Maternal mortality at Kenyatta National' hospital (Nairobi, Kenya) 2000-2008
Abstract
Developing countries account for majority(99%) of maternal deaths globally.
These countries have committed themselves to reducing maternal mortality by
three quarters by the year 2015, in line with the millennium development goals.
This study intended to establish whether interventions towards achieving this
goalin Kenya have influenced the pattern of maternal mortality at Kenyatta
national hospital, the biggest referral hospital in Kenya.
Objectives
To describe the magnitude, causes, contributing factors and trends of maternal
mortality at KNH for the 9 year period starting 1st January 2000 to 31st
December2008 -:
Design
Analysis of maternal deaths
Setting
Kenyatta National Hospital (KNH)
Study population
A" maternal deaths that occurred over the 9 year period starting 1st January
2000 to 31st December 2008
Methodology
The inpatient numbers and dates of deaths for all past cases of maternal deaths
were obtained from the coding and indexing section of the records department;
files were then retrieved from the secondary filing section. Patient files for
maternal deaths that occurred during the study were obtained from respective
departments. A questionnaire comprising both open and close-ended questions
was then used to extract required information. Data was analyzed using
statistical computer programmers - excel and SPSS.
Results
There were 1024 maternal deaths and 56,866 deliveries; MMR was therefore
1800/100,000 live births. Direct and indirect obstetric causes accounted for 54%
and 29% of the deaths respectively.Overall, HIV (18.8%), abortion complications
(14.9%), eclampsia (13.9%), puerperal sepsis (12.7%) and postpartum
hemorrhage (5.1 %) were the leading causes of maternal deaths. Over threequarters
of direct obstetric deaths were due to eclampsia, abortion, and
puerperal sepsis in almost equal proportions. HIV accounted for most indirect
obstetric deaths (64.4%), followed by anemia (16.1 %), malaria (11.1 %), and
cardiac disease (6.4%). Mean age and mean parity at death were 26.61 years
and 1.79 respectively. Decision to intervention intervals for emergency surgeries,
blood transfusions and -leu admissions were within 2 hours for only 52%, 38%
and61%cases respectively
Conclusion
HIV has emerged as the leading cause of maternal mortality at KNH, surpassing
all the traditional major causes of maternal deaths i.e. hemorrhage, abortion,
puerperalsepsis/and hypertensive disorders in pregnancy.
Suboptimal care was also a contributing factor to the maternal deaths
Majorityof women who died were between 20-34 years, which is the peak of
childbearing age in Kenyan women
Recommendations
Periodic maternal mortality studies should be done to monitor emerging trends in
maternal mortality causes, as well as evaluate effectiveness of interventions
aimed at reducing maternal mortality.
Regular CMEs should be organized and SOPs on management of the major
causes of maternal mortality formulated to ensure optimal patient care.
Citation
Master of medicine in Obstetrics/gynaecologySponsorhip
University of NairobiPublisher
Department of obstetrics/gynaecology