Preventing Maternal and Child Death in Rural Sierra Leone
Improved care, training, systems save more lives every year
Posted on Jan 11, 2024
With her left hand on an expectant mother’s belly, Sister Patricia Efe Azikiwe raises her right hand, wiggles her fingers, and explains how to examine the patient’s abdomen. With the fingertips, not the palm, she emphasizes. And don’t press down. Instead, gently move the hand in a circular motion.
For years, Azikiwe, a reproductive, maternal, newborn, child, and adolescent clinical program manager at the Partners In Health-supported Koidu Government Hospital (KGH), has guided the next generation of clinicians in eastern Sierra Leone. She uses a direct, practical approach, is passionate about her work, and has become a key part of training and care delivery within the facility’s maternal ward.
“No mother should die in pregnancy, at birth, or after delivery. And how we ensure that is by mentoring,” she says. “That will help us to reduce maternal deaths.”
Indeed, fewer mothers are dying. In 2020, the lifetime risk of women dying in pregnancy or childbirth in Sierra Leone improved from 1 in 20 to 1 in 52. For context, the same rate is 1 in 3,800 in the United States. Sierra Leone’s is still one of the highest maternal mortality rates in the world, yet care is steadily improving at KGH, where there was an 8% decrease in maternal deaths from 2020 to 2022.
Azikiwe and her colleagues hope to see that rate steadily improve over time through their hard work and dedication.
New approach, one goal: “save patients”
PIH Sierra Leone began supporting KGH in 2016 during the Ebola epidemic. Back then, the hospital was structurally in rough shape, care was expensive, and resources were sparse. There was no water or reliable electricity. If a patient needed surgery, their family member would need to supply the fuel to power the generator for the operation.
Today, the hospital is a renovated and welcoming space, where most services are free and significantly more comprehensive.
The expansive facility has surgical suites, maternal and child health and internal medicine departments, and the only emergency ward outside of Freetown, the capital. The maternity unit has many components, including an outpatient area for prenatal appointments, labor and delivery, its own surgical suite, recovery and post-operating rooms, family planning, and an adolescent and youth-friendly services section with a separate entrance to maintain patient privacy. A pharmacy and a blood bank are also housed in the ward. The latter is especially important, as it has made it possible to safely screen and store blood, meaning postpartum hemorrhage is no longer a death sentence for women. That is largely because PIH staff regularly speak with patients’ family members and have conducted community outreach about the importance of blood donation, as it was not historically an accepted practice.
These renewed services and resources are critical. And patients have noted the difference; the facility saw a 36% increase in women choosing to give birth there from 2020 to 2022. From January to July alone, there were 2,537 women who gave birth at KGH.
Among those women, 880 had lifesaving C-sections. In 2022, approximately 37% of births at KGH were C-sections. The percentage is high because KGH is a key referral facility for pregnancy complications, which often lead to a C-section.
“Saving someone’s life is something I’m so, so passionate about,” says Azikiwe. “This is a referral [hospital]. And as soon as a patient comes here, let us do what we are known for and save patients.”
“Good news room”
Attached to the maternity unit is the special care baby unit (SCBU), which was established about two years ago and is similar in capacity to a neonatal intensive care unit. Infants born outside the facility—at home or a district clinic—are cared for in one section, and those born in the hospital are housed in another section, all to prevent infection. In a short time, there has been high demand, including a 27% increase in monthly neonatal admissions between 2021 and 2022. From January to July of 2023, there were about 85 admissions a month, far surpassing the unit’s planned 20-person capacity.