Risk Factors for Maternal Death in an Urban Tertiary Hospital in Kenya:
A Case-Cohort Study
Abstract
Objective: To evaluate the risk of maternal death following the
intensification of Maternal and Perinatal Death Surveillance (MPDSR)
activities and the substitution of dinoprostone for misoprostol for
labour induction. Design: Case-cohort Setting: Kiambu
County Referral Hospital(KCRH), Kiambu County, Kenya Population
or Sample: Mothers delivering at KCRH during January 2018 - December
2021 Methods: We recruited all 58 mothers who died between
January 2018 and December 2021 as cases. A random subcohort of 232
mothers who did not die was selected from a retrospective cohort study
of 411 mothers as controls. Multiple logistic regression was used to
model the determinants of maternal mortality adjusted for intensified
MPDSR activities and labour induction agents. Main Outcome
Measures: Adjusted odds ratio of maternal mortality for mothers induced
with misoprostol versus dinoprostone and for delivery prior to and after
the intensification of MPDSR activities. Results: Factors
associated with increased risk maternal mortality included: unemployment
(AOR 1.83; 95% C.I.: 0.52 – 7.50), singlehood (AOR 3.47; 95% C.I.:
0.59 – 17.9), labour induction with misoprostol (AOR 7.17; 95% C.I.:
0.72 - 182), multiparity (AOR 3.11; 95% C.I.: 1.37 – 6.98, p = 0.006),
or being pre-term (AOR 4.79; 95% C.I.: 1.56 – 15.7, p = 0.007).
Conclusions: The risk of maternal mortality did not decrease
with the intensification of MPDSR activities but increased with the use
of misoprostol to induce labour. Funding: Ministry of Health
(Kenya), Transforming Health for Universal Health Coverage