The Ministry of Health has launched a new strategy to tackle the maternal and perinatal deaths in Uganda through focusing and implementing programs on key areas in the health system.
The new initiative was revealed at the launch of the activity implementation framework, an intervention plan geared to accelerate reduction of maternal mortality due to excessive bleeding during childbirth -Postpartum hemorrhage. The event was held on Thursday at Hotel African in Kampala.
The objective of the framework is to effectively rollout clinical guidelines and protocols to aid health workers in prevention and management of postpartum hemorrhage. Uganda loses about 16 women everyday due to excessive bleeding during childbirth which translates into approximately 6000 mothers dying from pregnancy related causes every year on average according to the UDHS report 2016.
At the launch, MOH also released the National Annual Maternal and Perinatal Death Surveillance and Response report for the year 2019/20, which showed improved reporting and review of maternal and prenatal deaths, which provides opportunity for the targeted interventions by government to lower the maternal mortality rates.
Ending preventable maternal mortality is a global priority under the Sustainable Development Goals –SDG agenda, whose target is to reduce the average global maternal mortality ratio to less than 70 maternal deaths per 1000 live births and neonatal mortality to at least 12 deaths per live births by 2030.
Analysis of the reviews undertaken by the ministry shows that a total of 1,182 maternal deaths and a total of 28,050 baby deaths were reported in FY 2019/2020 compared to about 1050 maternal deaths reported the previous year.
The report was compiled from analyzed data that was collected from 108 of 135 districts through the national Health Management Information System (HMIS), using the maternal/perinatal death notification and review forms captured through a standard software -DHIS-2.
According to the report, a total of 1,182 maternal deaths were reported in the financial year 2019/20 with 95 districts reaching the annual target for Institutional Maternal Mortality Rate (98 out of 100,000 deliveries) of which 17 reported zero maternal deaths.
The report shows that majority of the reported maternal deaths occurred at the higher levels of care including General Hospitals (453 cases), Regional Referrals (117), and National Referrals (177), accounting for 90 percent of all reported deaths.
The report also shows a reduction in Mortality ratio in regions of Acholi, Ankole, Bunyoro, Elgon, Tooro and West Nile. However, majority of the regions (60%) did not register a similar trend.
Maternal mortality rate appeared to be more with age among adolescent girls and young women, with about 36 per cent involving adolescents girls and young women while 30 percent were teenagers.
At regional level, Kampala region contributed the highest maternal mortality rates followed by Busoga and Bukedi respectively. However, the report showed a substantial reduction in maternal deaths in Acholi, Bunyoro, and Elgon regions from 2018 to 2020, a trend attributed to various interventions funded by the World Bank which have enabled facilities to collect blood, procure uterotonics and motivate health workers
Of the districts with the highest number of maternal deaths reported, those with regional referral hospitals including Hoima 352, Masaka 310, Kabalore 268, Mubende 224, Gulu 217 disproportionately have the highest burden.
Also, districts that registered the highest institutional maternal mortality rates have hospitals with high number of deliveries pointing to gaps in quality of care during the intrapartum and puerperal period including Butambala (225), Kamuli (184), Masindi (182), Bukwo (177), Nebbi (165).
Severe bleeding was the leading cause of death among women with more than a half of all maternal death occurring within 24 hours of delivery. The irony is that majority of these deaths could be averted or prevented.
The report identified several bottlenecks to combating maternal deaths including human resource gaps at various levels of maternal health care and critical shortage of neonatal nurses and neonatologists.
Efficiency by medics in terms of timeliness, availability of logistics such as ambulances and their readiness to transport mothers, shortage of blood as well as uneven geographical coverage of regional blood banks, inadequate facilities to support full time availability of medical officers and anesthetists and non-availability of lifesaving commodities, were also highlighted in the report as existing bottlenecks.
Speaking at the launch, the Permanent Secretary in the Ministry of Health Dr Diana Atwine appealed to health workers to priorities implementation of policies and guidelines that have been developed in order to reduce the maternal mortality burden. Dr Diana said maternal and child health services form the backbone of any health care system and a litmus paper to show how effective the system is.
She said she welcomes the issue-by-issue approach the ministry has taken to tackle one issue at a time notwithstanding other factors including inadequate budget finance for healthcare services.
“I am more than convinced with all my heart that even with a few resources we have as a country, we can implement the cost-effective measures that can reduce maternal deaths. It is possible ..we can make a lot of difference in the lives of mothers and children in this country” Dr Diana said as she appealed to everyone to play their role “honorably.”
The Principal Medical Officer at MOH, Dr Mutumba Robert, who presented the report said the improved reporting and review on maternal and child deaths will be immensely helpful in implementing interventions by the ministry to reduce Maternal deaths.
Over the last five years, mortality deaths in Uganda reduced from 438 per 100,000 live births to 336 out of 100,000 live births according to the Uganda Demographics Household Survey 2016.
However, comparing UDHS 2011 and 2016, the neonatal mortality rate has stagnated at 27 deaths per 1000 live births falling short of the target of 16 deaths per 1000 live births.