Members of the public participate in a past Beyond Zero Half Marathon.The marathon is part of a campaign led by the first Lady Margaret Kenyatta to eliminate maternal and child mortality.Photo by Beyond Zero Campaign

Poor Diagnosis, Negligence Leading Cause of Child and Maternal Deaths in Kenya

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Medical care for first time mothers and their babies is in a deplorable state which requires an urgent action. The rate of death among mothers during pregnancy, delivery and after childbirth has remained a steady high at 488 deaths per 1000 births in Kenya, according to Kenya Demographic and Health Survey 2014.

The survey is conducted every five years by the Kenya National Bureau of Statistics. The last was done from May 2014 to October 2014. It is the sixth Demographic and Health Survey since 1989.It would be interesting to find out if the next one which will be conducted this year will paint a different picture.

According to health experts, there are different causes of maternal death with some stemming from maternal health illiteracy by the expectant mothers.  In addition, poor infrastructure, ill-equipped medical centres and poor diagnosis and negligence are among health practitioners play a leading role in child mortality and maternal deaths in Kenya.

 

Personal experience

 

This sorry state of affairs has continued to cause deaths to new born babies and first time mothers. Mary Apondi, is one of the unlucky mothers. At 28, she was expectant with hope of receiving her bundle of joy.  After nine months of adhering to prenatal care, she still lost her baby hours after delivery. Apondi hails from Nairobi’s Kibera slum. She says her son’s death was occasioned by medical negligence by the medics at Bahati Heath Centre in Kibera.

Shortly after giving birth on December 22, 2019, she noticed her son could not breathe properly. She alerted the health officials at the hospital who advised her to breastfeed the child.

“I noticed the child was not breathing well, I informed the doctors that the child had a breathing complication and they told me to breastfeed him,” she recalls, holding up her tears.

The first time mother says she kept complaining about her child’s condition to the doctors for a whole day with no action from the medics. Consequently, the child was referred to Pumwani hospital the following day in a critical condition where he passed away while being attended to.  The doctors at Pumwani hospital told her that if the child had been referred early enough, he would have survived. Apondi’s plight paints a picture of how negligence among health workers in Kenya has contributed to the increased death cases among new born babies and first time mothers.

 

Prevention

 

According to Dr James Gitonga, the head of Maternal and Priinatal Death Surveillance and Response (MPDSR) at the Ministry of Health, a significant amount of these deaths can be prevented by an adequate prenatal care, qualified health workers during delivery and proper post-natal medical care for new mothers and their babies.

“Child and maternal deaths in Kenya is in a sorry state, with doctors, nurses and clinical officers routinely ignoring clinical guidelines with inadequate skills to treat and manage complications arising after giving birth,” said Dr. Gitonga, adding that lack of essential drugs and limited access to life-saving services are also undermining the well-being of first time 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 Indicator Survey (SDI) 2018  released recently.

“The two conditions – post-partum haemorrhage and neonatal asphyxia – are the leading causes of deaths in first time mothers and their babies during birth,” says Dr. Gitonga.

In addition, about 9,327 newborns died from neonatal asphyxia within the first 27 days of their birth in Kenya in 2018, according to the World Health Organization (WHO). Severe bleeding during birth is the leading cause of maternal deaths, accounting for a third of them in sub-Saharan Africa.

 

 

According to the report done in 3,094 health facilities across Kenya, only 16 percent of doctors and clinical officers prescribed the right treatment for neonatal asphyxia even though 88 percent accurately diagnosed the condition. Likewise, less than half (43 percent) of health providers prescribed the correct treatment for post-partum haemorrhage while 90 percent gave an accurate diagnosis.

The actions of health providers are under the spotlight against a backdrop of growing complaints over misconduct by health providers. The report further notes that four in five expectant mothers who die in hospital receive poor care where a different health management could have saved their lives or that of their child.

In order to fast-track progress in addressing child and maternal deaths in the country, in 2013, the Government addressed high maternal death and the lack of access to quality maternal health services (including antenatal, delivery, and post-natal services) by waiving all fees for maternity services at all public facilities.

 

Performance by counties

 

This led to the number of births recorded at home halving between 2011 and 2015 with the number in health facilities increasing by 60 per cent, according to a 2017 situation analysis report by UNICEF on mother and child. The increase occurred in 43 of the 47 counties, with many of low coverage counties, such as :

1 Tana River

  1. Wajir
  2. Mandera
  3. Kwale,

showing dramatic increases.

In Turkana and Kitui, investments in infrastructure through building of new facilities and incorporation of maternity services at dispensaries (lower levels of healthcare provision) have led to improvement in skilled birth attendance.

This has also been facilitated by the engagement of Community Health Volunteers, who follow-up with mothers during pregnancy, and the linkage with health facilities increasing the use of health services at the community level. In a number of cases, the process has been facilitated by the involvement of traditional birth attendants as birth companions, responsible for referring and accompanying mothers to the health facilities when their labour begins, and on a few occasions assisting nurses during the birth.

Factors behind the downward trend in childhood mortality include high impact interventions, such as increased use of mosquito nets among children, immunization programmes, and improvements to the health system, including community-based systems.

 

Qualitative research for the 2016 Multidimensional Child Poverty study indicated that coverage of immunization improved with devolution because of improvement in accessibility of health facilities, engagement of Community Health Volunteers.

In addition, other initiatives such as the Beyond Zero Campaign, adopted a campaign style to create momentum, mobilize leadership and commitments towards achieving results in HIV, maternal, newborn and child health.

The campaign rolled out a mass distribution of mosquito nets to over 100 households in at least six (6) Counties namely West Pokot, Narok, Trans Nzoia, Kisii, Nyamira and Makueni respectively to support pregnant mothers and children.

However, the scenario is a bit different across Kenya’s neighbouring Uganda. Uganda has a much lower maternal mortality ratio within sub-Saharan Africa (SSA) region, 430 versus 619 deaths per 100,000. SSA fertility rate is 119 per 1,000 – which is significantly less than Uganda.

 

Neighbouring countries

 

According to Uganda Demographic and Health Survey 2016 estimates released by UNICEF and the WHO in 2019, the country recorded slight progress in reducing child and maternal mortality, with infant deaths reduced from 56 deaths per 1,000 live births in 2011 to 43 deaths per 1,000 live births in 2016.

Tanzania has registered a substantial reduction in child mortality rates. According to data from WHO, the infant mortality rate was 68 deaths per 1000 in 2005, a vast improvement from the 1999 figure of 99 deaths per 1000. The under five mortality rate also decreased from 147 deaths per thousand in 1999 to 112 deaths per 1000 in 2005. This decrease can be in part attributed to improved breastfeeding practices and high immunization coverage.

On the other hand, maternal mortality has not benefited from trends similar to those of child mortality. Maternal deaths in Tanzania, with a ratio of 578 per 100 000, represent 18 percent of all deaths of women age 15-49. The main direct causes of maternal death are haemorrhages, infections, unsafe abortions, hypertensive disorders and obstructed labours.

The statistics indicate that the three countries are at different stages of improving child and maternal deaths. The global target for ending preventable maternal mortality (SDG target 3.1) is to reduce global maternal mortality ratio to less than 70 per 100 000 live births by 2030. The world will fall short of this target by more than 1 million lives if the current pace of progress continues.

 

What journalists should do:

 

Kenya’s progress in achieving key maternal, infant, and child health targets has been slow as set out in key national policy documents. For Kenya to make rapid progress towards Universal Health Coverage http://www.health.go.ke/resources/policies/, a health system needs to have skilled human resources, minimum inputs such as drugs, commodities and infrastructure, financing, leadership and governance, and health information systems.  But Journalists seeking to pursue this story may want to report on:

  1. Why Kenya still registers high child and maternal deaths despite high funding put in the sector
  2. What are the existing or ongoing projects/programmes/initiatives by the government and other actors aimed at reducing the child and maternal deaths in the country
  3. How has Kenya implemented its key national policy documents on health?
  4. How much the government has spent on child and maternal programmes and why they haven’t yielded much result?
  5. The impacts of Kenya’s free maternal health care policy in improving the well-being of the mothers and their babies
  6. How Counties are coping with the ever rising cases of child and maternal deaths at the lower levels health facilities
  7. The journalists can also explore a regional perspective why the countries are at different levels in addressing child and maternal deaths and the challenges they face in trying to eradicate the problem.

By George Achia