Malaria poses danger to expectant mothers

By Brenda Zulu   

In Zambia, women living in malaria endemic areas become pregnant every year. Malaria still remains a threat both to themselves and their babies as a result of malaria in pregnancy.

Recently, I attend a funeral of a woman who died from malaria in pregnancy in my neighbourhood. She was three months pregnant when she died.  She is said to have been on self treatment of malaria.

According to the World Health Organisation (WHO), pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity making her more susceptible to malaria infection and increasing the risk of illness, severe anemia and death.  For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight a leading cause of child mortality.

The 2007 Zambia Demographic Health Survey shows that Malaria is endemic in Zambia with seasonal and geographical variations. In 2007, 4.3 millioncases of malaria (confirmed and unconfirmed) were reported countrywide with 6,149 deaths (MOH, 2008). The annual malaria incidence was estimated at 358 cases per 1,000 population in 2007, a drop from 412 cases per 1,000 population in 2006 (MOH, 2008). Northern and Eastern provinces had the highest annual incidence of malaria, while the disease was lowest in Lusaka province. Malaria accounts for up to 40 percent of all infant mortality and 20 percent of all maternal mortality in Zambia (MOH, 2008). Malaria poses a severe social and economic burden on communities living in endemic areas.

The Government of the Republic of Zambia has identified the eradication of malaria and other major diseases as a priority to attain the Millennium Development Goals targets for reducing maternal and child mortality rates in Zambia (MOFNP, 2006). The country is also implementing specific short- and medium-term programmes under the National Malaria Control Action Plan (NMCAP) aimed at scaling up malaria control and prevention strategies. These measures include a target to reduce malaria incidence by

75 percent by 2010 (MOH, 2007).

A visit to the Macha Research Trust revealed that babies could be born with malaria. Dr Phil Thuma, a Senior Scientific Advisor at Macha Research Trust said previous research found malaria parasites in the placenta.

 “We also did a study in Macha way back in the 1980s showing that babies could be born with malaria from their mother as it can go past the placenta called congenital malaria. So even if the baby survives the pregnancy they could even be born with malaria. It is not seen often but it is seen in places where malaria is very endemic.

So if you are born with malaria it is going to lead to anemia later in life and this is also passed on to the baby,” said Dr Thuma.

He added that there was evidence that suggests that malaria was the main cause of miscarriage especially in the first pregnancy because of the act on the placenta.

“Historically we have felt that malaria is one of the causes of a miscarriage or abortion. When the mother gets pregnant and she does not immediately show signs of malaria we know that the parasite likes to live in the placenta. In fact there are many studies done on the fact that the parasite goes to live in the placenta. You might even look in their blood and not see it but it is hiding in the placenta that interferes with proper blood supply to the fetus and can lead to miscarriages,” explained Dr Thuma.

Explaining why expectant mothers die from Malaria, Dr Thuma said women die because in the first pregnancy because of the way each woman’s immune system reacts, one is more likely to get severe forms of malaria like cerebral malaria depending on their immune system reaction.

“Most of the deaths in malaria in pregnancy are due to cerebral malaria. If you get cerebral malaria you get very sick very quickly. You go into a coma and even sometimes when we treat it you can’t survive.  The increased death in pregnancy and malaria is related to severe forms of malaria due to cerebral malaria. Those forms of malaria seem to be related to the way one’s immune system reacts,” explained Dr Thuma.                                                                                                                                                               

 Explaining why self treatment was bad for pregnant mothers, Dr Thuma said  

usually if a pregnant mother tried to be on self treatment she does not always try and finish the course properly.

“In pregnancy, in the first trimester we should not use the usual malaria drug like Coartem. If a mother uses Coartem she could harm the fetus and in using self treatment she might not know that she should not use Coartem in the first place.  Most mothers never finish the dosage when they are on self treatment,” said Dr Thuma.

Making a comment on the abuse of the malaria drug he recalled the old days when Chloroquine was used for abortion by women.  He was however saddened by press reports which showed that Coartem the one supplied for public health was being sold to private chemists of which he said that was a form of abuse.

In an effort to protect women based on available evidence, the World Health Organisation (WHO) recommends the use of Insecticide treated nets (ITNs), intermitted preventive treatment and the effective case management of malaria illness. It is also important that all pregnant women attend the antenatal clinics presenting a major opportunity to prevent and treat malaria.

 In an effort to overcome malaria in pregnancy challenges major issues to be considered include the issue of drug resistance and safe and appropriate use of different anti malarial drugs increases during pregnancy. Research in this area is high priority. There is also a challenge of health care reaching pregnant women who do not attend antenatal clinics or those who attend only for the first visit or too late during pregnancy.

The availability of insecticide treated nets, effective intermittent preventive treatment and a means of delivery through anatenal clinics, provide a unique opportunity that must be taken to protect the millions of  Zambian women who become pregnant each year and their babies.

Meanwhile, Dr Thuma observed that not all women give birth at the rural health center. He observed that even when it is now government policy that all pregnant women should deliver at a hospital the reality of it is in the rural areas  was that women still deliver at home.

A visit to a Habulile Rural Health Centre in Chief Chikanta’s area showed that the centre was under staffed as the nurse who manages it had gone to church. There were were only two mothers in the labour ward of which one had delivered while the other one had just entered into labour. The rural health center needs more staff.

Cervical Cancer Questions and Answers as obtained from the Cancer Diseases Hospital and the Centre for Infectious Diseases and Research (CIDRZ)

By Brenda Zulu

Q. What is cervical cancer?

A. This is an abnormal growth of cells on a woman’s cervix.

Q. What are the symptoms of cervical cancer?

A. In it’s the early stage the disease is asymptomatic. It will start symptoms in the late stages as listed below:

Bleeding after intercourse (sexual intercourse)

Post Menopause bleeding

Intermenstrual bleeding

An increase in the length or amount of bleeding

Waterly or blood or odoriferous vaginal discharge

Pain during sexual intercourse

Lower back pain

Weight loss

Yellowish vaginal discharge

Blood in urine

Q. Are there different type of cervical cancer?

A. No, but we have different types of Human Papilloma Viruses (HPVs). Not all HPVs cause cancer of the cervix but some cause genital warts.

Q. Who is at risk of cervical cancer?

Every woman who is sexually active.

Risk factors include

Early onset of sexual intercourse before 18 years of age

Multiple sex partners

Tobacco use

Alcohol abuse

History of sexually transmitted disease eg HPV

Multiple Pregnancies

Infection with HPV Virus

Decreased level of Vitamin A, Vitamin C and Folic Acid in the diet

Q.  What is cervical cancer screening? What methods are available in Zambia?

Screening is the test done to determine wherether abnormal cells are present at the cervic, or not.

There are two methods available in Zambia, the Visual Inspection with Ascetic Acid (VIA), which uses common household vinegar applied to the cervix for a few minutes and visualized through special camera lens that magnify the picture of the cervix to see whether there are changes in the cells.

The other method is the Pap smear test which is when cells are taken frfom tehsurface and senr to the laboratory to be checked for abnormality. With the VIA, results are seen almost immediately whereas the pap smear test usually takes about two weeks for the results to be known. However, both these tests should be done by qualified personnel, with special instruments that open up the vaginal canal.

Q. How important is cervical screening and how many times should it be done?

This is very important and should ideally be done annually if the first result was negative for cancer. However, it is vitally important that individuals with compromised immunity be checked often or as per health practitioners’ advice. If the test was positive, the health care provider will advise on how often one should go back for another test.

Q. What age group of women should undergo cervical cancer screening?

All sexually active women or women who are 18 years of age and above (Child bearing age)

Q. How effective is the treatment?

The earlier the stage of cancer, the better the treatment and cure rate. In its earliest stage, cancer of the cervix is totally surable. The treatment in the later stage is determined by how far the cancer has spread.

Q. Why is cervical cancer the second cause of death for women in Zambia?

Women in Zambia rarely get check ups/screened

Nature of the disease, the early stage has no signs or symptoms

Women don’t see their cervix, so have no way of detecting changes in the cervix

Lack of screening/ treatment services especially in rural areas

Women are vulnerable.

Q. How should women react to positive cervical cancer results after screening?

They should take this as an eye opener and make sure that they follow exactly what the health care practioner tells them and keep their follow up appointments.

Q.  How safe is a baby born from a mother with cervical cancer?

Cancer of the cervix affects the woman’s cervix. It has no effect on the baby.

Q. How safe is pregnant mother with cervical cancer?

This depends on what stage the cancer is in. Cancer is usually a slow progressing disease and usually given after delivery, so a pregnant woman should remember to go back for treatment six weeks after delivery.

Q. Where can women get treatment for cervical cancer?

Cervical cancer screening and treatment for is available at most DHMT clinic including Kanyama, Chawama, George, Matero reference, Ngombe. Mtendere, Kalingalinga, Chelstone, UTH-AIDC building, Chongwe, Monze mission hospital, Chilenje, Bauleni and the Cancer diseases hospital at UTH.

Q. Is there a relationship between cervical cancer and HIV?

YES, just as there is a relationship between HIV and any other disease. Women who have HIV are more predisposed to having cervical cancer because of their compromised immune system, and also cancer progresses at a faster rate in women with HIV than in those who are negative, therefore it is important for HIV positive women to get screened regularly.

MALARIA A THREAT TO PREGNANT MOTHERS

By Brenda Zulu   

In Zambia, women living in malaria endemic areas become pregnant every year. Malaria still remains a threat both to themselves and their babies as a result of malaria in pregnancy.

Recently, I attend a funeral of a woman who died from malaria in pregnancy in my neighbourhood. She was three months pregnant when she died.  She is said to have been on self treatment of malaria.

According to the World Health Organisation (WHO), pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity making her more susceptible to malaria infection and increasing the risk of illness, severe anemia and death.  For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight a leading cause of child mortality.

The 2007 Zambia Demographic Health Survey shows that Malaria is endemic in Zambia with seasonal and geographical variations. In 2007, 4.3 millioncases of malaria (confirmed and unconfirmed) were reported countrywide with 6,149 deaths (MOH, 2008). The annual malaria incidence was estimated at 358 cases per 1,000 population in 2007, a drop from 412 cases per 1,000 population in 2006 (MOH, 2008). Northern and Eastern provinces had the highest annual incidence of malaria, while the disease was lowest in Lusaka province. Malaria accounts for up to 40 percent of all infant mortality and 20 percent of all maternal mortality in Zambia (MOH, 2008). Malaria poses a severe social and economic burden on communities living in endemic areas.

The Government of the Republic of Zambia has identified the eradication of malaria and other major diseases as a priority to attain the Millennium Development Goals targets for reducing maternal and child mortality rates in Zambia (MOFNP, 2006). The country is also implementing specific short- and medium-term programmes under the National Malaria Control Action Plan (NMCAP) aimed at scaling up malaria control and prevention strategies. These measures include a target to reduce malaria incidence by

75 percent by 2010 (MOH, 2007).

A visit to the Macha Research Trust revealed that babies could be born with malaria. Dr Phil Thuma, a Senior Scientific Advisor at Macha Research Trust said previous research found malaria parasites in the placenta.

 “We also did a study in Macha way back in the 1980s showing that babies could be born with malaria from their mother as it can go past the placenta called congenital malaria. So even if the baby survives the pregnancy they could even be born with malaria. It is not seen often but it is seen in places where malaria is very endemic.

So if you are born with malaria it is going to lead to anemia later in life and this is also passed on to the baby,” said Dr Thuma.

He added that there was evidence that suggests that malaria was the main cause of miscarriage especially in the first pregnancy because of the act on the placenta.

“Historically we have felt that malaria is one of the causes of a miscarriage or abortion. When the mother gets pregnant and she does not immediately show signs of malaria we know that the parasite likes to live in the placenta. In fact there are many studies done on the fact that the parasite goes to live in the placenta. You might even look in their blood and not see it but it is hiding in the placenta that interferes with proper blood supply to the fetus and can lead to miscarriages,” explained Dr Thuma.

Explaining why expectant mothers die from Malaria, Dr Thuma said women die because in the first pregnancy because of the way each woman’s immune system reacts, one is more likely to get severe forms of malaria like cerebral malaria depending on their immune system reaction.

“Most of the deaths in malaria in pregnancy are due to cerebral malaria. If you get cerebral malaria you get very sick very quickly. You go into a coma and even sometimes when we treat it you can’t survive.  The increased death in pregnancy and malaria is related to severe forms of malaria due to cerebral malaria. Those forms of malaria seem to be related to the way one’s immune system reacts,” explained Dr Thuma.                                                                                                                                                               

 Explaining why self treatment was bad for pregnant mothers, Dr Thuma said  

usually if a pregnant mother tried to be on self treatment she does not always try and finish the course properly.

“In pregnancy, in the first trimester we should not use the usual malaria drug like Coartem. If a mother uses Coartem she could harm the fetus and in using self treatment she might not know that she should not use Coartem in the first place.  Most mothers never finish the dosage when they are on self treatment,” said Dr Thuma.

Making a comment on the abuse of the malaria drug he recalled the old days when Chloroquine was used for abortion by women.  He was however saddened by press reports which showed that Coartem the one supplied for public health was being sold to private chemists of which he said that was a form of abuse.

In an effort to protect women based on available evidence, the World Health Organisation (WHO) recommends the use of Insecticide treated nets (ITNs), intermitted preventive treatment and the effective case management of malaria illness. It is also important that all pregnant women attend the antenatal clinics presenting a major opportunity to prevent and treat malaria.

 In an effort to overcome malaria in pregnancy challenges major issues to be considered include the issue of drug resistance and safe and appropriate use of different anti malarial drugs increases during pregnancy. Research in this area is high priority. There is also a challenge of health care reaching pregnant women who do not attend antenatal clinics or those who attend only for the first visit or too late during pregnancy.

The availability of insecticide treated nets, effective intermittent preventive treatment and a means of delivery through anatenal clinics, provide a unique opportunity that must be taken to protect the millions of  Zambian women who become pregnant each year and their babies.

Meanwhile, Dr Thuma observed that not all women give birth at the rural health center. He observed that even when it is now government policy that all pregnant women should deliver at a hospital the reality of it is in the rural areas  was that women still deliver at home.

A visit to a Habulile Rural Health Centre in Chief Chikanta’s area showed that the centre was under staffed as the nurse who manages it had gone to church. There were were only two mothers in the labour ward of which one had delivered while the other one had just entered into labour. The rural health center needs more staff.

Raped And Become HIV Positive

By Brenda Zulu

“I was raped when I was 18 years old in 1993. Due to the history of rape I did an HIV test in 2004 as I had not encountered any sexual relationship with any man. I did not disclose anything to anyone because back then it was very hard. When I was tested I started medication and lived positively. That is when I started sharing information about my status.

In 2006, I got married to an HIV negative man and through counseling and consulting doctors I was able to conceive without infecting him. Throughout the pregnancy I was monitored until I delivered and chose not to breastfeed and that was a personal choice. I gave birth to an HIV negative baby and my partner is still negative because we follow precautions,” said Sophie Bwalya.

Sophie is one woman among many women who has managed her HIV status and the fact that she wanted to taste the joy of motherhood, being HIV positive did not stop her having a baby.

 According to the 2010 National Protocol Guidelines, under the integrated prevention of mother to child transmission (PMTCT) of HIV, the 2010 guidelines emphasize the introduction of more efficacious regimes and extended Nevirapine administration for the infant during the breastfeeding period as recommended by the World Health Organisation (WHO).

In Zambia, PMTCT services are available to address the burden of vertical transmission of HIV. With a high antenatal HIV prevalence estimated at 16.4 percent in 2008, approximately 80 000 infants born annually are at risk of acquiring HIV from their mothers. Integration of PMTCT into all maternal, newborn and child health services throughout the country will contribute to a significant reduction of transmission of HIV and subsequent child morbidity and mortality.

The entry point into the PMTCT programme for every pregnant woman and her partner is knowledge of their HIV status. The programme encourages a family centered approach. HIV testing is part of the routine Antenatal Care (ANC) services and results and post test counseling are provided for on the same day.

HIV infection transmitted from an HIV-infected mother to her child during pregnancy, labour delivery or breastfeeding is known as Mother-To-Child Transmission (MTCT). The prevention of mother-to-child transmission (PMTCT) is a highly effective intervention and has huge potential to improve both maternal and child health.

Mwelwa Nsabika a Nurse and Tuberculosis (TB) focal point at Kara Counseling and Research Center observed that health centers still face challenges in administering PMTCT programmes as some HIV positive women who are on medication will not say beforehand when they want to conceive.

  “It was important for an HIV positive woman to ask the health care provider beforehand if they wanted to conceive. This is very important for women who are already on medication because they will be taught the right time to conceive and monitored if there is need to change medication,” said Nsabika.

She added that the other challenge was that not all women were able to attend the clinic with partners as some were not willing. “This is important because they need to have protected sex during pregnancy and not expose the partner to HIV,” said Nsabika.

Speaking about family planning, Nsabika pointed out that all family planning was safe for HIV infected mothers except for the intrauterine device (IUD) of which health personnel have taken precautions in case the woman has another infection which could be a sexually transmitted disease (STD) or an inflammatory disease.

“In many cases we advise mothers to use dual family planning method for people on Lopinavir and Nevirapine as all family planning has a failure rate,” said Nsabika.

She explained that among HIV-infected women, the prevention of unintended pregnancies was essential for preventing mother-to-child transmission of HIV. She said HIV positive women are given all the information on family planning but those who intend to conceive were also asked to visit the clinic with their male partners.

She said male partners’ role in the PMTCT services was important in Zambia as couples were taught the right time when the woman could conceive which was between the 11^th  day from the first day she had her monthly period to the 14^th day although it is not guaranteed that the woman will be pregnant.

“That is the right time when HIV positive couples can meet without a condom and it should not be everyday because there is need to let the sperms mature so that they are not weak,” said Nsabika.

“Being HIV positive does not mean that you cannot have a child who is healthy. It is also important to go for cervical cancer screening which is also raised when one has HIV,” she said.  

Family Planning in Zambia

By Brenda Zulu

The focus on this article is on women who are sexually active because these women have the greatest risk of exposure to pregnancy and the need for regulating their fertility.

According to the Zambia Demographic Health Survey (ZDHS) 2007, contraceptive methods are grouped into types which are modern and traditional methods. Modern methods include female sterilization, male sterilization, the pill, intrauterine device (IUD), injectables, implants, male condoms, female condom, diaphragm, foam/jelly, lactational amenorrhoea (LAM) and emergency contraception. Traditional methods include the rhythm methods (periodic abstinence) and withdrawal. This also includes Folk methods.

Zambians widely know modern than traditional methods.  Among traditional methods, withdrawal is the most commonly known among women.

Similarly to women, the most common known method among men is the male condom. It is worth noting that among men is the likely as women to know of implants.

Younger women aged between 15 to 19 and women living to western province are least likely to know of a contraceptive method. For men, knowledge of any family planning method is almost uniform regardless of age, residence, province, educational level or wealth quintile.

The pill is the most common method of contraception followed by the condom and injectables. Implants, IUD and the emergency contraception are the least used methods with less than 1% of women having ever used any of these methods. Cycle beads are the least used. Among males less than 1% of men have used sterilization. For the traditional methods, withdrawal is more common than rthym method.

On the knowledge of family planning preference, a Elijah Kabwe a married with two children said he did not trust the norplant which his wife has inserted on her arm and as a result he has continued to use the withdrawal method as he did not want to have another child.

Asked if he would then choose to go for vasectomy Kabwe said he wouldn’t as he was already satisfied with his family planning method of choice.

For Zambia, the use of family planning method increases with age from 10% in the age group 15 to 19years to 40% in the age group 25 to 29 years and then starts to decline to 24% in the 45 to 49 age group. The female condom is the least used modern method for women (1%).

 The contraceptive prevalence rate for modern methods has increased from 7% in 1992 to 25% in 2007. Contraceptive use is higher among women in urban areas than among women in rural areas. Eastern province has the highest proportion of women currently using family planning methods, followed by Copperbelt. The lowest proportion of married women using a family planning method is in Luapula. In general, women do not beg to use contraception until they have had at least one child.

Contraceptive use among women increases with educational attainment compared to women who are uneducated. Condom use has more than doubled from 2 percent in 1992 to 6percent in 2007. The proportion of married women undergoing female sterlisation has remained relatively stable between 1992 and 2007 at 2%.

Among pill users the brand commonly used are safeplan and Microgynon and Oralcon. Among women using injectables, 56 % use DepoProvera and 42% use Noristerst.  The most common brand of male condom used is the Maximum classic.

“From one menstrual period to the next, are there certain days when a women is more likely to get pregnant if she has sexual relations?” A women is most likely to conceive halfway between two periods. Users of natural family planning methods users are more knowledgeable about their fertility period.

Couples use family planning methods to limit family size or delay the next birth. Couples using family planning as a means to control family size adopt contraception when they have already had the number of children they want. When contraception is used to space birth, couples may start to use family planning earlier with the intention to delay a pregnancy. This may be done before a couple has had their desired number of children. In a culture where smaller family size is becoming a norm, young women adopt family planning at an earlier age than their older counterparts.

Women start using contraception at a younger age while some use contraception before they had any children. Timing of sterilization for many women is at 34 years. The many women who use modern methods contraceptives obtain them from the public sector, mostly government health centres private medical institutions are the second most common course of contraception while non medial sources are the least common.

There has been a shift away from reliance on private medical sources for contraceptives methods. The proportion of current users relying on private medical sources has declined from 32% in 1992 to 17% in 2007.

The cost of contraception for people who use modern methods get them for free and or not so many people buy contraception. About 8 in 10 women who obtained their family planning methods from public sector facilities were informed about two thirds of women who obtained their methods related problems and how to address them should they occur.

There are some married women who have no intention of using any method in the future and 5% are unsure of their intentions.

Reasons for women not intending to use contraception in the future include fertility related reasons which include infrequent sex, no sex, menopausal, had hysterectomy, subfecund, infecund and wants as many children as possible.

Opposition to using contraceptives is also prevalent because of many other reasons which include the religion and the fact that some people are no longer sexually active.

Zambia’s population growing rapidly

By Brenda Zulu

The Zambian population has been growing rapidly for a long period of time.  According to the Zambia Population Factors and National Development under the Ministry of Finance and National Planning, the population grew from only about 2.3 million persons in 1950 to 9.9 million at the time of 2000 census.

According to the 2010 census report, the population of Zambia is now at 13.4 million. Third high population growth is in part due to Zambia’s high fertility rate as Zambian women have 6.2 children each, on average  one of the higher levels of fertility in Africa. Because fertility has been high for a long time, Zambia has a very young population. About 46 % of the population is under the age of 15.

The health sector already faces severe human resource and infrastructure shortages. Zambia aims to reduce the population growth. For example, the long term goal is one nurse for everyday 700 persons in the population. In that case, the nursing cadre would need to increase from 9 200 in 2007 to 47 100 in 2037 a fivefold increase if high fertility continues.

Declining fertility would reduce the severity of the nursing shortages in 2037, 33, 700 nurses would be required be required with declining fertility. The country would also need fewer health centers and other facilities and could save in health expenditures. If saving is reinvested, Zambia could move closer to achieving a level of health expenditure per capita comparable with middle income economies.

What does a growing population mean to a Zambian family?

A rapid population increase will place a greater burden at a household in terms of housing and the need for employment to help sustain a family. In particular this pressure will exacerbate the already poor living conditions for low income populations and people in urban slums, who face overcrowding, inadequate shelter, lack of clean water and adequate sanitation and increased vulnerability to exploitation and abuse.

As evidenced in other countries declining fertility and a slower rate of population growth can contribute to economic transformation by creating conditions for greater saving and investment,  more educational opportunities,  and modernized agriculture. The Zambian vision to becoming a middle income country can best be achieved a combination of fast economic growth and slower rate of population growth.

In terms of policy response there is need for family planning education to help couples voluntarily plan and space birth as an important intervention to reduce fertility. However, contraceptive use in Zambia needs to increase and at the same time Zambia Demographic Health Survey reports a high level of unmet need for family planning. About 26.5 % of married women of reproductive age want to space or limit birth but were not using contraceptives.

To satisfy unmet need, Zambian couples who want to space or limit their birth needs access to choice of contraceptive consistently available at affordable prices. Public policies and programmes can be adopted to help satisfy unmet need. Political and other leaders, planners and programme implementers can all contribute to these efforts. By moving to satisfy current unmet need, Zambia will be on track to achieve lower fertility. In the end, good demographic outcomes depend on good policies that empower individuals and couples to make free choices.

Zambia’s young population

The young population age structure means, on the one hand, than the dependency burden will continue to be high as the working age population has to support large number numbers of child, young and old age dependents. This can retard the process of economic growth and present challenges for achieving poverty reduction and other MDGs. The youthful structure also means that demographic momentum is likely to continue to swell population numbers while spurring massive migration within and between countries. This has implications for environmental depletion, political stability and the inception.

Maternal death in Zambia

By Brenda Zulu

Too many women are suffering and dying from complications of pregnancy and childbirth in Zambia.  These women are in the reproductive age group of 15 to 49 years.  Most of these deaths occur amongst the poorest in our society.

According to the 2007 Zambia Demographic Health Survey (ZDHS) maternal deaths are a subset of all female deaths and are associated with pregnancy and childbearing. Maternal death are defined as any death that was reported as occurring during pregnancy, childbirth, or within two months after birth or termination of a pregnancy. Estimates of maternal death are solely on the timing of the death in relationship to the pregnancy.

A specialist in Maternal Health at the University Teaching Hospital (UTH) Dr Swebby Macha says that the major causes of maternal deaths in Zambia were excessive bleeding, infection, unsafe abortion, high blood pressure and obstructed labour. 

“Pregnant women who suffer from malaria, HIV/AIDs, TB, anemia and poor Nutrition are more likely to die.  Poverty, low levels of education, low status of women and violence against women in our society also increases the risk of women dying in pregnancy and child birth,” said Dr Macha.

He also observed that Zambia’s Maternal Mortality Ratio (MMR) which currently stands at 591 deaths per 100, 000 live births were unacceptably high.

 “There has been only a marginal decrease from the MMR of 729 deaths per 100, 000 live births (2003),” said Dr Macha.

He also observed that many women in the developing world and most women in the world’s least developed countries give birth at home without skilled attendants and when they seek help for complications at local health facilities; basic equipment, medicines, blood transfusion services are lacking.

Zambia officially launched the Campaign for Accelerated Reduction of Maternal Mortality in Zambia (CARMMA-Z) in June 2010 aimed at successfully tacking the major issues behind Maternal Mortality.  The theme for this campaign is “Zambia Cares:  No woman should die while giving life”.

Under CARMMA there is hope that every pregnant Zambian woman will have access to the availability and use of universally accessible quality health services including those related to reproductive and sexual health which are critical for reducing maternal mortality.

A main challenge to women’s maternal health arises from inequitable distribution of health care services, particularly in rural areas. Service delivery in Zambia is characterized by many challenges, not limited to lack of availability of emergency obstetric care.

A visit to Haabulile Rural Health Center in Chief Chikanta’s area revealed that the health centers are not staffed. The nurse in charge had gone to church and there was a pregnant girl and a woman who had just given birth.

In an environment that respects women, pregnancy, birth and motherhood could powerfully affirm women’s rights and social status without risking their health.  The enabling environment for safe motherhood and child birth depends on the care and attention provided to pregnant women and newborns by communities and families, availability of skilled health personnel at delivery and the availability of adequate health care facilities, equipment, and medicines and emergency care when needed.

Globally according to Dr Macha, 530, 000 women die of pregnancy related complications during child birth of which 99% occur in developing countries.  For every woman who dies from causes related to pregnancy or childbirth, it is estimated that there are 20 others who suffer from pregnancy related injuries, infections, diseases and disabilities, often with lifelong consequences.  The truth is that most of these maternal deaths are preventable. Research has shown that approximately 80% of maternal deaths could be averted if women had access to essential maternity and basic health- care services.

High fertility, close pregnancies and large families are still the norm in rural areas, partly because of lack of reproductive health services and the lack of choice of women in the matter. These factors contribute significantly to the high levels of maternal mortality. Current mortality trends are linked to among others poor nutrition, a lack of education, ill health and a lack of access to appropriate health services, factors that impend human and social development.

 The main causes of the high maternal mortality in Zambia include lack of national commitment; limited financial support; weak coordination and partnership; increasing poverty; the low status of women on the continent; weak health systems; the adverse effects of HIV/AIDS, tuberculosis and malaria and the exodus of medical personnel to overseas destinations. Experience has shown that safe motherhood can be achieved if every birth is attended to by a trained health worker with midwifery skills, if transport is available for referral services and if quality basic emergency obstetric care is available. Without such interventions Zambia might not achieve the fifth Millennium Development Goal (MDG 5) to improve maternal health by 2015. 

published in October 2011