Welcome to Korogocho, the worst place to give birth in East Africa

Sunday August 14 2011

By CHRISTABEL LIGAMI

Kenya’s maternal mortality rate of 706 deaths per 100,000 live births in two of Kenya’s slums has raised concern. One million babies are born in Kenya every year.

It stands higher than the country’s current average of 488 per 100,000 live births, according to study findings of the African Population and Health Research Centre (APHRC).

The study conducted in Viwandani and Korogocho found that most facilities where poor women seek services lack qualified personnel, equipment and supplies to handle even minor obstetric complications.

“The private healthcare providers located within the slums are not regulated by the government and many are illegal as they are not licensed,” said Catherine Kyobutungi, head, health systems and challenges, APHRC.

Kyobutungi said only 14.3 per cent of the health facilities were equipped to manage complications like eclampsia (pregnancy-induced hypertension).
A functioning referral system, vital in saving lives in cases of emergencies that require higher levels of care was lacking in most facilities.
APHRC research results showed that about 10 per cent of births in the slums are handled by traditional birth attendants (TBAs).

“These attendants lack skills to handle delivery and Kenya’s National Reproductive Health Policy has banned them from delivering women,” she said.

Nairobi’s largest public-owned delivery hospital, Pumwani Maternity, frequented by women from the slums, is also choking under increased demand for its limited services.

The hospital currently delivers more than 100 babies daily, with 128 being the highest number recorded in a single day. Lack of funding to recruit more medical personnel, buy vital life-saving equipment has also made the situation worse.

According to the study poor women prefer traditional birth attendants to nurses when seeking services.

“The TBAs feel that they are offering useful services especially to poor women who are unable to afford high hospital charges arguing that many women prefer them to nurses in public health facilities because the nurses are abusive towards the women,” Dr Kyobutungi said.”

The study revealed that while most deliveries and abortions that eventually resulted in maternal deaths took place outside of a healthcare facility, the actual death happened at a healthcare facility.

“This is a pointer to delays in recognising a complication, making a decision to go to a healthcare facility and reaching it or receiving care while at the facility,” said Dr Kyobutungi.

Cost of accessing maternal health services is a critical factor in seeking healthcare in Kenya. This is even more critical for poor communities, such as informal settlements, that live in abject poverty.

Antenatal care services

Research shows that overall, antenatal care services are paid for in nearly all the facilities where slum women seek services and only 16 per cent of the facilities not charging.

The major causes of maternal death are: abortion, ante/post partum haemorrhage (bleeding), postpartum sepsis (infection), eclampsia (hypertension during pregnancy), and ruptured uterus. Abortion complications accounted for more than 30 per cent of all maternal deaths.

“Of all the maternal deaths recorded by this study, only 21 per cent were delivered or aborted with the assistance of a health professional,” noted Dr Kyobutungi

Adding that because most maternal deaths occur among women who deliver outside of a health facility and with the help of unskilled personnel, there is a need for increased availability and use of quality emergency obstetric care services for growing slum populations.

This indicates that there is need to regulate and supervise lower-level public and private providers offering services to slum residents to ensure that they are able to provide a minimum package of quality emergency obstetric services and better ways to waive or remove delivery costs for poor women.

The lack of emergency ambulance services in the slums where infrastructure is non-existent and insecurity deters movement at night. further complicates referral.

The United Nations Populations’ body (UNFPA) latest statistics shows that everyday, 1,000 women die and 5,500 new-borns die in the first week of life for lack of adequate medical care.

Maternal mortality remains a challenge in East Africa, although figures from a 2008 report released by the WHO  indicate a general decline globally. According to the report Kenya and Tanzania,  are among 11 countries in the world in which 65 per cent of the maternal deaths occur. Rwanda and Burundi have maternal mortality rates of at least 1000 per 100 000 live births. There has been a significant improvement in maternal health in the two countries according to WHO and these will be reflected in the new report to be released this year.

Uganda’s maternal mortality rate stands at 435 deaths per 100,000 live births which is still high.

The UN’s MDG 5 target of reducing  maternal mortality is 131 per every 100,000 live births by 2015.

In Sub – Saharan Africa, a woman has a one in 16 chance of dying in pregnancy or childbirth; and the lifetime risk is 100 times more than elsewhere in the world.