Mothers in Zanzibar suffer too often and too much: we want to improve their quality of life and the quality of their health care


Campaign Complete. This project has ended on February 21, 2018. No more contributions can be made.

  • £6,741.00

    Pledged of £3,750.00 Goal

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All funds will be collected by February 21, 2018.

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“We have reached our first goal! A big thanks to all the backers so far. This allows us to keep the research going for at least another 3 months (March-May 2018). To improve the robustness of the study we would like to continue the study until October 2019. Our current stretch goal is to have Tanneke’s presence in Zanzibar guaranteed until September 2018 which means raising a further £4,000, working on the current project now & on sustainability of the project after she leaves, for another year, by training researchers and research assistants from Zanzibar. Please do continue to support the project to help us reach our next goal of £7,750”

Around the globe, attempts are made to improve the health outcomes of women during pregnancy and childbirth. Low-income countries, and especially the ones in Sub-Sahara Africa, carry the highest burden of poor maternal health. Unfortunately, many severe outcomes would be preventable if health care systems are comprehensive and of high quality, as it is in many high-income countries. On an individual level, this results in the unnecessary suffering of many women, who luckily did not die in pregnancy or childbirth, but still have to cope with physical and mental complications. On a societal level, this means that families and communities lose women with full potential and capacity, and are socially challenged because of it.

About the Project

When looking at women who go through severe complications in pregnancy or childbirth, research tends to focus on the in-hospital setting and measures for improvement are aimed at the phase of acute care. Little research has been done into the actual long-term impact of these poor maternal health outcomes on women, their families and their communities. Impact can be measured in different dimensions, such as physical health, quality of life, disability, mental health, social life and child development. It is not common practice, anywhere in the world, to actively assess women months after delivery in these different dimensions. We believe that doing this in women who have had a serious obstetric complication, will reveal problems that are potentially addressable and curable, that would otherwise have remained covered. In addition to that, it will reveal the true impact of possible traumatic experiences in the hospital setting, on the daily life of a person. Lastly, it facilitates conversation with these women, asking them on their experiences, their needs and hopefully their suggestions for change for the better.

Why is this Project Important?

We believe that a true understanding of the impact of severe morbidity on the life of a woman will help improve maternal health care in three main ways. First, the quantitative and qualitative outcomes will add weight in addressing policy makers and stimulating change of a health care system in order for it to give better outcomes. Second, it gives women an often unheard and unvalued voice. A voice that is potentially very valuable in finding the fragilities of health care systems, where the women are much more familiar with from within, than the people making the policies. Third, it will reveal problems that women are coping with that are actually quite well addressable, for example: women with symptoms of depression or post-traumatic stress disorder could be referred to mental health care, women with disabilities that hamper daily activities could get training in physical or occupational therapy and women with ongoing hypertension could be referred to the medical clinic.

The Project Goals

We hypothesize that we will find a poorer overall physical and mental health in women who were in a life-threatening situation in the hospital, compared to women with a relatively uncomplicated pregnancy and childbirth. An example of this would be that we expect to find higher rates of depressive symptoms amongst women who had a severe complication. Furthermore, we think this group of women will experience a lower quality of life and a higher level of disability. In addition to that, other research suggests that the child, if it survived the complicated pregnancy or child birth, still has a higher chance of dying in the months and years following. On another level, we expect to be able to reflect the women’s feelings and needs and use their quotes and suggestions in order to show a more qualitative image of maternal health in Zanzibar.

Budget

Salary 1 full time medical researcher (Dutch) for 3 months (reduced rate) – £2,500
Translator salary (part time) – £1,000
Other cost (internet, printing) – £250

Total: £3750

Any funds raised over and above £3750 will go towards extending the project.

Team

Tanneke Herklots

Working as a researcher in Mnazi Mmoja Hospital, Zanzibar; PhD student at University Medical Centre Utrecht, the Netherlands.

For me, the profound inequality in the quality of healthcare that people receive around the world drives me to work in low-income countries. I have been working in Mnazi Mmoja Hospital on the maternal health research project since its initiation. This first year after graduation, I will continue working on-site in Zanzibar as a full-time researcher.

The project started with basic outcome registration, following an approach on maternal morbidity of the World Health Organization (WHO’s near-miss approach, Say et al., 2009). Findings of the first 6 months registration period have been published with open access (Herklots T, van Acht L, Meguid T, Franx A, Jacod B (2017) Severe maternal morbidity in Zanzibar’s referral hospital: Measuring the impact of in-hospital care. PLoS ONE 12(8): e0181470. https://doi.org/10.1371/journal.pone.0181470). Findings of the first 12 months registration and, in addition to that, validation of this WHO near-miss approach in our setting, are currently being prepared for submission for publication.

I feel that extending the project’s focus on in-hospital care with out-of-hospital, long-term effects of morbidity will result in a holistic understanding of the burden of maternal morbidity and mortality in Zanzibar. Ultimately, this will help in improving overall wellbeing of these women and their children.

Fatma Mrisho MD

Working as a registrar in the department of Obstetrics & Gynaecology, Mnazi Mmoja Hospital, Zanzibar.

Next to my clinical work, I think it is very important to conduct research in our setting in order to find ways for improvement of maternal health care. This is not possible without high quality research and I think that should involve the stories of the women as well. I have been involved in research before, that addressed the poor quality of care for mothers and children throughout hospitals in Zanzibar.

Benoit Jacod, MD, PhD

Working as an obstetrician in Radboud University Medical Centre, Nijmegen, the Netherlands.

As a Maternal and Foetal Medicine specialist trained in The Netherlands, I was shocked by the dire reality of pregnancy and childbirth I encountered in Madagascar and Zanzibar where I made several rotations in high-volume, high-mortality hospitals. What kept me going and made me come back was the courage of the women I treated. I realised, however, the need to go beyond the treatment of acute complications to address the whole journey of these women, coping with long-term difficulties or with the loss of their children. It is time to show the extent of their courage and ask them how we can help.

Tarek Meguid, MD, MSt-IHRL, MPhil-MCH

Working as a consultant obstetrician/gynaecologist in Mnazi Mmoja Hospital, Zanzibar.

This type of research is especially important because it does not only reveal where we have to do more to prevent morbidity and mortality, but also speaks to the humane aspect of the care that patients should be entitled to receive. In addition, it has the potential to open the hearts and minds of decision makers who are ultimately the ones who are in a position to enable health systems to prepare adequately for the challenges they should master.

Arie Franx, MD, PhD

Working as an obstetrician in University Medical Centre Utrecht, the Netherlands.

I am a professor of Obstetrics and the chair of the division Woman & Baby of the University Medical Centre Utrecht, a large tertiary hospital in the Netherlands. Throughout my career in pregnancy and childbirth care I have initiated, conducted and led research of pregnancy complications, in particular the consequences of these complications for the mother, her baby, her family and the community. In the privileged setting of Dutch healthcare these consequences are considerable, in low- and middle-income settings as Zanzibar they must be huge. I feel connected to this project because it is an effort to uncover the health consequences of pregnancy complications to women and their families in less privileged situations, with the ultimate goal to improve the outcome for these women.

What other funding options have been investigated?

So far, we have no other funding options. The people involved from the Dutch side are doing this on their personal title, with formal but very limited financial support from their affiliated University hospitals. Mnazi Mmoja Hospital in Zanzibar has no budget for research so far. Coming from this, we have been looking for suitable funds. We do feel that our monetary goal is reachable, so we want to try it through crowdfunding.

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  • 5 Backers

    All supporters will be invited to an online seminar on the research project where I will share learnings and the outcomes of the project.

  • 39 Backers

    Thank you for your support. You will be part of a group of supporters enabling daily continuation of the project by having actual feet and hands on the ground.

  • 24 Backers

    Thank you for your support. This pledge will help with addressing the project sustainably: because the researcher can be on-site, training of local researchers can continuously be done & the quality of the assessment of the women can be guaranteed.

  • 16 Backers

    Thank you for your support. this pledge contributes to trustworthy and robust collaboration between foreign and local researchers and clinicians, allowing the daily reality of the project to be of the highest quality

  • 6 Backers

    Thank you for your support. A pledge at this level will have a major impact in the quality of the project on-site, by allowing a foreign researcher to be present and invest in high quality, training and support.

  • Backers

    Thank you for your support. A pledge of this level will have a much-needed impact on sustainability and quality of the project here. It will allow the project to be consistent and of high quality.

  • Backers

    Thank you for your support. A pledge at this level will help fund this next phase of research. You will have main role in the execution of this project in the most sustainable and comprehensive manner, leading to robust study outcomes and enabling the formation of honest and relevant recommendations for much-needed policy change

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General Overview

This Campaign has ended. No more pledges can be made.

  • 5 Backers

    All supporters will be invited to an online seminar on the research project where I will share learnings and the outcomes of the project.

  • 39 Backers

    Thank you for your support. You will be part of a group of supporters enabling daily continuation of the project by having actual feet and hands on the ground.

  • 24 Backers

    Thank you for your support. This pledge will help with addressing the project sustainably: because the researcher can be on-site, training of local researchers can continuously be done & the quality of the assessment of the women can be guaranteed.

  • 16 Backers

    Thank you for your support. this pledge contributes to trustworthy and robust collaboration between foreign and local researchers and clinicians, allowing the daily reality of the project to be of the highest quality

  • 6 Backers

    Thank you for your support. A pledge at this level will have a major impact in the quality of the project on-site, by allowing a foreign researcher to be present and invest in high quality, training and support.

  • Backers

    Thank you for your support. A pledge of this level will have a much-needed impact on sustainability and quality of the project here. It will allow the project to be consistent and of high quality.

  • Backers

    Thank you for your support. A pledge at this level will help fund this next phase of research. You will have main role in the execution of this project in the most sustainable and comprehensive manner, leading to robust study outcomes and enabling the formation of honest and relevant recommendations for much-needed policy change