High maternal deaths blamed on far away hospitals-Womens Day Supplements

By Agnes Kyotalengerire

LAST September, Cecilia Nambozo a former teacher at Busamaga Primary School in Mbale bled to death during child delivery. Allegedly medical officers refused to attend to her because she couldn’t raise sh300,000 they had asked for.

Soon after, another woman died in Lyantonde district, while giving birth at Kasambya Health Centre IV. Her brother said the doctor operated on her before discovering that the centre had no stitches. However, the health centre denied this explaining that she died of excessive bleeding.

These two are just a drop in an ocean of women who die every year while giving birth in Uganda. Globally, 350,000 women die from pregnancy, childbirth or related complications. However, in Uganda, the trend is not any better; 20% of the burden of diseases is due to maternal and perinatal conditions, observes Dr Romano Nkumbwa Byaruhanga, president AOGU. Maternal mortality ratio is still high although there is a slight decrease from 435 per 100,000 live births  (UDHS) to 274 per 100,000 live births. This is approximately 6000 deaths per year with 16 deaths per day.Though the ratio has slightly gone down, losing 16 women per day puts Uganda way off the Millennium Development Goal Five of reducing maternal mortality to at least 130 by 2015.

Kangaroo mother care made neonatal care easy Twelve years down the road, mothers to premature babies can afford to stay away from hospital and nurse their babies at home. Thanks to the kangaroo mother care initiative that started 12 years back. Dr Jolly Nankunda a senior consultant pediatrician and neonatologist Mulago hospital a brain behind introduction of the Kangaroo mother care initiative in Uganda notes before kangaroo mother care as introduced, premature mortality rate was very high. “Many premature babies had challenges of being kept warm yet the incubators were very few,” affirms Dr Nankunda adding that sometimes they had to warm up the room which was rather uncomfortable for the staff working in the unit.

However, in 2000 Dr Nankunda together with Harriet a nursing officer in charge Special Care Unit by travelled to Bogota Columbia to attend one month training on the use Kangaroo mother care as a substitute for incubators. Initially, mothers were very apprehensive to have their babies placed directly on their skin but later embraced the idea, she recalls. This helped to shorten the hospital stay and enabled mothers take care of themselves and recovered faster while at home.

In addition to providing warmth, Dr Nankunda notes that Kangaroo mother care stimulates continuous breathing through keeping babies close to their bodies. Besides, babies are able to breastfeed better as well as improving bonding. It is one way mothers gain control over their small babies early enough.

Even with incubators in place, Dr Nankunda says Kangaroo mother care is a commended practice mothers with premature babies are encouraged to adopt. “Before discharge we encourage mothers to keep their babies strapped close to their chests during the sit- up position or while lying down”.

What are challenges?

The midwife is a key person in reducing maternal deaths says Dr Pius Okongo, chairperson health service commissioner. However, it becomes challenging when midwives get overloaded with other activities taking a lot of their time instead of caring for mothers. Besides, health facility structures are old and may not be well equipped, salaries and work conditions are not good. Management at hospitals and health centers does not favor health workers to mentor and improve many aspects like timely availability of resources, attitude of health workers towards patients and health care. Long distances still make it difficult for women to travel to health centre four to deliver.

What has Ministry of health done?

Dr Okongo observes that each district is responsible for recruiting and managing staff related to maternal health while Ministry of Health gives technical support, facilitates recruitment and deployment of relevant staff; for example midwives, nurses, laboratory personnel pharmacists and anesthetics in national referral and regional hospitals. However, it becomes challenging when districts fail to attract and recruit health workers in rural areas.

Dr Anthony Mbonye head of department community health notes that Government received a 30 million loan from World Bank to improve health systems of Uganda and maternal health focusing on improving infrastructure and increasing recruitment of more staff.

In this regard, Dr Byarunga notes that the Ministry of Health has partnered with various organisations like: WHO, UNICEF, family planning associations and professional organisations to help address different aspects of reproductive health affecting maternal health.