Maternal mortality

July 6, 2022

Yesterday I woke up to a disturbing story in the New-vision newspaper of Tuesday, 5th July 2022 and this is what it read. “16 mothers die everyday due to negligence, extortion” A story is told of a mother, 23 years of age from Kiboga district who loses her life and that of her new born baby because of lack of platelets at the hospital as well as where she was transferred (Hoima Hospital). The different accounts given of what took place that day are even more disturbing. This is one of the many stories you will hear about maternal mortality in Uganda.

SDG 3-Target 1

Sustainable Development Goal (SDG) 3 target 1 is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. According to the Uganda Demographic Health Survey (UDHS), maternal mortality rates refer to the number of maternal deaths per 1,000 women age 15-49. The number of deaths is the number of sisters reported as having died in the 7 years preceding the survey either during pregnancy or delivery, or in the 42 days following the delivery, by their age group at the time of death. Deaths due to accident or violence are excluded. The maternal mortality ratio for the 7-year period before the 2016 UDHS is estimated at 336 maternal deaths per 100,000 live births. We have only 8 years to reduce this number if we meet our SDG 3 target goal 1. (With our current situation I cannot tell you that I am very confident).

This not only grieves my heart but also freaks me out because that can be me or anyone I know. No one deserves to die giving life for goodness sake neither does a child deserve to die coming to life. Some of the reasons given for these number of deaths in the newspaper article include; lack of infrastructure, gaps in human resources, inadequate supplies and commodities, knowledge and skills gap among health workers to mention but a few. The question for you and I is what can we do?

According to a report on Reducing maternal mortality by UNFPA, almost all cases of maternal mortality are preventable but if this is so, what is failing us and causing so much grief to you and I? A lack of information among many is one of the reasons sighted and if just 2 sentences in this blog will help prevent just 1 mother from dying at their next child birth, my life is more than complete.

Where to start

Teenage Pregnancy | Plan International

Teenage pregnancies

An old saying goes ” Prevention is better than cure”. According to World Health Organisation, The risk of maternal mortality is highest for adolescent girls under 15 years old and complications in pregnancy and childbirth are higher among adolescent girls age 10-19 (compared to women aged 20-24). Teenage pregnancy and motherhood has been a major health and social concern in Uganda for some time.
The 2016 UDHS results showed that 25% of women age 15-19 have begun childbearing; 19% have had alive birth, and 5% are pregnant with their first child. The health, social and economic consequences that come with teenage pregnancies are too undesirable therefore better to prevent than to deal with the consequences. The next you are drawn to a teenager, think about the many things at stake especially for the girl. Do not let the wig and booty fool you. It could be your sister someone is messing with. It can surely wait.

Pregnancy related complications

These may not be completely done away with but something can still be done. Many of these develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. These pregnancy related complications include but are not limited to severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia) to mention but a few.

First and fore most the onus is on you to care for your own life. No one will like or love your life more than your self thus the need to choose you first. Your mother, man or pastor will not do that for you. Dear lady don’t wait to conceive to start on the healthy journey. Some of these complications like severe bleeding, pre-eclampsia can be avoided or at-least their severity reduced if you prepared your body early enough. Pregnancy is an intense period that requires all hands on deck for you to go through it and bring forth healthy life. Take care of your body if you have plans of creating life so that we can avoid or reduce the risk of maternal mortality.

I cannot over emphasize the need for antenatal care. I know of some people who go only to find out the sex of their child and that is it. Why do you do yourself a disservice to this extent? It is in routine antenatal care visits that unwanted pregnancy and other post pregnancy complications can be prevented. Going back to the story I began with, low platelets in the blood can be detected early enough during these visits and early preparations can be done. Yes! I know our hospitals are not doing the best but atleast let us do our part. Remember no one will love your life more than you do. Do not give up the fight. Ask as many questions as you can, even those you consider silly or obvious. It could be the one to save your life and the unborn child.

Kolhapur illegal abortion

Unsafe abortion

According to World Health Organisation, nearly 8 % of maternal deaths worldwide are abortion-related and 99.5% of these occurring in developing regions. In Africa, 99% of abortions are unsafe resulting in one maternal death per 150 cases. It is high time we embraced comprehensive sexuality education to avoid having our girls finding themselves at cross roads that may warranty abortions. Culprits who defile, rape girls and women ought to be seriously apprehended and let us save the mothers of this nation.

These are some of the things I could point out for now, what do you have in mind? Please share with me in the comment section. If you think this is worthy information to pass on to someone for whom it can benefit, the pleasure is all mine.

Thank you for always coming back

See you next Wednesday.

Prenatal nutrition

June 1, 2022

We have always talked about the importance of prenatal nutrition but we still do not appreciate the magnitude of the effects as we should and it is my goal to help us understand in the easiest way. Listen to this.

If a pregnant woman found herself in a situation where her nutrition conditions are poor for example in times of famine, war or simply food scarcity, a pregnant woman can modify the development of her unborn child such that it will be prepared for survival in an environment in which resources are likely to be short. Whereas this may sound like a good or let us say reasonable thing nature allows so that in whatever situation, life can be brought forth, it has a downside to it.

In 1992, Nick Hales and David Barker proposed a hypothesis that an undernourished fetus becomes thrifty which explains the situation I described above. Fetal undernutrition leads to impaired development of the pancreas, liver, and other tissues (e.g., muscle), leading to low insulin secretion and insulin resistance, which maintains high levels of sugar in the fetal bloodstream to preserve brain development, but may trade-off muscle development. Once adopted, this thrifty behaviour becomes permanent and, combined with adiposity in later life, leads to type 2 diabetes.

To put it in simple terms when this child comes into the world and is now able to afford better nutrition conditions, and get nutrients in the right amounts, they are at risk of several chronic conditions later in life, including coronary heart disease, stroke, diabetes, and hypertension resulting from adaptations made by the fetus in an environment limited in its supply of nutrients.

In the American journal of clinical nutrition, it is noted that in developing countries, the health and nutrition of females throughout their entire life is affected by complex and highly interrelated biological, social, cultural, and health service-related factors. Good maternal nutrition is important for the health and reproductive performance of women and the health, survival, and development of their children.

Over 200 million women become pregnant each year with many of these at risk of suffering from both ongoing nutritional deficiencies and the long-term cumulative consequences of undernutrition during childhood. Pregnancy-related health and nutritional problems affect a woman’s quality of life, that of her newborn infant well beyond delivery, and that of her family and community.

The effect of women’s prenatal health and nutritional status on child growth, health, survival, and development occurs both through reproductive performance and survival and through fetal growth and development.

Prenatal nutrition

Strategies to improve prenatal nutrition

Promotion of optimal nutrition

This needs to be emphasized right from childhood especially among girls because it can result in a buildup of the nutritional reserves needed during periods of increased nutritional demand, including the adolescent growth spurt, pregnancy, and lactation. This can be done by all players in the field like myself (nutritionists) to make nutrition information as common and accessible as silver in the times of Solomon’s reign of Israel. Community- and facility-based health and nutritional care can be combined just like we have been doing for malaria eradication programs.

Invest in female education

I know this has been a song that has been singing for so long but before you come at me about the increasing imbalance that is being caused by over pushing for investment in female education hear me out. There is strong evidence that associates higher levels of maternal education with improved child survival and nutritional status. Educating women means they will make better-informed decisions in terms of their nutrition and health for both themselves and their families. For those in school, how can we include nutrition education in the curriculum right from primary school? We continue to witness teenage pregnancies and we cannot afford to wait until they are in tertiary school for them to know about nutrition in its totality.

Increase access to quality nutrition services

Much as nutrition is a vital component of antennal visits, the reality is that it is not held in high regard and is often missed or talked about in passing yet it determines a lot in the development of a growing child. This can begin with expectant mothers demanding these services because they need them. This way stakeholders will strengthen the healthcare delivery infrastructure; improve the quality of services for women including nutritional services and increase the number of healthcare providers for women. This will make monitoring the nutrition status of pregnant women easy and we can avert many of these negative consequences when it is still early.

In a bid not to write a thesis, I will stop here and hope this can be a trigger for us to think about the nutrition health of our women whose health and nutrition status directly affects the health of a child and consequently a whole generation.

Prenatal nutrition

Do not hesitate to share with me your thoughts in the comments.

See you next Wednesday

Foods to best avoid during pregnancy

April 20, 2022

Pregnancy is a very delicate season for both the baker (mother) and the one who is being baked (child). It is easy to know the most important foods a mother must eat to ensure that both her and the unborn child come out of this season good but sometimes if not most times it is important to know what foods may do more harm than good during your pregnancy so that you can press the pause button for just a season.

Top 5 foods to stay away from during pregnancy

Organ meat

This may come as a surprise to a few of you (or even many, who knows!!!). Liver is an example of an organ meat and much as organ meats are packed with countless useful nutrients like iron, vitamin B12, vitamin A, zinc, selenium, and copper, our concern is with Vitamin A. Eating too much animal-based vitamin A is not recommended during pregnancy because of the risk on Vitamin A toxicity which can lead to congenital malformations and miscarriage especially in the first trimester of pregnancy. Do not take them out completely from diet, rather reduce their intake.

Juicing and juice cleanses

As healthy as juicing and juice cleanses are, please keep away from these during pregnancy. (this applies to the breastfeeding ones too). During a juice fast, your body is getting rid of toxins and guess where these toxins go? To the bloodstream so that they make their way out of the body. As expectant or breastfeeding mothers, this means that these toxins will also be passed on to your precious little one too. Toxins that their tiny little body cannot handle. Organic juice is just fine.

Caffeine

Lovers of coffee you will have to sacrifice for the benefit of your child in this season. Caffeine is easily absorbed into the placenta but babies and their placentas don’t have the main enzyme needed to metabolize caffeine. This means levels can build up real quick and will be really high. Caffeine has been linked to birth defects in humans so you may want to stay away.

Processed foods

At all times we need to emphasize the consumption of nutrient-dense foods other than energy-dense foods and processed foods are a good source of the latter. For the benefit of both you and your growing little one, you will need increased amounts of many essential nutrients, including proteins, iron, folate e.t.c.

Also, consumption of processed foods during pregnancy can increase your risk of excess weight gain, gestational diabetes, pre-eclampsia and complications which can have long-term health implications for you and your child.

Raw or under-cooked meat

If you are the type that loves their steak medium, be careful during pregnancy. Eating undercooked or raw meat increases your risk of infection from several bacteria or parasites, including Toxoplasma, E. coli, Listeria, and Salmonella. Cook all meat and poultry thoroughly taking care that there is no trace of pink or blood. Take particular care with poultry, pork, sausages and minced meat. These bacteria may threaten the health of your little one, possibly leading to stillbirth or severe neurological illnesses, including intellectual disability, blindness, and epilepsy.

The foods listed here are not an end in themselves. Their intake may be paused now but that does not mean they have been stopped for good.

To every pregnant lady, may your journey be smooth and enjoyable.

See you next Wednesday

Nutrition

Liver and Pregnancy

March 9, 2020

My friend (let us name her Grace) walks into her salon, gasping for breath like she just finished an olympic marathon and throws her weight in the red fluffy chairs she finds in the lobby. Grace cannot believe that just two flights of stairs could get her this weary, but when you are pregnant and in the final lap, even a stroll in the backyard will leave you feeling like a hike to the top of the hill.

As soon as she is settles her now enormous weight that she carries around like a drum, the hunger pangs begin to dig in. They bite so hard that she muffles a silent groan as she asks her stylist to get her the waiter from the built-in restaurant. At this moment in time her taste buds are craving for liver, so she orders for french fries and liver.

As if not sure whether to say it or not, the waiter leans in and whispers to Grace, “I would not advise you to take liver in your state’ and briskly walks away like his job is on the line for this one statement he has made. Grace eventually changes her order but she is greatly disturbed because no one has ever warned her against eating liver especially when she is pregnant. Grace quickly sends me a text telling me the whole ordeal and asks me to clarify.

LIVER and PREGNANCY

From time memorial Liver is generally considered a healthy food that is rich in minerals, vitamins and protein, but it contains high amounts of preformed vitamin A. (A more scientific name is called retinol). Preformed vitamin A is found in animal products like eggs, milk, and liver. Too much of this type of vitamin A in your pregnancy diet can cause birth defects in your developing baby, especially during the first months of pregnancy. The other type of vitamin A is called provitamin A (carotenoids), which are found in fruits and vegetables. There’s no limit to the amount of carotenoids an expectant mother can safely consume, so you don’t have to worry about getting too much vitamin A from fruits and vegetables.

Benefits of eating Liver during pregnancy

Liver contains some vital elements that are considered essential for a mother and her baby during pregnancy, which makes consumption of liver quite a beneficial choice. (This is done with caution like we have discussed above)

Liver is a good source of proteins which are the core source of energy every pregnant woman must have in good amounts through out pregnancy, and she can get enough of them from the liver.
A child’s neurological development is one of the first things that happen as soon as conception takes place. Liver contains folic acid which plays a key role in the protection of the child within the womb as well as boosting the child’s neurological development.
Vitamin A directly impacts the development of eyesight and immunity of a developing child and there is no doubt that liver has plenty of this.
The mere fact that liver has an overwhelming presence of iron, is one of the major reasons why pregnant women need to consume liver since it reduces risks of anemia and keeps the blood healthy.

How much liver is safe for consumption?

If I told you, this is how much of the liver you can eat in a day, I would be telling a lie. There is no benchmark at how much proportion of liver is considered safe in which form for a pregnant woman. The proportions of vitamin A in it are quite substantial so it is quite easy to overdo them if one has regular consumption of liver. Therefore, it is generally advisable to keep its consumption restricted to once a week or twice a month.

The ball is now in your court, take that bite in your liver with caution the next time you are pregnant