Why Are Many Gambians Dying Young? (Take 3)

Thursday, January 10, 2013

Too Many (Maternal) Deaths!

By Bakary M. Jallow

One of the crucial health indicators of any nation is the reproductive health of its people. Maternal mortality and morbidity is a good measure of how well a country is taking care of its vulnerable population. There are 3-4 groups of people in a society that all citizens have the moral obligation to protect and preserve. These are: the young, the elderly, pregnant women and the mentally disabled. Maternal mortality ratio is one of the important health indicators of a country. It is the death of a woman during or shortly after pregnancy. The Gambia’s maternal mortality ratio in 2010 according to the World Health Organization (WHO) is 360 per 100,000 live births (Gambia, 2012). We have a lot of room for improvement.

Pregnant women and their unborn fetuses are vulnerable to adverse health outcomes if they are not taken good care of during pregnancy, labor and delivery. Adverse health outcomes that are a result of poor healthcare range from premature delivery, fetal growth retardation, low birth weight, and a variety of other congenital abnormalities.

In rural Gambia, Maternal Mortalities Run Rampant!

It is becoming not very uncommon in The Gambia to hear women going into labor and end up dying or losing their baby. It is frightening to go into labor if one is wondering if you are going to lose your baby or if you will ever make it through your labor. That stress alone could lead to adverse health outcomes for either the baby or the mother. Stress is well known in impairing people’s immune systems making them prone to illnesses (Diet, exercise, 2008). This problem can be mitigated through concerted efforts from all stakeholders such as the Ministry of Health, independent healthcare practitioners, non-governmental agencies (e.g MRC), pharmacy or drug store business owners, and pregnant women and their families. The communication and coordination of care among the different healthcare providers for pregnant women is crucial if we are to minimize the deaths of our young and healthy mothers.

Our problem, I believe, stems from prenatal care which is care during pregnancy. Changing people’s behaviors is paramount during this stage. Our women have to be taught that wellness checks are imperative during pregnancy. Pregnancy is a delicate period for both the mother and the fetus. The norm of going to pregnancy clinics commonly called “Nurse” only when women are 4-6 weeks due for delivery is a precursor to a bad pregnancy outcome. I wonder if there any statistics out there showing on average, how many times pregnant Gambian women go to the clinic.

Having well-trained medical personnel who have the knowledge and skills in attending to the needs of a pregnant woman is essential. These individuals should be able to detect subtle changes in the health of their clients and try to resolve them before it is too late. The most important reason for going to “Nurse” is for preventive care. Taking weights, checking blood count levels and mere palpation and auscultation of pregnant bellies is not worth it if one cannot catch the abnormal. Educating a pregnant client about eating well and rehydration will go long way towards avoiding dehydration. Telling a pregnant woman that nausea and vomiting is not unusual during pregnancy without explaining the benefits of staying hydrated tantamounts to improper medical and nursing training. Excessive vomiting during pregnancy warrants hospitalization and intravenous infusion of fluids to correct electrolyte imbalances.

Highly trained health care workers are needed to detect conditions that are induced by pregnancy such as diabetes or hypertension. Hemorrhage in early pregnancy is fatal and can be detected during wellness visits. Some of our women or their babies, who died during labor or shortly after labor, could have been saved if their risk statuses were identified early on and proper precautions taken. Low birth weight as a result of babies borne to mothers without prenatal care is three times more likely than babies by those with prenatal care (Women's Health, 2009).

One cannot overemphasize how important is to encourage your loved ones in taking prenatal vitamins during pregnancy. These vitamins will help supplement poor diet intake during pregnancy but cannot replace eating regular healthy meals. Nausea, vomiting and poor appetite all lead to poor food intake. Adequate intake of nutrients and electrolytes helps a mother to carry her pregnancy to term and helps with the normal development of the unborn fetus. Folic acid is documented to help prevent neural tube defects in the unborn. Taking 400 to 800 mcg of folic acid daily three months prior to pregnancy and during pregnancy is also recommended. Regular intake of iron will help to prevent anemia. Greens such as “Supa” or “Plazas” are good sources of iron (Women’s Health, 2009). In fact, in their 2002 study on Maternal Deaths in Rural Gambia, University of Oslo researchers Mamady Cham, Johanne Sundy and Siri Vangen, cited anemia as the leading cause of maternal deaths in the country.

Because of lack of accurate and up-to-date information or data, one can only imagine what might be possibly going wrong that is making us lose our loved ones during childbirth. I will say puerperium infection probably has claimed the lives of many Gambian women. Puerperium is the period during childbirth and immediately thereafter during which the uterus attains its normal size. Only 43% of births of rural women in The Gambia are attended by skilled health personnel compared to 83% for urban dwellers (Gambia, 2012).

Beating the Odds: Smiling Even in the Face of Adversity; Gambian Mother and Daughter in Yallal Ba, Sabach Sajal, North Bank Region

With my experience and the experience of a loved one, there are countless infection prevention breaches we endure during labor and delivery in The Gambia. Could you imagine being told to lay on a bed that a woman just delivered on with blood splatters and without prior proper cleaning? I am talking about laying on a mattress without bed linens which have dry and sometimes fresh blood on them. How about walking around a health facility sighting human placenta with the umbilical cord attached dumped in an open ditch? At a health facility in The Gambia (name withheld), new born babies are discharged from the facility without being given baths. Newborns are just wiped with a towel and handed to the mother without a bath until discharged. How disgusting is that and not to mention the enormous risk for infection!

We have to change practice and follow recommended guidelines if we are to save the precious members of our society - women and children. Simple hand washing and sanitizing of our labor units, adequately and regularly, could save many Gambia lives. Our health personnel should learn to be empathetic to the women they help during labor and the delivery of our future generation.

References

Diet, Exercise, Stress and the Immune system [Internet] 2008. Cleveland (OH); [cited 2012, December 10]. Available from: https://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome/hic_diet_exercise_stress_and_the_immune_system.aspx

Gambia: health profile [Internet] 2012. Gambia. World Health Organization; [cited 2012, December 5]. Available from: https://www.who.int/gho/countries/gmb.pdf

Prenatal Care fact Sheet [Internet] 2009. Washington DC.  Womenshealth.gov; [cited 2012, December 2]. Available from: https://www.womenshealth.gov/publications/our-publications/fact-   sheet/prenatal-care.cfm

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The Series/Why Are Many Gambians Dying Young?/By Bakary M. Jallow

https://www.mybasse.org/news/why-are-many-gambians-dying-young-/   (Monday, July 2, 2012)

https://www.mybasse.org/news/gambians-and-the-scourge-of-diabetics-why-are-many-gambians-dying-young-take-two-/  (Wednesday, October 3, 2012)

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About the author: My Basse Associate Editor Bakary M. Jallow, RN, BSN, MPH, is an Infection Preventionist Clinician with the John C. Lincoln Hospitals Network in the United States. He lives in Phoenix, Arizona with his wife Mariama Korka Bah-Jallow and their young daughter.