Tragedy of mothers dying when bringing forth life

Rebecca Mutiso @rebeccamutheu

At least 16 Kenyan women who will go to hospital to give birth today will not return home. They will die on the delivery bed and be part of the statistics of women—between 6,000 and 8,000—who die during pregnancy and labour annually. But majority of the deaths are preventable.

The graphic tragedy of this daily statistic is equivalent to a 14-seater matatu with two extra passengers crashing and killing all on board. But according to the Kenya Health Demographic and Health Survey 2014, which is set to be released today, 4,000 women die annually from pregnancy-related complications.

A new report by the Health ministry lays bare the reasons behind the high number of maternal deaths, with a stinging indictment on quality of care in our hospitals.

The report—Saving Mothers Lives 2017— the first confidential report into maternal deaths, indicates that nine out of 10 women who lost lives during childbirth in 2014 died because of sub-standard care in hospitals. What’s more, seven out of 10 deaths occurred between 5pm and 8am on weekdays, weekends and public holidays when the number of nurses and doctors on duty was low.

The damning report, prepared by the National Maternal and Perinatal Death Surveillance and Response committee through the Reproductive and Maternal Health Service Unit, analysed 484 cases out of 954 maternal deaths reported in the District Health Information System in 2014.

This is despite the many affirmative programmes and other interventions such as free maternity care in the last seven years to arrest alarming maternal and child mortality rates in the country.

And this morning, the ministry in what is seen as a pro-active step to arrest the plight of expectant mothers being stalked by preventable death, is releasing an eight-point action guideline to address issues identified in the report.

Reproductive Health and Maternal Health Service Unit (RHMSU) head Dr Gondi Joel says 98 per cent of the deaths occur in 15 counties, most of them in far-flung regions. “We need to admit that we are having a problem and put in place measures to deal with the crisis. We only have 400 gynecologists in the country and many of them are in urban areas.

That is why more women are dying in remote counties,” he said. The report reviewed 745 cases of maternal deaths that occurred in 96 major referral hospitals in Kenya. At least 93 per cent of the cases reviewed or 446 were from a public health facility.

The data was collected between July 2015 and June 2016. A majority of the women who died—374—delivered in hospitals. The figure is almost 90 per cent of all deaths analysed. At least 7.5 per cent delivered at home or on their way to hospital. The place of delivery was not specified in 3.7 per cent of the cases.

What this means is, 89.3 per cent of maternal deaths were as a result of delays in starting treatment (33 per cent) inadequate clinical skills (28 per cent), inadequate monitoring (27 per cent), prolonged abnormal observation without action (23.6 per cent) and incomplete initial assessment (23 per cent).

Other reasons women died include lack of obstetric life-saving skills, inadequate resuscitation, inadequate antenatal care, delay in deciding to refer a patient, wrong diagnosis, wrong treatment, or failure to receive treatment at the health facility.

The report further shows that two out of five women who passed away when giving life, bled to death because of obstetric hemorrhage while one out of every five women died due to complications such as HIV and Aids and anaemia.

Majority of those who died of obstetric hemorrhage received poor quality services and their lives could have been saved had they been in better hands.

Out of the 353 deaths, whose causes were available, 169 of them died due to avoidable administrative factors such as absence of trained staff on duty, infrastructural problems, lack of equipment, lack of blood transfusion and lack of qualified staff.

Family Health Division head Mohamed Sheik said the ministry is now working toward reducing the number of deaths in health facilities by half through provision of quality care.

“No mother should die at a health facility because of preventable causes,” he said. In line with this, 2,000 healthcare workers have been trained on emergency obstetric care. Dr Sheik said the report is a confidential inquiry that is not designed to lay blame on anyone, but will help reshape policies and guidelines on maternal healthcare.

The average age of many of the women who died is 27, while the youngest was 14 and the oldest 47. Some 63.7 per cent of the women who died were having their first, second or fifth pregnancy.

Although the government made maternal death notification mandatory in 2004 and put in place a maternal death review system the same year, the district health information system (DHIS 2) and civil registration and vital statistics systems have not captured the number of maternal deaths adequately.

Only 15 per cent of the maternal deaths that occurred in 2014 were recorded, meaning that maternal deaths are under-reported. The report recommends additional investments in maternal and child healthcare by both National and county governments and use of new technologies to save mothers’ lives. At the county level, the report urges devolved units to, within a year, improve performance at facilities and train workers.

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