As expectant mothers stare at preventable death, here is some advice going forward
By Dr Duku Fred | The commonest cause of maternal deaths in developing countries including Uganda is bleeding especially after delivery which accounts for more than 40% of maternal deaths.
By statistics, about 17 mothers die of pregnancy related complications in Uganda daily. In addition to patient related factors, labor management skills of health workers and shortage of supplies like medicines for controlling/preventing bleeding like Oxytocin (drugs that enhance contraction of the uterus) or and blood for averting complications contribute immensely.
Mothers most at risk of severe bleeding or complications after delivery are those with prolonged labor, high parity (pregnancies above 6 or 7), twin or multiple pregnancies, mothers with bleeding disorders etc. The causes affect both the poor and rich or educated with a slight tilt towards the poor. Certainly, we have noted a rise in incidence of prolonged or obstructed labour occurring and being mismanaged in lower health facilities and commonly though unfortunately by traditional birth attendants (TBAs).
In the past over one-month health facilities including those in Kamuli district did not receive Oxytocin, a drug that aids contraction of the uterus after delivery to prevent or control bleeding. The sole supplier National Medical Stores reportedly recalled a batch that was supposed to be supplied and the substitute of Misoprostol tablets have not received to by many facilities. However, I don’t know what the situation is like in other districts.
Local pharmacies that would provide an out of pocket expenditure option equally do not possess these essential medicines due to depletion caused by the sudden high demand. For those that have them, the price for example of oxytocin has been inflated from 2,000 Uganda shillings ($0.54) to 10,000 shillings ($2.7). Where does this leave the poor pregnant woman awaiting labour which appears a death trap occasionally? In the presence of all the risks for bleeding after delivery and active TBAs what do we do as stakeholders to avert maternal deaths in the wake of shortage of such essential medical supplies?
The phrase “prevention is better than cure” to me still counts. Some solutions in the short term, midterm or long term may lie but are not limited to the following:
- Health facility managers to seek residual supplies of Oxytocin or misoprostol still present in low volume health facilities and have efforts to restock their maternity departments.
- Mothers with a higher risk of bleeding after delivery should be screened at antenatal and recommended to deliver at higher level facilities where management of complications after delivery may be possible.
- Proper labour monitoring to detect prolonged or obstructed labor early and taking proper timely action as guidelines recommended as a way of minimising risk of bleeding after delivery.
- Continuous health education for mothers to attend all stages of labour at health facilities.
- 5.Law enforcers and politicians to help health professionals in the fight to curtail activities of TBAs instead of being accomplices.
- Let everyone be an advocate for better medical supplies to health facilities with emphasis on those that manage conditions affecting the most vulnerable mothers and children. Use every opportunity, media, policy making platforms, campaigns, community dialogues, relevant meetings, state house visits, caucus meetings etc. I rest my case for now.
*The author is medical doctor working in Kamuli District.