INTRODUCTION TO MATERNAL MORTALITY IN AFRICA

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					INTRODUCTION

Maternal health care services is simply defined as measures or programmes

designed to meet the special health needs of women. The very high level of

mortality and mobility in pregnant women in Africa places them in a high risk

group. Various statistical indications like maternal mortality ratio show the serious

health problems that affect this group in developing countries. Around the world, a

woman dies every minute from pregnancy-related causes. Globally 500,000

maternal deaths is recorded per year, the majority which are in Africa where in

many places the mortality is as high as 1000 deaths per 1,000,000 live births. And

these deaths are on the increase: one in every 16 African women faces the lifetime

risk of dying from pregnancy complications, particularly those from marginalized

communities and those living in poverty. The tragic situation is partly due to high

service cost, lack of trained staff and supplies, poor transport and patients’

insufficient knowledge. The combination of such factors means that 60 percent of

mothers in Africa give birth without a health worker present. That in turn heightens

the risk of complications and contributes to greater maternal death and disability.

The major causes of maternal mortality in developing countries include anaemia,

heamorrhage, eclampsia, infections, abortions and complications of obstructed

labour. All these causes are preventable.

The World Bank estimates that ensuring skilled care in delivery and particularly

emergency obstetrics care would cut maternal deaths by 74%. Similarly access to


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voluntary family planning could reduce maternal deaths by 20 – 35%. According

to the latest estimates by the African Union (AU) over the next ten years there will

be 2.5 million maternal deaths another 2.5 million child deaths and 49 million

maternal disabilities in Africa alone, if urgent action are not taken.

The objectives of the maternal health services are to ensure that as far as possible,

pregnant women should remain healthy throughout pregnancy, have healthy

babies, family planning, organization of family health services that women should

recover fully from the physiological changes that take place during pregnancy and

delivery. Ideally every pregnant woman should have access to a minimal module

of maternal health services consisting of three elements. They are:

(a)   Community-based services (Primary Health Care)

(b)   Essential obstetrics care at a first referral centre to deal with complications

(c)   Effective communication and transportation between the community-based

      services and the first referral centre.

One will ask why special services for mothers, the reason are numerous, among

many of them are because they are:

(a)   High-risk groups – Maternal and perinatal conditions together with

      childhood diseases make a substantial contribution to burden of disease.




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(b)   Interrelated problems – Some specific health interventions jointly protect

      pregnant women and their babies’ e.g nutritional supplement during

      pregnancy, tetanus toxoid immunization.

(c)   Early diagnosis – For mothers, early detection and treatment of

      complications is an important approach for preventing serious complications

      and death.

(d)   Critical care at delivery – Because both the mother and the baby are at high

      risk during childbirth, it is essential for the delivery to be managed by a

      skilled person.

(e)   Operational convenience – The special services can provide continuity of

      care of the child from the womb, jointly with the care of the mother

The components of maternal health services include Antenatal Care, delivery

services and postnatal care


TALES OF FAILURE SURROUNDING THE MATERNAL HEALTH

SERVICES IN AFRICA

The World Health Organization (WHO) reports that Maternal Health problems

account for more than one third of the total burden of disease in women.

Worldwide at least 1,600 women die each day from the complications of

pregnancy and childbirth, including abortion, and virtually all these deaths occur in




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developing countries, which accounts for 99% of all deaths. Of those who survive

many more go on to develop disabilities that last for their entire lifetime.

Maternal mortality rates in developing countries average in the range of 450 to

2000 per 100,000 live births as compared to about 30 per 100,000 births in

developed countries. The major causes of maternal mortality in developing

countries include anaemia, heamorrhage, eclampsia, infections, abortions and

complications of obstructed labour. Mothers in developing counties die in

childbirth at a hundred or more times the rate in developed nations (MDG). Access

to emergency obstetric care the most important remedy for women in these regions

is not highly regarded as a priority.

According to Rafigual in countries like Bangladesh 68.7% of the women gives

birth without assistance of trained birth attendants. Instead relative or traditional

midwives who are often not capable of handling complications during the delivery

serve as birth assistants.

Most women do not have access to the health care and sexual health education

services that they need. In many developing countries complications (mainly at the

level of preconception and prenatal care are the leading cause of death among

women of reproductive age. Any woman can experience sudden and unexpected

complications during pregnancy, childbirth and just after delivery, although high

quality, accessible health care has made maternal death a rare event in developed


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countries these complications can often be fatal in developing world. At least 40%

of women experience complications during pregnancy, childbirth, and the period

after delivery. An estimated 15% of these women develop potentially life-

threatening problems. Long term complications can include chronic pain, impaired

mobility, damage to the reproductive system, and infertility. About 50% of the

birth in developing countries takes place without a medically skilled attendant to

aid the mother. Women in sub-Saharan Africa mainly use traditional birth

attendants, with little or no medical training, this largely account for the high

number of maternal death in this region.

Many factors prevent women in Africa from getting the healthcare they need, they

include distance from health services, cost (direct fees as well as the cost of

transportation, drugs and supplies) multiple demand on their time and woman’s

lack of decision making power within the family. The poor quality services,

including poor treatment by health providers also make some women reluctant to

use services.

According to WHO report in 2004 bad maternal condition account for the fourth

leading causes of death for women after HIV/AIDS, these death occur in low

income countries, a woman in sub-Saharan Africa has a 1 in 16 chance of dying.

Furthermore maternal problems causes almost 20% of the total burden of disease

for women in Africa. The maternal mortality ration is 72 times higher in the sub-



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Saharan than industrial countries, 940 against 13 deaths per 100,000 live births

(OMS, 2005). “The Africa region suffers more than 24% of the global burden of

disease but has access on only 3% of health workers and less than 1%. The world

financial resources even with loans and grant from abroad, countries with relative

needs have the highest number of health workers, while those with the greatest

burdens of diseases have to make do with a much smaller health work force”

(OMS, 2006).

There are challenges for low maternity health care services in Africa. It includes:

(a)   Weak health system that led to commodity disruption, inadequate

      management, poor availability and use of information, and lack of

      supervision and oversight.

(b)   A health manpower crisis that affect all levels of the health sector.

(c)   An HIV/AIDS epidemic that erodes human capacity, divert scarce resources,

      degrades organizational capacity, and fragment social and economic

      networks.

(d)   High comorbidity of malaria and HIV\AIDS.

(e)   National prevalence of nutritional due to food insecurity and poor nutritional

      practice.

(f)   Frequent use if informal providers, including traditional healers and

      traditional birth attendants.




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Maternal health services in Africa can be truly said to be surrounded by tales of

failure but all these we know can be remedied or prevented if appropriate measures

are put in place by all and sundry especially the government, by this it will go a

long way in saving the lives of women in Africa.


MEASURES OR IMPROVEMENTS IN MATERNAL HEALTH SERVICES

IN AFRICA

An African expert on reproductive health in Harare pointed a grim picture of

maternal and child health in the region and warned that the situation could worsen

in the next decade if no immediate remedial action were taken by Africa’s

government and development partners. The cost benefits analyses of investing in

maternal health in Africa show that basic maternal health care can cost less than

US$3 per person per year. On the other hand if action is not taken to reduce

maternal deaths and associated disabilities, there will be a US$ 22 billion loss due

to maternal deaths and US$ 23 billion due to disabilities – giving a total of US$ 45

billion in lost productivity. Overall the Commission on Macroeconomics and

Health (CMH) report revealed that an investment of US$66 billion annually in

health sector in low-income countries now would lead to economic benefits of at

least US$360 billion a year in 2015 - 2020. (Paul BK. 1993).

Regarding this persistent situations, some African government try to improve

population health especially in rural areas of Africa. In Senegal, different health



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programme have been created an increase in primary health care service, hospitals

were opened all over the country. Also in Senegal, the Ministry of Health and

United Nations Population Fund (UNFPA) jointly fund the work of community

health workers who bicycle to visit women in their village. They are trained to

monitor the health status of pregnant women, refer the women to local health

centres for prenatal checkups and ensures that they get to a centre where skilled

attendants can assist with delivery. In addition, UNFPA provides the villages with

about $50 in seed money to set up community health funds. Villagers work out

among themselves how to replenish the funds, usually through small monthly

donations. The funds are used for emergency cases, such as getting a woman to a

district hospital when complications arise.

In Malawi, traditional leaders are empowered to create awareness by campaigns to

improve maternal health. The chief facilitate the formation of local village health

centre. The committees encourage pregnant women to seek health care in these

centres. Reports from UNFPA Malawi indicate that these initiatives are working;

the country’s central district of Mchinji has seen no maternal deaths in the past two

years.

In 1987, experts development professionals and policy makers gathered in Nairobi

to inaugurate the Safe Motherhood Initiative. The impact and the progress of the

Safe Motherhood Initiative are tremendous. They are one of the first – and are still



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one of the few international agencies to raise global awareness about safe

Motherhood, define goals and programmatic priorities for the initiative, stimulate

research, mobilize resources, and share information on how to make pregnancy and

are childbirth safer. A special focus of our work is improving women’s access to

skilled care throughout pregnancy, childbirth, and the postpartum period. It is also

focused on improving women’s access to comprehensive family planning

information, consulting, and services.

In some countries in Africa, maternal mortality rates have been reduced by the

integration of services and the development of multi-purpose health professionals

and specialized health professionals which has helped in the area of referral

services as well as to provide necessary backstopping training of other groups.

There have been improvements in maternal health services in Africa, owing to the

fact that there is a reduction in maternal mortality.




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CONCLUSION
Maternal mortality in Africa continues to be a serious public health problem. Any
success in this domain requires an adequate political will, appropriate multi
disciplinary programmes of prevention and early management case in obstetrical
resuscitation units.

Until a drastic, violence and radical solution or action is taken to avert this threat if
not maternal mortality will continue to increase in African and all the effort will
continue to be abortive because most of the health problems in Africa can be tied
to preventable diseases so emphasis should be given to preventive measures which
are relatively cheap.

There is no doubt that pregnancy related deaths could be considerably minimized
in Africa. The health risk of mothers is greatly reduced as the population of babies
delivered under the supervision of health professionals increases. However, only
small proportion of babies born in most African countries is delivered in health
facilities.

Post natal care is also important to the health of mothers, as a large proportion of
maternal deaths occur shortly (within 48 hours) after delivery because of limited
access to maternal health services and the poor quality of existing services




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REFERENCES

1.   Addai – 1 2000 Determinant of use of maternal and child health services in
     rural Ghana Journal of Biosocial Science 32 (1): 1-5.

2.   Addai – 1 1998 Demographic and social cultural factors
     influencing use of Maternal Health Services in Ghana. Africa Journal of
     Reproductive Health 2 (1) 73 – 80

3.   Adetunji J.A – 1 991Response of parents to five killers. Among children
     In a Yoruba Community Nigeria Social Science and Medicine 32 (12): 1379
     – 1387


4    OMS 2005 – Report on slow reduction on Maternal Mortality in Africa
     2005

5.   2006 – Report on Maternal Mortality in Africa

6.   Pilirani S.B. Cultural and Personal sacrifice: panic is the journey Panic
     women in Hi-teach Africa step up to fight against maternal and clinical
     death.

7.   Adekunle C.U. Fillipi W. Graham – P. Onyemmunwa and E. Udjo 1990:
     Patterns of Maternity care among women in Ondo State Nigeria
     Determinants of health and mortality in Africa.




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