Maternal mortality in Nigeria is one of the highest in the world. The rate is higher in the rural communities than in the urban. Given the complexity of causes of maternal mortality, it appears that the community is an important resource that is frequently overlooked. The contribution of which could be explored through collaboration with professional healthcare providers, to bring about reduction in maternal mortality. This study, proposed to empower members of the community to take action to prevent maternal mortality. Action research design was utilised, comprising cycles of fact-finding, planning/action, and evaluation with the aim of working towards a change in the status quo. In collaboration with the action research group, data were generated through 29 interviews, 8 focus group discussions and observation of 7 persons. Women of childbearing age were interviewed to gain understanding of their knowledge, attitude and practice towards maternal mortality. Focus group discussions were carried out with a cross section of the community. Observations were undertaken of skilled and traditional birth attendants (TBAs) in their places of practice. Altogether, there were 86 general participants and 12 action research group members in the study. Thematic data analysis and critical reflection were undertaken with emphasis on data which promote learning and change. The study revealed childbirth fallacies as evidenced in the causes of maternal deaths being attributed to superstitious beliefs. Other findings included religious beliefs/practices, birth practices, negative attitudes, lack of money, lack of transportation and health facilities issues as contributory factors. These findings were critically reflected upon by the action research group and actions based on the findings, aimed at empowering the people to take action to prevent maternal deaths were undertaken. The actions included community education, TBA training and development of a common forum between skilled birth attendants and TBAs. Participatory evaluation was undertaken from the perspectives of the participants to identify what made sense to them from the actions. Findings included some degree of empowerment and emancipation of the people evidenced in the acquisition of new knowledge which led to the repudiation of certain superstitious beliefs. Other findings include resumed utilisation of the service of skilled birth attendants at the local health facility by the women. The findings of this study have demonstrated implications for practice, policy and research to prevent maternal mortality in Bakassi LGA, Nigeria. Conclusion drawn is that, the community is an important resource which if mobilised through the process of action research, would be empowered to take action to prevent maternal mortality. The process will also foster the collaboration between skilled birth attendants and traditional birth attendants to improve maternal health care in the rural community.

Background: Medical student involvement in clinical care of obstetrical emergencies is limited. Wearable technology, namely Google Glass, has been used to enhance the simulation experience for trainees at our institution. We present a pilot study that examines the utility of this technology in medical students’ education through remotely-conducted exercises in obstetric emergencies. Materials & Methods: A total of thirteen medical students accepted the opportunity to participate in an obstetric emergencies training exercise with remote monitoring. Students wore the Google Glass device while participating in two simulated obstetrical emergencies: shoulder dystocia and vaginal breech delivery. A remote instructor monitored the students’ performance and gave verbal instructions during the simulation. Students then filled out a questionnaire grading the effectiveness of the exercise. Results: Of all participating students, 55% reported Glass extremely valuable for their education. None reported it as not being valuable. 15% reported that Glass distracted them in their simulation activity. 100% of participants reported it being more than “successful" in its potential to improve emergency obstetric care. 55% reported that Glass or a similar device is “extremely likely” to be incorporated into medicine. None reported that it is unlikely to be used in the future of medicine. Conclusions: Wearable technology has the potential to provide improved learner experience. This technology can be successfully used to provide student exposure to simulated emergencies. Further studies evaluating the participation of students and other learners in simulated obstetrical emergencies are needed to determine how effective wearable technology can become in medical education and ultimately patient care as well.

La mortalité maternelle est considérée depuis quelques années comme un problème de santépublique au Sénégal ; ce qui a engendré pendant ces dernières décennies, un ensemble d’actionsparfois pertinentes, mais dont la mise en oeuvre est très souvent discutée, comme c’est le cas dansde nombreux pays africains.En 2010, le ratio de mortalité maternelle du pays est estimé à 392 décès maternels pour 100 000naissances vivantes selon le rapport de l’enquête démographique et de santé (EDS). Ce niveau resteélevé en dépit d’une hausse considérable du recours à l’assistance à l’accouchement.L’assistance médicale à l’accouchement qualifiée, définie comme « le processus par lequel unefemme reçoit des soins adéquats durant le travail, l’accouchement et le post-partum précoce », estapparue dans plusieurs études comme un déterminant-clé dans le processus de réduction de la mortalitématernelle.Deux conclusions principales sont obtenues à partir de nos analyses.D’une part, la très forte hausse du recours à l’assistance médicale à l’accouchement observée aucours de la première décennie des années 2000 a été sanctionnée par une baisse régulière, mais modérée,de la mortalité maternelle. D’autre part, cette faible baisse s’explique par une offred’assistance médicale à l’accouchement excessivement centrée sur des sages-femmes dont les qualificationssont hétérogènes et trop souvent limitées. Elle s’explique aussi par des infrastructures encoretrop peu adaptées à la gestion des urgences obstétricales.En effet, malgré tous les progrès accomplis dans ce domaine, il reste encore une marge importantepour poursuivre l’accès à un accouchement assisté. C’est en particulier le cas dans les campagnes,chez les femmes les plus jeunes, celles qui ont reçu une faible instruction et qui dépendent exagérémentde leurs conjoints. De ce fait, il serait intéressant de mener des politiques de sensibilisationdu côté des hommes.Au final, les enjeux futurs de l’assistance médicale à l’accouchement au Sénégal continuent à combinerdes problèmes d’offre et des problèmes de demande malgré les progrès accomplis dans cedomaine. / Maternal mortality is considered for several years as a public health problem in Senegal; which resultedin recent decades of a set of relevant actions sometimes, but the implementation is very oftendiscussed, as is the case in many African countries.In 2010, the maternal mortality ratio in the country is estimated at 392 maternal deaths per 100,000live births according to the report of the Demographic and Health Survey (DHS). This level remainshigh despite of a significant increase in the use of Delivery Assistance.The qualified medical assistance in childbirth, defined as "the process by which a woman receivesadequate medical care during labor, delivery and the early postpartum," has appeared in severalstudies as a key determinant in the maternal mortality reduction process.We can note two main conclusions from our analysis.First, the very strong increase in the use of medical assistance in delivery which has been observedin the first decade of the 2000s was sanctioned by a regular but moderate decline in maternal mortality.Then, this small decrease is due to a medical assistance in childbirth entirely performed bymidwives whose qualifications are heterogeneous and often limited. It is also explained by infrastructureswhich are not adapted to the management of obstetric emergencies.In fact, despite all the progress made in this field, there still are significant things to do before accessingto assisted delivery. This is particularly the case in rural areas, among younger women,those who received low education and who depend excessively on their husbands. Therefore, itwould be interesting to make aware of men on this issue.In the end, the future challenges of Assisted Reproduction Technology (ART) in Senegal continueto combine problems of supply and demand problems despite the progress made in this field.