Dispatch

Counties with the Highest Burden of Maternal Mortality

13 August 2014

 

 

 

 

 

 

 

 

Maternal mortality is one of the indicators of reproductive health status of the population. Efforts to reduce maternal deaths have for decades been a focal point of international agreements and a priority for women's rights and health groups throughout the world because a maternal death is one of life's most tragic outcomes. The irony is that almost all maternal deaths are entirely preventable given proper medical surveillance and intervention.

In the last round of censuses, the United Statistics Statistical Division (UNSD) encouraged many developing countries to include questions on pregnancy related deaths as a way of helping improve on the quantity and quality of data needed in the estimation of maternal mortality in the world. This was subsequently adopted in the 2009 Kenya Population and Housing census.   Respondents were asked to report any death in the household in the last 12 months prior to enumeration. These were subsequently named the recent deaths in the household.  Among the deceased females age 12 to 49 subsequent questions were asked on whether the female deaths were pregnancy related (i.e. during pregnancy, during delivery or within two months after delivery).

Measurement of maternal mortality

Several indicators are used to measure maternal mortality in order to display sources of different risks as well as interventions. In the first place, all maternal deaths as outcomes from pregnancy and the first definition ispregnancy-related death which is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.  When information on the cause of death is available, then we havematernal death, which is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

However, for comparison purposes between different contexts due to differences in the risk of pregnancy maternal mortality ratio (MMR) are often used. Maternal mortality ratio (MMR) is thus the number of maternal deaths during a given time period per 100,000 live births during the same time period. MMR captures the risk of death in a single pregnancy or a single live birth or in technical terms it measures the extent of obstetric risk.

In the entire country, a total of about 32,021 women of reproductive age were reported to have died out of which 6,632 died of pregnancy related causes. Out of the total number of women of reproductive age who had died, 21 percent was as a result of pregnancy related causes. Table 1 shows the ranking of top 15 counties by number of maternal deaths and maternal mortality ratio. Columns 1-3 are the ranks by number of   maternal deaths. It indicates that only 15 out of 47 counties account for 98.7 % of the total maternal deaths in the country. However, the number of deaths masks important considerations such as the size of women population in the region as well as the frequency of pregnancies, an alternative ranking is by maternal mortality ratio which takes into account the obstetric risk. This is provided from column 4 to 6. Mandera and Wajir still rank highest in terms of absolute number of maternal deaths as well as the increased obstetric risks.

 

TABLE 1: RANKING OF COUNTIES BY NUMBER OF MATERNAL DEATHS AND MATERNAL MORTALITY RATIO

 

         

Rank

Region

maternal deaths

Rank

Region

Maternal mortality ratio (deaths per 100,000 live birth

 

KENYA

6,623

 

KENYA

495

 

   

 

 

 

1

MANDERA

2,136

1

MANDERA

3795

2

WAJIR

581

2

WAJIR

1683

3

NAIROBI

533

3

TURKANA

1594

4

NAKURU

444

4

MARSABIT

1127

5

KAKAMEGA

364

5

ISIOLO

790

6

KILIFI

289

6

SIAYA

691

7

NANDI

266

7

LAMU

676

8

BUNGOMA

266

8

MIGORI

673

9

HOMABAY

262

9

GARISSA

646

10

MIGORI

257

10

TAITATAVETA

603

11

KISUMU

249

11

KISUMU

597

12

SIAYA

246

12

HOMABAY

583

13

TRANSNZOIA

234

13

VIHIGA

531

14

GARISSA

208

14

SAMBURU

472

15

KWALE

203

15

WESTPOKOT

434

 

Other counties

85

 

 

 

 

Total

6,538

 

 

 

Percent of the total number of deaths

98.7

 

 

 

 

Although Nairobi, Nakuru, Kakamega, Kilifi, Nandi Bungoma, and Kwale rank higher in terms of number deaths, in terms of MMR they do not rank higher. In terms of the maternal mortality burden it is therefore important to include risks in number of deaths as well as obstetric risk. This is shown in Table 2. At national level nearly half of deaths (48 %) occur during delivery. In 5 counties (Lamu, Garissa, wajir, Mandera and Turkana) over half of deaths occur during delivery. The county with highest proportion dying during pregnancy is Marsabit. Siaya, Kisumu and Taita taveta have the highest proportion dying in the post-partum period. The implication here is that different factors influence the risk of maternal death in the different counties. Kenya is among the top 10 Countries with the highest number of HIV-associated maternal deaths and about 20 percent of maternal deaths is indirectly related to HIV. Thus HIV may be important in Nyanza region counties which have the highest prevalence of HIV while other factors may be important in Mandera, Wajir and Garissa with low prevalence of HIV.

 

TABLE 2: RANKING OF COUNTIES BY BURDEN OF MATERNAL MORTALITY

County

Maternal deaths

MMR

Percent of deaths during

     

Pregnancy

Delivery

2 months after delivery

Mandera

2,136

3795

28

56

16

Turkana

175

1594

24

54

22

Wajir

581

1683

28

60

12

Migori

257

673

24

45

30

Nakuru

444

374

28

40

31

Siaya

246

691

22

28

50

Kisumu

249

597

18

33

48

Nairobi

533

212

25

38

38

Homa Bay

262

583

22

34

43

Kakamega

364

316

20

44

36

Garissa

208

646

25

61

13

Marsabit

97

1127

30

47

23

TaitaTaveta

129

603

16

36

48

Isiolo

32

790

25

56

19

Lamu

52

676

10

65

25

Kenya

6,623

495

26

48

26