Download This is why I am launching the `Beyond Zero Campaign` which will

Care of critically ill mothers at KNH Gaps and
Opportunities.
Zahida Qureshi
John Ongech
7th February 2014
Political will
• Maternal healthcare is a primary concern for
the Jubilee Government. President Uhuru
Kenyatta decreed free maternal healthcare for
all women in Kenya.
• Courtesy of President Kenyatta’s policy, we
shall strive to provide an environment where
every pregnancy is wanted, every childbirth is
safe, and every young person’s potential is
fulfilled.
• In order to improve maternal and child health outcomes in
the country, the First Lady of Kenya, Margaret Kenyatta
launched the ‘Beyond Zero Campaign’ on 24 January in
Kenya’s capital Nairobi.
• “I am deeply saddened by the fact that women and
children in our country die from causes that can be avoided.
It doesn’t have to be this way,” said Ms Kenyatta. “This is
why I am launching the ‘Beyond Zero Campaign’ which will
bring prenatal and postnatal medical treatment to women
and children in our country.”
• The ‘Beyond Zero campaign’ is part of the initiatives
outlined in the Strategic Framework for the engagement of
the First Lady in HIV control and promotion of maternal,
newborn and child health in Kenya that was unveiled on
World AIDS Day 2013.The campaign aims to raise funds to
help improve maternal and child health care in the country.
2012/2013
Deliveries July2012June 2013
Normal Delivery
Vaccum
BBA
C/S
Breech
0% 1%
Mode of
Delivery
Normal
Delivery
2%
2012/2013
6097
39%
C/S
4059
Vacuum
21
Breech
70
BBA
Total
196
10443
58%
Labour ward Admissions July12-June
2013
REPRODUCTIVE HEALTH MONTHLY REPORT DEC 2013
ADMISSIONS
Pts booked (ANC 18)
470
Pts not booked
1049
Total
1519
MVA ward 1D
SVD
Caeserean section
Breech
Vacuum
BBA
Still Births
Post c/section sepsis
91
847
404
2
3
21
64
10
Average Decision-Theatre time
No. of pts
Average(Hrs)
392
4.6
Ward 1C
41
46
0
0
0
5
MATERNAL MORTALITY TREND (JULY 2012
– JUNE 2013= 119)
WARD
AGE
REFERAL
FACILITY
DIAGNOSIS
1
1A
38
MARAGUA
2
1D
20
-
3
1D
32
KAJIADO
4
1D
27
MAKUENI DH
PEUP. SEPSIS
5
LW
30
MURANGA DH
PPH
6
LW
29
-
CHORIOAMNIONITIS
7
LW
24
THIKA DH
SEPSIS
8
A/E
30
-
SHOCK/INCOMPLETE ABORTION
9
A/E
22
-
POSTARBORTAL SEPSIS
10
A/E
35
MAMA LUCY KIBAKI
HOSP
PPH/RUPTURED UTERUS
11
ICU
35
PCEA KIKUYU
PPH/POOR REVERSAL
12
ICU
25
-
SEVERE PET/SEPSIS
13
RENAL
36
-
AKI/PET/SEPSIS
DH
RENAL FAILURE, SEVERE ANAEMIA,
PEUP SEPSIS
PEUP SESIS/HEPATIC
ENCEPHALOPATHY
DH
AKI/ECLAMPSIA
Multicountry survey in 20 hospitals in Kenya 2012
Hospital
Deliveries
Near miss
Death
Nairobi
Kenyatta*
Pumwani Maternity*
Mater
Aga Khan University
M P Shah
Nairobi
1959
2770
449
748
146
607
22
4
0
7
0
1
20
3
0
0
0
0
1305
816
1072
1304
1329
949
295
4
0
2
6
5
1
0
0
1
1
1
3
1
0
1337
1339
1117
492
1101
439
861
6
3
2
1
3
1
8
6
8
0
2
5
0
4
20435
77
55
Central
Nyeri Provincial General
Karatina District
Kerugoya District
Thika District *
Kiambu District*
Gatundu District
Consolata Mathari
Rift Valley
Rift Valley Provincial General*
Moi Teaching & Referral*
Naivasha District
Kabarnet District
Kitale District
Iten District
Tenwek Mission
Total
WHO Maternal Near Miss identification criteria
05_XXX_MM10
Critically sick mothers
•
•
•
•
•
•
•
Haemorrhage
Hypertensive disease
Medical conditions
Infectious disease
Obstructed labour
Abortion complications
Sepsis
– Acute kidney failure
– Anemia
Obstetrical conditions requiring critical
care Oct-Dec 2013
Conditions
No. of patients
Eclampsia
31
Postpartum haemorrhage 65
Ruptured uterus
3
Postarbrotal sepsis
3
Total
102
Table 5: Adequacy of partograph completion Variable
scored at least one observation recorded
Variable scored
Cervical dilatation
Contractions
*Fetal heart rate
*Maternal blood pressure
*Fetal head descent
*Maternal pulse rate
*Liqour
*Degree of moulding
*Maternal temperature
*Maternal respiratory rate
*Done in ≤ 50% of the time
% of time documented
reported
56
59
50
46
49
42
34
27
17
30
Level of care in patients with obstetric haemorrhage
Variable scored
% of time documented
reported
Blood pressure charting
Pulse rate charting
Catheter
Input-output chart
*Respiratory rate charting
*Done in ≤ 50% of the time
60
52
88
64
44
Level of care in patients with severe pre-eclampsia and eclampsia
Variable scored
Blood pressure charting
Pulse rate charting
Fetal surveillance
Loading dose-Magnesium sulphate
Maintenance dose-Magnesium sulphate
Input-output chart
Full blood count
U/E/C
LFT
*Tendon reflexes
*Done in ≤ 50% of the time
% of time documented
reported
92
88
84
60
72
96
80
68
56
12
Outcome by diagnosis
Fetal
Alive
Fresh stillbirth
Macerated stillbirth
Normal
Labour
N= 29
n(%)
Obstetric
hemorrhage
N=25
n(%)
PET/
Eclampsia
N= 25
n(%)
Emergency
Cesarean
N=59
n(%)
28(97)
0
2(6.9)
20(80)
3(12)
2(8)
15(60)
4(16)
5(20)
49(83)
6(10)
3(5)
Immediate
1(3.4)
6(24)
11(44)
16(27)
complications
*Immediate complications include: prematurity, asphyxia, RDS, congenital
malformations, death
Maternal
Mode of delivery
Normal delivery
22(76)
8(32)
9(36)
0
Cesarean section
6(21)
17(68)
16(64)
59(100)
*Complications
0
5(20)
5(20)
9(15)
*Complications include: admitted to ICU, dialysis, coma, convulsions, death,
resuscitation
Posterior Tear
Decapitated Head
KNH/UON sits at the apex of the pyramid of the
KEPH levels. This is the ultimate referral
Centre.
•
•
•
•
•
•
•
Referral system
Infrastructure
Human resource
Multidisciplinary management
Supplies, equipment
Support from Lab and imaging dept
Emergency response
– Teams
– Skills/ drills
• There is need to set the standards, norms and SOPS for
improved MCNH