Motorcycle ambulances bring down Uganda maternal deaths

Accessing health care in mountainous eastern Uganda can be difficult especially for pregnant mothers who are about to give birth. Mothers who are in areas that cannot be accessed by motor vehicles have to walk long distances to the maternity centers to give birth.If it is an emergency case, the mother risks losing her baby or even herself dying. Others stay home to be nursed by elderly women or traditional birth attendants who may not have enough skills to help a woman deliver.The introduction of motorbike ambulances in the eastern Ugandan districts of Mbale, Manafwa and Bududa districts has helped curtail maternal deaths during child delivery, according to health officials. Because of the motorbikes, more mothers are delivering their babies in health centers.The ambulance is a high-powered multi-terrain motorbike with a sidecar stretcher “bed” for a patient. There is also space for emergency on-site medical supplies and room to carry a health worker out to remote communities.They are stationed at health centers, and health workers or community members are trained to ride and maintain them. The bikes are able to navigate difficult road surfaces than car ambulances, especially during rainy seasons.In Mbale district, the ambulances are situated in the sub counties of Busiu, Wanale and Namanyonyi while in Manafwa district, they serve Bubulo and Bugobero sub counties. In Bududa, they are situated in the sub counties of Bushika and Bushiyi.John Baptist Waniaye, the Mbale district health officer told Xinhua in an interview that the region being a mountainous area, the ambulances were allocated to far-to-reach sub counties.Waniaye said unlike in the past where most pregnant mothers in the rural areas either delivered at home with the help of elderly women or traditional birth attendants, more mothers in the districts where the ambulances have been allocated now delivered in health units.“In Mbale district, a total of 11,000 women delivered at the Government health units last year, an increment of 39 percent the previous year. Coupled with the bad roads and steep terrain, there are areas in this region that become inaccessible to vehicles especially during heavy rains. These bike ambulances can access nearly any area,” Waniaye said.He noted that because Mbale has only two double cabin pick-up ambulances which cannot serve the whole district, the motorbike ambulances have partly bridged the gap.Roslin Nandaula, a midwife at Busiu health center, Mbale district, said statistics at the health unit for the first quarter of the year indicate that a total of 68 mothers delivered at the health unit in January, 72 in February and 78 in March.“Mothers tend to deliver at odd hours, like the night. These ambulances operate 24 hours which eases delivery to health units,” she said.She said the rural communities in the region often deliver mothers in very unhygienic conditions, for instance, tying the umbilical cord of the newborn baby with a banana fiber which increases the risk of infection.“Delivery in the health unit minimizes these risks including mother to child transmission of HIV/AIDS,” Nandaula said.The seven motorbikes were introduced by Partnership Overseas Networking Trust, a civil organization operating in eastern Uganda in partnership with the Uganda government two years ago.One of the main reasons for the introduction of the motorbike ambulances was to help reduce maternal mortality in the region.Uganda’s current maternal mortality rate is at 435 per 100,000 live births, according to ministry of health statistics.The UN Millennium Development Goal (MDG) Four aims at reducing by two-thirds, between 1990 and 2015, the under five years old mortality rate, from 93 children of every 1,000 dying to 31 of every 1,000.MDG Five targets at improving maternal health include reducing by three-fourths the maternal mortality ratio and achieve universal access to reproductive health.A study, which examined whether motorbike ambulances placed at rural health centers in Malawi were more effective than car ambulances, found that the bikes reduced referral times between health units and hospitals by between two and more than four hours.“Depending on the site, median referral delay was reduced by 2- 4.5 hours. Purchase price of a motorcycle ambulance was 19 times cheaper than for a car ambulance. Annual operating costs were 508 U.S. dollars, which was almost 24 times cheaper than for a car ambulance,” said the study which was published in the International Journal of Gynecology and Obstetrics in 2008.It concluded that in resource-poor countries motorcycle ambulances at rural health centers are a useful means of referral for emergency obstetric care and a relatively cheap option for the health sector.The researchers however added that the motorbikes did not eliminate the need for car ambulances altogether, and the reluctance of drivers to ride at night and the cost of, and access to, fuel were raised as possible obstacles to the use of motorbike ambulances.

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Motorcycle ambulances bring down Uganda maternal deaths