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You want an early death? Try giving birth in Kenya

Saturday April 17 2010
PIX 5

A mother attends to a her sick child in hospital. Maternal deaths in Kenya still one of the highest in the world. PHOTO/ FILE

A major decline in the number of women dying at childbirth in the region signals hope for containing the sad scenario that has gripped families for ages.

Despite the sharp decline in Kenya over the past decade, the country still remains among those with the highest rates in the world.
In Tanzania, there was a steep decrease from 750 deaths of 100,000 women recorded in the year 2000 to an average of 470 per 100,000 women recorded in 2009.

In Uganda, although the numbers were going down,  maternal mortality rate could be on the rise again mainly due to many women delivering from out of professional delivery-facilities, severe bleeding and obstructed labour, access to caesarian sections is not up to speed yet.

The results of a global study of maternal mortality that was conducted by a team of scientists from the University of Washington paint a gloomy picture of the situation in Kenya.

It stands at position 13 out of 181 countries in order of the number of maternal deaths.

Therefore, there is urgent need for innovative strategies to reverse this trend if the country is to achieve the Millennium Development Goal of significantly improving maternal health by 2015.

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A target has been set for reducing the rate of deaths at childbirth by three quarters.

With barely five years to go to the deadline, Kenya has only managed to restore the runaway maternal mortality rate recorded at the turn of the century.

Steep decrease

In Tanzania, about 8,000 women died at childbirth in 2008, translating into roughly 470 maternal deaths per 100,000 live births in Tanzania for that same year, also, like Kenya, a steep decrease from the 750 per 100,000 recorded eight years earlier.The highest rate was 850 deaths for every 100,000 deaths in 1998.

According to Unicef’s, countdown to Millennium Development Goals 2015 Report, 34 per cent of maternal deaths in the country is caused by haemorrhage.

Sepsis, a condition caused by toxic micro-organisms inthe bloodstream; and HIV/Aids cause 16 per cent of the deaths.

Hypertensive disorders contribute to at least nine per cent of the maternal deaths while anaemia, obstructed labour and abortion, all claim 4 per cent of the maternal mortality in the country.

Researchers correlate the maternal mortality rate trend with HIV and Aids, which, according to National Statistics Bureau, the infection rate of women had dropped to 6.8 per cent in 2007 from 8.0 per cent in 2003 while that of men also came down to 4.7 per cent in 2007 from 7.0 per cent during 2003 in Tanzania.

In Uganda, increasing maternal mortality is also blamed on an increase in the prevalence rate of HIV, a correlation that a report in The Lancet confirms.

‘Every One’ drive

Indeed, Ugandan First Lady Janet Museveni is scheduled to launch a drive against maternal mortality dubbed “Every One” next month.

Legislators have also responded to the wake-up call, saying that they did not approve a supplementary budget recently presented by the Finance Ministry because it did not show any urgent plans for the health sector, particularly reducing maternal mortality.

The Ministry of Health has provided equipment needed in delivery and drugs that stop women from excessive bleeding to health centres in sub-counties, although professional health assistants in birth delivery are few compared withthe workload in these places.

Antenatal care attendance is still under 50 per cent. It is reported that only 17 per cent of women adhere to recommendations of the World Health Organisation to visit hospital by the 10th week of their pregnancy.

In Uganda, traditional birth attendants (TBA) help a significant number of women deliver especially in the countryside, the reason why many non-governmental organisations have dedicated resources to training them, rather than urging the women to walk kilometres to professional health centres.

According to the study that was published in The Lancet, Kenya’s figures recorded two years ago are close to what they were as at 1990. The trend is attributed to the effects of HIV/Aids.

The disease had the worst ravages in the region during this period, leading to a spike in maternal deaths. Over the past few years, there has been a drop in Aids-related deaths, which has also brought down the maternal deaths.

In 2008, the study published in The Lancet indicates, 6,200 Kenyan women died in childbirth, translating into roughly 413 maternal deaths per 100,000 live births.

This was a steep decrease from the 730 deaths per 100,000 live births recorded eight years earlier.

Even so, there is still an urgent need for creative ways of reducing maternal deaths in Kenya. Already, the country has embarked on introducing the maternal child health handbook, a strategy that has succeeded in bringing down deaths in parts of Asia and Middle East.

The handbook that will replace the health records that are currently in use is intended to track the health of the mother from the time of conception until birth, and eventually, early life of the baby.

“The handbook is designed to provide records of conditions of mothers during pregnancy, delivery and growth of the child, as well as his or her immunisation records so that the health workers can refer to it in case of referrals, follow ups and emergencies,” a senior advisor on health at the Japan International Co-operation Agency Keiko Osaki, told a recent regional workshop to explore the feasibility of rolling out the handbook.

Already,it has been introduced in Indonesia, Palestine, Phillipines, Vietnam, Laos, Cambodia, among other countries.

Monitoring role

Mr Osaki said that it would be used for monitoring the mothers’ health and educating them, besides acting as a referral tool. It would also improve communication between the mother and the health workers concerning their health conditions.

The handbook was introduced in Japan in the 1940s. Japan had one of the lowest maternal mortality rates in 2008, according to the results of the study, standing at only seven out of 100,000 live births.

Prof Miriam Were, a health scholar, said that the handbook would be effectively applied through the community health strategy that has been applied in Kenya.

“It is in the communities that the mothers are to be found,” she said.
Prof Were said that since it had succeeded in improving the status of maternal and child health, the handbook would support a big reduction in death of mothers and children by the Millennium Development Goal target year of 2015.

Kenya is amongst eight other countries in Eastern Africa considering the introduction of the handbook.

This, coupled with improvement of the public healthcare system that caters for most mothers by employing skilled birth attendants and acquiring modern equipment would undoubtedly bring the maternal death rates down.

Like Kenya, many other countries require such innovative approaches to improving maternal health. This includes the six countries in which about half of the 343,000 maternal deaths worldwide occurred in 2008 occurred: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo.

Mothers’ death rates were highest globally in Afghanistan (1,575 per 100,000 live births) and lowest in Italy (4 per 100,000).

By Kevin Kelley, Cosmas Butunyi, David Malingha Doya and Wilfred Edwin

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