Kenya slow to tackle stillbirths, study finds


Kenya slow to tackle stillbirths, study finds

Despite free maternity services in public hospitals, one-third of births in Kenya still take place at home.

A child is twice as likely to be born dead in Kenya as in Mauritius and Seychelles, the countries with the lowest stillbirth rates in sub-Saharan Africa, a new report reveals.  

The Ending Preventable Stillbirths report, that was published in the medical journal, TheLancet, also finds that a child is less likely to be born alive in Kenya than in any other East African country, except Burundi.

With about 23 stillbirths per 1,000 births in 2015, which translates to nearly 96 babies born dead daily, Nation Newsplex found that Kenya is ranked next to last in East Africa. Burundi with 27 stillbirths per 1,000 births has the worst record in the region while Rwanda with 17 stillbirths per 1,000 has the best record followed by Uganda (21 stillbirths per 1,000) and Tanzania (22 stillbirths per 1,000).

Even though Kenya’s stillbirth rate declined by 15 per cent from 26 stillbirths per 1,000 in 2000, the pace did not match reductions in maternal and under-five death rates.

It will take more than 160 years before a pregnant woman in Africa has the same chance of her baby being born alive as a woman in a high-income country today, according to the study.

It warns that the rate of progress in reducing the number of babies stillborn each year will need to double in many countries, including Kenya, if agreed international targets of 12 stillbirths per 1,000 or fewer in all countries by 2030 is to be achieved.

Stillbirths remain stubbornly high despite significant progress in reducing maternal, neonatal, infant and under-five deaths.

Inversely, the probability of a child being born dead in Pakistan or Nigeria is almost double that of Kenya.

Between 2000 and 2015, the global average stillbirth rate fell from 25 to 18 stillbirths per 1,000 births, a 17 per cent drop. The decline is equivalent to an annual rate of two per cent, which is much slower than the progress made for maternal deaths rate (3.0 per cent) and child deaths rate (4.5 per cent).

Globally, according to the study, Kenya is in position 158 among 186 countries that were included in the study. There are 27 sub-Saharan Africa countries in the top 35 (77 per cent) countries with the highest (worst) stillbirth rate.

The stillbirth rate in Kenya is almost eight times that of developed countries, which is at three per 1,000 births. The five countries with the lowest stillbirth rates in the world are Iceland (1.3 per 1,000 births), Denmark (1.7 stillbirths per 1,000), Netherlands and Finland (both with 1.8 stillbirths per 1,000) and Croatia with 2.0 stillbirths per 1,000 births.

Inversely, the probability of a child being born dead in Pakistan or Nigeria is almost double that of Kenya. The two countries have the worst stillbirth rates, at 43 per 1,000 births.

The study reveals that almost 35,000 babies were born dead in Kenya last year, a 10 per cent increase from almost 32,000 in 2000.These findings reflect data from the 2014 Kenya Demographic and Health Survey (KDHS), which indicates that the perinatal death rate declined to 29 deaths per 1, 000 births from 37 deaths per 1,000 pregnancies reported in the 2008-09 KDHS.

MOTHER'S CONTRACTIONS

Pregnancy losses occurring after seven completed months of gestation (stillbirths) plus deaths to live births within the first seven days of life (early neonatal deaths) constitute perinatal deaths.

Interventions at critical times during birth can prevent many stillbirths. In fact, labour and delivery account for around half. Dr John Ong’ech, the head of Surgical Services at Kenyatta National Hospital, says many stillbirths can be avoided if mothers attend antenatal clinics (ANC) religiously

“It’s is very worrying when the first trimester ANC visits are nearly 97 per cent and, in the second it drops to at 60 per cent and in the last to 50 per cent. So much happens in the nine months that would have been monitored,” he says.

Dr Ong’ech adds that it is very important that the expectant woman be accompanied by her partner for “support and to be aware of the pregnancy development.” Despite the introduction of free maternity services in public hospitals in Kenya in 2013, one-third of births still take place at home, according to the KDHS.

Whereas more than 2.6 million stillbirths continue to occur globally every year, two-thirds happen in south-east Asia and Africa,with 60 per cent occurring among rural families. The stillbirth rate in sub-Saharan Africa is about 10 times that of developed countries (29 versus 3 per 1000 births).

According to the head of the Department of Obstetrics and Gynaecology at the Aga Khan University, Dr Marleen Temmerman, this trend can be corrected if the quality of health care is “greatly improved”. Dr Ong’ech agrees, and adds that health facilities should be equipped with a cardiotopography machine, which monitors a baby's heart rate and a mother's contractions while the baby is in the third trimester.

The study defines a stillbirth as a baby born without any sign of life in the seventh month of pregnancy onwards

OLDER AND VERY YOUNG WOMEN

“Some stillbirths can be prevented if we can tell the foetal heart beat is dropping and we need to go for an emergency caesarean section,” said Dr Ong’ech. He says KNH, a few former provincial hospitals and some private health facilities have the machine.

He says the common cause of stillbirths is cord accidents and placenta complication. “It simply means something disrupted the blood flow to the baby through the cord, like an entangled umbilical cord for instance”. Stillbirths can also occur if the placenta separates early, he told Newsplex.

Other major causes of stillbirth, according to the World Health Organisation, includechildbirth complications, post-term pregnancy, maternal infections in pregnancy (malaria, syphilis and HIV), maternal disorders (especially hypertension, obesity and diabetes), foetal growth restriction and congenital abnormalities.

According to the study, the risk factors associated with stillbirth can be prevented by treating infections such as malaria and syphilis during pregnancy, managing pregnancy diabetes and hypertension, and strengthening access to quality family planning services, especially for older and very young women who are at higher risk of stillbirth.

The research series was developed by 216 experts from more than 100 organisations in 43 countries and comprises five papers.

-Additional reporting by Dorothy Otieno