Case reports and commentaries in obstetrics and gynaecology

Abstract

Background: While other health indicators in Sub-Saharan Africa have improved over the years, maternal morbidity and mortality rates and ratios have not. Many safe motherhood strategies so far employed are facility based and there is no literature that links birth preparedness to maternal and fetal outcomes. Birth and emergency preparedness was defined as adequate preparation for action in the event of complication and a plan for a desired place of birth, use of a preferred skilled birth attendant and companion for routine birth. This study aimed to evaluate birth preparedness and its influence on maternal and fetal outcomes. Objective: To evaluate birth preparedness and its influence on maternal/fetal outcome Design: Cross-sectional descriptive study Setting: Postnatal wards of Pumwani Maternity Hospital, Nairobi Subjects: Postnatal mothers and their newborn babies Materials and methods: The Kenyatta National Hospital and Pumwani maternity Hospital ethics and research committees approved the study. A crossectional study involving three hundred and seventy five respondents who delivered after 28 weeks gestation were interviewed at the Pumwani Maternity Hospital, Nairobi. 27 women (7.2%) had eventful outcomes (i.e. Morbidity and mortality) and of these, 22 (81.5%) had morbidity outcome and 5 (18.5%) were mortality cases. Every other bed occupant was included in the study. A structured questionnaire was administered through face-to-face interviews by the principal investigator and two assistants who were final year medical students. Data was collected between June and August 2006 then entered and tabulated using SPSS 11.5 for windows software. Pearson Chi-square, Odds ratio and logistic regression were used to determine associations, the likelihood of occurrence and the birth preparedness model respectively. Main outcome measures: The mam outcome measures were socio-demographic factors, birth/emergency preparedness and maternal and fetal outcome. Results: ANC attendance in this study was 98% with 43.8% attaining at least 4 visits that are recommended in the WHO focused antenatal care models. Most of the non attendances (85.7%) were under 20 years of age (P value <0.001) and were all primigravidae (P value 0.001). Low level of education and teenage pregnancy were two most important determining factors for lack of knowledge of danger signs (P value <0.001 and <0.001 respectively). 77.1 % women had an upfront choice of delivery and 80% of women made decisions on their own. Teenagers were unlikely to have made arrangements for emergency transport (P value <0.008). Higher level of education and

mean time taken to hospital (.:s 30 minutes) were other important determinants of having emergency transport (P value < 0.001 and 0.04 respectively). Parity was not a factor in determining prior emergency transport arrangements. Education level of primary and below was associated with less likelihood of setting aside emergence money (P value <0.001), but married women were likely to set aside emergency money and have emergency transport arrangements (P value <0.001 and 0.001 respectively). PPH was the biggest cause of maternal morbidity and mortality (22.7% and 40% respectively). Decision making other than self was associated with poor maternal outcome (P value 0.006). ANC non attendance was associated with the likelihood of a mother having a stillbirth [OR 7.3 (1.3-40.4) P value 0.008]. Primigravidity and ANC non attendance were risk factors for preterm delivery [OR 0.4 (CI 0.2-0.9) P value 0.024, OR 6.8 (CI 1.1-42.5) P value 0.017 respectively). Conclusions: By use of logistic regression model, this study shows that educational level of the woman is the single most important determining factor in determining maternal and fetal outcome followed by the woman's individual income and marital status. Age, parity, and the spouses' socioeconomic status did not affect maternal and fetal outcome.