Doctors with Africa CUAMM Annual report 2014
p. 14
Doctors with Africa CUAMM
09 An Angolan woman weaving a straw basket in Chiulo (CUAMM Archive) 10 Searching for water in Cunene province (CUAMM Archive)
09
10
Annual Report 2014
Report on Africa/Angola
p. 15
Report on Africa/Angola
ANGOLA FLASH
www.doctorswithafrica.org/angola
392,750 Inhabitants involved by the intervention
3,263 Assisted normal deliveries
9,400 People reached by HIV awareness-building activities Uige Damba Uige
Luanda
Cunene Chiulo Municipality of Ombadja
Political profile*
Ondjiva
Healthcare profile*
Surface area
1,246,700 sq km
Population
21,472,000
Number of doctors
1.7 per 10,000 population 16 per 10,000 population
Capital
Luanda
Number of nurses/ widwives
Average age of the population
16
Neonatal mortality
47 per 1,000
Average number of children per woman
Under-5 mortality
167 per 1,000 live births
5.9
Maternal mortality
460 per 100,000 live births
Human Development Index Rank (UNPD)
149th out of 187 countries
Prevalence of HIV/AIDS 2.4% (between 15 and 49 years) Life expectancy (m/f)
50/52
* Source of surface area data: World Bank (2014) Source of Human Development Index Rank: UNDP (2014) Source of all other data: WHO website (2014)
p. 16
Doctors with Africa CUAMM
Annual Report 2014
Report on Africaa/Angola
OUR HISTORY Intervention by Doctors with Africa CUAMM in Angola
1997
2004
First interventions by CUAMM at the hospitals of Uige and Negage.
CUAMM supports the healthcare system in the delicate transition from emergency to development status, extending its intervention to the hospitals of Songo, Maquela do Zombo, Damba and Chiulo. The CUAMM nurse Marisa Ferrari is killed in a traffic accident in Chiulo.
12
15
14
16 2000
13
1990
1970
1980
11
Events in Angola
2002 End of the civil war, with general armistice leading to the signing of peace treaties.
July 1975
November 1975
Start of the civil war.
Declaration of independence from Portugal.
11 Disabled patients at Negage hospital
12 CUAMM doctor Enzo Pisani holding a training course for midwives in Uige
13 Paediatric patients at Negage hospital
14 CUAMM doctor Enzo Pisani working at Negage hospital
15 Aerial view of Chiulo hospital
16 Portrait of Marisa Ferrari, a CUAMM nurse who died after a traffic accident
p. 17
Report on Africa/Angola
2014
2005
2012
The CUAMM paediatrician Maria Bonino loses her life caring for the children admitted to Uige during a dramatic outbreak of Marburg fever.
The “Mothers and Children First� project gets underway to guarantee access to safe child delivery and newborn care in 4 African countries (Angola, Ethiopia, Tanzania and Uganda).
20
CUAMM focuses its activities in three geographic areas (the capital Luanda and Uige and Cunene provinces) in the field of the mother-child health and in the fight against HIV/AIDS and tuberculosis.
18
2014
19 2010
17
2005 An epidemic outbreak of haemorrhagic Marburg fever strikes Uige province.
17 Portrait of Maria Bonino, a CUAMM doctor who fell victim to an outbreak of Marburg fever
18 A mother breastfeeding her baby in Kilamba, in the province of Luanda
19 A newborn baby with its mother at Damba hospital
The organization is implementing an innovative project on the diagnosis of diabetes and hypertension associated with tuberculosis patients.
20 Children smiling and playing in Kilamba, in the province of Luanda
All photos are from the CUAMM Archive
p. 18
Doctors with Africa CUAMM
Annual Report 2014
LUANDA
Results
Doctors with Africa CUAMM provides technical assistance to the Angolan Ministry of Health in implementation of the National Programme for the Prevention and Treatment of Tuberculosis in Angola. The intervention is accompanied by an innovative approach designed to contribute to improving the diagnosis of diabetes and hypertension among tuberculosis patients: all cases with suspected tuberculosis attending the four main Directly Observed Therapy (DOT) centres of Luanda are also tested for these chronic pathologies.
Luanda Training
In this province CUAMM organized numerous courses for health centre staff, focussing particularly on mother-child care and HIV and malaria prevention and treatment. The organization guaranteed the supply of material and medicines for the area’s dispensaries and community-level activities were promoted in the municipality of Damba through mobile clinics. Visits were carried out in two villages per week, to promote health education for the population and preventive care and epidemiological surveillance with the municipal Health Department. In the municipality of Damba, the diocesan hospital Rainha Santa was reinstated and equipped to be a mother-child health centre. The facility is awaiting government authorization to start activities. A midwife joined and supported local municipal hospital staff in improving the quality of antenatal visits during community-based activities. Hospitality and care was provided to pregnant women from the remotest areas at the Maria Bonino waiting house.
23 A mother during an ultrasound scan at Chiulo hospital (CUAMM Archive)
391
1
Patients with tuberculosis screened for diabetes
UIGE PROVINCE
22 A child being vaccinated during visits to the villages of Damba municipality (CUAMM Archive)
13 Health workers trained to monitor and screen for diabetes in TB patients
Prevention
21 Check up of a woman with tuberculosis, in Luanda (CUAMM Archive)
Report on Africa/Angola
Results2 Uige Province Visits
Antenatal visits in the municipality of Damba
Villages per quarter
30
Prevention
Care
Over 4,000
84
Children benefitted from immunizations during the visits to the villages
Women received hospitality at Maria Bonino waiting house during 2014
1
2
From August 2014 to 31 January, 2015
24 A CUAMM doctor giving a toy to a child admitted to Chiulo hospital (CUAMM Archive) 25 Two newborns with their mother at Chiulo hospital (CUAMM Archive)
21
+15.7%
925
22
The percentage values refer to variations between 2013 and 2014
p. 19
Report on Africa/Angola
CUNENE PROVINCE Within the framework of the “Mothers and Children First� project, Doctors with Africa CUAMM is committed to contributing to the reduction of maternal and newborn mortality in the municipality of Ombadja, providing skilled delivery care free of charge, both at Chiulo hospital and in the local health centres. Operational research into improving care provision is an integral part of the project. A study conducted in 2014 to assess coverage of emergency obstetric and newborn care in
the peripheral health centres revealed a lack of basic services to manage safe child delivery. Over the coming months, the onus will be on stepping up availability in the area of intervention and on improving the capacity of the peripheral health centres to deliver these services.
1 Parenteral administration of antibiotics
Basic emergency obstetric and newborn care services3
Chiulo hospital Mukope health centre Okanautoni health centre Onepolo health centre Shangalala health centre
Service not available
2 Parenteral administration of oxytocin
Service introduced in 2014
9 C-section
3 Pemoval of retained conception products
Municipality of Ombadja, Angola
8 Blood transfusion
3
Tool applied: Need assessment of emergency and neonatal care. Columbia University. AMDD 2011
23
4 Manual removal of the placenta
7 Vaginal delivery with vacuum or forceps
5 Neonatal resuscitation with ambu bag and mask 6 Parenteral administration of anticonvulsants
24
25
p. 20
Doctors with Africa CUAMM
Annual Report 2014
Report on Africa/Angola
CUNENE PROVINCE
A second study explored equity of access to care at Chiulo hospital. This second survey revealed that the majority of women who deliver at hospital belong to the lowest population quintile, i.e. the weakest socioeconomic group. Other investigations are warranted to establish the applicability of the tool in this setting since there may be difficulties in correctly distinguishing social classes, probably because the hospital is located in a particularly poor area. The outcome of the study is nonetheless encouraging since it shows that accessibility to safe childbirth services is also guaranteed to the least privileged population groups.
50%
Besides the programme to guarantee access to assisted child delivery, CUAMM’s work involved the fight against HIV/AIDS in Cunene, a province with one of highest prevalence rates in the country. Community-based awareness-building and local staff training activities were carried out, most notably on HIV prevention and the treatment of AIDS patients. The intervention was completed by the promotion and production of information at community level on treatment and prevention methods.
20%
49,1
40%
30,7 30%
9,4
10%
8,6
2,1
richer
Quintile 5
Quintile 4
Quintile 3
Quintile 2
Quintile 1
poorer
0%
Hospital Survey 2014
Results4 Chiulo Hospital
Cunene Province Hiv/Aids
97 Women monitored for HIV prevention in the newborn
over 1,500 people
Deliveries
Assisted deliveries
1,028
Hiv testing
+23.11%
C-sections
90
-3.2%
Municipality of Ombadja Deliveries
Visits
Assisted deliveries
1,377
3,249
+20.36%
Visits
13,700
4
The percentage values refer to variations between 2013 and 2014
1,675
+20.2% Mortality
Antenatal visits
+225%
-19.8%
Paediatric admissions
Coverage of total expected deliveries
22%
Antenatal visits
Neonatal mortality rate (intrapartum and at 24 hours of delivery). Lower than the countrywide mortality rate of 4.7%
1%
Hospital maternal mortality due to direct obstetric causes. Standard <1%
2.6%