During a visit to Kabale Regional Referral Hospital in 2010, I was very anxious to get to the maternity and newborn baby units, this being the place where I expected to feel professionally most at home.
Things started off very well as my host, Dr. Michael Odongo Osinde, an obstetrician who doubled as the hospital’s medical superintendant, led me into the unit. Two very pleasant midwives cheerfully informed me that they had already delivered 12 babies since the start of their shift in the maternity unit. It was still very early in the afternoon.
When I asked how many midwives were on duty, the cheerful duo informed me that they were it, along with their obstetrician, Dr. John Wanyama, who was as jovial as his nursing colleagues.
Their cheers belied the enormous burden, risks and private stress they shouldered as they did their best to help women realize their dreams of safe motherhood.
Their smiles did not blunt my instant anguish as I watched new mothers, with their fresh bundles of joy in their hands or at their breasts, packed like bananas, unknowingly sharing all sorts of bugs that were likely to claim the lives of some of these vulnerable patients.
The 30-bed maternity unit was well over its maximum capacity. In the 12-month period that ended on June 30, 2009, the Kabale unit had admitted 4,434pregnant women and others with other reproductive problems. 2,448 babies were born alive and 152 were born dead [stillbirths]. Of those born alive, 22 died before discharge, with an unknown number dying after they went home. 23 of the mothers died.
No subject is dearer to my heart that the urgent need to drastically reduce the deaths of Sub-Saharan Africa’s women, especially Ugandans, while pregnant or within 42 days of termination of pregnancy, from causes related to or aggravated by pregnancy or its management.
And so as I walked through Kabale’s maternity ward, various figures began to swirl in my head, reminding me that the women before my eyes were perhaps the lucky ones. At least they had a slightly better chance than their peers who were in the smaller health centers, let alone those who were carrying their pregnancies without any hope of ever receiving antenatal care or trained assistance during delivery in the villages.
The African woman bears a cross with thorns that sprout each time she conceives.
To put the tragedy of motherhood in Uganda and in Sub-Saharan Africa into context, let us look at the state of affairs at the time of my visit to Kabale Hospital in 2010.
Globally, 529,000 women died every year from pregnancy-related causes. 50 per cent of these deaths occured in Sub-Saharan Africa. (Uganda lost 6,000/year.)
A common way of expressing this is by the maternal mortality ratio, which is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period.
As of 2010, the worldwide maternal mortality ratio was 400 per 100 000 live births. The maternal mortality ratio in Sub-Saharan Africa was 1,000 per 100,000 live births. The figure for Uganda was 435 per 100,000 live births [range 345-524.] The numbers for Kenya, Rwanda and Tanzania were 1000, 750 and 578 respectively.
Of note is that when I was a student at Makerere University Medical School 40 years ago, we were taught that Uganda’s maternal mortality ratio was 500 per 100, 000 live births.
Thus the most recent figure of 435 per 100,000 live births could be interpreted as a positive trend in the right direction.
However, the authors of the 2006 Uganda Demographic and Health Survey [UDHS] Report pointed out that the sampling errors in successive estimates were large and so it was impossible to say with confidence that maternal mortality had declined.
“Moreover,” the UDHS report stated, “a decline in the maternal mortality ratio is not supported by the trends in related indicators, such as antenatal care coverage, delivery in health facilities, and medical assistance at delivery, all of which have increased only marginally over the last ten years.”
So by 2010, there had been no change in the rate at which Ugandan women were dying of pregnancy related causes over the previous four decades.
Remember the number of babies who were born alive at Kabale Hospital in one year? Yes, 2448. And how many women died? 23, which translated to a staggering maternal mortality ratio of 940 per 100,000 live births!
Another way of looking at the scope of the problem is the odds or probability of death during a woman’s reproductive life. Whereas the global figure for the probability of a woman dying during her reproductive life in 2010 was 74, the figure for Sub-Saharan Africa was 1 in 16 and for Uganda it was 1 in 13.
While Uganda was not as badly off as, say, Sierra Leone, which weighed in at a risk of 1 in 6, we were still well behind target, five years before the target date of the Millennium Development Goal of reducing the MMR by 75 per cent. Uganda had a very long way to go before our women could enjoy the low risks of reproduction of Canadian or Swedish women which were 1 in 8,700 and 1 in 30,000 respectively.
What was killing Ugandan and other African women in 2010? The top five killers were severe hemorrhage (bleeding), hypertensive diseases, infection, obstructed labor and induced abortions.
Of the 166,000 deaths from hemorrhage that occurred globally each year, about 50 per cent occurred in sub-Saharan Africa.
The tragedy of childbirth in Uganda and Sub-Saharan Africa was not limited to the preventable deaths of mothers, of course. The rates of death and disability were equally high among the newborns.
Of the 2,448 babies born alive at Kabale Hospital in the year ending June 30, 2009, 22 died before being discharged home. Add this number to the 152 who were born dead and a truly tragic picture emerges. And no doubt many more died after going home.
During the last five years, a lot of effort and money have been invested in attempting to reduce maternal and neonatal mortality in East Africa. High profile political and philanthropic leaders have lent their weight to the=is effort. The shared goal for all involved has been to give the African woman a reason to view her pregnancy with joy and assured optimism, and not with fear of the cross of thorns that brings tears – and even death – to thousands every year.
What is the state of maternal and neonatal mortality in East Africa today?
To be continued………………..