African Mothers Health Initiative

Providing care for critically ill mothers and vulnerable infants in Malawi.

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Activity Updates

November 2021

  • 8 babies were enrolled (6 orphans and 2 babies with mothers hospitalized in critical care).  Nurses visited 162 babies and discharged 12.  We are currently following 248 babies (newborns – 24mo).
  • 3 women were enrolled. Two of the three had stillborns and two of the three had total hysterectomies.

Baby Care Story.  Dalitso’s mom attended prenatal care throughout her pregnancy.  She wasn’t exactly certain how far along she was, and on 24th October Dalitso was born, weighing less than 5lbs.  His mom lost a lot of blood during the delivery and was transferred to the District Hospital for a blood transfusion.  Within the relatively short period of three hours after the birth, she arrived at the referral hospital and received the first unit of blood.  It took another seven hours for her to receive a second unit and by that time her condition had deteriorated significantly.  She died during the transfusion.

Postpartum hemorrhage is one of the most common causes of maternal death in Malawi.  The contributing factors include: pre-existing severe chronic anemia (malnutrition), poor management of obstetric hemorrhage, a poor emergency transportation system, poor access to emergency obstetric care, inadequate supply of blood products, and difficulty in accessing available blood products.  It is unlikely that midwives attending her at the referral hospital had an accurate estimate of the blood she lost during the birth.  The midwives were most likely assessing her need for blood by her vital signs and unfortunately a woman can lose 25% of her blood volume before she becomes symptomatic.  Even if she had received the two pints immediately following the hemorrhage, it is unlikely that this intervention alone would have saved her life.  She was 21 years old.   After the funeral, Dalitso’s grandmother brought him to Joyful Motherhood to enroll him in our program.  Our nurses will visit Dalitso and his grandmother monthly to provide formula and ensure that he remains healthy over his first two years of life.   DONATE

October 2021

17 babies were enrolled (12 orphans including a set of twins, 4 babies with mothers not producing milk (including another set of twins and one baby unable to latch due to hydrocephalus), and 1 baby of a mom with postpartum psychosis. Nurses visited a total 165 babies and discharged 13. 253 babies are currently being followed

4 mothers enrolled nurses visited 15 visited and are following 24.

Baby Care Story. Grace was born in June.  She weighed only 5lbs but she was healthy and left the hospital in her mother’s arms after 24hrs.  Breastfeeding went well and Grace filled out quickly and beautifully.  In early September Grace’s mother fell ill suddenly and lost her ability swallow.  She sought treatment at her local hospital and was then referred to the Regional Hospital for imaging.  There she was diagnosed with metastatic cervical cancer.  She died on September 24th. She was 39 with four children. Cervical cancer screenings (pap smears) are not routinely done in Malawi, there is not sufficient laboratory or pathology capacity to provide this service that is considered routine in the US.

Mother Care Story.  After several days of a tortuous labor, 18year-old Justina was transferred from a health center to a hospital capable of conducting a c-section. After the surgeon opened her uterus he lifted her recently deceased baby from her wound.  That loss was already more than her heart felt capable of bearing. After several days her surgical wound started to leak and gape, her abdomen became distended and painful.  She returned to the District Hospital, where the c-section was conducted and from there was referred to the Regional Hospital. When the surgeons opened her, her uterus, which should have been a vibrant pink/purple muscle was black and foul smelling. He removed her uterus and her ovaries, he did not speak to her or her family member. The following day the nurse on-duty at the hospital, informed the patient and her accompanying family member the significance of the surgery.

Our nurses will follow Justina over the next several months, monitoring and supporting her physical and emotional health. They will follow Grace until her second birthday.

September 2021

10 babies were enrolled (7 orphans and 3 whose mother critically ill in hospital). 147 babies were visited and 6 discharged. 243 babies are being followed

2 mothers were enrolled and one discharged. 23 women are being followed

Mother Care Story. 19-year-oldRhoda was healthy and had a normal pregnancy.  When her labor started she went to the nearest health center.  Labor was long and painful and did not progress.  After 24hours she was referred to the District hospital for a c-section.  At the time of the c-section her baby was already deceased.  She stayed in the hospital, with her cramping empty wound and empty arms listening to the crys of newborns around her for two days and then was discharged.  After spending just two days at home she noticed her abdomen beginning to swell and returned to the District hospital.  From there she was sent to the Regional hospital.  She began vomiting blood and seizing.  She was taken back to the operating room and a total hysterectomy was done – uterus, ovaries, baby gone.  On the medical ward her condition failed to improve and she was diagnosed with covid and then placed on isolation.  Rhoda is young and after several weeks her health was stable enough to discharge her but the emotional scars are deep.  Nurses will follow her not only to check on the visible wounds but also to counsel and encourage her as she begins to address the other invisible wounds that remain.

Baby Care Story. 19-year-old Dorothy went to her regular prenatal appointment toward the end of her pregnancy and diagnosed with pre-eclampsia.  Her legs were swollen and her blood pressure was quite high.  Within a few days her labor started on it’s own and she delivered a healthy baby boy.  Dorothy began to hemorrhage and was referred to Salima District Hospital.  There she received a transfusion of two units, but her blood loss had been significant and she died soon after.  Dorothy’s husband heard about our work through someone in his community and his mother arrived with the baby in arms.

August 2021

In August 19 babies were enrolled in the Baby Care Program. Of the 19, 13 of these babies were orphans, 2 babies with cerebral palsy and unable to breastfeed, 2 babies with mothers were unable to lactate, and one set of twins whose mother was not producing enough milk to sustain them both. Nurses visited 155 infants and 21 women.

Two women were enrolled in the Mother Care program.  One experienced sepsis and a difficult recovery, and the other mother had a severe postpartum infection which led to a complete hysterectomy. Both of their babies survived birth.

240 babies are currently being followed, 23 women are being followed.

Baby Admission Story. Chisomo’s mother became sick during her last trimester.  She developed a cough and a terrible headache that was unrelenting.  When she arrived at the hospital, nurses diagnosed her with high blood pressure and admitted her.  In an effort of self-preservation four days later, her body delivered Chisomo one month early.  She remained hospitalized for observation for an additional six days and then was discharged home.  Within two weeks, her condition deteriorated.  She died on her way back to the hospital.  No one knows the true cause of her death.  Covid? Pre-eclampsia? Severe anemia? Sepsis?  All these are possibilities.  What is known is that a previously healthy 39-year-old woman died on July 31st.  And with her death, her daughter Chisomo’s survival was also imperiled.   Thankfully Chisomo’s family was guided to Joyful Motherhood by someone who came to pay her respect at the funeral. Our nurses will continue to follow and support Chisomo over the next two years.

July 2021

In July we admitted 24 babies, this is the most admission we have ever had in a single month. 17 of these babies are orphans including 2 sets of twins.  Nurses are currently following 233 babies and 21 women.  Nurses visited 216 babies and women this month and distributed 587 tins of formula.

Baby Care Story. Everything went smoothly with Hajira’s fourth pregnancy. She experienced the regular fatigue and discomforts but she still managed to keep up with her other four children, even the twins. Thankfully the delivery was also uneventful, her daughter was born on May 19th and after 24hrs, Hajira took her new baby home to introduce her to the family.  Initially, everything continued well her baby was an eager feeder, she produced plenty of milk and she watched her daughter grow and change day by day. In mid-June Hajira felt the familiar symptoms of malaria – severe pain in her back and joints – and went to the hospital. She was treated for malaria and seemed to recover but then one week later she developed a cough. When she returned to the hospital, she was treated for asthma, but this time there was no improvement. Hajira died on July 5th.  Hajira did not have any pre-existing lung condition and though no one will ever know for certain it is possible that she may have died from Covid. Her family was immediately referred to Joyful Motherhood for continued support of her infant. 

As always we depend on your support to provide quality care to our beneficiaries, and with such a large increase in admissions our resources are stretched more than usual. Please consider making a donation in honor of Hajira.

We appreciate your generosity.

June 2021

In June we enrolled 6 infants, including 3 orphans and 3 babies without access to breast milk. Two of the mothers of orphans died from postpartum hemorrhage and the third died from unknown causes (they were 20, 21, and 25 years old).   Three postpartum women were enrolled, each suffered severe postpartum infections which ultimately led to total hysterectomies (they were 17, 19 and 30 years old). Nurses visited 148 babies and women in their homes. 589 tins of formula were distributed.

Mother Care Admission. Zione knew she would deliver her baby by c-section, her first two children were born by c-section and the safest option for her would be another c-section.  When her labor started she presented to the hospital and clinicians delivered her son again by c-section.  She returned home with her baby three days later. About a week later she noticed drainage from the wound and returned to the hospital. Her wound was reopened, and they found that her uterus was necrotic. She had a total hysterectomy.  Despite her severe illness and close brush with death, Zione recovered well and continues to breastfeed.  Joyful Motherhood nurses will continue to follow her at home until her recovery is complete.

Baby Care Admission.  Georgina was 21 years old and excited about having her first baby.  The midwives advised her to await labor on the grounds of the District Hospital (as opposed to at home or at a health clinic) so that she might access emergency obstetric care if necessary.  At the end of her pregnancy, she packed a bag and traveled to the District Hospital.  She waited two weeks before her labor started.  Her daughter was born on March 20th healthy and screaming but Georgina bled profusely.  Midwives stopped the bleeding but the following day it was clear that her condition was poor and she would need a transfusion.  She was transferred to the Regional Hospital but before any additional action was taken, Georgina died.  Her family assumed care for her newborn, struggling to feed and provide for her.  This month they were finally directed to Joyful Motherhood and we will continue to follow the family, provide home-based nursing care, formula and later porridge for the baby until age two.

Donate to support Georgina’s daughter and nursing visits to Zione.

May 2021

In May 8 babies were enrolled, including 7 orphans and 1 baby whose mother is admitted due to postpartum psychosis.  Mothers of the orphans died from:  seizure disorder (diagnosed in childhood), tuberculosis, 3 from severe anemia and an unknown illness, a respiratory illness, and an unknown illness.

This month we lost two babies.  Jennix was a twin whose health was strong during his first year but over the past several months he struggled with abdominal issues and this month he developed pneumonia.  He died in hospital.  Chifuniro was an orphan still receiving formula he developed a fever and respiratory illness in the village, he died before his family made it to the hospital.

Three women were admitted in May.  We are currently following 234 infants and 23 women.  140 visits to infants and women were made and 546 tins of formula were distributed to babies in need of formula. 

Mother Care Admission Story.  19-year-old Annie had a long labor and after 24hrs in hospital her baby boy was delivered by c-section on April 11th.  The baby developed a fever the following day and was admitted to the nursery (there is no NICU and only babies needing support are admitted to the nursery). Annie was discharged after two days but stayed on the hospital grounds waiting for her baby to recover.  On the fifth day after delivery, she experienced severe abdominal pain and began vomiting. She was transferred to the Regional Hospital and when the doctors opened her abdomen (11 days after delivery), they found that her uterus had ruptured during the delivery and it was also completely necrotic.  They did a complete hysterectomy and admitted her to the ICU.  She was discharged this month but is not producing any breast milk. Joyful Motherhood will continue to provide at home nursing care for both Annie and her son.

April 2021

In April we admitted 11 babies (10 orphans, which included one set of twins) and one baby without breast milk.  The 9 mothers died from: 5 from postpartum hemorrhage, 3 from unknown causes and 1 from postpartum sepsis.

We are following 233 babies and 21 women. Nurses conducted 155 visits to babies and women in their communities this month. 477 tins of formula were distributed.

We lost baby Matness this month to a case of severe malaria. The baby girl developed a fever and died within 48hrs, despite care in the hospital.

Mother Care Admission. 22 year-old Martha started labor on March 28th, three days later she had not progressed and midwives noticed that the baby was experiencing distress.  From an outlying maternity clinic she was transferred to the District Hospital for a c-second.  Once she arrived, her baby boy was promptly delivered by c-section and they were discharged three days later.  On April 8th, Martha returned to the hospital, she felt dizzy, her abdomen was swollen, she was feverish and nauseous.  The clinicians opened her wound and found a severe infection, the purulent fluid was drained and she received a blood transfusion.  Martha was discharged home on April 20th.  She was enrolled in the Mother Care program by Joyful Motherhood nurses and they will visit her six times at home to check on her wound and to assess the progress of her healing.

Baby Care Admission. When 18-year-old Laina progressed into her third trimester of pregnancy, midwives at her clinic told her to wait for her labor to start at the hospital.  As a first-time mother they knew it would be safer for her to labor close to a hospital where emergency obstetric services including an operating room would be available.  Even though her belly appeared to be the size of a complete pregnancy, she was only 34 weeks when her labor started and Laina went directly to the District Hospital.  She had an ultrasound in early labor and was told that she was expecting twins.  The baby boys delivered without complication even though her second baby came out bottom first.  Then immediately following their birth Laina began to bleed profusely.  Thankfully the midwives were able to stop the bleeding and stabilize Laina.  Laina and her babies were discharged the following day.   At home, even with the support of her mother, the first days were very difficult and then her condition seemed to worsen rather than improve.  After a week at home her family took her back to the District Hospital.  Clinicians who admitted her knew that she was suffering from severe anemia and they admitted her but she did not receive a blood transfusion.  Finally, thirteen days after the birth a transfusion was ordered.   Blood was available but they did not have a blood transfusion set. Two days later, previously healthy 18-year-old girl died leaving orphaning her twin boys.  She died because there was no blood transfusion set at a District Hospital, where she had gone following the advice of her midwives specifically so she would have access to expedient emergency obstetric care.

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