MATERNAL MORTALITY IN SUB-SAHARAN AFRICA STILL A MAJOR CHALLENGE: UGANDA’S PERSPECTIVE

Introduction

World Health Organization (WHO) defines Maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes” while Maternal health as “the health of women during pregnancy, childbirth, and the postpartum period”

Maternal health status of the mother which includes the environment before and during pregnancy matters greatly since it significantly impacts a lot on the health and well-being of a child’s health. Therefore, achieving optimal child health highly depends on the health and well-being of a child’s mother.

State of maternal mortality in Sub-Saharan Africa

Every day in 2017, according to WHO, approximately 810 women died from preventable causes related to pregnancy or childbirth. Sub-Saharan Africa accounts for more than two-thirds of all these maternal deaths per year worldwide.

A whopping 533 maternal deaths per 100,000 live births occur in Sub-Saharan Africa (WHO, 2019). Recent data from WHO shows that inequalities in access to quality health services between rich and poor have accounted for the high maternal mortality rate (MMR) in low-income countries. For example in 2017 according to WHO, MMR was 462 per 100 000 live births in low-income countries and only 11 per 100 000 live births in high-income countries. This shows that there is a lot needed to be done in Sub-Saharan Africa especially if a Sustainable Development goal of reducing the global maternal mortality ratio to less than 70 per 100 000 live births between 2016 and 2030 is to be achieved.

It should be noted that the complications in pregnancy and childbirth are higher among adolescent girls of ages 10-19 compared to women aged 20-24 (Ganchimeg, et al., 2014). This is because younger girls are at high risk of developing deadly obstetric fistula which is a serious medical condition in which a hole develops between the vagina and rectum or the urinary bladder and this often leads to death. Still according to WHO report, Adolescent girls (ages 15–19) are at high risk of childbirth pregnancy-related complications, where “The probability that a 15-year-old woman will eventually die from a maternal cause is 1 in 3,700 in developed countries versus 1 in 160 in developing countries” (WHO, 2014).

Major causes of maternal deaths 

According to WHO (2014), the main causes of maternal deaths are severe bleeding after birth, post-childbirth infections, high blood pressure during pregnancy, unsafe abortion, sepsis and diseases such as malaria and HIV/AIDS.

Hemorrhage such as obstetrical bleeding which occurs before, during, and after childbirth remains the leading cause of maternal mortality, accounting for over one quarter (27%) of deaths. Postpartum bleeding specifically which is as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth has been a great challenge in Sub-Saharan Africa due to poor road networks to connect expectant mothers to good health facilities in time and also mothers preferring to give birth from homes.

Gestational Hypertension also referred to as Pregnancy-Induced Hypertension (PIH) is a condition characterized by high blood pressure during pregnancy. This can lead to a serious condition called Preeclampsia and has led to increased cases of maternal deaths in most low-income countries.

Unsafe abortion is still leading to high maternal deaths in sub-Saharan Africa, according to WHO (2019), it is estimated that 3 out of 4 abortions that occurred in Africa and Latin America were unsafe and Each year between 4.7% – 13.2% of maternal deaths can be attributed to unsafe abortion.

Much as most of these complications leading to maternal death can occur at any time without warning during pregnancy, during child delivery and after childbirth, most of these maternal deaths can be prevented if births are attended to by skilled health personnel such as doctors, nurses or midwives who are equipped and have access to quality obstetric services and are furnished with life-saving drugs, such as antibiotics, and are able to provide blood transfusions needed to perform cesarean sections or other surgical interventions.

Uganda’s maternal mortality Perspective

Maternal mortality ratio in Uganda remains high at 343 deaths per 100,000 live births (UBOS, 2016) though dropping over the period from 684 in 1990. This is however still way far below the Global Sustainable Development goal of achieving less than 70 per 100,000 live births by 2030.

Efforts put up to reduce maternal mortality in Uganda

Uganda has put up measures to reduce high maternal deaths in the country through different programs such as; The Second National Development Plan 2015/16-2019/20, National Health Policy II 2010-2020 and the Health Sector Development Plan (HSDP) 2015/16-2019/20. These programs are to guide the health sector in building a supportive community network, developing a modern maternal health system, and putting up interventions to forecast high-risk obstetric events and strengthen referral systems, in the long run, reducing morbidity and mortality.

Different policies aiming at empowering a girl child have also been designed and implemented. These policies such as National Gender Policy (2007) has helped in ensuring that girls access education in Uganda, are empowered economically, and also their opinions heard. This will also in the long run reduce maternal deaths since women will be empowered economically and will be able to access better health care. Studies show that women who have access to Education and are economically empowered have reduced risk of succumbing to pregnancy-related deaths (Alvarez, et al., 2009).

Challenges faced in reducing maternal deaths in Uganda

Like any other sub-Saharan country in Africa, Uganda still has many challenges hindering the reduction of maternal death. Among many, Uganda has poor health care services, these services are also not easily accessed and where they are available, there is under-staffing and also common is low medical supplies of essential medication. All these have a direct effect on determining the health outcomes of expectant mothers and their babies.

Malaria remains high in Uganda and is the leading cause of death. Out of 30-50% outpatients, 15-20% of hospital admissions and 20% of hospital deaths are due to malaria according to Uganda Ministry of Health, (2014) and malaria prevalence among pregnant women stands at 8% and this has continued to cause maternal deaths in Uganda. In a study by Ngonzi, et al., (2016) to establish the causes and predictors of maternal deaths in a tertiary University teaching Hospital in Uganda, Malaria was found out to be the commonest indirect cause of maternal mortality accounting for 8.92%.

Much as 97% of pregnant women in Uganda seek Antenatal care services from skilled health personnel at least once in their pregnancy and 60% attending four or more times (UBOS, 2016), still, only 73% of the deliveries that occur, are in a health facility. This puts 1⁄4 of women delivering from home most of them coming from rural areas at risk. More efforts should be done to correlate ANC attendance and delivery from a health facility in order to save the life of the mother and their babies.

Low health funding remains a challenge in Uganda and still below the Abuja Declaration target agreed on in 2001 that set health financing at 15% of their annual budget. According to The National Budget Framework Financial year 2019/20 Uganda’s Health financing stands at 8.9%. This low funding hampers progress in maternal health improvement.

Conclusion

Maternal deaths are still very high in Uganda and sub-Saharan Africa in general and there is a long way to go in achieving a set target of reducing maternal deaths to less than 70 per 100,000 live births by 2030. Therefore individual governments should put up robust measures early enough to ensure that maternal health is improved. This can be done through increasing women empowerment, through education, economic support, and also governments increasing funding to their health sector. Efforts such as sensitizing women on the complications associated with pregnancy and how they can overcome them should be increased.

REFERENCES

Alvarez, J.L., Gil, R., Hernández, V. et al. Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study. BMC Public Health, (2009).

Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014 “Maternal Health”. World Health Organization (2018)

Ngonzi, J., Tornes, Y.F., Mukasa, P.K. et al. Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda. BMC Pregnancy Childbirth
(2016)

UBOS & ICF. (2016). Uganda Demographic and Health Survey, (March), 7–71. https://doi.org/10.2307/41329750

Uganda Demographic and Health Survey (2016) Key Indicators Report

Uganda Ministry of Health. (2014). The Uganda Malaria Reduction Strategic Plan 2014-2020, (May), 1–83. https://doi.org/10.1109/ISCO.2015.7282339

WHO. (2014a). Progress & impact series. The contribution of malaria control to maternal and newborn health.