Medical care for new mothers and their babies is in a sorry state, with doctors, nurses and clinical officers routinely ignoring clinical guidelines and lacking skills to treat and manage complications, reveals a NationNewsplex investigation.
Lack of essential drugs and limited access to life-saving services are also undermining the well-being of mothers and their babies.
While most health providers get the diagnosis of post-partum haemorrhage (severe bleeding after giving birth) and neonatal asphyxia (deprivation of oxygen to a baby before, during or just after birth) correct, only a small proportion offer the right treatment, according to the Kenya Health Service Delivery IndicatorSurvey (SDI) 2018 released recently. The two conditions are the leading causes of deaths in new mothers and their babies during birth.
Only 16 percent of doctors and clinical officers prescribed the right treatment for neonatal asphyxia even though 88 percent accurately diagnosed the condition, show figures from the survey that was done in 3,094 health facilities across Kenya. Likewise, less than half (43 percent) of health providers prescribed the correct treatment for post-partum haemorrhage while 90 percent gave an accurate diagnosis.
About 9,327 newborns died from neonatal asphyxia within the first 27 days of their birth in Kenya in 2017, according to the World Health Organization. Severe bleeding during birth is the leading cause of maternal deaths, accounting for a third of them in sub-Saharan Africa.
“If focus is not put on quality of care we might transfer deaths from communities to hospitals.”
Figures from the World Bank and the Ministry of Health study that was done from March-July last year show that the quality of treatment varied widely across the 47 counties. Less than five percent of health providers in 14 counties, including Nyandarua, Tana River, Mandera, Nyeri, Kiambu, Kirinyaga, Muranga, Bungoma, Nandi, Kakamega, Laikipia, Homa Bay, Mombasa and Vihiga, accurately got the treatment for neonatal asphyxia right, while about two-thirds of their counterparts in Garissa, Wajir and Makueni prescribed the accurate treatment.
Counties did marginally better in treating excessive bleeding during birth, with accuracy ranging from as low as less than a fifth in Mandera, Laikipia and Mombasa to about three-quarters in Isiolo, Baringo and Makueni.
Maternal and Perinatal Death Surveillance and Response (MPDSR) expert Peter Kaimenyi says perinatal healthcare is a much neglected area. “If focus is not put on quality of care we might transfer deaths from communities to hospitals,” he says.
Overall, health providers adhere to only a third of the clinical guidelines for managing pregnancy-related and newborn complications. Doctors adhere to a marginally larger share of guidelines (42 percent) compared to clinical officers (35 percent) and nurses (33 percent).
There is very little variation across facilities in managing maternal and neonatal complications. First-level hospitals have a higher adherence (40 percent) than health centres (35 percent) and dispensaries (32 percent).
Across counties, health workers in Wajir (70 percent), Garissa (60 percent) and Narok (56 percent) recorded the highest adherence to clinical guidelines for managing maternal and newborn complications while those in Vihiga (17 percent), Nyeri (20 percent), and Siaya and Nyandarua (21 percent each) had the lowest compliance.
Kaimenyi says that while a lot of effort has been put in promoting hospital delivery, more is needed to improve the quality of health services. Figures from the Kenya National Bureau of Statistics show that more than 70 percent of births across the country now occur in hospitals.