20 August 2012

Uganda: Maternal Mortality Ratio Drops

Uganda's maternal mortality ratio dropped to 310 deaths per 100,000 live births in 2010, from 435 deaths in 2006, translating to 4,300 maternal deaths every year, down from 6,000.

The number of women with a satisfied demand for Family Planning grew to 32% from 24% in 2006 (Uganda's Demographic Health Survey report of 2006) and the average number of children a woman is likely to produce in her lifetime reduced to 6.1. The 2006 UDHS reported 6.7.

The new statistics are according to the 2012 Countdown to 2015 report released in June. It was compiled by academicians and professions from several international organisations under The Partnership for Maternal, New-born & Child Health in Washington.

The organisations include Johns Hopkins University, the Aga Khan University, the University of Pelotas in Brazil, Harvard University, London School of Hygiene and Tropical Medicine, UNICEF, the World Health Organization, UNFPA, Family Care International, and Save the Children.

Quoting figures from the report, Dr Odongo Odiyo, the Manager of Family and Reproductive Health of the ECSA Health Community told journalists attending the sixth Best Practices Forum on maternal and new-born care in Arusha this week, that Lesotho with a maternal mortality ratio of 620 deaths per 100,000 live births had the highest maternal death ratio of the 14 ECSA countries.

In East Africa, Burundi (not an ECSA state) had the highest number of maternal deaths with a ratio of 800 deaths per 100,000 live births. Kenya's ratio is 360 and that of Tanzania 460 deaths.

Dr Odongo said the major cause of death for pregnant mothers in the region is postpartum haemorrhage which is over-bleeding after childbirth. It accounts for 36% of the deaths.

He said that despite this, an assessment carried out in Uganda, Tanzania and Ethiopia in 2007 on whether health workers in the health facilities in these countries could correctly use the Active Management of Third Stage of Labour to prevent bleeding, only 5.7% of the health workers were correctly using the technique.

Active Management of the Third Stage of Labour is a technique used to prevent and treat mothers for over bleeding after delivery and is recommended for all natural deliveries.

The procedure requires a midwife to give a mother drugs to prevent bleeding within one minute of giving birth; to gently tag at the cord during delivery of the placenta and massage the mother's uterus after delivery of the placenta.

The procedure has been found to be effective in preventing postpartum haemorrhage, a complication that kills many women after childbirth.

According to an Engender Health Fact sheet, AMSTL reduces the rate of bleeding after childbirth by up to 60%. When applied, the technique reduces the need for blood transfusion for mothers at risk. The practice, though simple, can prevent death and complications that could arise from over bleeding after childbirth especially for aneamic and malnourished mothers.

Despite this knowledge, health workers in the assessed countries are not adhering to this best-practice. "There are implementation problems. You find oxytocin, the drug given to women to prevent bleeding, stored without adequate refrigeration in the rural areas. This compromises its quality," Dr Odongo said.

He noted that the policies were in place but the challenge was their implementation to save mothers' lives. WHO's Dr Joao Paulo Souza in the keynote address to the forum said 35,000 mothers and 825,000 children under the age of five and died in the ECSA region in 2010 alone.

"This is the total of the 322,500 inhabitants of Windhoek Namibia, 231,000 of Gabarone Botswana, 148,000 of Port Louis in Mauritius, 84,000 of Seychelles and 70,000 of Arusha Tanzania all being wiped out in a year," he said.

He said to improve health outcomes required a multi-sectorial approach. The Best-Practices forum attracted health professionals, academicians, researchers and development partners to share innovative interventions to reduce the number of women and children that die due to pregnancy and childbirth complications.

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