Can “Tele-health” Cut Maternal Mortality in Zambia?

Brenda Zulu

Zambia is struggling with high maternal mortality rates, but new information technology will allow providers better access to patients' medical records and may make childbirth safer.

Zambia is
unlikely to meet the Millennium Development Goal (MDG) on maternal health as more than 700 women die each year from
pregnancy related complications. This is cording to former Health Minister
Angela Cifire, who bemoans that Zambia’s
maternal health is one of the highest in the sub-Saharan Africa region — with 720
of 1,000 live births resulting in death.

In the 2007 MDG report, Cifire observes that unlike the latest
Hollywood trend, in which celebrities give birth in an exclusive labor ward
especially furnished for the babies’ arrival with video cameras ready to put
everything on record and more doctors than necessary at one’s disposal, labor
is usually tormenting for most Zambian women — especially those in rural areas.

Recently there has been an
increase in cases of women even in urban areas delivering in non-conducive
situations, thereby endangering their lives. Most of these women die due to lack
of skilled labor, excessive bleeding, as well as lack of donated blood. The country must grapple with the challenges of meeting the millennium
development goal on reducing maternal mortality by the year 2015. Cifire called for collective action to save
hundreds of mothers who die from pregnancy related complications.

Women for Change Executive Director
Emily Sikazwe says she was saddened by the 
high maternal mortality rate in the country. World Health
Organization Country Representative Stella Anyangwe said it was sad that the
just-launched Vision 2030 does not address maternal health and primary health
care like it does on HIV/AIDS.

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In 2001-2002, 77.2 per cent of the women who had a non-institutional
delivery did not
postnatal check-up. W
omen in rural areas (81 percent) were discharged before receiving the
postnatal check-up, compared with those in urban (53 percent) who did not
receive the postnatal care. Other reasons for increasing Maternal Mortality Ratio
(MMR) include limited access to facilities due to few health facilities; long
distance to facilities; lack of or costly transportation facilities;
shortage of trained staff; attitude of some health staff; and poor quality of
care (untrained staff and lack of surgical and medical supplies). Low postnatal
care, prenatal complications, complicated deliveries, postpartum deaths from hemorrhage
and infections and post abortion complications also contribute to increased maternal mortality rates. 

mortality increased from 649 deaths per 100,000 in 1996 to 729 deaths per
100,000 births during the period 2001 to 2002.
to the UNDP 2003 MDG report, the target for maternal mortality ratio in 2015
is 162. The critical indicators in maternal health include access to antenatal,
delivery and postnatal care. A total of 95.7 per cent of the women in
2001-2002 received antenatal care; 93.4 per cent from a health
professional and 2.3 per cent from a Traditional Birth Attendants (TBAs). 

percentage of women receiving antenatal care from a health professional
slightly decreased from 96 per cent in 1996 to the 93.4 per cent in 2001-2002
period. One contributing factor to high maternal ratio could be the increase in
the number of women delivering at home. During the 2001-2002 ZDHS, 56 per cent
of the women delivered at home and fewer of them, 44 percent, at a health

persons are also attending slightly fewer deliveries, while the proportion of
births attended by traditional birth attendants (TBAs) increased to the highest
record in 2001-2002 since 1992. The proportion of women delivered by a medical
person declined, from 51 per cent of births in 1992 to 47 per cent in 1996 and
44 per cent in 2001-2002. The proportion of women delivered by a relative or
friend consequently, increased from 33 percent in 1992 to 41 per cent in 1996,
though slightly declined to 38 per cent in 2001-2002. Postnatal care is
important in detecting complications related to delivery.

Meanwhile, the use of information communication technologies (ICTs) in delivering
care to pregnant women and newborns in Lusaka is on the verge of becoming
easier and more efficient, thanks to the advent of Tele-health, which is
simply the use of information technology to deliver health services and
information from one location to another.

Collins Chinyama, former information technologist at the Central Board of
Health, describes the concept of tele-medicine as a multimedia system using
voice, video and data to deliver medical services remotely. "People may phone
their doctors and prescriptions are done either by telephone or fax," he says.

But the new technology overcomes the limitations of the telephone and fax to
ensure that patients are diagnosed from remote locations. Tele-medicine has its
advantage and negative sides: though it meets government needs for bringing
health care as close to the family as possible, the need for medical workers
will also diminish. But it has the potential to bridge the gaps created by Africa’s
brain drain as health professionals seek greener pastures in developed nations.
"There is need for tele-health in Africa because it has
very few doctors and there are increasing health needs and staff constraints in
most hospitals," says Chinyama.

Tele-health works by installing information technology such as digital cameras,
camcorders, digital senders and other medical equipment in all health centers. Lusaka
women and their babies are the first beneficiaries of new technology in health,
with the establishment of an electronic prenatal record system.

It is fitting that this new technological adventure should start at the source
of life: many of the basic needs in the care of pregnant women and newborns
have largely been unmet in Zambia.
This is despite the fact that inadequate resources can literally be a matter of
life and death in the maternity situation. Zambia’s
maternal and infant mortality indicators are unacceptably high. United Nations
statistics show a one in 14 lifetime risk of death in pregnancy for women. The just
released demographic and health survey show that these statistics have not
improved over the past five years, making this a high priority concern.

Customized software designed by doctors from Lusaka district, the University of
Zambia Teaching Hospital (UTH) and the Central Board of Health (CBOH) will
eventually replace the paper records currently in use. Computers in all Lusaka
clinics that provide antenatal care will be linked with several wards at the teaching
hospital through a high speed wireless network. Patient data will, therefore,
be entered just once and not a dozen times. Whether or not a woman goes to the
same clinic, the nurse attending her will be able to see all the relevant
information about her without having to ask for it and re-entering it again.

Healthcare for pregnant women in Lusaka
is a large and complex system. Nearly 50,000 deliveries take place in Lusaka
district clinics and the teaching hospital. Most mothers make multiple antenatal
and postnatal visits, and many of them go to several sites for health care.
Benefiting groups will receive better care because clinicians will have more
information and more time to focus on giving care.

Maureen Chitalu, a mother of three, says she hopes the use of information
technology will also manage complicated cases. She explains: "I live in
Mutendere, where I also go for my antenatal care. During my previous
pregnancies, nurses kept on referring me to the UTH, where there are
specialists, because I delivered by cesarean section last time I was pregnant.
It was not easy. I had to spend a lot of money on transport and, in the
process, wasted a lot of time. With the new system in place this should now be
a thing of the past."

At one time, clinic staff at the teaching hospital could not find her records
as they were never kept in an organized manner. But the tele-health project now
means clinicians will be able to monitor and track patients, see their entire
history at a glance and analyze the outcomes. Health care officials will be
able to generate better information about the population.

Tele-health will also ensure security and confidentiality of patient
information because it will be more difficult to gain access to patient data.
Nurses and doctors will have to enter a password to see individual records.
Although officials of the Central Board of Health and the district health
management board will be able to see statistical information but only
authorized clinicians will have access to personal patient information.

For now, an automated referral system is being written for Lusaka
and it will be the first program that will be used in the computers. It is
hoped to be introduced soon.

Chinyama explains that each clinician will receive an individual e-mail
address. Telephones will be connected to the computers, allowing phone calls
throughout the network and training manuals will be available on the computers.
Free computer training is expected to take place through the end of 2003. It
will include general computer knowledge, e-mail, filling out web-based forms,
refereeing patients using the automated referral system and using Acrobat
reader to access training manuals.

The benefits to clinical care will be that training materials will be easily
available and there will be better communication between sites and automated
checks on care quality. Voice Over Internet Protocol (VOIP) telephone will
allow district health management board midwives to speak to teaching hospital
midwives or doctors at any time. The health management board midwives will also
be able to track their referred patients as the system will allow more accurate

It is of great relevancy that Zambia
applies emerging technologies to empower rural communities towards the
attainment of the MDGs goals as this is the theme of the Africa
Telecommunications Day which is observed on December 7 every year.

Topics and Tags:

Childbirth, Maternal mortality

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