How complete were maternal death reviews in Central Kenya 2015 - 2018?

Benson K. Mwaniki, Jeffrey K. Edwards, Walter Kizito


In response to high maternal mortality ratio (MMR) Kenya implemented mandatory maternal death reviews (MDR) in 2004. This retrospective study used MDR data to assess the completeness of MDR process in seven hospitals of Thika sub-county, central Kenya from January 2015 to June 2018. Of all 43 maternal deaths that occurred, 98% were notified while 64% were audited. MDR forms were filled in 55% of the cases of which only 7% had complete documentation.  The median age of patients was 30 years majority of whom died within 24 hours of admission. Caesarean sections were associated with 48% of deaths, with haemorrhage accounting for most of the direct causes. Data on hospital-related delays, missed opportunities and action points were most frequently omitted in MDR forms. Capacity building for audit teams is recommended to improve quality of MDR process particularly focusing on identifying causes of preventable maternal deaths. (Afr J Reprod Health 2020; 24[4]: 122-131).

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World Health Organization (WHO). Time to respond: A

report on the global implementation of Maternal Death Surveillance and Response. 2016;1–64.

Smith H, Ameh C, Godia P, Maua J, Bartilol K, Amoth

P, Mathai M and Nynke van den Breok. Implementing Maternal Death Surveillance and Response in Kenya: Incremental Progress and Lessons Learned. Global Health Science and Practice. 2017;5(3):345-54.

World Health Organization, UNICEF, United Nations,

Department of Economic and Social Affairs, Population Division, World Bank. Trends in maternal mortality 1990; to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.

Hoque M. Incidence of Obstetric and Foetal

Complications during Labor and Delivery at a Community Health Centre, Midwives Obstetric Unit of Durban, South Africa. International Scholarly Research Network, ISRN Obstetrics and Gynecology 2011;1-6.

Moran AC, Jolivet RR, Chou D, Dalglish SL, Hill K,

Ramsey K, Rawlins B and Say L. A common

monitoring framework for ending preventable maternal mortality, 2015–2030: phase I of a multi-step process. BMC Pregnancy and Childbirth 2016;16(1).

Smith H, Ameh C, Roos N, Mathai M and van den Broek

N. Implementing maternal death surveillance and response: A review of lessons from country case studies. BMC Pregnancy and Childbirth. 2017; 17:233.

World Health Organization. Strategies toward ending

preventable maternal mortality (EPMM). 2015; 6736:1–4.

Jolivet RR, Moran AC, O’Connor M, Chou D, Bhardwaj

N, Newby H, Requejo J, Schaaf M, Say L and Langer A. Ending preventable maternal mortality: phase II of a multi-step process to develop a monitoring framework, 2016–2030. BMC Pregnancy Childbirth. 2018 Dec;18(1):258.

World Health Organization. Maternal Death Surveillance

and Response. Technical guidance information for action to prevent maternal death. 2013

Measure evaluation, USAID. Opening the Black Box of

Maternal and Newborn Deaths in Kenya. A report on Technical Support for Implementation of Maternal and Perinatal Death Surveillance and Response 2017.

Estimates by WHO, UNICEF, UNFPA, The World Bank

and the United Nations Population Division. Trends in maternal mortality: 1990 to 2013

Ministry of Health [Kenya]. National Guidelines for

Maternal and Perinatal Death Surveillance and Response 2016.

Achoki T, Miller-Petrie MK, Glenn SD, Kalra N, Lesego

A, Gathecha GK, Alam U, Kiarie H W, Maina IW, Adetifa IMO, Barsosio HC, Degfie TT, Keiyoro PN, Kiirithio DN, Kinfu Y, Kinyoki DK, Kisia JM, Krish VS, Lagat AK, Mooney MD, Moturi WN, Newton CRJ, Ngunjiri JW, Nixon MR, Soti DO, Van De Vijver S, Yonga G, Hay SI, MurrayCJL and Naghavi M. Health disparities across the counties of Kenya and implications for policy makers, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Global Health. 2019;7(1): e81–95.

Ministry of Health Kenya: Saving Mothers Lives. First

Confidential Report into Maternal Deaths in Kenya 2017.

Borko H, Apurva S, Jane B, Addo LG, Umutesi A, John

R, Wangui KJ, Nderitu CP, Kathy W, Michael GP, Mistiaen JA, Tom F, Toru N, Battaile WG, Raiph VD, Sebastian J, Honore HC, Xavier C, Paulina MM, Isabelle GF and Harun O. Kenya Country Economic Memorandum. From Economic Growth to Jobs and Shared Prosperity. World Bank Group 2016.

DHIS Kenya:

Thaddeus S and Maine D. Too far to Walk: Maternal

Mortality in Context. Social Science & Medicine. 1994;38(8):1091–110.

Combs Thorsen V, Sundby J, Meguid T and Malata A.

Easier said than done! methodological challenges with conducting maternal death review research in Malawi. BMC Medical Research Methodology 2014; 14:29.

Muchemi OM, Gichogo AW, Mungai JG and Roka ZG.

Trends in health facility-based maternal mortality in central region Kenya: 2008 - 2012. Pan African Medical Journal 2016: 23:259.

Hamersveld KT Van, Bakker E Den and Nyamtema AS.

Barriers to conducting effective obstetric audit in

Ifakara: a qualitative assessment in an under-resourced setting in Tanzania. Tropical Medicine and International Health 2012;17(5):652-7.

Congo B, Sanon D, Millogo T, Ouedraogo CM,

Yameogo WME, Meda ZC and KOuanda S. Inadequate programming, insufficient communication and non-compliance with the basic principles of maternal death audits in health districts in Burkina Faso: a qualitative study. Reproductive Health 2017; 14:121.

Pourasghar F, Malekafzali H, Kazemi A, Ellenius J and

Fors U. What they fill in today, may not be useful tomorrow: Lessons learned from studying Medical Records at the Women hospital in Tabriz, Iran. BMC Public Health 2008; 8:139.

Lazzerini M, Ciuch M, Rusconi S and Covi B.

Facilitators and barriers to the effective implementation of the individual maternal near-miss case reviews in low/middle-income countries: a systematic review of qualitative studies. BMJ Open 2018; 8: e021281.

Melberg A, Mirkuzie AH, Sisay TA, Sisay MM and

Moland KM. “Maternal deaths should simply be 0”: politicization of maternal death reporting and review processes in Ethiopia. Health Policy and Planning 2019; 1-7 doi: 10.1093/heapol/czz075

Abouchadi S, Zhang W-H and De Brouwere V.

Underreporting of deaths in the maternal deaths surveillance system in one region of Morocco. PLoS ONE 2018;13(1).

Madzimbamuto FD, Ray SC, Mogobe KD, Ramogola-

Masire D, Phillips R, Haverkamp M, Mokotedi M and Montana M. A root-cause analysis of maternal deaths in Botswana: towards developing a culture of patient safety and quality improvement. BMC Pregnancy and Childbirth 2014; 14:231.

Hounkpatin B, Obossou AAA, Aguemon CT,

Hounkponou FN, Aboubakar M, Sehlouan C, Tonato-Bagnan A and Perrin RX. The Impact of Audits of Maternal Deaths and Near Miss at University Hospital of Mother and Child Lagoon (Benin). Clinics in Mother and Child Health 2016; 13:218.


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