“Our country has conducted its first Confidential Enquiry into Maternal Deaths (CEMD) that sought to evaluate the circumstances surrounding the maternal deaths that occur”- Dr. Jackson Kioko, Director of Medical Services, Ministry of Health, Kenya.
The findings of the first confidential enquiry into maternal deaths in Kenya have been published by the Ministry of Health, Kenya. The enquiry reviewed 484 maternal deaths that occurred at major referral hospitals in 2014. The report, Saving Mothers’ Lives 2017, has revealed that most of these women could have had a better chance of surviving if their cases had been managed differently by their caregivers. Quality of care provided to mothers during pregnancy and childbirth period was found to be deficient across all health facilities where 9 out of 10 women who died received sub-standard care.
Massive blood loss was identified as the main cause of death for most women; 2 out of 5 women died from losing too much blood. Hypertensive disorders were also a significant contributor to most maternal deaths, and pre-existing conditions such as HIV and anaemia contributed to the death of 2 in 10 women.
The report also shows that most deaths occurred outside working hours when the staffing levels in the health facilities are lowest. Although most women were admitted at level 4, 5 and 6 health facilities, where specialized care should be available, obstetricians were only involved in the care of 1 out of 10 women.
The Director of Medical Services emphasized that “The CEMD report being presented today will go a long way in improving the survival of mothers and babies by providing clear and actionable strategies to address system gaps.”
The confidential enquiry was conducted between July 2015 and June 2016. The Reproductive and Maternal Health Services Unit at the Ministry of Health, Kenya, together with partners and with technical support from the Centre for Maternal and Newborn Health (CMNH), established support systems for the CEMD process. This involved setting up a National Maternal and Perinatal Death Surveillance and Response (MPDSR) Committee and establishing a National MPDSR secretariat. On 1st April 2016, the National MPDSR Committee was inaugurated to pave the way for commencing the CEMD process. The Committee is made up of 24 members who represent different organisations across the public health sector, population and development, civil registration, professional associations, training institutions, regulatory bodies, private hospitals, Council of Governors, development partners, religious bodies and human rights institutions.
A multidisciplinary team of maternal death assessors, who were trained through regional workshops, assessed anonymised maternal deaths using the WHO ICD-10 classification system. The assessors were composed of a mix of cadres and were drawn from different public and private organizations.
The Centre for Maternal and Newborn Health implemented MDSR in Kenya following the World Health Organization and Kenya Ministry of Health guidelines on Maternal and Perinatal Death Surveillance and Response. LSTM has also reported incremental progress and documented lessons learnt, implementing MPDSR in Kenya. With the launching of this report, Kenya joins a handful of sub-Saharan Africa countries that have published CEMD reports (Republic of South Africa, Rwanda and Malawi).
Support to CMNH for the implementation of MPDSR in Kenya has been from DFID Kenya and UNFPA Kenya. Dr Charles Ameh, Senior Clinical Lecturer at CMNH, who was responsible for the design and oversight of the project:
”We at CMNH are proud of this achievement and our partnership with the Ministry of Health in Kenya. We believe that we have established a solid foundation that will contribute to the implementation of specific response at national and county level, that will contribute to improved quality of maternal and newborn care in Kenya.”