On 9 May 2019, President Edgar Lungu declared maternal and prenatal deaths a Public Health emergency in Zambia with 10 to 15 women per week losing their lives in pregnancy due to preventable non-communicable causes. Analysis by Countdown to 2030, a multi-institutional collaboration focused on maternal and child health (MCH) highlighted that Zambia has one of the highest threats to early childhood development in the world.  Significantly, causes related to pregnancy and childbirth were the fourth leading reason for women’s mortality in 2018 with a Maternal Perinatal Death Surveillance Review (MPDSR) carried out by Gianetti et al (2018) highlighting 183 deaths per 100,000 live births.

The Zambian government aims to reduce the maternal mortality ratio to less than 100 deaths per 100,000 live births by 2021 - an aim that seems unlikely without urgent and frugal interventions. Furthermore, under-reporting is also likely to occur due to the inaccessibility/ engagement with antenatal services by outlying rural communities. There is an immediate need for clinical and educational interventions to tackle this crisis. 

University seed-funding enabled myself and Professor David Swann (Sheffield Hallam University) to respond to this emergency. In June and October 2019  we held exploratory meetings with St John Zambia and UNICEF Zambia who highlighted particular concern for prematurity among adolescent mothers:

  • 8% of young women have an ‘early sexual debut’;
  • 31% are pregnant by the age of 18;
  • 61% subsequently marry early; and
  • 6% experience sexual violence.

Furthermore, there are concerns that 56% of mothers have poor access to and poor quality antenatal care, with 44% experiencing poor quality of care during labour/birth and after.

The need for zero-cost intervention

Although all women are entitled to free maternal health care, MCH services can be resource-stressed with too few trained professionals and limited equipment. Even the cost of producing a basic educational leaflet for all expectant mothers can be a financial challenge. Limited or no availability of educational materials poses challenges for MCH teams in making their interventions effective.

It seems improbable that Zambia will meet the UN Sustainable Development Goals (SDG), specifically SDG 3, that seeks to ensure ‘healthy lives and promote well-being for all at all ages’ (United Nations, 2015). 

Health financing remains a challenge with declining economic growth and increasing fiscal deficit for Zambia in 2019. Furthermore, public health emergencies have both a historical and epidemiological foundation for their occurrence (Tilley, 2011) and require an approach working in partnership with local people and agencies to foreground their needs from their perspective.

Our earlier work with our partner agency  St John, Zambia, and their  MCH teams and volunteers is an example of this type of action. We worked with them to develop an idea based on a ubiquitous garment, the chitenge, as a frugal intervention (Reid and Swann, 2019). However, while we were able to print chitenges with important MCH messages, this too was not affordable and unsustainable. The solution came in a workshop with a group of women in Lusaka who, when we were exploring everyday parenting practices, began to sing the songs they sang to their children.

Life-saving lullabies

 

Our fieldwork trips to Zambia enabled us to develop the idea of educational and instructional lullabies and to co-create a ‘zero-cost’ intervention strategy that is adaptable, sustainable and scalable. Indeed, singing is common to all cultures.

The result was the world’s first ‘danger signs song’, conceived and performed by the St John volunteers at Chunga MCH clinic.

(Watch with sound)

Our aim now is to work with St John, Zambia, their volunteers and local women to develop more educational songs, to be sung at clinics, at home and in the community and to introduce the project across all St John sites in Zambia. We are also seeking funding to take the project to St John settings in neighbouring countries and to the Global North.

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