Levels and risk factors of operative deliveries in four health facilities in Kisumu District, Kenya.

A prospective study was conducted in Kisumu district, a region characterised by a high incidence of maternal and infant mortality, to determine the levels and prevalence of maternal and perinatal complications and suggest ways to make maternal and child health programmes in the area more effective and practical. Four health facilities (two health centres and two hospitals) were selected to act as sentinel centres with two each representing urban and rural clusters. From these sentinel facilities, all the obstetric related cases were recorded between January and July 1997 and the outcome of the pregnancy was recorded. Some details about the respondents' socioeconomic, demographic, biomedical and environment characteristics were also recorded. A total of 1455 cases were recorded out of which 59% experienced obstetric-related complications whereas 41% had no noticeable complication. Of those with complications, 18% had a caesarean section and 6% had a ventouse delivery. Cross-tabulations and multivariate analysis have been conducted to identify the major risk factors for both caesarean and vacuum deliveries in the study area. Among other things, the study reveals that unbooked operative deliveries are common. Most women who undergo such deliveries are from poor socio-economic background, teenagers, single mothers and rural residents who may have past obstetric complications. Any meaningful policy measures aimed at managing and reducing incidence of surgical obstetric deliveries should seek to identify and address all these risk factors.