Maternities of death in counties
A report by the Auditor-General has revealed the distressing condition of maternity facilities in counties.
What you need to know:
- Maternal deaths increased from 409 in 2017 to 1,053 between 2020 and 2021.
- Major causes of newborn deaths were premature birth, asphyxia and sepsis.
From insufficient equipment, shortage of trained health workers to neonates having to share incubators as mothers share beds, a report by the Auditor-General has revealed the distressing condition of maternity facilities in counties.
The audit, conducted in Nairobi, Mombasa,Kisumu, Nakuru, Bungoma,Taita-Taveta ,West Pokot, Makueni, Siaya, Isiolo and Garissa counties, evaluated the state of maternal and newborn health services in public hospitals.
It covered 67 public health facilities, including six level five, 26 level four, 22 level three, and 13 level two hospitals, and the period between 2017/2018 to 2021/2022.
A total of 60 per cent of the facilities were found to be lacking the equipment necessary to offer basic maternity services. Which would perhaps explain the upward trend in maternal mortalities between 2017 and 2022.
Maternal deaths increased from 409 in 2017 to 1,053 between 2020 and 2021. The number of newborn deaths also experienced an uptick.
For instance, the audit report shows that 409 mothers died in 2017 ,421 in 2018,459 in 2019 and 1,053 between 2020 and 2021 (at the height of Covid-19 in the country).
Interviews with health officials indicated that the major causes of newborn deaths were premature birth, asphyxia (death related to lack of oxygen and blood flow to the brain) and sepsis (severe infection in infants below 28 days).
Mothers deaths were primarily due to postpartum hemorrhage (excessive bleeding),sepsis and pre-eclampsia.
An ideal maternity unit should have a separate labour ward, delivery room, postnatal vaginal delivery ward, post caesarean section ward and antenatal ward.
However, the audit revealed that the sampled health facilities did not have such, were congested and mothers shared beds.
Most of the facilities were found to have a delivery room and a one room ward that serves as the antenatal, labour and postnatal room.
Garissa Referral Hospital, Iftin Sub-County Hospital, Garbatulla Sub-County Hospital, Isiolo Referral Hospital, Portreiz Sub-County Hospital and Moi Referral Hospital in Taita-Taveta are among the facilities without proper maternity units.
They were also found to be congested with mothers sharing beds, posing the risk of cross-infection among patients.
In some facilities, women who had lost their babies shared rooms with those who had successfully delivered and were nursing babies. This was a traumatic experience for the grieving mothers.
The audit further revealed that seven level four hospitals do not have maternity theatres and instead use the general surgical theatres. This resulted in delays in dealing with emergency maternity cases.
Facilities that did not have theatres would refer caesarean section cases to other facilities.
At Uthiru health centre in Nairobi County, the maternity theatre was not operational because of lack of equipment, including a three-phase autoclave machine used for sterilisation.
Miti Mingi, Kyau, Luuya Mwangea and Dunga health facilities lacked laboratory services to determine the health condition of expectant women.
The audit further established that some level four hospitals lack newborn units. Only 29 out of the 67 facilities audited had newborn units.
Other health facilities lacked kangaroo mother care services. This is a method of care for pre-term infants that usually involves skin-to-skin contact.
Most of the facilities, according to the report, could not provide ultrasound services, which are necessary to confirm the pregnancy and check the foetus for any defects or problems.
The audit further established that most of the facilities did not have enough beds. For instance; Mbagathi Hospital in Nairobi had 26 beds against 56 daily patients at its maternity wing.
Mama Lucy Hospital also had 26 against an average of 52 patients per day, while Moi County Referral Hospital in Voi had 24 beds against an average of 33 patients.
Many of the facilities had at least two women sharing a bed. However, two health facilities in Bungoma and Nairobi had up to three sharing one bed. Others had women on mattresses laid on the floor.
To deal with congestion, the audit established that some other facilities resorted to early discharge of patients to accommodate others.
Most of the facilities also lacked enough incubators, phototherapy machines, among other crucial equipment. For instance, it was established that two to three newborns shared an incubator.
At Mama Lucy Kibaki, three to four babies were sharing an incubator. Other inadequacies included shortage of ambulances as well as nurses and other medics.
