RESUMO
OBJECTIVE: To evaluate the factors that led to maternal mortality over a five-year period at the Rift Valley Provincial General Hospital, Nakuru. DESIGN: A retrospective survey based on secondary data. SETTING: Department of Obstetrics and Gynaecology, Rift Valley Provincial General Hospital, Nakuru, between 1994 and 1998. SUBJECTS: Evaluation of 109 deaths where records were available. RESULTS: The average maternal mortality was 3.16/1000 live births. Twenty eight (26%) occurred in teenagers. Sixty two deaths (58%) accounted for those aged (14-24 years). Thirty four per cent of sixty two deaths occurred in nulliparous and primiparous patients. The commonest cause of death was haemorrhage and ruptured uterus (44%). Most deaths (53%) occurred within 24 hours of admission. Of these, 36 (62%) came directly from home in labour or ill or where deliveries were being attempted by non-medical persons. CONCLUSION: Most of the deaths evaluated were preventable. Management of the major causes of death include blood (haemorrhage and ruptured uteri) transfusion. With poor blood transfusion services and the risk of HIV, this calls for alternatives to direct blood transfusion. Referral systems need to be overhauled and referring health institutions should get properly staffed. Despite good antenatal clinic attendance and availability of resources most patients still deliver at home.
