Voting
How would you evaluate this website?
Improved Care for Newborns
FERGANA VALLEY, Uzbekistan, 31 August 2010. - Watching her new born baby sleep, in the special care unit at the Namangan Centre of Obstetrics and Gynecology, young mother Bobokhanova Madina wears the kind of loving smile that can only come from someone who knows how lucky she is to be a mother.
“The baby only lived for a few days,” she told us. “It was 2.8 kilogrammes, was taken away from me to be treated, and did not survive.”
 |
Regional training centres established under the joint Ministry of Health, EU and UNICEF project help ensure that trained professionals share with their teams newly gained knowledge and skills on newborn and child care. |
But that was six years ago, and well before a joint initiative by the Ministry of Health of Uzbekistan, the European Commission and UNICEF, to improve mother and child health services across the country.
Weighing less than two kilogrammes, Madina’s new baby is clearly well and thriving, and is allowed to be with her all the time. “The doctors include me in all aspects of the baby’s treatment,” she said.
Now at the end of the second year of implementation of the Ministry of Health, EC and UNICEF project, 11,000 health professionals have been trained in maternal and child care in the eight regions, including Namangan. Out of these, 3,000 have received additional training in new-born care, which is having a direct impact on reducing child mortality in the region. The project also monitors health professionals for improvement in the quality of medical care they are able to provide following the training.
 |
Marguba Tukhtabaeva with her new born son Mukhammad Yusuf at the Namangan Perinatal Centre. |
“Mothers are able to choose the position to give birth and can have husbands and relatives present,” said Dr. Abdukhalieva. Fellow Neonatologist, Kodirova Manzura, pointed out other benefits. “We’ve also been taught the importance of breast milk and exclusive breast feeding,” she said. “And have introduced immediate contact between new born babies and their mothers, which helps good breast feeding.”
 |
Having just arrived in labour, Marguba Tukhtabaeva and her husband Akmal Muminov are awaiting the birth of their baby. The midwife Sohiba Sadriddinova helps them prepare with exercises. |
 |
Pediatrician Uktamkhon Toirova from Andijan attends training on new born and child care techniques under the joint project of the Ministry of Health of Uzbekistan, the European Commission and UNICEF. |
“This exercise is very useful,” explained Paediatrician, Toirova Uktamkhon, during a break in the training. “Sometimes we have to find solutions quickly, so this helps to improve our skills.”
Overseeing the session was Trainer Mukhitdinova Munavvar. “This will allow them to bring new skills into their practices,” she explained, “And ultimately to bring down child mortality.”
One of the main goals of the project is indeed to reduce Uzbekistan’s relatively high new-born death rate of 26 per 1,000 live births, and that, despite practically all births being attended by a medical professional.
By focusing on new-born care, the joint project of the Ministry of Health, EC and UNICEF is already making positive contribution to the overall health sector reform and quality of care.
Among them was Mamakhanova Mashura, who had to be induced ten weeks prematurely, to avoid potentially life-threatening complications. Weighing just 900 grammes, her tiny baby would almost certainly have died in the past. Now, cared for by trained and skilled health professionals on new-born technology, she had every expectation of thriving in the future to reach adulthood.
Breastfeeding: Health workers help get things right
By Nigina Baykabulova
GULISTAN, Uzbekistan, 5 August 2010. - A two-month old Abdulaziz is sleeping quietly in the arms of his mother. He looks very healthy like the big cute baby doll counselors use in maternity hospitals across the country to teach new mothers the basics of breastfeeding.
Dildora Rakhmankulova, 24, is not a first-time mother. Her elder daughter Diyora was born in the same maternity hospital as Abdulaziz and is already three years old. What is striking for the young mother is the difference in the way she is feeding her newborn now than what she did with three years ago with his sister.
 |
Dildora Rakhmankulova, 24, feeds her two-month old son Abdulaziz only with breast milk. |
“I’m giving my son only breast milk, no other food, and no water. I see that he is doing really well, especially in comparison to my daughter. He didn’t have a cold or any other illness so far,” says Dildora. She thinks it’s all because of the benefits of exclusive breastfeeding: “I am convinced that my breast milk is the best and the most natural food for my child. It makes him stronger and also helps prevent various childhood illnesses”.
On the contrary, looking after her daughter during the first few months after she was born was a real challenge. Dildora didn’t know how to breastfeed and who to refer to for a piece of advice. Her daughter often fell sick and she sometimes gave her breast milk, at other times milk formula and medicines ever so often.
Clearly, it was not her intention to treat the older child that way. “I simply did what the doctors had prescribed and told me to do,” she adds.
Supporting mothers
Health providers are essential in getting mothers to breastfeed their newborns and infants. They watch women closely during their pregnancy, as well as during and after delivery, and are called on for expert advice. But far too often, health workers themselves lack up-to-date knowledge and skills and fail to guide the would-be mothers correctly.
“For years, we have been taught to keep mothers and newborns separately, feed infants not on demand, but according to the clock. Similarly common was the practice of giving breast milk substitutes. In fact it was considered a progressive thing to do,” explains Maryam Hojimatova, chief doctor of the maternity unit of Gulistan’s health department in Syrdarya region.
Her maternity unit was not actively promoting breastfeeding till three years ago. But now it is taking big strides to change the situation in the region. Maryam-opa’s team has achieved this by making a big push to create a fully supportive environment for mothers, expectant and nursing alike. Promotion of exclusive breastfeeding is a major component of this effort.
“We seem to have long underestimated the role of exclusive breastfeeding for both children and their mothers. We now understand that it lays the foundation for the future well-being of a child,” says Maryam-opa.
After taking part in a series of very useful trainings, her team became a passionate advocate for breastfeeding among women and their families. Immediate relatives of the health workers were to benefit first. “It’s not easy to say “no” to old practices if you are not convinced yourself,” admits the senior nurse Dildora Mavlyanova.
This August, the Gulistan maternity unit was listed among other 35 health facilities of Uzbekistan, which successfully joined the “Baby-Friendly Hospital Initiative” supported by UNICEF. This means they follows the 10 steps to successful breastfeeding and encourage all new mothers to come along.
 |
Nargiza Rozikova, 30, (left) delivered her third child at Gulistan’s maternity unit just two days ago. After counseling by health workers, she is determined to spread the word about the importance of exclusive breastfeeding in her home village Bogoriston of Syrdarya region. |
Making impact last longer
As elsewhere, in Uzbekistan women do not stay long in maternities. Few days of counseling are not enough to keep new mothers fully committed and continue breastfeeding. They soon go out and enter a different world, full of contradicting messages and misinformation. It is not surprising then that the national rate of exclusive breastfeeding stands at 26%, which is below the global average of 37% which is already low.
That is why the Gulistan maternity unit extended its chain of influence by involving four family clinics and five rural health points in their area. “We all receive the same patients, at one point or another. So we thought, why not work together to improve our women and children’s health,” says Maryam-opa.
Mothers’ support groups are also part of this chain. Led by nursing mothers, sometimes the groups enjoy greater trust in the families and communities. “A doctor’s advice may not always come through strongly. Healthy babies of healthy mothers are a better proof of the value of breastfeeding,” acknowledges Maryam-opa.
The collective effort is yielding some positive results. This year the ‘connected’ rural health points are reporting fewer or no cases of diarrhea and other routine illnesses among the babies, while the Gulistan maternity unit confirms that all deliveries have been safe.
Make every child count
SAMARKAND, Uzbekistan, 14 May 2010. – A newborn son of Fatima Kulmurodova – Islombek - is only 5 days old. He sleeps quietly in a small cot near his mom’s bed. Appearance of unexpected guests in the room seems not to disturb him.It is a second child of a 25-year old teacher from Samarkand lyceum #1. Fatima’s first delivery occurred in the Taylak district maternity five years ago and left the feeling of fear and pain.
“There were too many people around me, putting an ice on my stomach, giving lots of anesthetics. I felt lost”, recalls the young woman.
This time all went differently. Fatima decided to go to Samarkand-based maternity # 3. Her family relied on “the word of mouth” when making the choice and had no clue that the hospital was officially recognized as baby-friendly. It were workmates who told Fatima that it’s warm, the doctors and nurses were good and attentive. They also knew that family members would be admitted to delivery rooms.
Fatima’s expectations turned true. She and her little son feel well and are waiting now only for a birth certificate to come.
“It’s a pity there were no such a place in our times,” admits Fatima’s mother-in-law Rukhsora Normamadova, 48. The mother of four, she lived through that and knows how crucial it is to create the right conditions for pregnant women. Rukhsora-opa has stayed with her daughter-in-law during the delivery and says Fatima will get full support at home.
 |
Fatima Kulmurodova with her newborn son Islombek and mother-in-law Rukhsora Normamadova. |
© UNICEF Uzbekistan/2010/Pirozzi
Life-saving techniques are within reach
Not all stories about childbirth in Uzbekistan would have the same happy ending. Nearly every delivery takes place here in maternities with skilled attendance. Yet, medical support is often inadequate or poor. The country’s maternal and infant mortality rates are therefore high compared to those of the middle-income countries. Poor health of women also serves as a contributing factor. According to MICS 2006, half of the mother and child mortality cases in Uzbekistan are caused by complications before, during and after the delivery.
“Many situations that have led to the death of newborns could be prevented or handled without complex and expensive technologies. There are new “low cost-high impact” strategies that help save more and more babies’ lives all over the world. The main thing is to change the maternal and newborn care practices inherited from Soviet times,” says Dr Hari Krishna Banksnota, MCH Specialist at UNICEF Uzbekistan.
He leads a nationwide project on improving maternal and child health, which is being implemented by the Ministry of Health and UNICEF with the European Union’s funding since 2008.
One of the key goals is to scale up application of the universally recognized standards in emergency obstetric care, neonatal resuscitation, and essential newborn care. Some of them are simple and do not require high-tech equipment: keeping babies warm and with mothers, feeding with breast milk, avoiding over-medication. Training of health specialists is complemented by advocacy at the policy level so that upgraded knowledge and skills sustain over time.
Leading by example
Samarkand maternity # 3 is one of the many beneficiaries of the EU-funded project. Few years ago this institution set an example in the region by supporting safe motherhood principles and the Baby-Friendly Hospital initiative. It also began promotion of exclusive breastfeeding ahead of other local health facilities. It’s not surprising then that the very same maternity took the chance of training its staff in effective perinatal care. Opening of a training centre and a new department on neonatal resuscitation followed.
“Our staff attended different workshops on safe motherhood in the past and felt well prepared. However, the training on neonatal resuscitation turned out very useful and timely. It brought up to our attention lots of nuances we didn’t know about, “says Sayyora Sobirova, Chief Doctor.
For example, they used to underestimate the role of temperature in saving the life of a newborn. Now they know: if it’s below the set minimum, no other invention will help a baby survive. Besides, the old school of medicine placed too much value on drugs in neonatal resuscitation. As a result, prescribing long lists of medicine was rooted in the practices of local neonatologists.
“All medical interventions for neonatal survival should be well justified. Otherwise, they can bring more harm than good,” says Sayyora.
The team she leads is determined to keep adopting the new techniques that proved effective. It doesn’t matter what it will cost them if babies’ lives are at stake.
Communication Award - Project of the Year goes to Uzbekistan
The joint project of the Ministry of Health of Uzbekistan, European Commission and UNICEF on improving mother and child health care wins the EuropeAid Communication Award for Asia
The Project for the Improvement of Mother and Child Health Services in Uzbekistan is a two and half year project launched in 2008 to improve the quality of health care for children and their mothers. The European Commission contributed 3.5 million Euro to the project.
The Communication Award has been given in recognition of both its exemplary communication’s work and successes on the ground.
A central feature of this project is the training of health workers at hospitals, maternities and primary health care facilities on newborn and child survival techniques. To date, more than 7,500 health professionals across Uzbekistan have upgraded their skills and knowledge and are able to provide better mother and child care. By introducing new practices and care methods, the project is contributing to the improvement of the health of young children and mothers in eight regions.
To ensure continuity, a pool of trainers was also created and 16 regional training centres were renovated and equipped. The work is under way to amend the curricula of eight medical institutions so that fresh medical graduates are familiar with and can apply modern international standards on child and maternal health care. Strong commitment of the Ministry of Health to introduce changes at the policy and service delivery levels is yet another factor contributing to the success of the project.
 |
“Our attitude towards a baby has changed. We feel more confident when come across difficult cases. We know that it is in our hands to save a newborn,” says Nigora Rusimuradova, head of the Neonatal Resuscitation Department from Samarkand maternity # 3. She is one of the many beneficiaries of the project, who has also been certified as a trainer. |
 |
For the EuropeAid Communication Award 2009, 15 projects on the issues ranging from environment to education and childcare were presented in the Asia category. |
The communications portfolio of the Uzbekistan’s project included two videos, a website, leaflets and other publications geared for various target groups. The project got into a short list after the online voting of two thousand EU staff. The final round, which took place offline at the EU Headquarters in Brussels, has brought it 53% winning votes.
The EuropeAid Communications Award was presented to Francesco Buscaglia, Programme Manager for Centralized Operations for Asia and Central Asia of the European Commission’s EuropeAid Co-operation Office at a special ceremony held at the EU Headquarter.
Tangible proof of the changes that have taken place in the mother and child health services right here before us! And all thanks to the partnership of the Government of Uzbekistan, the European Commission and UNICEF, for saving new-born lives and creating a healthy generation.