Health resources should be focused on those in greatest need in developing countries. It is important to identify groups of women who have an increased risk of maternal mortality and develop appropriate policies to target them. But could a woman's choice of hospital be an important risk factor?

A study by the UK University of Southampton examines the effect of the sociodemographic characteristics of women on maternal mortality in Kenyan hospitals. It also assesses variation between hospitals. The majority of births in Kenya take place at home, so the study represents only a sub-group of women. But among those who do attend hospitals, what are their chances of dying from pregnancy-related causes and which factors are likely to increase this risk?

Regardless of hospital choice, the women with greatest risk of maternal death are those who are over 35, have not attended antenatal clinics, are uneducated or have large families. The study also found that:

• There is a large variability in maternal mortality between hospitals. The risk of maternal death for a high-risk woman varies from four to 280 deaths per 1000 admissions depending on the hospital. For a low-risk woman the risk is between 0.16 to 19.6 deaths.
• The main causes of maternal mortality are anaemia, postpartum and antepartum haemorrhage, sepsis and malaria. Other causes include delay in arriving at the hospital, eclampsia, ruptured uterus, sexually transmitted infections including HIV, and the use of harmful traditional drugs.
• Antenatal clinic attendance is satisfactory. But postnatal care is usually only given to women who deliver by Caesarean section. Some hospitals do not have established postnatal clinics.
• Factors that hinder clinic attendance include distance coupled with lack of transport, ignorance on the availability and importance of maternal healthcare services, poverty, traditional beliefs and the unfriendly attitude of nurses.
• Suggestions from hospital staff on ways to reduce maternal mortality include intensifying primary healthcare education and improving the accessibility and quality of services provided.

Although most of the hospitals with significantly lower maternal mortality risks are in more developed parts of Kenya, there are differences between hospitals within some regions. Attention should be paid to individual hospitals that currently provide a poor level of maternal care. Other policy measures to reduce maternal mortality include:

• educating women on the risks of childbearing at older ages
• creating awareness of the availability and importance of health services
• introducing outreach health services including mobile clinics to improve access
• training health workers to ensure timely identification of high-risk cases, good labour management, an improved referral system and reduced risk of infection.

Source(s):
‘Analysis of factors associated with maternal mortality in Kenyan hospitals’, Journal of Biosocial Science 33, by M. Magadi, I. Diamond and N. Madise, 2001

Funded by: The Population Council; the University of Southampton

id21 Research Highlight: 4 April 2002

Further Information:
Monica Magadi
Department of Social Statistics
University of Southampton
Southampton
SO17 1BJ
UK

Tel: +44 (0)23 8059 5832
Fax: +44 (0)23 8059 3846
Contact the contributor: mmagadi@socsci.soton.ac.uk

University of Southampton

Nyovani Madise
Department of Social Statistics
University of Southampton
Southampton
SO17 1BJ
UK

Tel: +44 (0)23 8059 2534
Fax: +44 (0)23 8059 3846
Contact the contributor: njm@socsci.soton.ac.uk

Other related links:
See id21's collection of links relevant to maternal and child health.