Indirect causes fuelling maternal deaths in pandemic

KATHMANDU: FEB. 11 – Three weeks ago, Salina BK from Simikot Rural Municipality-5 of Humla district died of postpartum complications. She had delivered a baby through a Caesarean section and her condition suddenly started deteriorating two days after the childbirth.

The district hospital Humla had reportedly tried to airlift her to a well-equipped hospital outside the district but could not succeed in arranging a helicopter as it was during the night that her condition deteriorated.

BK was among 84 women, who died of labour complications in the last six months (from July 16 to January 15).

But what is concerning is that these deaths occurred due to indirect causes, meaning these deaths do not happen due to excessive bleeding after childbirth, pre-eclampsia and eclampsia (pregnancy-related high blood pressure disorders), according to doctors.

“Indirect causes are responsible for a majority of maternal deaths,” Nisha Joshi, a senior public health administrator at the Family Welfare Division, told the Post. “The indirect causes include infections and Covid-19 infections.”

Nepal has to reduce maternal deaths by 116 per 100,000 births by 2022 to meet one of the Sustainable Development Goals.

The country has already missed its own 2020 target to reduce maternal mortality to 125 per 100,000 births. It had reduced the maternal mortality rate from 539 per 100,000 births in 1996 to 239 per 100,000 births in 2016—for which the country even received the Millennium Development Goals award.

The health target under the UN’s Sustainable Development Goals is to reduce the maternal mortality rate to 75 for every 100,000 births by 2030.

Officials at the Health Ministry admit that there may have been more maternal deaths during the last six months, as all deaths do not come in the government records.

As the country is still struggling to come out of the third wave of the pandemic, maternal health experts warn that the ongoing third wave could cause more maternal deaths.

“Public perception of the Covid infection risk has declined now compared to during the first and second waves of the pandemic and people have been saying that mere infection is not a big issue,” said Dr Ganesh Dangal, chairman of the Nepal Society of Obstetricians and Gynecologists. “Risk of infection remains high for pregnant women.”

In the first wave of the pandemic, authorities in most districts enforced restrictions—which has meant restrictions on public movement and all non-essential transport, and a drastic limitation on health care services as hospitals focus on Covid-19—only made things worse, say experts.

In many places, health care workers were too afraid of contracting Covid-19 and denied their services to patients, which resulted in many deaths including women.

Due to the fear of virus transmission, health workers seek coronavirus test reports from non-Covid patients before starting treatment and it can take several hours to get a Covid test report, which means, even after reaching the health facilities, pregnant women were deprived of timely treatment.

The institutional delivery rate, which was already low at around 59 percent, had declined further.

In the second wave of the pandemic, most hospitals providing maternity services were treating Covid-19 patients, which has discouraged pregnant women from seeking institutional delivery, fearing that the infection might transmit from the health facilities and health workers.

During the ongoing third wave of the pandemic driven by Omicron, a highly contagious iteration of the SARS-CoV-2, pressure has not increased in the healthcare facility, as the virus variant turns out to be of a mild type.

“Though maternity services have not halted during the current third wave, many women might have not sought the services fearing infection,” said Dr Aruna Karki, a consultant gynaecologist. “Those who have pregnancy-related complications must consult doctors.”

Maternal health experts said that the authorities concerned should not give up the measures aimed at preventing maternal deaths even during the pandemic. They said that the authorities should promote vaccination among pregnant women and new mothers, which lessens deaths from coronavirus.

So far, 15,932,041 or 54.6 percent of the total population have been fully vaccinated in Nepal.

On Wednesday, 2,401 people tested positive for coronavirus—1,851 in 11,603 polymerase chain reaction tests and 550 in 4,753 antigen tests.

In the last 24 hours, 14 people died of Covid-19 infections. Active cases stand at 30,241 throughout the country.

“Covid-19 infection could increase additional risks for pregnant women,” said Dr Damaru Prasad Paneru, a maternal and child health expert and an associate professor of public health at Pokhara University. “After the Covid-19 infection chances of secondary bacterial infections also increased in pregnant women. Pregnant women and their family members should take extra precautions.”

-Kathmandu Post