How mothers are left to die at night, weekends and holidays in referral hospitals

Pregnant woman

Seven out of 10 women who die from maternal health complications die at night, on weekends or public holidays.

Photo credit: Shutterstock

What you need to know:

  • The deaths are mainly attributed to postpartum haemorrhage.
  • Report blamed doctors’ absenteeism and inadequate healthcare skills.

Seven out of 10 women who die from maternal health complications do so at night, on weekends or public holidays, a new report has found, raising questions about the care provided when hospitals typically work half shifts.

The report by the Ministry of Health (MoH) and Amref Health Africa says this devastating reality translates to an estimated 5,000 maternal deaths annually, with 60-70 percent of the deaths occurring in referral hospitals and 65 percent happening after 28 weeks of gestation.

“Fifty percent of expectant mothers in the country die of haemorrhage, 20 percent die of pre/eclampsia while 11 percent die of sepsis. Seven out of 10 women die at night, on weekends and on public holidays,” the report highlights.

This is after investigations conducted last year identified doctors’ absenteeism, inadequate healthcare worker skills, insufficient drug administration, inadequate medical supplies and drugs, lack of blood and platelets, and the lack of transport between health facilities as the reasons behind the deaths.

In one case highlighted by the study, a 35-year-old expectant woman was admitted to hospital on March 12, 2023, and passed away the same day. Upon admission, the diagnosis was postpartum haemorrhage secondary to a cervical tear. An under-dose of oxytocin for a postpartum haemorrhage was administered late after delivery, and no vitals were recorded post-delivery.

Dr Edward Serem, the head of the Division of Reproductive and Maternal Health at MoH, said 13 counties recorded the highest number of maternal deaths.

They are Tana River, Garissa, West Pokot, Elgeyo Marakwet, Machakos, Homa Bay, Siaya, Wajir, Kilifi, Murang’a, Makueni, Migori and Turkana.

The deaths are mainly attributed to postpartum haemorrhage, which is blood loss of at least 500ml within 24 hours after birth. It affects about five percent of all women giving birth around the world, according to the United Nations Fund for Population Activities .

Dr Janet Karimi, the Head of Newborn and Child Health at MoH, says that 24 health facilities across the 13 listed counties contributed significantly to the persistently high rates of maternal and neonatal deaths.

maternal death

Most expectant mothers in the country who die during childbirth die as a result of postpartum haemorrhage.

Photo credit: Shutterstock

“We have to safeguard and make the lives of our expectant mothers and newborns a priority, we have to consolidate all efforts to achieve this and help the highest burdened counties,” Dr Karimi told the Nation.

The maternal mortality ratio in Kenya currently stands at 355 per 100,000 live births while the neonatal mortality rate stands at 21 per 1,000 live births. It is far below the United Nations target of 70/100,000 live births by 2030.

With the worrying figures, Amref has proposed a number of solutions to save the lives of women and children.

First, Amref urges counties and national government to prioritise the uptake of innovative models at referral hospitals. It wants the number of gynaecologist consultants increased in all target counties for more high-risk mothers to access their services.

Regarding the lack of health commodities, Amref proposes the deployment of a range of medication they described as a ‘combi pack’, which includes heat-stable carbetocin, oxytocin, tranexamic acid, misoprostol, magnesium sulfate, calcium gluconate fluids and cannulas, obstetric drape, among others, for management of obstetric emergencies in all target counties.

Amref further urges counties and national government to scale up technologies such as drones in the 13 high-burden counties to move essential maternal and newborn health commodities to areas with access challenges.

In terms of infrastructure, equipment and system challenges, Amref called for an increase in comprehensive maternity services from five to 100 percent in high-burden counties (maternity, theatre and ICU).

“We urge the government to establish an emergency response system comprising multi-disciplinary teams in all referral facilities and deploy M-MAMA (an innovative emergency transport system) to improve referral services to all target counties,” the agency said.

The health ministry has partnered with Amref Health Africa to launch the Maternal and Newborn Health Big Bet initiative, named Sparking Change, Saving Lives - Quality Healthcare for Moms and Babies.

“The initiative endeavours to enlist the support of Kenyan governors, particularly from regions burdened with high maternal and newborn deaths, to champion maternal health and accord it paramount importance within their jurisdictions,” Dr Meshack Ndirangu, the country director for Amref Health Africa, said during a roundtable involving governors and stakeholders from the high-burden counties.

Speaking during the launch of the initiative, Elgeyo-Marakwet Governor Wisley Rotich, whose county is among the 13, urged all stakeholders to prioritise achieving zero maternal mortality in the country.