MPDSR
MPDSR stands for Maternal and Perinatal Death Surveillance and Response. It’s a quality improvement intervention focused on reducing maternal and newborn deaths by identifying, analyzing, and responding to the causes of these deaths. The goal is to prevent future deaths by strengthening healthcare systems and improving the quality of maternal and newborn care.
One of the best and most effective interventions that has occurred in maternal and perinatal health in the recent past is the county and intercounty MPDSR meetings encouraged by the Council of Governors. This has led to a significant improvement of the maternal and perinatal morbidity and mortality status.
County MPDSRs, CEBA, KOGS Central Branch, Murang’a, Kiambu, Tharaka Nithi, Homa Bay
The few counties that have embraced county MPDSR have noticed a significant improvement in their responses to maternal and perinatal health needs. A major reason for the improvement is the direct involvement of county administration in helping to solve the gaps identified in MPDSR by actually participating in the County MPDSR meetings. County governments for instance are responsible for ensuring that the supply of the drugs that help the uterus to contract after delivery are available at the time of need. So it is more effective for a governor and his or her team, to hear first hand, that a mother in his or her county died because the county government did not supply the needed drugs. This is more likely to elicit a response than the traditional way where reports were written by the health personnel and it was unclear whether they ever reached the relevant offices in the county governments.
CEBA
The Championing Evidence Based Advocacy (CEBA) project by KEPRECON was a 3-year (November 2021-October 2024) project that aimed to increase the capacity for local advocacy partners to support governments and, where necessary, hold them accountable for policy implementation and to improve health data usage for more effective advocacy and government decision-making in Kenya. The project reached out to policy makers to ensure that they support improving RMNCAH+N outcomes. The increased involvement in MPDSR of top national and county government officials and first ladies, is part testament of the success of the CEBA project.
Murang’a MPDSR
The County Government of Murang’a is an excellent example of the great impact of County MPDSR. The Chief Officer of Health and the County Executive Council Member Health (CECH), County Nursing Officer In Charge and other County Government Officials, attend the county weekly Tuesday Murang’a MPDSR meetings convened by our County Gynaecologist, the lovely Dr Grace Wanjiku. So popular has the platform become that the capacity of the online platform had to be increased. Hospitals in Muranng’a County take turns in presenting their cases and all have the opportunity to contribute. This has led to dramatic improvement of the response to maternal and perinatal needs including the formation of a county rapid response WhatsApp group that incorporates all health facilities in Murang’a County including public, faith-based and private ones. You never know where a mother will land needing help. Community post mortem is also done. Facility visits for those who need support and training is also done. To increase access consultants in Murang’a County have even been given the greenlight by the Governor Irungu Kang’ata to work in any facility in Murang’a County.
Kiambu MPDSR
In the Kenya Obstetrical And Gynaecological Society (KOGS) Central Branch the intercounty MPDSR sessions have been spearheaded by the KOGS Central Branch secretary, Dr Mary Maina. Dr Mary Maina has convened many meetings on MPDSR at a county and national level and she breathes and dreams about maternal health and improvement of care in my parents home county Kiambu. The county government through its Chief Officer Dr Nyagah has been very supportive of this venture leading to Kiambu District Hospital reporting zero maternal mortality over the last few months, a big kudos to them.
Tharaka MPDSR
On 7th August 2025 Dr Grace Kanyi, the gynaecologist of Marimanti SubCounty Hospital in Tharaka County invited the KOGS Central members to an intercounty MPDSR meeting where we discussed one of the rarer but deadly causes of maternal mortality, Amniotic Fluid Embolism.
Homa Bay MPDSR
With the devolution conference happening in Homa Bay, let me mention my good friend Kevin Osuri, now the chief officer of Homa Bay County. Kevin has helped incorporate MPDSR into Homa Bay County with dramatic results to the extent that Governor Gladys Wanga is now an MPDSR expert and advocate. A big kudos to the Homa Bay team.
Maternal Mortality in Kenya
Causes
The major causes of maternal mortality in Kenya are haemorrhage (antepartum, intrapartum and postpartum), hypertensive disorders in pregnancy such as preeclampsia, infections, both postabortal and postpartum, ruptured uterus. Indirect causes such as HIV/AIDS and anaemia and other illnesses exacerbated by pregnancy also contribute to maternal deaths.
Near Miss
In MPDSR we also discuss success stories. A “near miss” refers to a woman who nearly died but survived a severe complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. These cases are crucial for understanding and improving maternal health outcomes, as they provide insights into the factors contributing to severe morbidity and mortality.
Post Partum Haemorrhage
Let me delve into PPH in a little more detail because haemorrhage is the leading cause of maternal mortality in Kenya with postpartum haemorrhage being the most common of the haemorrhages.
Kigumo Subcounty Hospital MPDSR
On 7th August 2025 at Kigumo Subcounty Hospital at our monthly MPDSR meeting we discussed a case of a mother who developed Post Partum Haemorrhage (PPH) following a routine normal delivery. So much was the bleeding that the mother needed Examination Under Anaesthesia (EUA) to comfortably establish where the bleeding was emanating from. The PPH protocol was activated. The laboratory was activated.The bleeding injuries were repaired in theatre, arresting the bleeding. She was transfused and she survived, testament to great team effort of all departments.
Causes of Post Partum Haemorrhage
The mnemonic for sources of PPH in medical school, OBGY rotation, is 4 Ts.
1. Tone – The uterus may be hypotonic and not contracting well, leading to the huge uterine vessels not being compressed well by the muscles of the uterus, hence bleeding. After delivery the uterus is literally supposed to contract and close out those big bad blood vessels that have been supplying the placenta with blood. There are drugs called uterotonics that are administered to help the uterus contract. As the name suggests they literally increase the uterine tone. Examples of uterotonic drugs include oxytocin, misoprostol. The latest kid on the block is Heat-Stable Cabetocin (HSC) nicknamed ‘Kausha’ by the support staff of Makueni County Hospitals because of its role in significantly reducing blood loss in the delivery rooms to the extent that the significant reduction is obvious to those who have been cleaning the blood for many years. Dr Ruth Wamae past KOGS Treasurer has been the champion in ensuring that HTC is available in all county hospitals. Kudos to her, she has done a good job.
2. Tissue – Any tissue that remains in the uterus may lead to continued bleeding by the uterus. Tissues include retained products of conception and even blood clots that may lead to the vicious cycle of hypotonia, more clots retained, more bleeding and more hypotonia. This is the reason for removal of clots from the uterus after delivery. The placenta should also be inspected well to ensure that the whole placenta has been delivered. Occasionally lobes of the placenta can remain in the uterus leading to PPH. The placenta may also have an accessory lobe that gets retained after the main placenta is delivered and this can easily be missed if the uterine cavity is not examined after delivery
3. Trauma. Delivery can lead to traumatic injuries to the uterus, the vaginal walls and to the external genitalia. A uterine rupture, a cervical tear, a vaginal and perineal tear are a few examples. If this happens where there is a large blood vessel, torrential bleeding can occur and quickly exsanguinate a mother.
4. Thrombin. Pregnancy and delivery can lead to changes in the circulatory system that may make mothers susceptible to bleeding. Thrombocytopenia, a condition characterized by low platelet counts, is relatively common during pregnancy, affecting 7-11% of pregnancies, with most cases occurring in the third trimester. Conditions like severe preeclampsia and HELLP Syndrome can lead to a fall in the platelet count making the mother vulnerable to bleeding. Platelets are the blood cells that help in clotting. Some mothers may have preexisting conditions that make them susceptible to bleeding such as thrombocytopenic purpura, hereditary thrombocytopenia and antiphospholipid syndrome.
I hope that the evidence presented at the Devolution Conference will help in the continued improvement of mothers and newborns going forward. We will be joining in to listen to our colleagues.
Dr Simon Mucara Kigondu, OBGY at Excella Healthcare
Simonkigondu.co.ke