Tag Archives: Fistula

ETHIOPIA: Still too many deaths in childbirth

 

ADDIS ABABA, 25 April 2012 (IRIN) – A lack of awareness of the importance of skilled hospital deliveries in Ethiopia, cultural beliefs, and transport challenges in rural areas are causing a high number of deaths during childbirth, say officials.

Only 10 percent of deliveries take place within health facilities, according to the Ethiopia’s latest (April) Demographic Health Survey results. Nevertheless, the figure is a significant improvement on 6 percent in the previous 2005 survey.

Commenting on the results, Health Minister Kesetebirhan Admasu said: “About 60 percent of mothers who did not attend health facilities while giving birth do not see the benefit of delivering in health facilities, while the remaining 30 percent abstain from going there by giving culture and beliefs as their reason.

“That [the] majority of women did not appreciate the value of institutional delivery, calls for a concerted effort to educate women and families about the importance of skilled birth attendance and postnatal care.”

Many women prefer delivering at home in the company of known and trusted relatives and friends, where customs and traditions can be observed, according to a 2011 study published in the Ethiopian Journal of Health.

“Even though communities are aware of the dangers around childbirth, contingencies for potential complications are rarely discussed or made, such that most families hope or pray that things will turn out well. When things go wrong precious time is lost in finding resources and manpower to assist in the transfer to a health facility,” the study said.

About 80 percent of all maternal deaths in Ethiopia, are due to haemorrhage, infection, unsafe abortion, hypertensive disorders, and obstructed labour, along with HIV/AIDS and malaria, said a senior Health Ministry maternal health expert, Frewoine Gebrehiwot.

The maternal mortality ratio in Ethiopia is 676 for every 100,000 births. This compares to an average of 290 per 100,000 births in developing countries, and 14 per 100,000 in developed countries, according to the UN World Health Organization.

Besides death, at least 500,000 Ethiopian women and girls who miss out on skilled health care during delivery, end up suffering other complications including obstetric fistula.

Behaviour change needed

The Health Ministry is working on behaviour change through health extension programmes and is providing each of Ethiopia’s550 districts with an ambulance to facilitate transport for pregnant mothers who want to deliver in health facilities free of charge.

But some of the hospitals are lacking in equipment, skills or policy guidance to enable them to provide basic emergency obstetric and newborn care, according to a study by the Health Ministry and its partners, who, using 2008 data, found that only 51 percent of hospitals qualified as offering comprehensive care.

“Most of the health facilities which are far from Addis Ababa are either not fully staffed with skilled service providers or fully equipped with the necessary supplies and equipment that can provide quality services related to complications during pregnancy and childbirth,” said the UN Population Fund (UNFPA).

“Limited human resources, especially midwives, hamper efforts to provide adequate services, especially in rural areas. Gaps in training and remuneration have led to attrition and turnover among public sector health care professionals.”

According to UNFPA, public facilities routinely suffer stockouts and obstetric care equipment shortages due to budget deficits and poor management.

Free services provided at health centres are to blame for the shortages, according to the Health Ministry which hopes a new health insurance scheme, to be piloted in 13 rural districts, will help to provide more funding.

At present, the ministry is seeking to increase the number of women delivering in hospitals by tapping into those seeking antenatal care and providing sustained family planning services at the district level.

“We are particularly trying to decrease mothers’ deaths by retaining the significant numbers of pregnant women who come to receive antenatal care from hospitals but [go] missing [during] delivery,” said Frewoine.

At least 34 percent of pregnant women aged 15-49 receive antenatal care from a skilled health provider such as a doctor, nurse or midwife, but only 10 percent give birth there.

“The same can be said about the high unmet need for family planning in couples and also among young people,” she said, adding that plans are under way to assign two midwives to every health centre in every district in the next three years.

So far, close to 1,630 nurses have been trained as midwives in a one-year accelerated training programme. Their number is expected to reach 4,674 by 2015.

[courtesy of IRIN News]

SIERRA LEONE: Fistula Hotline Launched

 

FREETOWN, 22 November 2011 (IRIN) – Nurse Zainab Blell’s mobile phone has been ringing all morning at the Aberdeen Women’s Centre, a clinic in Freetown, Sierra Leone’s capital. After explaining to countless callers that this is a hospital line, Blell gets a genuine request for help and tries to get more details. “When did you give birth? When did you start having a problem?”
The woman on the phone is in a remote Sierra Leonean town. She says her sister leaks urine uncontrollably, and suffers from rashes and peeling skin on her inner thighs.

Blell is one of three nurses answering calls on a newly launched “fistula hotline”, a free phone number for women who suffer from this debilitating condition that is seldom spoken about.

Fistula, also known as vesico-vaginal fistula or VVF, is a hole in the birth canal that leaves women with chronic incontinence, and often a stillborn baby. It is usually caused by several days of obstructed labour. It affects an estimated two million women in developing countries; and 50,000-100,000 women worldwide each year.

The fistula hotline, which is run by the centre, is the result of a public-private partnership between the Gloag Foundation, USAID, the United Nations Population Fund (UNFPA) and telecommunications company Airtel.

In the last month more than 8,000 calls have been received, but so far just 0.1 percent have been about cases of fistula.

The Aberdeen Women’s Centre provides the only comprehensive fistula repair service in the country. Despite the small number of calls concerning the condition, Jude Holden, the centre’s Country Director, is pleased with the result. “We have received 90 cases since the hotline opened, and this is a great success,” she told IRIN.

Shortly after the hotline opened in October, radio messages were broadcast in the local Krio language and in English, describing fistula and telling anyone who thinks they are affected to call 555.

“There is very little awareness of fistula and why it happens. Women are stigmatized and often blamed for their condition. Because of this we found it difficult to get women with fistula to the centre for treatment.”

Fistula occur most often in young women (15 to 30 years old), most of whom come from rural areas with poor access to healthcare, according to a 2005 Ministry of Health survey.

In Sierra Leone, some estimates put fistula prevalence at a similar rate to maternal mortality – one in eight women – but there is little research to back up these estimates.

Free healthcare services for lactating mothers and pregnant women were launched in 2010, but the maternal health infrastructure is inadequate and the Ministry of Health is struggling to implement the policy. Only 137 trained midwives practice in the country, and there are just 16 emergency obstetric facilities.

During and after Sierra Leone’s decade-long civil war, widespread rape trauma was a major cause of fistula, according to Sarah Walker, VVF programme manager at the Aberdeen Women’s Centre. Most of the resultant traumatic fistula cases have been dealt with, she said, and the problem now stems mainly from poor ante-natal care and a high level of teenage pregnancy.

“Most of the [women with fistula] are uneducated farmers… They don’t have access to any sort of healthcare, pre-natal or post-natal. We see it a lot in young girls, mostly because their bodies are not developed yet, and so when they’re in labour the child gets stuck in the pelvis,” said Walker.

In Njala town in the Southern Moyamba district, Kadiatu Ngegba’s husband heard the radio advert and called the number. Ngegba, now aged 24, developed a fistula when she was just 15 years old, after being in labour for two days before a doctor came to perform a caesarean section.

“My baby died,” Ngegba says. “After the operation, the doctor pulled out the catheter and I was covered in urine.”

When she got home, Ngegba’s first husband abandoned her and she was sent to live with relatives. “I was really unhappy. Everyone made fun of me. I wanted to go back to school but because of this problem I had, I couldn’t.”

Ngegba had fistula repair surgery in 2006, but when she gave birth to her second child without a caesarean, the fistula reappeared.

Experts say prevention, rather than treatment, is the key to ending fistula. This means providing women with family planning, ante-natal care, skilled birth attendants and emergency obstetric care, according to the UNFPA Campaign to End Fistula.

“We need a preventative as well as a therapeutic approach,” Sas Kargbo, Director of Reproductive Health at Sierra Leone’s Ministry of Health, told IRIN, adding that the free phone line is an important step to finding the women and treating the problem.

Sierra Leone is currently finalizing a strategic plan to tackle fistula and will appoint a focal person by the start of 2012.

At the Aberdeen Women’s Centre, almost 10 years after developing her first fistula, Ngegba waits for surgery. She smiles and hugs Naomi, her two-year-old daughter. “When I get well,” she says, “my husband will send me back to finish school.”

[Courtesy IRIN News]