Making childbirth safe

Pregnancy-related deaths in Malawi remain rampant.

According to the Ministry of Health, the country has one of the highest maternal mortality ratios estimated at 439 in every 100 000 live births.

One of the major causes is adolescent pregnancies, with nearly a third of Malawian girls getting pregnant by their 19th birthday.

This claims 15 lives of every 100 girls and women killed by pregnancy complications. The top four killers include high blood pressure, bacterial infection, unsafe abortion and obstructed labour.

Rural reach

Chitipa district medical officer Esther Ching’ani is worried that health facilities in rural areas remain few, far apart, understaffed and ill-equipped to save lives of pregnant women.

Oftentimes, pregnant women endure long travels to give birth safely in a clinical setting.

“The situation is made worse by shortage of transport in health facilities, knowledge gaps and lack of capacity building opportunities,” says the medical doctor.

For three years, Cowater International has been implementing Integrated Pathways for Improving Maternal, Newborn and Child Health (Inpath) project to reduce deaths of women and children in Chitipa, Salima and Kasungu.

Inpath team leader Tambudzai Rashid says the project supported by Canada is closing the maternal and infant health gaps identified by the district health management teams.

The interventions include renovation and construction of maternity wings in the three districts. These blocks are equipped with necessary tools and machines.

Inpath has also provided training for health workers, ambulances for constrained facilities and orientation for communities to understand their role in averting deaths of pregnant women and infants.

Transport relief

Rashid is excited that Nthalire Health Centre, located almost 115 kilometres from Chitipa District Hospital, has a new maternity block.

In Salima, Khombedza Health Centre has acquired a theatre to reduce congestion at the district hospital in the lakeshore setting.

Rashid says the project hit the targets in many aspects and overshot in a few areas.

“We discovered that transport challenges in the three districts were huge and many preventable maternal deaths were occurring due to delayed referrals, so the project has provided 13 ambulances—four in Chitipa, six in Kasungu and three in Salima,” she says.

The project also invested in solar-powered water pumps for the facilities as well as sexual and reproductive health intervention, including modern family planning and behaviour change communication in communities to ensure sexually active men and women take control of childbearing.

To improve service delivery, the project has introduced community score card which empower citizens to record trends and access health facilities’ performance, including deaths of pregnant women and children.

Ching’ani says maternal and newborn deaths have decreased in Chitipa and communities increasingly participate in making every pregnancy and childbirths safe.

“From July 2017 to June 2018, we registered  four maternal deaths. The following financial year, the figure grew to 11. But from July 2019 to June 2020, it has dropped back to four,” she says.

Chitipa registered a slight decline in the annual death rate of newborns from 12 in every 1 000 live births between July 2017 and June 2018 to 10.

Emmanuel Golombe, director of health and social services in Kasungu, says apart from reducing maternal and newborn deaths, the tobacco-growing is experiencing a rising number of young people, men and women demanding sexual and reproductive health, including family planning.

“It was very unlikely to see a man going to an under-five clinic, let alone escorting his wife when going for labour. However, it is a common sight nowadays. Inpath has brought a new mindset and health workers are finding their work exciting,” he says.

No long waits

His Salima counterpart Jones Chise says the new theatre at Khombedza will be operational by December.

He explains: “Due to shortage of bed space at the district hospital, at times, pregnant mothers had to wait for their turn when their time to give birth had come.

“However, we did not have an option because the district registers so many births per day and there was only one theatre for all of them.”

Chise says the rural theatre is a huge relief and a milestone for the lakeshore district.

“This means the district has two theatres which will be complementing each other, thereby improving service delivery,” he explains.

Inpath has also expanded the maternity wing at Salima District Hospital and furnished it with extra beds to accommodate more women.