A community based approach to reducing maternal mortality in South Sudan

Despite recent progress in global maternal health, recent estimates placed Sub-Saharan Africa with two- third of global maternal deaths. The biggest challenge in this region to address maternal health is to increase the outreach of existing effective solutions for those who need them most. Fragile states, like South Sudan with the highest maternal mortality rate globally, pose especial limitation in this area. During 2010-14, a community-based health care delivery project was implemented in rural South Sudan aimed at reducing maternal mortality. A descriptive, quasi-experimental, before and after design was used to document coverage of a maternal package including seven evidence-based maternal interventions (antenatal care, tetanus vaccinations coverage, iron supplement, skilled birth attendant, active management of third stage of labor, bed net usage in pregnancy, and intermittent preventive treatment in pregnancy) delivered through a community platform. A total sample of 808 mothers of children under two years was selected using a two-stage 30-cluster sampling. Analysis of data included descriptive statistics, p values, confidence intervals and odds ratios for each variable. All seven maternal variables experience statistical significant upward coverage rates changes, ranging from 5 percent points increased for active management of third stage of labor to 40 percent points increased for intermittent preventive treatment in pregnancy. The community based delivery platform utilized increased coverage rates for selected maternal interventions in a fragile state setting. The success of this project can serve as a potential model on how to implement health services through a community structure in other high risk settings.