Risk factors for maternal mortality in a Tertiary Hospital in Kenya: a case control study
1 Department of Health Policy and Management, Moi University, P. O Box 4606, Eldoret 30100, Kenya
2 University of Newcastle, HMRI Building, Callaghan, NSW 2308, Australia
3 Centre for Clinical Epidemiology and Biostatistics, Callaghan, NSW 2308, Australia
4 Research Centre for Gender, Health and Ageing, Callaghan, NSW 2308, Australia
5 Department of Reproductive Health, Moi University, P.O. Box 4606, Eldoret 30100, Kenya
6 National Centre for Epidemiology and Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
7 Department of Public Health and Clinical Medicine Epidemiology and Global Health, Umeå University, Umeå, Sweden
BMC Pregnancy and Childbirth 2014, 14:38 doi:10.1186/1471-2393-14-38Published: 22 January 2014
Maternal mortality is high in Africa, especially in Kenya where there is evidence of insufficient progress towards Millennium Development Goal (MDG) Five, which is to reduce the global maternal mortality rate by three quarters and provide universal access to reproductive health by 2015. This study aims to identify risk factors associated with maternal mortality in a tertiary level hospital in Kenya.
A manual review of records for 150 maternal deaths (cases) and 300 controls was undertaken using a standard audit form. The sample included pregnant women aged 15-49 years admitted to the Obstetric and Gynaecological wards at the Moi Teaching and Referral Hospital (MTRH) in Kenya from January 2004 and March 2011. Logistic regression analysis was used to assess risk factors for maternal mortality.
Factors significantly associated with maternal mortality included: having no education relative to secondary education (OR 3.3, 95% CI 1.1-10.4, p = 0.0284), history of underlying medical conditions (OR 3.9, 95% CI 1.7-9.2, p = 0.0016), doctor attendance at birth (OR 4.6, 95% CI 2.1-10.1, p = 0.0001), having no antenatal visits (OR 4.1, 95% CI 1.6-10.4, p = 0.0007), being admitted with eclampsia (OR 10.9, 95% CI 3.7-31.9, p < 0.0001), being admitted with comorbidities (OR 9.0, 95% CI 4.2-19.3, p < 0.0001), having an elevated pulse on admission (OR 10.7, 95% CI 2.7-43.4, p = 0.0002), and being referred to MTRH (OR 2.1, 95% CI 1.0-4.3, p = 0.0459).
Antenatal care and maternal education are important risk factors for maternal mortality, even after adjusting for comorbidities and complications. Antenatal visits can provide opportunities for detecting risk factors for eclampsia, and other underlying illnesses but the visits need to be frequent and timely. Education enables access to information and helps empower women and their spouses to make appropriate decisions during pregnancy.