Namayingo grappling with high maternal, child deaths

Namayingo District is grappling with high maternal and child deaths that have left at least 14 people dead over the past three months, the authorities have said.
At Buyinja Health Centre IV, eight babies died shortly after delivery, with the medics saying their mothers reported to the wards late because of restrictions on transport during the coronavirus pandemic.

In Lolwe Sub-county in Bukhooli Islands, three mothers and their babies died from severe bleeding during childbirth.
“The babies were tired due to prolonged labour and died shortly after they were born,” a medical source said at the weekend.

Mr Anthony Bwire, the clinical officer in-charge of Sigulu Health Centre III, said the mothers and their babies died due to failure to access on time health services on the mainland where they had been referred.
“We lost mothers and their babies to severe bleeding because we could not organise a quick boat to take them to the mainland where we had referred them,” Mr Bwire said.

He said quarterly, Sigulu Islands alone loses two mothers and their babies at the health facility, while many community deaths go unreported, attributing the fatalities to lack of facilities such as oxygen cylinders, blood transfusion services and surgery centres at Sigulu Health Centre III.

In an interview with Daily Monitor in December 2018, Mr James Ouma Wandera, the Namayingo District secretary for health and education, said expectant mothers were taking a 20-kilometre boat ride to Kenya to give birth and immunise their children.
“They sail to Kenya and back at Shs30,000 and after giving birth, they make another trip to immunise the child,” he said.

Mr Wandera says Ugandan mothers, who do not have Kenyan national identity cards, have to part with KShs500 (about Shs16,000) to have their children immunised despite the service being free in Uganda.
“Those who cannot afford the fees are denied immunisation which directly impacts the child and its mother,” he added.

Sigulu Island is the only sub-county in Namayingo District with a health centre III, while Lolwe and Bukana sub-counties have health centre IIs, which the officials say are poorly equipped.

The health facility is the biggest in Bukooli, which is made up of nine islands, including Lolwe, Hama, Bukana, Yebe, Biisa, Wayasi and Siiro, among others.
Mr Bwire, who oversees all health facilities on the islands, partly blamed the deaths on restrictions imposed by the government to check the spread of Covid-19, which has seen a ban on water transport, and rampant cases of teenage pregnancies.

Residents say
Mr Peter Okeyoh, a resident of Matoolo Village in Sigulu Islands, said Sigulu Health Centre III is understaffed and lacks facilities, while health centre IIs in Bukana, Bumalenge, Rabaachi, Kadenge, Singila and Hama lack capacity to respond to emergencies.
The Namayingo District Local Government abstract (2017) indicates the district has a population of 243,881, but has only one health centre IV, four health centre IIIs and 20 health centre IIs.

The data also shows that the doctor-patient ratio is 1:5401, while clinical officers’ ratio stands at 1:1023.
On deliveries at the health facility, few mothers delivered under skilled professionals, with the figures standing at 49.2 per cent, while infant mortality rate stood at 50 per 1,000 live births, with under five mortality rate standing at 70 deaths per 1,000 live births .

Maternal mortality stands at 385 deaths per 100,000.
Mr Okeyoh said most of the health facilities were understaffed and said many postings have opted to leave because of the area being hard-to-reach.
“I am disappointed that the few health workers who have accepted to work at the islands are not facilitated with hard-to-reach allowances as directed by the Ministry of Health.”

Mr Mathias Mangeni, the Namayingo assistant district health officer, said the deaths have just not started during the Covid-19 period, but have been happening.
“We have many islands but with poorly equipped health facilities that cannot handle emergency cases, yet transport to the mainland is a big challenge,” he said.

He said both maternal and child deaths reported from the districts of Busia and Bugiri are majorly cases from Namayingo, which were referred late.
“Transporting a mother from Lolwe or Hama Island who has suffered obstruction or bleeding is a big challenge and many die while being transported,” he explained.

Challenges of boat transport
Mr George Ouma Abbot, the Bukooli Islands Member of Parliament, said transporting a mother from Lolwe or Hama Island, requires a boat that will travel between four and six hours to reach the mainland, while the cost of hiring a boat is not less than Shs600,000.
Besides, the family of the expectant mother has to buy 120 litres of fuel.

Mr Ouma says from Busiro Landing Site, a mother has to be carried on a motorcycle to either Buyinja Health Centre IV or to Busia and Bugiri districts where they can access better health services.
He says the challenges of accessing health services on the islands have forced many mothers to resort to visiting the traditional birth attendants (TBAs) and witchdoctors, who promise to offer safe delivery services.

“I am aware that some mothers are now visiting witchdoctors and TBAs for delivery, where many end up losing lives and their newly-born babies,” the MP revealed

Mr John Bosco Nyabenze, the Lolwe Island chairperson, said mothers have died because they could not get transport to the mainland for further attention.
“Being pregnant in Lolwe is next to a death sentence; we have seen many mothers bleeding to death even when their lives would have been saved,” he said.
He said Lolwe Island lacks a boat ambulance, while the boat that was donated to residents by Ms Hope Robinah Mukisa, the District Woman MP, lies idle due to lack of fuel.

Statistics
Maternal and child mortality deaths are aggravated by the rampant child pregnancy on the islands.
A Uganda Bureau of Standards demographic and health survey, key indicators’ report of 2016 established that 48.7 per cent of girls aged between 15 and 19 years in island areas of the country are already mothers or pregnant with their first child. The survey was taken between June 15 and December, 18 2016
Whereas the Uganda demographic survey indicated a downward spiral in cases of infant and maternal mortality rates from 524 in 1994, 418 between 1999 and 2006, and 368 in 2016, the mortality rates remained high in Bukhooli Islands.

Intervention
Progress. Mr Mangeni said plans are underway to upgrade Sigulu Health Centre III to a mini-hospital and provide equipment to handle emergencies related to obstetric care, assisted delivery, vacuum extraction, oxygen concentrators and blood bank.

He added that they are planning to have a boat ambulance with specialised facilities and fuel to handle the emergencies and are collaborating with the Ministry of Health to ensure more medical workers are recruited and deployed to various health facilities on the islands.
“We have had challenges of recruiting and deploying medical staff on Bukooli Islands, but with ferry services coming, we think the staff can be willing to move and work on the waters,” Mr Mangeni said.

Mr Stephen Mayende Dede, the Bukooli South MP, said they had already secured 15 acres of land in Isinde Village, Buyinja Sub-county for the construction of a district hospital and are currently pursuing for a land title which is needed by the Ministry of Health before they can commit funds for the construction.