COVID-19 continues to be a global nuisance with changes noted only in changed epicentres. South America is the new epicentre with Brazil threatening to be one of the worst-hit countries. It is unfortunate that Brazil President Jair Bolsonaro did not embrace lockdowns and other common sense public health measures like social distancing and wearing of masks in public. The flame has become too big to extinguish, morbidity and mortality are now at unprecedented levels.
Data so far shows that COVID-19 is most dangerous for elderly persons and for people with underlying health conditions especially heart disease, hypertension and obesity. Recent reports have suggested that pregnant women are not at higher risk of developing COVID-19 complications and transmission to the foetus during pregnancy is unlikely.
Zimbabwe celebrated its first COVID-19 Caesarean section two weeks ago at Gweru Provincial Hospital. Both mother and baby are well today. Hats off to our team of diligent, cultivated and fervent doctors and nurses.
With research showing there are no direct increased chances of COVID-19 transmission and complications, the real impact of COVID-19 on maternal health will be felt in two major areas:
lConstrained access to reproductive and maternal healthcare and a subsequent increase in adverse health outcomes. lRapid societal changes disproportionately and negatively affecting families especially those from already marginalised communities.
In countries where COVID-19 pounded, for example United States, the health system was overwhelmed to the extent that maternal health distressed as resources were diverted to combating the spread of the virus.
The difficulty of tracking higher-risk pregnancies intensified as prenatal check-ups became virtual and the fear of contracting the virus deterred women from seeking in-clinic check-ups and even hospital deliveries.
Zimbabwe, like many other African countries, embarked on a lockdown which saw law enforcement agents manning roadblocks and demanding letters of travel exemptions in order to reduce the movement of people.
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We applaud such measures as the country has not witnessed an avalanche of mysterious deaths though the number of cases continue to increase. Maternal care has been grossly affected in Zimbabwe although there is no sufficient scientific data as of now.
Can maternal mortality rise from the 458 deaths per 1 000 live birth in 2017 because of COVID-19? It is, therefore, prudent to look into possible ways in which pregnant women have been affected:
Travel restrictions – The level 5 lockdown limited movement of people with banning of intercity mobility. Exemption letters were demanded at roadblocks and those without satisfactory letters were turned back. Pregnant mothers were not spared in the melee. A lot of antenatal care was lost and high risk pregnancies were lost to follow up.
Suspension of antenatal clinics — A lot of hospitals closed all non-emergent units in preparation for COVID-19.
Outpatient and antenatal services were suspended at referral centres like Parirenyatwa and Sally Mugabe hospitals.
Many pregnant women were left to do virtual consultation with some complications not detected early. It is good news now at Parirenyatwa as antenatal care is to resume.
Limited resources — Major focus in all health facilities seems to be on COVID-19 care. A lot of resources seem to have been diverted to the purchase of COVID-19 items like face masks, respirators, gowns, sanitisers. Maternal services have been relegated to low levels of support.
Maternity requires a lot of blood for transfusion. With schools closed in Zimbabwe and gatherings banned, the collection of blood has been compromised to a great extent. The big result is acute shortage of blood and in rural hospitals in Zimbabwe, getting blood for transfusion is a taboo.
Loss of post-partum support — Post-partum support has been compromised as travelling remains restricted. In our traditional societies, after delivery, it is expected that family elders give comfort to the post-partum mothers.
Some time is spent educating the new mothers on how to properly breastfeed their babies, how to clean the umbilical stump among other things. Moreover, post-natal visits are again compromised with the prevailing limitations to travelling.
Considering the above factors, it is incumbent upon authorities to consider some of the following strategies to mitigate against possible maternal complications: lHave full-time antenatal clinics with enough staff at all health centres.
lContinue with provision of maternal resources despite prevalence of COVID-19 virus. PPE for all health workers should be a priority in order to allay contraction fears. A fearful staff will not like to work. lPregnant mothers going for their scale should be allowed to pass through roadblocks so that follow-ups are not lost. lMaternal services should be as free as possible. With numerous job losses due to COVID-19, it is prudent that pregnant women are supported so that those without money can still manage to deliver. All of us need to assist in order to reduce maternal mortality.
Dr Johannes Marisa is a medical doctor, educationist and public health practitioner who can be accessed on [email protected]
