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. 2025 Sep 11;25(1):932.
doi: 10.1186/s12884-025-07726-6.

Trends in maternal mortality and stillbirths by county in health facility data, Kenya, 2011-2022

Rose Muthee  1 , Martin Mutua  2 , Helen Kiarie  3 , Hannah Kagiri  3 , Edward Serem  3 , Simon Muchemi  3 , Scolastica Wabwire  3 , Ties Boerma  4
Affiliations

Trends in maternal mortality and stillbirths by county in health facility data, Kenya, 2011-2022

Rose Muthee et al. BMC Pregnancy Childbirth. .

Abstract

Background: Reports on maternal deaths and stillbirths in health facilities are a critical but underutilized source of information to monitor the quality of care. In addition, with increasing coverage of deliveries by health facilities, such data can improve population estimates of maternal mortality and stillbirth rates. Data quality concerns, however, have often deterred use of facility data. This study aims to assess subnational trends in institutional mortality and examine its utility for improving population-based estimates of mortality.

Methods: Data from the routine monthly reporting system of the Ministry of Health in Kenya were used to assess levels and trends in maternal mortality and stillbirth rates in 47 counties from 2011 to 2022. Data quality was assessed using multiple methods, including consistency of annual reporting of live births, stillbirths and maternal deaths by counties, plausibility of the ratio of reported stillbirths to maternal death, the county institutional mortality in comparison to delivery coverage, socioeconomic development and health system characteristics. The consistency between institutional and population estimates of mortality was assessed using different scenarios.

Results: Institutional live birth coverage increased from 64.0% in 2014 to 87.8% in 2022, ranging from 49 to 99% in counties. Kenya and 39 of its 47 counties experienced a decline in institutional maternal mortality ratio and stillbirth rate during the study period 2011-2022. The national institutional maternal mortality decline stagnated from 2018 and was 99 maternal deaths per 100,000 live births in 2022. Consistency of reported data by county was good over time but several indicators suggest that maternal death reporting was incomplete and more so in less-developed counties. Estimates of the population maternal mortality ratio, derived from the facility data, were much lower than global estimates or census results, while the stillbirth rates were consistent.

Conclusion: The health facility data on maternal death and stillbirths are an important data source for monitoring national and subnational institutional maternal mortality and stillbirth rates and can also inform population estimates. Systematic sustained assessment of reporting completeness will be critical to achieve the full potential of facility data-derived mortality monitoring.

Keywords: Data quality; Health facility data; Kenya; Maternal mortality; Stillbirths.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was based on secondary data analyses and no new data were collected. The Kenya Health Information System data used in the study are routinely collected as monthly aggregates from health facilities and counties by the Ministry of Health as part of its ongoing program management. No individual information is available in these data sets. Similarly, the program provided the data from the Maternal Death Surveillance and Response System at the aggregate level with no individual identifiers. Under the Ministry of Health practice, no ethical clearance is required for analyses of such data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map of counties with coverage of institutional live births in the two years preceding the survey, DHS 2022, Kenya
Fig. 2
Fig. 2
Maternal mortality per 100,000 live births and stillbirths per 1,000 births in health facilities, Kenya routine health information system (KHIS), 2011–2022
Fig. 3
Fig. 3
County levels and trends in institutional maternal mortality ratio (upper panel) and stillbirth rates (lower panel), 2011-14 and 2019-22 (counties lowest coverage group are red, highest coverage group green and intermediate coverage groups pink)
See this image and copyright information in PMC

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