General
East Africa’s high maternal death rate
Judith Awino died on her 25th birthday as she gave birth, on a dusty roadside, to her second child.
She had endured a long and difficult labour but was unable to get admitted to hospital because of a nurses’ strike.
Her baby also died.
Her short life symbolises the tragedy behind the high maternal death rate in Kenya where the maternity system faces extreme pressure.
Whereas Kenya’s overall crude death rate is on a par with Europe, its maternal death rate in 2015 was 43 times higher than that seen in high-income countries?—?with 510 women dying in every 100,000 live births.
And that picture is not just restricted to Kenya.
Across Africa, countries are unlikely to hit the Sustainable Development Goal to significantly reduce preventable maternal deaths.
A team from the University of Leeds, Makerere University in Uganda and the Catholic University of Eastern Africa is investigating a new approach to improving maternal health. It is funded by the UK’s Global Challenges Research Fund (GCRF), money from the UK’s aid budget with the aim of bringing the best research to target the big, intractable problems facing the world.
The UK Government believes research excellence is achieved by people from different academic backgrounds working in collaboration and across borders.
The project in Kenya has researchers with a medical humanities background working alongside medical and public health specialists, bringing fresh insight into why maternal death rates are high.
One of the issues that’s emerged is that a high proportion of pregnant women seek maternity care very late in their pregnancy.
Jane Plastow, Professor of African Theatre in the School of English and History at Leeds, said her approach is to use drama-based workshops to allow women and their families to feel at ease in speaking about their experiences or to act out what has happened to them.
Professor Plastow said: “We have been able to show that there are good reasons why many poor women are not able or willing to interact with health professionals and these need to be much better understood and taken into account if services are to respond well.
“The research is revealing that the challenges facing women are immense. Most people using the public health service are poor and live in remote villages, and for many it was impossible or costly to access antenatal care.”
She also commented that people felt ambulances could not be relied on. The women spoke about being treated badly when they went for antenatal advice or went into labour?—?with feelings that nurses would be dismissive, disparaging or judgmental, particularly if they regarded the patients as poor or illiterate.
Maternity units were reportedly overwhelmed, with many women not being assessed quickly enough. Both hospitals and rural clinics lacked blood products and equipment.
The research is suggesting that women have become more vulnerable because of the changes in the support they get from their families, sometimes with women under pressure to return to work days after giving birth.
Shane Doyle, Professor of African History at Leeds who is leading the project, said: “One of our goals is to encourage hospitals to adapt their maternal health provision in light of this research, so that, for example, greater attention is devoted to ongoing care and delivery and discharge.”
The researchers are working with Kenyan TV to reveal the problems faced by poorer women and it will feature the case of Judith Awino.
The project will also look at the relationship between patients and healthcare staff who often work under extreme pressure.
Professor Doyle added: “One of our aims is to show that this cross-cutting research opens up a fresh understanding of the experiences of pregnant women and health care workers.
“Kenya has attempted to improve the maternal death rate by introducing free maternity services and opening new hospitals but they’ve not had the impact that was hoped.
“Research that understands the socio-cultural issues and health issues in maternal death rates is likely to suggest more sustainable ways of tackling the problem.”
The University of Leeds has been hugely successful in securing support from the Global Challenges Research Fund. It was established in 2016 and over five years will allocate a total of £1.5 billion to UK science with the aim, the Government said, of ensuring Britain meets its “…moral obligation to the world’s poorest.”
The UK Medical Research Council awarded the GCRF grant. Dr Mark Palmer, Director of International Relations at the MRC, said: “Improving on maternal and neonatal health is a major global health challenge that we are committed to tackling.
“This research is pivotal to better understanding why maternal death rates are so high, taking a multidisciplinary approach to gain insight into how to help pregnant women, along with the healthcare workers and communities that support them. The findings could lead to positive changes and better outcomes for maternal health around the world.”
The University of Leeds is involved in 70-plus projects financed through the fund covering a range of issue from equipping scientists in the developing world with technology to safely make vaccines, low-cost endoscopy for stomach cancer and the ways people can protect themselves from the kidnapping epidemic in Mexico.
Find out more about the University of Leeds and GCRF.
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The College of Veterinary Medicine, Animal Resources and Biosecurity (CoVAB) on Thursday 17th June, 2021 commenced celebrations to mark 50 Years of Veterinary Higher Education, Science, Technology, Innovation and Services (HESTIS) in Uganda. The blended event held at the Industrial Livestock Research, Incubation and Skilling (ILRIS) Center at Nakyesasa, Namulonge as well as online was presided over by the Chancellor, Prof. Ezra Suruma and First Lady and Minister of Education and Sports (MoES), Hon. Janet Museveni both represented by the Vice Chancellor, Prof. Barnabas Nawangwe.
The event, held as part of Makerere University Centenary Celebrations (1922-2022) was a moment of celebration for 1,930 skilled livestock agribusiness entrepreneurs who were awarded certificates in recognition of completion of their respective courses. Owing to the strict Standard Operating Procedures (SOPs) instituted by the Ministry of Health (MoH) to curb the spread of COVID-19, the students from Incubation Hubs in Atiak, Butaleja, Mubende, Nakyesasa, Sheema and Wakiso were awarded their certificates virtually.
In her remarks read by Prof. Barnabas Nawangwe, Hon. Janet Museveni thanked Makerere University for supporting grassroots level development through groundbreaking innovations under the Africa Institute for Strategic Services and Development-Skills for Production Enterprise Development and Accreditation (AFRISA-SPEDA) model.
“I am extremely pleased that Makerere University, through those innovative approaches, has developed and launched the alternative approach to building human capital and transferring knowledge to enterprises in communities.
“I would like to encourage all those involved in skills development to adopt methodologies that transform those trainees that go through these programs in ways that enable them also transform the societies they live in” read the Minister’s remarks.
She further noted that commissioning of the CoVAB@50 celebrations was both timely and rewarding. “The commissioning of the college innovations indeed has made meaning. This is a true path to growth of an Academic and Development College of the University, and we congratulate you again.”
Addressing the congregation as Chancellor, Prof. Barnabas Nawangwe congratulated CoVAB alumna and incoming Minister of Science, Technology and Innovation (MoSTI) under the Office of the President, Dr. Monica Musenero upon her recent appointment. “We thank His Excellency the President for identifying you. Science is in good hands.”
Prof. Nawangwe urged Dr. Musenero to address the structures of managing research and innovation in Uganda, “including the role of the Uganda National Council for Science and Technology and the apparent need to establish a Research Council for Uganda.”
In the same breath he thanked the outgoing and pioneer Minister of Science, Technology and Innovation, Hon. Dr. Elioda Tumuwesigye, for his role in ensuring that the ministry is empowered to carry out its mandate.
The Chancellor congratulated CoVAB upon training the bulk of Veterinary Doctors in Uganda over the last 50 years and more recently, Laboratory Technologists at the highest level. He recognised Makerere University‘s obligation to contribute to the economic self-determination of Uganda and thanked CoVAB for conducting research that addresses hindrances to national development, especially in the livestock industry.
“The anti-tick vaccine is one of such innovations which will solve the huge problem of tick-borne diseases that have caused enormous losses to our farmers. There are many other problems on which the college is researching and we thank you for the enthusiasm” he added.
The Chancellor commended CoVAB for being the vanguard of transformation of the grassroots communities through the SPEDA model. “I urge Government to fund this important initiative so that it can more meaningfully contribute to solving the big problem of youth unemployment.”
In her remarks, Dr. Monica Musenero commended the Principal, CoVAB, Prof. John David Kabasa for fulfilling the College’s dream of enabling the masses who drop out of the education value chain as well as those who complete education but have no skills for livelihood, to attain certification in agribusiness entrepreneurship.
“Many people attain academic success and write papers, publish and they become professors but without demonstrable impact on their nation. You have shown by the thousands that you have touched nationwide that indeed you are a professor of national transformation. Congratulations,” remarked Dr. Musenero.
She therefore congratulated the teams at CoVAB and AFRISA upon successfully conceiving and executing a model that is non-traditional, informal, not easily understood and not documented in any textbooks.
As Minister, Dr. Musenero noted that witnessing thousands of individuals from across the country whose skills had been honed through a university programme receiving certificates gave her a lot of hope and material to embark on her tenure with. “I will be looking forward to harnessing these resources as we initiate work on the next leg of Science, Technology and Innovation in the country under the President’s Office.”
The invitation to the Principal, CoVAB to present students for the award of the ordinary diplomas, ordinary certificates and artisan certificates was given by the Deputy Vice Chancellor (Academic Affairs), Dr. Umar Kakumba. He congratulated the awardees upon successfully completing their respective courses and graduating with evidence on an enterprise.
Prof. Kabasa clarified that the approach used to train the day’s awardees was not simply a vocational skilling. “The combination of action research with knowledge transfer, skilling, plus assessment and accreditation processes done by organs like the DIT (Directorate of Industrial Training, MoES) has given us this result, for the University to provide true leadership and transformation of the community.”
Present at the celebrations were the Director, DIT, MoES-Mr. Byakatonda Patrick and the Deputy Commissioner Social Services Development, MoES Madam Elizabeth Bateme who have worked through the Academic-Community-Public-Private-Partnership model to ensure that students graduate as entrepreneurs with micro enterprises.
Prior to presiding over the ceremony, Prof. Barnabas Nawangwe, on behalf of the First Lady and Minister of Education and Sports officially commissioned the SPEDA Training, Incubation and Research Centre – Nakyesasa.
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