Lusaka and Copperbelt Provinces have continued to record high number of maternal deaths despite having the best health facilities.

The development was highlighted by Dr Angel Mwiche, Assistant Director RMNCH, Department of Public Health at Ministry of Health during the Zambia Association of Gynaecologists and Obstetricians [ZAGO] Annual General Meeting [AGM] and Scientific Congress, when he gave an overview of maternal mortality for 2022.

According to latest figures, the risk of women dying during birth is higher in Lusaka and Copperbelt than in other provinces, such as Luapula. This picture presents unfortunate state of affairs given the modern health facilities in the two provinces.

“MMR [Maternal Mortality Ratio] measures the risk of the woman dying in a single live birth. Live births for LSK[Lusaka] and CB[Copperbelt] are way too low when compared with calculated expected deliveries (171, 000 and 142, 480 respectively); [University Teaching Hospitals) U.T.H 5,482 (Kitwe Teaching Hospital) KTH 4,559]. Higher level facilities are the ones known to under report. How can we improve data capturing in referral facilities?” Dr Mwiche wonders.

MMR as at 30 September 2022

He shares that major causes of maternal deaths still remain the same, with hemorrhage as a leading cause, while others include, sepsis, unsafe abortion, anesthetic, HPTN disorders, Covid19 etc.

“The contributors to maternal mortality have remained the same. However, there seems to be a swap between sepsis, Hypertensive disorders and indirect causes. Anesthetic deaths have increased from 2% to 4% between 2021 and 2022 and covid-19 related deaths reduced from 2% to one percent. There is need to reposition our care to respond not only to hemorrhage but also to indirect causes and hypertensive disorders,” he adds.

He notes with sadness that during the period under review, most deaths occurred in facilities with skilled birth attendants.

“These facilities must be instrumental in the review of these women who died and further be proactive in finding solutions to these gaps: it be in their facility or outside their facility,” Dr Mwiche advises. “Maternal deaths that occurred at primary care (HC and HP) require strong engagement of both staff at primary health care and the community. Mortalities that happen at community level require strong community mobilization.”

Majority of women that die during birth are between 20 and 35 years, with a potential to contribute to national development, he continues.

“15% of those lost were adolescents who should have been in school. It might be important to start looking into the various policies we have [to] start talking to each other (The free education policy, ending child marriages and Reducing Adolescent Pregnancies). As a profession, it might be important to start discussing the risks of late age pregnancies,”” he explains.

He further decries high number of Fresh Still Births [FSB] in health facilities across the country.

“There was a relationship between maternal death and FSB because the provinces that recorded low maternal death were also the ones that reported low FSB. If this data is accurate, it might be reasonable to start concluding that Provinces that reported high numbers of FSB, might also require capacity building in managing labour and delivery,” Dr Mwiche notes. “Most of the Fresh Still Births occurred in referral facilities (District, Central and General Hospitals where we expect to find skilled birth attendants. It will be important to find dedicated time to thoroughly review these poor outcomes by SBAs in these facilities and they should be part of the solution to the problems within and outside these facilities. The fresh still births that occurred at primary health facilities (HC and HP) require engagement of staff at health facilities and communities. Fresh still births that occurred at home require mobilization for communities to promote facility delivery.”

He attributed fetal distress as major cause of Fresh Still Birth.

“Difficult and prolonged labour can be addressed if labour is monitored using partograph. Here, PIH surfaces as a problem for the unborn baby, it might be important to brain storm on how we have been very success in saving the mother than the baby from it,” he advises. “Congenital anomalies continue to appear in the picture as a problem, there is need for us to conduct research to know the common anomalies and the cause of the anomaly. There is urgent need to ensure that management of fetal distress is enhanced.”

Dr Mwiche further shares how neonatal deaths have continued to be recorded especially in referral health facilities – a situation he calls for urgent attention to address the problem. “Unfortunately, most of the neonatal deaths continue to be reported from the national referral facility here in Lusaka Province. This requires urgent attention to review factors contributing such mortalities and be proactive in finding remedies to problems within and outside this facility. Other provinces must also follow a similar approach to improve neonatal outcomes. The referral facilities that reported most of these facilities with skilled personnel that must at the center of review of these mortalities to identify gaps and find remedial measures within and outside these facilities,” he elucidates. “U.T.H in particular [as] a Center of Excellence and therefore, this is urgent. Primary health facilities reporting neonatal mortalities require engagement together with their communities to know why this happens at this level. Knowing that the majority of these mortalities were attributed to asphyxia must shift our attention to what is happening in labour ward and ensure that we begin to offer quality delivery health services. In the Antenatal period, risk factors for prematurity must prioritized and institute interventions to optimize the outcome. Like in FSB, urgent research into the common congenital malformation and causes should be undertaken. Infection prevention during labour and delivery and also in the neonatal period require enhancement.”