Dying bringing life: plight of rural expectant mothers

Mothers wait for medical services at Biguli Health centre II in Kamwenge District recently. Photo by Francis Tusiime  

By FELIX BASIIME

Posted  Thursday, April 14   2016 at  01:00  http://www.monitor.co.ug/Magazines/Health---Living/Dying-bringing-life--plight-of-rural-Expectant-mothers/-/689846/3157846/-/tnaese/-/index.html

IN SUMMARY

The country’s current maternal mortality ratio is at 310 deaths per every 100,000 live births. In simple terms, three women die everyday while giving birth. In rural areas, the situation is dire, and if nothing is done, the numbers are bound to rise.

Last June, Grace Kobusinge, 35, died at Bukuuku Health centre IV, shortly after giving birth.
She had been rushed to the facility, located in Ibonde II village, Bukuuku sub-County, Kabarole District, by a boda boda rider after the onset of labour pains. The baby was Kobusinge’s third born following two teenagers. 
“From the time my daughter told me she was pregnant I feared for her life. I thought having a baby after 12 years was a bad idea,” Joyce Nkwenge, the mother of the deceased, says.

Nkwenge, 65, is the one who attended to Kobusinge at the health centre. She says immediately her daughter gave birth to a baby girl, her immediate concern was to let their relations know of the new addition. 


However, the celebration was short lived, because in a matter of minutes, medical workers had pronounced Kobusinge dead. Although she had given birth normally, she had developed internal complications.

Nkwenge was told by the medical workers that Kobusinge died due to concealed uterine rapture on the blood vessel which takes blood to the uterus. 


Nkwenge shares that medical workers at the health facility tried to save Kobusinge by ordering for an ambulance to take her to Fort Portal Referral Hospital for further management but the van came a little too late. 


The lone ambulance, which serves the Tooro sub-region, had to first deliver blood at another facility in Kibiito before heading to Bukuuku. Kibiito is about 27km on Fort Portal-Kasese road while Bukuuku Health Centre IV is about 15 km on Fort Portal-Bundibugyo road.

Kobusinge represents many mothers who die under similar circumstances in the countryside due to different factors including poor facilities, low staffing and small budgets.


At Bukuuku Health Centre IV, the facility does not have electricity.


Rwenzori Anti-corruption Coalition (RAC), an anti-graft body operating in the Rwenzori sub-region, was tipped off by their rural monitors about Kobusinge’s death.

In their report, RAC believes Kobusinge’s life would have been spared had there been facilities in place. 


“…What is shocking is that the life of Kobusinge would have been saved had there been power and blood at the health centre,” the report reads in part.


After Kobusinge’s death, Baylor Uganda offered to fund the power extension project to the health centre in a bid to curtail more maternal deaths. The project is estimated at Shs120m.
Baylor has also funded the construction of a fully-fledged maternity ward worth over Shs 400m.

Meagre funds

Kabarole District chairman, Richard Rwabuhinga says such cases are happening in the district due to the meagre health district budget.


“We are still receiving little funds to enable us improve health services to people’s expectation in the district,” Rwabuhinga says.


The district director of health services, Dr Nathan Ruhinda, says his office receives Shs10m every month for Primary Health Care (PHC) non-wage. 


“To run my activities well, my office needs at least Shs100m per quarter,” Dr Ruhinda says, adding that the district receives Shs397m for the health sector the whole year and for the financial year 2016; Shs200m was committed to Kabarole Hospital as Presidential pledge under the Public Private Partnership to private not for profit health centres. 


Ruhinda further explains that Shs150m was committed to Kasunganyanja Health Centre III to build the maternity ward there.


“So after these expenditures, my office was left with Shs 47 million for funding each and every activity,” Dr Ruhinda explains.


Ruhinda says the district has a total of 560 workers and only 28 per cent can be accommodated and those who get chance of being accommodated share or partition the small cubicles they are given. 


“Our health staff share staff quarters like police officers,” Dr Ruhinda observed.

He said the district has no money for development like construction. Our investigations revealed that health centre IIIs get Shs600,000 while health centre IIs get Shs400,000 every quarter respectively. “The healthy sector is grossly underfunded” Ruhinda asserts.

Dilemma of expectant mothers

However, Dr Ruhinda observes that delays by mothers to decide where to deliver from is one of the causes of maternal mortality in the district and many parts of the country. 


“Some mothers report to health centres long after the labour pains have kicked in making it impossible for health workers to save their lives” he explains.


According to Dr Ruhinda, mothers are supposed to report to the hospital or health centres a week before the day of delivery so that they can be given the attention they deserve.


He adds that health workers are few and the ones who are there are always overworked. 


“There are situations where you find that by the time a mother who is badly off is brought in, the doctor supposed to work on her is very tired after having worked on more than 12 operations,” Ruhinda reasons.

Poor transport

Transport, according to Dr Ruhinda, is another cause of maternal mortality. He says sometimes pregnant women reach the health centres late when they are already weak because of the long distances they have to trek to the health centre. 


This, when compared to the few health workers and lack of equipment at most health facilities, escalates the mortality rate. 


On a positive note, the district has tried to minimize neonatal health. 


“The percentage has gone down by 10 per cent. We have moved from 72 per cent in the last three to four years to 62 per cent to date in terms of maternal and neonatal,” he says.


According to the records at Fort Portal regional referral hospital, more than 5,348 women gave birth between July 2012 and 2013. Out of this number, 10 mothers died. The report further highlights that all these were from Kygegwa District.


Dr Ruhinda says most of these cases are brought in after traditional birth attendants have failed to manage the cases.

What ought to be done

Dr Ruhinda says there is need for health systems to be strengthened with quality facilities, personnel, equipment and medicine made accessible to all women. This also calls for comprehensive sexuality education and services for young people must also be made available. 


Supervised deliveries, improved antenatal services and increased use of contraception, access to emergency obstetric care, ensuring skilled medical attendance to mothers at birth, universal access to family planning and antenatal care.


Rwabuhinga on the other hand calls for innovation. “There is need to improve roads to facilitate access to 
health units, provision of standby ambulance for referral, car and bicycle ambulances, telephone communication to health units and carrying out public sensitisation campaigns.”

Maternal mortality rate in Uganda

Maternal Mortality Rate. MMR is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.


According to CIA World Factbook, maternal mortality rate in Uganda stands at 310 deaths/100,000 live births.


According to a report by Centre for Health, Human rights and development (Cehurd) published on June 27, 2014, maternal deaths have reduced by 45 per cent since 1990.

According to a report by World Health Organisation, there were 523,000 deaths that occurred from complications in pregnancy or childbirth in 1990; in 2013, the number stood at 289,000. 


Despite this global progress, most countries were not on track to meet the fifth Millennium Development Goal (MDG 5) target on maternal mortality, which was cutting maternal mortality ratio by 75 per cent by 2015.

Breakdown.

 The report reveals that 10 countries accounted for around 60 per cent of all maternal deaths: India (50,000), Nigeria (40,000), the Democratic Republic of the Congo (21,000), Ethiopia (13,000), Indonesia (8,800), Pakistan (7,900), the United Republic of Tanzania (7,900), Kenya (6,300), China (5,900) and Uganda (5,900).

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