Targeting the causes of perinatal mortality in a Kenyan hospital

Out of every hundred births, seven newborn babies do not survive the first week of life in Africa.  In developed countries only 1% of babies die during this period.  The London School of Hygiene and Tropical Medicine, together with the Kenya Medical Research Institute, studied the maternity ward of a rural Kenyan hospital to find the causes of perinatal mortality, that is, stillbirth or death in the first week of life.

The women in the study gave birth in Kilifi district hospital between January 1996 and July 1997.  Kilifi is a predominantly rural district on the Kenyan coast, 60km north of Mombasa. The study included 910 births but it is not representative of the district as a whole because less than half of Kilifi women give birth in hospital.  There is a higher proportion of more educated urban women in the study and a higher proportion of women with complicated deliveries.   Blood samples were taken on admission into hospital and samples of the placenta were taken after delivery. The women were interviewed, and the mothers’ weight and height were measured just before discharge from hospital.

Out of the women, who were aged between 14 and 43:

•  all had attended at least one antenatal appointment
• 30% gave birth to their first child
• 25% had no formal education
• 14% had severe anaemia, 9% were HIV-positive and 47% had evidence of placental malaria infection during pregnancy
• one in five suffered from complications during labour.

Complications in labour such as haemorrhage, premature labour, prolonged membrane rupture, or 'babies in the wrong position in the womb', increase the risk of death enormously.  Women who bled before childbirth were more than sixty times more likely to lose their baby. Following the analysis of the data collected, the researchers found that:

• 10 out of a hundred babies were stillborn or died in the first week of life.
• 53% of the deaths of newborn babies were due to complications during labour.
• Risk of perinatal mortality was higher amongst women without any schooling, with a history of stillbirths, and amongst those who had attended fewer than three antenatal appointments.
• Perinatal mortality was linked with poor nutrition in the mother but not with placental malaria or HIV.

The study recommends that although better care will not completely eliminate the risk of death, considerable reductions could be made in perinatal mortality:

• if labour were better monitored
• if breech deliveries were better managed
• if there were emergency care for haemorrhage before or during labour.

Labour complications remain the most common cause of perinatal mortality in Africa. Alongside better labour care, the earl detection and management of antenatal risks such as hypertension continue to be important.

Source(s):
‘Labour complications remain the most important risk factors for prenatal mortality in rural Kenya’, Bulletin of the World Health Organisation, 81(8), by R. Weiner, C. Ronsmans, E. Dorman, H. Jilo, A. Muhoro, C. Shulman, 2003 Full document.

Funded by: UK Department for International Development

id21 Research Highlight: 3 June 2004

Further Information:
Caroline Shulman
Honorary Senior Lecturer
Department of Infectious and Tropical Disease
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Contact the contributor: Caroline.Shulman@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Kenya Medical Research Institute

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