Even as moves are desperately being made by the Ministry of Health to bring the instances of maternal death to zero, the past year saw the health sector recording a total of 18 such deaths, a figure that Chief Medical Officer, Dr Shamdeo Persaud is calling “way too high.”
He, during an interview with this publication yesterday, said that of the recorded cases, 11 were directly linked to pregnancy complications while seven were triggered by indirect circumstances ranging from malaria to even a heart condition.
But according to Dr Persaud, it is usually only the direct causes that are used in the calculation of the maternal mortality rate. Moreover, he disclosed that the Health Ministry, based on the estimated number of births for last year, recorded a maternal death rate of 79.7 per every 100,000 live births. “This is just about where we should be in terms of our Millennium Development Goal…we should be 80 or less in terms of our indicator; so this means that we can absolutely have no more than 11 direct maternal deaths,” said Dr Persaud.
The main direct causes recorded last year were mostly due to haemorrhagic conditions, hypertension in pregnancy, eclampsia and adverse effects relating to bleeding. There was also a case related to an ectopic pregnancy and two related to termination of pregnancies where some complications were encountered.
Two of the indirect cases were linked to malarial complications and there were three cases with patients who had various types of chronic diseases – with at least one being an HIV related complication.
One case entailed a patient who had an underlying heart condition as well which led to the unfortunate outcome of death, Dr Persaud disclosed.
Ten of the 18 deaths occurred at the Georgetown Public Hospital Corporation (GPHC), of which six were related to direct pregnancy complications. Other institutions that recorded deaths were the Suddie, Diamond, New Amsterdam and West Demerara Regional Hospitals and the privately operated Balwant Singh Hospital, each of which recorded one death during the past year.
However, at least five of the women who succumbed to the various pregnancy complications were from Region Four; three each were from Regions One and Two; two each were from Regions Three and Five and one each was recorded in Regions Six, Seven and Eight.
Several of these cases – both direct and indirect – warranted disciplinary action, Dr Persaud said.
He disclosed that disciplinary action would have been required in the case of the malaria associated death since the Ministry had some time ago instituted emergency re-examination of the guidelines for the management of malaria in pregnancy. Moreover, he said that it is now mandated that for all malarias areas, every pregnant mother have her malaria smear done at each clinic visit.
But according to Dr Persaud, “a lot of times it is only done when she complains of a fever…not even a symptom. So mothers come and they have headaches, they have joint pains, they have other symptoms and they may not have reported fever and a smear is not done and you miss a subtle malaria infection.” This development, according to the Chief Medical Officer, could result in complications that have the potential of causing a pregnant woman to die. But according to Dr Persaud “I hope that we don’t have any more deaths of women relating to malaria.”
Additionally, Dr Persaud said that although high-risk pregnancies are seen as an indirect cause of maternal death, there is also need to ensure that persons with HIV infections, for example, are properly managed and therefore need not die during pregnancy. “They need not die because there is HIV treatment available that can ensure that a pregnant mother survives her pregnancy and is also able to care for her newborn baby, who should be HIV negative once everything is done correctly,” Dr Persaud insisted.
At times, he noted that high risk cases are defined by pregnant women above the age of 35 years-old and even those who are deemed to be too young as well. But according to Dr Persaud it has been observed that more women are in fact delaying their birthing experience in order to achieve professional goals. “This is typically what we are seeing in more and more developed societies, they delay that part of their life,” he noted.
But according to Dr Persaud, the health sector now has in place under its family health manual, a recommendation that each pregnant woman be evaluated, at least once, during the initial phase of her pregnancy by a clinician. And if she is found to be a high risk case such a patient, he said, should be evaluated by an obstetrician. “So regardless of where they are around Guyana, we need to get them evaluated either by referring them or by us providing an obstetrician on a roving basis.”
Recently, the public health sector added to its range of professionals an obstetrician who is expected to soon fill the roving capacity tasked with catering particularly to the far-flung regions. The efforts of this doctor, Dr Persaud said, will be complemented by primary health care doctors, including a number of young doctors who have returned and are still returning from their studies in Cuba. These doctors, according to him, were strategically trained in the Advanced Labour and Risk Management (ALARM) course. “When they go out there they can also see the mothers at the high risk clinics…so even though we do value our nurses and midwives who have done a good job we want to institute these measures so that we also avoid the in-direct deaths…” said Dr Persaud, who insisted that his vision is to see zero in the both the areas of direct and indirect maternal deaths.
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