Factors Associated with Severe Maternal Morbidity at Kenyatta National Hospital

Abstract

Maternal mortality is an area of particular concern in public health especially in Africa where maternal deaths are the highest in the world. Despite these high numbers comprehensive studies are difficult as maternal deaths at health facility levels are far between coupled with poor data because even routine sources such as vital registration are not well documented. This has necessitated a different approach to the issue hence the emphasis on maternal morbidity. Since women who suffer maternal morbidity encounter the same difficulties during pregnancy as the ones who die, they also have similar risk factors. Focus on maternal morbidities in other countries have shown a significant improvement in maternal health outcomes. The major objective of this study was to determine the factors associated with severe maternal morbidity and its prevalence at Kenyatta National Hospital. This was an analytical cross-sectional quantitative study. Data was collected from postnatal women admitted in the maternity wards at Kenyatta National Hospital obstetrics and gynaecology department using a structured questionnaire. 162 respondents were selected through systematic sampling and an additional 18 respondents were also included in case there were missing records. Univariate, bivariate and multivariate analysis was carried out with both descriptive statistics and inferential statistics obtained. The prevalence of severe maternal morbidity during the one month of this study was at 36.1%. The factors that were associated with the occurrence of a severe maternal morbidity were: husband’s education; being married; being referred from another facility; having a pre-existing condition; experiencing a complication postnatally; stillbirth outcome and delivery via caesarean section. The most common severe maternal morbidity was pre-eclampsia. Referral status- a component of the third delay- came to the fore as a factor that projects the occurrence of severe maternal outcomes. It can therefore be inferred that the referral system in Kenya is wanting since urgent care to mothers is being delayed during the process. Policymakers at the Ministry of Health should review policy guidelines on the use of caesarean sections to ensure they are used when benefits outweigh risks.