-districts of Mwanza Region, Ukerewe is made up of 38 islands, though only 15 are inhabited.
But, authorities in the district are struggling to reduce the number of maternal and newborn deaths by putting in place necessary environment for safe delivery.
The move is in line with the harm reduction model, which is grounded in the principle of providing health education and other services without prior moral judgment, professionals provide information in order to reduce the risks associated with a specific practice.
To them (District Council), the death of a woman during pregnancy, at delivery, or soon after delivery is a tragedy for her family and for society as a whole.
In 2016, 15 women died in the district during delivery, whereby 14 died in health facilities and one at home and last year, reports show that only eight died (five in health facilities and three at home).
Most of these deaths are caused by postpartum hemorrhage, which is caused by poor nutrition—a result of poor dietary system,” says Dr Raphael Mhana, Ukerewe District Medical Officer (DMO).
He also cites worms as one of the contributing factors of maternal deaths in the district taking into accounts that most people living in Lake Victoria's islands drink water directly from the lake--this has been a challenge--particularly during pregnancy
“For those women who attend clinics are being given mebendazole –as part of the world Health Organization (WHO) recommendation ions. But, the challenge remains for those who don’t attend health facilities,” he says.
Other causes, according to Dr Mhana, include malaria, which accounts for 51 percent in the district followed by eclampsia, HIV/Aids and TB infections.
In 2015, 42 per cent of women delivered in health facilities, but now this has gone up to 78 percent.
“To us this is a big achievement and I’m sure we’ll meet the target due to the ongoing interventions.”
He reveals that the success story is a result of a number of interventions such as having all the essential medicines—ferrous sulfate, mesoprostol and oxytocin.
The availability of these drugs is between 90percent and95 percent, for the past four years, he says. The district hospital has been improved to meet the demand and “we’ve also improved four health centers and so far we’ve 34 dispensaries.”
Other interventions according to Dr Mhana include refurbishing two health centers out of four to the extent of offering surgery services to pregnant mothers in the district with the population of more than 400,000 people.
Active involvement of key players in the health sector has been cites as one of the interventions that helped in calling down maternal deaths in the district.
Traditional birth attendants (TBAs) and community health workers are very helpful when it comes to improve maternal health in the district, the district chief physician says.
He also points out that community health workers who are in every village can help to address some of the maternal related challenges.
It estimated that Ukerewe with 76 villages has a total of 152 community health workers, who are being paid some allowances (8,000/-) for them to work smoothly.
“The challenge is sustainability of these payments as most of them are being paid by some of our partners—NGOs. Our suggestions are for the government to see the possibilities of bringing on the government payrolls these people for their services to be sustainable.
He says having in place specialized mobile clinics to create awareness to the community on sexual reproductive health.
Despite the fact official data show that early pregnancies have been going down in recent years in 206/17--teen pregnancies were 127, 2017/18 were 72 and last year were 19, Dr Mhana says: “We’re planning to have regular visits to schools to educate youth on the dangers of teen pregnancies and inform them on best ways of addressing the challenge, which has been plunging them into early adulthood responsibilities.”
He also suggests the need to have an adolescent friendly health service centers that would make teenagers feel comfortable and my not think of terminating pregnancies.
“Most teenagers fear of being stigmatized by the society. So, we need to put in place supportive environment that will make teen pregnancy feel free to access MCH service in health facilities. They need special attention rather than the current system, where they are being mixed with adults.”
District Executive Director, Ester Chaula admits that maternal deaths as a challenge thwarting development in the district, which is made up of several isolated islands, something that makes hard to address the challenge.
Apart from geographical location, Chaula says limited number of civil servants in the health and other sectors has been worsening the situation as most people who are being relocated in the district refers the appointment as a penalties and there are lots of misconception and myths in the district.
There are those who don’t want to work here due to witchcraft believe, something which isn’t true,” she says, adding that the situation has putting health sector in a tight corner.
It was high time for the government to take Ukerewe as a special case when it comes to civil servants’ employment, she suggests.
The government should come up with a new program by employing people who are ready to work in Ukerewe District. Advertise employment for Ukerewe District only. This will help to address this challenge, she says.
Ukerewe District Council is now building an ambulance speed boat to easy transport for pregnant mothers who are referred to the district hospital or regional hospital. The boat is being constructed by Songoro Marine Transport at the tune of 191m/- and is expected to start operation this month.
“This new facility will help in saving mothers and their newborns in the Lake Victoria’s islands,” Chaula says.
The 2015-16 Tanzania Demographic and Health Survey and the Malaria Indicator Survey (TDHS-MIS) show that Mwanza, one among six regions of the Lake Zone records high maternal mortality, high fertility rate, low contraceptive prevalence rate (CPR) and high HIV prevalence rate than the national rates.
While the national CPR stands at 32percent, Mwanza uses 18 percent and it has around 53 percent of births at health facilities. The Lake Zone fertility rate is 6.4 children per woman where 36 percent of children are stunted,
The neonatal mortality rate stands at 24 for every 1,000 live births while the HIV prevalence in the region is 7.2 percent, in contrast with 4.7 percent national prevalence rate, the report shows.
Tanzania’s maternal and child deaths rate is one of the highest in the world at 556 per 100,000 live births. For comparison, the ratio for all developing countries is 240 per 100,000 live births, and that for all developed countries is 16 per 100,000.
About 66 percent of mothers don't have postnatal check in first two days after birth, while unsafe abortion is also associated with high levels of morbidity, the report indicates.
TDHS-MIS 2015-16 points at increasing teenage pregnancy and motherhood, as 27 percent of girls between the ages of 15 and 19 are already mothers or pregnant with their first child, compared with the national average where 17 percent of girls between the ages 15-19 are already mothers and another six percent are pregnant with their first child.
According to the latest UN global estimates, 303,000 women a year die in childbirth, or as a result of complications arising from pregnancy. This equates to about 830 women dying each day – roughly one every two minutes.