Assessment Of Obstetric Services And Pregnancy Outcomes At Kiambu District Hospital, Central Province, Kenya
Ngugi, S M
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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.