Doctor cites poor infrastructure and education for high maternal mortality rate

Stung Treng Province

AS Dr Heng Nhoeu, director of the Stung Treng provincial Health Department, addressed a delegation of 20 government officials there last weekend, the power cut out four times in 90 minutes, effectively underscoring one of his main points: that poor infrastructure is hindering his efforts to lower the maternal mortality rate.

However, the challenges he and his staff face are not limited to inferior facilities and sometimes-impassable roads, as there is also a pervasive lack of education, particularly when it comes to health issues, he said.

“Maternal health is related to infrastructure and education,” he said.

“Stung Treng is the centre of the region with the most issues because it is a remote area where the density of the population is very low and there is a high percentage of illiteracy.”

Despite these problems, government statistics indicate that Stung Treng has made considerable strides in lowering its maternal mortality rate, which has remained stubbornly high nationwide.

Ho Naun, a Cambodian People’s Party lawmaker and head of the National Assembly’s public health committee, cited estimates pegging the rate at around 200 deaths per 100,000 live births, far lower than the 461 deaths nationwide recorded in the 2008 census.

“From what I understand, Stung Treng is one of the best examples of progress in reducing maternal deaths in the region,” she said. She added that she had opted to take the delegation there in order to learn from its successes.

But during the visit, which took place last Saturday, officials were intent on highlighting their concerns that the maternal mortality rate will only rise again if healthcare resources are not vastly expanded.

The presentation by Heng Nhoeu was followed by comments from Ung Soviet, director of the provincial referral hospital, who emphasised what he described as an urgent need for basic medical supplies and equipment.

“The hospital has only one ambulance, and it is too small. We cannot stand up inside the ambulance, and it makes our work more difficult,” he said. “We have to spend a lot of money on maintenance. We recently hit a cow, and it was very expensive.”

Conducting births

The delegation met with health officials and commune leaders from Stung Treng, Kratie and Ratanakkiri provinces to discuss areas of improvement and persistent challenges.

Heng Nhoeu called for more public-education campaigns aimed at raising the number of deliveries attended by professional health workers, which he said would be crucial for meeting the Millennium Development Goal pertaining to maternal health.

The maternal mortality target under the goal is 140 deaths per 100,000 live births, though Health Ministry officials requested last year that the target be raised to 250.

Heng Nhoeu said roughly two-thirds of pregnant women in Stung Treng deliver using traditional birth attendants, and that 5 percent of births in the province tend to have serious complications requiring emergency obstetric services, which traditional attendants are generally unable to provide.

He also said traditional attendants tend to work with unhygienic instruments, and that they have less formal training.

Around 3,000 births take place each year in Stung Treng’s health centres, where mortality figures are low, he said.

His department recorded four deaths in 2007, six in 2008 and two in the first quarter of 2010, he said.

Ho Naun said the Health Ministry might introduce incentives for traditional attendants to refer women to health centres, though Heng Nhoeu said it would take time to dramatically increase the number of births conducted by skilled attendants, and that more training should also be provided to

traditional ones.

Despite these and other challenges cited by the officials, Ho Naun said the delegation had been encouraged by what it had heard.

“I feel optimistic about the [Millennium Development] Goal because we have seen a reduction in maternal deaths,” she said.