Pre-eclampsia, Leading Cause of Maternal Deaths at Mulago National Referral Hospital

On 22nd May, 2018, Uganda joined the rest of the world to commemorate the world pre-eclampsia day with an aim of creating awareness about the condition in pregnant mothers. Pre-eclampsia is a life-threatening, pregnancy-induced high blood pressure disorder that can lead to seizures and other fatal complications in the last half of a pregnancy and postpartum.

According to the World Health Organization, over 99% of pregnancy-related deaths occur in low-and middle-income countries, including Uganda. It is estimated that 6% of maternal deaths in Uganda are as a result of preeclampsia.It is against this background that HEPS Uganda together with the HSA Partners, ACHEST and Amref Uganda conducted health facility visits to assess their ability to handle mothers with pre-eclampsia. The team also comprised of seven Members of parliament.

Flavia Nambi an enrolled midwife at Nankandulo HC IV, in Kamuli district said that one of the biggest challenges in managing the condition is frequent stock outs of the essential drugs such as Magnesium Sulphate and Dexamethasone. She said that the facility has a non- functional theater ad Blood Pressure machine.

“We receive an average of 30 pregnant women who come for antenatal services on a daily basis and record at least 80 deliveries every month. But sometimes we fail to take their blood pressure because our machine is non-functional. Also those whom we diagnose clinically are referred immediately to Kamuli hospital  where there is a functional theatre and reliable supply of the needed drugs.” she said

The referral system of mothers from lower health facilities to the main hospital is also a challenge since there are no ambulances. Robert Kizito, the Assistant in Charge of Nabirumba HC III said that mothers have to use motor cycles to reach Kamuli hospital. He however notes that sometimes the mothers are stranded especially in the night when they cannot get access to motor cycle riders.

Moses Lyagoba, the Assistant District Health Officer in charge of maternal and child health in Kamuli district said that most health workers in the district also lack capacity to manage the condition. He said that the knowledge gaps among the medics can lead to wrong diagnosis thus endangering the lives of mothers.

Dr. Annette Nakimuli a Pre-eclampsia specialist at Mulago National Referral Hopsital said that the condition is a life-threatening, pregnancy-induced high blood pressure disorder that can lead to seizures or convulsions and other fatal complications in the last half of a pregnancy and postpartum.

She adds that in Uganda, 336 women die from pregnancy and childbirth-related causes per 100,000 live births. Hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia is one of the most common causes of maternal deaths after postpartum hemorrhage accounting for 6% of maternal deaths.

Dr.Evelyn Nabunya, the clinical head of the Directorate of Obstetrics and Gynaecology in Mulago hospital noted with concern that in 2017, the pre-eclampsia ward received 520 mothers with severe pre-eclampsia, 132 with eclampsia, 14 Postpartum Eclampsia and 12 maternal deaths. She notes that the frequent stock-out of essential drugs such as Magnesium Sulphate is the biggest challenge the hospital faces in managing mothers with pre-eclampsia.

Denis Kibira the Executive Director at HEPS-Uganda says that the frequent stock outs of essential medicines puts the lives of pregnant mothers at risk. “Magnesium Sulphate is a must have drug by all health facilities at any time for proper management of mothers with Pre-eclampsia. But this is not the case as in-charges have reported that they never have the drug at the time it is needed most.” he says.

The HSA partners appealed to the government to increase funding for the drugs that are essentail in managing pre-eclampsia, train heaalh workers on management of the mothers with the condition and to recruit more health force to close gaps of staffing.