Makueni, one of the top ten counties that recorded the highest maternal mortality in the country, has not recorded a single death due to excessive bleeding in public health facilities since 2022 due to an aggressive strategy of ensuring healthcare workers can detect when mothers have excessive bleeding and treat within 15 minutes.
One of the strategies the county uses in its public hospitals is calibrated drapes, a clear curtain-looking paper placed on the bed where mothers give birth, to measure the loss of blood accurately. A year after the Ministry of Health the World Health Organization recommended using the calibrated drapes to measure blood loss after childbirth accurately, Makueni County has purchased 11,000 of the drapes. There is no known county in Kenya that has purchased drapes of this magnitude.
Dr Stephen Mwatha, Makueni County’s Director of Preventive and Promotive Services, said that the county’s health department has distributed the drapes to all hospitals that offer childbirth in Makueni.
“The plan is to ensure that excessive bleeding is detected early, manage, and prevent complications that arise from losing blood, like transfusion and even the death of the mother,” Dr Mwatha.
The calibrated drapes are to diagnose severe excessive bleeding after childbirth, medically known as post-partum hemorrhage (PPH), which is Kenya’s and the world’s deadliest maternal health complication. PPH is responsible for two in five maternal deaths in Kenya, according to the Ministry of Health’s First Confidential Report on Maternal Deaths in Kenya. Kenya followed the 2023 World Health Organization (WHO)-recommendation from the E-Motive trial that involved over 200,000 women in four countries: Kenya, Nigeria, South Africa, and Tanzania.
Michael Mwiti, a midwifery and maternal health specialist at the Johns Hopkins Affiliate, Jhpiego, said that PPH kills women because it is detected late and or even misdiagnosed altogether.
“Most healthcare providers check visually to assess bleeding, and that often tends to underestimate how much blood the mother has lost, and then treatment is delayed, leading to life-threatening consequences that could lead to the mother losing her uterus or dying,” he said.
The WHO-backed study conducted in 80 public hospitals in the four countries also showed that after the diagnosis, the healthcare provider offers all the treatments available within 15 minutes, and not one after another as has been the practice. When the treatment is bundled as opposed to offering them one after another it reduces severe bleeding, surgery due to severe bleeding, and death by 60%.
Makueni is among the first counties to wholly change tact in Kenya to manage the deadly complication by using calibrated drapes and then giving all the treatments as a bundle of massaging the uterus, giving uterotonics (medicines to contract the womb and stop the bleeding), giving the mother intravenous fluid and the healthcare examining the mother to see whether there is need for referral.
While the drapes are not as costly, changing the operations of a health system is far from affordable: it involves training healthcare workers in more than the 100 health facilities in Makueni that offer childbirth. Cash strapped, the county worked with partners like UNITAID which worked with the county through the project called Accelerating Measurable Progress and Leveraging Investments for Postpartum Haemorrhage Impact—AMPLIPPHI, pronounced Amplify.
Michael Mwiti, the project lead for the AMPLI-PPHI said that the project trained 570 healthcare workers on all the aspects of the bundling method and tested how it works if integrated into the county’s health system.
Mr Mwiti said: “AMPLIPPHI also gave Makueni quality-assured medicines that can last the county three years, supplied 36 training models for the healthcare workers, and talked with the community through opinion leaders like businesspeople county officials and community health promoters to ensure that everyone knows the danger signs of pregnancy and when to seek healthcare, including the importance of giving birth in hospital.”
