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Maternal death- Will delivery kits save rural women?

By Vision Reporter

Added 15th February 2009 03:00 AM

HASIFA Nanyonjo of Kyamugugu village, Mubende district, recently gave birth to her eighth child at home, where another four of her children were also delivered.
“I find it cheaper delivering at home rather than at hospital which is very expensive an

By Gladys Kalibbala

HASIFA Nanyonjo of Kyamugugu village, Mubende district, recently gave birth to her eighth child at home, where another four of her children were also delivered.
“I find it cheaper delivering at home rather than at hospital which is very expensive and far,” she says.

Nanyonjo is not alone. Many women in her village do not deliver in hospital due to lack of transport. They also fear incurring high hospital bills.

She says she only pays between sh20,000 and sh25,000 when she delivers at home with the help of a traditional birth attendant (TBA). However, in hospital, she would have to pay sh40,000.

Reports from health experts show that Uganda is behind its fourth Millennium Development Goal (MDG) target of maternal mortality and child survival.
“We need to do more about this.

Many women continue delivering at home in unhealthy conditions, which sometimes leads to death,” says Dr Sam Zaramba, the director of health services at the Ministry of Health.

Zaramba says the ministry allowed Health Centre IIs to conduct deliveries to reduce on the number of women producing at home.

He says in addition to providing equipment and mesoprosol (a drug used to stop women from severe bleeding after delivery) to all Health Centre IIs, more delivery centres would be set up in distances not exceeding 5km.

Zaramba says severe bleeding after delivery is one of the leading causes of maternal mortality and should be reduced.

However, a survey in many rural health centres shows that they lack skilled personnel and offer poor services. Many women interviewed said health workers bark at and at times slap them during labour.

Reports show that whereas the ministry’s target is to reduce the maternal mortality ratio from 505/100,000 live births to 345/100,000 live births by 2009/10, the figure had reduced to 435/100,000 by 2006.

The assistant commissioner in charge of reproductive health at the ministry of health, Dr Anthony Mbonye, says delivery by skilled attendants (those assisted by personnel with midwifery training) have increased from 38% to 42%, while antenatal care attendance has improved from 37% to 47%.

However, he says, only 17% of pregnant women attend their first antenatal visit by the tenth week of their pregnancy as recommended by the World Health Organisation (WHO).

Meanwhile, Dr Esther Karamagi Nkolo, the in-charge of health services at the Population Services International (PSI) says about 23% of women in rural areas deliver with the help of TBAs, 25% are helped by relatives or friends who are neither trained nor equipped, while 10% deliver without any assistance.

She says to reduce the problem, PSI, in partnership with MAIA Foundation, launched a campaign in Mubende district a few months ago to provide mothers with “Maama Kits”, to help women deliver in clean a environment.

The campaign aims at reducing maternal mortality among women in six sub-counties — Kitenge, Kigando, Kasambya, Bageza, Bukuya and Kiyuni.
The kit contains a plastic sheet for the mother and the baby, a surgical blade, gloves, soap and a sterilised chord for tying the umbilical cord.

Others are zinc tablets and a home-based water treatment tablet, Water Guard.

“The pack, provided at a little fee, can help reduce maternal mortality as the clean environment can stop infection to the mother and the newborn,” Nkolo says.

The pack, she says, reduces vaginal infections, eye infections and tetanus as a result of delivering in a dirty environment.

Oral rehydration salt packets are also included in the pack to protect babies from diarrhoea which, she said, is one of the killer diseases in children under five years.

A pregnant woman, Aidah Nassolo, at Kitokolo Health Centre, said the kit had helped many women in the village.
“In the past, I would use old clothes and knickers for padding myself, which I would later wash and wear,” she said.

Nassolo said the Maama Kits, which they buy at sh3,500 from Maama Ambassadors in their areas, are cheaper than cotton wool and polythene sheets which would cost sh8,000.

Dr Karamagi warned that the dirty clothes which women use for padding themselves after delivery can easily cause infections, including abscess.

Meanwhile, the public relations manager of PSI, Monica Ariyo Rukundo, says 20 Maama Ambassadors who were identified by community-based organisations, visit homes of pregnant mothers and sensitise them about the need to produce in hospitals and the importance of using the Maama Kit.

Maternal death- Will delivery kits save rural women?

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