In the era of humanitarian crisis, young women continue to die in childbirth in Mali

Abstract

Maternal mortality occurs mostly in contexts of poverty and health system collapse. Mali has a very high maternal mortality rate and this extremely high mortality rate is due in part to longstanding constraints in maternal health services. The central region has been particularly affected by the humanitarian crisis in recent years, and maternal health has been aggravated by the conflict. Sominé Dolo Hospital is located in Mopti, central region. In the last decade, a high number of pregnant or delivering women have died in this hospital.We conducted a retrospective and exhaustive study of maternal deaths occurring in Mopti hospital. Between 2007 and 2019, 420 women died, with an average of 32 deaths per year. The years 2014–2015 and the last 2 years have been particularly deadly, with 40 and 50 deaths in 2018 and 2019, respectively. The main causes were hypertensive disorders/eclampsia and haemorrhage. 80% of these women’s deaths were preventable. Two major explanations result in these maternal deaths in Sominé Dolo’s hospital: first, a lack of accessible and safe blood, and second, the absence of a reference and evacuation referral system, all of which are aggravated by security issues in and around Mopti.Access to quality hospital care is in dire need in the Mopti region. There is an urgent need for a safe blood collection system and free of charge for pregnant women. We also strongly recommend that the referral/evacuation system be reinvigorated, and that universal health coverage be strengthened.

Individual and contextual factors associated with maternal healthcare utilisation in Mali: a cross-sectional study using Demographic and Health Survey data

“…4 14 More than 80% of these women's deaths in Mali are preventable. 15 This high maternal mortality ratio, however, comes at the backdrop of various interventions implemented by the government to ameliorate the status quo. [16][17][18][19] For instance, in efforts to improve access to maternal healthcare service, Mali, on 1 January 2005, introduced a fee exemption policy for C-sections which covered the cost of all C-sections including the surgical procedure and preoperative assessments, the surgical kit and postoperative treatment, and hospitalisation in public and private health facilities.…”

“…Mali’s maternal mortality ratio is estimated to be as high as 562 deaths per 100 000 live births 4 14. More than 80% of these women’s deaths in Mali are preventable 15. This high maternal mortality ratio, however, comes at the backdrop of various interventions implemented by the government to ameliorate the status quo 16–19.…”

Review of maternal death audits in refugee camps in UNHCR East and Horn of Africa and Great Lakes Region, 2017–2019

“…Achieving the global target of less than 70 maternal deaths per 100 000 live births by 2030 requires a mortality reduction more than double the rate achieved between 2000 and 2015. As an immediate measure there is a crucial need to improve quality and coverage of comprehensive SRH services, particularly comprehensive emergency obstetric care, which includes management of PPH; these services should be inclusive of refugee hosting areas 26,27 . Sustained progress in reducing maternal deaths will require progress on health system and multisector enablers and an equity‐driven approach encompassing, inter alia, universal health coverage, poverty reduction, improved nutrition, and gender equality 19…”

The psychological impacts of COVID-19 related stressors on Syrian refugees in Turkey: The role of resource loss, discrimination, and social support

“…Refugees are especially at great risk of infection and mortality during the pandemic ( Kluge, Jakab, Bartovic, d’Anna, & Severoni, 2020 ) because they mostly live in low- and middle-income countries with limited social and economic resources ( United Nations High Commissioner for Refugees, 2020a ). In such countries, COVID-19 puts an extra burden on already insufficient health care and economic infrastructure ( Fouad, McCall, Ayoub, Abu-Raddad, & Mumtaz, 2021 ; Lancet, 2020 ). Further, refugees are exposed to potentially traumatic events such as torture, injury, and captivation before arriving to host countries ( Steel et al, 2009 ), all of which might affect person’s physical and mental health leaving the person more vulnerable to disease.…”

“…Among them, a qualitative study with refugees in Uganda showed that COVID-19 brought significant changes in social and work life. It was also associated with fear, panic, and feeling of helplessness ( Logie et al, 2021 ). In a longitudinal study with Yazidi refugees in Iraq, Kizilhan and Noll-Hussong (2020) showed that the prevalence of post-traumatic stress disorder (PTSD), depressive and anxiety disorders significantly increased during the COVID-19 compared to before the COVID-19 period.…”