Assessment Of Obstetric Services And Pregnancy Outcomes At Kiambu District Hospital, Central Province, Kenya
Abstract
CONTEXT: Maternal mortality has been recognized internationally as a public
health problem owing to the thousands of women who lose their lives during
pregnancy or childbirth and many more who suffer complications, some of which
are debilitating. In recognition of this problem, a lot of attention is now being
concentrated in activities that will ensure women go through pregnancy safely
and that their babies are born alive and healthy.
OBJECTIVE: The main objective of this study was to assess the obstetric care
and pregnancy outcomes among mothers who sought maternity care at Kiambu
District Hospital.
MATERIALS AND METHODS: This was a cross-sectional study that was carried
out between June and August 2002. Convenient sampling was used in identifying
study subjects and 310 eligible and consenting mothers were recruited at the
time of delivery and their pregnancy outcomes documented. Review of the care
the mothers had received during antenatal period, delivery and postpartum was
carried out on all respondents and a physical check on the state of the
infrastructure, equipment and consumable supplies was carried out in an attempt
to describe the quality of obstetric care.
RESULTS: From the assessment of the structural aspects of care, some basic
essentials such as blood giving sets, anticoagulants, plasma expanders,
equipment for care of the newborn and an adult weighing machine were lacking.
The quality of care did not meet the expected standards, as all mothers did not
receive the expected care antenatally and intranatally. Regarding antenatal care,
30% of the mothers did not have a complete antenatal profile, haematinics were
given to only 17.5% of the clients, and nutritional advice to only 24% of them.
Use of the partograph was 80%, though most of them were incorrectly filled.
Monitoring of the maternal condition during labour was poor and the focus
seemed to be monitoring of the progress of labour. Postpartum care received
least attention and only ceasarean section mothers and those with complications
were given much attention.
The proportion of mothers who developed complications during labour and
delivery was 23.5% and the common maternal complications were prolonged
labour, haemorrhage and hypertension. The maternal mortality ratio at the facility
during the study period was 671 per 100,000. The caesarean section rate was
6.4%, and over 90% of the mothers had a normal delivery.
Preterm babies represented 4.5% of the babies born, low birth weights were
11%, stillbirths were 4.5% and those who had a poor Apgar score at five minutes
were 7.2%. Factors that were significantly associated with low birth weight
include maternal age and gestation at the time of delivery. A poor Apgar score
was significantly associated with mode of delivery, experience of complications
during labour and delivery and marital status. Stillbirths were more likely to occur
for a mother who had experienced a complication during labour and delivery.
Perinatal deaths occurred more for babies who scored poorly at five minutes, low
birth weight babies and babies with congenital malformations.
CONCLUSION: The readiness of Kiambu District Hospital to provide quality care
was not sufficient and this can be improved by procuring the supplies, drugs and
equipment that were found to be lacking. The quality of antenatal care,
intrapartum care and post partum that the mothers received is wanting given that
aspects of care that were assessed are those considered minimum and should
be provided universally to all clients. The proportion of mothers who developed
complications is close to the figure postulated by WHO, and the complications
were prolonged labour, heamorrhage and hypertensive diseases. Majority of the
foetal outcomes were good, as more than 90% of the babies were live births of
normal weight and had had a good Apgar score at five minutes.
RECOMMENDATIONS: The Hospital management team can improve on the
preparedness of the facility to provide quality care by looking into ways of
sourcing for equipment and supplies that are lacking and also look into ways of
establishing a well-equipped newborn care unit. The Kiambu District Medical
Officer of Health needs to enforce the Ministry of Health policy of universal
supplementation on all pregnant women with Iron and Folic acid and ensure
dietary advice for all pregnant women given the high prevalence of anaemia
(38%). The Medical Superintendent needs to organize for staff updates so that
staff can be reoriented on obstetric care.
Citation
Master Of Public Health Of The University Of Nairobi, 2004Publisher
University of Nairobi,
Description
A Thesis Submitted In Part Fulfillment For The Award Of The Degree Of Master Of Public Health