Maternal morbidity and mortality in peri-urban Kenya--assessing progress in improving maternal healthcare.

OBJECTIVE: Improving quality of maternal healthcare delivery is pivotal to reversing the trend of maternal health in developing countries and consequently achieving the 5th millennium goal of reducing maternal mortality and improving universal access to reproductive health. Periodic facility-based reviews of maternal morbidity and mortality are crucial to improving quality of care delivered. METHODS: This retrospective study was conducted in PCEA Kikuyu Hospital Kenya. Data on sociodemographics recorded antenatal care activities maternal morbidities and deaths were elicited from case notes of all pregnancies and births over a 2 year period and subsequently analyzed. RESULTS: There were 1716 deliveries during the period. 1405 (91%) of the women booked for antenatal care; 1068 (57.3%) had at least 3 visits before delivery. 842 (45.9%) were either untested for Human Immunodeficiency Virus or their results were not documented; 55 (3%) tested positive. The caesarean section rate was 27.4% (n=470); PMTCT (Prevention of Mother to Child Transmission) constituted 1.6% (10) of the indications. Urinary tract infection was the commonest maternal illness in pregnancy (14.5% n=270) however it was not found to be associated with any adverse outcome. Genital tract trauma was the commonest morbidity suffered by the women during delivery (90.6% n=800). Psychological disorders constituted 5.3% (7) of reported postpartum complications. There were 2 maternal deaths out of 1673 live births giving a maternal mortality ratio of 119.55 per 100000 live births. The deaths resulted from septic abortion and eclampsia. CONCLUSION: Urinary tract infection is an important cause of maternal illness during pregnancy. Routine screening is recommended. PMTCT needs further consolidation to increase the number of screened women and ensure those who need interventions like caesarean sections get access to them. Diagnosis and management of psychological disorders in pregnancy remain unsatisfactory. Further studies to identify the true burden of these conditions are needed.