Maternal Mortality in Kenema City: A cause for Serious Concern!
Becoming a mother is a source of joy, love, pride, and a lot more in a community that place values on and respect for pro-creation. But for many women, it can be painful and life-threatening. Child-birth remains among the leading causes of death for women globally. A recent report by the World Health Organization estimates that in 2015 alone around 303,000 women died as a result of pregnancy or childbirth, leaving hundreds of thousands of children motherless.
According to the WHO, the term "maternal mortality" is defined as 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 maternal mortality rate 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.
With 1,360 mothers dying per 100,000 live births, Sierra Leone has one of the worst maternal mortality ratio in the world.
According to the latest estimates in 2015, 1 in every 17 mothers in Sierra Leone has a lifetime risk of death associated to childbirth. This has become a key concern for the World Health Organization (WHO) and its partners that are working in collaboration to tackle the issue through investment in training, equipment and medical supplies.
Moreover, the country still remains top of the list in terms of recording maternal mortality ratio in the world, with Kenema District as one of the most dangerous places to give birth. However, in 2010 the government of Sierra Leone introduced the "Free Health Care" services aimed at combating maternal mortality by providing medical facilities for pregnant women, lactating mothers and children under the age of five years.
Meanwhile, during the first year of the "Free Health Care" initiative, there were some achievements, apparently because the facilities to take care of pregnant women and suckling mothers were in a better shape. However, maternal deaths began to rise when most of the services started degenerating and health workers were "disincentivised."
At the moment, the Free Health Care service exist only in its name with nothing good to write home about because many people in Kenema District are complaining about the lack of facilities and personnel such as a specialized gynecologists to implement the initiative; and as a result, majority of the beneficiaries, especially pregnant women in rural communities have opted to returned to the traditional practices of visiting unskilled traditional birth attendants.
Giving the status of maternal mortality rate in Kenema District, a senior data analyst close to the District Medical Officer who is also the in-charge of the maternity ward of the Kenema Government Hospital, revealed that from January to October 2017, a total number of forty-five (45) women have lost their lives during child-birth at both the Kenema Government Hospital and the surrounding communities, a situation she described as unfortunate.
The maternal mortality data analyst said that among the sixteen chiefdoms in the Kenema District, Lower Bambara continue to record the highest cases of maternal deaths in the district. She pointed out that bleeding after child birth otherwise referred to as post-partum hemorrhage, severe anemia, criminal abortion among others, which are not properly handled outside equipped health facilities especially in isolated and hard to reach parts of the district where women have access only to basic health services, are the major causes of maternal deaths.
According to the officer-in-charge who preferred anonymity, “many women never even make it to a health facility to give birth. That means they are a long way from professional help should any complications arise. In rural parts of Kenema District, many women continue seeking services from Traditional Birth Attendants who are not skilled to address the major killers of mothers.”
She also noted that many of the patients brought to the hospital are in a bad condition, adding that they are already in a very bad shape by the time they get to the hospital, and that some patients come to the hospital without any relative to donate blood. She lamented that the hospital has only one functioning ambulance to cover the 16 chiefdoms in the district, and that delays the process of getting patients, women and children to the hospital or health Centre on time.
Moreover, the existing shortage in skilled health workers in Sierra Leone, which has been aggravated by the Ebola epidemic, has also negatively affect the provision of health services particularly in the Kenema District where only few specialize health practitioners ply their trade.
Breaking the cycle of maternal deaths in Kenema District:
Meanwhile, some health experts are of the view that as part of the recently adopted Sustainable Development Goals, the global maternal mortality ratio needs to be reduced to less than 70 per 100,000 live births by 2030, and that to achieve this target in Sierra Leone, a large number of pregnant women will need to have equitable access to high quality care by skilled personnel during pregnancy and childbirth.
They also say that beyond staff training and equipment, a key goal is to ensure that at least five fully functional Basic Emergency Obstetrical and Neonatal Care centers and one Comprehensive Emergency Obstetric and Neonatal Care centers should be made available in every one of Sierra Leone’s fourteen districts.
To reverse maternal mortality rate in the Kenema District particularly, and the country generally, all hands must be put on deck while community sensitization needs to be strengthened and the quality of services provided at ante-natal care needs to be improved.
Several relatives of the deceased, who lost their life at the Kenema Government Hospital during delivery, have expressed disappointment in the health sector particularly the Kenema Government Hospital. They have also expressed frustrations over the unprofessional attitudes of some of the nurses toward pregnant women by embarrassing them away from the hospitals, and thus resorting to the old method of traditional birth attendants at community levels.
Many are of the view that for maternal mortality to reduce in the Kenema District, the Ministry of the Health, especially District Health Management Team should embark on the improvement of nurses and patients relationship, as well as conducting regular training for health workers to improve other attitudes.
The National Supervisor of Health for All Coalition, a civil society group for health matters that is monitoring reproductive health and the activities of the Ministry of Health and Sanitation in the Kenema District has observed that maternal death was in the increase before the introduction of the government free health care initiative for pregnant women, lactating mothers and under-five children in 2010.
It should be noted that in the earlier days of the free health care initiative, more facilities were created to help save the lives of pregnant women and teenage girls, and that drugs, equipment, training programmes for nurses on reproductive health activities and the intervention of doctors contributed greatly towards reducing the high rate of maternal mortality in the district.
Observers say that the problem of maternal death started increasing three years after the introduction of the initiative, when most of the services, especially the ambulance service for referral cases, and the availability of essential drugs became almost non-existent in the Kenema District.
Another findings that have over the years been identified as factors responsible for the increase in maternal death in the Kenema District, is the high teenage pregnancy rate among adolescent girls. Statistics have shown that most of the teenage girls become pregnant below the age of eighteen years and most of them who are at high risk of dying during delivery are within the ages of eighteen to twenty five years old.
Moreover, health workers say most of the pregnant women particularly in rural communities do not go for ante-natal care services at government health facilities and clinics, where health workers give counseling and other necessary health education that could save lives. Another factor for the increase in maternal mortality is the delay in, and frequency of visiting the clinics during pregnancy. Most will go to those clinics only when the begin experiencing complications, and by which time it is almost late to save their lives.
In terms of recommendations for the reduction of maternal mortality in Kenema District particularly and the country as a whole, while everybody should come together to ensure a reduction of this stigma, the government should renew its political will for the programme by training more health workers on maternal health issues, give more support to family planning, provide facilities and more drugs and equipment to clinics, improve the salaries of health staff, and implement the existing health laws and policies with a determination and courage to punish those found wanting for violating those policies.
On the part of the Ministry of Health and Sanitation, there should be constant monitoring and oversight to ensure that the District Health Management Teams make judicious utilization of the resources allocated to them for the prevention of maternal deaths. The Ministry of Health should support nurses, especially community health workers to embark on continuous sensitizations on maternal health issues with special focus on teenage pregnancy.
Other health observers have stressed on the need for District Health Management Teams to execute effective monitoring of maternal health activities in the communities while noting that the services of Traditional Birth Attendants should be involved but upgraded, especially in remote communities for the overall prevention of maternal mortality in the district and the country at large.
On the part of the communities, the Health for All Coalition believe that traditional authorities should formulate by-laws that frowns at the practice of giving birth to babies at home, and encouraging pregnant women and teenage mothers to attend ante and post-natal services at clinics. The organization notes that communities should support the health ministry to organize regular meetings on maternal health at chiefdom levels for the purpose of sensitization.
On the part of health-related NGOs, coordinated efforts should be made to support the Ministry of Health and Sanitation in its fight to reduce maternal mortality in the country by helping to provide oversight for the distribution and judicious utilization of medical supplies, equipments and other resources.
It is my hope that haven identified numerous factors accounting for maternal deaths in the country generally and Kenema District particularly, and the proffering of some recommendations to address that health challenges, the high rate of maternal mortality would be drastically reduced if the government and Ministry of Health and Sanitation pay attention to those recommendations.
This investigative story is funded by the Media Reform Coordinating Group in Sierra Leone.
According to the WHO, the term "maternal mortality" is defined as 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 maternal mortality rate 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.
With 1,360 mothers dying per 100,000 live births, Sierra Leone has one of the worst maternal mortality ratio in the world.
According to the latest estimates in 2015, 1 in every 17 mothers in Sierra Leone has a lifetime risk of death associated to childbirth. This has become a key concern for the World Health Organization (WHO) and its partners that are working in collaboration to tackle the issue through investment in training, equipment and medical supplies.
Moreover, the country still remains top of the list in terms of recording maternal mortality ratio in the world, with Kenema District as one of the most dangerous places to give birth. However, in 2010 the government of Sierra Leone introduced the "Free Health Care" services aimed at combating maternal mortality by providing medical facilities for pregnant women, lactating mothers and children under the age of five years.
Meanwhile, during the first year of the "Free Health Care" initiative, there were some achievements, apparently because the facilities to take care of pregnant women and suckling mothers were in a better shape. However, maternal deaths began to rise when most of the services started degenerating and health workers were "disincentivised."
At the moment, the Free Health Care service exist only in its name with nothing good to write home about because many people in Kenema District are complaining about the lack of facilities and personnel such as a specialized gynecologists to implement the initiative; and as a result, majority of the beneficiaries, especially pregnant women in rural communities have opted to returned to the traditional practices of visiting unskilled traditional birth attendants.
Giving the status of maternal mortality rate in Kenema District, a senior data analyst close to the District Medical Officer who is also the in-charge of the maternity ward of the Kenema Government Hospital, revealed that from January to October 2017, a total number of forty-five (45) women have lost their lives during child-birth at both the Kenema Government Hospital and the surrounding communities, a situation she described as unfortunate.
The maternal mortality data analyst said that among the sixteen chiefdoms in the Kenema District, Lower Bambara continue to record the highest cases of maternal deaths in the district. She pointed out that bleeding after child birth otherwise referred to as post-partum hemorrhage, severe anemia, criminal abortion among others, which are not properly handled outside equipped health facilities especially in isolated and hard to reach parts of the district where women have access only to basic health services, are the major causes of maternal deaths.
According to the officer-in-charge who preferred anonymity, “many women never even make it to a health facility to give birth. That means they are a long way from professional help should any complications arise. In rural parts of Kenema District, many women continue seeking services from Traditional Birth Attendants who are not skilled to address the major killers of mothers.”
She also noted that many of the patients brought to the hospital are in a bad condition, adding that they are already in a very bad shape by the time they get to the hospital, and that some patients come to the hospital without any relative to donate blood. She lamented that the hospital has only one functioning ambulance to cover the 16 chiefdoms in the district, and that delays the process of getting patients, women and children to the hospital or health Centre on time.
Moreover, the existing shortage in skilled health workers in Sierra Leone, which has been aggravated by the Ebola epidemic, has also negatively affect the provision of health services particularly in the Kenema District where only few specialize health practitioners ply their trade.
Breaking the cycle of maternal deaths in Kenema District:
Meanwhile, some health experts are of the view that as part of the recently adopted Sustainable Development Goals, the global maternal mortality ratio needs to be reduced to less than 70 per 100,000 live births by 2030, and that to achieve this target in Sierra Leone, a large number of pregnant women will need to have equitable access to high quality care by skilled personnel during pregnancy and childbirth.
They also say that beyond staff training and equipment, a key goal is to ensure that at least five fully functional Basic Emergency Obstetrical and Neonatal Care centers and one Comprehensive Emergency Obstetric and Neonatal Care centers should be made available in every one of Sierra Leone’s fourteen districts.
To reverse maternal mortality rate in the Kenema District particularly, and the country generally, all hands must be put on deck while community sensitization needs to be strengthened and the quality of services provided at ante-natal care needs to be improved.
Several relatives of the deceased, who lost their life at the Kenema Government Hospital during delivery, have expressed disappointment in the health sector particularly the Kenema Government Hospital. They have also expressed frustrations over the unprofessional attitudes of some of the nurses toward pregnant women by embarrassing them away from the hospitals, and thus resorting to the old method of traditional birth attendants at community levels.
Many are of the view that for maternal mortality to reduce in the Kenema District, the Ministry of the Health, especially District Health Management Team should embark on the improvement of nurses and patients relationship, as well as conducting regular training for health workers to improve other attitudes.
The National Supervisor of Health for All Coalition, a civil society group for health matters that is monitoring reproductive health and the activities of the Ministry of Health and Sanitation in the Kenema District has observed that maternal death was in the increase before the introduction of the government free health care initiative for pregnant women, lactating mothers and under-five children in 2010.
It should be noted that in the earlier days of the free health care initiative, more facilities were created to help save the lives of pregnant women and teenage girls, and that drugs, equipment, training programmes for nurses on reproductive health activities and the intervention of doctors contributed greatly towards reducing the high rate of maternal mortality in the district.
Observers say that the problem of maternal death started increasing three years after the introduction of the initiative, when most of the services, especially the ambulance service for referral cases, and the availability of essential drugs became almost non-existent in the Kenema District.
Another findings that have over the years been identified as factors responsible for the increase in maternal death in the Kenema District, is the high teenage pregnancy rate among adolescent girls. Statistics have shown that most of the teenage girls become pregnant below the age of eighteen years and most of them who are at high risk of dying during delivery are within the ages of eighteen to twenty five years old.
Moreover, health workers say most of the pregnant women particularly in rural communities do not go for ante-natal care services at government health facilities and clinics, where health workers give counseling and other necessary health education that could save lives. Another factor for the increase in maternal mortality is the delay in, and frequency of visiting the clinics during pregnancy. Most will go to those clinics only when the begin experiencing complications, and by which time it is almost late to save their lives.
In terms of recommendations for the reduction of maternal mortality in Kenema District particularly and the country as a whole, while everybody should come together to ensure a reduction of this stigma, the government should renew its political will for the programme by training more health workers on maternal health issues, give more support to family planning, provide facilities and more drugs and equipment to clinics, improve the salaries of health staff, and implement the existing health laws and policies with a determination and courage to punish those found wanting for violating those policies.
On the part of the Ministry of Health and Sanitation, there should be constant monitoring and oversight to ensure that the District Health Management Teams make judicious utilization of the resources allocated to them for the prevention of maternal deaths. The Ministry of Health should support nurses, especially community health workers to embark on continuous sensitizations on maternal health issues with special focus on teenage pregnancy.
Other health observers have stressed on the need for District Health Management Teams to execute effective monitoring of maternal health activities in the communities while noting that the services of Traditional Birth Attendants should be involved but upgraded, especially in remote communities for the overall prevention of maternal mortality in the district and the country at large.
On the part of the communities, the Health for All Coalition believe that traditional authorities should formulate by-laws that frowns at the practice of giving birth to babies at home, and encouraging pregnant women and teenage mothers to attend ante and post-natal services at clinics. The organization notes that communities should support the health ministry to organize regular meetings on maternal health at chiefdom levels for the purpose of sensitization.
On the part of health-related NGOs, coordinated efforts should be made to support the Ministry of Health and Sanitation in its fight to reduce maternal mortality in the country by helping to provide oversight for the distribution and judicious utilization of medical supplies, equipments and other resources.
It is my hope that haven identified numerous factors accounting for maternal deaths in the country generally and Kenema District particularly, and the proffering of some recommendations to address that health challenges, the high rate of maternal mortality would be drastically reduced if the government and Ministry of Health and Sanitation pay attention to those recommendations.
This investigative story is funded by the Media Reform Coordinating Group in Sierra Leone.