Quality care key to reducing mother and child deaths

Just like most first-time mothers, 35-year-old Mercy Atieno was excited upon discovering that she was pregnant in 2016.

She visited a local hospital in Homa Bay County, during the early months of the pregnancy and was glad to be informed that everything was fine.

Despite the good news, Atieno states that the visit left a sour taste in her mouth since the nurse that attended to her and other mothers, kept them waiting for long.

"She seemed to be in a bad mood on that day and was just quarrelling staff and patients every now and then. We were all afraid to ask questions and couldn't wait to be done," recalls Atieno.

As a result of the experience, she vowed to never step foot in the hospital again, until her delivery date.

"I decided to keep away from the clinic unless it was really necessary. My health seemed good throughout the pregnancy. I never got sick at any point, so I knew that the baby was fine."

Unknown to Atieno, she suffered from hypertension during that period which led to her losing the baby through as a stillbirth.

She is among the many women who lose children out of causes that can be averted with effective pregnancy check-ups.

The World Health Organisation (WHO) recommends that pregnant women have at least four antenatal care (ANC) visits before they give birth.

During the appointments, a mother's weight, blood sugar, iron levels and blood pressure measurements are often assessed. Doctors also check for infections among other conditions.

These ANC visits (structured to encompass the first, second and third trimesters of pregnancy) enable health workers to prevent or detect and address pregnancy complications before they adversely affect mothers and their unborn children.

Yet, government statistics from the Kenya Demographic and Health Survey (KDHS) show that only 58 percent of expectant women meet those targets.

"The number of women who make first ANC visits is usually high. But they end up reducing in subsequent visits. We need to ask ourselves why this is happening," said Dr Sheikh Mohammed, the head of the family health department at the ministry of health (MoH).

According to him, the declines could be an indication of the quality of care that affected women are exposed to.

"Mothers need to be well taken care of. If they feel mistreated at the hospital, then they will not come back and this puts their life at risk," stated Dr Sheikh during the 2020 Partnership for Strengthening Maternal, Newborn, Child Health and Nutrition conference that was held last week in Nairobi early this month.

Even though the introduction of free maternity care led to an influx of women giving birth at health facilities, health experts are still perturbed by the high maternal and child deaths in Kenya.

Figures from MoH show that Kenya has a high infant mortality rate of 39 deaths per 1,000 live births. This means that one in every 26 children born, dies before celebrating their first birthday.

"This is once again a quality-of-care issue. Mothers can reach hospitals in good time; but if medical staff are not well trained or equipped to perform safe deliveries and handle arising complications, we will continue losing our women and children," said Dr Stephen Kaliti, the head of the reproductive and maternal health division at MoH.

"Aside from quality care, we should also recognise the role that proper nutrition plays in the health of women and children," said Daniel Muhinja, a health and nutrition expert at World Vision Kenya.

Generally, women need a balanced diet during pregnancy and increased quantities of certain nutrients - especially iron - for proper heath and development of the child.

Sufficient iron guards against pregnancy anaemia, which is thought to be the most frequent cause of maternal death. The condition increases the risk of induction of labour or caesarean section. It also enhances a mother's chances of dying in case of excessive blood loss after delivery (postpartum haemorrhage).

Iron deficiency anaemia during pregnancy is also linked to a number of harmful effects on the foetus. They include intrauterine growth restriction, death, infection, preterm delivery and neuro-developmental (nerve) damage, which may be irreversible.

Once the baby is born, exclusive breastfeeding for the first six months of life is recommended. Aside from meeting all nutrition requirements for the child, the milk also acts as an immune booster that protects the child from diseases.

Muhinja noted that mothers should also get access to family planning services whenever they need them.

This enables them to adequately space their births - for at least two years - as per the WHO guidelines.

Research shows that when women get pregnant early (shortly after delivery), their children have a high risk of being born prematurely or having low birth weight that is detrimental to their health.

To attain universal access to maternal and child services, Muhinja stated that women need to be knowledgeable about what they should do during pregnancy, so as to take good care of their health and well-being of the unborn children.

"This is a role that community health volunteers can play effectively, so long as they are empowered and motivated to perform their tasks well."