Muthee Rose, Mutua Martin, Kiarie Helen, Kagiri Hannah, Serem Edward, Muchemi Simon, Wabwire Scolastica, Boerma Ties
Ministry of Health, Nairobi, Kenya.
African Population and Health Research Center, Nairobi, Kenya.
BMC Pregnancy Childbirth. 2025 Sep 11;25(1):932. doi: 10.1186/s12884-025-07726-6.
Reports on maternal deaths and stillbirths in health facilities are a critical but underutilized source of information to monitor the quality of care. In addition, with increasing coverage of deliveries by health facilities, such data can improve population estimates of maternal mortality and stillbirth rates. Data quality concerns, however, have often deterred use of facility data. This study aims to assess subnational trends in institutional mortality and examine its utility for improving population-based estimates of mortality.
Data from the routine monthly reporting system of the Ministry of Health in Kenya were used to assess levels and trends in maternal mortality and stillbirth rates in 47 counties from 2011 to 2022. Data quality was assessed using multiple methods, including consistency of annual reporting of live births, stillbirths and maternal deaths by counties, plausibility of the ratio of reported stillbirths to maternal death, the county institutional mortality in comparison to delivery coverage, socioeconomic development and health system characteristics. The consistency between institutional and population estimates of mortality was assessed using different scenarios.
Institutional live birth coverage increased from 64.0% in 2014 to 87.8% in 2022, ranging from 49 to 99% in counties. Kenya and 39 of its 47 counties experienced a decline in institutional maternal mortality ratio and stillbirth rate during the study period 2011-2022. The national institutional maternal mortality decline stagnated from 2018 and was 99 maternal deaths per 100,000 live births in 2022. Consistency of reported data by county was good over time but several indicators suggest that maternal death reporting was incomplete and more so in less-developed counties. Estimates of the population maternal mortality ratio, derived from the facility data, were much lower than global estimates or census results, while the stillbirth rates were consistent.
The health facility data on maternal death and stillbirths are an important data source for monitoring national and subnational institutional maternal mortality and stillbirth rates and can also inform population estimates. Systematic sustained assessment of reporting completeness will be critical to achieve the full potential of facility data-derived mortality monitoring.
医疗机构中关于孕产妇死亡和死产的报告是监测医疗质量的重要信息来源，但未得到充分利用。此外，随着医疗机构分娩覆盖率的提高，此类数据可改善孕产妇死亡率和死产率的人群估计。然而，数据质量问题常常阻碍了机构数据的使用。本研究旨在评估国家以下各级机构死亡率的趋势，并检验其在改进基于人群的死亡率估计方面的效用。
利用肯尼亚卫生部每月例行报告系统的数据，评估2011年至2022年47个县的孕产妇死亡率和死产率水平及趋势。采用多种方法评估数据质量，包括各县活产、死产和孕产妇死亡年度报告的一致性、报告的死产与孕产妇死亡比例的合理性、与分娩覆盖率、社会经济发展和卫生系统特征相比的县机构死亡率。使用不同情景评估机构死亡率估计与人群死亡率估计之间的一致性。
机构活产覆盖率从2014年的64.0%增至2022年的87.8%，各县范围为49%至99%。在2011 - 2022年研究期间，肯尼亚及其47个县中的39个县机构孕产妇死亡率和死产率有所下降。全国机构孕产妇死亡率自2018年起停滞不前，2022年为每10万活产99例孕产妇死亡。各县报告数据的一致性长期良好，但多项指标表明孕产妇死亡报告不完整，欠发达县情况更严重。根据机构数据得出的人群孕产妇死亡率估计值远低于全球估计值或人口普查结果，而死产率则较为一致。
医疗机构关于孕产妇死亡和死产的数据是监测国家和国家以下各级机构孕产妇死亡率和死产率的重要数据源，也可为人群估计提供信息。系统持续评估报告完整性对于充分发挥机构数据得出的死亡率监测的潜力至关重要。
