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Cited by 120Global Maternal and Child HealthMaternal and fetal healthcareReproductive Health and Contraception

Maternal mortality in the informal settlements of Nairobi city: what do we know?

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Ziraba, Abdhalah Kasiira, Madise, Nyovani, Mills, Samuel, Kyobutungi, Catherine, Ezeh, Alex·2009·Reproductive Health
DOI 10.1186/1742-4755-6-6PMC PMC2675520
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Abstract

BACKGROUND: Current estimates of maternal mortality ratios in Kenya are at least as high as 560 deaths per 100,000 live births. Given the pervasive poverty and lack of quality health services in slum areas, the maternal mortality situation in this setting can only be expected to be worse. With a functioning health care system, most maternal deaths are avoidable if complications are identified early. A major challenge to effective monitoring of maternal mortality in developing countries is the lack of reliable data since vital registration systems are either non-existent or under-utilized. In this paper, we estimated the burden and identified causes of maternal mortality in two slums of Nairobi City, Kenya. METHODS: We used data from verbal autopsy interviews conducted on nearly all female deaths aged 15-49 years between January 2003 and December 2005 in two slum communities covered by the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). In describing the distribution of maternal deaths by cause, we examined maternal and late maternal deaths according to the ICD-10 classification. Additionally we used data from a survey of health care facilities that serve residents living in the surveillance areas for 2004-2005 to examine causes of maternal death. RESULTS: The maternal mortality ratio for the two Nairobi slums, for the period January 2003 to December 2005, was 706 maternal deaths per 100,000 live births. The major causes of maternal death were: abortion complications, hemorrhage, sepsis, eclampsia, and ruptured uterus. Only 21% of the 29 maternal deaths delivered or aborted with assistance of a health professional. The verbal autopsy tool seems to capture more abortion related deaths compared to health care facility records. Additionally, there were 22 late maternal deaths (maternal deaths between 42 days and one year of pregnancy termination) most of which were due to HIV/AIDS and anemia. CONCLUSION: Maternal mortality ratio is high in the slum population of Nairobi City. The Demographic Surveillance System and verbal autopsy tool may provide the much needed data on maternal mortality and its causes in developing countries. There is urgent need to address the burden of unwanted pregnancies and unsafe abortions among the urban poor. There is also need to strengthen access to HIV services alongside maternal health services since HIV/AIDS is becoming a major indirect cause of maternal deaths.

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  • In Kenya, a study based on verbal autopsies reported unsafe abortion to be responsible for 31% of all maternal deaths.

    “However, there are great variations between regions and countries, and a recent study from Kenya, based on verbal autopsies, reported unsafe abortion to be responsible for 31% of all maternal deaths (27).”

    From Unsafe abortion and postabortion care - an overview (2011) · cites this paper as [27]

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Authors
Ziraba, A. K., Madise, N., Mills, S., Kyobutungi, C., & Ezeh, A.
Affiliations
  • African Population and Health Research Center (KE)
  • University of Southampton (GB)
  • World Bank (US)
Corresponding author
Ziraba, Abdhalah Kasiira
ORCID
Venue
Reproductive Health
Publisher
Springer Science and Business Media LLC
Published
2009-04-22
Volume
6
Issue
1
Pages
6-6
ISSN
1742-4755 (ISSN-L)
DOI
10.1186/1742-4755-6-6
PMC
PMC2675520
OpenAlex
W2159590809
Cited by
119
References
46
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 8 · 2020: 10 · 2019: 4 · 2018: 9 · 2017: 10 · 2015: 13 · 2014: 12 · 2013: 12 · 2012: 6
FWCI
6.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Reproductive Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • World Bank Group
  • Wellcome Trust
  • African Population and Health Research Center
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
maternal mortality, informal settlements, slums, Nairobi, verbal autopsy, causes of maternal death, abortion complications, HIV/AIDS, anemia, eclampsia, hemorrhage, sepsis, uterine rupture, unwanted pregnancy, unsafe abortion, urban poor, civil registration

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