Maternity in Malawi is a DIY gamble
We’ll deliver your baby, say the country’s rural clinics, but sepsis control is your problem
Hospitals in Malawi are expecting pregnant women to supply their own delivery kits — including unsterilised plastic sheets used during childbirth — amid a growing public health crisis aggravated by a budget squeeze.
An amaBhungane investigation revealed the widespread use of private delivery kits, which are seen as exposing mothers and newborns to postnatal infection.
Postnatal sepsis accounts for between a third and half of neonatal deaths in Malawi.
The funding shortfalls facing hospitals and clinics have been worsened by a development aid embargo by major donors in reaction to the plundering of government funds in the Cashgate scandal.
Local media have reported that ambulance services have ground to a halt as hospitals cannot afford fuel. In another sign of strained finances, a major hospital in the northern rural area of Mzimba wrote to the health ministry complaining its October allocation has been halved.
An amaBhungane investigation of district health facilities in the Malawian districts of Zomba, Ntchisi, Rumphi, Chikwawa, Phalombe, Nsanje, Dedza, Chiradzulu, Salima and Balaka established that the use of home-made delivery kits is the norm.
According to one official interviewed, expectant women are asked at antenatal classes to bring to hospital a metre of black plastic sheeting, to cover the bed during delivery, a razor blade to cut the umbilical cord; cotton wraps, for bed sheets and to wrap the baby after birth; and thread to tie the umbilical cord.
The practice is particularly prevalent in rural health facilities and district hospitals. The situation is not clear in referral hospitals located in urban areas, such as Kamuzu and Queen Elizabeth central hospitals, which did not answer questions sent to them.
Still, women who have given birth at these hospitals told amaBhungane that they had used their own delivery kits.
All the district hospitals interviewed by amaBhungane indicated that they are experiencing financial problems due to underfunding.
None of them had a specific budget for bed linen, which was incorporated in the drug budget.
Driving the use of plastic sheeting is the shortage of high-volume laundry facilities.
Some districts said their primary health clinics lack the large laundries needed to handle the volumes of soiled linen, and cannot afford to transport it to larger facilities.
The health ministry denied the use of private delivery kits and condemned the practice, saying hospitals supply the necessary materials.
According to government figures, neonatal deaths account for 40% of all child deaths in Malawi.
An estimated 18 000 newborn babies die in the first month of life. Neonatal infection is one of the three leading causes of neonatal death, alongside preterm births and breathing difficulties.
The current maternal mortality rate is 600 per 100 000 live births, with infection and bleeding being the major causes of mortality at health facilities.
A health ministry action plan launched in July this year says that neonatal sepsis accounts for between 33% and 48% of newborn deaths and emphasises that simple cord care and clean practices can make a major difference.
The document notes that leading causes of neonatal mortality are not comprehensively addressed and there is no policy to tackle the issue.
Frank Banda, a spokesperson for Mzuzu Central Hospital in northern Malawi, agreed that the hospital is underfunded. But he insisted that “Mackintosh” — waterproof sheets for the temporary protection of beds — is always made available for the use of expectant women.
However, Liana Tembo, chairperson of Chipwaira Health Facility in