By Wezi Tjaronda
WINDHOEK
The Government will have to roll out emergency obstetric care (EmOC) to reduce the current maternal mortality rate by three quarters by the year 2015, the United Nations Children’s Fund (Unicef) has said.
At the current rate of reduction of 2.1 percent, Unicef says Namibia would require 40 years to reach the Millennium Development Goals of reducing child mortality and improving maternal health. The maternal mortality rate has increased from 271 per 100 000 births to 449 deaths per 100 000 live births in six years.
An issue paper entitled Safe births, Save lives: Improving Maternal Health Services and Reducing Mother/Infant Mortality in Namibia 2007, said the most common direct causes of maternal death – severe eclampsia, hemorrhage, and obstructed and prolonged labour – could be treated if prompt access to emergency obstetric care was available.
Indirect obstetric causes of maternal deaths include anaemia, diabetes, malaria, domestic violence aimed at the mother, heart disease and HIV/AIDS. HIV/AIDS was by far the most common cause accounting for 37 percent of the deaths.
Currently, very few health centres have ambulances and all health centres currently lack the capacity to deliver EmOC facilities, forcing some mothers experiencing problems to travel long distances at short notice to find appropriate treatment.
In addition, a study conducted by the Ministry of Health and Social Services in 2006 of all 34 state hospitals and seven private hospitals, 32 health centres and 263 health clinics, found only four health facilities proved capable of provi-ding all eight functions in three months preceding the ministry’s study.
Two of these are in Khomas Region, while the others are in the Otjozondjupa and Oshikoto regions.
“Although all the other health facilities offered some life-saving functions, none met the criteria for Basic Emergency Obstetric Care (BemOC) accreditations,” the paper said.
The UN minimum recommended level of care is one CEmOC and four BemOCs per 500 000 people.
For a health facility to be classified as comprehensive EmOC, it should administer parenteral antibiotics, parenteral oxytoxic drugs and parenteral anticonvulsants for pre-eclampsia and also perform manual removal of placenta, retained products, assisted vaginal delivery, blood transfusions and Caesarean delivery.
The paper said 90 percent of the health centres had not conducted any Caesarean sections, blood transfusions, or manual placenta removals in the three months prior to the ministry’s study, while 40 percent had administered parenteral antibiotics.
With only four in the whole country Namibia, said the paper, falls far short.
Three factors identified as causes of maternal and infant mortality include delays in recognising the need to seek health care, getting to an appropriate facility and also delays in receiving care when at the facility.
The paper said the majority of all doctors and medical specialists are concentrated in Windhoek, and government and United Nations figures show that people live far away from a health care facility.
“Although health workers visiting programmes and a network community of health workers is in place to service those people who are in remote areas, the number of health facilities and access to these facilities need to be improved,” the paper added.
Unicef said by rolling out EmOC provisions to rural areas the potentially fatal issue of delay in antenatal crisis will be averted and delay-induced morta-lity reduced.