Abstract
Introduction
Kenya did not meet the maternal health targets of the Millennium Development Goals. There is no evidence that national policies to improve access to maternal health services implemented since 2013 have resulted in significant reductions in maternal deaths (MDs). Kenya instituted a confidential enquiry into maternal deaths (CEMD) to improve the quality of care (QoC) in 2015. The first Kenya CEMD report (2014 deaths) was published in 2018. The second report (2015/2016) will be published in 2019. We present a comparison of the key findings in both reports and identify opportunities to improve the QoC.
Methods
Standard CEMD methodology was used. International Classification of Diseases maternal mortality classification was used to attribute the cause of death, and also, the overall quality of care and factors associated with death were identified.
Results
There was no significant change in the proportion of reported MDs from the included facilities (97% or 1334 in 2015/16 and 96% or 484 in 2014) included. There were more assisted vaginal deliveries (1.9% or 20 versus 1.4% or 7) and caesarean sections (39.6% or 424 versus 28.5% or 138) in 2015/16 compared to 2014. The three most common causes of MDs in both reports were obstetric haemorrhage (OH), hypertensive disorders of pregnancy, and nonobstetric complications. However, there was an increase in the proportion of MDs due to hypertensive disorders of pregnancy (17.9% or 239 in 2015/16 versus 15.3% or 74 in 2014) and nonobstetric complications (22.2% or 296 in 2015/16 versus 19.8% or 96 in 2014). There was a reduction in the proportion of deaths due to OH in 2015/16 (35.5% or 473) compared to 2014 (39.7% or 192). The proportion of women who received suboptimal care in which a different management approach might have resulted in a different outcome increased from 81.4% (394) in 2014 to 98.1% (1310) in 2015/16. The most frequent factors associated with MDs were health worker related in both reports. These included delays in starting treatment (33% or 160 in 2014 versus 41.3% or 549 in 2015/16), inadequate monitoring (27% or 131 in 2014 versus 30.9% or 411 in 2015/16), and inadequate clinical skills (28% or 136 in 2014 versus 29.1% or 387 in 2015/16).
Conclusion
To improve the QoC, systems for regular training to improve competency and adherence to treatment protocols/guidelines are needed. The inclusion of nonhealth facility MDs will improve the understanding of factors that contribute to MDs in Kenya.
Kenya did not meet the maternal health targets of the Millennium Development Goals. There is no evidence that national policies to improve access to maternal health services implemented since 2013 have resulted in significant reductions in maternal deaths (MDs). Kenya instituted a confidential enquiry into maternal deaths (CEMD) to improve the quality of care (QoC) in 2015. The first Kenya CEMD report (2014 deaths) was published in 2018. The second report (2015/2016) will be published in 2019. We present a comparison of the key findings in both reports and identify opportunities to improve the QoC.
Methods
Standard CEMD methodology was used. International Classification of Diseases maternal mortality classification was used to attribute the cause of death, and also, the overall quality of care and factors associated with death were identified.
Results
There was no significant change in the proportion of reported MDs from the included facilities (97% or 1334 in 2015/16 and 96% or 484 in 2014) included. There were more assisted vaginal deliveries (1.9% or 20 versus 1.4% or 7) and caesarean sections (39.6% or 424 versus 28.5% or 138) in 2015/16 compared to 2014. The three most common causes of MDs in both reports were obstetric haemorrhage (OH), hypertensive disorders of pregnancy, and nonobstetric complications. However, there was an increase in the proportion of MDs due to hypertensive disorders of pregnancy (17.9% or 239 in 2015/16 versus 15.3% or 74 in 2014) and nonobstetric complications (22.2% or 296 in 2015/16 versus 19.8% or 96 in 2014). There was a reduction in the proportion of deaths due to OH in 2015/16 (35.5% or 473) compared to 2014 (39.7% or 192). The proportion of women who received suboptimal care in which a different management approach might have resulted in a different outcome increased from 81.4% (394) in 2014 to 98.1% (1310) in 2015/16. The most frequent factors associated with MDs were health worker related in both reports. These included delays in starting treatment (33% or 160 in 2014 versus 41.3% or 549 in 2015/16), inadequate monitoring (27% or 131 in 2014 versus 30.9% or 411 in 2015/16), and inadequate clinical skills (28% or 136 in 2014 versus 29.1% or 387 in 2015/16).
Conclusion
To improve the QoC, systems for regular training to improve competency and adherence to treatment protocols/guidelines are needed. The inclusion of nonhealth facility MDs will improve the understanding of factors that contribute to MDs in Kenya.
| Original language | English |
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| DOIs | |
| Publication status | Published - 12 Jun 2019 |
| Event | RCOG World Congress - London, United Kingdom Duration: 17 Jun 2019 → 19 Jun 2019 |
Conference
| Conference | RCOG World Congress |
|---|---|
| Country/Territory | United Kingdom |
| City | London |
| Period | 17/06/19 → 19/06/19 |
