Quality of care in severe maternal morbidity in a referral hospital in Kenya

Background: Studying cases of near miss or severe acute maternal morbidity are increasingly recognized useful  measures in implementation of quality obstetric care.  Objective: To describe the quality of care in severe maternal outcomes at Kenyatta National Hospital. Method: This was a prospective mixed method study design done from the Reproductive Health, Accident and  Emergency, Renal Unit and Critical Care Unit of Kenyatta National Hospital. Two hundred and twenty eight health  records of patients with severe maternal outcomes and key informant interviews were performed via simple  random sampling. Data was entered into STATA checked for completeness, errors and outliers. Summarized data  were presented in tables, graphs and charts.  Results: All 5 units assessed had required resources to provide comprehensive Emergency Obstetric Care and  specialized care to patients diagnosed with severe maternal morbidity. Peer reviews were mostly done through  inter departmental consultations. There was no clear reward mechanism for good work done, however, disciplinary  measures were well outlined through relevant committee. Adherence to standard operating procedures was  generally poor and deteriorating over the time of the study.   Conclusion: Gaps exist in comprehension of standard operating procedures while managing severe maternal  morbidity at Kenyatta National Hospital despite this hospital having resources for better services. We recommend  regular and scheduled clinical audits of severe maternal morbidity followed with feedback to clinicians to facilitate  better use of evidence based guidelines.