What are the causes ofmaternal mortality in Africa?Experiences of a UgandanObstetricianAnnettee Nakimuli,Obstetrician & gy...
Preamble• I have worked at Mulago Hospital for a  decade• It is the National referral Hospital and  also the teaching hosp...
Map of Uganda
Selected health indicators for Uganda              1991-2011Indicator                                     YEAR            ...
Mulago Hospital
A typical day on the labour ward• The team on duty consists of 5 doctors• Duty starts at 8:00 am• Followed by a round in t...
The work load on the ward• 80-100 deliveries conducted daily• This is over 3 times the bed capacity• On average 20 caesari...
Maternal mortality trends at Mulago             Hospital
Causes of maternal death at Mulago     Hospital in Jan-Mar 2012                  unknown                     6%           ...
Physical & psychological challenges of fistula10
Challenges faced• Women present too late• Patient congestion leading to “floor cases”• Shortage of midwives• Shortage of a...
Records keeping
Floor cases on the ward
Why they come late• Await permission from spouses and close  social networks• As a sign of strength• Fear of caesarean del...
Male involvement is great sometimes
Effects of high maternal mortalityon the service providers• Emotionally draining• Poor and slow emergency response• Lack o...
Pre-eclampsia research• I am doing doctoral studies on the  immuno-genetics of pre-eclampsia• I was inspired because pre-e...
Preliminary research findings• A combination of immune genes in the  mother and fetus increase risk of pre-  eclampsia• Th...
Obstetricians & gynaecologists of Mulago Hospital
THANK YOUASANTE SANA
Annettee Nakimuli: New Approaches to Maternal Mortality In Africa
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Annettee Nakimuli: New Approaches to Maternal Mortality In Africa

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Annettee Nakimuli (Obstetrician; Lecturer and PhD student in the Department of Obstetrics and Gynaecology, Makerere University)
Maternal Mortality in Africa: Experiences of a Ugandan Obstetrician

Published in: Health & Medicine
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Annettee Nakimuli: New Approaches to Maternal Mortality In Africa

  1. 1. What are the causes ofmaternal mortality in Africa?Experiences of a UgandanObstetricianAnnettee Nakimuli,Obstetrician & gynaecologist,Lecturer and PhD Student,Makerere University(Uganda)
  2. 2. Preamble• I have worked at Mulago Hospital for a decade• It is the National referral Hospital and also the teaching hospital for Makerere University• It is the biggest hospital in the country• Conducts close to 32,000 deliveries a year
  3. 3. Map of Uganda
  4. 4. Selected health indicators for Uganda 1991-2011Indicator YEAR 1991 1995 2002 2007 2011Contraceptive Prevalence Rate 5 14.9 22.8 23.7 30Total Fertility Rate 7.1 6.9 6.9 6.7 6.2Unmet need for FP (%) 54 29 35 41Maternal MR(100,000 live 527 506 505 435 310births)Adolescent pregnancy (%) 44 43 32 25Infant MR (/1000) 122 81 85 76 54HIV prevalence rate 30 15 6.1 6.4 7.3Supervised deliveries (%) 38 38 38 41 57
  5. 5. Mulago Hospital
  6. 6. A typical day on the labour ward• The team on duty consists of 5 doctors• Duty starts at 8:00 am• Followed by a round in the labour ward that usually lasts 4 hours• At the round clinical progress is reviewed & prioritization of patients is done
  7. 7. The work load on the ward• 80-100 deliveries conducted daily• This is over 3 times the bed capacity• On average 20 caesarian sections performed daily• Generally 4 maternal deaths occur in a week
  8. 8. Maternal mortality trends at Mulago Hospital
  9. 9. Causes of maternal death at Mulago Hospital in Jan-Mar 2012 unknown 6% haemorrhage indirect 29% 26% pre-eclampsia 14%others direct abortion 6% 8% sepsis 11%
  10. 10. Physical & psychological challenges of fistula10
  11. 11. Challenges faced• Women present too late• Patient congestion leading to “floor cases”• Shortage of midwives• Shortage of anaesthetists• Inadequate supply of blood for transfusion• Heavy loads of mothers in the antenatal clinics• Inadequate intensive care facilities• Shortage of basic supplies like suture materials, surgical gloves• Poor staff remuneration
  12. 12. Records keeping
  13. 13. Floor cases on the ward
  14. 14. Why they come late• Await permission from spouses and close social networks• As a sign of strength• Fear of caesarean delivery• Use of local herbs• Start with the traditional birth attendants• Delay in referral• Transport problems• Failure to recognize danger signs of pregnancy• Attitude of health workers
  15. 15. Male involvement is great sometimes
  16. 16. Effects of high maternal mortalityon the service providers• Emotionally draining• Poor and slow emergency response• Lack of motivation to work• “Blame game tactics”• Worsening service delivery• Mothers staying away or delaying to come• Increasing maternal mortality!
  17. 17. Pre-eclampsia research• I am doing doctoral studies on the immuno-genetics of pre-eclampsia• I was inspired because pre-eclampsia is common at Mulago• Linked up with Prof Ashley Moffett• Over 250 pre-eclamptics and 500 normal controls recruited• Genotyping performed at the University of Cambridge• Data analysis is underway
  18. 18. Preliminary research findings• A combination of immune genes in the mother and fetus increase risk of pre- eclampsia• This combination is similar to that seen in Caucasians• Is more common in Africans• A bit more from Ashley Moffett
  19. 19. Obstetricians & gynaecologists of Mulago Hospital
  20. 20. THANK YOUASANTE SANA

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