There is no bigger disparity for any health care outcome between African and high-income countries than the morbidity and mortality of mothers and their babies. In Uganda, at least 16 women die every day due to complications of pregnancy and at delivery.
Action to reduce these rates has been largely restricted to the fields of medicine and public health. At the same time, there is a spectrum of challenging social and cultural factors that are an inescapable context within which maternal mortality occurs. However, the challenge has been to design research methods that effectively engage hard-to-reach populations, are replicable and scalable and which provide valid empirical socio-cultural evidence.
We used methods grounded in African social realities, opted for low-tech but widely used communications channels, and worked with local languages and natural forms of expression.
Over four weeks, three Luganda radio stations in Kampala broadcast weekly interactive shows that included a testimonial from a woman who had experienced pre-eclampsia, and a related question for the audience to respond to. Listeners could participate by sending a free text message to Africa’s Voices SMS platform. Some messages were read live on air. Participants received an SMS survey in reply that asked for their demographics and a topic-related question.
We gained 4462 SMS during the one-month study from over 2000 people. 49.6% of participants were women [Uganda population=51.2%] and 56.3% of participants were 20-29 years [Uganda population=29.0%]. Most messages were in Luganda, and some in English, requiring an innovative approach to analysis that combined in-depth qualitative techniques with large-scale automated analysis
Our analysis of the SMS data revealed a range of insights into what beliefs influence pregnant women’s decision to seek maternal health services.
For example, we identified gender variations in perception of internal causes (related to biology or supposedly dispositional traits of the mother) vs external causes (linked to low quality of health care, lack of support from husband of complications during pregnancy). Men tend to perceive internal causes, women more. In turn, men tend to perceive themselves and their partners as not at risk, and that complications are more likely to happen to women other than their partner.
Project team: Dr. Claudia Abreu Lopes (research lead), Rainbow Wilcox (project manager), Grace Kentaro (research assistant), Giles Barton-Owen (data analyst), Dr. Sharath Srinivasan (director) and Meddie Baliddawa (translator).
Research collaborators: Prof. Ashley Moffett, Dr. Annettee Nakimuli, Prof. Grace Kyomuhendo, and Dr. Gabriel Recchia.
The first phase of analysis looked at the quantitative data collected: numbers of participants, their location, age and gender. Below is the results from this initial analysis for radio station CBS FM. A similar infographic was provided for each station that took part to thank them for their involvement and so they can share results with their audiences.
Listen to the testimonial (in Luganda) of Nangoma*, which was played in the first show, when the audience was asked “What do you think caused Nangoma’s problems?”. Below is an English translation. NB: high blood pressure is a key symptom of pre-eclampsia.
During my first pregnancy I went for my first antenatal appointment at eight months. That is when I got to know I had mild blood pressure and was given an injection and stayed there for monitoring. But the pressure was increasing. I was admitted to the hospital on that day, slept there and the pressure kept increasing.For a long time I hadn’t gone to antenatal because I was scared of the hospital telling me those things of pressure. I was not feeling any pain that is why I did not bother to go for antenatal until 8 months.
I woke up in the morning and pressure was just increasing because of the medicine I had been injected with. Even the baby was affected. The baby’s heartbeat was so low that I was rushed to the theatre for emergency cesarean. Unfortunately the operation was delayed and my baby died because the baby was too tired. The baby was due in two weeks, but was removed at eight months because of my high blood pressure.
I have been pregnant four times with high blood pressure but only my third baby survived and is now five years and a half. The pregnancy of my third baby I got to know that I had pressure through my mouth when I was having lunch. I got paralysed in the mouth – it felt like electricity in the mouth. Then I went to the hospital they told me I was suffering from high blood pressure again. The third pregnancy survived because doctors made a decision to remove the baby at seven months.
I studied and heard that only fat people are the only ones who suffer from high blood pressure. I didn’t know that pregnancy brings pressure but learnt from the hospital. I found other women with the same conditions in the hospital. They used to tell us that swollen feet is a sign of twins in the womb, but I got to know from the hospital that it is a sign of high blood pressure. I also had headache because of pressure but when I went for check-up for pressure it is there but mild.
I don’t have any problem of high blood pressure when am not pregnant and I don’t even take any medicine. My husband thinks that when pregnant am too tough and very angry all the time and that is why I develop high blood pressure. Other people think that stressing myself with problems and work lead to this condition, I do a lot of hard work that is why my pregnancies do not survive and I get high blood pressure on each pregnancy.
*All names changed here and during radio shows to protect the privacy of the contributors.
We ran a series of discussion shows in Luganda (the major language of Uganda) about issues related to complications in pregnancy in August 2015. Audience members text in, with messages managed by an SMS platform developed by Text to Change.
Meet the radio hosts in the photos below:
Thank you very much for the opportunity you gave us. It was really great working with Africa’s Voices and we look forward to working with you again in the future. It makes me and Beat FM proud that our audience produced great results.