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Semin Perinatol. 2019 Aug;43(5):252-259. doi: 10.1053/j.semperi.2019.03.014. Epub 2019 Mar 16.

Place of delivery and perinatal mortality in Kenya.

Author information

1
Indiana University School of Medicine, Department of Pediatrics, 699 Riley Hospital Drive, RR 208, Indianapolis, IN, United States; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. Electronic address: mdkunkel@iu.edu.
2
Moi University College of Health Sciences, School of Medicine, Department of Child Health and Paediatrics, P.O Box 4606, 30100, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. Electronic address: mareteirene07@yahoo.com.
3
Indiana University School of Medicine, Department of Pediatrics, 699 Riley Hospital Drive, RR 208, Indianapolis, IN, United States; 410 W. 10th Street, Suite 2000A, Indianapolis, IN 46202. Electronic address: echeng@iu.edu.
4
Indiana University School of Medicine, Department of Pediatrics, 699 Riley Hospital Drive, RR 208, Indianapolis, IN, United States; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. Electronic address: shbucher@iu.edu.
5
Indiana University School of Medicine, Department of Pediatrics, 699 Riley Hospital Drive, RR 208, Indianapolis, IN, United States; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. Electronic address: eliecht@iu.edu.
6
Moi University College of Health Sciences, School of Medicine, Department of Child Health and Paediatrics, P.O Box 4606, 30100, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
7
RTI International, 3040 Cornwallis Road, Durham, NC 27709, United States. Electronic address: jbartz@rti.org.
8
RTI International, 3040 Cornwallis Road, Durham, NC 27709, United States. Electronic address: mcclure@rti.org.
9
Indiana University School of Medicine, Department of Pediatrics, 699 Riley Hospital Drive, RR 208, Indianapolis, IN, United States; Moi University College of Health Sciences, School of Medicine, Department of Child Health and Paediatrics, P.O Box 4606, 30100, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; 410 W. 10th Street, Suite 2000A, Indianapolis, IN 46202. Electronic address: rvreeman@iu.edu.

Abstract

BACKGROUND:

Increasing access to skilled birth attendants is a key goal in reducing perinatal mortality. In Kenya, where 40% of births occur at home, efforts toward this goal have focused on providing free maternity services in government facilities and discouraging home births.

PURPOSE:

To identify trends in facility deliveries and determine the association between delivery location and PM in Kenya.

METHODS:

We utilized data on 36,375 deliveries from the Kenya site of the Global Network for Women's and Children's Health Research, which maintains a prospective, population-based observational study of pregnancy and neonatal outcomes. We identified temporal trends in facility utilization and perinatal mortality. We then assessed associations between delivery location and PM using generalized linear mixed equations.

RESULTS:

The percentage of facility births increased from 38.4% in 2009 to 47.6% in 2013, with no change in perinatal mortality. Infants delivered in a facility had a higher risk of perinatal mortality than infants delivered at home (aOR = 1.41, p = 0.005). In stratified analyses, hospital deliveries had a higher adjusted odds of perinatal mortality than home and health center deliveries, with no difference between health center and home deliveries.

CONCLUSION:

The increase in facility deliveries between 2009 and 2013 was not associated with a decline in perinatal mortality. Infants born in facilities had a 41% greater risk of perinatal mortality than infants born at home. Further research is needed to assess possible explanations for this finding, including delays in referring and caring for complicated pregnancies, higher risk infants delivering at facilities, and poor quality of care in facilities.

KEYWORDS:

Africa; Delivery, obstetric; Developing countries; Health facilities; Home childbirth; Home delivery; Kenya; Maternal health services; Perinatal mortality

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