Zwedru

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UK instructors, Jo and Julia, arrived in Zwedru on 2nd November along with local Liberian instructor trainees Kola, Advanced Neonatal Nurse Practitioner (ANNP) with Maternal and Child Health Advocacy International (MCAI), Agnes, Gertrude and Christina, all of whom have been trained as neonatal clinicians (nurses with extended roles) within the MCAI programme.  Kola has been training two neonatal clinicians here in Zwedru and they have set up a neonatal unit which they hope to expand.  UNICEF is collaborating with MCAI now to further develop the programme around safe delivery of babies and extend it into the rural areas around Zwedru.  Our role here this week is to help with the training of the nurses and midwives based in Grand Gedeh county.  Our 4 Liberian colleagues (well, Kola’s Nigerian actually but based here now) will do the Generic Instructor Course in the next 2 days and then – supervised by Jo and Julia – teach the Newborn Care Course to nurses and midwives here in Zwedru.

Getting here was quite fun!  The rainy season has gone on a little longer than usual in West Africa this year and the roads from the capital, Monrovia, are impassable.  So we came by twin engine plane….

Muddy, red laterite soil landing strip in Zwedru
Medical Aviation Fellowship (MAF) 10-seater twin-engine plane and a pretty impressive Australian pilot
Selfie of the instructor team on board the aircraft. 2 of them had never flown before.
Tropical rainforest from the plane window

Kalafong wraps

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Kim and Julia have been busy in London (and Alison in Amersham) making these baby slings for mothers of preterm babies in Liberia.  They will be used on the training courses in November and then left in country for use on the neonatal unit.  Skin to skin mother care develops the bond between mother and baby as well as helping to prevent infection and keeping the baby warm.  You can read more about the advantages of skin to skin care at https://www.nicheinternational.org.uk/2018/11/13/skin-to-skin-mother-and-father-care/.

We call them kalafongs on the Newborn Care Course but they are not actually called kalafong wraps – even in Kalafong hospital in South Africa which is where the pattern for these (very cheap and easy to make) skin to skin wraps is from, see https://www.up.ac.za/media/shared/Legacy/sitefiles/file/45/1335/877/thariinstructionsnewkmcwrappatternmay2011.pdf.

Childhood mortality in Liberia

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I’ve been thinking about what I wrote yesterday about the drop in percentage of population who are over 15 compared to the under 15s.  Liberia has a very high under 5s mortality rate and it is probably that that skews the chart so heavily.  In the UK, our under 5s mortality rate (expressed as the number of children under 5 dying per 1000 live births) is very similar to our infant mortality rate (number of under 1s dying per 1000 live births).  ie. if you survive till your first birthday in the UK, the likelihood is that you will survive till your 5th.  Not so in countries like Liberia and Cameroon.  Take a look at the table below (2017 data from UNICEF).  All forms of childhood mortality are expressed as the number dying per 1000 live births:

COUNTRY NEONATAL MORTALITY
 INFANT MORTALITY  

UNDER 5 MORTALITY

 
UK 2.6 3.7 4.3
CAMEROON 25.5 55.1 84
LIBERIA 25.1 55.9 74.7

 

Many children die between the ages of 1 and 5 in low income (eg. Liberia) and lower middle income (eg. Cameroon) countries (World Bank classification according to GNI (more on this tomorrow I think)).  Actually, according to UNICEF statistics (https://www.unicef.org/liberia/children.html), Liberia has done rather well recently in reducing under-five child deaths, from 241 to 78 per 1,000 live births between 1990 and 2011.  This is great but still means there’s a long way to go before the UN’s sustainable development goal (SDG) of 25 per 1,000 by 2030 is achieved (https://www.un.org/sustainabledevelopment/health/). 

The SDG neonatal mortality goal which is what NICHE International is all about is “at least as low as 12 per 1,000 live births” worldwide.  Take a look at my table above again.  We have some work to do.