On August 22, 2012, the New Vision Newspaper, also the government’s mouthpiece, published an optimistic overview of the 5th Uganda Demographic and Health survey, 2012 released by the Uganda National Bureau of Statistics (UBOS). This report cast a surprising appraisal of the health sector that disputed the increasing apathy among Ugandans towards healthcare services.
Of particular interests were maternal health and mortality rate. According to UBOS, there are more pregnant women visiting antenatal clinics and are receiving preventive care such as immunization against tetanus and regular monitors of vital signs such as blood pressure; more women delivered in public health facilities in 2011 than the previous years and; a decline in the number of women who delivered from home or in transit, were recorded. Most notable is the reported decline is maternal deaths - from 550/100,000 in 2001 to 438/100,000 in 2011. By any standards, this report exceeded expectations and should be received with much delight.
The United Nations’ 2012 “The Millennium Development Goals Report”, indicates that the antenatal care for pregnant women has improved significantly across the world and that for Africa; Southern Africa continues to lead in achieving concrete gains in this aspect. Despite general improvement in antenatal care across the world, Sub Sahara Africa’s achievement in all the Millennium Development Goals was the slowest. For instance, in 2010, an estimated 287,000 maternal deaths occurred worldwide, which is 47% decline from 1990. Of these maternal deaths, Sub-Sahara Africa (SSA) accounted for 56% and Southern Asia 29%. This is 85% of global burden of maternal death (245,000 deaths) between SSA and S. Asia.
Given the colorful status of the 5th Uganda Demographic and Health Survey report, many Ugandans who have endured challenges to access basic health care services will have to ask many questions. Such baseline demographic reports are often not very representative. Attaining credible statistics that is representative of maternal status in Uganda is nearly impossible because of adverse culture of record keeping; most deaths in Uganda are not reported, and even those that are reported, may not be accompanied by exact cause of death. Obtaining credible statistics requires stringent and massive resource allocation, for which, with the pervasive nature of corruption and incompetence in supervision, collection, monitoring and verification of data, one doubts the credibility of such demographic or health data.
The International Classification of Diseases, in its 9th and 10th Revisions (ICD-9, ICD-10) defines maternal death as “the death of a woman while pregnant or while within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to, or aggravated by the pregnancy or its management but not from accidental or incidental causes”. ICD discerns maternal death from direct obstetric death which results purely from obstetric complication of the pregnant state (pregnancy, labour and puerperium), from interventions, omission or incorrect treatment, or from the chain of events resulting from the aforementioned.
It is of utmost imperative for frontline health care providers to understand the above classification of the causes of maternal deaths if UBOS and other researchers are to ever get credible data. There are conceptual models that have helped us to explicate the underlying preventable and avoidable causes of maternal deaths. Most practitioners are aware that pregnant women die from complications of heamorrhage, sepsis, abortion complications, hypertensive disorders, obstructive labour, ruptured uterus, ectopic pregnancies and complications resulting from HIV/AIDS, Malaria and waterborne diseases, among many.
However, for public health policy and ethics of practice, the three delays and “near miss” model developed by Thaddeus and Maine (1990) should help to reinforce the knowledge of challenges that pregnant mothers endure trying to access antenatal care. According to Thaddeus and Main, many pregnant women do reach health facilities in such a poor condition that they cannot be saved, and the time taken to receive adequate care is key factor in their deaths. The three delays; delay in deciding to seek care by the woman and/or her family feeds into the delay in reaching an adequate health care facility and, the delay in receiving care at that facility.
Each of these delays is facilitated by certain key factors motivated by poverty or attendant socio-economic inequalities. Thaddeus and Maine named women who survive death from pregnancy complications, either by chance or by receiving timely care as maternal “near-miss” and argued that these woman share similar experiences with those who died due to pregnancy complications.
The three delays model has profound implication for practice and research. First, that the establishment of public health facilities and infrastructure that is supportive and accessible to the child bearing woman is a collective virtue. Further, it calls on the moral imperatives and ethical responses from health care workers to prioritize the care accorded to women, whether pregnant or not. This also has major implication for health policies, funding and leadership to ensure a reduction in the interval between onset of a complication and its efficient management in all health facilities.
END
No comments:
Post a Comment