title: Trends in health facility based maternal mortality in Central Region, Kenya: 2008-2012.
abstract: BACKGROUND
  WHO classifies Kenya as having a high maternal mortality. Regional data on maternal mortality trends is only available in selected areas. This study reviewed health facility maternal mortality trends, causes and distribution in Central Region of Kenya, 2008-2012.
  
  
  METHODS
  We reviewed health records from July 2008 to June 2012. A maternal death was defined according to ICD-10 criterion. The variables reviewed included socio-demographic, obstetric characteristics, reasons for admission, causes of death and contributing factors. We estimated maternal mortality ratio for each year and overall for the four year period using a standard equation and used frequencies means/median and proportions for other descriptive variables.
  
  
  RESULTS
  A total 421 deaths occurred among 344,191 live births; 335(80%) deaths were audited. Maternal mortality ratios were: 127/100,000 live births in 2008/09; 124/100,000 live births in 2009/2010; 129/100,000 live births in 2010/2011 and 111/100,000 live births in 2011/2012. Direct causes contributed majority of deaths (77%, n=234) including hemorrhage, infection and pre-eclampsia/eclampsia. Mean age was 30(±6) years; 147(71%) attended less than four antenatal visits and median gestation at birth was 38 weeks (IQR=9). One hundred ninety (59%) died within 24 hours after admission. There were 111(46%) caesarian births, 95(39%) skilled vaginal, 31(13%) unskilled 5(2%) vacuum deliveries and 1(<1%) destructive operation.
  
  
  CONCLUSIONS
  The region recorded an unsteady declining trend. Direct causes contributed to the majority deaths including hemorrhage, infection and pre-eclampsia/eclampsia. We recommend health education on individualized birth plan and mentorship on emergency obstetric care. Further studies are necessary to clarify and expand the findings of this study.
authors: Ministry of Health, Kenya; Field Epidemiology and Laboratory Training Program, Kenya.
authors: Onesmus Maina
authors: OM
authors: Muchemi
authors: Field Epidemiology and Laboratory Training Program, Kenya.
authors: Agnes Wangechi
authors: AW
authors: Gichogo
authors: Ministry of Health, Kenya; Field Epidemiology and Laboratory Training Program, Kenya.
authors: Jane Githuku
authors: JG
authors: Mungai
authors: Ministry of Health, Kenya; Field Epidemiology and Laboratory Training Program, Kenya.
authors: Zeinab Gura
authors: ZG
authors: Roka
mesh_terms: D000328:Adult; D004461:Eclampsia / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008428:Maternal Mortality / Q000639:trends*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000401:mortality; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D055815:Young Adult
keywords: Trends; causes of death; distribution; maternal mortality