In Sierra Leone, medical professionals are worried about the effects of Covid-19 restrictions on maternal and child mortality, an issue that UN children’s agency Unicef has also flagged.
Binta Kamara, a nurse at the Kabala government hospital in northern Sierra Leone, says patient turnout is a problem. “Patients are refusing to come to hospital. We have to go out in surrounding homes to encourage them to visit health centres. Before the virus, we used to get close to 100% turnout, but now, we’re struggling to hit 50%.”
Misinformation plays a significant role in this, Kamara says. “There is lots of information flowing on social media and many of these [stories] are fake news. It makes people fearful of health facilities.”
Since the onset of the pandemic, health facilities in Sierra Leone have been plagued by erratic patient visitation. Informed by fears of the 2014 to 2016 Ebola outbreak, people worry about cross-contamination from hospital environments and prefer to seek alternative treatment.
The precarious condition of pregnant women and children under five is particularly concerning. Sierra Leone has one of the highest maternal mortality ratios in the world and remains one of the riskiest places to give birth. Almost 3 000 mothers lose their lives because of pregnancy or childbirth every year, according to the World Health Organisation.
For Kamara, this is a wake-up call. “What we have observed right now is that pregnant women prefer taking blind treatment at home and only rush to hospitals when their conditions become critical. Often they come very late and there is little or nothing we can do to help.”
This problem is not limited to Sierra Leone. Maternal health services are largely inadequate in sub-Saharan Africa. More than two-thirds of the world’s maternal deaths happen on the continent and four-fifths of these are because of poor care during and after pregnancy.
At a time when malaria deaths on the continent could double to 769 000 as the coronavirus disrupts efforts to fight the disease, pregnant women in Guinea, Sierra Leone and Liberia are particularly vulnerable.
This is very disconcerting, says Neneh Sesay, another nurse from the Kabala government hospital. “[Pregnant women] are so scared of the virus that even those scheduled for routine medical checkups do not come,” she notes. “The few who turn up come with malaria-induced complications like anaemia.
“Malaria leads to anaemia in pregnancy and this can lead to premature delivery, miscarriages and even death in some extreme situations.”
A pregnant woman, Fatmata Koroma, who lives in Kabala town, says a negative experience dissuaded her from visiting the health centre. “I went to the hospital once, but the nurses refused to treat me … They asked me to return home and self-isolate for two weeks. They could not even ask … what was wrong with me.“I felt really bad. I returned home that day feeling unwell.”
Kamara denies that nurses are part of the problem. “We are here for the patients and we feel bad that they’re not coming to the health centre … We try our best to respond to them, even though it’s not easy for us as well.”
In Nigeria, like Sierra Leone, profound levels of fear, coupled with misinformation, have left many doubtful about health centres. Now more people have less access to health facilities in a country where the doctor to patient ratio wobbles at about 1:2 500. Difficulties in accessing hospitals means that most people self-medicate by taking drugs without a prescription. It also means that some turn to herbal concoctions.
The practice of taking herbal treatments is common in Sierra Leone. Even in ideal situations, some pregnant women prefer to give birth in secret or at home with traditional birth attendants.
There are about 45 000 traditional healers in Sierra Leone, a country with nly one nurse or midwife for every 10 000 people. Traditional healers were banned from operating during the Ebola crisis, as many rural dwellers ran to them for treatment instead of going to hospitals.
Already, pre-existing challenges, such as lack of pre- and postnatal care, put pregnant African women in life-threatening situations.
“We must not let mothers and children become collateral damage in the fight against the virus,” said Unicef executive director Henrietta Fore.