Maternal mortality in Zanzibar - Cristina's experience

May 28, 2019

This week’s case comes from Cristina, a HIPZ nurse who has been working at Kivunge Hospital since October focusing on paediatrics...


This week I would like to share with you a sad and unfair situation which happens frequently in Sub-Saharan Africa, the region that suffers from the highest maternal mortality ratio in the world. 


Maternal mortality refers to deaths due to complications from pregnancy or childbirth. Haemorrhage remains the leading cause of maternal mortality worldwide. Hypertensive disorders of pregnancy (including eclampsia), as well as sepsis, embolism and complications of unsafe abortion also claim a substantial number of lives. According to the World Bank in 2015, in Tanzania the maternal mortality ratio was 398 per 100,000 live births. This is unacceptably high, especially if we compare it with some European countries like the UK (9 per 100,000 live births) or Spain (5 per 100,000 live births).


Unfortunately we have some cases of maternal death in our hospitals in Zanzibar. I would like to share with you one of our recent cases and how we are helping the resulting orphaned babies from our paediatric outpatient clinic.


One day in January we went to the outpatient department to help in an emergency. It was a 23 year old woman three days post delivery of her second daughter at home. According to her family, the day before she had gone to another hospital, complaining of dizziness, fever and severe bleeding, but after being examined she was discharged. When she arrived to Kivunge hospital, unfortunately we were only able to confirm her death. Her mother and her husband were completely in shock, and so were we. It was a terrible, sad and unfair situation, but at least we could still do something for her small baby girl. So after we comforted her family, I gave them enough formula milk to feed the baby until the next paediatric clinic. Since then we have been following her progress, and she is a healthy baby girl who always comes with her grandmother and dad who are taking care her and her big sister.

During these seven months working in Zanzibar, the orphaned babies project has been one of my priorities. From the beginning it has been something personal because during my first week in Kivunge Hospital, one patient died three months postdelivery, likely due to post-partum cardiomyopathy (heart failure due to pregnancy). Her baby girl has been followed in the clinic until now.


I have been working near to these families, supporting them with counselling and formula milk to try to reduce the impact and consequences in these small babies because when a mother died in Sub-Saharan Africa, there are serious negative consequences for her family, community, and the entire process of economic and social development. 


Fortunately we can give formula milk from our hospitals, kindly donated from ZIDO. We give formula milk to orphaned babies during the first year of life because if we don't provide it to them, these babies have a high risk of dying from malnutrition, diarrhoea and infections. Currently we are helping 9 orphaned babies from our paediatric outpatient clinic in Kivunge. During the last months we have improved the protocols, nutritional counselling and register in order to help these families more efficiently.


According to UNICEF between 1990 and 2015, maternal mortality worldwide dropped by about 44%. Most maternal deaths can be prevented if births are attended by skilled health personnel – doctors, nurses or midwives – who are regularly supervised, have the proper equipment and supplies, and can refer women in a timely manner to emergency obstetric care when complications are diagnosed. 


In HIPZ we are supporting training of the maternity staff to prevent more maternal deaths and education of the population to give birth attended by skilled health staff. 

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HIPZ (Health Improvement Project Zanzibar) is a registered charity (no: 1171687) and limited company (no: 10168369).

Our registered office is Rosehill, Broomfield, Bridgwater TA5 2EL, England