Mothers bleeding to death in Marsabit.


The sorry state of maternal care in Marsabit County.

A passionate post on the recurrent maternal deaths at Marsabit County Referral Hospital shared on Facebook doing rounds on social media in Marsabit. The post has started a necessary debate with many releasing bottled up frustrations by highlighting the stories of the maternal death of their relatives and friends at the Marsabit County Referral hospital.

This post was triggered by the death of a 30 year old mother at the Marsabit County Referral Hospital on earlier last week. Mrs. Huqa’s death was attributed to postpartum hemorrhage (blood loss) by the hospital administration who were quick to point out that there was a looming and dire blood shortage at the referral hospital.

This has emerged hot on the heels of the launch of the Kshs. 150 Million Mother-Child complex at the Marsabit County Referral Hospital.

Through the Facebook thread many irate residents of Marsabit cited negligence, inefficient hospital management, poor leadership and lack of basic medical supplies. They pointed accusing fingers to the hospital management, blaming them for lack of sound and concrete plans to address the high cases of maternal deaths at the hospital.

Grim Picture

Marsabit County is one of the county’s leading in maternal mortality in Kenya. According to the 2008-2009 Kenya Demographic and Health Survey (KDHS) statistics 1,200 women will die for every 100,000.

A source at the hospital informed Marsabit Times that between January and April 2019 at least six maternal deaths have been reported through the District Health Information System (DHIS). This prompted an internal maternal death audit at the health department. According to the source, preliminary findings linked almost all of the deaths to blood loss and one case to hypertension. In the first four months of 2019 according to the DHIS data at least 6 women bled to death in Marsabit County. Many other maternal deaths resulting from home deliveries are not reported.

Marsabit County  
Period/ Data Maternal Deaths Audited
November 2018 1
December 2018 1
January 2019 3
February 2019 1
March 2019 1
April 2019 1

Data from District Health Information System May, 2019

Data for maternal deaths for the past 5 years is as shown

                                                        Marsabit County
Period /Data Adolescents (10-19 years) Maternal deaths Maternal deaths 20+ years Maternal deaths audited
2014   6 3
2015   8 5
2016 3 7 6
2017 4 8 4
2018 1 12 11

Data from District Health Information System May, 2019

Most of these deaths could have been avoided.
The underlying reason given for these deaths have been the lack of blood for transfusion at the hospital. This is despite the establishment of a satellite blood bank at the Marsabit County Referral facility.

How then did Mrs. Huqa die due to post-partum hemorrhage?
Dr. Jaama Wolde the CEC for Health during a press briefing explained that the hospital did not have the right blood group type for transfusion. He is quoted as saying “We are appealing to the general public to come out and donate blood. There is acute shorting of blood that may paralyze services in hospitals”
This appeal for blood, prompted by the outcry of members of the public can be read as a knee-jack reaction.

The health department has always had ready-made explanations of why such deaths are happening. Explanations like the unwillingness of local communities in Marsabit to donate blood or that most mothers end up dying at the hospital because they did not attend all required antenatal care during pregnancy. Other reasons like late referrals from small dispensaries when it was already too late have also been mentioned by health practitioners. An element of all these may be present in certain cases but these should not be the definitive cause of maternal deaths. The tragedy of this matter lies in the frequent repetition of the same reasons every year. What has been done to remedy the situation? How many more mothers shall continue to die as a result of ineffective planning at the hospital?

Lack of Blood at the county referral hospital? 

Daudi, a resident of Marsabit narrates how he was handed a blood bag, a few years ago and asked to go and source for blood. His brother’s wife had delivered at the hospital and lost a lot of blood, he had to travel all the way to Thika- 8 hours away. Emergency cases are often referred to Meru, Kiirua Mission hospital receives large number of referrals from Marsabit County. Crucial time needed to save lives are often lost on transit from one town to another in search of blood.

Marsabit County Referral Hospital sources its blood from far off places like Machakos, Thika and Meru, places that have sound blood donation drives.

In Marsabit there has not been a well-publicized and sustained blood donation drive. Even when an individual donates blood at the Marsabit County Referral Hospital the donated blood will be transported to Embu for screening. Embu is about 400 kms and almost 7 hours from away from Marsabit.

Why can’t the hospital equip its own blood bank with the necessary equipment for testing blood at the facility? There is genuine demand for blood transfusion. Data on the DHIS shows that between November 2018 and April 2019 a total of 64 women experienced Post-Partum Hemorrhage. This data does not mean that all the women who experienced PPH died.

Marsabit County
Period/Data PPH (Post-Partum Haemorrage  )
November 2018 11
December 2018 13
January 2019 16
February 2019 9
March 2019 7
April 2019 8

Data from District Health Information System May, 2019

This trend should institute an effective plan to ensure ready and constant supply of blood for transfusion to avoid emergencies and blood loss leading to maternal deaths.

Misplaced priorities?

The Health department has a budgetary allocation of KES 1,948,036,300 for 2018/19 FY with KES 1,181,072,500 being recurrent expenditure and 766,963,800 as development expenditure. This huge figures have over the years been spent on brick and mortar development like perimeter walls, pit latrines, more dispensaries, building medical college etc. Even grants from donors have been directed into such investments. This development initiatives cant on their own solve the problems at the hospital without a sound service delivery and strategic management plan.

While laments are endless, numerous positive steps have also been taken at the health department. Renal and kidney dialysis unit, a mother-child complex, a CT scan, KMTC, Research Centre have been launched or are being constructed. All the well-meaning efforts, the dedication of a few staffs and all the amazing new facilities being launched will not mean much if it cannot be employed to address avoidable problems like maternal deaths through blood loss.

The necessity of the mother-child complex is justified by the high neonatal (when baby dies in the first 28 days of life) and macerated still birth in Marsabit county.

  Marsabit County
Period/Data Neonatal Deaths Macerated Still Birth
November 2018 6 14
December 2018 1 14
January 2019 6 13
February 2019 3 6
March 2019 5 14
April 2019 7 12

Data from District Health Information System May, 2019

Infant and Maternal deaths in Marsabit calls for a concerted effort to ensure that the beyond zero maternal deaths is achieved.

Way forward
There is an urgent need for a concerted effort to ensure that our mothers, sisters, daughters and wives don’t continue bleeding to death.

More scrutiny and vigilance is needed from the county assembly to ensure that the Health Department does not squander their resources on wrong projects leaving crucial services pending. The health committee should also carry out an independent audit and establish what is happening at the hospital, give recommendations, allocate the necessary finances and follow up to make sure that the recommendations are implemented.
Members of the public need to come out in huge numbers to donate blood to the hospital. A fit adult can donate blood at least 4 times a year.

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