Power outage a major cause of maternal mortality in Uganda

Ensuring that every woman can deliver safely and with dignity is paramount. Maternal mortality is death due to complications from pregnancy or childbirth. Between 2000 to 2017, the UN inter-agency estimates that the global maternal mortality ratio declined by 38 per cent from 342 deaths to 211 deaths per 100,000 live births.

Uganda’s maternal mortality rate has persistently been one of the highest in the world with 375 deaths per 100,000 live births, according to the United Nations Children's Fund (UNICEF). This implies that one woman out of every 49 mothers will die from a maternal related complication.

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Available data indicates that in Uganda, currently,1 in 4 adolescent women aged 15-19 are already mothers or pregnant with their first child and women have an average of 5.4 children. Teenage childbearing is higher in rural areas (27%) than in urban areas (19%).

Since 2000, fertility has decreased from 6.9 children per woman to the current level. This demonstrates a decline of 1.5 children. Further, 48% of Uganda’s population are women of reproductive age (15-49 years). According to the annual health sector report 2020/2021, women had an estimated 1.2 million health facility deliveries across the country. Many of these child deliveries were through caesarean section.

Rwekubo and St Paul Health Centre IV in Kasese District conducted a total of 3,005 caesarean sections. caesarean section is an important intervention in complicated births when the safety of a mother or baby is at stake. The safety of birth by caesarean is dependent on several factors including the availability of adequate and safe blood for transfusion. Without this, a mother can bleed to death.

Despite many interventions to reduce maternal mortality in Uganda, the number has over the years stagnated and the country is far from reaching its national target.

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Between 2020 and 2021, maternal death among health facility deliveries across the country was 92 per 100,000 yet the target was 78 per 100,000 with haemorrhage contributing 42% of the death.

Blood transfusion is the only intervention for haemorrhage that occurs during childbirth however many health facilities across the country lack the necessary facilities to store and maintain blood that would save many bleeding mothers during childbirth.

Kamuli General Hospital serves one of the largest populations in Uganda. The hospital however experiences frequent power interruptions. With no money to buy fuel for the hospital generator, the laboratory blood bank spends long hours switched off which leads to the deterioration of blood units required for emergency blood transfusion to bleeding mothers in the labor ward or theatre.

I had the opportunity to visit Kamuli General Hospital for close to a week in April 2022 while conducting a laboratory mentorship in Quality Management Systems, but throughout that period, electricity from the national grid was never available for an overall of 24 hours at any given day.

At some point, for over two consecutive days, there was a total blackout in the entire Kamuli Town- including the hospital and the blood bank. Awful.

The hospital laboratory quality officer, Mr Safani Isabirye, informed me that ice packs that would be used to keep the blood safe have all melted and therefore all the units ought to be discarded. This is a huge risk to the many mothers in the maternity ward awaiting labor pains many of whom may require blood transfusion. Certainly, these may be part of the maternal mortality statistics for the financial year 2022/2023.

If the laboratory had a stable power backup system, it would support the blood bank refrigerator for a long time until the main power is restored.

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However unavailability of the above implies that a significant number of blood units get spoilt now and then.

The Ugandan government in conjunction with responsible stakeholders should intervene so that losing mothers during childbirth (maternal mortality) can be lessened in especially most of the country’s rural based health facilities.  

* Elias Musiime is the Ubora Foundation Africa | Executive Director| [email protected] +256700702247