Women in the country are five times more likely to die after a caesarean section (CS) than natural deliveries, making Malawi one of the deadliest places for surgical births, a new study has found.
Despite accounting for only 16 percent of births, according to the research, caesarean sections are responsible for 51.8 percent of all maternal deaths.
“In comparison with global data, Malawi has a higher proportion of CS-related maternal deaths.
“Worldwide, 32.8 percent of post-natal maternal deaths follow a CS; in sub-Saharan Africa this rises to 38 percent,” reads a study report published last week by BMJ Global Health titled Maternal Mortality Following Caesarean Section in a Low-Resource Setting: A National Malawian Surveillance Study.
It was conducted by scientists from Kamuzu College of Health Sciences, University of Liverpool, the Malawi-Liverpool-Wellcome Clinical Research Programme and institutions in Uganda and Norway.
A caesarean section is a surgical procedure that delivers a baby through incisions in the mother’s abdomen and uterus.
It is usually carried out when a natural birth is too risky for the mother or baby.
The scientists point out that they used data collected between 2020 and 2022 from 89 098 caesarean sections and 465 375 natural births.
It was from 33 healthcare facilities across Malawi, including all four central (tertiary level) hospitals, 27 district hospitals and two health centres.
“Deaths occurring outside of these facilities such as in the community and in private for-profit and private mission hospitals are reported by the corresponding district hospital and are, therefore, also included in our analysis,” the scientists explained.
The study identified a couple of systemic issues worsening maternal deaths with healthcare worker factors contributing to 89.1 percent of caesarean deaths.
Prolonged abnormal observations without action, delays in treatment and insufficient blood transfusions are the other highlighted leading issues.
Postpartum haemorrhage, infections and eclampsia are primary causes of deaths following caesarean sections, the researchers write.
“The risk of dying from infection after a caesarean section is more than double that of natural deliveries, with an odds ratio of 2.03,” the report further reads.
Malawi’s maternal mortality rate of 685 deaths per 100 000 live births is among the highest globally, far above the United Nations’ target of fewer than 70 deaths per 100 000 by 2030.
“There is an immediate need for caesarean-specific interventions to address the disproportionately high risks faced by women undergoing this procedure,” the study advises.
The Ministry of Health had not responded to our questionnaire as we went to press.
However, the Medical Council of Malawi (MCM), the health sector regulator whose primary mandate is to protect patients and the public, described the study as informative.
In a telephone interview on Friday, MCM chief executive officer Davie Zolowere said the high death rate could be attributed to the fact that the CS is often recommended when there are complications.
“When there are such complications, chances of survival are already diminished
“This study, however, underscores the need for us to continue the work we do as a council,” he said.
Zolowere further disclosed that 25 percent of complaints they handle are related to childbirth, highlighting the public’s concerns about how maternal cases are managed.
He said the council will continue inspecting health facilities to ensure they are adequately equipped with resources and expertise to execute their duties efficiently.
Meanwhile, health analyst Maziko Matemba, commenting on the findings, said they reflect the ongoing challenges Malawi faces when it comes to maternal deaths.
“The study’s findings are significant and accurate given the difficulties in health care systems in low-income countries such as Malawi. These findings should serve as a wake-up call for service providers,” he said.
Matemba was particularly concerned with the 89.1 percent causes of death attributed to healthcare workers’ misconduct.
“Immediate action is needed to protect the lives of women and girls. As civil society organisations, we urge the Ministry of Health to take action in response to these findings.
“This is about safeguarding the lives of women and girls, which must always be a priority,” he said in response to our questionnaire.
Physicians Assistants Association of Malawi (Paum), whose members play a critical role in performing caesarean sections, described the findings as a true reflection of realities on the ground.
“Most of these findings can be accepted when you consider the prevailing conditions and contributing factors,” said Paum president David Chomba.
However, he defended health workers, arguing that they operate under harsh conditions that make it difficult to achieve perfection.
“We have clinical officers working 24 hours a day. When I was at Mzuzu Central Hospital, I worked in the theatre from 7 pm to 7 am, conducting operation after operation because there was insufficient staff,” he said.
Chomba also highlighted the lack of medical supplies as a major barrier to infection prevention.
“A lot of health facilities fail to follow infection prevention protocols. You find someone going into the theatre and there are no antiseptics,” he explained.
