Each year April 11 is set aside as the International Day for Maternal Health and Rights, which celebrates the right to quality, safe, and respectful maternal health care. The issue of maternal health has always been on the front burner in Africa, and of particular interest, Nigeria. Tribune Online presents the outcome of her exclusive interview with selected foreign based Nigerians health experts in commemoration of 2024 International Day for Maternal Health and Rights:
Dr Adebayo Williams AWONIYI, a United Kingdom-based Consultant Obstetrics and Gynaecology; excerpts from interview with Dr Awoniyi:
What is maternal mortality?
The World Health Organization (WHO) defines maternal mortality as a woman’s death while pregnant or within 42 days of the end of pregnancy. This includes deaths from any cause related to or made worse by the pregnancy or its management. It means maternal mortality goes beyond the period of pregnancy to that of lactation and may pose serious threat to the survival of the infants left behind when such occurs within 42 days post-partum.
What is the global picture of maternal mortality in terms of occurrence?
With reference to the WHO, “In 2020, almost 800 women died each day from preventable causes related to pregnancy and childbirth”. This totals to 292,000 deaths per annum or about 33 deaths every hour globally. Figures from the WHO confirms that “almost 95% of all maternal deaths in 2020 occurred in low and lower middle-income countries”. It therefore means that developing economies must do more in the area of primary healthcare, especially as it relates to maternal health. Also, between 2000 and 2020, the maternal mortality ratio (MMR) dropped by about 34% worldwide. Going by the definition by UNICEF, maternal mortality ratio (MMR) is a measure of the number of maternal deaths during a given time period per 100,000 live births during the same time period. In other words, MMR is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (without recourse to accidental or incidental causes). The good news is that the WHO has a target to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. However, regional health policies and programmes go a long way in the realisation of this target.
What is Live birth, and what is picture of its report globally?
World Health Organization – Global Health Observatory (2024) defines Live birth as “the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached”. Reporting of live birth is very efficient in developed countries while it remains a difficulty in developing countries due to several factors including giving of births at home and other non-approved venues in addition to those births occurring in remote areas where there is hardly any modern health facility. These factors put together, increase maternal mortality in developing countries.
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Dr Taiwo AKINDAHUNSI, a United States-based clinical Epidemiologist at the Department of Neurosurgery, John Hopkins School of Medicine; excerpts from interview with Dr Akindahunsi:
How do neurogenerative diseases relate to maternal mortality?
Infectious diseases of the nervous system during pregnancy can cause considerable maternal mortality. There is now an evolving understanding of the immunologic alterations during pregnancy that likely play a key role in susceptibility to infection. Evidence shows that adaptive immune responses are reduced, leading to impaired pathogen clearance with advancing pregnancy and, possibly, increased susceptibility to severe infection. There is also evidence that the hormonal environment during pregnancy contributes to local suppression of cell-mediated immunity at the maternal–fetal interface.
How do neurogenerative diseases manifest during pregnancy or within 42 days after the end of pregnancy?
Neurogenic pathogens can be viral, parasitic, or bacterial in origin. An example of a causative pathogen is parvovirus B19. Pregnant women have nonspecific flu-like symptoms during primary infection with Parvovirus B19, including fever, malaise, myalgia, and pruritis. Approximately 20%–30% of all people infected with the virus have no symptoms. The classic “slapped cheek” or reticular rash is reported more often among immunocompetent individuals than those with altered immunity, particularly in children.
What are the available diagnostic techniques for neurodegenerative diseases especially as it relates to maternal health?
Diagnosis of neurodegenerative diseases can be challenging given the variable presentation and concerns regarding neuroimaging in the pregnant patient. Neuroimaging in pregnant women remains an area of controversy and some concern for most practitioners. However, neuroimaging in one form or another is both safe and feasible in most cases despite worries regarding the potential for long-term effects if the fetus is exposed to radiation or a strong magnetic field. Magnetic Resonance Imaging (MRI) is often the preferred imaging study for a pregnant patient as there is no radiation involved. Paramagnetic contrast agents are to be avoided however, as they cross the placenta with an unknown rate of clearance from the amniotic fluid.
Dr Oluwafemi MORAWO, a Primary are physician with the Ministry of Health, Saudi Arabia, excerpts from interview with Dr Morawo:
What is the place of maternal health in primary healthcare?
Maternal health holds a central place in primary healthcare as it directly impacts the health and well-being of both women and their children, forming the foundation for a healthy population. Primary healthcare services provide essential care throughout a woman’s reproductive life, including family planning, prenatal care, skilled birth attendance, and postnatal care. These services are crucial for preventing complications during pregnancy and childbirth, ensuring safe deliveries, and promoting healthy outcomes for both mothers and infants. By focusing on preventive care and early detection, primary healthcare helps reduce the risks associated with maternal mortality and morbidity, making it a critical component of public health.
How integrated are maternal health services within primary healthcare systems?
Moreover, maternal health services within primary healthcare systems are integrated with child health services, ensuring that newborns receive the necessary immunizations, nutrition, and early development support. This integration highlights the interconnectedness of maternal and child health, emphasizing the need for comprehensive care that addresses the health of both mother and child. In addition, primary healthcare ensures equitable access to these essential services, particularly for marginalized populations, thereby reducing health disparities and improving overall maternal and child health outcomes.
Failure in primary healthcare can significantly harm maternal health by leading to inadequate prenatal care, delayed detection of complications, and lack of access to skilled birth attendants. This increases the risks of maternal mortality, unsafe deliveries, and poor health outcomes for both mothers and babies. Without effective primary healthcare, essential services like family planning, antenatal care, and emergency obstetric care become inaccessible, leaving women vulnerable to preventable health issues during pregnancy and childbirth.
How would you advise pregnant women and nursing mothers against maternal mortality?
Pregnant women and nursing mothers should actively be engaged with primary healthcare services. They should attend all scheduled check-ups, follow vaccination schedules, and seek guidance on nutrition and breastfeeding. I advise them to utilise primary healthcare services to address any concerns early and ensure both mother and baby receive comprehensive care. Prioritizing primary healthcare is key to maintaining maternal and infant health.