ANALYSIS OF TRENDS FOR WEEKLY EPIDEMIOLOGICAL MATERNAL AND PERINATAL DEATHS. A CASE OF UGANDA WITHIN THE CONTEXT OF
COVID-19, JANUARY – SEPTEMBER 2020
ABSTRACT
The main purpose of the study was analysis of trends for weekly epidemiological maternal and perinatal deaths. A case of Uganda within the context of covid-19, January – September 2020. The study was guided by the following objectives; to analyze the trends of maternal and perinatal deaths for epidemiological week 1 to week 38 in Uganda and to describe the distribution of maternal and perinatal death for epidemiological week 1 to week 38 by districts and regions of Uganda.
The study involved secondary data from the DHIS. The Weekly Epidemiological Record (WER) was used in the analysis of study results.
From analysis it was evident that the peak of maternal deaths was at its highest level in week 24 2020. From the analysis it is evident that perinatal deaths in 2020 wear much higher than 2019.
Most pregnant women did not attend antenatal services because of lack of transport services since the government had banned taxis and Boda bodas the common means of transport and yet they are few ambulances in Uganda, which could not match the demand.
The pregnant women feared going for antenatal services because of fear contracting the disease and being quarantined in the process and on another note Neonates and macerated deaths were also high because the women did not attend antenatal services.
There is need for the government to increase access to ambulances to pregnant women by for example setting up ambulance every parish to help transport pregnant women to the hospital during pregnancy period. The government also needs to sensitize the people on the benefits of seeking antenatal services since there is knowledge gap. There need also provide counselling services to pregnant women during antenatal services to help enlighten them on the benefits of the service.
ACRONYMS/ABBREVIATIONS USED.. vii
1.1 Introduction and Background. 1
1.3. Statement of the Problem and Justification for the study. 5
1.5 Questions to be answered. 6
2.1 Study setting and participants. 7
2.2. Study population –inclusion and exclusion criteria. 7
2.4. Sample size calculation. 8
2.5. Data collection methods. 8
2.6 Data Management and analysis. 8
2.10. Ethical considerations. 9
3.2 Trend analysis of maternal deaths in 2020 and 2019. 11
3.3.1 DISTRIBUTION FOR MATERNAL DEATHS IN 2020. 14
DISCUSSION AND RECOMMENDATIONS. 17
4.1.1 Discussion on the trend and distribution of maternal and perinatal deaths in 2020. 17
LIST OF FIGURE
Figure 1: Line graph showing the trend of maternal deaths in 2019 and 2020. 12
Figure 2: Trend analysis of macerated, neonates, and fresh still births in 2020. 12
Figure 3: Trend of perinatal deaths in 2020. 14
Figure 4: Analysis of the trend in 2019 and 2020 of perinatal deaths. 14
Figure 5: map showing distribution of maternal deaths in different districts in uganda in 2020. 17
LIST OF TABLES
DEFINITION OF TERMS
Early Neonatal Death: Death occurring during the first seven days of life
Live Birth: This is the complete expulsion or extraction of a fetus/baby of 1000grams or 28 weeks of gestation form its mother – which after separation shows any evidence of life or breathes, beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles whether or not umbilical cord has been cut or the placenta attached.
Maternal Death: Maternal death is defined as death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and site of pregnancy and any course related to or aggravated by the pregnancy or its management but excluding accidental or incidental causes
Macerated Still Birth: Is the degenerative changes and discoloration and softening of the tissues and eventual disintegration of a fetus retained in the uterus after its death
Perinatal Death: Death that occurred around the time of birth; it includes both still births and early neonatal death up to 7 completed days after birth
Still Birth: Death prior to complete expulsion or extraction from its mother of a fetus/baby of 1000 grams or 28 weeks of gestation the death is indicated by the fact that the fetus does not breathe or show any signs of life after separation
ACRONYMS/ABBREVIATIONS USED
DHIS : District Health Management Information Software previously
EPI WK : Epidemiological Week
END : Early Neonatal Death
FSB : Fresh Still Birth
HMIS ; Health Management information System
IESD/PHE : Integrated Epidemiology, Surveillance Department and Public Health Emergencies
IDSR : Integrated Disease Surveillance and Response
LB : Live Birth
MOH : Ministry of Health
MD : Maternal Death
MPDSR : Maternal and Perinatal Death Surveillance and Response
WHO : World Health Organization
SDG : Sustainable Development Goal
INTRODUCTION/BACKGROUND
1.1 Introduction and Background
Perinatal and Maternal mortality is one of the most revealing indicators of health system status and one of the challenges countries face. In 2017, maternal mortality was unacceptably high at about 295 000 women died during and following pregnancy and childbirth (Lindtjørn, Mitiku, Zidda, & Yaya, 2017). The vast majority of maternal and prenatal deaths (94%) occur in low-resource settings and most are preventable; however, the emergency of the Novel coronavirus the story of maternal and perinatal mortality is different since the disease affects both rich and poor countries in unimaginable scale (Tsegaw, Cherkos, Badi, & Mihret, 2019).
It has been shown that emerging novel strains of influenza and coronaviruses that cause severe respiratory disease1e typically disproportionately affect pregnant women, in part owing to adaptive immunology and cardiopulmonary physiology of pregnancy (Livingston, & Bucher, 2020).
Before the emergency of the Novel coronavirus the variations in maternal and prenatal deaths has always been a major concern, In some rich countries the average rate in the European Union is 8 maternal deaths per 100,000 live births. In some countries such as Poland, Greece, Finland and Sweden, the rate is even lower at 3 to 4 per 100,000 (Schwartz, 2020).
COVID-19 impacts on prenatal and maternal mortality cannot be underestimated due to the fact that the major influenza pandemics of the last 100 years (1918, 1957,1958, and 2009),pregnant women in their second or third trimester were considerably more likely to be hospitalized or die compared with the general population. During the 1918 H1N1 pandemic, the case fatality proportion among pregnant women was 27%. In the most recent influenza pandemic (2009 H1N1), pregnant women in the United States accounted for 6.4% of all hospitalizations and 4.3% to 5.7% of all deaths even though they generally represent only 1% of the population (Covid, C. D. C., Team, Covid, C. D. C., COVID, C., Team, & Skoff, 2020).
Based on initial reports largely from China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) does not appear to follow these historical patterns of worsened disease risk in pregnancy. The reports indicates that SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) in pregnancy or in neonates (as of April 8,2020). Unexpectedly, although these case reports or retrospective case series include some information on a total of154 pregnant women and 118 live-born neonates (1 set of twins, 1 second trimester termination, 1 fetal death, 34 undelivered only a few gravid reported as having experienced morbidity requiring respiratory support and critical care (Smith, Seo, Warty, Payne, Salih, Chin, & Wallace, (2020).
Of the 2.5 million infant deaths that occur within the first month of a child’s life, the vast majority take place in low- and lower-middle income countries. Levels of maternal death are nearly 50 times higher for women in sub-Saharan Africa and their babies are 10 times more likely to die in their first month of life, compared to high-income countries (Akpan, Asibong, Omoronyia, Arogundade, Agan, & Ekott, 2020).
Before the COVID-19 pandemic Uganda’s Maternal and perinatal Mortality Rate has consistently been one of the highest in the world with 440 deaths per 100,000 live births, In Uganda, one woman out of every 49 will die of a maternal complication related to pregnancy or delivery (Atukunda, & Conecker, 2017). In 2016 its stillbirth rate was 21 per 1000 births and neonatal death rate was 19 per 1000 live births, approximately double of the targets set forward in the Every Newborn Action Plan (Tesfalul, Natureeba, Day, Thomas, & Gaw, S2020). However the figure for neonatal deaths in Uganda in 2019 increased to 20 deaths per 1000 live births , while in 2020 maternal deaths was 336 deaths per100,000 this is still far below the target set by world health organization of 70 deaths per 100,000 (World Health organization, 2020).
Ever since when the president of republic of Uganda declared COVID-19 a public health emergency following the declaration from world health organization in 30th January 2020, when WHO, declared COVID-19 a public health emergency the world is facing ever since second world war. The government of Uganda declared a partial lock down first on March 20th, this was followed by other lockdowns and in March 20th the government declared a total Ban on movement from people and also a total Ban on public transport facilities like Boda Boda, Taxis, Minibuses, and Bus, this was all done to limit contacts among people and curtail the spread and it was not until the June 4th 2020 that the government lifted the Ban on transport services by allowing them to carry people this allowed. However this almost three months on Banning transport facilities some scholars have criticized as being unplanned since it prevented pregnant mothers from accessing health facilities and something they blame that it could have led to many deaths of pregnant mothers, Amoth, (2020), indicates that admissions in Kenyan hospitals like Nairobi reduced during COVID-19 due to the government policy of Baning public transport system and this led to deaths of mothers since they lacked medical attention.
1.2. Literature Review
Maternal and foetal outcomes are closely associated. When the mother does not survive through pregnancy and child birth, there are minimal chances that the foetus will survive (Cheptum, 2012). According to a study done by Gershim Asiki et al (2009-2013), it was found that a third of women in reproductive age (15-49years) in rural south western Uganda reported at least one adverse pregnancy outcome during their life time and that one out of ten pregnancies reported ended in a still birth or an abortion (Gershim Asiki et al, 2013).
Lack of antenatal care has reportedly led to poor maternal and neonatal outcomes such as ruptured uterus or stillbirth. Similarly women with comorbidities for example HIV or Hepatitis are also at increased risk of severe morbidity or mortality if they were to develop COVID-19 as they do not have access to antenatal HIV testing.
In Uganda where travel by private car is banned, laboring women are encouraged to contact their local community leaders for ambulances to take them to a health care facility. This presented a challenge, as ambulances have not been readily available meaning that more women than previously have been giving birth without access to skilled professionals. In the community health setting, a midwife who runs a not for profit Non-Governmental Organisation, where she counsels local youth in issues related to reproductive health, has stayed in touch with the young women she normally counsels, all of whom are staying home. She sends text messages or telephones to keep them informed and safe but is particularly concerned for those in this vulnerable group whom she cannot reach (Ndedi, 2020).
Although the burden of maternal mortality attributable to SARS-CoV-2 infection in high-income countries seems to be low, the impact in low- and middle-income countries has not been fully described. To estimate the number of excess deaths in pregnant women that could be directly or indirectly attributed to COVID-19, investigators in Mexico used data from the Mexican Ministry of Health to assess weekly maternal death counts during the first 32 weeks of 2020 compared with the years 2011–2019. The 523 maternal deaths in 2020 (42.4/100,000) exceeded the upper bound of expected maternal deaths (29.5/100,000). Among these deaths, 32.0% were caused by respiratory disease; by contrast, between 2011 and 2019, respiratory disease accounted for 1.6% to 10.3% (mean, 4.9%) of maternal deaths. COVID-19 is now the leading cause of death during pregnancy in Mexico. Lumbreras‐Marquez, M. I., Campos‐Zamora, M., Lizaola‐Diaz de Leon, H., & Farber, M. K. (2020).
In Uganda, mothers are dying at an alarming and increasing rate. Uganda’s Maternal Mortality Rate (MMR) has consistently been one of the highest in the world with 440 deaths per 100,000 live births, meaning one woman out of every 49 will die of a maternal complication related to pregnancy or delivery.
Some of the causes of maternal mortality rate has been attributed to multiple barriers women face in accessing critical routine and lifesaving maternal health care. The barriers fall into the Three Delays Model: delay in deciding to seek care, delay in reaching care (e.g. transportation and lack of road infrastructure), and delay in receiving adequate and appropriate care (e.g. lack of skilled birth attendants). In Uganda, the leading causes of maternal death are hemorrhage, eclampsia (high blood pressure), unsafe abortion, and infection. All of these causes of death are largely preventable. What makes the Three Delays Model so important is that with appropriate medical care, the vast majority of these deaths would not occur. This model addresses the barriers to accessing lifesaving treatment by outlining where each barrier may occur. Central to this model is the practice of encouraging women to seek care as soon as possible, in order to ensure survival.
Maternal and newborn deaths are a major concern in Uganda. In 2008, the Ministry decided to incorporate perinatal death auditing owing to its close linkage with maternal deaths. Maternal deaths in relation to births are few, but each one has enormous consequences for the family and for the immediate and greater society. Many more women with the same medical conditions escape death. In fact, maternal deaths are regarded as the visible tip of the iceberg, many more cases where death was prevented occur just below the water, and go undetected. If by various interventions the number of maternal deaths decrease, the number of women who just escaped death will also decrease.
A study done in Eastern Uganda reported a new-born mortality rate of 27 per 10000 live births (Bua John et al, 2014). According to another study in Uganda, a neonatal mortality rate of 34 per 1000 live births was reported (Ronald M. Kananura, 2016). A case control study done in India reported a proportion of 5.8% preterm births (Chythra. Rao et al, 2014). A Brazilian Multicentre study reported preterm births to have a prevalence of 12.3 %( Renato Passin Jr et al, 2014).
Maternal Death Surveillance and response (MDSR) is an important strategy to improve the quality of obstetric care and reduce maternal mortality and morbidity. The importance of MDR lies in the fact that it provides detailed information on various factors at facility, district, community, regional and national level that are needed to be addressed to reduce maternal deaths. Analysis of these deaths can identify the delays that contribute to maternal deaths at various levels and the information used to adopt measures to fill the gaps in service (National rural health mission, 2015)
1.3. Statement of the Problem and Justification for the study
Prenatal and maternal mortality remains a major public health issue in developing countries, particularly those in sub-Saharan Africa and Uganda in particular. By Nov 2020, the maternal mortality ratio in Uganda was 336 maternal deaths per 100,000 live births. Perinatal mortality is 43 deaths per 1000 live births, with 42% of the mortality occurring during the neonatal period.
Despite the several efforts by the government for example from as early as 2008 maternal and perinatal death were declared a national emergency by the President of the Republic of Uganda, Several activities including integration of maternal and perinatal death into the list of notifiable condition for surveillance purposes and notification have been undertaken since then among them is functionalizing MPDSR and integration of maternal and perinatal deaths reporting in the IDSR epidemiological system through Mtrac/HMIS 033 and DHIS a web data base used to capture Health management information system (HMIS). , however despite the efforts by the government of Uganda maternal and perinatal deaths continue to be the one of the biggest killers in Uganda this was also further escalated by COVID-19 which further increased the challenge.
Given the disproportionate burden of severe and mortal respiratory disease previously documented among pregnant women following other related coronavirus out breaks, the absence of reported maternal and perinatal mortality with COVID-19 is unexpected in Uganda, it is upon this background that this study intends to investigate into Analysis of trends for weekly epidemiological maternal and perinatal deaths. A case of Uganda within the context of Covid-19, January – September 2020.
1.4 JUSTIFICATION
Maternal and Perinatal deaths especially neonatal deaths are key health impact indicators monitor used the quality of care provided to women throughout pregnancy, labor, delivery/childbirth and puerperium. Uganda has a good record of trying to reduce maternal and perinatal deaths as part of its plan for national development and realization of SDG and Vision 2040. So far maternal and perinatal deaths tracked as league table indicators the annual health sector performance reports (ASHPR) by the MOH and also as key indicators in the Uganda Demographic Health survey (UDHS). Uganda is committed to bringing to an end preventable maternal and perinatal deaths through various interventions, it is very important to monitor trends of maternal death and perinatal deaths for real time actions in routine service delivery and in pandemics like COVID-19.
1.5 Questions to be answered
- What is the trend of maternal and perinatal deaths in Epi week 1 to Epi week 38?
- Where were the highest and lowest number of maternal and perinatal deaths reported?
- How did the COVID-19 pandemic impact on the number of maternal and perinatal deaths?
1.6 Objectives
The objectives of the study were to:
- Analyze the trends of maternal and perinatal deaths for epidemiological week 1 to week 38 in Uganda
- Describe the distribution of maternal and perinatal death for epidemiological week 1 to week 38 by districts and regions of Uganda
CHAPTER TWO
METHODS AND MATERIALS
2.1 Study setting and participants
The study was conducted at the Ministry of Health headquarters in Kampala. It is a cabinet level government ministry of Uganda responsible for the overall planning, delivering, coordination and monitoring of all the health services in Uganda. The ministry has a structure which is aligned to 17 departments, several divisions, sections and subsections which use data to help the ministry to deliver its mandate. MOH’s departments develop strategic and operation work-plans; these work plans have indicators and targets for international and national level that expected to be achieved within stipulated time. Some of the indicators are aligned to the six WHO building blocks. The resource center is responsible for supporting health facilities in all the 148 districts and cities in Uganda that are enrolled in the health data bank/ DHIS to collect and submit health data through the DHIS. Some of these data is submitted as periodic reports on weekly, monthly, quarterly or annual basis and is shared with responsible departments / divisions for monitoring and action.
The division of SIKM is responsible for public health surveillance data; weekly epidemiological data on notifiable diseases, diseases targeted for eradication and public health emergencies for international concern. Maternal and Perinatal deaths in Uganda are a public health burden and are still unacceptably high especially neonatal death which makes it a priority not only for the national development agenda but also for the sustainable development goals. The 2 conditions are monitored indicators on the Annual Health Sector Performance Report(AHSPR) and it is the responsibility of the Reproductive Health(RH) under the Maternal and Perinatal Surveillance (MPDSR) tool and SIKM Department to ensure that data is widely share with the stake holders so that real time solutions to ending preventable causes of maternal and perinatal death are sought.
2.2. Study population –inclusion and exclusion criteria
The study targeted weekly epidemiological data for Epi WK 1 to Epi WK 38 (Jan-October 2020) on Maternal and perinatal death. All early neonatal deaths, Fresh and Macerated still births were included in the study. Weekly epidemiological data from all districts and Regions in Uganda was included.
2,3, Study Design
A retrospective observational study design which involved review of weekly epidemiological data on maternal and perinatal deaths for Epi wk 1 to Epi wk 38; January to October 2020.
2.3. Sampling procedure
The study used secondary data and therefore determination of a sampling procedure was not necessary
2.4. Sample size calculation
Sample size calculation was not considered in this study given that secondary weekly epidemiological data was used and the study period was well defined.
2.5. Data collection methods
The study involved secondary data from the DHIS. The Weekly Epidemiological Record (WER) serves as an essential tool for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the International Health Regulations. (WHO,2020).
2.6 Data Management and analysis
The study used secondary data from the ministry of health regarding maternal deaths and prenatal deaths both for 2019 and 2020. During the analysis of data the study used Epiinfo, stata and microfosoft excel to analyze data and ensure that it easy for interpretation using line graphs, charts and stata analysis tables.
2.8 Data extraction, process
Data on maternal and perinatal deaths (FSB, END and MSB) is reported through the IDSR system and can only be accessed by those who have access rights like the Senior Biostatisticians who supported the data extraction process.
Data for Epi wk 1 to Epi wk 38 (1st January 2020 to 30th October 2020 was extracted from DHIS as Pivotal table. It was then saved in Ms excel work boo, cleaned and saved in CSV format. Data for districts was large and needed to presented in an easy to visualize form so the data was further saved in Coma Delimited file format to suit the analysis which was done using Ms excel, Epi info and stata
2.9 Study variables
The variables considered during analysis were mainly prenatal and maternal deaths in Uganda for both 2019 and 2020. Using Microsoft excel the trend of maternal and prenatal deaths were analyzed and the stata package was also used to determine the variation and the trend in the different regions during the study.
2.10. Ethical considerations
During the process of getting the secondary data the researcher ensured that before the information that was to be used for data analysis was got from a proper source or an organization with great reputation and to this researcher got data from ministry of Health.
The data got also was further examined to ensure that the researcher got the proper information she needed to be able to carry on with the analysis of data.
The data was also got by first seeking permission of authority and informing that information will be kept confidential and only used for academic or research purposes.
Confidentiality of the respondents ‘information was assured and the researcher also informed them that the study was strictly for academic purposes and therefore, they should not fear giving information.
Only respondents who were selected were given questionnaires and only those meant to be interviewed were actually interviewed.
3.0 RESULTS
3.1 Introduction
This section presents the analysis of the study as got from the secondary data
3.2 Trend analysis of maternal deaths in 2020 and 2019
From the line graph above it is evident that the peak of maternal deaths was at its highest level in week 24 in both 2019 and 2020. The line graph further shows that the maternal deaths were very low at week 5 in 2020. The line graph also further shows that the maternal deaths extremely high in week 37 in 2020 while in week 37 in 2019 there was extremely low maternal deaths.
Figure 2: Trend analysis of macerated, neonates, and fresh still births in 2020
In analyzing the trend for macerated, neonates and fresh still birth in 2020 , specifically the Macerated death; the line graph above indicates that macerated deaths was highest in week 13 of the 2020, and also macerated deaths was lowest at week 1.
Neonates deaths; the line graph indicates that the trend for neonates was highest in week 25 of the year 2020 and lowest at week 1.
Fresh still birth; the line graph also further indicates that the trend for Fresh still birth has been irregular since in week 25 it was at its highest level and lowest in week 1.
In summary all macerated death, neonates deaths and Fresh still birth have irregular patterns sometimes they are high and other times they are low.
Figure 3: National trend for maternal death, Uganda 1st Jan 2020 – October 2020
The trend from 1st January to October 2020 indicates that there was high death rates in week 25 indicating that this was the week when the mother were not able to have access to health workers.
Table 1: Analysis of the mean variation in the trend of marcerated, neonates and fresh still birth in 2020
From the analysis it is evident that macerated deaths are more prevalent since the the mean value was 81.34211, while the mean value for the neonates was 66.26316 and the fresh still births was at 71.94211.
Figure 4: Trend of perinatal deaths in 2020
Perinatal deaths were much high in 2020 deaths in week 25 as indicated by the line graph above.
Figure 5: Analysis of the trend in 2019 and 2020 of perinatal deaths
From the analysis it is evident that perinatal deaths in 2020 wear much higher than 2019 this has been evident in the fact that the mean value for 2020 was 138.1053 while the mean value for 2019 was 130.0263. The findings further indicates that the maximum perinatal deaths in 2020 was 256 while in 2019 it was 222. The above cooperative analysis further shows that the figures for 2020 were much than 2019 this could be attributed due to the COVID-19 pandemic in the country.
3.3 Describe the distribution of maternal and perinatal death for epidemiological week 1 to week 38 by districts and regions of Uganda.
3.3.1 DISTRIBUTION FOR MATERNAL DEATHS IN 2020
Analysis of maternal deaths in 2020 in different districts of Uganda
From the analysis above Kampala has the highest mean (average maternal death) in a weak of 4.02 while Karamoja had the lowest maternal mortality average of 0.270, from the above analysis it was also further indicated that Teso region also has one of the lowest maternal death with the mean value of 0.270.
The table further indicated that the average mean value for all the regions was 19.40541 with the maximum total for all the regions being 85.
It can therefore be concluded that the key regions with the lowest maternal deaths included; Bukedi, with a mean value of 0.6216216, Kigezi with mean value of 0.864864, and lango region with a mean value of 0.756756. While on the other note other regions with the highest maternal deaths included; northern central with a mean value of 1.756757.
3.3.2 Distribution of neonates, macerated, neonate and fresh birth date in 2020 in different regions
The graph indicates that Kampala has the highest distribution of macerated, neonate and fresh still birth dates in 2020 in different regions of Uganda. The figure further indicates that Bukedi and karamoja had one of the lowest cases while kamapala was followed by North central region, south and Bunyoro as having high figures than the other regions.
Figure 6: map showing distribution of maternal deaths in different districts in Uganda in 2020
From the map above Kampala had the highest maternal deaths , the total maternal deaths in kampala was greater than 200 deaths, this was also followed by key places like mbale whose maternal deaths total was more than 100-200 deaths. The map further indicates that other regions with maternal deaths more than 50-99 were the districts of west like Hoima, kasese, kiryandongo, masindi. The map further indicates that the districts of Abim, Lwengo, Nakasongola and Kanungu among others did not have data concerning their maternal deaths.
DISCUSSION AND RECOMMENDATIONS
This section discusses discussion and recommendations
4.1 Discussion
4.1.1 Discussion on the trend and distribution of maternal and perinatal deaths in 2020
The results from the study indicated that that the peak of maternal deaths was at its highest level in week 24 (June) in 2020, during this period many of the mothers died. The reasons for this high trend in maternal deaths in WEEK 24 could be as a result of the challenge in accessing medical medical facilities since during COVID medical professionals were engaged with the fight against coronavirus leaving the pregnant women with no immediate medical personnel to attend to them , the findings of this study was also in line with (Lizaola‐Diaz de Leon, & Farber, 2020) who indicated that in Mexico maternal deaths increased during coronavirus period he further stated that the 523 maternal deaths in 2020 (42.4/100,000) exceeded the upper bound of expected maternal deaths (29.5/100,000). Among these deaths, 32.0% were caused by respiratory disease; by contrast, between 2011 and 2019, respiratory disease accounted for 1.6% to 10.3% (mean, 4.9%) of maternal deaths. COVID-19 is now the leading cause of death during pregnancy in Mexico.
During the coronavirus lock down many pregnant women were not able to attend antenatal care because of challenges in transport facilities since there was a ban on the many transport services like taxis and Boda Boda , this also contributed to high maternal and perinatal mortality rate in 2020.
Redirecting of the country’s few medical facilities and Human resource in the fight against coronavirus made many pregnant women to fail to get the medical attention that they needed leading to many maternal deaths in WEEK, 24, this was also indicated by Amoth, (2020), who indicated that Midwives have reported low numbers attending maternal health clinics since medical professionals are busy attending to COVID-19 patients.
Uyoga, et al., (2021), further indicated that women are afraid to visit the hospitals for fear of contracting coronavirus, the women also fear being tested for COVID-19 as a positive result means being sent to mandatory quarantine away from their families. This has led to women coming into hospitals too late, sometimes ending with undesirable outcomes like stillbirths, neonatal and maternal death
The findings in the study indicates that Macerated death was highest in week 13 of the 2020, , this further indicates that during this time period the pregnant women did not get the required medical attention something that led to macerated deaths. In the analysis of the study it was discovered that the death of neonates was highest in week 25 of the year 2020 while Fresh still birth also was highest in week 25, this was also cited by Ndedi, (2020) who indicated that Lack of antenatal care has reportedly led to poor maternal and neonatal outcomes such as ruptured uterus or stillbirth in Uganda.
4.1 Conclusion
- Most pregnant women did not attend antenatal services because of lack of transport services since the government had banned taxis and Boda bodas the common means of transport and yet they are few ambulances in Uganda, which could not match the demand.
- The pregnant women feared going for antenatal services because of fear contracting the disease and being quarantined in the process.
- Neonates, fresh still births and macerated deaths were also high because the women did not attend antenatal services.
4.2 Recommendations
There is need for the government to increase access to ambulances to pregnant women by for example setting up ambulance every parish to help transport pregnant women to the hospital during pregnancy period.
The government also needs to sensitize the people on the benefits of seeking antenatal services since there is knowledge gap.
There is need also to provide counselling services to pregnant women during antenatal services to help enlighten them on the benefits of the service and the government should also set up village health teams to enable in the provision of necessary information to the pregnant women.
During the Coronavirus pandemic the government should realize the challenges that pregnant women face and therefore they should not be subject to transport Bans like other members of the society since this makes it hard for them to access transport facilities and therefore preventing them from getting access to health services.
The government needs to recruit more health workers since during this pandemic the few Human resource has been over stretched and this has affected the women from being able to have access to medical facilities.
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