Trends in health facility based maternal mortality in Central Region, Kenya: 2008-2012.

INTRODUCTION: WHO classifies Kenya as having a high maternal mortality. Regional data on maternal mortality trends is only available in selected areas. This study reviewed health facility maternal mortality trends, causes and distribution in Central Region of Kenya, 2008-2012. METHODS: We reviewed health records from July 2008 to June 2012. A maternal death was defined according to ICD-10 criterion. The variables reviewed included socio-demographic, obstetric characteristics, reasons for admission, causes of death and contributing factors. We estimated maternal mortality ratio for each year and overall for the four year period using a standard equation and used frequencies means/median and proportions for other descriptive variables. RESULTS: A total 421 deaths occurred among 344,191 live births; 335(80%) deaths were audited. Maternal mortality ratios were: 127/100,000 live births in 2008/09; 124/100,000 live births in 2009/2010; 129/100,000 live births in 2010/2011 and 111/100,000 live births in 2011/2012. Direct causes contributed majority of deaths (77%, n=234) including hemorrhage, infection and pre-eclampsia/eclampsia. Mean age was 30(±6) years; 147(71%) attended less than four antenatal visits and median gestation at birth was 38 weeks (IQR=9). One hundred ninety (59%) died within 24 hours after admission. There were 111(46%) caesarian births, 95(39%) skilled vaginal, 31(13%) unskilled 5(2%) vacuum deliveries and 1(<1%) destructive operation. CONCLUSION: The region recorded an unsteady declining trend. Direct causes contributed to the majority deaths including hemorrhage, infection and pre-eclampsia/eclampsia. We recommend health education on individualized birth plan and mentorship on emergency obstetric care. Further studies are necessary to clarify and expand the findings of this study.

Factors associated with low birth weight among neonates born at Olkalou District Hospital, Central Region, Kenya.

INTRODUCTION: Ninety-two percent of Low Birth Weight(LBW) infants are born in developing countries, 70% in Asia and 22% in Africa. WHO and UNICEF estimate LBW in Kenya as 11% and 6%by 2009 Kenya Demographic Health Survey. The same survey estimated LBW to be 5.5% in Central Province, Kenya. Data in Olkalou hospital indicated that prevalence of LBW was high. However, factors giving rise to the problem remained unknown. METHODS: A cross-sectional analytic study was therefore conducted to estimate prevalence and distribution and determine the factors associated with LBW in the hospital. LBW was defined as birth of a live infant less than 2500 g. We collected data using a semi-structured questionnaire and review of health records. A total 327 women were randomly selected from 500 mothers. Data was managed using Epi Info 3.3.2. RESULTS: The prevalence of LBW was 12.3% (n = 40). The mean age of mothers was 25.6 ± 6.2 years. Mean birth weight was 2928 ± 533 grams. There were 51.1% (n = 165) male neonates and 48.9% (n = 158) females. The following factors were significantly associated with LBW:LBW delivery in a previous birth (OR = 4.7, 95%C.I. = 1.53-14.24), premature rapture of membranes (OR = 2.95, 95%C.I. = 1.14-7.62), premature births (OR=3.65, 95%C.I. = 1.31-10.38), and female newborn (OR = 2.32, 95%C.I. = 1.15-4.70). On logistic regression only delivery of LBW baby in a previous birth (OR = 5.07, 95%C.I. = 1.59-16.21) and female infant (OR = 3.37, 95%C.I. = 1.14-10.00)were independently associated with LBW. CONCLUSION: Prevalence of LBW in the hospital was higher than national estimates. Female infant and LBW baby in a previous birth are independent factors. Local prevention efforts are necessary to mitigate the problem. Population-based study is necessary to provide accurate estimates in the area.

Maternal mortality in Central Province, Kenya, 2009-2010.

INTRODUCTION: Maternal mortality for Kenya was 488/100,000 live births in 2009. Maternal mortality estimate for Central Province is unknown. We retrospectively reviewed data between 1st July 2009 and 30th June 2010 to estimate the hospital based maternal mortality ratio, characterize deaths by time, place and person and describe possible causes of deaths in Central province, Kenya. METHODS: We abstracted data using a standard form from maternal death notification and review forms and the district reproductive health reports. Data was entered and analyzed using Microsoft Excel. RESULTS: There were 89,512 live births and 111 deaths. The facility-based maternal mortality ratio was 124/100,000 live births. Seventy-three (66%) deaths had been audited. Thirty seven (33%) were aged 25 to 34 years. The mean age was 31 years (±6). Thirty seven (33%) had a parity of less or equal to 2. Most case deaths (19%, n = 21) had attended 2 or less antenatal visits. The main gestation was below 37 weeks with 48% (n = 53). The main mode of delivery was vaginal (26%, n = 29). Majority (35%, n = 32) case deaths had delivered a live birth. Thirty seven (33%) mothers had been stable on admission. The main reason for admission was labor with 12% (n = 13). Thirty-eight (34%) died within 24 hours after admission. Majority (27%, n = 30) were admitted antepartum but 39% (n = 43) were postpartum at the time of death. Thirty-five (32%) died of hemorrhage and 8 (7%) Eclampsia. CONCLUSION: Maternal mortality is of public health importance in the region. Most deaths occurred within 24 hours after admission. Third delay was important. Bleeding and Eclampsia were the main causes of death. A third (34%) of notified deaths were not reviewed.

Antimicrobial resistance: capacity and practices among clinical laboratories in Kenya, 2013.

INTRODUCTION: Antimicrobial resistance is neglected in developing countries; associated with limited surveillance and unregulated use of antimicrobials. Consequently, delayed patient recoveries, deaths and further antimicrobial resistance occur. Recent gastroenteritis outbreak at a children's home associated with multidrug resistant non-typhoidal Salmonella spp, raised concerns about the magnitude of the problem in Kenya, prompting antimicrobial resistance assessment preceding surveillance system establishment. METHODS: Eight public medical laboratories were conveniently selected. Questionnaires were administered to key informants to evaluate capacity, practice and utilization of antimicrobial susceptibility tests. Retrospective review of laboratory records determined antimicrobial resistance to isolates. Antimicrobial resistance was defined as resistance of a microorganism to an antimicrobial agent to which it was previously sensitive and multidrug resistance as non-susceptibility to at least one agent in three or more antimicrobial categories. RESULTS: The laboratories comprised; 2(25%) national, 4(50%) sub-national and 2(25%) district. Overall, antimicrobial susceptibility testing capacity was inadequate in all. Seven (88%) had basic capacity for stool cultures, 3(38%) had capacity for blood culture. Resistance to enteric organisms was observed with the following and other commonly prescribed antimicrobials, ampicillin: 40(91%) Salmonella spp isolates; Tetracycline: 16(84%) Shigella flexineri isolates; cotrimoxazole: 20(100%) Shigella spp isolates, 24(91%) Salmonella spp isolates. Comparable patterns of multidrug resistance were evident with Shigella flexineri and Salmonella typhimurium. Ten (100%) clinicians reported not using laboratory results for patient management, for various reasons.