Muriithi Francis G, Easter Christina, Osoti Alfred, Qureshi Zahida, Devall Adam, Coomarasamy Arri
WHO Collaborating Centre for Global Women's Health, Department of Metabolism and Systems Science, School of Medical Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom.
Institute of Applied Health Research, College of Medical and Dental Sciences, Public Health Building, University of Birmingham, Birmingham, United Kingdom.
Front Glob Womens Health. 2025 Mar 4;6:1481495. doi: 10.3389/fgwh.2025.1481495. eCollection 2025.
In many countries in sub-Saharan Africa, the burden of preventable maternal deaths is still unacceptably high. Most Maternal Mortality Ratio (MMR) estimates are national, rarely sub-national. This study explores Kenya's 2021 national health facility dataset on maternal deaths and live births for sub-national variability to describe the pattern and trend in variation in institutional maternal mortality ratios (iMMRs).
Country-wide health facility data on live births and maternal deaths for 2021 were requested from the District Health Information System (DHIS-2). A descriptive comparison of sub-national (Regional and County) iMMRs to national iMMR was carried out. Against a national average iMMR for Kenya of about 100 per 100,000 live births, those regions and counties with an iMMR <75 per 100,000 live births were defined as positive outliers, and those with an iMMR >125 were defined as negative outliers.
In 2021, 1,162 maternal deaths and 1,174,774 live births occurred within Kenya's health facilities. The annual national average iMMR was 99 per 100,000 live births [95% confidence interval (CI): 93.3, 104.8]. There was sub-national variability in iMMR at both regional and county levels. Central, Western and Rift Valley regions were positive outliers; North-Eastern Coast and Nairobi regions were negative outliers, while Nyanza and Eastern regions had an iMMR consistent with the national average. Seventeen counties were positive outliers, namely Baringo, Siaya, Nyamira, Elgeyo-Marakwet, West Pokot, Nandi, Kiambu, Laikipia, Nyeri, Samburu, Marsabit, Vihiga, Bungoma, Nyandarua, Kajiado, Murang'a and Trans-Nzoia. Ten counties were negative outliers: Tana River, Mandera, Machakos, Kilifi, Taita-Taveta, Kisumu, Nairobi, Garissa, and Mombasa and Isiolo. The iMMR in the remaining twenty counties was consistent with the national average. The effect sizes of the observed health facility variation were zero and there was no evidence of month-to-month variation.
There is evidence of sub-national variability in Kenya's iMMRs. Understanding these reasons for the variability is crucial for developing strategies for improving maternal health outcomes. If positively deviant behaviours and practices are identified, they could form the basis for adopting asset-based approaches such as the positive deviance approach to improve maternal healthcare delivery processes and outcomes and reduce preventable maternal deaths.
在撒哈拉以南非洲的许多国家，可预防的孕产妇死亡负担仍然高得令人无法接受。大多数孕产妇死亡率（MMR）估计是全国性的，很少有次国家级的。本研究探讨了肯尼亚2021年全国卫生设施关于孕产妇死亡和活产的数据，以了解次国家级的差异，描述机构孕产妇死亡率（iMMR）的变化模式和趋势。
向地区卫生信息系统（DHIS-2）索取2021年全国卫生设施关于活产和孕产妇死亡的数据。对次国家级（地区和县）的iMMR与全国iMMR进行了描述性比较。以肯尼亚全国平均每10万活产约100例的iMMR为参照，iMMR<每10万活产75例的地区和县被定义为正异常值，iMMR>125的地区和县被定义为负异常值。
2021年，肯尼亚卫生设施内发生了1162例孕产妇死亡和1174774例活产。年度全国平均iMMR为每10万活产99例[95%置信区间（CI）：93.3，104.8]。地区和县级的iMMR均存在次国家级差异。中部、西部和裂谷地区为正异常值；东北海岸和内罗毕地区为负异常值，而尼扬扎和东部地区的iMMR与全国平均水平一致。17个县为正异常值，分别是巴林戈、锡亚、尼亚米拉、埃尔盖约-马拉奎特、西波科特、南迪、基安布、莱基皮亚、涅里、桑布鲁、马萨比特、维希加、邦戈马、恩丹达鲁瓦、卡贾多、穆兰加和特兰斯-恩佐亚。10个县为负异常值：塔纳河、曼德拉、马查科斯、基利菲、泰塔-塔韦塔、基苏木、内罗毕、加里萨、蒙巴萨和伊索洛。其余20个县的iMMR与全国平均水平一致。观察到的卫生设施差异的效应大小为零，没有证据表明存在逐月变化。
有证据表明肯尼亚的iMMR存在次国家级差异。了解这些差异的原因对于制定改善孕产妇健康结果的策略至关重要。如果识别出正向偏离行为和做法，它们可以成为采用基于资产的方法（如积极偏差方法）来改善孕产妇医疗服务提供过程和结果以及减少可预防的孕产妇死亡的基础。
