Posts

Maternal Mortality in Sierra Leone

Maternal mortality may not be a constant fear of yours if you think about pregnancy. However, this threat has not been eliminated in many parts of the world. Simply because developed countries have significantly decreased this issue with medical advances, many women in various regions must contend with this terrible plight. Maternal mortality in Sierra Leone, specifically, is still considered to be of high risk and something women should consider prior to pregnancy.

The Most Dangerous Place to Become a Mother

The most dangerous place in the world to become a mother, in fact, is Sierra Leone. This country has one of the highest maternal mortality rates globally. Around every one in 17 pregnancies end in the death of the mother- an overly alarming statistic. An endeavor that is supposed to be filled with joy and excitement is now clouded with fear as mothers worry about their health instead of being able to focus on their babies. This worry is not one experienced globally: Sierra Leone women are 300 to 400 times more likely to die with each pregnancy in comparison to women in Sweden, Finland, and other high-income countries.

Factors That Contribute to Higher Rates of Maternal Mortality in Sierra Leone

Postpartum hemorrhaging has accounted for 32% of deaths along with bleeding, hypertension, abortions, obstructed labor, and infections. Hemorrhaging is problematic because a blood transfusion is required immediately to resolve the issue. However, when a woman gives birth at a local clinic, it can take hours to transport her to a hospital for the procedure. Unfortunately, many women bleed to death while waiting. However, most of these conditions can be treated with the correct healthcare, but due to extreme poverty, an overwhelming percentage of families do not have access to the necessary care.  This has resulted in unnecessary deaths.

Another significant factor that contributes to higher maternal mortality rates is that women in low-income countries tend to have more children. As a result, this increases their risk of complications. On average, women in Sierra Leone have five children, which, is considerably high when looking at countries like the United States whose average is 1.73 children. More children typically mean earlier pregnancies. In a 2016 report, researchers found 20% of deaths were girls ages 15 to 19 years old; a grim statistic especially when considering a 15-year-old is three times more likely to die during childbirth than a 22-year-old.

The Good News

Although the facts appear troubling, all hope is not lost. The United Nations has recognized maternal mortality as a serious issue. Thus, it has begun to combat the risk of death during pregnancy and the six weeks that follow.

The UN agency called the United Nations Fund for Population Activities (UNFPA) has started supporting midwifery through three government-run schools that graduate 150 students each year to tackle the high mortality rates. This alone will not improve the situation, as the majority of women in Sierra Leone already have midwives. It should result in better outcomes as these midwives will be better trained and even more common.

The UNFPA also focuses on family planning which reduces mortality by 25 to 30%. This UN organization provides 90% of the country’s forms of contraception through an annual $3 million budget. They estimated that from 2015 to 2017 this service prevented 4,500 maternal deaths and 570,000 unplanned pregnancies.

Maternal mortality in Sierra Leone may be among the highest rates in the world, but the country is taking imperative steps to diminish the risks, steps that have been working thus far. By 2023, UNFPA hopes that they can reduce adolescent births to 75 per 1,000. This, in turn, will massively decrease maternal mortality.

Victoria Mangelli
Photo: Flickr

Uterine Balloon TamponadeThe Every Second Matters Uterine Balloon Tamponade (ESM-UBT), a device designed by Massachusetts General Hospital (MGH) to stop postpartum hemorrhaging (PPH), is a condom that is attached to a Foley catheter. When a mother experiences profuse bleeding which cannot be stopped through other means, the condom is placed within the uterine cavity and filled with water using a syringe and a one-way valve. Within minutes, the bleeding is expected to stop. This device has been effective in preventing fatalities associated with pregnancy and childbirth.

The device is easy to use and requires minimal training. Since the training of more than 850 South Sudanese health workers in 2010 and 2011, MGH began using and researching the usage of the device in the countries of India, South Sudan, Kenya, Sierra Leone, Ghana, Senegal, Tanzania, Zambia, Peru, Honduras, Uganda and Nepal.

The Beginning Stages

Training of 46 health providers from 12 health centers to use the device began in Kenya in August 2012. During the first year after training, twenty-six ESM-UBTs were used. The patients who required the device were either unconscious or in an unstable mental state as a result of the severe bleeding they were experiencing. In each case, once the device was put into place, the bleeding was stopped, and the patients were saved. As a result of these successful interventions, the Kenyan Ministry of Health has formally integrated the program into the national policy for PPH.

The ESM-UBT’s Potential

A study was published in 2013 that predicted how many lives could potentially be saved by the use of a uterine balloon tamponade in the year 2018.  These predictions were made based on the availability, use, and efficiency of technologies in health care centers that provide maternal and neonatal services. The model estimated that when the use of a uterine balloon tamponade is implemented, 6,547 lives can be saved, which is an eleven percent decrease in maternal deaths, 10,823 surgeries can be prevented and 634 severe anemia cases can be avoided in sub-Saharan Africa every year.

In 2018, there was a case that involved complex vaginal lacerations which may have resulted in death, but the ESM-UBT was used to control the bleeding. The 26-year-old woman, who was 39 weeks pregnant, went to the Muhimbili National Referral Hospital in Tanzania to deliver her baby. Although she was in good health, she began experiencing significant blood loss. After uterine massage, administration of oxytocin and removal of the placenta, the patient was still bleeding and became unconscious.

Upon examining her pelvis, doctors discovered second degree bilateral vaginal sulcal lacerations. They attempted to suture the lacerations, but the bleeding persisted, so they decided to insert an ESM-UBT device, which was inflated with 300 cc of water. Finally, the bleeding stopped. After forty-eight hours, the device was removed, with no more need for repair. The mother left the hospital two days after giving birth and had fully recovered by her six-week postpartum visit.

As of now, over 670 ESM-UBT devices have been used. MGH has plans of distributing these devices to 350 health centers in South Sudan and Kenya. In addition, technology has been developed to allow for the tracking of referrals of this device as well as the results of its use. The ESM-UBT device has great potential to reduce the number of maternal deaths in developing nations.

– Sareen Mekhitarian
Photo: Unsplash

postpartum hemorrhaging
In the advanced world, a postpartum hemorrhage is a very manageable and preventable condition; however, postpartum hemorrhaging is a leading cause of maternal mortality. A staggering 99 percent of all deaths resulting from postpartum hemorrhaging occur in lower income countries. Postpartum hemorrhaging is responsible for 59 percent of maternal deaths in Burkina Faso, 43 percent in Indonesia and 52 percent in the Philippines.

Why Postpartum Hemorrhaging Is Common

In these developing countries, the increased frequency of postpartum hemorrhages is due to a lack of experienced obstetricians and caregivers who can properly treat the condition. There is also a lack of access to proper medications as well as care for those medications.

Oxytocin is currently the most common drug prescribed for preventing postpartum hemorrhages. The World Health Organization recommends that oxytocin be routinely administered and actively managed; however, oxytocin must be stored and transported at two to eight degrees Celsius, two conditions of which developing countries cannot accommodate.

A Possible Solution

A rival drug has been in the works to be as efficient as oxytocin in preventing excessive bleeding post childbirth as well as be more manageable in the living conditions of developing countries. The drug is a heat-stable carbetocin. This type of drug does not need refrigeration and can maintain its efficacy for at least three years when stored at 30 degrees Celsius. These requirements are far more realistic and achievable in developing communities.

The World Health Organization conducted a comparative study between the heat-stable carbetocin and oxytocin for prevention of postpartum hemorrhages. Approximately 30,000 women were sampled and given either drug to study the effects each had on prevention. It was concluded that the heat-stable carbetocin was not inferior to oxytocin.

Saving Mothers’ Lives

With such a high rate of deaths from postpartum hemorrhaging in developing countries due to the strict requirements for oxytocin that cannot be met, the heat-stable carbetocin will drastically improve the mortality rates. The new drug will be readily available and easily managed where it was once not.

Permitting the usage of the heat-stable carbetocin has many benefits that will better developing countries in a multitude of ways. If used widely, the drug could very possibly put an end to this tragically common occurrence.

– Samantha Harward
Photo: Flickr