By Ruth O’Neill
Due to flooding and growing violence, an estimated 1.5 million people have been internally displaced in Cameroon—most of them women and children. In such conditions, pregnant women are especially vulnerable and face an increased risk of pregnancy loss or death due to complications during pregnancy or childbirth.
“These women are less likely to be educated on pregnancy health, and as such, less likely to identify pregnancy-related complications,” said Dorothy Dissake, MD, medical director in Cameroon for the International Medical Corps. “And due to the insecurity, there are very few or no medical doctors or midwives in most settings.”
Health challenges faced by women and children in areas of instability are not unique to Cameroon. According to the Partnership for Maternal, Newborn and Child Health (PMNCH), a startling 60 percent of the world’s maternal deaths and 45 percent of newborn deaths occur in areas impacted by crises like war, food insecurity or natural disasters. In these settings, disrupted or overburdened health systems, political unrest or forced displacement can prevent people from accessing essential health services. As a result, many pregnant women and babies die of complications that could have been prevented or treated by quality care during pregnancy and delivery, and after childbirth.
Saving lives requires a better understanding of where, how and why these maternal and newborn deaths occur. Unfortunately, countries in crisis often lack accurate public health data about maternal and newborn health.
To address this critical gap in information, the CDC Foundation and the Centers for Disease Control and Prevention (CDC) launched the Pregnancy Outcome and Death Surveillance (PODS) project in January 2020. With support from the Bill & Melinda Gates Foundation, the PODS project partnered with ministries of health, humanitarian organizations and other groups working in Cameroon, Chad and Burkina Faso—three countries facing complex humanitarian conditions. These partnerships will implement, strengthen and expand systems for gathering and reviewing data on deaths among pregnant women and newborns—known as Maternal and Perinatal Death Surveillance and Response (MPDSR).
“The primary goal of MPDSR is to eliminate preventable maternal and perinatal mortality,” said Daphne Moffett, PhD, CDC country director in Cameroon. “We want to not only collect but use information for public health actions and monitoring their impact.”
The Cameroon Ministry of Health has made considerable progress in improving existing maternal and newborn surveillance programs by implementing the PODS project recommendations. With support from CDC and the CDC Foundation, the Ministry of Health now has the guidance and tools to strengthen MDPSR among internally displaced persons and refugees. In April 2021, as part of this effort, the PODS team helped the Ministry of Health activate an incident management system that included plans for expanded surveillance in the Central and Littoral regions where there are large numbers of internally displaced persons and high rates of maternal mortality.
In November 2021, the PODS project also sponsored an intensive five-day training for district health officers to strengthen their MPDSR knowledge and skills. During the course, participants were presented with a maternal or perinatal case study and instructed on how to identify cause of death and contributing factors. The officers were also trained in establishing surveillance systems in a health facility, reviewing MPDSR data gathered in the field and using data to create a response plan to prevent future deaths.
“The training we did was a mind-opening training, because after this, the Ministry came to me and wanted to redesign how they are doing MPDSR on the national level,” said Soreya Dawa, MD, PODS Cameroon coordinator. “They are welcoming this project, and their expectation is big.”
While the training was focused on equipping hospitals and government health centers to gather information on birth outcomes, facility-level data represents only a fraction of the total cases in Cameroon.
“Quite a good number of deliveries are made at home or to traditional birth attendants without reaching the hospital setting,” Dissake said. “Complications and maternal and neonatal deaths recorded in these settings are often not investigated or followed, making it difficult to prevent them from happening.”
To capture more thorough MPDSR data, the PODS project is working with the humanitarian organization International Medical Corps to expand community-level surveillance. In Cameroon, many people rely on community health workers, local frontline responders who provide health services in the home or other locations far from hospitals or government health facilities.
Through the PODS project, the International Medical Corps will help train community health workers to conduct MPDSR in the community setting using a digital data collection application.
“Implementing a well-monitored program where every death is investigated, and actions taken to directly mitigate causes, will generate trust within the community, promoting early care-seeking behaviors and improved outcomes,” Moffett said.
The work of the PODS project is urgent. Pregnant women and babies in crisis settings continue to die at an unacceptably high rate in Cameroon and all over the world. By increasing the quality and scope of surveillance, the PODS project will help to inform stronger, more effective public health strategies to end these tragic and preventable deaths.
Ruth O’Neill is a senior communications officer for the CDC Foundation’s department of infectious disease programs.