The Challenges of Maternal Care in the Midst of the Ebola Epidemic

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Dr. Louise Mapleh Kpoto_web.jpg
Dr. Louise Mapleh Kpoto

Liberia’s immediate pre-Ebola era had a maternal mortality rate of 1072/100,000 live births (2013 DHS key findings), an evidence of disimprovement from 770/100,000 live births in 2007(WHO), and therefore now having one of the highest maternal mortality rates in the sub-region.

The devastating Ebola Virus outbreak is no pacifier as it is further exacerbating the statistics of maternal deaths thus producing the greatest challenge in the care of the pregnant mother.

There are several factors, both general and specific, that are responsible for the vulnerability of the expectant mother: a) General, i.e. Cultural and traditional beliefs and practices, coupled with a weak health system; and b) Specific.

The sudden mass closures of both public and private health care facilities as a result of the Ebola crisis (a) deaths of skilled health workers who were in the early stages neither trained nor equipped to identify or treat Ebola infected patients, (b) consequent fear and panic among health workers who refused to work because they saw their colleagues infected at the rate of, on average, one health worker infected daily and one death every two days (calculated from MOH regular situation report to date).

Uniquely for the pregnant mother whose hemodynamic physiology and indwelling fetus also likely serving as a (Petri-dish) medium for the growth and virulence of the virus, the risk is highest and therefore infection almost always leads to the death of both mother and child. To date, there is no known record of a pregnant woman surviving the Ebola virus disease infection in Liberia.  The female to male infection and death ratios, according to the MOHSW is high, skewed toward the females.
Maternal care, which includes, care for health of the woman during pregnancy, childbirth, and in the Puerperium (6 weeks after delivery) has suffered a dramatic decline during the epidemic. This has led to expectant mothers seeking care from traditional birth attendants and other unlikely places. In the process, at times, they give birth in streets while shopping for available health facilities.

The situation at JFK hospital epitomizes what is happening all over the country where mothers are rushed in weak anaemic and moribund in obstructed labour after running all over the city looking for where to deliver. Majority come with the baby already dead in uterus.  Many of these mothers have died due to obstetrics complications that could otherwise be avoided if handled early in hospital setting. These complications include fistula formation, puerperal sepsis, and postpartum mental disorder, etc., thus making motherhood a tragic and humiliating experience instead of the expected, joyful and fulfilling one.

The post-Ebola maternal morbidity and mortality statistics is surely going to increase above the 1076/100,000 live births due to the multiple factors enumerated above, if the government does not take advantage of the positive feedback of this crisis and accelerate opening of health facilities and save our mothers and infants.

Although the rate of infection is reducing, thanks to the enormous international goodwill and all Liberians both at home and abroad who have joined in the fight against the EVD, Ebola will remain a public health challenge in Liberia as evidenced from other countries. We therefore need to keep up the best practices and behavioral changes we have learned over the past months. We must also harness the   opportunities provided by the precedent international goodwill to improve our health system and infrastructures, build and strengthen health manpower capacity in order not only to be prepared for future outbreaks but also to have an efficient healthcare system that will help decrease the maternal morbidity and mortality long after the international partners are gone.

Finally, I pray for all expectant mothers to be protected from EBOLA and advise them to seek help and advice early in their pregnancies. I also pray for the souls of all those who died including those Liberians who died in their mothers’ wombs even though they do not and will never form part of the vital statistics of deceased Liberians in this national crisis.
To my health worker colleagues I say many thanks for the sacrifices and my condolences to the families of those who laid down their lives for all of us during the course of performing their professional duties.

Dr. Louise Mapleh Kpoto is Resident, Obstetrics and Gynecology at the University of Nairobi and Kenyatta National Hospital in Nairobi, Kenya.

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