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Maternal mortality in the informal settlements of Nairobi city: what do we know?

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Background: current estimates of maternal mortality ratios in Kenya are at least as high as 560 deaths per 100,000 live births. Given the pervasive poverty and lack of quality health services in slum areas, the maternal mortality situation in this setting can only be expected to be worse. With a functioning health care system, most maternal deaths are avoidable if complications are identified early. A major challenge to effective monitoring of maternal mortality in developing countries is the lack of reliable data since vital registration systems are either non-existent or under-utilized. In this paper, we estimated the burden and identified causes of maternal mortality in two slums of Nairobi City, Kenya.
Methods: we used data from verbal autopsy interviews conducted on nearly all female deaths aged 15–49 years between January 2003 and December 2005 in two slum communities covered by the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). In describing the distribution of maternal deaths by cause, we examined maternal and late maternal deaths according to the ICD-10 classification. Additionally we used data from a survey of health care facilities that serve residents living in the surveillance areas for 2004–2005 to examine causes of maternal death.
Results: the maternal mortality ratio for the two Nairobi slums, for the period January 2003 to December 2005, was 706 maternal deaths per 100,000 live births. The major causes of maternal death were: abortion complications, hemorrhage, sepsis, eclampsia, and ruptured uterus. Only 21% of the 29 maternal deaths delivered or aborted with assistance of a health professional. The verbal autopsy tool seems to capture more abortion related deaths compared to health care facility records. Additionally, there were 22 late maternal deaths (maternal deaths between 42 days and one year of pregnancy termination) most of which were due to HIV/AIDS and anemia.
Conclusion: maternal mortality ratio is high in the slum population of Nairobi City. The Demographic Surveillance System and verbal autopsy tool may provide the much needed data on maternal mortality and its causes in developing countries. There is urgent need to address the burden of unwanted pregnancies and unsafe abortions among the urban poor. There is also need to strengthen access to HIV services alongside maternal health services since HIV/AIDS is becoming a major indirect cause of maternal deaths

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Citation

Ziraba, Abdhalah Kasiira, Nyovani, Madise, Samuel, Mills, Catherine, Kyobutungi and Alex, Ezeh (2009) Maternal mortality in the informal settlements of Nairobi city: what do we know? Reproductive Health, 6, (6) (doi:10.1186/1742-4755-6-6).

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Published date: April 2009

Identifiers

Local EPrints ID: 71063
URI: http://eprints.soton.ac.uk/id/eprint/71063
ISSN: 1742-4755
PURE UUID: e77d0dca-489e-4e66-aeab-784dc9a745fb
ORCID for Madise Nyovani: ORCID iD orcid.org/0000-0002-2813-5295

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Date deposited: 15 Jan 2010
Last modified: 19 Jul 2017 00:02

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Contributors

Author: Abdhalah Kasiira Ziraba
Author: Madise Nyovani ORCID iD
Author: Mills Samuel
Author: Kyobutungi Catherine
Author: Ezeh Alex

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