Counties with highest burden Maternal Mortality

 

COURTESY OF UNFPA Kenya

13th August 2014

Maternal mortality is one of the indicators of reproductive health status of the population. Efforts to reduce maternal deaths have for decades been a focal point of international agreements and a priority for women’s rights and health groups throughout the world because a maternal death is one of life’s most tragic outcomes. The irony is that almost all maternal deaths are entirely preventable given proper medical surveillance and intervention.

In the last round of censuses, the United Statistics Statistical Division (UNSD) encouraged many developing countries to include questions on pregnancy related deaths as a way of helping improve on the quantity and quality of data needed in the estimation of maternal mortality in the world. This was subsequently adopted in the 2009 Kenya Population and Housing census.   Respondents were asked to report any death in the household in the last 12 months prior to enumeration. These were subsequently named the recent deaths in the household.  Among the deceased females age 12 to 49 subsequent questions were asked on whether the female deaths were pregnancy related (i.e. during pregnancy, during delivery or within two months after delivery).

Measurement of maternal mortality

Several indicators are used to measure maternal mortality in order to display sources of different risks as well as interventions. In the first place, all maternal deaths as outcomes from pregnancy and the first definition ispregnancy-related death which is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.  When information on the cause of death is available, then we have maternal death, which is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

However, for comparison purposes between different contexts due to differences in the risk of pregnancy maternal mortality ratio (MMR) are often used. Maternal mortality ratio (MMR) is thus the number of maternal deaths during a given time period per 100,000 live births during the same time period. MMR captures the risk of death in a single pregnancy or a single live birth or in technical terms it measures the extent of obstetric risk.

In the entire country, a total of about 32,021 women of reproductive age were reported to have died out of which 6,632 died of pregnancy related causes. Out of the total number of women of reproductive age who had died, 21 percent was as a result of pregnancy related causes. Table 1 shows the ranking of top 15 counties by number of maternal deaths and maternal mortality ratio. Columns 1-3 are the ranks by number of   maternal deaths. It indicates that only 15 out of 47 counties account for 98.7 % of the total maternal deaths in the country. However, the number of deaths masks important considerations such as the size of women population in the region as well as the frequency of pregnancies, an alternative ranking is by maternal mortality ratio which takes into account the obstetric risk. This is provided from column 4 to 6. Mandera and Wajir still rank highest in terms of absolute number of maternal deaths as well as the increased obstetric risks.

 

TABLE 1: RANKING OF COUNTIES BY NUMBER OF MATERNAL DEATHS AND MATERNAL MORTALITY RATIO

Rank Region maternal deaths Rank Region Maternal mortality ratio (deaths per 100,000 live birth
KENYA 6,623 KENYA 495
1 MANDERA 2,136 1 MANDERA 3795
2 WAJIR 581 2 WAJIR 1683
3 NAIROBI 533 3 TURKANA 1594
4 NAKURU 444 4 MARSABIT 1127
5 KAKAMEGA 364 5 ISIOLO 790
6 KILIFI 289 6 SIAYA 691
7 NANDI 266 7 LAMU 676
8 BUNGOMA 266 8 MIGORI 673
9 HOMABAY 262 9 GARISSA 646
10 MIGORI 257 10 TAITATAVETA 603
11 KISUMU 249 11 KISUMU 597
12 SIAYA 246 12 HOMABAY 583
13 TRANSNZOIA 234 13 VIHIGA 531
14 GARISSA 208 14 SAMBURU 472
15 KWALE 203 15 WESTPOKOT 434
Other counties 85
Total 6,538
Percent of the total number of deaths 98.7

 

Although Nairobi, Nakuru, Kakamega, Kilifi, Nandi Bungoma, and Kwale rank higher in terms of number deaths, in terms of MMR they do not rank higher. In terms of the maternal mortality burden it is therefore important to include risks in number of deaths as well as obstetric risk. This is shown in Table 2. At national level nearly half of deaths (48 %) occur during delivery. In 5 counties (Lamu, Garissa, wajir, Mandera and Turkana) over half of deaths occur during delivery. The county with highest proportion dying during pregnancy is Marsabit. Siaya, Kisumu and Taita taveta have the highest proportion dying in the post-partum period. The implication here is that different factors influence the risk of maternal death in the different counties. Kenya is among the top 10 Countries with the highest number of HIV-associated maternal deaths and about 20 percent of maternal deaths is indirectly related to HIV. Thus HIV may be important in Nyanza region counties which have the highest prevalence of HIV while other factors may be important in Mandera, Wajir and Garissa with low prevalence of HIV.

 

TABLE 2: RANKING OF COUNTIES BY BURDEN OF MATERNAL MORTALITY

County Maternal deaths MMR Percent of deaths during
Pregnancy Delivery 2 months after delivery
Mandera 2,136 3795 28 56 16
Turkana 175 1594 24 54 22
Wajir 581 1683 28 60 12
Migori 257 673 24 45 30
Nakuru 444 374 28 40 31
Siaya 246 691 22 28 50
Kisumu 249 597 18 33 48
Nairobi 533 212 25 38 38
Homa Bay 262 583 22 34 43
Kakamega 364 316 20 44 36
Garissa 208 646 25 61 13
Marsabit 97 1127 30 47 23
TaitaTaveta 129 603 16 36 48
Isiolo 32 790 25 56 19
Lamu 52 676 10 65 25
Kenya 6,623 495 26 48 26

– See more at: http://kenya.unfpa.org/news/counties-highest-burden-maternal-mortality#sthash.tt7GUS3y.dpuf

New WHO guidelines to improve care for millions living with female genital mutilation

Courtesy of WHO

News Release

New WHO recommendations aim to help health workers provide better care to the more than 200 million girls and women worldwide living with female genital mutilation.

Female genital mutilation (FGM) describes all procedures that involve the partial or total removal of external genitalia or other injury to the female genital organs for non-medical reasons. FGM has no health benefits, can cause grave harm, and violates the rights of girls and women. Procedures can cause severe bleeding, problems urinating, and later cysts, infections, and death. FGM can also result in complications in childbirth and increased risk of newborn deaths.

International migration has now made the practice, prevalent in 30 countries in Africa and in a few countries in Asia and the Middle East, a global health issue.

The need for health care

Health workers across the world now need to be prepared to provide care to girls and women who have undergone FGM. But, health workers are often unaware of the many negative health consequences of FGM and many remain inadequately trained to recognize and treat them properly. As a result, many women may suffer needlessly from physical and mental health consequences due to FGM.

“Health workers have a crucial role in helping address this global health issue. They must know how to recognize and tackle health complications of FGM,” says Dr Flavia Bustreo, WHO Assistant Director General. “Access to the right information and good training can help prevent new cases and ensure that the millions of women who have undergone FGM get the help they need.”

Since 1997, there have been growing international efforts to stop FGM. These include research, work within communities, revised legal frameworks and growing political support to end the practice, as well as international monitoring bodies and resolutions that condemn it. In 2007, the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF) initiated the Joint Programme on Female Genital Mutilation/Cutting to accelerate the abandonment of the practice.

The WHO guidelines build and contribute to these efforts, underlining the recognition that action must be taken across sectors to stop the practice and help those who are living with its consequences.

The recommendations focus on preventing and treating obstetric complications; treatment for depression and anxiety disorders; attention to female sexual health such as counselling, and the provision of information and education.

The guidelines also warn against the so called “medicalization” of FGM, for example when parents ask health providers to conduct FGM because they think it will be less harmful.

“It is critical that health workers do not themselves unwittingly perpetuate this harmful practice,” adds Dr Lale Say, WHO Coordinator, Department of Reproductive Health and Research at WHO.

Global strategy to stop health-care providers from performing female genital mutilation

In 2010, WHO published a “Global strategy to stop health-care providers from performing female genital mutilation” in collaboration with the UNFPA and UNICEF Joint Programme on Female Genital Mutilation/Cutting and other partners.

One fundamental measure to prevent medicalization of FGM is the creation of protocols, manuals and guidelines for health providers. These include what to do when faced with requests from parents or family members to perform FGM on girls, or requests from women to perform re-infibulation after delivery.

The guidelines also highlight the need for more research to improve evidence-based practice, so that health workers can better manage the complications arising from FGM, and the health community is better informed about the associated health risks, which also can contribute to effectively work towards the elimination of this harmful practice.

Note to editors:

Recommendations include:

  • de-infibulation to prevent and treat obstetric complications, as well as to facilitate childbirth, and prevent and treat problems with the urinary tract system;
  • mental health including cognitive behavioural therapy and psychological support to treat depression and anxiety disorders;
  • female sexual health covering sexual counselling to prevent or treat female sexual dysfunction;
  • information and education for all women and girls who have undergone female genital mutilation, and health education and information on de-infibulation, where appropriate, for both health-care providers and for women and girls.

http://www.who.int/mediacentre/news/releases/2016/female-genital-mutilation-guidelines/en/

The Painful Knife

fgm

 

By Alex Omari

Female Genital Mutilation has been a cultural practice for some of the Kenyan communities over decades but it’s time we all stood up and said “No to FGM”. Despite it being illegal, some people still practice it privately. In 2011, Kenya banned female genital mutilation by passing a law to make it illegal to practice FGM or to take someone abroad to be ‘cut’ famously known as the “ Prohibition of FGM Act”. Faith, a 10 year old girl (not her real name) told me of her story of how she went through the terrible ordeal of going through the knife.
‘‘When I closed school for the December holidays, I was told by my mum that we are to visit our aunt for the festive season. My aunt and my mum had planned it all leaving me in darkness .When we were at my auntie’s place; I was told that I would remain behind as mum left. After that, a strange woman visited our house and that’s when the aunt said that I was going to be a big girl ’’

FGM is very painful, traumatizes girls and results in numerous negative health consequences that last for ages and can even cause death. This is a form of violence against girls that oppresses them and hence prevents the girls from fully participating in the nation’s progress.

Over 140 million girls and women globally, are estimated to have undergone some form of FGM. Currently, more than three million girls, majority being below 15 years of age, undergo the procedure each year. The just released recent Kenya Demographic Health Survey (KDHS, 2014) indicates that 21 percent of women reported to being circumcised, as compared with 27 percent in 2008-09 and 32 percent in 2003.
Research shows that FGM is practiced by different ethnic within the country in different ways. It is far more prevalent among the Somali (93.6percent), Kisii (84.4 percent) and Maasai (77.9 percent) communities.

From the survey data, Kenya achieved an annual rate of reduction of 6 percent in the prevalence of FGM between 2008 and 2014. FGM has both immediate and long-term effects on women’s health and these include severe bleeding, infection, shock and recurrent urinary tract infections.

The current statistics indicate that we are heading towards the right direction though much needs to be done if we are to realize vision 2030 developmental goals. This can only be achieved if we have uncompromising leadership and political will supported by on toes law enforcement and effective community mobilization. The social norm change practice should be felt at the community level.

https://twitter.com/alexomari1

Teenagers (Students) Arrested For Sex and Alcohol Abuse

teens

Around 550 children have been arrested for public indecency in Uasin Gishu County, Eldoret. The students are alleged to have been drinking and engaging in sexual activities at a night club.

The youngsters who were found in Sam’s Discotheque after a raid conducted by police and officials from National Authority for the Campaign against Alcohol and Drug Abuse (NACADA).

It is reported that a section of those apprehended were aged between 13 and 18 years and were found in possession of bhang, khat, used condoms and banned alcohol brands.

Confirming the incident, Alcohol Control Board Chairman Amstrong Rono, said they had been investigating the club on operating without proper documentation and allowing underage drinking.

He added that the club would remain closed as the manager and employees who were working on Sunday night had also been arrested and would be arraigned in court.

Eldoret West Acting OCPD Samson Rukunga explained that the adolescents were placed under police custody for protection.

“The children were taken to safe custody after it emerged that majority were under the age of 18 and we are currently handing them over to their parents.” said Rukunga.

Parents were expected to pay a cash bail of Sh1000 as they picked their children. The students’ parents asked the authorities to shut down clubs operating without licenses while on the other hand the authorities told parents to be cautious of their children’s activities.

This incident comes two months after thirty five secondary school students from different schools in Kirinyaga were allegedly caught smoking bhang and having sex inside a bus . The students hired the bus at Sh 600 each and the matatu crew looked the other way as the students indulged in drugs and sex party.

A female student in the bus was allegedly found in possession of bhang hidden in her innerwear.

Courtesy of  Waridi Ajambo:

May 28: International Day of Action for Women’s Health, Women’s Rights Defenders

The Women’s Global Network for Reproductive Rights (WGNRR) undertook the re-launch of the May 28 campaign in collaboration  international, regional and national organizations, in an effort to mobilize women and advocates all over the world to demand the Women’s Health as a matter of great concern;this includes sexual and reproductive health and rights .  May 28 Call for Action. #WomensHealthMatters #SRHRDialogues #May28

https://editor.storify.com/556732c49df314b61d350558

Peanuts may reduce risk of death, heart disease

Eating peanuts, in small amounts, may reduce the risk of mortality, especially death from cardiovascular disease, a new study Monday showed.The report compiles research from people of varying races, including Caucasians, African Americans and Asians, all from low income backgrounds.

Researchers found that consuming peanuts regularly reduced mortality among men and women from all groups, and suggests that eating the nuts — which are relatively affordable — can be an inexpensive and nutritious way to reduce mortality and cardiovascular disease around the world.
The study, published in the Journal of the American Medical Association, Internal Medicine includes more than 70,000 Caucasians and blacks in the United States and some 130,000 Chinese people in Shanghai.
“We found that peanut consumption was associated with reduced total mortality and cardiovascular disease mortality in a predominantly low-income black and white population in the US, and among Chinese men and women living in Shanghai,” said senior author Xiao-Ou Shu, associate director for Global Health at the Vanderbilt-Ingram Cancer Centre (VICC).

There was a reduced risk of total mortality of in 17 to 21 percent of participants, the study showed.

RISK SLASHED
The risk of death from cardiovascular disease was slashed by between 23 and 38 percent.
But co-author William Blot warned that because the data was from observational epidemiological studies and not randomized clinical trials, “we cannot be sure that peanuts per se were responsible for the reduced mortality observed.”
“The findings from this new study, however, reinforce earlier research suggesting health benefits from eating nuts, and thus are quite encouraging,” added Blot, who is also associate director for cancer prevention control and population-based research at VICC.

Peanuts are less expensive and more widely available than many other nuts, and are eaten by many cultures around the world.The nutritious nuts — which are actually legumes — are high in and unsaturated fat, fibre, vitamins, and anti-oxidants and can boost cardiovascular health with as little as 30 grams eaten weekly.
“The results suggest that including a modest amount of nuts as part of a well-balanced diet may be of benefit,” said Peter Weissberg, director of the British Heart Foundation, who did not participate in the study.
“The data do not show that the more peanuts you eat the lower the risk of a fatal heart attack, so people should not start eating large quantities of nuts, particularly salted nuts, in the hope that it will protect them from heart disease,” he added.

Previous research has focused on white upper class research subjects.The participants in this latest study were observed for between five and 12 years.

Courtesy of AFP (Agence France-Presse)- an international news agency headquartered in Paris.The oldest news agency in the world and one of the largest.

15 Heart-Healthy Foods You Should Be Eating

by Stacey Feintuch

 To keep a heart-healthy diet, you need to replace the bad—trans and saturated fats, added sugars and salt—with the good—fruits, vegetables, lean proteins and whole grains. If you’re looking for extra heart-health credit, there are certain foods that are especially good for your ticker.

That’s important, because cardiovascular disease is the leading cause of death globally, accounting for 17.3 million deaths per year, according to the American Heart Association (AHA). And that number is expected to rise to more than 23.6 million by 2030.

So add these 15 heart-healthy foods to your grocery list:

Walnuts: Purchase them unsalted in bulk and store in the freezer to extend their shelf life. Add them to pastas, muffins, oatmeal and salads, or grab a handful when you have the munchies. They’re a good source of heart-healthy omega-3 fatty acids, fiber and folate (a B vitamin). However, don’t overdo it, because they’re high in calories. A serving is about 12 to 14 walnut halves.

Oatmeal: Enjoy oatmeal for breakfast or snack on an oatmeal-raisin cookie. Avoid flavored and instant oats because they’re loaded with sugar. Instead, opt for unprocessed, plain oatmeal and add your own nuts or dried fruit. Oatmeal boasts omega-3 fatty acids, potassium, calcium and other nutrients.

Kidney or black beans: One cup of cooked beans can replace two ounces of fish, poultry or meat for a serving of protein, according to the AHA. Stir some beans into a soup or salad to boost your intake. Beans contain heart-healthy omega-3s and folate.

Sardines: They’re brimming with omega-3s, which raise good cholesterol levels and lower triglycerides, a type of unhealthy fat found in the blood. Opt for fresh sardines instead of salty canned ones.

Kale: Kale-like cauliflower, broccoli and cabbage-is a cruciferous vegetable. They’re known as cancer-fighting powerhouses, but they’re also good for heart health, because they’re rich in anti-inflammatories and antioxidants, as well as vitamins, minerals and other phytochemicals. Specifically, the sulforaphane in cruciferous veggies can improve blood pressure. This dark, leafy green offers omega-3s, fiber, potassium and more. Add it to soups, pasta sauces or smoothies. Or make a kale salad, adding fruit, nuts or even sweet potatoes.

Cauliflower: This cruciferous vegetable is very versatile. You can eat fresh cauliflower raw as a snack or in salads or you can steam or roast it. You can even mash it, instead of potatoes. Just stay away from the cheese sauce, or you’ll lessen those heart-healthy benefits.

Asparagus: This vegetable boasts vitamins C and D and folate. Serve it as a side dish: Lightly steam, grill or roast asparagus and top with lemon and olive oil. It’s best fresh during the spring and early summer. If you can’t get it fresh, opt for frozen over canned.

Soy milk: It’s loaded with heart-healthy nutrients like niacin, calcium, magnesium and potassium. Add this low-fat beverage to your whole-grain cereal or oatmeal or blend it in your smoothie.

Papaya: Help combat heart disease with this exotic fruit’s vitamins, potassium and fiber. Enjoy it on its own or make a tropical fruit salad of papaya, mango and pineapple.

Salmon: The AHA recommends at least two servings of fish a week, and salmon is a good choice because it’s high in heart-healthy omega-3s. Flavor fish with spices or lemon juice, avoiding cream sauces.

Sweet potatoes: Serve sweet potatoes baked or roasted as a side dish or make a meal of them. They boast beta-carotene, which lowers your risk of heart disease. Available year-round, refrigerate sweet potatoes to help them last longer.

Cantaloupe: Cut and enjoy this sweet and juicy melon any time of day. It boasts vitamin C, folate, potassium, fiber and more.

Red bell peppers: Add bell peppers to your salads, sandwiches and fish. You’ll get a dose of folate, potassium and fiber.

Brussels sprouts: Sure, not everyone likes them, but they’re members of that powerful fiber-rich cruciferous vegetable family, so give them another try. They contain folate, potassium, magnesium and more. Mix thin sprout slices into a salad. For a crunchier texture, pan fry them or roast, tossed with red grape halves, olive oil and sea salt.

Avocado: You’ll get good monounsaturated fats from avocado, helping reduce blood clots and cholesterol. Slice and top salads and sandwiches with avocados.Or use them to make guacamole. Like nuts, both of which contain healthy fats, they’re high in calories, so don’t overdo it.

A tip of the Untold Stories

By Alex Omari

Video, Courtesy of KTN

So, how far is the  magnitude of unsafe abortions in Kenya. A study  “Incidence and Complications of Unsafe Abortion in Kenya” by the Ministry of Health in partnership with African Population and Health Research Center (APHRC)  indicated that close to 465,000 induced abortions occurred in Kenya in 2012. This corresponds to an induced abortion rate of 48 abortions per 1000 women of reproductive age (15-49 years) while 266 out of the 1000 who procure abortions die. It is also estimated that 157,762 women received care for complications of induced and spontaneous abortions. An overwhelming 119,912 women had complications due to induced abortions with the remainder (37850) women had spontaneous ones.

In 2002 the induced abortion rate in Kenya  was 45/1000 while in 2008 it further stretched to 48/1000. This is a shock but to make matters clearer, the induced abortion rate in Kenya cant go unnoticed when compared to  the East African and African rates in general  which are at 39/1000 and 29/1000 respectively.

As at January 2015, the issue still remains a menace as needless deaths of women occur.Are Kenyans really feeling the pinch of this issue ,and if yes, which steps are in place to curtail this mammoth called unsafe abortion. Below is just a tip of the untold stories occurring at the backyard.

”Police in Kakamega county  launched a manhunt for a man who has allegedly been aiding abortions for school girls and women in Furave village. This is after a discovery of a hole that contained human skeletons was found in his compound.”, reported by KTN.

Here are the details.