13 counties most affected by postpartum haemorrhage

What you need to know:

• According to the Ministry of Health, Kenya records about 5,000 maternal deaths each year.
• Most expectant mothers in the country who die during childbirth die as a result of postpartum haemorrhage.

According to the Ministry of Health, 14 expectant mothers die in childbirth every month, casting a shadow of deep concern.

This devastating reality adds to an estimated 5,000 maternal deaths annually, according to official data from the Ministry of Health.

Dr Edward Serem, the head of Reproductive and Maternal Health at the MoH, reveals that most expectant mothers in the country who lose their lives during childbirth die as a result of postpartum haemorrhage (PPH), with Tana River, Garissa, West Pokot, Elgeyo Marakwet, Machakos, Homabay, Siaya, Wajir, Kilifi, Murang’a, Makueni, Migori and Turkana counties recording the highest number of deaths.  

PPH is the loss of at least 500ml of blood within 24 hours of giving birth and affects about five per cent of all women giving birth worldwide, according to the United Nations Fund for Population Activities (UNFPA).

Dr Janet Karimi, the MoH’s director of newborn and child health, says 24 health facilities in the 13 listed counties are major contributors to the persistently high rates of maternal and newborn deaths.

Inadequate access to skilled health care providers, limited availability of essential medical supplies and equipment, and gaps in emergency obstetric care all contribute to the deadly toll of PPH.

In addition, cultural norms and social stigma surrounding maternal health often prevent women from seeking timely and appropriate care, further increasing the risk of complications during childbirth.

This is despite progress in improving maternal and newborn health in the country, with the head of the department revealing that the maternal mortality ratio currently stands at 355 per 100,000 live births, while the neonatal mortality rate is 21 per 1000 live births.

This is far from the Sustainable Development Goals (SDG) target of 70 per 100,000 live births by 2030.

According to Dr Serem, this is why the Ministry of Health decided to partner with Amref Health Africa in Kenya to launch the Maternal and Newborn Health (MNH) Big Bet initiative, aptly named Sparking Change, Saving Lives – Quality Healthcare for Mothers and Babies.

The initiative aims to forge new alliances to spearhead investment and implementation of transformative strategies with a resolute focus on improving the survival and well-being of expectant mothers and newborns in Kenya’s counties.

Speaking at the launch of the initiative, Elgeyo Marakwet County Governor Wisley Kipyegon Rotich, who leads one of the most affected counties, urged all stakeholders to prioritise achieving zero maternal mortality in the country and thanked Amref for taking the lead.

“We are grateful to Amref Health Africa for their support in moving us towards zero preventable maternal and child deaths. Based on the Ministry of Health’s findings, we, the governors and the health committee, are committed to supporting the MNH Big Bet initiative and working towards zero maternal mortality in our counties,” he said.

“To achieve this, it is critical to adopt a data-driven approach, using AI-enabled data analytics within health management systems for targeted interventions. Blanket interventions are no longer enough. We also recognise the importance of developing infrastructure, including a strong network of Community Health Promoters (CHPs) – our true ambassadors on the ground,” Governor Rotich added. “Investment is needed to achieve these ambitious goals.

In addition, the initiative seeks to enlist the support of Kenyan governors, particularly from regions with high maternal and neonatal mortality, to champion maternal health and prioritise it in their jurisdictions,” Dr Meshack Ndirangu, Amref Health Africa’s Country Director in Kenya, told a roundtable with governors and stakeholders from the high burden counties, adding that in this initial phase they will work with the counties with the highest burden.

“To achieve the set target, there is a need for increased investment in maternal and newborn health by ecosystem stakeholders.

Dr Ndirangu went on to highlight the strategic alignment of these game-changers with Amref’s 2023-2030 Strategic Plan, which he said aims to transform communities’ health through primary health care, with a focus on women and young people.

It also aligns with the Kenyan government’s commitment to achieving Universal Health Coverage (UHC) and its commitment to the Ending Preventable Maternal Mortality and Every Newborn Action Plan.

“Under the Maternal and Newborn Health Big Bet, we have identified four critical game-changers to address the high number of deaths and ensure healthy pregnancies and safe deliveries in 60 referral health facilities in high-burden counties.

These game-changers include establishing High Response Maternity Units, strengthening neonatal emergency response systems, strengthening primary health care, and strengthening accountability for every mother and newborn,” he said.

He reminded us that investing in maternal and newborn health is more than a moral obligation; it is a smart financial decision.

“According to the Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030, every US$1 invested yields a remarkable return of US$9 in economic and social benefits.

In particular, households affected by maternal mortality spend about one-third of their annual per capita consumption expenditure on health care, highlighting the urgent need for targeted interventions to break the cycle of poverty caused by maternal mortality,” said Dr Ndirangu.

The World Health Organisation (WHO) highlights that although PPH affects millions of women every year and accounts for more than 20 per cent of all maternal deaths reported worldwide, death from PPH is largely preventable and has been almost eliminated in high-income countries (HICs).

“However, women in low- and middle-income countries (LMICs) continue to be disproportionately affected. Most maternal deaths from PPH occur in sub-Saharan Africa and South Asia”.

Recognising the growing need for global action to improve PPH prevention and care, the World Health Organization and its partners developed a Roadmap for PPH in October last year.

“The roadmap outlines goals, activities and milestones for research, normative work (on norms and standards), implementation and advocacy at the global level between 2023 and 2030 to address key PPH priorities and accelerate progress towards SDG target 3.1 on reducing the global maternal mortality ratio to less than 70 per 100,000 live births.

It also sets out an innovative, solutions-oriented and tailored strategic framework that focuses on the maternal health goals and priorities of countries with a high burden of PPH, and calls for investment in critical areas of health systems, with a particular focus on low- and middle-income countries (LMICs).

Dr Karimi told the Nation that the war against PPH in Kenya can be won if all hands are on deck.

“We need to protect and prioritise the lives of our expectant mothers and newborns; we need to consolidate all efforts to achieve this and help the most burdened counties.”

Article first published on https://nation.africa/kenya/health/13-counties-most-affected-by-postpartum-haemorrhage-4572162