Using data to improve maternal health care for Kenyan mothers

Kenya’s maternal mortality rate stood at an unacceptable 510 per 100,000 live births as estimated by the World Bank in 2015.

The Kenya Demographic and Health Survey (KDHS), however, quotes a much lower rate, 362 maternal deaths per 100,000 live births between 2007 and 2014, a decline from 520 per 100,000 during the period of 2008/2009.

One of the cause of these fatalities is failure by expectant women to go for the four antenatal checkups as recommended by the World Health Organisation (WHO), where obstetric problems that may lead to fatal complications are identified and interventions planned earlier.

At Jacaranda Hospital in Nairobi, data has been used not only to communicate with mothers about the pregnancy, but also to ensure that the facility adheres to international standards on obstetric care.

At the entrance of the facility, Faith Ndanu*, a first time mother, who has come for her last checkup on a Tuesday, told  Healthy Nation: “I honestly did not know that I am supposed to come for all those visits”.  Faith is 26, in the age bracket 25 to 29 which contributes the largest percentage (27 per cent) of maternal fatalities according to KDHS 2014.

One of the messages, specifically because of her late gestation period read: “Please remember to carry money and your bag for the hospital to Jacaranda when in labour”.

Throughout the whole pregnancy, Faith received information ranging from nutrition, to saving tips advising her to save Sh30 each day so that she is able to afford the Sh9,000 the hospital is charging for normal deliveries.

The hospital caters for women in low-resource settings of Mwiki, Githurai and Kiamumbi.

VITAL DATA

Jacaranda Hospital’s Chief Medical Officer Faith Muigai told Healthy Nation that the facility based in Kahawa earned 30 per cent more from deliveries yet it is only a year old as compared to the mother hospital in Ruiru.

There are 70 deliveries in the nine-bed facility every month in Kahawa, while the one in Ruiru caps at 30.

The messages are a subtle but creative way of encouraging medical seeking behaviour in the patients and marketing the hospital’s services.

Another mother, Maria*, said that she received a message warning her of signs that could indicate that her pregnancy was in danger. The messages give her an option to call or make a missed call to the customer care line to ask for assistance in case she is incapacitated so that the hospital can send an ambulance to get her. The response the patient gives to the short code will guide the information and communication desk at Jacaranda to determine whether it is a customer care issue or clinical.

The journey begins with the mother from the first day she steps into the hospital. At the reception, she is asked to fill a form with her biodata—age, name, where she comes from, whether it is her first pregnancy, phone numbers and other information.

Men have a strong influence on women’s health and their access to care. Reproductive health programmes are increasingly trying to involve men.

A report of the a World Health Organisation meeting on Reproductive Health in Washington DC, US, in 2001 reported that: “Multimedia campaigns have proven most effective when communication channels and message content are carefully matched with specific audiences”.

With this in mind, Jacaranda tries to reach the partners of the women that seek maternity services in the facilities.

One of the check boxes that the woman has to mark is consent for messages to be sent to her regularly.

The woman also gives consent for messages to be sent to her partner.

Faith says: “No matter how much we equip mothers, the men still pay the hospital bills.”

All these details are later be fed into a computer program modelled after the Ministry of Health’s standard care for expectant mothers.

From the details, the mother’s file is generated and whatever care she received at the hospital is documented: if she responded normally as per standard, she gets a tick while an asterisk indicates a need for close monitoring because of a danger.

This data is what will be used by the cooks in the kitchen where the mother’s food is prepared taking into account her allergies, type of birth she had which would determine nutritionally sound foods for her.

CUSTOMER CARE

Once the mother has delivered, the information desk will  print a card with her name where the hospital management will be congratulating her for her bravery. The card is given whether she delivered the baby successfully or not.

Data is also used to keep health care workers at peace in the facility. At the waiting room, an expectant mother laughs at another as they compare how big their tummies have become. The other women are glued to the television in front of them, with a video teaching them — among many other tips on infant care — how to hold the baby properly when feeding them, how to burp and check their temperature.

There is information on every wall in each department informing the patients and the health workers what that department is and the roles and names of each health worker.

This includes which nurse would be scrubbing the doctor’s hands should there be surgery or who would be cleaning and at what intervals and how much a patient would be expected to pay for services rendered in that department.

There is a board on which notes from all departments are fed, and the performance of each judged against Ministry of Health standards. These  include which department has most customer complaints and why, the month that there were too many caesareans against the WHO recommended 15 per cent of all births.

The data also shows the mothers that stay longer in the facility due to an infection what they acquired in the hospital and whether that was related to not adhering to and other standard hygiene procedures.