Antenatal care visits and pregnancy outcomes at a Kenyan rural district hospital: a retrospective cohort study

Background: The goal of antenatal care (ANC) is to improve maternal and neonatal outcomes. Fewer ANC visits in focused antenatal care (FANC) model can affect maternal and perinatal outcomes in low income settings where the number ANC visits are often low.Objective: To determine the number of ANC visits and their influence on maternal and perinatal outcomes at a rural Kenyan hospital.Study design: Retrospective cohort.Study population: Women who received ANC and were admitted at Longisa District Hospital postnatal ward after delivery at or above 28 weeks gestation.Study site: Postnatal ward, Longisa District Hospital, Bomet County, Kenya.Results: Between 1st July and 31st August 2014, 200 (83%) of the screened postpartum (n=241) women were found to be eligible. Majority (n=122, 61.0%) of the women received less than 4 ANC visits. Most women were: married (83.5%), housewives (65.5%), and had: parity of 2 to 4 (50.5%); primary education (66.5%); live births (93.0%); spontaneous vertex delivery (82.5%); spontaneous onset of labour (n=192, 96.0%) and no complication at or post-partum (n=175, 87.5%). Majority of the neonates had 5 minute APGAR score >7 (88.0%); and were with their mothers after 24 hours postpartum (81.5%). High parity (≥5) was associated with reduced frequency of ANC visits (OR=0.29, 95% CI 0.1-0.87, p=0.027). Early perinatal and maternal outcomes were not significantly associated with the number of ANC visits.Conclusion: In this rural Kenyan hospital, few women had 4 or more ANC visits. Parity of 5 or greater was significantly associated with fewer than 4 ANC visits. Early perinatal and maternal outcomes did not vary with the number of visits. Quality rather than number of ANC visits should be evaluated as a measure of ANC

MILLENNIUM DEVELOPMENT GOAL 5: A REVIEW OF MATERNAL MORTALITY AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI

Objectives: To review if there is a change in the maternal mortality rate at the Kenyatta National Hospital since the inception of the Millennium Development Goal strategy in 1990, compared to earlier reviews.Design: A retrospective descriptive study.Setting: Kenyatta National Hospital.Subjects: Maternal deaths attributed directly to obstetric causes.Main outcome measures: Determination of maternal mortality rates of all patients admitted to the Kenyatta National Hospital Maternity and died after admission up till six weeks of admission. Also determine any avoidable causes of the same.Results: During the period under review, there were 27,455 deliveries and 253 maternal deaths giving a maternal mortality ratio of 921.5 per 100,000 live births. Direct obstetric causes accounted for 71% of all maternal deaths with sepsis, haemorrhage, andhypertension being the leading causes. Respiratory tract infections associated with HIV/AIDS infection was the prominent indirect cause. 67.5% of deaths occurred in women aged between 25 and 35 years and 78.7% were Para 2 or less. Evidently there was poor antenatal clinic attendance with only 28.6% having had any attendance at all.Conclusion: Antenatal clinic attendance needs to be re-emphasised if an impact is to be realised in curbing maternal mortality; moreover there is need for early referrals and encouraging mothers to deliver under skilled care