National guidelines for MNH - Government of Kenya

1 2 National guidelines for Quality Obstetrics and Perinatal Care SECTION 1: MATERNAL HEALTH 3 National guidelines for Quality Obstetrics and Perinatal Care Table of Contents 4 National guidelines for Quality Obstetrics and Perinatal Care ACKNOWLEDGEMENTS The process of drafting the National MNH guidelines / reference manual involved a series of workshops composed of multidisciplinary teams including highly specialised and experienced personalities from a cross section of participating institutions and organisation. In order to capture current practice while avoiding bias and maintaining accuracy, the participation of many experts was imperative.

2 It is therefore possible that some may have been left out on the list of participants. For those affected by this oversight, please accept our apologies for the omission. We sincerely wish to thank our bilateral partners, NGOs, Training institutions, and individuals who participated in this process. A selected guidelines working group undertook the review process during which a culture of exemplary consistency, dedication and commitment evolved. In this regard the following people are particularly recognised: The late Dr Njoroge Waithaka, Dr Guyo Jaldesa, Dr Zahida Qureshi (KOGS / UON); Charlotte Warren, Charity Ndwiga (population Council); Dr Marsden Solomon (FHI); Sam Mulyanga (FCI); Roselyn Koech (Nursing Council of Kenya ); Dr Joyce Lavussa, Janet Kagai (WHO); Dr Shiphrah Kuria, Dr Janet Omyonga, Ruth W.

3 Muia, Anne Njeru, Mary Gathitu (DRH / MOPHS); Simon Mueke, Lucy Gitonga (MOMS); Margaret Njoroge (KMTC), Josephine Mutua (DTC Nairobi); Dr Gathari Ndirangu (Capacity project), Sam Mulyanga (FCI) and Dr Nancy Kidula (WHO /Jhpiego), The DCAH wishes to recognise the following contributors to the newborn care section. Dr Annah Wamae, Head, Department of Family Health and Dr Migiro, Head, Division of Child and Adolescent Health who led the process. The following people also made significant contribution to this work: Crispin Ndedda, Lydia Karimurio, Charity Tauta, Alice Mwangangi, Prisca Odityo, Elizabeth Washika from the Ministries of Health, and Evangeline Mugo from the Nursing Council.

4 The technical inputs of Professor Rachel Musoke and Dr Florence Murila were invaluable. Dr Assumpta Muriithi (WHO) and Lilian Mutea (USAID) also made crucial inputs throughout the entire process. Editorial support was provided by Dr Shiphrah Kuria, Dr Marsden Solomon, Dr Janet Omyonga, Dr Gathari Ndirangu, Ms Terry Wefwafwa (nutrition component), Dr Florence Murila (Newborn care) and Dr Herman Wenyanga (TB component); with Dr Nancy Kidula (ACCESS Uzima) as the chief editor. In order to capture current evidence based and emerging issues, a wide array of documents have been perused and used as references especially for those elements of the guidelines that are new and emerging and have not been classically included in previous versions of this document.

5 The standard template used was the National guidelines for Obstetric and Perinatal care -2004 and the EOC guidelines for Kenya . A lot of the standardised regimens have been drawn from available WHO guidelines on the selected issues. All participating organisations shared their materials on various areas in MNH and these have been useful in determining the content of this document. The first section of the consolidated MNH guidelines comprises the guidelines for maternal health. Section 2 comprises the guidelines for Newborn Health. Special and sincere acknowledgements go to WHO MPS program and USAID ACCESS Uzima program for supporting the development and finalisation of these guidelines .

6 Dr Isaac Bashir Dr Santau Migiro Head- Division of Reproductive Health Head- Division of Child and Adolescent Health 5 National guidelines for Quality Obstetrics and Perinatal Care FOWARD The Millennium Development Goal number 5 is to improve maternal health with a target of reducing MMR by 75% between 1990 and this to be attained there is need for a decline in MMR annually from 1990. However, globally the reported annual percentage decline in MMR between 1990 and 2008 was only Among countries with an MMR 100 in 1990, it is evident that 30 countries have made insufficient or no progress.

7 This list includes 23 countries from sub- Saharan Africa ( in Maternal mortality 1990-2008). Sadly Kenya is among these countries with an MMR of 488 per 100,000 live births, with some regions reporting MMRs of over 1000 per 100 000 live births. (KDHS 2008/09) The United Nations Secretary-General in 2010- launched the Global Strategy for Women s and Children s Health, which is a catalyst for renewed and enhanced commitment by all partners for adequate financing and policy to improve women s and children s health. These commitments will support the following elements to accelerate progress towards MDG 5: Country-led health plans, a comprehensive, integrated package of essential interventions and services, Health systems strengthening, Health workforce capacity building, and coordinated research and innovation.

8 The five Strategic Thrusts of the Ministries of Health (K) defined as the priority areas for health services, include equitable access to health, improving quality of care, efficiency, effectiveness and responsiveness of health services. The National Reproductive Heath Policy s priority actions for maternal and newborn health also echo the ministries goals and objectives of increasing the health workforce trained in provision of maternal health services and increasing the proportion of deliveries conducted by skilled attendants. Kenya has also developed the National RH training plan whose goal is to ensure that health personnel have the knowledge, technical skills and positive attitude, to handle reproductive health issues within a comprehensive and integrated system The development of this reference manual is in response to the need for emerging, updated evidence based interventions that have proved successful when applied throughout the continuum of care of the woman s pre conception , pregnancy , childbirth and the postpartum period.

9 Both the obstetrical and medical conditions and the complications that would affect a woman during this period have extensively been described along with the management of the same. It is hoped that this document which is designed to equip all Health care providers with maternal healthcare Knowledge, skills and positive attitudes at all levels of service delivery implementation will go a long way in accelerating reduction of maternal and newborn morbidity and mortality and get the country on track to attaining MDG 5. Dr Anna Wamae Head Department of family Health Ministry of Public Health and Sanitation Republic of Kenya 6 National guidelines for Quality Obstetrics and Perinatal Care ACRONYMS AFASS -Acceptable, feasible, Affordable, Sustainable.

10 Safe AMTSL -Active management of Third Stage of labour ANC -Antenatal Care APH -Ante partum Hemorrhage ARV -Antiretroviral Therapy BF -Breast feeding BP -Blood Pressure CCC -Comprehensive Care Clinic CHW -Community health Worker C/S -Caesarean Section COCs -Combined Oral Contraceptives CPR -Contraceptive Prevalence Rate CT -Counseling & Testing DBP -Diastolic Blood Pressure DCAH - Division of Child and Adolescent health DOT -Directly Observed Treatment DRH - Division of Reproductive Health DTC - Decentraliised Training Centre EOC - Essential Obstetric Care ESAR -Eastern & Southern African Countries FANC -Focused Antenatal care FBOs -Faith based organizations FCI -Family Care International FGC -Female genital Cutting FHI -Family Health International FS -Female sterilization HAART -Highly Active antiretroviral Therapy Hb -Haemoglobin HTSP-Health Timing and Spacing of pregnancy IYCF -Infant and Young Child Feeding IUCD -Intrauterine Contraceptive Device KAIS - Kenya AIDS Indicator Survey KDHS - Kenya Demographic and Health Survey KEPH - Kenya Essential Package for Health KMTC - Kenya Medical training College KNH -Kenyatta National Hospital KOGS - Kenya Obstetrical and Gynecological Society LAM -Lactational Amenorrhea LBW -Low Birth Weight LLITN -Long Lasting Insecticide Treated Net MEC -Medical