Kenya – maternity medical centres in Nairobi are death traps
Most maternity medical centres in Nairobi are no more than death traps, lacking in facilities, medicines and human skills.
A study carried out by the Nairobi-based African Population and Health Research Centre, the World Bank and two UK universities — Southampton and Liverpool John Moores — found high maternal deaths related to poor medical services.
In a study published in the Journal of Reproductive Health, the researchers surveyed 25 health centres in Korogocho, Viwandani and surrounding areas and found that not only were medicines, human skills and equipment lacking, but these centres are not supervised by any government authority.
For example, a drug of choice, used in the treatment of eclampsia — a serious complication of pregnancy that includes high blood pressure — was available in only seven health facilities. The drug is calledparenteral magnesium sulphate.
A woman developing complications in these facilities has very little chance of being evacuated in time to a higher level facility. “Only five health facilities had emergency transport on site for referral of obstetric emergencies. The lack of ambulances was reflected in the high level of emergencies that arrive at referral hospitals (56 per cent) on foot or public transport.”
Realising how urgent this problem is, the government in its current Budget, has allocated money for the purchase of 300 ambulances countrywide. To make the ambulances more effective and available even in insecure city estates, the minister for Medical Services, Prof Anyang’ Nyong’o (right) has suggested that all ambulances, both public and from private sectors, be put in a common pool.
In such an arrangement, he has argued, it would be more effective for the ambulances to respond to an emergency from any part of the city. Such a programme would be subsidised by the government. What seemed to surprise the researchers more was the fact that only six health facilities provide preventive HIV treatment in case staff get exposed to the virus through infected blood.
Although the law requires that such facilities be under regular external supervision, this does not happen. Many “operate without proper supervision and regulation with 20 per cent reporting no supervisory visit for more than a year,” say the researchers.
In a follow-up study, the same team sought to identify the main causes of maternal deaths among slum women in Nairobi. The pregnancy outcome of more than two-thirds of the pregnancies that ended in death was either a miscarriage or induced abortion.
“We also observed that all abortion-related maternal deaths had the pregnancy terminated outside of health care facility and by non-skilled personnel. Less than half died in a health centre, implying that most abortion seekers do not seek care even in the event of a complication.”
A significant number of women were found to be dying following delayed maternal causes. Such deaths occur between six weeks to one year after the termination of a pregnancy. “Aids and tuberculosis accounted for about 59 per cent of all late maternal deaths.”
Most of the deaths, say the researchers, happened following mismanaged labour or abortion by non-skilled attendants. “All abortion-related deaths followed an event carried out by a non-professional and less than 50 per cent sought care before death.”