Deaths at Birth Illuminate Tanzania's Health Challenges

For further information, contact Melissa Maimann at Essential Birth Consulting. Link

In Wayali Hospital in Bagamoyo, Imani Msisi - just over eight months pregnant - lies motionless on a narrow metal bed, pressing a thin sheet to her chest.

She was referred to the hospital several days ago because of unusually sharp pains in her abdomen. There is no nurse or doctor in Msisi's village, only a health officer with some basic medical training. Fearing the worst, he sent Msisi in a taxi on the nearly hour drive to Wayali.

She was found to be having a false labor and was treated at the hospital, but is being kept there until she gives birth. If Msisi goes home and a complication does occur, she may not be able to make it back in time.

"In the villages ... If [pregnant women] are hemorrhaging they are transferred here but sometimes they die before they leave ..." ...

According to the most recent maternal mortality data ... 578 women died in 2004 per every 100,000 live births, and that rate has increased since 1999.

World Health Organization data paints an even bleaker picture, listing the Tanzania maternal mortality rate for 2005 at 950 deaths for every 100,000 live births. In comparison, the United States had 11 maternal deaths for every 100,000 live births in 2005.

... The leading cause of maternal death in Tanzania is excessive bleeding before or after birth ... Infection and high blood pressure also cause many maternal fatalities ...

... "In the rural areas [it is] an average of 5 to 10 kilometers for someone to walk to the nearest health facility ..." ...

... the ministry is planning to have a dispensary and health officer in each village, and is upgrading some dispensaries to health clinics, which can handle minor operations. The country is also working to train more health professionals to ease the dire nursing and doctor shortage in the country.

Assistant medical officers, with three years of medical training, have had to take up many of the responsibilities of doctors in Tanzania, and perform about 80 percent of cesarean sections.

... About 53 percent of deliveries in Tanzania are attended by unskilled people, while 47 are attended by skilled health care professionals ...

"... [traditional healers] are a necessary evil," ... because there simply are not enough health workers and some people only trust healers. In response the government is trying to provide some training to traditional healers, teaching them to recognize danger signs and providing them with antiseptics.

... maternal deaths are "just a part of life" and she estimates the Morogoro hospital sees as many as 20 maternal deaths in a month.

... "You could have three or four birth on one day," Massi said. "Sometimes if they are rushing they can't sterilize the equipment between births so that is dangerous."

... While assistant medical officers are an important resource, Im says she gets angry when she sees women suffering with botched cesarean sections, which should be a simple operation.

... Efforts to educate women about the importance of antenatal care have been successful ...

Melissa Maimann, Essential Birth Consulting 0400 418 448