The Observer (Kampala)
Elizabeth Kameo
14 February 2008
Ahead of the national conference organised by the Medical Association of Uganda, gynecologists and obstetricians are calling for an increase in the numbers of trained midwives to reduce maternal deaths in the country.
"Trained, equipped midwives and not Traditional Birth Attendants (TBAs) will help reduce the number of maternal deaths in the country," said Dr. Daniel Zaake, a member the Association of Gynaecologists of Uganda.
"We need to get more midwives out there, empower them and at the same time empower clinical officers so they are able to carry out cesarean sections when the need arises," he said.
He attributed maternal deaths mainly to the lack of skilled attendants at childbirth. Traditional birth attendants are not considered skilled, yet they are at the centre of many child deliveries in Uganda. Their skills are not adequate to detect complications or diagnose them. "We are not saying they are completely useless but they will not help reduce maternal deaths," says Dr. Zaake.
According to the 2006-7 Uganda Health and Demographic Survey, only 40% of pregnant women deliver with skilled assistance. In 2000-2001, only 18% of Ugandan women delivered with the assistance of a skilled attendant, one of the lowest percentages in sub-Saharan Africa.
According to Dr. Zaake, the increase in the number of women who have skilled care during birth is as a result of government's roll out of the Level 2 health centres at sub-county level. Unlike before, when it was only hospitals equipped and allowed to attend to deliveries, these health centres at sub-county level have been equipped for deliveries.
According to the same survey, 34% of women in Uganda deliver without a nurse, 35% are assisted by a relative or any other person, and 12% deliver on their own.
Skilled assistance at child birth is defined as being attended to by a trained doctor, nurse or midwife. Uganda has only about 100 gynecologists and obstetricians: meaning one gynecologist is available for every 50,000 women. There are about 5 million women of reproductive age (15-49 years).
Up to 30% of expecting women develop complications which can only be detected by a skilled attendant. Up to 90% of these will die or develop life-long complications such as continuous leaking of urine and or faeces (fistula).
The conference, which will take place in Mbarara from February 21- 23, seeks to find ways in which Uganda's medical personnel can help reduce maternal mortality levels in the country.
Uganda has one of the highest levels of maternal deaths in sub-Saharan Africa with 500 women dying at childbirth per 100,000 live births. This means every year, 6,000 women in Uganda die as a result of maternal complications which could have otherwise been avoided.
Reduction of maternal mortality is one of the Millennium Development Goals. It seeks to reduce by three-quarters this ratio by 2015.
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