Conference presentation on Maternal and Newborn Health

1. Nyongesa Paul, Odunga Jack, Charles Ammeh, Pamela
Godia, Tonui Philip, Rotich Evelyn
Presented at the 42nd Kenya Obstetric and Gynaecological
Society Annual Scientific Conference.
Theme: Meeting the challenges in reproductive health
through impactive training: guiding the way into the 21st
Century
Affiliations: Moi Teaching and Referral Hospital Moi University,
School of MedicineMoi University, School of Nursing, Liverpool
School of Tropical Medicine

2. Background
 Staff levels in acute care hospitals tend to be
lower on weekends and public holidays than
on weekdays and more so at night than
daytime despite similar burdens of disease.
It is also uncertain whether in mortalities
among patients with serious conditions
differ according to the period of admission
for different causes of maternal deaths.

3. Objective
The objective of the study as part of
the confidential enquiry into
maternal deaths (CEMD) was to
determine the effect of period of
admission and time of death on
maternal deaths in Health facilities
in Kenya in 2014.

4. Methods
 The Maternal Death Surveillance and Response
(MDSR) system was authorized by the Ministry of
Health (MOH), coordinated by the National Maternal
Deaths review Committee with technical support from
The Liverpool School of Tropical Medicine (LSTM).
 Maternal deaths were divided into groups, which were
labeled as “office hours” (08:00–18:00 on weekdays)
and “non-office hours” (18:00–08:00 on weekdays, and
all times on weekends) according to their admission
times.

5. Methods
The proportions of deaths were
compared between different groups.
The length of stay in the hospital and
admission on weekends and public
holidays, at night, and various days of
the week on hospital mortality were
also evaluated.

6. Results
 The commonest cause of maternal deaths
was obstetric haemorrhage at (192) 40 % out
of 484 deaths reviewed in health facilities.
Deaths were more during non-office hours
compared to deaths in office hours (p-
value= 0.005, OR 1.65, CI 1.3738 - 5.4457).
The night shift was longer than the day shift
by 4hours.

7. Study significance
The outcomes of the study will
contribute to correct staffing policy
required to reduce the high
maternal mortality ratio in Kenya

8. Maternal Deaths distribution by Region
15
39
24
17
13
28
34
24
0 5 10 15 20 25 30 35 40 45
Central region
Coast region
Eastern region
Nairobi region
North Eastern region
Nyanza region
Rift valley region
Western region

9. Socio Demographic -Age at death
8.9%
23.1%
27.5%
21.5%
12.6%
4.3%
0.4%
0%
5%
10%
15%
20%
25%
30%
<20 20-24 25-29 30-34 35-39 40-44 45+

10. Socio Demographic-Parity at death
20.9%
21.5%
15.3%
14.5%
7.2%
5.8%
8.3%
6.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
0 1 2 3 4 5 6+ Unknown
% Maternal Deaths
% MD

11. Socio Demographic -GRAVIDITY at Death
20.0%
18.8%
15.7%
14.7%
8.7%
15.5%
6.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
1 2 3 4 5 6 Not
Recorded
% Maternal Deaths
% Maternal Deaths

12. Received
ANC
Frequency Percent
Yes 229 47.3
No 55 11.4
Unknown 200 41.3
Total 484 100

13. Clinical Characteristics-HIV status
52.7%
12.7%
34.6%
Negative Positive Not recorded

14. Mode of Delivery Frequency (n) Percent (%)
Assisted Vaginal 7 1.4
Caesaerean
Section
139 28.7
Ectopic
pregnancy
2 0.4
Not Applicable 81 16.7
Undelivered 70 14.5
Vaginal 185 38.2
Total 484 100

15. Cause of Death
Variable Frequency (n) Percent (%)
Direct death without an
obstetric cause
1 0.2
Hypertension disorders
in pregnancy
74 15.3
Non Obstetric
complications
96 19.8
Obstetric haemorrhage 192 39.6
Other obstetric
Complications
13 2.8
Pregnancy with
abortive outcomes
40 8.3
Unknown 68 14
Total 484 100

16. Timing of emergency and death
3
43
0 1 0
70
0
67
300
3
0
50
100
150
200
250
300
350
Early Pregancy Antenatal period
20W+
Intrapartum Postpartum During anaesthesia
Timing of emergency and death
Timing of emergency Timing of death

17. Place of Death
Variable Frequency (n) Percent (%)
County Referral
Hospital
199 41.1
National
teaching/Referral
hospital
96 19.8
On The way 5 1
Private/faith Based 38 7.9
Secondary Referral
Hospital
98 20.2
Sub County
Hospital
48 9.9

18. Period of death Frequency (n) Percent (%)
Public holiday 2 0.4
Weekday out of
hours
210 43.4
Weekday
working hours
129 26.3
Weekend 143 29.5
Total 484 100

19. Bivariate Analysis
Variable Chi square P value
Age 7.073 0.000
Parity 9.796 0.000
Gravidity 8.409 0.000
Received ANC 5.288 0.000
HIV Status 5.141 0.000
Delivery Mode 9.809 0.000
Timing of death 4.739 0.000
Place of death 7.178 0.000

20. Multivariate Analysis
Variable P value Adjusted OR 95% CI
Age 0.275 0.344 0.24 to 0.83
Parity 0.006 15.7 0.24 to 1.38
Gravidity 0.004 1.43 0.33 to 0.178
Received ANC 0.000 1.26 0.24 to 0.358
HIV Status 0.154 0.025 0.17 to 0.19
Delivery Mode 0.000 18.0 0.338 to 0.454
Timing of death 0.000 8.45 0.207 to 0.292
Place of death 0.000 7.71 0.241 to 0.301

21. Conclusion

22.  .