
Saving Mothers, Giving Life-Designated Learning and Scale-Up Districts in Uganda and Zambia
Source: Adapted from Saving Mothers, Giving Life.57
Tables
Article No. Article Title 1 Saving Mothers, Giving Life: it takes a system to save a mother 2 Impact of the Saving Mothers, Giving Life approach on decreasing maternal and perinatal deaths in Uganda and Zambia 3 Addressing the first delay in Saving Mothers, Giving Life districts in Uganda and Zambia: approaches and results for increasing demand for facility delivery services 4 Addressing the second delay in Saving Mothers, Giving Life districts in Uganda and Zambia: reaching appropriate maternal care in a timely manner 5 Addressing the third delay in Saving Mothers, Giving Life districts in Uganda and Zambia: ensuring adequate and appropriate facility-based maternal and perinatal health care 6 The costs and cost-effectiveness of a district-strengthening strategy to mitigate the 3 delays to quality maternal health care: results from Uganda and Zambia 7 Saving lives together: a qualitative evaluation of the Saving Mothers, Giving Life public-private partnership 8 Community perceptions of a 3-delays model intervention: a qualitative evaluation of Saving Mothers, Giving Life in Zambia 9 Did the Saving Mothers, Giving Life initiative expand timely access to lifesaving care in Uganda? A spatial district-level analysis of travel time to emergency obstetric and newborn care 10 Saving Mothers, Giving Life approach for strengthening health systems to reduce maternal and newborn deaths in 7 scale-up districts in northern Uganda 11 Sustainability and scale of the Saving Mothers, Giving Life approach in Uganda and Zambia Indicator Uganda Zambia Maternal mortality ratio (per 100,000 live births) 420a 262a Deliveries in facilities 57%b 48%c Births by cesarean delivery 5%b 3%c Birth attended by skilled birth attendant 57%b 47%c Antenatal care coverage: at least 4 visits 48%b 60%c HIV prevalence among adults 15–49 7%d 12%d Pregnant women with HIV receiving antiretroviral therapy 61%d 93%d Total fertility rate 6.2b 6.2c Modern contraceptive prevalence rate among all women 15–49 21%b 25%c Neonatal mortality rate (per 1,000 live births) 27b 34c Abbreviation: SMGL, Saving Mothers, Giving Life.
↵a 2010 data from Trends in Maternal Mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division (https://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/).
↵b 2011 data from Uganda Demographic and Health Survey 2011 (https://dhsprogram.com/pubs/pdf/FR264/FR264.pdf).
↵c 2007 data from Zambia Demographic and Health Survey 2007 (https://www.dhsprogram.com/pubs/pdf/FR211/FR211[revised-05-12-2009].pdf).
↵d 2011 data from UNAIDS AIDSinfo (http://aidsinfo.unaids.org/).
Basic Services Comprehensive Services 1. Administer parenteral antibiotics Perform signal functions 1 through 7 plus: 2. Administer uterotonic drugs (i.e., parenteral oxytocin, misoprostol) 8. Surgery (cesarean delivery) 3. Administer parenteral anticonvulsants for preeclampsia (i.e., magnesium sulfate) 9. Blood transfusion 4. Manually remove the placenta 5. Remove retained products of conception (e.g., manual vacuum extraction, misoprostol, dilation and curettage) 6. Perform assisted vaginal delivery (e.g., vacuum extraction, forceps delivery) 7. Perform basic neonatal resuscitation (e.g., bag and mask) Source: WHO, UNFPA, UNICEF, and Mailman School of Public Health.27
SMGL Indicator Uganda Zambia 2012 Baseline 2016 Phase 2 Endline % Change Baseline to Phase 2 Significancea 2012 Baseline 2016 Phase 2 Endline % Change Baseline to Phase 2 Significancea GOAL Institutional MMR (per 100,000 live births) 534 300 −44 *** 370 231 −37.6 *** Community MMR (per 100,000 live births) 452 255 −44 *** 480 284 −40.8 *** Pre-discharge neonatal mortality rate (per 1,000 live births) 8.4 7.6 −10 NS 7.7 8.7 +14 NS Institutional perinatal mortality rate (per 1,000 births) 39.3 34.4 −13 *** 37.9 28.2 −26 *** Institutional total stillbirth rate (per 1,000 births) 31.2 27.0 −13 *** 30.5 19.6 −36 *** DEMAND Health facilities that report having a VHT (Uganda) or SMAG (Zambia) (%) 18 92 +400 *** 64 93 +46 *** Institutional delivery rate (%) 46 67 +47 *** 63 90 +44 *** Deliveries in EmONC facilities (%) 28 41 +45 *** 26 29 +12 *** Deliveries in lower-level facilities (health center II, III) (%) 17 26 +48 *** 37 61 +67 *** ACCESS Facilities that report having an associated mother's shelter (%) 0 4 NA NA 29 49 +69 *** Institutional deliveries supported by transport vouchers (%) 6 24 +277 *** Vouchers not provided in Zambia Number of BEmONC facilities where the 7 signal functions were performed in last 3 months 3 9 +200 NA 3 8 +167 NA Number of CEmONC facilities where the 9 signal functions were performed in last 3 months 7 17 +143 NA 4 5 +25 NA 24/7 services at health centers (%) 75 89 +18 NS 65 96 +41 *** QUALITY OF CARE Facilities reporting having performed newborn resuscitation in the previous 3 months (%) 34 88 +155 *** 27 75 +173 *** Facilities providing active management of the third stage of labor (%) 75 96 +28 *** 72 96 +33 *** Population-based cesarean delivery rate (%) 5.3 9.0 +71 *** 2.7 4.8 +79 *** Hospitals that currently have at least 1 long-acting family planning method (%) 63 94 +51 ** 50 75 +50 NS Number of women receiving PMTCT treatment 1262 2155 +71 NA 930 1036 +11 NA HEALTH SYSTEMS STRENGTHENING Hospitals conducting maternal death audits or reviews (%) 31 94 +201 *** 50 100 +100 NA Health facilities that did not experience stock-outs of oxytocin in the last 12 months (%) 56 82 +46 *** 75 75 −0.4 NS Health facilities that did not experience stock-outs of magnesium sulfate in the last 12 months (%) 48 64 +34 *** 20 43 +115 *** Abbreviations: EmONC, emergency obstetric and newborn care; BEmONC, basic emergency obstetric and newborn care; CEmONC, comprehensive emergency obstetric and newborn care; MMR, maternal mortality ratio; NA, not applicable; NS, nonsignificant; SMAG, Safe Motherhood Action Group; VHT, Village Health Team; PMTCT, prevention of mother-to-child transmission of HIV.
↵a *** P <.01; ** P <.05; * P <.10. NA in cases where significance testing was not warranted.
Source: Serbanescu et al.38
Indicator Public-Sector Facilities Private-Sector Facilities Significancea Maternal mortality ratio (per 100,000 live births) 301 295 NS Direct case fatality rate 1.8 1.5 NS Perinatal mortality rate (per 1,000 births) 34.0 36.4 NS Intrapartum stillbirth rate (per 1,000 births) 13.8 17.0 ** Total stillbirth rate (per 1,000 births) 26.6 28.7 NS Pre-discharge neonatal mortality rate (per 1,000 live births) 7.6 7.9 NS Abbreviation: NS, nonsignificant.
↵a ** P<.05.
Source: Serbanescu et al.38
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