AFRICANEWS

Zambia

Safe motherhood eludes many maternal mothers

More than half a million women die from maternal causes each year in developing countries, Zambia inclusive. To arrest this problem the country has been training community based Traditional Birth Attendants (TBA) who have helped many women procure safe deliveries.

Mrs Muyambo, 34, of Mandefu Village in Mwense district some 700 kilometres north of the capital Lusaka has conducted 20 safe deliveries in the communities since September 2000 when she trained as a Traditional Birth Attendant (TBA).

Prior to that, Mrs Muyambo had carried out several deliveries without any training, but she has now seen the danger of doing so. "I started helping mothers to deliver in 1996 but is only last year that the community chose me to go for training as a TBA," Mrs Muyambo said. "There is a big difference between being trained and not being trained. We have learnt a lot like identifying complications which should be referred to hospital, monitor the health of the baby and that the mother," she said.

Mrs Muyambo says she has learnt to refer to hospital maternal mothers with complications from the way the baby lies in the womb. Those with a prolonged bleeding and with a retained placenta are also sent to hospital, she said.

Other cases she refers to hospital are those with serious ailments like TB, asthma, first pregnancies, short mothers and those who lose a lot of blood before delivery. Besides assisting mothers with delivery, Mrs. Muyambo encourages women to practice family planning and refers them to Community based Distributors (CBDs).

She traverses a large area for no pay. What motivates her is the need to help others and to make friends. "My area is very big. For short distances, we walk but for long distances, we cycle. What motivates me is to help others with complications and to make friends," she said.

The Zambian ministry of Health through the Zambia Intergrated Health Project funded by the United States International Development Aid (USAID), has sponsored countrywide training programmes for TBAs in rural areas.

In Zambia, the official mortality rate is 200 deaths per 100,000 live births as compared to only 10 in Northern Europe. Central Board of Health (CBoH) spokesperson Dr. Ben Chirwa revealed that between 200 to 1400 mothers per 100 000 births die during child delivery.

Statistics as released by the Maternal and Neonatal Health Programme under the ministry of Health indicate that 4,000 women die of pregnancy related causes in Zambia each year, leaving 9,800 children motherless. One of Mrs Muyanbo's clients, Royda Mwila, 28, of Mandefu village, is among those who have come to appreciate the services of TBAs and has realized the dangers of delivering at home without the help of trained personnel. "I can only deliver with the help of people like her who are trained. I can never deliver at home without the aid of a TBA," Mrs Mwila said. "We have confidence in the TBAs because they are trained and provide health education such as diet in pregnancy unlike ordinary birth attendants who have no knowledge about such values," she further said.

Mrs Muyambo is one of the 21 TBAs that have been trained by the Catholic's Mambilima Mission Hospital in conjunction with Zambia Integrated Health Programme (ZIHP) to promote safe motherhood in a district where more than 40 percent expectant mothers deliver at home, in dangerous circumstances.

Gladys Simfukwe, a midwife at Mambilima Mission Hospital, says that the hospital decision to train TBAs and other community health workers has helped maternal deaths in the hospital's catchment of some 13,000 people. "In the past, most deliveries were attended to by untrained people, but now each zone has two TBAs and the people have been advised to go to these people. We used to have preventable maternal deaths because women were kept home until late into labour but since we trained TBAs, we haven't recorded any maternal deaths in the last two years," she said.

As a way of motivating them, TBAs are given bicycles to enable them cover distant places. TBAs are also given protective material to prevent them from contracting HIV/AIDS from those mothers who have the disease. She says they have also been given basic counselling training to advise HIV positive mothers.

Statistics show that while the number of expectant mothers who attend ante-natal clinic in Mwense is high, only a few deliver at health centres as the majority prefer to deliver at home. Mwense district health information officer McCloud Chalibonena says 80 per cent of expectant mothers in the district attend ante-natal clinic but less than 40 percent deliver at health centres.

"Generally, the problem pertaining to safe motherhood in Mwense district is that despite a good number of ante-natal mothers, very few come to health centres for safe delivery. Ante-natal attendance is quite high but few deliver at health facilities as most prefer to deliver at home basically due to long distances to health facilities and others due to traditional beliefs," Mr Chalibonena said. The average distance to the health centre is 20 km. ''In certain instances, a few have made an effort to come and ask for an ambulance, but by the time the ambulance reaches there, the woman has delivered under very dangerous circumstances," he said.

Mwense District Health Board administration manager Elizabeth Musaba says some mothers deliver at homes in order to apply traditional rituals which they cannot do at health centres. Ms. Musaba, who is a reproductive health specialist says some mothers after delivering many times reach a stage where they feel they are experts to deliver at home while "others deliver at home because they are not comfortable with the attitude of staff at health centers and because most of the health workers at hospitals are male," Ms Musaba said.

Ms. Musaba warns that delivering at home is always dangerous because one may not know how to control bleeding, care for a mother who has delivered and also some people may not know that delivery is a natural process and use herbs to force delivery. "Cases have been seen where reproductive organs of a woman have been swollen because of forcing delivery," she said

Mr Chalibonena, district health information officer told AFRICANEWS that to address the problem of safe motherhood in the district, the health board has embarked on education during ante-natal attendance emphasising the importance of delivery and the need for communities to support TBAs so that they can be motivated to do their voluntary work. "We have 64 TBAs in 21 rural health centres but the TBAs are not enough and at the same time, some people don't utilise their services. TBAs are supposed to be supported by communities but when they are not, they tend to relax," he said.

According to the Population Reports document published by the Population Information Programme of the Johns Hopkins School of Public Health in the US, Nearly all of these deaths could be prevented, the document states. It lists the five main causes of maternal mortality as hemorrhage, obstructed labour, infection, pregnancy-induced hypertension, and complications of unsafe abortion.

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