Kiambu turns tide on maternal health

The first thing Josephine Njambi remembers about the birth of her second child is not the joy of holding her new born, but waking up four days later in a hospital ward.

Somewhere between the operating theatre and the ward, the mother from Gathangari village in Githunguri, Kiambu County, had come dangerously close to losing her life.

She had gone through most of her pregnancy without a problem, attending her antenatal clinics and expecting another routine delivery. Then, at about seven months, doctors discovered that her blood pressure had risen sharply.

Unlike her first pregnancy, which had passed without incident, this one had suddenly become a high-risk case.

Doctors at Kiambu Level Five Hospital began watching her closely. When she was eventually admitted for delivery, they knew the danger they were dealing with and prepared accordingly.

After a Caesarean section, Njambi began losing a lot of blood.

As her relatives watched anxiously, doctors moved to stabilise her. Blood was transfused and the emergency was brought under control.

Njambi, however, was unaware of how close she had come to death until she regained consciousness four days later and went through her medical records.

The diagnosis was pre-eclampsia, a serious pregnancy complication, accompanied by heavy bleeding during delivery.

Her near-death experience reflects a much wider national challenge where women face complications while giving birth.

Hypertensive disorders of pregnancy, including pre-eclampsia and eclampsia, have long ranked among the leading causes, accounting for about 20 per cent of maternal deaths in Kenya’s national confidential inquiry into maternal deaths.

More recent national health information puts eclampsia alone at about 14 per cent of maternal deaths.

Against that national picture, Njambi's survival story mirrors how Kiambu’s public hospitals have managed to confront two of the most dangerous complications of pregnancy and childbirth, turning what can quickly become a fatal emergency into a complication that can be detected early and treated in time.

According to health officials in the county, a deliberate overhaul of maternal emergency care has helped public hospitals go seven months in 2026 without a single maternal death from postpartum haemorrhage.

The county has changed how it identifies women at risk, strengthened antenatal surveillance, placed specialist obstetricians closer to mothers and ensured maternity facilities have essential medicines and blood. Ambulance services, referral systems and intensive care have also been strengthened so that when a woman deteriorates, the response does not begin from scratch.

At the centre of the changes is a system that examines maternal deaths and near misses to establish where care failed and what needs to change.

Dr Mary Maina, chairperson of the county Maternal and Perinatal Death Surveillance and Response committee, says the reviews have helped health workers move beyond recording deaths to preventing them.

“We review what happened, identify where the gaps were and ensure that the recommendations are implemented. This has helped us move from simply reporting deaths to actively preventing them,” Dr Maina says.

The county has also ensured that public facilities offering maternity services, including Level Three hospitals, stock heat-stable carbetocin and tranexamic acid, medicines used to control excessive bleeding.

There are now 33 specialist obstetricians deployed across Kiambu health facilities, including all Level Four hospitals, reducing the distance women with complicated pregnancies have to travel before seeing a specialist.

Kiambu’s approach reflects a broader national shift in how the government is responding to maternal deaths.

Early this year, Health Cabinet Secretary Aden Duale inaugurated the National Maternal and Perinatal Death Surveillance and Response Steering Committee, saying every maternal death should trigger a structured review and corrective action.

The reviews are intended to expose gaps in emergency obstetric care, referral systems, blood and essential commodities and staffing, with the lessons used to prevent similar deaths.

Through the Expectant Fathers of Kiambu initiative, men accompanying their partners to antenatal clinics are encouraged to donate blood based on the mother's blood group and anticipated needs.

“We do not want to wait for a mother to start bleeding before we start looking for blood,” says Dr Patrick Nyaga, the Chief Officer for Health Services.

The seven-month record builds on gains made at Kiambu Level Five Hospital, which recorded no maternal death from any cause for seven months and went 11 months without a death from postpartum haemorrhage in 2025.

Dr Elias Maina, the County Executive Committee Member for Health Services, says the progress is the result of closing the gaps between the first warning sign and emergency treatment.

“This achievement is not the result of one hospital or one intervention. It is the result of strengthening the whole system, from the community to the maternity unit, the blood bank, ambulance services, specialists, referral hospitals and intensive care,” he says.