THE RISK FACTORS OF MATERNAL AND PERINATAL HEALTH PROBLEMS IN KISUMU DISTRICT

The risk of a woman dying in Kenya each time she becomes pregnant is estimated to be 1 in 20 times. This compares unfavorably with the industrialized countries where the rate is estimated to be as low as 1 in 1850. Perinatal health conditions have equally lagged behind in Kenya with a perinatal mortality rate estimated to be 45 per 1,000 live births compared to rates of 6 to 10 per 1,000 live births experienced in developed countries.This study examines the major maternal and perinatal health problems and risk factors associated with these health problems in Kisumu district. To achieve this, the study applied two methods. First, a situation analysis was conducted on all registered health centers, nursing homes and hospitals in the study area to establish their ability to offer safe motherhood according to WHO standards. Second, four health facilities were further selected by purposive sampling to act as sentinel centers from which a prospective study was conducted and data collected on maternity cases handled there for an uninterrupted period of six months. Information pertaining to respondents' obstetric history, health status during current pregnancy, background characteristics, pregnancy outcome and early neonatal health status was obtained. Postpartum mothers were followed to their respective homes on the seventh day after delivery to establish their health status and that of their infants during early neonatal period. In total 1455, cases were recorded out of which 59 percent experienced an obstetric problem and 41 percent never experienced any problem. Frequency distributions and cross-tabulations have been used to establish the variation in the occurrence of these problems along maternal socioeconomic, demographic, biomedicaland environmental characteristics. Multivariate case-control logistic regression analysis was applied to isolate the major risk factors of each of the reported problems.The main findings of this research reveal that there exists a major flaw in the public health care facilities in Kisumu district which are very few and therefore overcrowded, under-staffed, unevenly distributed with an urban bias, and at the same time inadequately supplied with basic drugs and equipment. This compromises the capability of the health facilities to adequately handle all maternal and perinatal cases in Kisumu District. There is a high prevalence of various reproductive health problems including low birth-weight (42%), anaemia (22%), antepartum haemorrhage (21%),caesarean deliveries (18%), obstructed labor (16%), eclampsia (14%), postpartum haemorrhage (12%), still-births (11%), sexually transmitted diseases (10%), pre-eclampsia (9%), abortion (9%), other operative deliveries, maternal deaths, and early neonatal mortality. The risk factors to these health problems lie in a complex web of socioeconomic, demographic, biomedical, and environmental variables that work together to determine pregnancy outcome.The study suggests short-term, medium-term and long term integrated policies that address the above proximate determinants of maternal and perinatal health. These policies should target the populations at risk through effective screening, promotion of public health care programs, promotion of female education up to secondary school levels, improvement of health infrastructure and availability of emergency obstetric care services to those in need by upgrading and equipping health centres in the both rural and urban areas. In addition, there is urgent need to encourage communities to establish revolving funds to cater for drugs and transport costs. Moreover, the government should set up mobile units for prenatal care to reach the rural areas that are not well covered by existing facilities, and to explore the possibility of starting maternity waiting homes for mothers from inaccessible areas with transport problems. There is need to develop a culturally accepted and scientifically valid community based maternity care that can be relied on for early diagnostic and therapeutic care