Salima Nanfuka, 36, a resident of Bunangwe Zone in Kamuli municipality started feeling dizzy, her face and feet started swelling and she was generally weak when she was five months pregnant. This was unusual from her three previous pregnancies.
“I was not feeling normal at all. But people kept on telling me that this was a sign that I was expecting twins or triplets. I was excited until when I went to hospital and I was told that I was suffering from a condition known as pre-eclampsia as a result of high blood pressure. The doctor told me that I had delayed to go for antenatal care so that the condition would be managed at an early stage of pregnancy.” she says
At seven months, Nanfuka delivered a prematurely, but the baby passed on after two weeks.
“Up to now am not sure what caused the condition. I want to have another child but am afraid my body may swell and lose the baby again.” she says
Lilian Nabalyango, a registered mid wife at Kamuli hospital says that most pregnant mothers delay to go for antenatal care and management of pre-eclampsia is complicated when the pregnancy is in advanced stages.
“Most mothers have no information about the condition as they tend to think that they are bewitched and instead of going to hospitals, they use other alternatives such as local herbs.” She says
A survey conducted by the Coalition for Health Promotion and Social Development-HEPS Uganda in several rural health facilities in Kamuli district revealed that many of them lack capacity to manage mothers with pre-eclampsia.
Nabalyango also notes that the frequent stock out of essential medicines for managing the condition such as magnesium sulphate complicates the situation.
“We receive atleast three mothers suffering from pre-eclampsia on a weekly basis and in most cases we have stock outs of magnesium sulphate which we use to stabilize the mothers. We tell them to buy from private facilities but there are those who are unable to afford so we get stranded.” she adds
Dr. Annette Nakimuli a Pre-eclampsia specialist at Mulago National Referral Hopsital says 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 preeclampsia and eclampsia is one of the most common causes of maternal deaths after postpartum hemorrhage accounting for 6% of maternal deaths.
“For the mother, complications of preeclampsia and eclampsia cause illness for an extended period of time and are strongly associated with the future development of a range of debilitating non-communicable diseases such as cardiovascular disease, type II diabetes and renal impairment.”she notes
Flavia Nambi an enrolled midwife at Nankandulo HC IV, in Kamuli district says that the health center is facing challenges in managing mothers with the condition. She says 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.”
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 says 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, Kamuli district Assistant District Health Officer in charge of maternal and child health says that most health workers in the district also lack capacity to manage the condition. He says that the knowledge gaps among the medics can lead to wrong diagnosis thus endangering the lives of mothers.
Lyagoba also says that mothers need to be sensitized about the condition so that lives are saved. “Hypertension cannot be self-detected. This means that mothers who report to hospitals late are treated of eclampsia instead of pre-eclampsia which is very deadly.” he says
The situation is not unique to the rural health facilities as records from Mulago National Referral hospital also have almost similar challenges.
Dr.Evelyn Nabunya, the clinical head of the Directorate of Obstetrics and Gynaecology in Mulago hospital says that in 2017, the 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.
However, with the support from Uganda’s policy makers, there is hope that the situation will be addressed. During a breakfast meeting organised by HEPS-Uganda on 25th May 2018 at Sheraton Hotel, the Speaker of Parliament Rt.Hon. Rebecca Alitwala Kadaga pledged to move the issue to the floor of parliament.
HealthLine Communications Uganda 