Miguel Lombera
President
Mexican Society of Public Health
/
View from the Top

Implementing Programs to Decrease Maternal Mortality

Wed, 09/07/2016 - 09:49

Q: What challenges does the country face in terms of public health?

A: The first issue is the rate of maternal mortality in childbirth. We need to reduce the risk especially in the most remote localities where the rate of teen and child pregnancy is significant. Most of these girls, primarily indigenous, are not receiving the proper medical care or preventive education to avoid high-risk pregnancies. The second biggest issue is that some women have very little antenatal care and that can impact the mortality rate for mothers and unborn children. A lack of family planning leads to older women entering high-risk pregnancies.

Q: What steps have been taken to investigate and provide solutions to high-risk pregnancies?

A: The SMSP has initiated a project concerning maternal mortality. We are focusing our efforts on preventing teen pregnancies and helping provide proper antenatal care for mothers in vulnerable groups. Such a venture requires resources such as personnel, vehicles and material. We carried out a beta test to intervene and educate these groups, so they may start making better decisions while still respecting their own customs. This initial test was quite successful, which led to a three-year program in a small number of localities where we not only focused on prevention and planning, but also in interacting with the people. For two years we have targeted 20 localities that have around 2,000 inhabitants in six states: Chiapas, Hidalgo, the State of Mexico, Oaxaca, Veracruz and Yucatan. We concluded that women with high-risk pregnancies were not experiencing proper antenatal care due to either cultural issues or misinformation. We undertook a pilot test in Yucatan to ensure people understood the message without misconceptions. We researched the effectiveness of using their local dialect instead of standardized Spanish and developed comic-book style material to support educational and training efforts. The best promoters for this type of venture were local health professionals.

Q: As these types of efforts and campaigns require funds the public sector cannot absorb in its entirety how can the private sector help and participate in these projects?

A: Interaction between the public and private sectors is paramount. There should not be any political interest when developing these studies and public health should be the main focus. Associations like the SMSP exist for this reason, to work as an intermediary and maintain neutrality. Public health’s mission should be to preserve health in society through prevention, promotion, control, protection and lobbying. In the family planning project, the SMSP took a public sector initiative and found the resources in the private sector, which is the ideal interaction from all three sides.

Q: If this project is replicated at a national level, how could the private sector help it come to fruition?

A: We collaborated with the Department of Planning and Health Development on a program called Fortalecimiento a la Atención Médica, aimed at providing medical attention with independent health mobile units, small vehicles in which a doctor and a nurse go to remote communities to help the most vulnerable people. We want to collaborate with the ministry on this project.

Q: What other projects relating to public health is the SMSP working on and how and when will these have an impact?

A: We have been working on different projects; some are having a very strong impact on our country already such as our vector-borne disease project. This is particularly relevant in Mexico with diseases such as dengue, zika and chikungunya transmitted by the mosquito Aedes aegypti. A year and a half ago we found if the mosquito did not exist, neither would the illness. Today both zika and chikungunya are public health issues. We offered the Ministry of Health a study to determine if the pesticide used for the campaigns was effective. We captured nearly 150,000 mosquitoes and showered them with pesticide. After 48 hours, if the mosquito remained stationary it was most certainly dead but we found that due to the mosquito’s resistance to pyretrhoid the pesticide would only immobilize them and after a period of four to five hours the insect would recover. Our study proved that in reality pyrethroid pesticides kill only four out of 10 mosquitoes.