Determinants of material mortality among women of reproductive age attending Kissi General Hospital, Kissi Central District, Kenya (January 2009 - June 2010)

Objective: To describe the causes and determinants of maternal mortality among women of reproductive age seeking healthcare services at Kisii General Hospital.Design: Descriptive retrospective study.Setting: Kisii General Hospital which is a Level-5 Referral Hospital.Subjects: Seventy-two women who had died as a result of pregnancy and childbirth related conditions who had sought obstetric services at Kisii General Hospital.Results: Majority 51 (70.8%) of deceased did not go to hospital promptly, due to; lack of transport 22 (30.6%), lack of money 17 (23.6%), and hospital distance 8 (11.1%). About 43 (60%) of those who died were between 15-25 years of age. Hospital experiences included; delay in service provision by staff 14 (19.4%), unavailability of blood for transfusion 6 (8.3%), and lack of money for drugs 12 (16.7%). Complications which led to maternal mortality were mainly; postpartum sepsis, bleeding, hypertension and cardiovascular conditions.Conclusion: Lack of lack of transport, inability to pay, delayed care seeking and lack of emergency obstetrics were the major challenges. Postpartum sepses, bleeding and pre-eclampsia were the leading complications that led to death

Predictors of maternal mortality among women of reproductive age seeking health care services at Kisii Level 5 Hospital

Background: The safe motherhood initiative was launched in 1987 as a flagship to set a base to reduce maternal mortality. Despite efforts by government and international agencies, Kenya has continued to experience a rise in maternal mortality.Objective: The purpose of this study was to identify the antecedents’ factors which have contributed to maternal deaths in Kisii County, Kenya.Methodology: A retrospective review of 72 maternal deaths which occurred between 1st January 2009 and 30th June 2010 was undertaken by an independent obstetrician. Interviews were conducted with relatives of the deceased women using a confidential questionnaire for female death based on distant as well as proximate factors that may have contributed to maternal death. Health care workers were also interviewed to assess the ability and readiness of the hospital to offer emergency obstetric care. Results: Among the 72 maternal deaths recorded during the study period 42 (58.3%) were as a result of direct obstetric complications which included haemorrhage, post-partum sepsis, pre-eclampsia and abortion. Thirty-three (45.8%) were as a result of indirect causes such as peritonitis, heart disease, HIV/AIDS, anaemia and convulsive disorders. Access to care was hampered by lack of money for transport and hospital user fees. Transport was also unavailable in some cases where money was not the problem. Besides, long distance to the hospital caused delay to seek care. But even for those who were prompt at the hospital also experienced delayed care as health service providers were unavailable as they were attending to other cases. Delay in service provision by healthcare workers, delayed quality obstetric emergency response and delayed care while at the hospital continue to be a challenge to maternal care. Conclusion: Maternal mortality continues as a result of failure of the health system, lack of access to quality care, poor health infrastructure, women empowerment and socio-economic  issues.Key words: Maternal mortality, Quality of care, Women empowerment, Health infrastructur