Four in five expectant and new mothers who die in hospital receive poor care where a different management could have saved their lives or that of their child, reveals a new study.

The First Confidential Enquiry into Maternal Deaths in Kenya shows that of the 484 maternal deaths assessed, 447 (92 per cent) received poor care. Of these, 394 (81 per cent) received substandard care where different care management could have resulted in a better outcome.

The assessment constituted 51 per cent of the 945 deaths of women who died in pregnancy or childbirth that were reported in the District Health Information System (DHIS) for the year 2014.

Obstetricians/gynaecologists were involved in the emergency care of only one in nine women who died even though more than 80 per cent of them received care at county and national referral hospitals where the specialists are supposed to be present.

The Head of Reproductive and Maternal Health Service Unit Dr Joel Gondi says that substandard care was defined as delay in initiating treatment, incorrect treatment, infrequent monitoring and skipping required laboratory tests.

About three-quarters (73 per cent) of the deaths occurred out of office hours between 5pm and 8am on weekdays, weekends and public holidays, shows figures from the study that was conducted from June 2015-June 2016.

Obstetricians/gynaecologists were involved in the emergency care of only one in nine women who died even though more than 80 per cent of them received care at county and national referral hospitals where the specialists are supposed to be present.

The highest cadre of healthcare provider involved in the management at the facility where an expectant woman or new mother (within six weeks of giving birth) died were mostly medical officers (54 per cent). About 19 per cent were attended to by nurses, clinical officers (two per cent) while more than six per cent of the women were unattended or managed by unskilled healthcare providers.

“The reason medical officers care for most of the women is because the protocol in the emergency or casualty units is that they attend to patients first then determine if specialised care is needed. But the concern is whether they are well-skilled to determine if a referral to a specialist is needed and to request for an obstetrician in good time,” Dr Gondi Joel, the Head of Reproductive and Maternal Health Service Unit, tells Nation Newsplex.

The study identified one or more health worker-related factors in three-quarters of the maternal deaths. The most frequent issues identified included: Delaying starting treatment (a third), inadequate clinical skills (28 per cent), insufficient monitoring (27 per cent), prolonged abnormal observation without action (24 per cent) and incomplete initial assessment (23 per cent). Others included wrong diagnosis, wrong treatment and no treatment.

Dr Gondi explains that there are not enough obstetricians/gynaecologists to care for all women who need their services and most of them are concentrated in urban areas.

On the issue of most deaths happening out of office hours, the Head of the Division of Family Health Dr Mohamed Sheikh explains that most county referral hospitals often only have one of each specialist, e.g., one obstetrician and an anaesthesiologist. After working long hours for the entire week they may end up taking a break at the weekend.

Currently, Kenya has 349 obstetrician/gynaecologists, one obstetrician-oncologist and 145 anaesthesiologists registered with the Kenya Medical Practitioners and Dentists Board (KMPDB). According to data from the Statistical Abstract 2017, there were 948,351 births in 2017.

Both Dr Gondi and Dr Sheikh say that out of the engagement with the professional bodies the Health ministry hopes to come up with a better line-up of the first and second line of staff on call, and the right mix and quantity of staff available in referral hospitals at all times.

Dr Gondi says the enquiry is part of the Ministry of Health’s response which started with identifying the gaps. He says the report has been shared with KMPDB and the Kenya Obstetrical and Gynaecological Society so that they can work together to find solutions to the issues raised.

Absence of staff

Page 1 of 2