Analytical summary - Maternal and newborn health
The MDG goal is to reduce maternal mortality ratio by 75 per cent between 1990 and 2015. In Addis Ababa early 2009, the Heads of States launched a Campaign of Accelerated Reduction of maternal mortality in Africa (CARMMA). In Swaziland, the campaign has been adapted to CARMMS, to be coordinated by the Ministry of Health at national level and coordinated and implemented by the Regional Health Management Teams in the regions. At community level, the committees shall be formed to look into issues of maternal and child health financing during obstetric emergencies.
As shown by table 4.6.1 the figures for maternal mortality ratio between 1995 and 2011 showed a decline up to 1997 then an upward trend. The upsurge of maternal mortality has been attributed largely to HIV /AIDS and declining health systems. Pregnant women in Swaziland continue to die from four major preventable causes; severe postpartum haemorrhage, obstetric infections, hypertensive disorders, unsafe abortion and obstructed labour.
HIV prevalence among pregnant women has been estimated at 41 per cent. HIV/AIDS predisposes to sepsis and haemorrhage the two commonest causes of maternal deaths in the country. In the context of the ICPD and the MDGs, the country has the task of reducing the MMR from the baseline figure of 370 (in 1992) to 92 by 2015.
Table 4.6.1: Maternal Mortality Ratios (MMR) in Swaziland (1995 to 2007)
Increasing maternal mortality is occurring in the context of improved indicators for access to antenatal services. The 2006-2007 DHS showed that a high 94 per cent of pregnant women accessed Ante-Natal Care at least once. Nearly three quarters (74.1 per cent) of women delivered in a health facility, thus reducing the risks of complications and infections that lead to morbidity for the baby and mother. Further, about 97 per cent of pregnant women were attended to by a skilled health professional during their antenatal period.
Data on access to services during ANC indicates a supportive environment. Reporting on the 265 health facilities in the country, the SAM 2010 report indicates that just under two thirds (64.5 per cent) of health facilities offered ANC services. All hospitals, health centres, public health units and clinics with maternity are providing ANC services while just over two thirds (66.7 per cent) of those without maternity offered such services.
Specialized clinics were less likely to offer ANC services; only 10.3 per cent were providing such a service. The 2006-7 SDHS showed that the neonatal mortality rate was 22/1000 live births, the infant mortality rate was 68.4/1000 live births and the under five mortality rate (UFMR) was 120/1000 live births. Looking at the age pattern of the UFMR 70 per cent of all deaths took place during the first year of the child’s life. In turn, the majority of infant deaths occurred during post neonatal period suggesting that the major causes occur in the intrapartum period and immediate postnatal period. Overall, the results suggest that child mortality has doubled in Swaziland since the early 1990s, most likely as a result of the AIDS epidemic.
The Government of Swaziland has called for the virtual elimination of MTCT in the country by year 2015. The country has made tremendous progress in providing PMTCT services; three facilities offered PMTCT services in 2003 and the number had increased to 137 facilities by 2009. With the introduction of the MTCT prevention programme in 2003, the percentage of HIV positive infants born to HIV infected mothers has been lowered to 16.9 per cent.
Perhaps a damper to that achievement, about a third (33 per cent) of HIV infected pregnant women were still without access to PMTCT services. HIV prevalence among pregnant women has steadily been increasing since 1992 from 3.9 per cent to 41 per cent in 2010. This is despite of almost universal awareness about HIV and preventive strategies.
A key strategy under PMTCT programme is HIV counselling and testing to be offered routinely as an integral component of essential pregnancy and delivery package for all women. In the 2010 SAM, 150 of the 171 health facilities providing ANC services also provided PMTCT services. This represented 87.7 per cent coverage. Single dose Nevirapine (NVP) dose has been widely used since 2003.
In 2008 the country introduced the use of dual ARV regiment of AZT and NVP as the commended regiment of PMTCT as well as the use of HAART where medically indicated and the facility has capacity to handle that. In addition to ARVs, women had to be given cotrimoxazole as prophylaxis for bacterial opportunistic infections (OIs). PMTCT Technical Guidelines have been developed are readily available in all health facilities offering PMTCT services.