Maternal and neonatal mortality in Moi Teaching and Referral hospital in Kenya

Abstract

The idea for this thesis originated while I was attending weekly mortality meetings at the Moi Teaching and Referral Hospital (MTRH) coupled with high maternal and neonatal mortality rates in Kenya. I shared the idea with two obstetricians who provided their support and willingness to help understand the problem. With support from the University of Newcastle and The Ministry of State for Public Service in Kenya, I received a scholarship to undertake my PhD at the University of Newcastle in Australia. This thesis by publication is composed of seven chapters including: an introduction, methodology, four papers (each a separate chapter), and conclusion. All papers relate to factors surrounding maternal and neonatal mortality at a tertiary hospital in Kenya. At the time of submission three papers have been published and one is under review. The first paper is a retrospective review of the incidence of maternal and neonatal mortality at MTRH and a description of characteristics of maternal and neonatal deaths at this hospital. The study identifies a range of socio demographic, clinical and health system factors as possible contributors to high maternal and neonatal mortality in Kenya. This paper was published in the Reproductive Health Journal. The second paper is a case-control study following a manual review of maternal records at MTRH. The study identified antenatal care and maternal education as risk factors for maternal mortality at MTRH. This paper was published in BMC Pregnancy and Childbirth. 16Paper Three is a case-control study of neonatal records at MTRH. Results showed that some risk factors for early neonatal mortality included: number of antenatal visits, gestational age, qualification of birth attendant, mother’s complication at birth, and low Apgar scores at five minutes, and congenital malformations. This paper has been published in BMC Pregnancy and Childbirth. The fourth paper presents an assessment of completeness of maternity data at MTRH including factors associated with missing data. The results showed that a range of maternal neonatal and health system factors were associated with missing data in the maternal and neonatal sample. This paper will be submitted for publication in a reputable journal. The support I received from my supervisors was overwhelming in terms of making the project more realistic. We prepared all the necessary documents and obtained necessary approvals and permission to undertake the study. I personally was involved in the data collection process which was the bulk of this thesis because we had to go through paper records to obtain data for this study. I also did the data analysis with the guidance of my supervisors. The outcomes of this study have had a huge audience globally as well as health system policy implications for the hospital and nationally. More specifically, one of the obstetricians in the hospital who was the study advisor (PN) had this to say about the study. “This study has had an impact in more revision and development of new protocols in the maternity unit on pre-eclampsia, triage of patients at admission, involvement of paediatricians in management of newborns, establishment of High 17Dependence Unit (HDU) in addition to the existing Intensive Care Unit (ICU), involvement of physicians in management of medical disorders in pregnancy and increased staffing of labour ward with more doctors. More population based studies of the same are underway to help clarify the study findings”.