image description

What do sanitation and hygiene have to do with maternal health?

18 January 2013

LSHTM researchers presented new SHARE research on the links between WASH and maternal health at the Global Maternal Health Conference in Arusha, Tanzania, this week. You can read Maternal Health Task Force blog on this session here

The conference was opened by the Vice President for the Republic of Tanzania, His Excellency Dr Mohamed Gharib Bilal, who declared that ‘no mother anywhere should die bringing life into the world’. He called on the conference to use science and research to identify ways to improve the quality of maternal healthcare and ultimately reduce maternal mortality. SHARE research - jointly undertaken by the London School of Hygiene and Tropical Medicine (LSHTM) and WaterAid – is contributing to this agenda by considering the role of WASH in improving maternal health.

SHARE, together with CEDPA India, the Public Health Foundation of India (PHFI), and the University of Aberdeen (UoA), convened a session entitled ‘Water and Sanitation, and MDG 5: The Enabling Environment for Quality of Care’. Prof Wendy Graham, chairing the session, challenged the audience to think beyond their immediate interests or focuses to identify blind spots in maternal health strategies that might drive progress towards Millennium Development Goal 5 to improve maternal health through reducing the maternal mortality ration by three quarters and achieving universal access to reproductive health.

The first presentation by Prof Oona Campbell of LSHTM set the scene by asking the question ‘what do we think and what do we actually know about the links between WASH and MDG 5’. Presenting the findings from a recent systematic review and related conceptual framework, she highlighted the many posited links and the strength of evidence for these. Most identified ecological and individual-level studies reported a strong association between maternal mortality and sanitation after adjusting for various likely confounding factors.

There were then two presentations of work by SHARE to assess the prevalence of safe water and sanitation in domestic and health facility birth settings. Oliver Cumming (LSHTM) presented analysis of existing DHS household survey data in four countries (Bangladesh, India, Malawi and Tanzania) to assess the proportion of births taking place at home and, of those, what proportion could be considered ‘WASH-safe’. The proportion of births taking place at home ranged from over 80% in Bangladesh to 25% in Malawi. Of those births taking place at home, the proportion estimated to be ‘WASH-unsafe’ were very low, ranging from 19% in Bangladesh to just 1.5% in Tanzania.

Lenka Benova (LSHTM) then presented analysis of WASH in facility birth settings. Using Tanzania as a case study she considered using existing facility survey data from the Service Provision Assessment (SPA). On average, based on existing facility survey data, she estimated that only 44% of facilities where births take place are WASH-safe, and only 24% of actual delivery rooms.

Sanghitta Battacharya from PHFI then presented qualitative work conducted in Jarkhand state, in India, to consider women’s perceptions of health facilities . She emphasized the importance of listening to women’s own voices in assessing quality of care’ and using these insights to continually improve service provision and increase access and use of health facilities.

The last presentation was from Prof Graham who opened by asking why we are so bad at learning lessons from history. Pointing to the early work of Alexander Gordon and Ignaz Semmelweis in the eighteenth and nineteenth centuries, she warned of new epidemics of puerperal fever unless quality of care improves. She then presented research – done in collaboration with Dr Atnefu Getachew (WHO Ethiopia) - that set out to answer a seemingly simple question ‘who cleans the labour ward’? As with WASH, hospital cleaners are absolutely key to improving the quality if care and yet represent a real ‘blind spot’ in current strategies.

Following these presentations there was a lively discussion with perspectives shared from countries across Africa and Asia. Two key points of consensus emerged: firstly, that there are some fundamentals, like WASH, that we need to get right to improve the quality of care; and, secondly, that integration is challenging and requires collaboration across sectors but the potential rewards are great.

If you’re interested in this topic, SHARE will shortly be publishing a series of papers on this research so please do sign up to the SHARE newsletter to keep up to date.