Factors Associated With Maternal Mortality Among Women Who Received Antenatal Care at Kenyatta National Hospital Between January 2006 and December 2015

Abstract

Background: Although MMR has reduced over the last two decades from 380 to 210 deaths per 100,000 live births globally, there are still many challenges in achieving acceptable levels. According to the new sustainable development goals (SDGs), SDG 3.1 targets to reduce by 2030, the global MMR to <70 per 100,000 live births. Objective: Todetermine factors associated with maternal mortality among women who received antenatal care at Kenyatta National Hospital between January 2006 and December 2015. Method: This was unmatched case-control study in which medical records were reviewed to identify cases and appropriate controls. Cases comprised women who experienced maternal mortality and controls comprised women who attended the antenatal clinic but did not die during the study period. The data was collected by using a structured questionnaire. Data collected was coded and entered into statistical analysis software (SPSS) version 23. Data was presented in the form of tables and figures. Logistic regression was used to evaluate the strength of the association of each determinant and associations was considered statistically significant at P values of <0.05. Estimates were presented as OR using 95%confidence interval. Result: Between January 2006 and December2016, a total of 200 files (50 cases and 150 controls) were identified. Cases had lower odds of having secondary education, OR 0.24 (95% CI 0.10-0.56), p<0.001or tertiary education, OR 0.32 (95% CI 0.14-0.71, p<0.001). Cases had greater odds of preterm delivery, OR 2.81, 95% CI 1.43-5.03, p <0.001.Hypertensive disease (eclampsia and preeclampsia) were the leading direct cause of maternal mortality (39.3%) and HIV/AIDS was the leading cause of indirect maternal mortality (36.4%).Conditions significantly associated with maternal mortality included: preexisting medical conditions (OR 6.048, 95% CI 3.012-12.15; p < 0.01), cardiac disease OR 24.43 (95% 2.75-217.2) p<0.01, HIV OR 6.20 (95% CI 2.49-15.44) p<0.001 and Anemia OR 4.371, 95% CI 1.041-18.34; p < 0.004). Conclusion: Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality Among KNH ANC clinic attendees, the risk factors for maternal mortality included included a lower level of educationlower level of educationlower level of educationlower level of educationlower level of educationlower level of educationlower level of educationlower level of educationlower level of educationlower level of educationlower level of educationlower level of education, preexisting medical conditions especially cardiac disease

and HIV/AIDS while hypertensive disorders and HIV/AIDs were the leading causes of maternal mortality. Recommendations: Based on the study findings, (i) being poor (lack education and unemployed) is in itself a barrier to seeking adequate care, a multi-sectoral approach to fight poverty among women in the society is recommended; (ii) there is evidence that screening for pre-existing medical conditions during the antenatal period plays a significant role in reducing the risk of death to the mother. Thus, efforts for specialized consultation and care is highly recommended; (iii)periodic maternal mortality studies should be done to monitor emerging trends in maternal mortality causes, as well as evaluate the effectiveness of interventions aimed at reducing maternal mortality.