Low blood levels pose risk to expectant mothers, babies

Mariam Barisa at the Kilifi Referral Hospital where she got transfused after losing her child due to lack of blood in Tana River County Hospital. [Marion Kithi, Standard]

Rehema Kavuna arrives at the Rabai Sub County Hospital feeling dizzy and struggling to breathe.

After examination and tests, doctors discover she has acute anaemia.

She is already in labour so doctors quickly arrange for a blood transfusion and move her to the delivery room, where she safely gives birth after receiving blood.

“I feared for my life when I learnt my haemoglobin levels were only 4,” says Kavuna.  “I am grateful they had blood ready to save my life,” she adds.

Like Kavuna, many expectant mothers struggle with low blood levels. Health data shows that at least 50 per cent of pregnant women presenting in hospitals in the Coastal region have low levels of Haemoglobin (HB),  a vital protein in red blood cells that carries oxygen.

“Pregnant women with HB of 11 or 12 are very rare,” says Loice Matho, maternity-in-charge at the facility.

“Most are at 7 or 8, a level that significantly increases the risk of death from post-partum haemorrhage,” Matho adds.

Data reveals that out of 200 women delivering at the hospital every month, 170 have low HB levels, with about 20 transfused.

Efforts to address these challenges include regular blood drives and hospital collaborations to ensure timely access to the vital body fluid.

“However, meeting demand remains challenging due to myths about blood donation,” adds Matho.

“Low haemoglobin levels increase bleeding risks and threaten the health of both mother and child,” stressed Janet Mwapao, deputy nursing officer, while underscoring the importance of early checks.

Rabai Sub-County Reproductive Health Coordinator, Choni Chigulu, reiterates the risk of post-partum haemorrhage (excess bleeding) as a result of low blood levels in pregnant women.

Other risks include premature labour because of placental insufficiency (lack of enough nutrients in the placenta).

On the other hand, babies born of women with low HB also risk low birth weight and stunted growth that further affects their cognitive function, resulting in poor academic performance.

Babies are also likely to die before maturity if a mother has low blood levels.

“A woman with anaemia stands a high risk of having a post-partum haemorrhage. This is why we insist on HB being above 11 so that even if they bleed, they are likely to survive,” adds Chigulu.

Kilifi County health data shows that last year, at least 43, 243 deliveries were recorded, out of which, at least 4,129 babies had low birth weight, a slight drop from 4,413 in 2022.

The data further documented 26 maternal deaths last year, a drop from 31 in 2022.

Damaris Zawadi has been spending dreary days and nights at Kilifi County Referral Hospital, waiting for blood supply.

The 27-year-old, who is nine months pregnant, requires a transfusion before delivery

She has five pints of blood and is slated to receive an extra two through transfusion.

Sadly, amid her wait, her blood level keeps dropping.

“Doctors say my case is dire, and to save my life and that of my baby, I need to be transfused, but I am yet to get a donor,” Zawadi tells ‘The Standard’.

To boost her haemoglobin, she has been feeding on green leafy vegetables, beetroot, supplemented by folic acid and blood boosters, but her level remains low.

Adjacent to Zawadi, is Miriam Barisa, who is scheduled for a corrective surgery following a botched Caesarean Section at the Tana River Hospital on June 10. She also had a history of high blood pressure, coupled with excessive bleeding.

“I came here because I needed a transfusion. I do not know how I lost blood from 11.9 HB during pregnancy to only 5 after delivery,” she poses, obviously distressed.

During a visit to the facility, Barisa had been transfused with 3 pints of blood, and taken to the theatre.

Lenox Taura, a nurse at the Kilifi referral hospital, says, “At least two women die in the labour room due to lack of blood, as well as three stillbirths every month”.

Kilifi’s health reports attribute low HB to poor diet and lack of pre-conception care.

In the area, most pregnant women’s diet majorly consists of rice, ugali, and potatoes, with almost zero green leafy vegetables.

Green leafy vegetables in a diet boost haemoglobin which helps prevent anaemia.

“Pregnant women prefer eating ‘viazi karai’ (fried potatoes) instead of eating a diet that is essential in increasing haemoglobin levels,” says Chigulu.

But challenges in blood drives in Killifi county, according to health director, Dr Hassan Leli, remain unclear.

Some locals believe that being transfused makes them “acquire donors’ characters”.

Dr Daisy Juma, the in-charge at Rabai Sub County Hospital during health sensitisation forum. [Mercy Kahenda, Standard]

“A lot of myths surround blood and there are unknown fears in blood donation. Some people fear how their blood is used,” says Leli.

“Through education, we assure them during messaging that when blood is donated, it is used to support someone,”, he adds.

Kenya National Blood Transfusion Services (KNBTS) manager Coastal region Grace Nzilani says maternity is the highest consumer of blood in Kilifi and Coastal region, followed by accident and cancer patients.

In Maternity, mothers require “whole blood, or platelets to stop bleeding, whereas cancer patients require platelets for treatment”.

However, myths surrounding blood donation and low haemoglobin among locals is a major hindrance to blood collection drives in Coastal region.

Kilifi for instance she says “men rarely donate blood for their wives because it is believed if they do, the wives are likely to die”, whereas women rarely donate for unknown reasons.

Additionally, she says haemoglobin levels among people in Coastal region is low because of high humidity, which limit their donation.

“People come to donation centres to donate blood only to be found to have haemoglobin levels 5. Out of 60 people turning out to donate blood, only 20 go through,” says Nzilani noting that highest HB level among men is 11.5, and 10.5 in women.

Annual blood target for coastal region is 100 per cent, but KNBTS together with partners only manage to receive about 70 to 80 per cent.

As a mitigation, KNBTS is sensitising communities through Community Health Promoters and local administrators on the importance of blood, and to demystify myths surrounding blood.

Additionally, individuals more so women are trained on nutrition to boost their haemoglobin levels, away from fast foods.

On her part, Chigulu observes that preconception care is key in boosting haemoglobin in maternal health.

“Before you get pregnant, your womb and body should be prepared,” Chigulu.

Additionally, Antenatal Care (ANC) helps correct anaemia in women who have not undergone pre-conception care.

Those with low HB are transfused, and then put on iron and folic acid supplements.

 A doctor’s experience in rush to donate blood did not save patient’s life

Dr Daisy Juma, a consultant family physician, was shaken.

She had just received a pregnant woman due for delivery and was bleeding, having had a uterine rapture.

She was wheeled to theatre, but could not be operated on, having had low blood levels. She was paper white (pale), yet blood banks at the hospital were dry.

“As a medical officer on call and a surgeon, I made multiple calls to different hospitals across the coastal region but could not get the commodity," recalls Juma. "The situation was dire,”.

The in charge at Rabai Hospital, who was by then working at Kilifi County Referral Hospital, dashed into the laboratory, to donate blood for the mother

Sadly, the woman died in the process of being transfused.

Dr Daisy Juma, the in charge at Rabai Sub County Hospital. [Mercy Kahenda, Standard]

“I am yet to get closure to the woman's death. If we had blood in our banks, I could have rushed her immediately to the theatre and removed the uterus to save her life. I got blood, but it was late,” recalls the doctor.

In another case, she witnessed a woman collapse at the admission area at the facility.

She rushed to save the life, but it was too late, woman had lost blood to internal bleeding as a result of uterus rapture, but delayed seeking care.

“I wish this particular woman was brought to the hospital on time, or any of her family members understood danger signs of lack of blood like dizziness, pain in the abdomen,” observes Juma.

Apart from the two, she says she has witnessed numerous cases of women bleeding to death as a result of uterus rapture.

Bleeding, she maintains, is risky in pregnancy, and leads to death if a woman is not attended to.

To avoid maternal deaths due to lack of blood, Juma notes that pregnant women should be sensitised on the importance of blood, eat healthily, and take folic acid and iron tablets.

This story was made possible with the support of the UZIMA-DS project, funded by the National Institutes of Health (NIH).