CHANGES IN PATTERN OF MATERNAL NEAR MISS MORBIDITY AFTER INTRODUCTION OF FREE MATERNITY POLICY IN A COUNTY HOSPITAL IN KENYA: A QUASI EXPERIMENTAL STUDY

Abstract

Background: The cost of healthcare is a major barrier to access of essential maternal services in the developing  world. On 1st June 2013, Kenya introduced Free Maternity Services (FMS) in an effort to promote access  and improve maternal outcomes. Subsequently, service utilization increased, resulting in pressure on existing  resources, potentially compromising quality of care. The World Health Organization (WHO) maternal near 

miss tool was used to evaluate maternal outcomes under FMS in a county referral hospital in Kenya. The  objective was to compare the pattern of maternal near-miss morbidity before and after FMS. 

Methodology: 

Study design: Retrospective quasi-experimental (pre-post type). 

Treatment group: Records of 186 women with near-miss morbidity after introduction of FMS. Post-period  was June 2014 to May 2016. 

Comparison group: Records of 185 women with near-miss morbidity before introduction of FMS. Pre period was October 2010 to May 2013. 

Setting: Embu County Referral Hospital in Eastern Kenya. 

Study population: Women offered maternity services at Embu county referral hospital between during the  pre- and post-periods. 

Data collection and analysis: The data abstraction form was adopted from the World Health Organization  (WHO) Maternal Near-Miss tool. Analysis used Statistical Package for Social Science (SPSS) version 24.  Pierson Chi-square test of significance was applied. 

Results: The commonest causes of maternal near-miss was severe post-partum hemorrhage (S.PPH) and severe  preeclampsia. S.PPH increased (91.0% up from 80.0% p= 0.005), while that of severe preeclampsia reduced  in the post-period (13.0% vs. 6.5%, p= 0.029). Anemia was the biggest contributory cause of near misses but  reduced in the post-period (43.8% vs. 30.1%, p= 0.020). Use of blood products increased significantly in the  post-period (68.2% vs 78.5%, p< 0.001). 

Conclusion: S.PPH remains a threat to women after introduction of free maternity services. There’s need to  optimize care maternities so as to reduce the risk of maternal mortality.