Date of Award

4-2025

Degree Type

Thesis

Degree Name

Master of Science in Advanced Practice Midwifery (MSc-APM)

First Advisor

Dr Evah Mumbi Maina

Second Advisor

Dr Ruth Wagathu

Third Advisor

Dr Abednego Ongeso

Department

School of Nursing and Midwifery, East Africa

Abstract

Background: Postpartum hemorrhage (PPH) refers to blood loss ≥500mls after vaginal birth and ≥1000mls after cesarean section. PPH is of concern in low and middle-income countries and is estimated to cause maternal mortality every 10 minutes, with a prevalence of 25% and 34% in Uganda and Kenya, respectively. Despite efforts to address this issue, the prevalence of PPH remains high and is associated with maternal and fetal risk factors that can present along the continuum of birth. Understanding the risk factors is necessary in designing appropriate interventions for their prevention.

Objective: To determine the prevalence, maternal and fetal risk factors of PPH among postpartum women in selected health facilities in Machakos County between 1st January to 31st December 2022.

Methodology: A multi-centered study approach utilizing a retrospective matched case-control study design was adopted. Cases were defined as blood loss of ≥ 500mls for spontaneous vaginal delivery, and ≥1000mls for cesarean section. The Health Records Information Officer (HRIO) in the selected facilities helped retrieve the files. Research assistants helped identify the cases by census sampling and controls by purposive sampling. Both univariate and multivariate logistic regression were performed to identify variables associated with PPH. Approval was granted by Aga Khan’s Institution Research and Ethics Committee [ISERC] (Ref:2023/ISERC-143(V4) and the National Commission for Science, Technology,y and Innovation [NACOSTI] (Ref No: 181374).

Results: The total number of births for selected facilities in 2022 was 136,59 with 230 cases of PPH identified. The majority of the participants were from Machakos Level 5 Hospital (n=225; 48.9%), had a secondary level of education (n=194; 42.2%), were unemployed housewives (n=330; 71.7%), and were Christians (n=454; 98.7%). The majority (83; 18.0%) were not from the nine sub-counties of Machakos County. The overall PPH prevalence was 1.7%, 95% CI: 1.5–1.9. Matuu sub-county hospital had the highest prevalence,2.9%, 95% CI: 2.2-3.7, and Mwala sub-county hospital had the lowest prevalence 0.4%, 95% CI:0.09-1.3. Maternal factors associated with PPH included gestational age (˂ 37 weeks) (p = 0.032 OR 0.39 95% CI (0.16-0.91)), birth canal trauma (p = < 0.001 OR 5.87 95%CI (2.96-12.25), and hemoglobin levels ˂11g/dl (p = 0.002 OR 0.33 95% CI (0.16-0.66). There were no fetal factors significantly associated with PPH.

Conclusion: The study found a lower PPH proportion compared to global and regional estimates. Significant maternal risk factors included preterm gestation, birth canal trauma, and anaemia. No significant fetal risk factors were identified.

Recommendation: It is important to identify the risk factors through risk assessment and initiate interventions to mitigate them.

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1

Last Page

100

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