Paidamoyo Chipunza Senior Health Reporter
Infants delivered at home during a month long withdrawal of labour by municipal nurses are being followed up to monitor their conditions and to provide necessary interventions where necessary.
This development follows six recorded perinatal deaths and two maternal deaths in November.
The World Health Organisation (WHO) defines perinatal mortality as the “number of stillbirths and deaths in the first week of life and maternal deaths as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management.
Hundreds of women are reported to have given birth at home during the period when only five of the 12 polyclinics in Harare were operational.
Harare City Council runs 40 satellite clinics and health centres, all of which were forced to close because of the strike which started on November 4.
Central hospitals, which normally attend to referral cases from the local authorities and manned largely by doctors, were also taking in limited numbers of mothers because of the doctors’ strike which began in September, way before nurses downed tools.
This forced mothers who could not afford to deliver at private facilities to turn to traditional birth attendants amid warnings from the Zimbabwe Society of Obstetrics and Gynaecology on potential short and long term side effects of home deliveries.
Women who deliver at home risk suffering from sequelae of obstructed labour such as urinary incontinence, leaking of urine from fistulae, and chronic pain while their babies may develop complications such as anaemia and brain damage.
The gynaecology society said to prevent these long term side effects, deliveries were supposed to take place in a health facility as this would allow monitoring of possible complications, including high blood pressure, diabetes and infections among others.
It said after delivery, measures should be taken to prevent heavy bleeding with maternal injuries repaired quickly, safely and correctly to prevent bleeding infection and failure to control passage of urine or faeces.
Babies should also get prophylaxis against bleeding (Vitamin K) and if necessary prophylaxis against HIV and eye infections.
City Health Director Dr Prosper Chonzi said these figures could actually be under-reported since no one was taking statistics hence the need to work with traditional birth attendants in following up on all those who delivered at home.
“The major issues that come with such withdrawal of labour has to do with maternity and child health services hence we still have to quantify the impact of the one month of withdrawal of labour in terms of maternal and child deaths and associated complications.
“We know women were going to deliver somewhere, we might not know where exactly, but we know that the private institutions are very expensive. Of course some could have been going to mission hospitals, but others were delivering at home,” said Dr Chonzi.
“Just last week we had two maternal deaths in the community. So far, we only know of these two and we do not know how many others died because we were not providing the services so we are still working on the figures.”
He said in the follow up process, the municipality was also working on providing services that could have been missed by those who delivered at home.
These services included immunisation against tuberculosis, known as BCG and administration of nevirapine for babies born to HIV positive mothers.
Head of epidemiology and disease control in the City Health Department Dr Kudzai Masunda said so far, the local authority had recorded six perinatal deaths.
Dr Masunda said owing to withdrawal of labour by doctors at central hospitals, the city also had to deal with an increased number of patients compared to what it usually attended to when systems were functioning normally.
He said this resulted in a decline in the number of transfers to central hospitals in the month of October.
“There was a 110 percent increase in the number of babies born before arrival (BBAs) for September 2019 in comparison with September 2018. BBAs are babies born without skilled birth attendants. This is as a result of the industrial action at both central hospitals and city health facilities,” said Dr Masunda.
Municipal nurses, however, returned to work starting last week resulting in reopening of all city council facilities and resumption of normal services including evening clinics.